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Biomedical subjects

S Iles

Publications and source records attributed to S Iles.

At least 19 recordsLinked to original sources
PubMed2003

Clinical experience and pre-test probability scores in the diagnosis of pulmonary embolism.

BACKGROUND: The Geneva and Wells pre-test probability scores are intended to replace empirical assessment of patients with suspected pulmonary embolism (PE). The effect of clinical experience on the inter-rater variability of these scores, and on empirical judgement, is unknown. AIM: To determine whether medical staff appointment grade affects the inter-rater variability of these pre-test probability scores, or empirical assessment, in patients with suspected PE. DESIGN: Questionnaire survey. METHODS: Doctors were grouped by grade (mean number of years since graduation+/-SEM): house officers 0.7+/-0.2, registrars 6.3+/-0.6, consultants 25+/-4 and applied pre-test probability scores to actual case scenarios. RESULTS: The Geneva score was the most consistent method of determining pre-test probability and was unaffected by clinical experience (Geneva kappa=0.73, Wells kappa=0.38, empirical kappa=0.23, p<0.001 ). With empirical judgement, inter-rater variability was inversely proportional to clinical experience (house officers kappa=0.37, registrars kappa=0.24, consultants kappa= 0.16, p<0.05). DISCUSSION: The Geneva score was the least variable method and can be applied by junior or senior doctors. Using empirical judgement, junior doctors were more likely to agree on the pre-test probability of PE than were their more senior colleagues. This may imply that as physicians gain experience, they recognize that the diagnosis of PE can be difficult to assess and are reluctant to exclude it on clinical grounds.

Aged↗
PubMed2002

Use of opioid analgesics in a patient with chronic abdominal pain.

Pethidine is the most commonly used opioid in hospitals in the UK, but it lacks potency, has a short duration of action and a narrow therapeutic index. These points are illustrated by a case history of a patient prescribed pethidine for chronic abdominal pain. Misplaced fears of the side-effects of morphine result in its underuse in the management of chronic pain with consequential restriction of patients' functional ability.

Abdominal Pain↗
PubMed1994

Pharmacokinetics, biodistribution and tumor localization of two anti-human B-cell chronic lymphocytic leukemia monoclonal antibodies and their F(ab)'2 fragments in a xenograft model.

We investigated the pharmacokinetics, biodistribution and tumor localization of intravenously injected Dal B01 and Dal B02, two monoclonal antibodies (MoAbs) directed against tumor associated antigens on human chronic lymphocytic leukemia (CLL) B cells, and their F(ab)'2 fragments in nude mice bearing xenografts of the human B cell CLL line D10-1. More of the percentages of the injected dose (% ID) of these two MoAbs and their F(ab)'2 fragments specifically localized in the tumor xenografts than in normal tissues. Compared to intact MoAbs, their F(ab)'2 fragments had lower % ID in tumors and were cleared from circulation faster. Well-defined tumor images were obtained at 24 and 48 h after administration of [131I]Dal B02 F(ab)'2 fragment and at 96-192 h after administration of [131I]Dal B02. A comparison between intravenous and intraperitoneal routes of administration of [131I]Dal B02 did not reveal any difference in the localization of % ID in tumor or normal tissues.

Animals↗
PubMed1993

Psychiatric outcome of termination of pregnancy for foetal abnormality.

Termination of pregnancy for foetal abnormality has become frequent with the increasing sophistication of techniques of antenatal diagnosis. The aim of this study was to obtain quantitative and qualitative information about psychiatric morbidity in women after termination of pregnancy for foetal abnormality. Two samples of women were compared. The first consisted of 71 women who had had a termination of pregnancy for foetal abnormality (FA group). The second consisted of 26 women who had experienced so-called missed abortion (MA group). Both groups had lost a pregnancy in the mid-trimester of pregnancy, but the MA group had no element of choice. Standardized psychiatric and social measures were used to assess both groups on three occasions after the termination. In both groups, 4 weeks after the termination psychiatric morbidity was high (four to five times higher than in the general population of women), and social adjustment was impaired. Six months and 12 months after the abortion, levels of psychiatric morbidity were near normal. Semi-structured interviewing was used to obtain information about the experience of grief after mid-trimester termination. For many women, symptoms of grief persisted throughout the year. These symptoms included typical features of grief as well as grief symptoms specific to pregnancy loss. The findings have implications for the counselling of women after termination for foetal abnormality or after missed abortion.

