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Biomedical subjects

G Walsh

Publications and source records attributed to G Walsh.

At least 55 records · Page 3Linked to original sources
PubMed1997

Healthy hospital: toward a better tomorrow. A demonstration project to promote culture change through participatory decision making.

The three-year "Healthy Hospital" project was designed to increase participatory decision making, thereby decreasing job stress and increasing job satisfaction. Evaluation methods included employee surveys, focus groups and key informant interviews. Overall stress levels, job satisfaction and self-esteem generally improved. The diverse types of evaluation converge on a conclusion that the project achieved modest but significant gains throughout the organization. Lessons for future research and applications are discussed.

British Columbia↗
PubMed1997

Ultrasound assessment of residual abnormalities following primary chemotherapy for breast cancer.

The purpose of this study was to assess the usefulness of ultrasonography (US) in the assessment of the breast following primary medical therapy (PMT) of large operable breast cancer. A total of 52 patients were studied; all had invasive breast cancer, confirmed by core biopsy, with initial size > 4 cm by palpation, T2-3, N0-1, M0. PMT was with epirubicin, cisplatin and continuous infusional 5-fluorouracil, as previously described (Jones et al, 1994, J Clin Oncol 12: 1259-1265). Independent clinical and US assessments were made during PMT before surgery or biopsy. A total of 31 (60%) patients achieved complete clinical response (cCR), but in only five of these was the post-treatment ultrasound normal. Post-treatment sonographic findings of diffuse parenchymal distortion or a mass lesion without Doppler signal were associated with more favourable histology (pathological CR, non-invasive or microinvasive carcinoma), whereas a mass with Doppler positivity was more often associated with residual macroscopic invasive carcinoma. Patients who did not achieve cCR had a high incidence of residual macroscopic carcinoma (71%) regardless of the sonographic characteristics. With median follow-up of 27 months (range 12-43), ten (19%) patients have relapsed and six (12%) have died, but only one relapse has occurred within treated breast. Ultrasonography is a sensitive technique for assessing the response to PMT, particularly in patients who achieve cCR. It may be helpful in selecting those patients who do not require post-PMT surgery and in localizing abnormalities in those who do, particularly in those with cCR. However, clinicians should be aware that a residual US abnormality is by no means pathognomonic of residual cancer.

Adult↗
PubMed1997

Reliability and validity studies of a new computer-assisted crossed-cylinder aberroscope.

PURPOSE: We assessed the reliability and validity of a new computer-assisted crossed-cylinder aberroscope technique which measures the monochromatic optical aberrations of the human eye. METHODS: Intra-image variability, the variability occurring when the same image is repeatedly measured, and inter-image variability, the variability occurring when different images collected from the same eye are measured, were assessed using 10 repeated measures on each of 10 different subjects. We compared the measurements made using the computer-assisted technique with manual measurements made when a human operator performed all the aberroscope grid intersection location tasks. RESULTS: One-way repeated measures analyses of variance (ANOVA) on the inter-image and intra-image variability showed that the mean of the measurements made was statistically independent of the occasion on which a group of subjects was measured, and inter-image variability was larger than intra-image variability. A two-way repeated measures ANOVA comparing computer-assisted results with manual results showed that the means of the measurements made with the two methods are not statistically different from one another. The manual results showed greater variability than computer-assisted measurements. CONCLUSIONS: The technique is reliable and valid compared to earlier objective crossed-cylinder aberroscopic techniques.

Humans↗
PubMed1997

Gold plating on spectacle frames.

An investigation was carried out into the thickness and standard of application of the plating and lacquer coatings applied to three metal spectacle frames. All conform to BS 6625 (1991) for plating thickness, but there was considerable variation in regularity and porosity.

Electroplating↗
PubMed1997

The variation in the threads of the dowel screws of spectacle frames.

British Standards specify a very small number of screw sizes as being acceptable for use in spectacle frames. We have measured the screw sizes of 50 frames, selected at random from the stock of Glasgow Caledonian University Clinic and have shown that very few of the screws used conform to these standards.

Equipment Design↗
PubMed1996

Antenatal renal pelvis dilatation: a predictor of vesicoureteral reflux?

