Staging imaging in women with primary operable breast cancer.
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Breast Neoplasms↗
Biomedical subjects
R Wilson
Publications and source records attributed to R Wilson.
Magnetic resonance imaging of anal cancer.
AIM: The purpose of this study was to evaluate the magnetic resonance imaging (MRI) appearances of primary and recurrent anal carcinoma, and to demonstrate the commonest patterns of local and distant disease spread. METHODS: A retrospective review was performed of 27 cases of biopsy-proven anal carcinoma, where MRI was used for primary staging (9 patients) or suspected recurrence (18 patients). Two oncological radiologists reviewed the MR images, following a standardized approach. The size, extent and signal characteristics of the anal tumour were documented. Metastatic disease spread to lymph nodes, viscera and bone was recorded. In all, 7 patients with recurrent disease underwent surgery and subsequent histological correlation was performed. RESULTS: Primary and recurrent tumours were of high signal intensity relative to skeletal muscle on T2-weighted images (T2WI), and of low to intermediate signal intensity on T1-weighted images (T1WI). Lymph node metastases were of similar signal intensity to the anal cancer. Recurrent tumours were more locally advanced than primary tumours and extended into adjacent organs and the pelvic skeleton. Recurrent lymph node disease involved perirectal, presacral and internal iliac nodes more commonly than did primary lymph node disease. CONCLUSION: MRI can be useful in the primary staging of bulky tumours or of those with a long craniocaudal extent. MR has a role in the preoperative evaluation and surgical planning of cases of recurrent disease following radiotherapy.
Adult↗
Multi-tasking in practice: coordinated activities in the computer supported doctor-patient consultation.
UNLABELLED: The paper provides detailed descriptions of general practitioners (GPs') interactions, both with their computers and their patients, with the aim of facilitating the detailed understanding of how GPs use their computers while in consultation with patients. The focus is on the coordinated activities of the doctor and patient and the multitasking that is required during consultation. The data consists of primary care doctor-patient consultations for asthma and angina where clinical scenarios, supported by dummy electronic and paper records for use by the doctor, were played out. Although not 'naturally occurring', the mock scenario is a traditional medical training technique. OBJECTIVE AND METHODS: This paper describes and demonstrates a data transcription methodology, involving seven discrete levels of activities, developed to account for the intricate multitasking that occurs in a GP consultation. The transcription method, developed to support the evaluation of a prototype medical prescribing decision support system (Prodigy) for use by general practitioners in consultation with patients, builds on data description techniques from conversation analysis (CA) and video analysis (VA). CONCLUSIONS: It is suggested that the methodology described could also be applicable to other scenarios involving the observation of human-computer-human interaction.
Decision Support Systems, Clinical↗
Chlorhexidine spray versus single use sachets for skin preparation before regional nerve blockade for elective caesarean section: an effectiveness, time and cost study.
INTRODUCTION: The importance of skin preparation before regional nerve blockade to prevent infection remains unchallenged. A multi-use spray chlorhexidine may have benefits over single use sachets in terms of convenience and cost, but its efficacy is unknown. We conducted a prospective randomised trial to compare spray and sachet chlorhexidine. METHODS: Elective caesarean section patients were randomised to receive chlorhexidine as a spray (chlorhexidine 0.5% in an alcoholic solution Hydrex DS Derma spray, Adams Healthcare, Leeds, UK) or sachet chlorhexidine (chlorhexidine 0.05% aqueous solution, Unisept, Seton. Leeds, UK) before a standardised combined spinal epidural technique. Skin colonisation was examined before skin preparation and again after epidural catheter removal. RESULTS: Both techniques were effective in reducing skin colonisation (P=0.0001). There was no difference in effectiveness between the groups, with the spray reducing skin colonisation from 88.5% before to 3% after catheter removal, compared with 90% to 12% in the sachet group. Time to achieve skin preparation was significantly reduced in the spray group (2.6 min compared to 4.5 min; P=0.02). The spray cost per patient was 0.01 compared to sachet 0.33. CONCLUSIONS: We suggest a chlorhexidine spray is as effective as single use sachets and is also quicker to apply and less costly.
Adult↗
Intraligamental analgesia for post-operative pain control in children having dental extractions under general anaesthesia.
