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Biomedical subjects

C Doherty

Publications and source records attributed to C Doherty.

At least 37 records · Page 2Linked to original sources
PubMed1997

Vascular events during follow-up in patients with aortic arch atherosclerosis.

BACKGROUND AND PURPOSE: An association between aortic arch atherosclerosis and vascular events has been demonstrated. However, few data exist regarding follow-up evaluation of this disease. METHODS: In this study, 183 patients with the diagnosis of aortic arch atherosclerosis were prospectively followed up. This diagnosis was made during an echocardiographic cross-sectional study. In 136 patients, raised plaques with thickness < 5 mm had been shown to exist, and in 47 patients complex plaques with thickness > or = 5 mm or plaques with mobile components had been demonstrated on the initial transesophageal echocardiography. RESULTS: During a mean follow-up period of 16 +/- 7 months, vascular events with a presumed embolic origin occurred in 15 patients. The incidence was 4.1 per 100 person-years in patients with raised plaques compared with 13.7 per 100 person-years in the group with complex plaques. The Kaplan-Meier survival analysis revealed a significantly higher rate of vascular events in patients who were found to have complex plaques (P < .01). In the Cox proportional hazards analysis, the finding of complex plaques (relative risk [RR], 4.3; 95% confidence interval [CI], 1.5 to 12.0; P = .006), coronary artery disease (RR, 4.0; 95% CI, 1.2 to 13.1; P = .02), and a history of previous embolism (RR, 4.0; 95% CI, 1.1 to 14.4; P = .03) were independent predictors of vascular events. CONCLUSIONS: Patients with the finding of protruding plaques or plaques with mobile components have a high risk of subsequent vascular events.

Adult↗
PubMed1997

A decade of change in obesity surgery. National Bariatric Surgery Registry (NBSR) Contributors.

BACKGROUND: The International (formerly National) Bariatric Surgery Registry began collecting data in January 1986. The aim of this study was to examine changes in the practice of surgical treatment of severe obesity that occurred during the decade of 1986 through 1995, as observed in the IBSR data. METHODS: All data submitted to the IBSR during the decade were transferred to the IBM mainframe computer for analysis. Characteristics of operative type populations were compared over time using analysis of variance (ANOVA) for age, body mass index (BMI), operative weight and Chi-square (chi2) test for gender. RESULTS: There has been a steady increase over the decade in mean patient weight. The operations used have changed from predominantly 'simple' operations to more frequent use of 'complex' operations. Within the categories of 'simple' and 'complex', an increase in the variety of operations occurred. As a group, patients with 'simple' operations have been heavier, more often male and public pay patients than those who have undergone 'complex' operations. One year weight loss was greater for Roux-en-Y gastric bypass (RGB) than vertical banded gastroplasty (VBG), but follow-up rates were too low to study the relative merits of the operations used. The reported incidence of operative mortality and serious complications (leak with peritonitis, abscess and pulmonary embolism) remained low. CONCLUSIONS: These observations and their implications can be summarized in three statements which relate to action for improved patient care in the beginning of the new century: (1) increasing weight of candidates for surgical treatment during this decade indicates the need for earlier use of operative treatment before irreversible complications of obesity can develop; (2) low risk of obesity surgery, decreasing postoperative hospital stay, and early weight control support the continued and increased use of surgical treatment; (3) continued widespread use of both 'simple' and 'complex' operations with increased modifications of standard RGB and VBG procedures emphasizes the need for standardized long-term data and analyses regarding both weight control and postoperative side-effects.

Adult↗
PubMed1996

Spread of beta-lactam-resistant Pseudomonas aeruginosa in a cystic fibrosis clinic.

BACKGROUND: Pseudomonas aeruginosa colonisation of the airways of patients with cystic fibrosis (CF) is associated with considerable respiratory morbidity. Although segregation of colonised patients from non-colonised patients to prevent cross-infection has been recommended, there is little evidence that such cross-infection is widespread. We observed that a high proportion of children attending our CF clinic were colonised with P aeruginosa that was resistant to ceftazidime and other beta-lactam antibiotics. We used two genomic fingerprinting techniques to see whether this may have arisen from epidemic spread of a single strain. METHODS: The prevalence of P aeruginosa colonisation and the antibiotic susceptibility of the organisms was determined from review of laboratory reports in the case-notes of 120 children with CF. Isolates were cultured from the sputum of 65 children colonised with ceftazidime-resistant P aeruginosa. Polymorphisms in total bacterial DNA from 92 isolates were analysed with two molecular fingerprinting techniques--pulsed-field gel electrophoresis after restriction enzyme digestion and assessment of flagellin gene polymorphisms by amplification of the whole gene and restriction enzyme digestion. RESULTS: 92 (76.7%) of 120 children were colonised with P aeruginosa, and 65 of the 92 harboured isolates that were resistant to ceftazidime. Only three of the 92 children had never been treated with ceftazidime. The results of the two molecular-fingerprinting techniques were concordant and showed that 55 of 65 children harboured the same epidemic strain. This strain was resistant to ceftazidime, azlocillin, and imipenem, and sensitive to tobramycin and ciprofloxacin. INTERPRETATION: This study provides the first molecular evidence of a long-term outbreak of P aeruginosa in a CF centre. We suggest that careful surveillance of the prevalence of antibiotic resistance in CF centres should be instituted with measures to prevent cross-infection. We believe that antipseudomonal monotherapy should be considered with caution.