Abortion, Eugenic↗
PubMed1993

The complementary role of hepatobiliary scintigraphy and abdominal sonography in a patient with a hepatic cyst and suspected acute cholecystitis.

A 51-year-old woman was admitted with suspected acute cholecystitis. A large hepatic cyst was found incidentally by abdominal sonography, which displaced an "abnormal" gallbladder. Hepatobiliary scintigraphy visualized the gallbladder and excluded acute cholecystitis, but required the anatomic information from sonography to verify the abnormal location of the gallbladder. Additionally, scintigraphy showed the cyst not to communicate with the biliary tract. Pathologic findings revealed mild chronic cholecystitis and a simple mesothelial hepatic cyst. This case illustrates the complementary role of hepatobiliary scintigraphy and abdominal sonography in patients with distorted hepatobiliary anatomy and suspected acute cholecystitis.

Acute Disease↗
PubMed1992

Regional observer performance variation in the evaluation of gated cardiac blood pool studies.

Receiver operating characteristic (ROC) analysis demonstrated that regional variations of sensitivity exist in the detection of wall motion abnormality in cardiac blood pool imaging studies. The observer response is significantly better in the apex than either the septum or posterolateral wall segments. The observer errors tend to be false-negative in the posterolateral wall segment and false-positive in the other two segments. Image presentation can make a significant difference to the overall sensitivity, and the monochrome cine-sequence performed best in this study.

Gated Blood-Pool Imaging↗
PubMed1989

Psychological problems and uterine bleeding.

Gynaecological complaints are often associated with psychiatric disorder. Women with psychiatric disorder are more likely to complain of excessive uterine bleeding than women without psychiatric disorder. When a woman complains of menorrhagia, yet also has a psychiatric disorder, it is important to establish which is the primary problem. If menorrhagia is primary, then any associated psychiatric disorder may be secondary to distress and fear caused by excessive menstruation. If the psychiatric disorder is primary, then psychological distress may lead a women to complain about her usual menstrual pattern or minor changes in it. If the complaint of excessive menstruation is secondary to psychiatric disorder, surgical or medical treatment of this complaint may not be justified. If the gynaecologist is to make the important distinction between complaints of menorrhagia which are primary and those which are secondary to psychiatric disorder, then he/she needs to be able to detect and assess psychiatric disorder in women who present with complaints of excessive uterine bleeding. Recent research has provided information about the relationship between the surgical treatment of menorrhagia and psychiatric disorder. Hysterectomy for menorrhagia seems to alleviate psychiatric disorder in many women who had psychiatric disorder before operation. The operation rarely induces psychiatric disorder in women who are psychiatrically well before surgery. There is no association between psychiatric disorder either before or after hysterectomy for menorrhagia and the presence of absence of demonstrable pelvic pathology. There is no evidence that those women who overestimate their menstrual blood loss have an increased likelihood of being psychiatrically disturbed after hysterectomy. However, an important determinant of psychiatric outcome after hysterectomy for menorrhagia is preoperative psychiatric status--for example, mental state before surgery, previous psychiatric history and neuroticism.

Female↗
PubMed1989

The loss of early pregnancy.

It is often assumed that early loss of pregnancy is not followed by emotional distress. When such distress does occur, it often goes undetected. Early loss of pregnancy is frequently followed by typical grief such as that occurring after any bereavement. Most recent studies have shown that although social termination of pregnancy in the first trimester has few adverse psychological sequelae for most women, there are vulnerable women who do experience significant emotional distress afterwards. Risk factors for poor psychological outcome include poor social support, past psychiatric history and ambivalence about the termination. The procedures used for second trimester terminations of pregnancy are likely to be a particular source of distress. Psychiatric disorder may also follow if termination is refused. Careful assessment of all women before social termination will identify vulnerable women who may benefit from counselling and support afterwards. After spontaneous abortion or miscarriage, many women experience significant emotional distress, which persists for several months. Guilt and anger are common. Some women are particularly vulnerable to developing psychiatric disorder after spontaneous abortion, for example women with a past psychiatric history, poor social support, previous spontaneous abortion and personality traits such as neuroticism. Many women would benefit from follow-up and support afterwards; extra support and reassurance are often needed during the next pregnancy. Termination for fetal abnormality is more likely to induce grief than relief for many women; these pregnancies are usually wanted, second trimester terminations are distressing, and there is often guilt at destroying a life and/or opting out of rearing a handicapped child. Recent research has demonstrated substantial levels of psychiatric morbidity after termination for fetal abnormality, particularly in those with a past psychiatric history, those with poor social support, and those who feel they have opted out of bearing a handicapped child. Women receive little support of follow-up after such terminations, yet many would benefit from it. Such women are in particular need of reassurance and support during a subsequent pregnancy.

