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Biomedical subjects

A Leslie

Publications and source records attributed to A Leslie.

18 recordsLinked to original sources
PubMed2002

The colorectal adenoma-carcinoma sequence.

BACKGROUND: It is widely accepted that the adenoma-carcinoma sequence represents the process by which most, if not all, colorectal cancers arise. The evidence supporting this hypothesis has increased rapidly in recent years and the purpose of this article is to review this evidence critically and highlight its clinical significance. METHODS: Medline searches were used to identify recent key articles relating to the adenoma-carcinoma sequence. Further pertinent articles were obtained by manual scanning of the reference lists of identified papers. RESULTS: The evidence supporting the adenoma-carcinoma sequence can be classified as epidemiological, clinicopathological and genetic. The most recent and largest body of data relates to molecular genetic events and their cellular effects; however, many other approaches, such as cytogenetics, molecular cytogenetics and cytometry, have also yielded valuable information. CONCLUSION: Recent work continues to support the adenoma-carcinoma sequence, but there is a paucity of data on the interrelationship between different genetic mutations and on the relationship between molecular and other types of genetic abnormalities. The clinical utility of the observations described has yet to be fully realized and global genetic analysis of colorectal tumours may prove to be central in rational adenoma management.

Adenoma↗
PubMed2002

Detection of colorectal carcinoma on double contrast barium enema when double reporting is routinely performed: an audit of current practice.

PURPOSE: To determine the sensitivity of double contrast barium enema (DCBE) in the detection of colorectal carcinoma (CRC) when double reporting is routinely performed. METHOD AND MATERIALS: Over a 1-year period all patients with a diagnosis of CRC within a large teaching hospital were identified. Using computer records, any patient with CRC who had had a DCBE within 5 years of diagnosis was identified. During this time period all DCBE were double reported by the radiographer or radiology trainee who performed the enema and by a consultant radiologist specializing in gastrointestinal radiology. RESULTS: Over the 1-year period 169 patients were identified with a diagnosis of CRC. Seventy patients had had a DCBE within the preceding 5 years. Sixty-four patients had had CRC diagnosed on the DCBE. One patient had a sessile polyp diagnosed, which was removed at colonoscopy and found to be an invasive adenocarcinoma. In five cases (7%) the CRC was not diagnosed on DCBE. In three cases the lesions could be seen retrospectively, in one case the lesion could not be seen and in one case the examination had been incomplete. CONCLUSION: In our series the miss-rate for CRC was 7%. Previous studies have shown miss-rates of 15-24%. These studies have not routinely employed double reporting. Our results suggest that double reporting of DCBE significantly reduces the miss-rate and that this reduction is due to fewer perceptive errors.

Adult↗
PubMed2002

Colonoscopy.

Colonoscopy is now the gold standard method for investigating most colonic symptoms. However, it is a demanding procedure that can be associated with low completion rates and significant complications, and it requires considerable skill to perform colonoscopy consistently well and safely. In this article, the key steps in performing colonoscopy are described with a view to providing the trainee with a logical sequence of manoeuvres on which to base a sound technique.

Colonoscopes↗
PubMed2001

Opportunity for audit: establishing and monitoring the use of protocols for nurse-led treatments of minor injuries.

During the last three years an integrated initiative has evolved in the casualty units of nine community hospitals in the Grampian region of Scotland. This has involved the development of nurse-led treatments for minor injuries based on a large number of assessment/treatment protocols. This paper describes how this change was used as an opportunity to initiate audit within clinical practice. Methods of auditing the use of the new protocols are detailed and baseline results are reported and discussed. In this way it is hoped that nurses involved in similar developments can learn from the strengths and weaknesses of this initiative.

Clinical Protocols↗
PubMed2001

Error in radiology.

The level of error in radiology has been tabulated from articles on error and on "double reporting" or "double reading". The level of error varies depending on the radiological investigation, but the range is 2-20% for clinically significant or major error. The greatest reduction in error rates will come from changes in systems.

