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Biomedical subjects

S Brady

Publications and source records attributed to S Brady.

At least 19 recordsLinked to original sources
PubMed2006

Do all epistaxis patients with a nasal pack need admission? A retrospective study of 116 patients managed in accident and emergency according to a peer reviewed protocol.

INTRODUCTION: Epistaxis is the most common nasal emergency and if nasal packing is required this commonly results in admission. METHODS: A literature search could find no published (UK) protocols for the management of this common condition in accident and emergency (A&E) departments. This paper presents a retrospective review of 116 patients with epistaxis, following implementation of the new peer reviewed protocol in June 2004. RESULTS: Apart from cautery, 62 had nasal packing inserted. Only 17 required admission. Forty-six patients were discharged with nasal packing in situ and only seven (16 per cent) returned due to bleeding. The overall return rate was 11 per cent. DISCUSSION: We feel this is a safe and logical protocol. Compared to mandatory admission after nasal pack insertion, we saved 39 admissions in five months. There were also the added benefits to patients of being able to recuperate at home rather than in hospital and avoidance of the risk of hospital acquired infection.

Adolescent↗
PubMed2004

Unexpected complexity in the haplotypes of commonly used inbred strains of laboratory mice.

Investigation of sequence variation in common inbred mouse strains has revealed a segmented pattern in which regions of high and low variant density are intermixed. Furthermore, it has been suggested that allelic strain distribution patterns also occur in well defined blocks and consequently could be used to map quantitative trait loci (QTL) in comparisons between inbred strains. We report a detailed analysis of polymorphism distribution in multiple inbred mouse strains over a 4.8-megabase region containing a QTL influencing anxiety. Our analysis indicates that it is only partly true that the genomes of inbred strains exist as a patchwork of segments of sequence identity and difference. We show that the definition of haplotype blocks is not robust and that methods for QTL mapping may fail if they assume a simple block-like structure.

Alleles↗
PubMed2004

A comparison of GluR-A-deficient and wild-type mice on a test battery assessing sensorimotor, affective, and cognitive behaviors.

Previous studies have demonstrated a spatial working memory deficit in glutamate receptor (GluR)-A (GluR1) AMPA receptor subunit knockout mice. The present study evaluated male and female wild-type and GluR-A-/- mice on a test battery that assessed sensorimotor, affective, and cognitive behaviors. Results revealed a behavioral phenotype more extensive than previously described. GluR-A-/- mice were hyperactive, displayed a subtle lack of motor coordination, and were generally more anxious than wild-type controls. In addition, they showed a deficit in spontaneous alternation, consistent with previous reports of a role for GluR-A-dependent plasticity in hippocampus-dependent, spatial working memory. Although changes in motor coordination or anxiety cannot explain the dissociations already reported within the spatial memory domain, it is clear that they could significantly affect interpretation of results obtained in other kinds of behavioral tasks.

Affect↗
PubMed2004

Closing the feedback loop: an audit of the use of imiquimod for the treatment of genital warts.

A retrospective case-note audit of 74 patients with 81 treatment episodes of anogenital warts with imiquimod from April 1999 until July 2000 was performed. The majority of patients had failed to clear their warts with other treatments, had recurrences after other treatments, or had other medical problems complicating their genital wart treatment. The overall clinically confirmed complete clearance rate was 33%. This is lower than other published data, but may be so because it includes patients with immunosuppression and difficult-to-treat warts. The complete clearance rate in immunocompetent patients was 37%. In addition, in this audit of clinical practice 17% of the patients did not return for full response to be assessed. The complete clearance rate in those who were able to tolerate treatment and who returned for follow-up was 45%. Based on the results of the audit we have extended the indications for the use of imiquimod in the clinic treatment guidelines. Patients are now offered imiquimod if six or more episodes of other treatments fail to give a good response. Earlier treatment with imiquimod is also offered to those patients with recurrent anogenital warts, and it is recommended as a first-line therapy for patients with multiple keratinized warts.

Aminoquinolines↗
PubMed2001

Refractive changes caused by hypoxia after laser in situ keratomileusis surgery.

OBJECTIVE: To determine whether hypoxia induces refractive changes in subjects who have had laser in situ keratomileusis (LASIK) refractive surgery. DESIGN: Prospective paired eye clinical trial. PARTICIPANTS: There were 20 LASIK subjects (40 eyes) and 20 myopic non-LASIK controls (40 eyes). INTERVENTION: Each subject had one eye exposed to ocular surface hypoxia (humidified nitrogen) by use of an airtight goggle system at sea level for 2 hours. The other eye was simultaneously exposed to humidified, compressed air (21% oxygen) with the same airtight goggle system. MAIN OUTCOME MEASURES: Keratometry, cycloplegic refraction, and pachymetry were compared before and after exposure by use of repeated measures analysis of variance. RESULTS: A significant myopic shift (P: < 0.01) occurred in LASIK corneas exposed to hypoxia compared with myopic control subjects. A significant increase in corneal thickening occurred symmetrically in both LASIK and control subjects exposed to hypoxia. There was a trend toward corneal steepening (keratometry) in LASIK subjects, but this was not statistically significant. CONCLUSIONS: These results suggest that ocular surface hypoxia induces a myopic shift in LASIK subjects.