OBJECTIVE: The purpose of our study was to evaluate the role of antenatally diagnosed renal pelvis dilatation (RPD) as a predictor of vesicoureteral reflux (VUR) in infants. SUBJECTS AND METHODS: All cases of RPD (i.e., those with a renal pelvis diameter equal to or greater than 5 mm) detected on routine antenatal sonography at our institution over a 3-year period were followed throughout infancy with serial sonographic evaluation. Infants with moderate to severe RPD on the initial postnatal study (i.e., those with a renal pelvis diameter greater than 15 mm) were further evaluated with voiding cystography or nuclear scintigraphy (99mTc-2,3-dimercaptosuccinic acid or 99mTc-benzoylmercaptoacetyltriglycerine). We have now reviewed all postnatal imaging on these infants. In addition, the records of all infants who presented to our institution with clinically symptomatic VUR during this same period have been retrieved. Antenatal sonograms were available for review in most of these cases. RESULTS: Seventy-six cases of RPD were detected on antenatal sonography at our institution over a 3-year period. Eight cases were lost to follow-up in early infancy. The remaining 68 infants had serial sonography performed throughout infancy. Twenty-five infants showed no evidence of urinary tract dilatation on postnatal sonography. Extrarenal pelves were present in eight cases, and 35 infants had moderate to severe RPD at 72 hr. On further evaluation of this last group with voiding cystography or nuclear scintigraphy, diagnoses were VUR (n = 6), pelvic-ureteric junction obstruction (n = 5), renal dysplasia (n = 1), and congenital megaureter (n = 1). VUR was detected in five male infants and one female infant. Twenty-two infants with moderate to severe RPD had neither an obstructive uropathy nor VUR. During this same period (July 1988-June 1991), 20 cases of VUR were detected at our institution. Antenatal sonograms were available for review in 16 of these cases. These showed evidence of RPD in five fetuses, whereas the remaining 11 antenatal studies were unremarkable. Our results show the positive predictive value of RPD for VUR to be 17%. CONCLUSION: Antenatally detected RPD, in isolation, is a weak predictor of VUR. Postnatal sonographic evaluation is, however, important in this group. Further investigation of infants showing moderate to severe RPD in the neonatal period is merited, as such investigation will lead to early detection of VUR in a significant number of cases (17% of RPD).

Dilatation, Pathologic↗
PubMed1996

Visual field defects due to spectacle frames: their prediction and relationship to UK driving standards.

One male and one female subject wore a selection of ten current spectacle frames in random order. Monocular visual fields were assessed using an Aimark perimeter in accordance with UK Driver and Vehicle Licensing Authority (DVLA) guidelines. Of the ten frames, seven plastic frames produced an absolute scotoma intruding into a 120 degrees x 40 degrees 'letterbox' area acting as a driving visual field template. Three metal frames gave a relative scotoma; however, our apparatus was too insensitive to plot these scotomata. Relevant frame and patient parameters were measured and entered into a computer program which enabled theoretical visual field defects due to a spectacle frame to be calculated. Good agreement is shown to be possible between actual and computed visual field defects. Spectacle frames can and frequently do cause visual field defects which may affect a driver's fitness to drive. Our data also show that a frame which allows an adequate field of vision at night could cause a marked visual field defect during daylight hours. A model and rule-of-thumb are given to determine the size of these potential defects and suggestions are given to minimise or eliminate them.

Adult↗
PubMed1996

Clinical comparison of the Keeler Pulsair 2000, American Optical MkII and Goldmann applanation tonometers.

The aim of our study was to evaluate the performance of both the Keeler Pulsair 2000 and the American Optical (AO) MkII non-contact tonometers (NCT) and compare these to the reference Goldmann standard using the same group of patients. Forty-five patients (89 eyes) receiving medical treatment for primary open angle glaucoma had their intraocular pressure (IOP) measured with each instrument in a random order using five experienced observers. In the IOP range of the sample (6-27 mmHg) the difference between means for each tonometer was small. The Pulsair 2000 (mean = 19.06 mmHg, SD 6.28) read slightly higher than Goldmann (mean = 18.01 mmHg, SD 4.88), whereas the AO MkII read slightly lower (mean = 16.27 mmHg, SD 5.93). However, all differences were statistically significant (P < 0.001, repeat measures ANOVA). Correlation coefficients for Pulsair 2000 versus Goldmann was r = 0.82 and for AO MkII versus Goldmann was r = 0.85. In addition, the repeatability for each NCT was assessed using 10 consecutive measurements on a further 10 subjects. The Pulsair 2000 showed significantly greater variation of IOP (mean SD 3.43 mmHg) than the AO MkII (mean SD 1.76 mmHg), confirming the need for taking at least four readings per eye with the Pulsair 2000. These variations are greater than that generally observed with Goldmann, and possible explanations why this occurs are discussed. In conclusion, subject to these limitations, both NCTs should be useful for measuring IOP as part of a screening protocol for glaucoma.

Aged↗
PubMed1996

Effect of the menstrual cycle on corneal curvature.

