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Biomedical subjects

R Gregson

Publications and source records attributed to R Gregson.

15 recordsLinked to original sources
PubMed2000

Severe retinopathy of prematurity and its association with different rates of survival in infants of less than 1251 g birth weight.

BACKGROUND: There is controversy over whether improved survival of preterm infants has resulted in a higher incidence of severe (grade 3 or greater) retinopathy of prematurity (ROP). AIM: To compare survival rates and rates of > or = stage 3 ROP-that is, with a high risk of sequelae-in preterm infants in five English cities where, anecdotally, the incidence of ROP is reported to show considerable variation. METHODS: All infants of birth weight < 1500 g and or gestational age < 32 weeks, born in 1994 in one of the cities or transferred in within 48 hours, were studied. The populations were adjusted for case mix variation using CRIB (clinical risk index for babies, a disease severity scoring system). The incidence of severe ROP, the actual death rate, and that adjusted for disease severity were determined. RESULTS: The rate of severe ROP per 1000 births was higher in city 1 than in all the other cities. This increase in comparison with city 2 and city 4 was significant (city 1, 167 (95% confidence interval (CI) 96 to 260); city 2, 24 (6 to 59); city 4, 16 (1 to 84)). A significant difference was not seen between city 1 and cities 3 (23 (1 to 120)) and 5 (74 (21 to 79)). The relative risk of developing severe ROP in city 1 compared with all the other cities was 5.5 (2.5 to 11.9). The actual death rate per 1000 births in city 1 was significantly lower than that predicted by modelling death against CRIB score (city 1: actual 270; predicted 385 (95% CI 339 to 431)). In contrast, the other cities had actual death rates as predicted, or worse than predicted, by CRIB. INTERPRETATION: A significantly higher incidence of severe ROP was identified in one of the five cities studied. Variation in survival rates among high risk infants may explain this observation.

England↗
PubMed1999

The standard of laparoscopic intraoperative cholangiography: a quality control study.

BACKGROUND AND STUDY AIMS: One reason why many surgeons do not attempt laparoscopic cholangiography is that it is considered to be technically difficult and to produce poor-quality images. PATIENTS AND METHODS: A retrospective comparison was made of twenty randomly selected intraoperative cholangiograms taken during laparoscopic cholecystectomy for each year from 1991 to 1994 (n = 80) by assigning a score (0-4) on the basis of anatomical parameters and radiographic quality. Twenty randomly selected intraoperative cholangiograms taken during open cholecystectomy (OC) were used as controls. RESULTS: The average score for the laparoscopic cholangiograms (LCs) was significantly lower than the average for OC cholangiograms (2.3 vs. 3.4, P< 0.001). In addition, a learning curve was demonstrated, which showed significant improvement in the quality of LCs over the years. Analysis showed that in LCs, only 34 % succeeded in demonstrating the entire biliary tree and only 49% managed to show the extrahepatic duct system. Choledocholithiasis could only be ruled out in 53 % of LC films, compared with 80 % of controls. CONCLUSIONS: Despite an improvement in the quality of laparoscopic cholangiography, it remains inferior to cholangiography during open cholecystectomy. Recommendations are made regarding ways in which improvements could be achieved.

Adult↗
PubMed1993

Community ophthalmology pilot study.

A randomly selected sample of subjects over 75 years old or housebound in three London inner city general practices were screened for eye disease by an ophthalmologist and an ophthalmic trained nurse. All subjects were examined at specialist outreach clinics run at the surgery of their general practitioner (GP), except for the housebound who were assessed by domiciliary visit. Patients presenting to their GP with an eye problem during the study were also seen at the outreach clinic at the GP's request. Over the 3-month period of the study, 126 over-75s, 62 housebound and 35 GP referrals were seen. This pilot study found high prevalence rates of treatable eye disease in the elderly and housebound subjects and these are compared with the findings of other epidemiological surveys. The needs for health care provision to this sector of the community and the feasibility of providing it through outreach clinics are also discussed.

Aged↗
PubMed1992

Current uses of ophthalmic lasers.

Current laser treatments are quick, relatively painless, and well tolerated. Some ophthalmic techniques can be performed only by laser while others have a lower morbidity than alternative treatments. Peripheral retinal photocoagulation and focal photocoagulation now offer greatly improved visual prognosis for diabetic patients with proliferative diabetic retinopathy or diabetic macular disease. Selected cases of macular degeneration may be treated by focal laser photocoagulation. The role of lasers in treating sub-retinal neovascular membranes is limited by the extent and location of the membrane at presentation and the high risk of recurrence after treatment. Patients with distorted vision must be referred urgently for specialist ophthalmic assessment. Flat retinal holes and tears may be sealed by laser therapy, thus preventing retinal detachment. Short pulsed neodymium-YAG photodisruptive capsulotomy effectively clears the visual axis of thickened posterior lens capsule after cataract surgery. Short pulsed neodymium-YAG photodisruptive iridotomy may be used to treat and prevent angle closure glaucoma. Laser trabeculoplasty aids the control of open angle glaucoma. Research is continuing into the role of other lasers in managing open angle glaucoma and of photoablative lasers in treating refractive errors and superficial corneal disorders.

