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Biomedical subjects

G Phillips

Publications and source records attributed to G Phillips.

At least 73 records · Page 4Linked to original sources
PubMed1995

Subspecies discrimination of staphylococci from revision arthroplasties by ribotyping.

Sixty-six cultures of Staphylococcus spp. were obtained from bone and tissue samples collected from 37 patients during revision arthroplasties and were speciated and ribotyped to assess strain diversity in each species. There were 10 ribotypes among 51 isolates of S. epidermidis, three among three isolates of S. capitis, two among four isolates of S. aureus and two among two isolates of S. simulans. One ribotype was found among each of: two isolates of S. warneri; two isolates of S. haemolyticus and single isolates of S. cohnii and S. saprophyticus. Low molecular weight bands of ribotype patterns characterized one or two related species whereas high molecular weight bands were useful for distinguishing types within species. Specimens from 17 patients yielded more than one isolate of Staphylococcus spp. In 13 of these patients the isolates were representatives of a single species but in only eight did ribotyping show the isolates to be identical. The findings of multiple species and ribotypes from samples taken from the same patient may have implications for understanding the nature of infection in revision arthroplasty and for antibiotic therapy.

Bacterial Typing Techniques↗
PubMed1995

Influence of ingesting a carbohydrate-electrolyte solution on endurance capacity during intermittent, high-intensity shuttle running.

The aim of this study was to examine the effects of ingesting a carbohydrate-electrolyte solution on endurance capacity during a prolonged intermittent, high-intensity shuttle running test (PIHSRT). Nine trained male games players performed two exercise trials, 7 days apart. On each occasion, they completed 75 min exercise, comprising of five 15-min periods of intermittent running, consisting of sprinting, interspersed with periods of jogging and walking (Part A), followed by intermittent running to fatigue (Part B). The subjects were randomly allocated either a 6.9% carbohydrate-electrolyte solution (CHO) or a non-carbohydrate placebo (CON) immediately prior to exercise (5 ml kg-1 body mass) and every 15 min thereafter (2 ml kg-1 body mass). Venous blood samples were obtained at rest, during and after each PIHSRT for the determination of glucose, lactate, plasma free fatty acid, glycerol, ammonia, and serum insulin and electrolyte concentrations. During Part B, the subjects were able to continue running longer when fed CHO (CHO = 8.9 +/- 1.5 min vs CON = 6.7 +/- 1.0 min; P < 0.05) (mean +/- S.E.M.). These results show that drinking a carbohydrate-electrolyte solution improves endurance running capacity during prolonged intermittent exercise.

Adult↗
PubMed1995

An in vitro study of fusidic acid susceptibility amongst isolates from conjunctival swabs.

The aim of this study was to examine the in vitro activity of fusidic acid against bacterial isolates from conjunctival swabs. Conjunctival swabs from 213 patients with conjunctivitis were examined. One or more pathogens were grown from 73 patients. Forty per cent of isolates were resistant to fusidic acid on disc sensitivity testing. Reduced sensitivity was detected by minimum inhibitory concentration testing in many isolates of H. influenzae and an isolate of S. pneumoniae. In addition, the in vitro activity of fusidic acid was determined against upper respiratory tract isolates of H. influenzae, S. pneumoniae and M. catarrhalis; this showed that many isolates had a reduced sensitivity to fusidic acid. Topical fusidic acid may not be optimal empiric therapy of bacterial conjunctivitis.

Anti-Bacterial Agents↗
PubMed1995

Techniques of partial hysterectomy: an overview.

With the advent of endometrial ablation and resection, and the laparoscopic techniques for hysterectomy, there has been renewed interest in subtotal or partial hysterectomy. A number of unsubstantiated claims have been made for these new techniques and these are critically reviewed. There appears to be no reason to advocate a change from total hysterectomy to partial hysterectomy on the basis of the currently available evidence.

Cervix Uteri↗
PubMed1994

Accelerated healing of chronic sickle-cell leg ulcers treated with RGD peptide matrix. RGD Study Group.