Adolescent↗
PubMed1996

Power Doppler ultrasound examination of the intracerebral and extracerebral vasculature.

Power Doppler is a new ultrasound technique based on the visualization of the Doppler power spectrum. In 22 patients with different lesions of brain-supplying vessels the results of power Doppler ultrasound were compared with those of digital subtraction angiography and conventional color Doppler ultrasound. In patients with intracranial high-degree stenoses, power Doppler was largely free of those artifacts that occur with conventional color Doppler (e.g., echoshadowing and aliasing). The vessel lumen was seen in all patients with more than 80% stenoses. Power Doppler was superior to conventional color Doppler in visualizing both middle cerebral artery stenosis and intracerebral aneurysms. Power Doppler visualization of intracranial pathology was similar to visualization by digital subtraction angiography. Power Doppler appears to be a valuable tool in the noninvasive imaging of intracranial and extracranial pathological vascular conditions.

Angiography, Digital Subtraction↗
PubMed1996

Impact of Vertical Banded Gastroplasty on Respiratory Insufficiency of Severe Obesity.

BACKGROUND: Respiratory insufficiency associated with morbid obesity can include sleep apnea syndrome (SAS), obesity hypoventilation syndrome (OHS), or a combination of both. The aim of our study was to determine the safety and effectiveness of vertical banded gastroplasty (VBG) in the treatment of severely obese patients with respiratory insufficiency. METHODS: From 1983 to 1994, 35 patients (25 males, ten females) who met the criteria for either SAS and OHS (1 9 patients) or SAS alone (1 6 patients) underwent VBG. RESULTS: Six patients (17%) died of subsequent pulmonary-cardiac disease despite significant weight loss. Need for nasal continuous positive airway pressure (CPAP) decreased after VBG from 68% of patients preoperatively to 22% postoperatively. Of the ten patients with sleep studies, the apnea/hyponea index decreased from 45 +/- 11 events per h preoperatively to 12 +/- 6 events per h postoperatively, while per cent ideal body weight (%IBW) also decreased (pre-VBG: 268 +/- 12, post-VBG: 204 +/- 12). Of the seven patients with arterial blood gases, PaCO&inf2; decreased from 55 +/- 4 torr preoperatively to 41 +/- 3 torr postoperatively, and PaO&inf2; increased from 50 +/- 4 torr preoperatively to 73 +/- 6 torr postoperatively, while %IBW decreased (pre-VBG: 263 +/- 16, post-VBG: 193 +/- 14). CONCLUSION: Respiratory insufficiency is a life-threatening complication of morbid obesity. In morbidly obese patients with respiratory insufficiency, VBG offers improvement in both SAS and OHS. Respiratory insufficiency due to obesity should be considered a strong indication for VBG.

Journal Article↗
PubMed1996

Pay Status as a Predictor of Outcome in Surgical Treatment of Obesity.

BACKGROUND: Higher complication rates and lower success in surgery for severe obesity have been reported for patients with government pay status. We examined the effect of pay status upon outcome in surgical treatment of obesity. METHODS: This was an observational study from an aggregate data set of individual patient information. Government pay status (G) was defined as full or partial medical care payment through Medicare, Medicaid, or Veterans Administration. Payment entirely by private insurance was defined as private (P). Operations were classified as either simple (S, gastric restriction) or complex (C, gastric restriction with small bowel bypass). Two measures of outcome, perioperative complication rate and weight loss success (</= 50% excess weight), were examined to determine pay status effect. RESULTS: More G than P patients were treated with simple procedures (79% vs 51%, p < 0.05). Perioperative complication rates were more common for G than P patients (14.4% vs 9.1%, p < 0.05). One-year weight loss success was higher for P than G, regardless of operation type. CONCLUSION: Pay status should be included in characterization of patient groups and in the analysis of results when effectiveness of surgical treatment for severe obesity is reported.