Cataract Extraction↗
PubMed1991

An analysis of the accuracy of prediction of intraocular implant power in the myopic patient.

A series of 90 eyes of 88 myopic patients who underwent extracapsular cataract surgery with intraocular lens implants (IOLs) between 1984 and 1989 were analysed in a retrospective study. The axial length as obtained by ultrasonic A scan and keratometry readings were applied to the SRK1 and modified SRK (SRK2) formulae and the result compared with the actual post-operative state achieved.

Cataract Extraction↗
PubMed1987

Magnetic resonance imaging in hydatid disease.

Magnetic resonance imaging was evaluated in 12 patients with hydatid disease (Echinococcus granulosus). Patients also underwent real time ultrasound and computed tomography imaging. Clear images of hepatic hydatid cysts were produced by magnetic resonance imaging, and intracyst structures were demonstrated. Changes in the appearance of cysts were seen following chemotherapy. Whilst not cost effective at present, if further improvements allow differentiation of simple (epithelial) and hydatid cysts or viable and dead hydatid cysts this technique could be of clinical value.

Echinococcosis↗
PubMed1987

Spontaneous healing of a gastro-colic fistula due to a benign gastric ulcer.

Gastro-colic fistula is an uncommon complication of a benign gastric ulcer (Laufer et al., 1976). The commonest causes of a gastro-colic fistula are carcinoma of the stomach, carcinoma of the colon and previous gastric surgery for peptic ulcer disease (Allison, 1973; Cody et al., 1975) and surgery is the treatment of choice. We report a case of gastro-colic fistula due to a benign gastric ulcer, which healed spontaneously without treatment. Only one previous case of spontaneous healing of a gastro-colic fistula has been described (Rivera, 1972) and this patient subsequently had surgery to exclude an underlying malignant disease.

Colonic Diseases↗
PubMed1985

Reflux versus dysphagia: an objective evaluation of the Angelchik prosthesis.

Twenty-seven patients with proven longstanding gastro-oesophageal reflux underwent insertion of an Angelchik anti-reflux prosthesis. Preoperative studies included oesophageal manometry, endoscopy, acid reflux provocation test (ARPT) and 24 h oesophageal pH recording (24 h pH). Following operation mean lower oesophageal sphincter pressure was increased from 11 to 20 cmH2O. ARPT revealed significant pre-prandial reflux before operation in 16/24 compared with only 1/20 postoperatively; 24 h pH also showed an improvement in that 21/22 patients refluxed before operation compared with no significant reflux after. Dysphagia for solids of some degree was seen postoperatively in 26 patients and this was also demonstrated by delay in transit of a marsh-mallow swallow test. Severe dysphagia was seen in 4 patients and in 3 of these was related to rotation and displacement of the prosthesis necessitating removal.

Deglutition Disorders↗
PubMed1983

Aorto-enteric fistulae: the role of radiology.

Four patients with aorto-enteric fistulae are reported and a fifth case of jejunal ulceration is included, which is thought to be the early state of fistula formation. The clinical presentation and radiological investigation of these patients is described and discussed. The most important presenting symptom is of bleeding from the upper gastrointestinal tract. Analysis of the pre-operative investigations showed that barium studies were diagnostic in each of the cases. The important role of the radiologist, in making the diagnosis of an aortoenteric fistula in patients who have had aortic reconstructive surgery, is emphasised.

Adult↗
PubMed1981

Primary lymphoma of the gastrointestinal tract.

Twenty-two cases of primary lymphoma of the gastrointestinal tract are reported. These have been seen over the past 16 years and consist of seven gastric, 13 small bowel and two caecal lesions. This number represents 0.07% of the barium examinations of the stomach and small bowel, conducted over this period. All the cases were examined by the conventional barium meal or barium meal and follow-through examinations using non-flocculable barium. All the lymphomas were verified by histological examination. The cases are analysed as to clinical and radiological presentation, and the clinical and radiological diagnostic scores are assessed. There was a very poor diagnostic score on clinical grounds alone; a high diagnostic score for radiological examination of the stomach of 71%, contrasted with a low radiological score of 26% for the small bowel. The radiological features of lymphoma in the stomach and small bowel are described and the differential diagnosis discussed. To improve the diagnostic score on radiological examination, an awareness of gastrointestinal lymphoma is essential, as is a knowledge of the possible radiological changes. The barium examination should carefully search for these changes where lymphoma is clinically possible.

Adult↗
PubMedDate not supplied

An audit of lower limb arteriography in diabetic patients.

The outcome of 83 diabetic patients with peripheral vascular disease who underwent arteriography between 1984 and 1988 was reviewed. Angioplasty was possible in 42 legs and was technically successful in 31 but led directly to clinical improvement in only 15. Five of 20 patients referred for vascular surgery also improved. Factors associated with a clinically successful outcome were presentation with claudication, palpable pulses in the contralateral foot, and radiographic evidence of either a short proximal lesion or 2-3 vessel run-off. Median life expectancy following arteriography was 36 months. The median time to amputation was 21 months and median survival with both life and limb intact was only 13 months.

Aged↗