The purpose of this research was to determine if a clinically significant variation in corneal curvature occurs with the menstrual cycle. The EyeSys Corneal Analysis System (CAS) was used to measure corneal curvature of a test group of three normally menstruating female subjects over three cycles and compared with a control group of three males, for three pseudocycles of 28 days. Measurements were taken on days 1, 4, 8, 15 and 22 of each of three menstrual cycles, with four CAS images taken on each day. Four points (along 45, 135, 225 and 315 degrees) were selected for each of rings 1, 3, 6 and 8, and the average curvature for each of these rings was calculated. The results showed that no detectable temporal effect occurred with the menstrual cycle, thus demonstrating that either cyclic variation in corneal topography was too small to be identified by this system or it did not take place.

Adult↗
PubMed1995

Prospective study of combination chemotherapy with cyclophosphamide, doxorubicin, and cisplatin for unresectable or metastatic malignant pleural mesothelioma.

BACKGROUND: This study was designed to determine the efficacy and side effects of a combination of cyclophosphamide (C), doxorubicin (D), and cisplatin (P) in patients with inoperable, unresectable, or metastatic malignant pleural mesothelioma. METHODS: Twenty-three patients with unresectable or metastatic malignant pleural mesothelioma were entered onto the study. The median age was 62 years (range, 42-74 years); there were 20 males and 3 females; the median performance status was 1 (Zubrod's scale). The histologic types included epithelial (14 patients), sarcomatoid (4 patients), unclassified (4 patients), and mixed type (1 patient). Twenty patients were known to have been exposed to asbestos and 3 were not. All patients were treated with the following starting dose of chemotherapy: a cycle comprised of C, 500 mg/m2 intravenously, day 1; D, 50 mg/m2 intravenously, day 1; and P, 80 mg/m2 intravenously, day 1 every 3 weeks. The cisplatin dose was reduced to 50 mg/m2 for the subsequent courses. For the assessment of tumor response, all patients had computed tomography scans of the chest after each three cycles of chemotherapy. RESULTS: Overall, 7 of 23 patients (30%) had partial responses (durations of responses [weeks]: 158+, 91+, 70+, 41+, 40, 39, 25), three had minor responses, and 14 had stable or progressive disease. One partial responder later underwent surgical resection and no viable tumors cells were found in the pathologic specimen. All patients have stopped treatment, and eight are still alive. The most common side effect was granulocytopenia (grade 4, 52%; grade 3, 17%). Other hematologic side effects were modest. Nonhematologic side effects included mild to moderate nausea and vomiting, neutropenic fever (three patients), peripheral neuropathy (one patient), and congestive heart failure (one patient). The overall median duration of survival was 60 weeks. CONCLUSION: Combination chemotherapy with CDP was well tolerated and had significant activity against unresectable or metastatic malignant pleural mesothelioma. The median duration of responses was 60 weeks; however, the survival rate was far from satisfactory. Continued development of new approaches including the biologic understanding of tumor development and testing new agents is warranted.

Adult↗
PubMed1995

Feasibility of five courses of pre-operative chemotherapy in patients with resectable adenocarcinoma of the oesophagus or gastrooesophageal junction.

The purpose of this study was to examine the feasibility of administering all chemotherapy pre-operatively to patients with resectable adenocarcinoma of the oesophagus or gastrooesophageal junction. 32 patients with potentially resectable adenocarcinoma of the oesophagus or gastrooesophageal junction were studied in a stepwise fashion in which combination chemotherapy with cisplatin, high-dose arabinoside and 5-fluorouracil was administered. In the first part, 15 patients were to receive three chemotherapy courses pre-operatively and two chemotherapy courses postoperatively. In the second part, the next 15 patients were to receive all five chemotherapy courses pre-operatively, provided there was an objective response after three courses. Endoscopic ultrasonography was also performed, when feasible, prior to chemotherapy and surgery, and in some patients sequentially between chemotherapy courses. All of the 14 assessable patients in the first group tolerated all three courses of pre-operative chemotherapy, and 86% of patients in this group completed all protocol chemotherapy. In the second group, 9 of 18 (50%) assessable patients tolerated all five courses of preoperative chemotherapy, and 100% of patients in this group received all protocol chemotherapy. The median number of chemotherapy courses for the entire group (32 patients) was five (range one to five). Forty-one per cent (13/32) of patients had a major response to chemotherapy. Sixty-nine per cent (or 76% of 29 patients taken to surgery) had a curative resection. One patient had a pathological complete response. The median survival time of 32 patients was 17 months (range 2-36+ months). 14 patients (37%) remain alive at a median follow-up time of 26+ months. There was a correlation between endoscopic ultrasonographic tumour and nodal stage and pathological tumour and nodal stages in 16 patients. The tumour stage correlation was higher (75%) than the nodal stage correlation (62%). Our data suggest that it is feasible to administer five courses of cisplatin-based chemotherapy to patients with potentially resectable adenocarcinoma of the oesophagus or gastrooesophageal junction. More effective chemotherapy regimens that might result in higher pathological complete response rates and acceptable toxic effects are needed.