Journal Article↗
PubMed1996

Power Doppler--a new tool for transcranial duplex assessment of intracranial vasculature.

The present study was undertaken to assess the clinical use of power Doppler (PD) as a new tool for transcranial vessel imaging. Power Doppler displays the integrated power of the Doppler signal instead of the Doppler frequency shift used in the conventional color flow Doppler (CFD) technique. Twenty-one patients were evaluated who had intracranial malformations or arterial stenoses [4 middle cerebral artery (MCA) stenoses, 2 intracranial carotid stenoses, 7 arteriovenous malformations (AVM), 5 intracranial carotid aneurysms, 3 Moya-Moya syndromes]. The PD results were compared with those obtained from CFD and digital subtraction angiography (DSA). Power Doppler was able to visualize 3 of 4 MCA stenoses with greater morphological detail than CFD, whereas PD and CFD were equally effective in diagnosing carotid stenoses. All AVMs were visualized using PD as well as CFD, but again PD revealed more morphological details, in a manner similar to DSA. Power Doppler was also superior to CFD in imaging intracerebral aneurysms and pathological collateralization associated with Moya-Moya syndromes. It is evident from these data that PD permits reliable and detailed transcranial imaging and therefore is a superior method for visualizing intracerebral vascular malformations and arterial stenoses.

Blood Flow Velocity↗
PubMed1995

Lung disease in the cystic fibrosis mouse exposed to bacterial pathogens.

Lung disease is the major cause of death in cystic fibrosis (CF), but there is no evidence for overt lung involvement at birth. We show here that the same is true for the gene targeted cftrm1HGU mutant mouse. Furthermore, this CF mouse model demonstrates an impaired capacity to clear Staphylococcus aureus and Burkholderia (Pseudomonas) cepacia, two opportunistic lung pathogens closely associated with lung disease in CF subjects. The cftrm1HGU homozygotes display mucus retention and frank lung disease in response to repeated microbial exposure. Thus, lung disease in the cftrm1HGU mouse develops in response to bacterial infection, establishing a model to dissect the pathogenesis of CF pulmonary disease and providing a clinically relevant end point to assess the efficacy of pharmacologic or genetic interventions.

Animals↗
PubMed1995

The Effect of Follow-up on Reporting Success for Obesity Surgery.

BACKGROUND: Much is written about the importance of follow-up in determining the effect of surgical treatment for obesity upon weight loss. When patients are lost to follow-up, it has been suggested that these patients should be considered as failures. This study was undertaken to determine the effect of incorporating patients not followed in a definition of success for weight loss at one year. METHODS: Data from 34 surgical practices were used to study the effect of using two different denominators, patients followed (Df) or patients eligible (De), to define success. The numerator used in both methods was the number of patients with </= 50% EW at 1 year. RESULTS: One-year follow-up was 61% (5091/8356). Success was 67% (3423/5091) when calculated using the denominator patients followed (Df). No correlation was found between success and follow-up when data within each surgical practice were averaged and used in a correlation analysis. CONCLUSIONS: This study does not support the thesis that patients who fall to return for follow-up should be considered as having failed in weight control.

Journal Article↗
PubMed1995

Vertical Banded Gastroplasty in the Severely Obese under Age Twenty-One.

BACKGROUND: The severely obese under 21 years of age are at high risk of missing normal development during a crucial period of life and should be considered for surgical treatment. Vertical banded gastroplasty allows patients to be treated effectively while continuing to have normal digestion and absorption without the risks of complex operations. METHODS: This was a retrospective outcome review of 47 severely obese who were under age 21 when surgically treated with VBG. RESULTS: There were no operative mortalities, leaks, or wound infections. Body mass index in 25 patients followed 5 years decreased from an average operative 48.1 to 36.2 kg m(2). Equally for 14 patients followed 10 years, BMI decreased from an average operative 49.6 to 39.2 kg m (2). Both patient groups had 74% follow-up. CONCLUSIONS: Sustained weight reduction improved general health and allowed participation in life activities that would otherwise not have been possible. Adherence to recommended operative technique and intraoperative measurement of pouch volume is necessary to avoid excessive enlargement of the pouch, with resulting weight gain, reflux, and need for revision.

Journal Article↗
PubMed1995

Reversal of small intestinal bypass operations and concomitant vertical banded gastroplasty: long-term outcome.