Adult↗
PubMed2001

Simultaneous modified Evans blue dye procedure and video nasal endoscopic evaluation of the swallow.

OBJECTIVE: To investigate the results of the modified Evans blue dye test (MEBD) aspiration detection rate to the video nasal endoscopic examination of the swallow (VEES) during simultaneous studies with direct viewing of the subglottis through the tracheostomy site opening by means of endoscopy. STUDY DESIGN: Prospective, consecutive. METHODS: Fifteen consecutive simultaneous MEBD and VEES studies were completed on patients with tracheostomies at an acute care rehabilitation hospital over a 4-month period. All patients were referred to the swallowing center for a video nasal endoscopic examination who had known or suspected dysphagia. RESULTS: Aspiration was present in 53% (8) of the studies as documented by the VEES. The MEBD showed an overall 50% false-negative error rate for the detection of aspiration as compared with the VEES. The MEBD identified aspiration in 67% of patients who aspirated more than trace amounts but failed to identify aspiration of trace amounts (0%). CONCLUSION: The results of the current investigation suggest that the MEBD, at best, should be viewed only as a screening tool for the presence of gross amounts of aspiration in patients with a tracheostomy.

Adult↗
PubMed2000

Difficult airway equipment in English emergency departments.

The need for tracheal intubation in the emergency department is often unpredictable and precipitous in nature. When compared with the operating room, a higher incidence of difficult intubation is observed. There are currently no accepted guidelines with respect to the stocking of difficult airway equipment in the emergency department. We have conducted a telephone survey to determine the availability of equipment for the management of the difficult airway in English emergency departments. Overall, the majority of units held a curved laryngoscope blade (100%), gum elastic bougie (99%) and surgical airway device (98%). Of alternative devices for ventilation, a laryngeal mask airway was kept by 65% of departments, a needle cricothyroidostomy kit by 63% and an oesophageal-tracheal twin-lumen airway (Combitube) by 18%. Of alternative devices for intubation, fewer than 10% held a retrograde intubating kit, intubating laryngeal mask, bronchoscope or lighted stylet. Seventy-four per cent of departments held an end-tidal carbon dioxide detector.

Airway Obstruction↗
PubMed2000

Increased left ventricular mass index and nocturnal systolic blood pressure in patients with Type 2 diabetes mellitus and microalbuminuria.

AIMS: To compare left ventricular mass (LVM) index and function in patients with Type 2 diabetes mellitus with and without microalbuminuria and to investigate the clinical determinants of left ventricular hypertrophy. METHODS: Echocardiography, electrocardiography and 24-h ambulatory blood pressure monitoring were performed in microalbuminuric (n = 29) and normoalbuminuric (n = 29) patients with Type 2 diabetes and no clinical evidence of heart disease. Groups were individually matched for age, sex and diabetes duration and smoking status. RESULTS: LVM index (62 (34-87) vs. 52 (33-89) g/m2.7, P = 0.04) and LVH prevalence, using two out of three definitions, were greater in patients with microalbuminuria (LVM/height2.7: 72 vs. 59%, P = 0.27, LVM/height: 66 vs. 38%, P = 0.04, LVM/body surface area: 59 vs. 31%, P = 0.03). Night-time systolic blood pressure (126 (99-163) vs. 120 (104-157) mmHg, P = 0.005) and the night/day systolic blood pressure ratio (0.92 (0.08) vs. 0.88 (0.06), P = 0.04) were higher in those with microalbuminuria. Systolic and diastolic function were similar in both groups. Linear regression analyses showed that body mass index (BMI) was significantly related to loge LVM index (R2 = 11.8%, P = 0.005) and a relationship with night/day systolic blood pressure was also suggested (R2 = 4.6%, P = 0.057). CONCLUSIONS: In patients with Type 2 diabetes, LVH is more common and severe in those with microalbuminuria. Its presence may be related to raised night/day systolic blood pressure ratio and is significantly related to BMI. The high prevalence of LVH strengthens the case for echocardiographic screening in Type 2 diabetes to identify high risk patients who might benefit from aggressive cardiovascular risk factor intervention.

Aged↗
PubMed1999

Axonal transport and distribution of immunologically distinct kinesin heavy chains in rat neurons.