Leg ulcers are a chronic manifestation of sickle-cell disease (SCD) and are often painful, disabling, and difficult to treat. RGD peptide matrix treatment is a novel therapy designed to provide a topical synthetic extracellular matrix that can act as a temporary substitute for the damaged natural matrix at the ulcer site. In this randomized, placebo-controlled, double-blind, prospective, multicenter investigation, SCD patients with full-thickness leg ulcers were treated with standard therapy plus RGD peptide matrix or saline placebo once weekly for up to 10 weeks. Healing in patients with chronic ulcers (2 months or greater in duration) was significantly accelerated (P = .0085) in RGD peptide matrix recipients compared with the placebo group. In these chronic ulcer cases, the average percent ulcer closure (decrease in ulcer surface area) in the RGD peptide matrix group (54.4% +/- 8.9%) exceeded that in the placebo group (19.0% +/- 24.3%) nearly threefold by study endpoint. Furthermore, RGD peptide matrix was equally effective in promoting healing of long persistent ulcers and ulcers of shorter duration. In contrast, standard therapy plus placebo was significantly less effective (P = .001) in promoting healing for ulcers of progressively greater duration. The results of this study provide preliminary evidence that RGD peptide matrix treatment may significantly accelerate healing of chronic sickle-cell leg ulcers.

Adolescent↗
PubMed1994

Intensive conditioning regimen for bone marrow transplantation in children with high-risk haematological malignancies.

Between September 1987 and May 1991, 21 children aged 10 months to 15 years (median 9 years) underwent bone marrow transplantation (BMT) for advanced haematological malignancies using a conditioning regimen consisting of total body irradiation (TBI), etoposide 1.8 g/m2 by continuous infusion, and cyclophosphamide 2 g/m2 on 3 consecutive days. The patients included 14 with acute lymphoblastic leukaemia (ALL), 1 with chronic myeloid leukaemia (CML), 1 with juvenile CML, 4 with non-Hodgkin's lymphoma and 1 with acute nonlymphocytic leukaemia. Eleven had an allogeneic BMT from an HLA-matched sibling, and 1 from an unrelated donor. Nine patients received 4-hydroperoxycyclophosphamide purged autologous marrow. Median time to myeloid engraftment (ANC > 500/microliters) was 19 days in allogeneic BMT patients and 28 days in autologous BMT patients (P < .01). Mucositis was the major regimen-related toxicity (RRT). GI toxicity in the form of diarrhoea affected ten patients and five had veno-occlusive disease of the liver. Two patients had mild bladder toxicity and one died of renal toxicity. There was no CNS or cardiac toxicity. There was no significant difference in the incidence of toxicity according to the type of BMT (autologous or allogeneic), total dose, or sequence of TBI. With a median follow-up of 44 months, ten patients are alive (6/12 allogeneic BMT patients and 4/9 autologous BMT patients). Of the 11 deaths, four were related to toxicity (2 aspergillus, 1 haemorrhage following liver biopsy, and 1 from haemolytic-uraemic syndrome), and 4/12 allogeneic and 4/9 autologous BMT patients died from relapsed disease. This conditioning regimen is well tolerated in children, demonstrating mild and reversible RRT.

Adolescent↗
PubMed1994

Persistence of microflora in biofilm within fluid pathways of contemporary haemodialysis monitors (Gambro AK-10).

Growth of bacteria within a biofilm, visible macroscopically as a yellow coating, was seen on the interior walls of semi-transparent plastic dialysis monitor fluid pipes. The level of bacterial growth along the water/dialysis fluid pathway, and the effect of in-line bacterial filters, on colony counts in reverse osmosis reject water and monitor effluent were examined. Little difference in colony counts was seen at either sampling point in monitors fitted with and without filters. Because of the increasing use of high-flux dialysis, and its potential for transmembrane transport of endotoxin and bacteria into patients, staff should be aware that dialysis fluid pathways may be colonized with viable bacteria, which are not readily killed by conventional heat and chemical cleaning processes.

Bacteria↗
PubMed1994

Factors influencing the outcome of endometrial laser ablation.

There have been more than 1000 endometrial laser ablations (ELA) performed at South Cleveland Hospital. The procedure has a high success rate in relieving the symptoms of dysfunctional uterine bleeding (83% sustained improvement over 1-4 years), and there has been no associated major morbidity. To identify factors that are associated with poor outcome, we have reviewed our data on women who progressed to hysterectomy after ELA. Twenty-nine of the first 524 women (5.5%) undergoing ELA have required subsequent hysterectomy. After excluding 3 cases where extensive endometriosis had been diagnosed at concomitant laparoscopy, these women were compared to 26 matched controls who had excellent outcomes. It was observed that young age, dysmenorrhea, and atypical pelvic pain at admission were factors associated with an increased chance of failure. Operative data, including uterine length and treatment times, were similar in both groups, and more than half the poor outcome group had entirely normal uteri. We conclude that good patient selection based on careful history and preoperative examination is of paramount importance in ensuring good treatment outcome.