Adenocarcinoma↗
PubMed1995

Congenital anomalies of the portal venous system--CT appearances with embryological considerations.

The portal vein is formed by the union of the splenic and superior mesenteric veins behind the neck of the pancreas. This system is derived from the vitelline veins, a component of the extraembryonic venous system. In this paper we report three cases, each of which illustrates a congenital variant of the portal venous system, describe their computed tomography appearances and discuss the embryological processes accounting for these anomalies.

Adult↗
PubMed1995

How much blame can be placed on laser photocoagulation for failure to attain driving standards?

One hundred consecutive patients who underwent bilateral pan-retinal photocoagulation (PRP) for proliferative diabetic retinopathy were assessed in accordance with the UK Driver and Vehicle Licensing Agency (DVLA) guidelines. Visual acuity was documented, and visual fields were assessed using the Esterman test. Among the 30% of patients who failed to reach the visual standards required for a driving licence, three groups were identified: those who failed to attain either the required binocular visual acuity (n = 4), or visual fields (n = 9), or both (n = 17). Previous studies reveal a large variation in DVLA field test failure following PRP treatment for proliferative diabetic retinopathy. Our results show a 19% failure rate solely attributable to treatment, which is at the lower end of previously reported studies (20-80%). The reasons for this discrepancy are discussed. We conclude that modern treatment procedures for proliferative diabetic retinopathy may be undertaken with the knowledge that in the majority of cases a patient's driving licence is unlikely to be revoked.

Automobile Driver Examination↗
PubMed1995

High complete remission rates with primary neoadjuvant infusional chemotherapy for large early breast cancer.

PURPOSE: To investigate the efficacy of continuous infusion fluorouracil (5FU) with every-3-week epirubicin and cisplatin (ECF) as primary chemotherapy instead of immediate mastectomy for patients with large, potentially operable, breast cancer. PATIENTS AND METHODS: Fifty patients with large operable breast cancer, median tumor diameter 6 cm (range, 3 to 12), were treated with 5FU 200 mg/m2/d via a Hickman line using an ambulatory pump for 6 months with epirubicin 50 mg/m2 intravenously (IV) and cisplatin 60 mg/m2 IV every 3 weeks for eight courses. Subsequent surgery and/or radiotherapy was determined by clinical response. RESULTS: Forty-nine patients achieved an overall response (98%; 95% confidence interval [CI], 94% to 100%), including 33 complete clinical remissions (CRs) (66%; 95% CI, 53% to 79%). Only three patients (6%) still required mastectomy. Tumor cellularity was markedly reduced on repeat needle biopsy following 3 weeks of treatment in 81% of patients versus only 36% in similar patients after conventional chemotherapy (P < .002). Severe (World Health Organization [WHO] grade 3 to 4) toxicity was rare, with nausea/vomiting being the most common, occurring in 20% of patients. CONCLUSION: Primary infusional ECF appears to be more active on clinical and histopathologic grounds than conventional chemotherapy for large operable breast cancer and is well tolerated. This approach now merits randomized comparison to determine if high CR rates may translate into improved survival.

Adult↗
PubMed1995

Case report: giant pararectal varices--computed tomographic appearances.

Computed tomography (CT) accurately identifies the presence of paraoesophageal, upper abdominal and anterior abdominal wall varices in portal hypertension. We present a case of giant pararectal varices and describe the value of dynamic contrast-enhanced CT in reliably establishing the nature of these structures.

Aged↗
PubMed1995

A new computerised video-aberroscope for the determination of the aberration of the human eye.

We have developed a video-based system for the acquisition and analysis of images produced by an aberroscope. The aberroscope uses a helium-neon laser to project a shadow image of a grid onto the retina. The retinal image is, in its turn, imaged onto a CCD video camera. As the grid forms a shadow image, the position of each grid intersection at the retina is affected by the aberrations of the eye. The emergent beam is imaged by the whole pupil, hence the grid shape is little affected by the eye's optics. We compute the aberrations of the eye by measuring the distortions of the grid. A video-digitiser converts the video camera image into data that can be processed by an Apple Power Macintosh computer using an image processing program (NIH Image V1.57). The program locates the grid intersection positions and computes the coefficients of a Taylor polynomial that describes the wavefront aberration. This technique has significant advantages over photographic methods that use manual image assessment. It gives immediate image storage and analysis, the ability to screen out poor quality images, requires significantly less or no operator interaction and is less labour intensive.

Humans↗