The functional significance of biochemical and immunochemical heterogeneity in neuronal kinesin remains uncertain. Confocal laser scanning microscopy, cytofluorimetric scanning, and immunoblots were used for quantitative analyses of axonal transport and cellular distribution of immunochemically distinct kinesin heavy chain isoforms (H1 and H2) in rat peripheral nerve and spinal cord. H1 and H2 immunoreactivities (IR) were observed in axons proximal to a crush as early as 1 hr after the crush operation and increased linearly with time, consistent with fast axonal transport of both. Only approximately 10% of the proximal accumulations of H1-IR and H2-IR accumulated distal to the crush, in contrast to synaptophysin-IR (approximately 70%). H2-IR was widely present in peripheral nervous system and virtually colocalized with synaptic vesicle proteins synaptophysin, synaptobrevin I, and SNAP-25 and two neuropeptides [calcitonin gene-related peptide (CGRP) and substance P (SP)], although H2-IR was weaker in spinal cord terminals. In contrast, H1-IR appeared preferentially enriched in large axons, probably motor and large sensory neurons, which contained synaptophysin-IR, synaptobrevin I-IR, SNAP-25-IR, and CGRP-IR. However, H1-IR was weak or absent from SP-containing thin and medium-sized axons. In addition, H1-IR appeared to be absent from spinal cord nerve terminals. H1- and H2-IR kinesins are both transported with fast axonal transport, and comparatively small amounts of kinesins are retrogradely transported. H2 was widely distributed in motor, sensory, and sympathetic neurons, whereas H1 was enriched in large motor and sensory neurons.

Animals↗
PubMed1999

Silent myocardial ischemia and microalbuminuria in asymptomatic subjects with non-insulin-dependent diabetes mellitus.

Microalbuminuria is an increase in urinary albumin not detected by conventional dipstick testing and is present in 20% of patients with non-insulin-dependent diabetes mellitus (NIDDM). Mortality in NIDDM patients with microalbuminuria is 60% at 8 years and is mainly due to cardiovascular disease. Because many deaths occur without warning symptoms, we have compared the prevalence and severity of silent myocardial ischemia in asymptomatic NIDDM patients with and without microalbuminuria. We have performed a cross-sectional, case-control study of asymptomatic NIDDM patients attending hospital diabetes clinics. Forty-three patients with microalbuminuria were matched for age, gender, diabetes duration, and smoking status with 43 normoalbuminuric patients. A symptom-limited exercise stress test was performed and reported blind to patient status. The degree of electrocardiographic ST-segment depression, exercise time, work performed, and maximum heart rate with exercise were recorded. Patients with microalbuminuria had a higher prevalence of ischemic response (>1 mm ST depression) (65% vs 40%, p = 0.016), reduced total exercise time (5 vs 7 minutes, p <0.001), reduced work (6 vs 8 METs, p <0.001), and reduced age-predicted maximum heart rate (94% vs 101%, p = 0.004). In multiple logistic regression, albumin excretion rate was shown to be the strongest independent predictor of ischemic response (p = 0.03). Silent myocardial ischemia is common in asymptomatic NIDDM patients but is more common in those with microalbuminuria. In these subjects, the higher prevalence of ischemic response at low workloads suggests a higher probability of future coronary events, and possibly a higher probability of potentially treatable coronary artery disease.

Aged↗
PubMed1999

Treatment of cutaneous lesions of xanthoma disseminatum with a CO2 laser.

We describe a case of a 15-year-old African American girl with widespread papulonodular lesions of xanthoma disseminatum especially in the periorbital area and on the flexural surfaces of the neck, axillae, arms, and legs. There were no mucosal lesions. An initial trial in the distant past of liquid nitrogen cryotherapy resulted in partial shrinking of cutaneous lesions but was too painful for the patient. She then underwent surgical excision of bilateral eyelid lesions with improvement, but additional procedures were deemed impractical when considering the great number and size of the lesions. Consequently we treated the patient with a carbon dioxide (CO2) laser with excellent results. The relatively great speed at which the CO2 laser procedure can be performed has made the removal of multiple lesions in each session possible. Additional advantages included precise vaporization of lesions, hemostasis during the operative procedure, and minimal postoperative pain and edema.

Adolescent↗
PubMed1999

Electrophysiological properties of the recipient atrial remnant after human orthotopic cardiac transplantation.