Adult↗
PubMed1994

Observation of pain behaviors during episodes of sickle cell disease pain.

OBJECTIVE: To assess the utility of a brief behavioral observation method to quantify pain. DESIGN: Correlational study. PATIENTS: 31 sickle cell disease (SCD) patients first seen in an outpatient clinic in painful crisis. OUTCOME MEASURES: Observed pain behaviors, physician rating of patient pain on a 0 to 10 scale, patient rating of pain on a 0 to 10 scale, and patient pain report from the McGill Pain Questionnaire. RESULTS: High interrater reliability for the brief behavioral observation was found, and observed pain behavior was found to correlate significantly with physician ratings of pain. CONCLUSIONS: This study is an important first step toward developing a systematic behavior-observation methodology for the analysis of SCD pain. The current methodology was found to be reliable and easily implemented in a busy, outpatient clinic.

Adult↗
PubMed1994

The value of ultrasound-guided fine needle aspiration in the assessment of solid breast lumps.

To assess the value of routine ultrasound-guided fine needle aspiration (US-FNA) of solid mass lesions of the breast, all such patients presenting to the breast clinic over a 5 month period were offered US-FNA in addition to standard imaging. One thousand, three hundred and eight-six consecutive patients were assessed and 77 solid mass lesions identified. US-FNA was performed in 49 of these. Sixteen demonstrated cytological features of malignancy that was confirmed at surgery. US-FNA did not diagnose malignancy in cases with typical benign imaging features. It did alter diagnosis from an equivocal suspicious mass lesion to a definite diagnosis of malignancy in four cases (25%). It also altered diagnosis from an equivocal, probably benign, diagnosis to a more confident diagnosis of benign disease in 18 (58%) of benign cases. US-FNA confirmed the diagnosis of malignancy in four cases where a suspicious mass could only be imaged by ultrasound. US-FNA is simple, rapid and, unlike large Tru-Cut biopsies, is not associated with complications. It causes only minimal discomfort to both patient and operator. We recommend that US-FNA becomes a routine component of the imaging workup of breast mass lesions both to exclude malignancy in equivocal cases and to confirm malignancy when this is expected.

Adolescent↗
PubMed1994

Adaptation and coping: a look at a sickle cell patient population over age 30--an integral phase of the life long developmental process.

Individuals with sickle cell disease experience a variety of psychosocial issues, some of which lead to maladjustments. To gather baseline data on coping and adjustment by a group of individuals over 30 years of age, a pilot study was conducted with 30 patients followed routinely at the Duke University Comprehensive Sickle Cell Center. The purpose of the study was to characterize such psychosocial parameters as coping behaviors, education, employment, group affiliation, health beliefs, marital status, parenting and perceptions regarding the disease. Using Erickson's stage of development as a point of reference, the middle adulthood stage was used as a theoretical framework for explaining and interpreting the results of this study. Study results reflect that, on the whole, the participants employed a wide variety of life skills to promote positive psychological and physical well being. These data suggest that this population of sickle cell disease patients have attained a reasonable level of psychosocial adjustment and many are leading productive lives. However, the minority of patients, who use the health care facilities more frequently, might lead one to speculate otherwise.

Adaptation, Psychological↗
PubMed1994

Thalidomide in the management of chronic graft-versus-host disease in children following bone marrow transplantation.

Chronic graft-versus-host disease (GVHD) is the major complication in patients surviving > 100 days post-allogeneic bone marrow transplantation and occurs in 30% of pediatric patients. It is most prevalent 1-2 years post-transplant. Treatment involves corticosteroids and other immunosuppressive therapy which may affect growth and increase the likelihood of infectious complications. We report five children with severe corticosteroid-dependent chronic GVHD treated with thalidomide 12-25 mg/kg/day. Response to therapy was based on resolution of symptoms of chronic GVHD and withdrawal of other immunosuppressive therapy. All the children showed clinical response to thalidomide with cessation or diminution in other immunosuppressive medication. Side-effects were minimal and no patient developed peripheral neuropathy. All patients are alive 48-65 months post-transplantation. Thalidomide is a safe and effective drug for the treatment of chronic GVHD in children and may avoid the use of long-term corticosteroid therapy.

Adolescent↗