AIM: This was to assess the effectiveness and safety of intraligamental local analgesia (ILA) for postoperative pain control in children having dental extractions under general anaesthesia (GA). The variables affecting the effectiveness of ILA were also investigated. METHODS: Data were collected from children having permanent molars extracted under GA using a randomised half mouth study design. ILA (bupivicaine 0.5% with 1:200,000 adrenaline) was used on the randomly assigned experimental side prior to extraction of the teeth, and the contralateral control side received no ILA. Children were interviewed pre- and post-operatively by the principal investigator (PA) who was blind to the side of ILA. Pre- and post-operative anxiety levels of each child were measured using the Venham Picture Test (VPT). Patients were asked to rate which side was better in terms of pain control, whether they felt numbness and whether they preferred the numbness. Their post-operative pain levels were also measured using the visual analogue scale (VAS). Self-inflicted trauma following ILA was noted. RESULTS: Thirty children, with a mean age of 11.3 years (SD+/-1.7) completed the study. None of the patients had self-inflicted soft tissue trauma following ILA. Nineteen children (63%) found that pain control was better post-operatively on the side with ILA. Twenty-one children (70%) reported numbness following ILA of whom 14 (67%) said that they preferred this. VAS scores were not significantly different between the experimental and control sides. A higher percentage of boys (85%) than girls (47%) rated the ILA side "better" (p = 0.034). VPT scores were significantly higher for girls postoperatively (p = 0.048). CONCLUSION: ILA was a useful and safe adjunct for postoperative pain control in children having permanent teeth extracted under GA. The technique was found to be more effective in boys than girls. However, less than half the children in this study preferred the side with numbness. Further research is needed to determine effective methods of pain control in children following dental GA and to investigate the reasons for gender differences of pain perception in children.
Adolescent↗
Re-organizing services for the management of upper gastrointestinal cancers: patterns of care and problems with change.
The 'Calman-Hine' report (1995) recommended that cancer surgery should be limited to specialist high-volume units. National guidance from the National Health Service (NHS) Executive in 2001 stated that specialist oesophagogastric cancer centres should 'aim to draw patients from catchment areas with a population of 1-2 million.' For pancreatic cancers, the catchment areas should be between 2 and 4 million, reflecting the relatively lower incidence of disease. For the West Midlands region, these recommendations would suggest that four or five centres might be required to provide specialist surgical management for oesophagogastric cancer, and one or two centres for pancreatic disease. We used Hospital Episode Statistics to analyse trends in management patterns for these tumours within the West Midlands during the period 1992-2000. Over 20 different units were involved in the management of oesophagogastric and pancreatic disease, and we were unable to discern any clear and consistent move towards the centralisation of the upper gastrointestinal work in high-volume units since the publication of the Calman-Hine report in 1995. Although the drive for centralisation might be anticipated to increase following the publication of the NHS Executive's guidance, there is a substantial way to go before the provision of surgical services for upper gastrointestinal cancers is limited to a small number of high-volume specialist units.
Cancer Care Facilities↗
Inhibition of adherence of Mycobacterium avium complex and Mycobacterium tuberculosis to fibronectin on the respiratory mucosa.
Mycobacterium species adhere to the respiratory mucosa via mucus and fibronectin of extracellular matrix exposed by damaged epithelium. We have investigated whether inhibiting adherence to fibronectin influences subsequent infection of human respiratory tissue by Mycobacterium avium complex and Mycobacterium tuberculosis. Human respiratory tissue was pretreated with mycobacterial fibronectin attachment proteins prior to infection with M. avium complex and M. tuberculosis and the number of recoverable bacteria over time was compared to untreated controls. Inhibition significantly reduced recovery of M. avium complex at 15min (P= 0.02), 7days (P = 0.04), and 14 days (P= 0.03); whereas recovery of M. tuberculosis was only reduced at 15 min (P = 0.01) and not at later timepoints. We conclude that M. avium complex and M. tuberculosis infection of the mucosa proceeds by different mechanisms, since M. tuberculosis infection is independent of fibronectin adherence.
Adhesins, Bacterial↗
Combined epidural/spinal anaesthesia: needle-through-needle or separate spaces?
