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Biomedical subjects

B R Parry

Publications and source records attributed to B R Parry.

44 records · Page 3Linked to original sources
PubMed1991

Competency and the colonoscopist: a learning curve.

The first 334 consecutive unassisted studies of a trainee colonoscopist were audited to analyse the relationship between experience and a target 90% completion rate of colonoscopy. The cumulative sum (cusum) score was applied to examine the time trend for the attaining of the target 90% completion rate. This technique described a learning curve which showed, in this instance, that approximately 100 studies were necessary before a 90% completion rate was approached. A further 100 studies were required before this target completion rate was achieved consistently. A trend for continued improvement above the 90% completion rate level was also seen after 200 studies. Polypectomy was completed in 117 of the 123 studies where indicated. Cusum analysis may be a useful method for monitoring the progress of the trainee colonoscopist and the attainment of satisfactory competence. Training requirements, therefore, might better emphasize the attainment of an acceptable completion rate rather than an arbitrary quota per se.

Clinical Competence↗
PubMed1990

Tumour necrosis factor in surgical illness.

TNF is a multipurpose molecule which works alongside other cytokines to stimulate and coordinate immune and inflammatory responses to antigenic challenges. It is extremely well conserved throughout all mammal species, and obviously confers considerable survival advantage. There are circumstances, however, in which TNF itself can be a source of tissue injury. This occurs in septic shock when the magnitude of the host response is overwhelming. TNF also initiates the energy substrate mobilization required to meet the heightened fuel demands associated with immunological, inflammatory and wound-healing activities. In chronic infection and malignancy this may lead to severe depletion of host tissues with its own attendant morbidity and mortality. At present our understanding of the host response is expanding rapidly. The challenge for the future will be to manipulate this response selectively, to maximize its influence on the disease while minimizing its negative impact on the host.

Animals↗
PubMed1990

Gardner's syndrome: a case report.

Gardner's syndrome, with characteristic dental abnormalities and osteomas involving the jaws, is described in an adolescent male. The sinister aspect of the syndrome relates to the malignant potential of intestinal polyps and therefore the need for early diagnosis and prophylactic colectomy. The dentist may be the first health professional to have an opportunity to make an early diagnosis and referral of a patient with Gardner's syndrome, and should therefore be aware of the features of the syndrome that affect the teeth and jaws.

Adolescent↗
PubMed1989

In vivo immunohistochemical identification of tumor necrosis factor/cachectin in human lymphoid tissue.

To find an alternative approach to the in vivo detection of tumor necrosis factor/cachectin (TNF alpha), an immunohistochemical method to identify TNF alpha in histologic sections was developed. This method employs the streptavidin-biotin immunoperoxidase technique, and TNF alpha-specific monoclonal and polyclonal antibodies, on cryostat sections of fresh frozen human lymphoid tissue. Staining was evident in most specimens displaying follicular hyperplasia, but was absent from histologically normal tissue. Both tingible body macrophages and follicular dendritic reticulum cells appeared from phenotype analysis in serial sections and by double staining experiments to constitute the main source of TNF alpha. This technique complements other systemically oriented assays that may fail to detect significant in vivo TNF alpha production and activity at a cellular level.

Humans↗
PubMed1985

Catheter-related sepsis in patients on intravenous nutrition: a prospective study of quantitative catheter cultures and guidewire changes for suspected sepsis.

One hundred and ninety-five central venous catheters used for intravenous nutrition in 113 patients were studied prospectively. Catheter-related sepsis (CRS), defined by recovery of the same organism from the catheter tip and peripheral blood cultures, occurred with only 3.3 per cent of catheters or 2.3 per 1000 days of therapy. In contrast, CRS was suspected with 30 per cent of catheters and catheter contamination occurred in 37 per cent. Contamination was defined by a positive catheter tip culture without recovery of the same organism from the blood. CRS was present in 4 of 12 cases (33 per cent) with greater than 1000 colony forming units on the catheter tip but in only 2 of 54 (4 per cent) with fewer organisms. Thirty-eight cases suspected of having CRS were randomized to have catheter removal and later replacement, or replacement over a guidewire. There were no significant differences in the catheter contamination rate but there were significantly fewer problems of insertion in the guidewire group. However, transfer of Klebsiella sp., during the guidewire procedure, resulted in subsequent sepsis in one case. It is concluded that replacement of catheters over a guidewire is a safe and convenient way of establishing whether sepsis is catheter-related. Because organisms may be transferred, the procedure is not an appropriate treatment for catheter-related sepsis.

Adolescent↗