Magnetic Resonance Imaging↗
PubMed2000

Who should be performing routine abdominal ultrasound? A prospective double-blind study comparing the accuracy of radiologist and radiographer.

AIM: To compare the accuracy of radiographers and radiologists in routine abdominal ultrasound. MATERIALS AND METHODS: One hundred consecutive patients attending for routine abdominal ultrasound were included. Each patient was examined by both a radiographer and radiologist. Both operators noted their findings and wrote a concluding report without conferring. Reports were compared. Where there was disagreement the patient was either re-examined by another radiologist or had further investigation. RESULTS: Of 100 patients, 52 were men and 48 were women. The age range was 19-88 years (median 52 years). Thirty-seven patients had renal tract ultrasound, one had an aortic ultrasound and 62 had general upper abdominal ultrasound. In 44 cases both operators reported the examination as normal. In 49 cases both operators reported the examinations as abnormal and there was complete agreement between the operators. In seven cases there was not complete agreement between operators. Three of these disagreements were considered minor and four major. In three of the seven cases the radiographer was correct, and in four the radiologist was correct. CONCLUSION: Experienced radiographers and radiologists are highly accurate in performing and interpreting routine abdominal sonography. Both operators missed a small minority of abnormalities. There was no statistically significant difference in the accuracy of radiographers and radiologist.

Abdomen↗
PubMed2000

The influence of clinical information on the reporting of CT by radiologists.

The aim of the study was to determine whether clinical information alters the CT report. This prospective blinded study consisted of 50 consecutive patients who attended a Department of Radiology for CT. Each study was interpreted by two of three consultant radiologists, before and after knowledge of the clinical information. 19 reports were changed after clinical information was known. Clinical follow-up was available in 15 cases. In ten cases the reports were more accurate after clinical information and in five cases the reports were less accurate. In three of the five cases where accuracy was reduced, the clinical information was incorrect. It was concluded that clinical information affects the CT report. If the information is accurate it has a beneficial effect; if it is inaccurate it has a detrimental effect. The more complex the investigation, the more important the clinical information. There was a correlation between readers regarding the influence of clinical information. Correct clinical information therefore improves the radiology report. It is the responsibility of the clinician to provide this information in an accurate and legible form.

Adolescent↗
PubMed1999

Plexiform neurofibroma of the small bowel infiltrated with metastatic adenocarcinoma.

Neurofibromatosis Type 1 (NF1) is not classically associated with gastrointestinal manifestations although these patients are at increased risk of several GI complications. We describe the ultrasound, CT and barium findings in a patient with NF1 who had a huge benign plexiform neurofibroma of the ileum that was infiltrated with metastatic adenocarcinoma.

Adenocarcinoma↗
PubMed1995

Illness behaviour in patients with arthritis.

OBJECTIVES: To determine if there are specific patterns of illness behaviour in patients with arthritis, and if abnormal patterns of illness behaviour are associated with withdrawal from trials of anti-inflammatory drugs, and to examine which aspects of illness behaviour are perceived by rheumatologist to be related to the disease process. METHODS: The illness behaviour questionnaire (IBQ) was administered to 211 patients with rheumatoid arthritis (RA) and 107 patients with osteoarthritis (OA) participating in five drug trials of NSAIDs at the beginning of the studies, and was commented upon by 17 clinical rheumatologists. RESULTS: Factor analysis of 211 patients with RA produced a unique factor solution. RA patients were more preoccupied with their illness and its effects and worried more about their health than patients with OA. Patients who withdrew from drug trials showed behaviour patterns similar to those of chronic pain patients, and different from those of patients who completed the studies. When asked to account for a rheumatoid patient's response to the IBQ, rheumatologists focused on physical symptoms and did not recognise some of the psychological issues which patients saw as being relevant. CONCLUSIONS: We have demonstrated differences in illness behaviour between patients with OA and with RA. Patients withdrawing from drug trials of NSAIDs showed differences in illness behaviour compared with those successfully completing the trials. Rheumatologists underestimated the impact of the disease on their RA patients' psychological well being.