BACKGROUND: Long-term complications of jejunoileal bypass (JIB) have been reported, prompting restoration of intestinal continuity and concomitant performance of vertical banded gastroplasty (VBG) for weight control. The aim of this study was to evaluate the presentation and reversal of JIB complications, late complications, mortality, and long-term weight control in patients who have undergone JIB reversal and concomitant VBG. STUDY DESIGN: From 1981 to 1994, 37 patients were treated for complications from JIB that included diarrhea (73 percent), arthritis (46 percent), malnutrition (22 percent), urolithiasis (19 percent), electrolyte disorders (19 percent), and lack of weight loss (8 percent). Four patients required preoperative parenteral nutrition to correct protein and electrolyte imbalances. Surgical management of all 37 patients included restoration of bowel continuity and VBG during the same operative procedure. RESULTS: Postoperative complications occurred in 11 patients, including prolonged ileus in seven patients, pancreatitis in three patients, and infectious complications in two. There were no deaths. Late morbidity included staple line dehiscence in four patients, incisional hernia in three patients, and reversal of the VBG in one. All patients with diarrhea, malnutrition, electrolyte disorders, and lack of weight loss had resolution of their symptoms, while urolithiasis and arthritis resolved in 86 and 53 percent of patients, respectively. In patients available for five-year follow-up evaluation, weight changes were small, shifting from a preoperative weight of 87 +/- 19 to 90 +/- 19 kg at five years (mean +/- SD). CONCLUSIONS: Restoration of intestinal continuity combined with VBG is a safe and effective operation that will reverse most of the long-term complications of JIB and provide stable weight control for up to five years.

Acid-Base Imbalance↗
PubMed1995

[Effect of morphological changes on perfusion and metabolism in cerebral microangiopathy. A comparison of PET, SPECT, and magnetic resonance imaging findings].

51 patients with cerebral microangiopathy were studied with MRI, 18FDG-PET, and 99mTc-HMPAO-SPECT. Exact morphological correlation of MRI-findings to functional data from PET and SPECT was obtained by a special head holder system applied to the patient's head. Patients with less than four lacunar infarctions (LI) and without or only slight deep white matter lesions (DWML) in MRI showed no significantly changed parameters (rMRGlu, rCBF) compared to patients with four or more LI and severe DWML. Patients with medium to severe outer and inner brain atrophy showed significantly lower rMRGlu and rCBF values in both cortex and white matter than patients with no to only slight atrophy. Thus, in patients with cerebral microangiopathy only atrophy and not the presence of LI and DWML is associated with a significant reduction of rCBF and rMRGlu.

Brain↗
PubMed1995

Do alpha-blockers have a role in lower urinary tract dysfunction in multiple sclerosis?

Lower urinary tract dysfunction is a major cause of morbidity in patients with multiple sclerosis. alpha 1-Adrenergic receptors are present at the bladder neck, where increased tone may be responsible for urinary retention and diminished flow rates. A randomized placebo controlled study was designed to test the hypothesis that blockade of these receptors using the selective alpha 1-adrenergic receptor antagonist indoramin would improve bladder emptying in patients with multiple sclerosis. Peak and mean urinary flow rates, residual volume and symptom score were evaluated at trial entry and again after 4 weeks in 18 men with multiple sclerosis. There was a mean 41% improvement in peak flow rate in the actively treated group compared with a 7.4% deterioration in the placebo group (p < 0.05). Residual volume improved in both groups. Patients taking indoramin reported a greater improvement in urinary symptoms. Modulation of the alpha 1-receptor may have a role in the management of lower urinary tract dysfunction in multiple sclerosis.

Adrenergic alpha-Antagonists↗
PubMed1994

Comparison of transcranial contrast Doppler sonography and transesophageal contrast echocardiography for the detection of patent foramen ovale in young stroke patients.

The prevalence of a patent foramen ovale was assessed by simultaneously performing transesophageal contrast echocardiography and transcranial contrast Doppler sonography (TCD) in 137 subjects (mean age 36 years) with stroke of unclarified etiology (n = 41), clarified etiology (n = 33), and in normal subjects (n = 63; mean age 32 years). Patent foramen ovale was found significantly more often in patients with unclarified than clarified strokes or in normal subjects (66% vs 33%, or 43%). Massive paradoxical embolism through a patent foramen ovale, identified by TCD, occurred significantly (p < 0.01) more often in patients with unclarified (64%) than clarified (27%) strokes or in normal subjects (3%). However, minimal shunts were typical in normal subjects (79%). Patent foramen ovale was detected indirectly by TCD when calculated on the basis of transesophageal contrast echocardiographic findings (sensitivity 89%, specificity 92%). Thus, TCD reliably detects paradoxical cerebral embolism through a patent foramen ovale, and provides important additional information for evaluating its clinical relevance by semi-quantification of embolic contrast material.

Adult↗