Abortion, Induced↗
PubMed1989

Maternity blues. II. A comparison between post-operative women and post-natal women.

A new scale for the detection and assessment of maternity blues was completed by 56 women daily for ten days after elective gynaecological surgery. When their responses were compared with those of 87 post-natal women, they differed significantly in frequencies of different symptoms at different times. The findings suggest that post-natal mood changes ('maternity blues') are characteristic of the puerperium and not simply non-specific reactions to physical and emotional stress.

Adolescent↗
PubMed1989

Comparison of scintigraphic diagnostic criteria in suspected pulmonary embolism.

Various criteria have been proposed for the interpretation of ventilation and perfusion (V/Q) scintigrams in diagnosing pulmonary thromboembolism. The Biello criteria, with modifications, have been a standard for years but they differ from the criteria currently being used in the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) trial. We carried out a retrospective study in an attempt to establish if one or the other set of criteria is better. Between February 1985 and September 1987, 38 patients had a V/Q scan for suspected pulmonary embolism and subsequently underwent pulmonary angiography. The V/Q scans were reviewed by two observers using the modified Biello and the PIOPED criteria. Receiver-operated characteristic curves were constructed separately for each set of criteria. Statistical analysis revealed that neither set of criteria was significantly better than the other, but the PIOPED criteria were felt to be better defined and easier to use. This may have implications for the practical application of the criteria.

Evaluation Studies as Topic↗
PubMed1988

Abnormal Tc-99m MAA accumulation.

Image findings are described in two patients who received radiochemically impure Tc-99m MAA radiopharmaceutical preparations. The cases are completely separate and show clinically the presence of hydrolyzed-reduced technetium (TcO2) in a radiopharmaceutical product.

Adult↗
PubMed1987

Psychiatric disorder and gynaecological symptoms in middle aged women: a community survey.

In a community survey 521 women aged 35-59 were selected at random from all patients registered in two groups practices. They were interviewed at home and assessed by means of standardised psychiatric measures and detailed gynaecological inquiry. Levels of psychiatric morbidity were found to be within the expected range for such a sample. Both psychiatric morbidity and the personality dimension of neuroticism were significantly associated with gynaecological symptoms, including dysmenorrhoea and premenstrual tension, some symptoms of excessive menstruation, and flushes and sweats but not disappearance of menstruation for over six months. Current psychiatric state was significantly associated with recent adverse life events and with indices of psychiatric vulnerability (neuroticism and previous psychiatric history), suggesting possible aetiological links with gynaecological symptoms. The findings of this study have implications for the management of gynaecological complaints in general practice.

Adult↗
PubMed1982

Activation of monocytes by portal serum and its relationship to immunoglobulin, immune complex and endotoxin content.

To investigate the possibility that a "spillover effect" of substances from the portal vein into the systemic circulation accounts for the abnormal monocyte function in patients with liver disease, we have incubated human peripheral blood monocytes with paired specimens of portal and systemic serum from humans and rabbits. Monocytes incubated with portal serum released more of a lysosomal enzyme, N-acetyl-B-glucosaminidase, than those incubated with systemic serum (p less than 0.05). In order to delineate the factors responsible for this increased activity, the content of immune complexes, immunoglobulins and endotoxin in the paired specimens of portal and systemic serum was measured. Endotoxin was found in none of 16 human specimens of portal blood and five of the 16 rabbit specimens. Modestly increased levels of immune complexes, particularly of the IgG class, were found in the portal serum compared to the systemic serum (p less than 0.01). Corresponding studies on immunoglobulins showed a higher concentration of IgA in portal serum (p less than 0.05), but no difference in other classes of immunoglobulins or complement levels. There was good correlation between the enzyme production by monocytes and the concentration of immune complexes, particularly IgA (r = 0.687, p less than 0.001), but there was no relationship to the presence or absence of endotoxin. This evidence suggests that portal serum contains substances, particularly immune complexes, which under normal circumstances are sequestered by the liver. These are capable of "activating" monocytes in vitro and may play a role in the pathogenesis of certain types of liver disease.

Acetylglucosaminidase↗