BACKGROUND AND OBJECTIVE: This prospective, randomized and blinded study compared the performance of a new needle-through-needle (NTN) kit (Epistar; Medimex, Germany) with the double-space technique for providing combined spinal epidural anaesthesia during Caesarean section. METHODS: Following local Ethics Committee approval and patient consent, 200 females were randomized to receive combined spinal epidural anaesthesia by the double-space (n = 100) or NTN (n = 100) technique. The frequency with which the intrathecal component could achieve a T5 block to touch for Caesarean section without the need for epidural augmentation or an alternative technique was determined. The time from start of procedure to achieving a block height to T5 was recorded. Pain and backache at insertion, and at 24 h follow-up were recorded using a visual analogue scale. To remove any bias due to posture, 50% of each group were further randomized to receive their block in the sitting or in the left lateral position. To evaluate improvement of performance over time the success in the first 100 study patients were compared to the success in the second 100. RESULTS: A successful block to T5 with the double-space and NTN techniques were 80 vs. 54, odds ratio 0.29. Failure to enter the intrathecal space once the epidural space had been located occurred in 29 patients in the NTN group. Time to readiness for surgery was 15 min (95% confidence interval (CI): 12.7-17.4) and 12.9 min (95% CI: 11.5-14.3) for the double-space and NTN techniques, respectively. The median (interquartile range) visual analogue scores for discomfort at insertion were 30 (12.5-51.5) and 32 (12.75-60) and for postoperative backache 0 (0-10) and 0 (0-10.75) in the double-space and NTN groups, respectively. The number of epidural augmentations was similar in both the groups and posture made no difference. There was a tendency to increased success in the second half of the study. CONCLUSION: The double-space technique had a greater success rate than the NTN technique.
Adult↗
Bystander help within a polyepitope DNA vaccine improves immune responses to influenza antigens.
A polyepitope DNA vaccine has the potential to generate protective immune responses to a range of antigens in a single construct. We investigated whether it was possible to obtain responses to individual epitopes from different antigens, directly linked in a string, and whether the response to a given epitope was enhanced by adjacent epitopes within the construct. A polyepitope plasmid was created, which included three Th epitopes (influenza haemagglutinin, moth cytochrome c and ovalbumin), a Tc epitope (ovalbumin) and two B cell epitopes (haemagglutinin and ovalbumin). Mice were immunized with DNA by using a gene gun. Responses to the polyepitope DNA vaccine were compared with those to DNA vaccine comprising only the haemagglutinin Th and B epitopes (HAT(h)B) or with responses to the recombinant protein. These experiments showed that the polyepitope DNA vaccine induced greater antigen-specific responses to HAT(h)B peptide than the HAT(h)B DNA vaccine. Antigen-specific in vivo cytotoxic responses following polyepitope DNA vaccination were also clearly demonstrable. We conclude that a 'naked DNA' polyepitope vaccine generates specific responses to constituent epitopes and that adjacent irrelevant epitopes may enhance these responses.
Animals↗
Addison's disease presenting with an acute abdomen and complicated by cardiomyopathy.
Adrenal insufficiency typically presents with non-specific symptoms, followed by shock secondary to a salt-wasting crisis and/or the vascular effects of glucocorticoid deficiency if it progresses to acute adrenal insufficiency. Rhabdomyolysis and cardiac dysfunction are rarely reported, particularly in children. We report a child with adrenal insufficiency, presenting with acute abdominal signs, probably secondary to rhabdomyolysis, and complicated by reversible cardiomyopathy. Acute adrenal insufficiency should be considered with this presentation. The possibility of impaired cardiac function during its treatment should also be considered.
Abdomen, Acute↗
Reproducibility of the Heidelberg retinal flowmeter in determining low perfusion areas in peripapillary retina.