Adolescent↗
PubMed1992

Casing the joint.

Explore the source record for details and available documents.

Contract Services↗
PubMed1992

Reduction of the concentration and total amount of keratan sulphate in synovial fluid from patients with osteoarthritis during treatment with piroxicam.

To study the effects of piroxicam on cartilage metabolism in vivo, a three phase (placebo/piroxicam 20 mg/day by mouth/placebo) double blind controlled trial was conducted in patients with osteoarthritis of the knee joint. Twenty one patients were recruited, 19 of whom (11 women, eight men, median age 70 years) completed the treatment schedule. The knee joint under study was aspirated to dryness at four week intervals. Treatment with piroxicam was accompanied by a decrease in the pain score, an improvement in the functional index, and an increased range of movement. Reductions in the concentration (mean (SEM) 120 (6) to 110 (8) micrograms/ml) and the total amount (1.22 (0.34) to 0.99 (0.37) mg) of keratan sulphate, but not the effusion volume (9.4 (2.5) to 8.3 (2.6) ml) were observed during treatment with piroxicam. These findings are consistent with decreased proteoglycan catabolism during treatment with piroxicam. Neither depressed synthesis nor enhanced clearance of degraded proteoglycan fragments can be excluded, however.

Adolescent↗
PubMed1992

A comparison of ketoprofen SR and sulindac in the elderly with rheumatoid arthritis.

The elderly (age > 65 years) are more vulnerable to side-effects induced by non-steroidal anti-inflammatory drugs (NSAIDs). We therefore performed a double-blind comparative study of ketoprofen SR and sulindac in patients with active rheumatoid arthritis, 65 years of age or older. Sulindac was chosen because of its possible renal sparing effects, and ketoprofen SR because of its short half life and sustained release delivery system. Eighty patients were entered. More patients withdrew from the study due to side-effects in the sulindac group; both treatment groups had a high incidence of side-effects during this study and during previous exposure to other NSAIDs, demonstrating that the elderly are susceptible to side-effects from NSAIDs.

Aged↗
PubMed1981

The bioavailability of erythromycin stearate versus enteric-coated erythromycin base when taken immediately before and after food.

1. Erythromycin plasma concentrations were determined in twenty subjects after a single dose, immediately before food, of erythromycin, 500 mg. as: (1) erythromycin stearate (Erythrocin, 500 mg, ovaloid tablets), and (2) erythromycin base (Eryc, 250 mg, capsules containing enteric-coated pellets). 2. Plasma concentrations were again determined in eighteen of the original subjects with the same dose given immediately after food. 3. Maximum Plasma Concentrations (mcg/ml) (See formula in text) 4. Erythromycin stearate was more bioavailable than erythromycin base when administered immediately before food. The preparations were bioequivalent when given immediately after food.

Biological Availability↗
PubMedDate not supplied

Staging of squamous cell carcinoma of the oral cavity and oropharynx: a comparison of MRI and CT in T- and N-staging.

PURPOSE: Our purpose was to assess the accuracy of CT and MRI in staging of squamous cell carcinoma (SCC) of the oral cavity and oropharynx. METHOD: Fifty-one episodes of primary and recurrent SCC were assessed with CT and MRI. The results were compared with pathological staging. RESULTS: For staging primary tumours, the accuracy of MR was 77% and that of CT was 67%. For detecting recurrent tumour, the accuracy of MR was 89% and that of CT was 100%. For N-staging, nodal sites were divided, according to the site of the primary tumour, into high and low risk. Sensitivity for high risk sites was 60% for clinical assessment, 35% for CT, and 75% for MR. Negative predictive value (NPV) was < or = 50% for all methods. For low risk sites, the NPV was > or = 95% for all methods. CONCLUSION: For T-staging, MR scanning is overall more accurate than CT. If degraded images and T1 tumours are excluded, the techniques are comparable. MR scanning is oversensitive for recurrent disease. For N-staging, all methods failed to detect small metastatic deposits.

Adult↗