AIMS: The recipient atrial remnant has been used as a control in studies ofchronotropic response following orthotopic cardiac transplantation and as a trigger for the donor heart. It is not known, however, whether its function is normal. We investigated the electrophysiological properties of the recipient atrial remnant. METHODS AND RESULTS: Fifty patients were studied, mean age 49 years (range 20-63) and mean time post-orthotopic cardiac transplantation of 31 months (range 1-107). Recipient atrial rhythm, spontaneous cycle length and sinus node function were determined. Atrial fibrillation/flutter was identified in 10/50 (20%). Of those in sinus rhythm, significant bradycardia was present in 12/40 (30%). The mean spontaneous cycle length was 929+/-188 ms. Three patients demonstrated variable atrial electrocardiogram morphology and a further three patients had marked variations in resting cycle length. The sinus node function was abnormal in 2/34 (6%). CONCLUSIONS: Only 56% recipient atria had normal sinus rhythm, with 21% of these demonstrating features consistent with a wandering atrial pacemaker. The recipient atrial remnant is not normal in the majority of transplant recipients and should be used with caution in studies involving its use as a control or as a trigger for the donor heart.

Adult↗
PubMed1998

Autonomic neuropathy in asymptomatic subjects with non-insulin-dependent diabetes mellitus and microalbuminuria.

Patients with non-insulin-dependent diabetes mellitus (NIDDM) and microalbuminuria (MA) are at increased risk of early death. In NIDDM patients without evidence of heart disease, we examined the links between MA and autonomic neuropathy (AN) and reduced heart rate variability (HRV), both of which have been linked to a poor prognosis. We have studied 43 asymptomatic NIDDM patients with MA and have matched them with 43 normoalbuminuric patients for age, gender, diabetes duration, and smoking status. AN was assessed by heart rate changes to deep breathing, Valsalva, and posture and blood pressure changes to posture and hand grip. Twenty-four hour Holter monitoring was used to evaluate HRV. Patients with MA showed evidence of AN and reduced HRV when compared with normoalbuminuric patients. In multivariate analysis, with measures of AN and HRV as outcome variables, Log albumin excretion rate was a significant independent predictor but stronger predictors were the presence of diabetic retinopathy, age, body mass index, claudication, alcohol consumption, and calcium channel blocker use. The presence of MA is linked to AN and reduced HRV in asymptomatic NIDDM patients. The nature of the relationship is complex, involving multiple relationships with other clinical parameters.

Aged↗
PubMed1998

Exercise response of the recipient atrial remnant after orthotopic cardiac transplantation: implications for recipient atrial triggered pacing.

The assumption that the recipient atrial remnant in the cardiac transplant recipient is normal has led to the suggestion that it is an appropriate trigger for permanent pacing in transplant recipients who need pacing or to restore chronotropic competence and/or mechanical synchrony of the composite atrium. We examined the chronotropic response to exercise in 12 orthotopic cardiac transplant recipients (mean age 49 years) at a mean time of 17 months posttransplantation. Recipient and donor atrial rates were noted and compared and chronotropic competence determined. Two of 12 recipient atrial remnants were in atrial fibrillation. Only six of the remaining 10 recipient atria exhibited chronotropic competence. Seven of 10 recipient atria had rates higher than that of the donor. Only four of ten recipient atria in sinus rhythm satisfied both criteria. Two of these had abnormally high atrial responses early into exercise. Of the remaining two, only one recipient atrial remnant demonstrated a > or = 20% increase in heart rate above that of the donor at peak exercise. Hence only 1 of 12 (8.3%) transplant recipients potentially could benefit from recipient atrial triggered pacing. While recipient atrial triggered pacing is an attractive theoretical concept for restoring chronotropic competence following orthotopic cardiac transplantation, it may rarely be practical because the recipient atrial remnant displays rhythm abnormalities, chronotropic incompetence, and abnormalities in its exercise response.

Atrial Function↗
PubMed1997

Speech perception deficits in poor readers: auditory processing or phonological coding?

Poor readers are inferior to normal-reading peers in aspects of speech perception. Two hypotheses have been proposed to account for their deficits: (i) a speech-specific failure in phonological representation and (ii) a general deficit in auditory "temporal processing," such that they cannot easily perceive the rapid spectral changes of formant transitions at the onset of stop-vowel syllables. To test these hypotheses, two groups of second-grade children (20 "good readers," 20 "poor readers"), matched for age and intelligence, were selected to differ significantly on a /ba/-/da/ temporal order judgment (TOJ) task, said to be diagnostic of a temporal processing deficit. Three experiments then showed that the groups did not differ in: (i) TOJ when /ba/ and /da/ were paired with more easily discriminated syllables (/ba/-/sa/, /da/-/fa/); (ii) discriminating nonspeech sine wave analogs of the second and third formants of /ba/ and /da/; (iii) sensitivity to brief transitional cues varying along a synthetic speech continuum. Thus, poor readers' difficulties with /ba/-/da/ reflected perceptual confusion between phonetically similar, though phonologically contrastive, syllables rather than difficulty in perceiving rapid spectral changes. The results are consistent with a speech-specific, not a general auditory, deficit.

Child↗