AIM: To evaluate the interobserver variability and retest reproducibility of confocal scanning laser Doppler flowmeter in measuring capillary perfusion of the peripapillary retina. METHODS: Blood flow measurements were performed in one eye of 10 normal subjects by two investigators on two different days (visits). Five separate measurements of the peripapillary blood flow parameters were recorded by each observer at each visit. The Heidelberg retina flowmeter was used to record capillary perfusion in a 2560x640 microm area of the superotemporal peripapillary region and pixel by pixel analysis was done from an area adjacent to the optic disc, with a minimum of 1600 pixels. The percentage of pixels with less than 1 arbitrary unit of flow (no flow) and 10, 25, 50, 75, 90th percentiles of flow values was calculated. Interobserver measurements were compared by paired t test. Intraclass correlations (ICC) were used to determine the interobserver variability and retest reproducibility of the measurements. Intrasession coefficients of variations (CV) were also calculated. RESULTS: There were no statistically significant differences between the two observers for all measurements and between visits for the percentage of pixels with no flow. ICC was 66% (range 57.09%-77.1%) for pixels with no flow. For the 10, 25, 50, 75, 90th percentiles of flow the ICC was 63.07% (53.91%-77.81%), 71.3% (64.23%-80.85%), 72.61% (66.02%-78.96%), 65.86% (58.53%-74.77%), and 60.05% (54.34%-70.06%), respectively. CV was 16.59%, 11.47%, 9.32%, 9.03%, 11.58%, and 16.05% for the percentage of no flow pixels and the 10, 25, 50, 75, 90th percentiles of flow, respectively. CONCLUSIONS: The Heidelberg retinal flowmeter allows reproducible measurements of all levels of capillary perfusion areas when pixel by pixel analysis is used.
Capillaries↗
Epidemiology of femoral fractures in children in the West Midlands region of England 1991 to 2001.
We have attempted to describe the epidemiology of femoral fractures in children in the West Midlands region of the National Health Service in England. Our source of data was the Regional Hospital Episode Statistics database for the years 1991-2 to 2001-2. Cases were defined as emergency hospital admissions in patients aged under 16 years, with a diagnostic code of femoral fractures in any field, and resident in the West Midlands. Between 1991-2 and 2001-2, 3272 children aged under 16 years with femoral fractures were admitted to hospital. The crude incidence during this period decreased from 0.33 to 0.22 femoral fractures/1000/year. Those caused by traffic accidents decreased by 43%, and by falls by 29%. The peak age-gender-specific incidence (0.91/1000/year) was in two-year-old boys, and this was 50% higher than in the next highest age-gender group. In the first year of life, the incidence in boys and girls was the same. Thereafter the rate in boys exceeded that in girls, varying from 1.6 times at 11 years to 4.7 times at 14 years. Falls accounted for 49% of the fractures, varying from 77% in one-year-olds to 26% in eight-year-old children. Traffic accidents were responsible for 26% of fractures varying from 55% in ten-year-old to 2% in one-year-old children. Maltreatment was recorded in 1.3% of all cases, and in 8.5% of children under one year. Twice as many fractures were seen in May to August than in January (winter). The rates of fractures were associated with deprivation for all age-gender groups. Fractures of the shaft accounted for 58% of all fractures, varying from 70% in three-year-old to 34% in 13-year-old children. Our findings show that there has been a decrease in the incidence of femoral fractures during the 1990s and early 2000s. Two-year-old boys had twice the rate than any other single-year age-gender group. More deprived areas had much higher rates which suggests the potential for greater prevention. A relatively low rate of maltreatment was recorded compared with that in some other studies.
Adolescent↗
Prophylactic antibiotic treatment of bronchiectasis with azithromycin.
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Adolescent↗
A survey of chronic renal failure in Jamaica.
The prevalence of chronic renal failure (CRF)/end stage renal disease and the accessibility of long term renal replacement therapy in Jamaica were evaluated. The study was conducted at six Jamaican healthcare facilities between July 1998 and December 1999 and included 605 patients with CRF. Men with CRF (57% of patients, mean age of 56.7 years) were significantly older than women (mean age 53.2 years). Hypertension was the most commonly associated medical condition (60.8% of patients) followed by diabetes mellitus (31.4% of patients). The estimated crude point prevalence of CRF in persons 20 years and over at the end of 1999 was 327 per million population. More than one-third of patients with CRF (39%) were receiving renal replacement therapy, the most common modality being haemodialysis, and only 1.8% of patients had received kidney transplantation. The prevalence of chronic renal failure was not increased in areas known to have high soil cadmium levels. Chronic renal failure is a significant public health problem in Jamaica and is placing an increasing financial burden on the healthcare sector.
