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Biomedical subjects

R Drury

Publications and source records attributed to R Drury.

14 recordsLinked to original sources
PubMed1999

Laser-assisted microdissection: applications in molecular pathology.

Tissue microdissection is potentially one of the most useful techniques in molecular pathology. Laser-assisted microdissection has been developed to procure precisely the cells of interest in a tissue specimen, in a rapid and practical manner. Together with multiplex molecular approaches, it is now feasible to study genetic alterations and isolate genes and proteins in defined cell populations from complex normal and diseased tissues. The fundamental advantage of this technique is the possibility of capturing single cells from which high-quality DNA and mRNA can be isolated for analysis of sequence and quantitation of expression. Moreover, the integration of laser-assisted microdissection and proteomic analysis could identify novel protein markers for disease. The advent of laser-assisted microdissection is likely to have a profound impact on molecular pathology.

Cell Separation↗
PubMed1997

A prospective study of the effect of limb-threatening ischaemia and its surgical treatment on the quality of life.

OBJECTIVE: To assess the quality of life after treatment for limb-threatening ischaemia. DESIGN: An open, prospective, observational study in a Vascular Unit of a University Hospital. MATERIALS: One hundred and fifty consecutive patients presenting with actual or threatened tissue loss of the leg. METHODS: A single, experienced observer assessed the patients for pain, mobility, anxiety, depression, self-care and lifestyle at presentation, 6 and 12 months later. RESULTS: Six different treatment outcomes were recognised: successful angioplasty, successful thrombolysis/thrombectomy, successful surgical bypass, amputation after failed revascularisation, primary unilateral amputation and primary bilateral amputation. Pain was significantly improved in all groups (p < 0.05) except for patients after failed revascularization (p = 0.08). Mobility improved in patients who underwent angioplasty (p = 0.05) or a successful surgical bypass (p = 0.001). Anxiety and depression both improved significantly only after surgical reconstruction (p < 0.02). Self-care ability improved significantly after angioplasty (p < 0.05), surgical reconstruction (p < 0.005) and unilateral primary amputation (p < 0.05), but was unaltered in the other groups. Lifestyle significantly deteriorated following thrombolysis/thrombectomy and failed surgical reconstruction (p < 0.05), but was maintained in all other groups. CONCLUSIONS: The treatment of limb-threatening ischaemia should aim to maintain pre-morbid lifestyle, an aim which is best achieved by limb-salvage. The patient's own expectations and needs have a major bearing on the choice of therapy.

Activities of Daily Living↗
PubMed1995

Surgery for limb threatening ischaemia: a reappraisal of the costs and benefits.

OBJECTIVES: To study the quality of life of patients following surgery for critical limb is ischaemia. DESIGN: Part retrospective, part prospective open study. SETTING: Vascular unit of a University Hospital. MATERIALS: Seventy-nine consecutive patients, medium age 75 years (range 44 to 94), who presented with leg threatening ischaemia and who underwent successful revascularisation or a major amputation were studied. CHIEF OUTCOME MEASURES: Six separate quality of life measures were recorded at 6 months: pain, mobility, anxiety, depression, activities of daily living (Barthel) and lifestyle (Frenchay). MAIN RESULTS: The mortality of this group of patients after six months was 24%. Forty-seven patients were available for quality of life assessment six months after initial intervention. Overall, amputation was more costly than successful revascularisation and limb salvage. Limb salvage resulted in greater mobility (p < 0.001) and better performance in self-care (p < 0.001) and lifestyle (p = 0.006), but produced more anxiety and depression (p = 0.04) than major amputation. A subgroup of patients who had major amputation after a failed limb salvage operation consumed a disproportionate amount of resources and, although their mobility was typical of amputees, their self-care and lifestyle scores were similar to those who had successful limb salvage. OBSTRUCTIONS: Limb salvage is attempted in up to 22% of patients for whom primary amputation may provide more expeditious rehabilitation with minimal impairment of their lifestyle performance.

Activities of Daily Living↗
PubMed1992

Characteristics and health service utilization patterns of ventilator-dependent patients cared for within a vertically integrated health system.

OBJECTIVE: To describe the characteristics and service utilization patterns of long-term ventilator-dependent patients. DESIGN: Using medical records, a cohort of ventilator-dependent patients was identified and followed. SETTING: A vertically integrated healthcare system in southwestern Pennsylvania. PATIENTS: Forty-nine adults requiring prolonged ventilatory assistance. MEASURES: Demographics, admission date, admission diagnosis, discharge diagnosis, reason for ventilator dependency, level of care to which the patient was admitted, dates of all transfer orders, dates of all transfers between levels of care, discharge destination and subsequent readmissions. RESULTS: The major reason for long-term ventilator dependency was progressive debilitating disease of either a pulmonary or nonpulmonary nature. The mean length of stay within the system was 72.6 days +/- 42.55 (median = 59 days, range = 24 to 267 days). Patients had an average of 3.3 transfers +/- 2.53 within the system (median = 3, range = 0 to 10). No delays in transfer to lower levels of care were found. Health utilization variables were largely unrelated to reason for ventilator dependency. Almost half of the patients (n = 24 or 49.0%) died in the system. Patients who died in the system were significantly older than patients for whom discharge home was possible. CONCLUSIONS: Additional studies are necessary to describe the prevalence, etiology, health status and functional status of ventilator patients at all levels of care; the impact of different system approaches on patient well-being and cost of care; and the process of medical decision making. Economic analyses of costs and outcomes for ventilator-dependent patients using a cost-utility approach are also needed.

Acute Disease↗
PubMed1991

Immunoglobulin G subclasses and spirometry in patients with chronic obstructive pulmonary disease.

Immunoglobulin G (IgG) subclass levels were measured in 58 patients with chronic obstructive pulmonary disease (COPD) and in 125 healthy controls. Total IgG values were significantly lower in the 27 COPD patients on steroid therapy compared with patients not taking steroids (8.31 (0.14) vs 9.80 (0.14), p less than 0.05), geometric mean (log SD). Total IgG (9.80 (0.14) vs 12.18 (0.16), p less than 0.005), IgG1 (5.87 (0.19) vs 6.68 (0.12), p less than 0.05) and IgG2 levels (2.75 (0.21) vs 3.70 (0.20), p less than 0.005) were significantly reduced in the COPD patients not taking steroids compared with the controls. IgG3 values were significantly elevated in smokers compared with nonsmokers in both the control and COPD groups. Fifteen COPD patients (25.9%) had a low level of one or more subclasses. IgG2 subclass deficiency was the most common, being present in 9 patients. A significant correlation was found between forced expiratory volume in one second (FEV1) and IgG2 subclass levels (r = 0.415; p less than 0.005). IgG subclass deficiencies may contribute to the development and progression of respiratory disease in COPD patients.

Adult↗
PubMed1977

Using a cool spot to improve the thermal comfort of glassmakers.

Glassmakers monitoring a rolled plate process suffered discomfort from the high temperature environment. This was caused by the radiant heat emitted by the furnaces and associated equipment surrounding the glassmakers' working area, combined with a high air temperature. The glassmakers are responsible for monitoring the glass rolling machine to ensure that the product is manufactured to specification, and to prevent the molten glass sticking to the rollers. This study improved their thermal comfort by the construction of a cool area. They were also brought nearer to the rolling machine. This, with the addition of a cooler environment, improved their monitoring performance. The cool spot was constructed using glass and aluminium radiant heat shields, air curtains and low velocity cooling air.

Journal Article↗