Adult↗
Laparoscopic vs open resection for the treatment of diverticular disease.
INTRODUCTION: The aim of this study was to evaluate whether laparoscopic colon resection (LCR) offers any advantages over open colon resection (OCR) in the treatment of diverticular disease. METHODS: Between 1992 and 2002, 95 patients underwent LCR and 80 patients underwent OCR for the treatment of diverticular disease. Demographics, details of operative procedure, outcome, and pathology were compared. RESULTS: Patients in both groups were matched for age, sex, body mass index, history of previous abdominal operations, comorbidities, location of the disease, and presence of complications. LCR resulted in significantly less estimated blood loss and postoperative complications, shorter time to first bowel movement, and shorter length of stay than the OCR. There was no difference in operative time, intraoperative complications, mortality rates between groups. CONCLUSIONS: LCR is a safe and effective approach for the treatment of patients with diverticular disease. It results in less estimated blood loss, shorter time to first bowel movement, less postoperative complications, and shorter length of hospital stay.
Aged↗
Genetic and clinical characterization of patients with an interstitial duplication 15q11-q13, emphasizing behavioral phenotype and response to treatment.
The clinical significance of an interstitial duplication of (15)(q11-q13) remains unclear and controversial. The reported phenotypes vary widely and appear to be influenced by the parent of origin of the duplication. Aside from cases of dup(15) reported with autism, the behavioral phenotype of individuals with dup(15) has not been described. We present three families, two with intrachromosomal duplication (15)(q11-q13) ascertained because of developmental delay in a relative. Two families show clear evidence of multigenerational maternal inheritance. The individuals discussed in this paper have minor anomalies and developmental delays. In addition, we describe a behavioral phenotype which often includes attention deficit hyperactivity disorder (ADHD) and autistic spectrum disorder. Responses to medications used to manage these behaviors are also described, including a positive response to methylphenidate and a poor response to fluoxetine. The duplication in each presenting individual, and available family members, was investigated utilizing cytogenetic and molecular techniques including high resolution cytogenetics, fluorescence in situ hybridization (FISH), DNA methylation studies, and quantitative fluorescence PCR. High resolution cytogenetic techniques alone missed some cases, demonstrating the need to confirm results with other methods.
Child↗
Lesson of the month: Necrotizing sarcoid granulomatosis with skin involvement.
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Adult↗
Indigenous and contaminant microbes in ultradeep mines.
Rock, air and service water samples were collected for microbial analyses from 3.2 kilometres depth in a working Au mine in the Witwatersrand basin, South Africa. The approximately metre-wide mined zone was comprised of a carbonaceous, quartz, sulphide, uraninite and Au bearing layer, called the Carbon Leader, sandwiched by quartzite and conglomerate. The microbial community in the service water was dominated by mesophilic aerobic and anaerobic, alpha-, beta- and gamma-Proteobacteria with a total biomass concentration approximately 10(4) cells ml(-1), whereas, that of the mine air was dominated by members of the Chlorobi and Bacteroidetes groups and a fungal component. The microorganisms in the Carbon Leader were predominantly mesophilic, aerobic heterotrophic, nitrate reducing and methylotrophic, beta- and gamma-Proteobacteria that were more closely related to service water microorganisms than to air microbes. Rhodamine WT dye and fluorescent microspheres employed as contaminant tracers, however, indicated that service water contamination of most of the rock samples was < 0.01% during acquisition. The microbial contaminants most likely originated from the service water, infiltrated the low permeability rock through and accumulated within mining-induced fractures where they survived for several days before being mined. Combined PLFA and terminal restriction fragment length profile (T-RFLP) analyses suggest that the maximum concentration of indigenous microorganisms in the Carbon Leader was < 10(2) cells g(-1). PLFA, 35S autoradiography and enrichments suggest that the adjacent quartzite was less contaminated and contained approximately 10(3) cells gram(-1) of thermophilic, sulphate reducing bacteria, SRB, some of which are delta-Proteobacteria. Pore water and rock geochemical analyses suggest that these SRB's may have been sustained by sulphate diffusing from the adjacent U-rich, Carbon Leader where it was formed by radiolysis of sulphide.
Air Microbiology↗