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H M Cameron

Publications and source records attributed to H M Cameron.

At least 19 recordsLinked to original sources
PubMed2001

Dextran reduces embolic signals after carotid endarterectomy.

One hundred fifty patients undergoing carotid endarterectomy were randomly assigned to receive intravenous 10% dextran 40 or placebo. Transcranial Doppler monitoring of the ipsilateral middle cerebral artery 0 to 1 hour postoperatively detected embolic signals in 57% of placebo and 42% of dextran patients, with overall embolic signal counts 46% less for dextran (p = 0.052). Two to 3 hours postoperatively, embolic signals were present in 45% of placebo and 27% of dextran patients, with embolic signal counts 64% less for dextran (p = 0.040). We conclude that dextran reduces embolic signals within 3 hours of CEA.

Aged↗
PubMed2000

An unusual case of trisomy and triploidy in a chorion villus biopsy.

A case is reported of a 35-year-old woman who underwent a chorion villus biopsy (CVB) at 17 weeks' gestation after intrauterine growth retardation and oligohydramnios were diagnosed by ultrasound scan. Chromosome analysis of the CVB direct preparations showed a 47,XX,+6 karyotype in all cells. The pregnancy was terminated and subsequent analysis of cultured cells from both the CVB and the post-mortem placenta showed three cell lines: 46,XX, 47,XX,+6 and 69,XXX, while fetal skin and muscle were entirely 69,XXX. An explanation is proposed for the origin and distribution of the three cell lines.

Adult↗
PubMed1992

Prospective study of necropsy audit of geriatric inpatient deaths.

AIMS: To evaluate the accuracy of clinical diagnosis by specialists in geriatric medicine and to compare this with a previous study involving non-specialists. METHOD: Clinical and necropsy diagnoses from consecutive hospital inpatient deaths from the University Department of Geriatric Medicine were analysed for discrepancies at regular audit meetings. Three main categories of diagnosis were considered and any therapeutic implications discussed. RESULTS: Between 1987 and 1989 necropsies were performed on 100 patients (38 men, 62 women, aged 63 to 99 years) from a total of 207 deaths, a necropsy rate of 50%. There was complete agreement between necropsy and clinical diagnoses in 32% of cases. Disagreement involved the main diagnosis in 28%, contributory conditions in 32%, and cause of death in 34%. In 10% of cases the diagnostic discrepancy was considered therapeutically important. Specialist geriatricians correctly diagnosed the main diagnosis in 72% of cases; non-specialists in the previous study were correct in only 47% of cases. CONCLUSION: Specialist geriatricians diagnose elderly people more accurately than non-specialists. But rates of misdiagnosis are still significant and necropsies continue to be a useful form of audit.

Aged↗
PubMed1992

MR pelvimetry--a practical alternative.

Pelvimetry remains a useful technique as part of the assessment of the term breech pregnancy where vaginal delivery is planned. MR pelvimetry is accurate, well tolerated and shows soft-tissue structures as well as bone. It avoids the potentially carcinogenic effects of ionising radiation and is thought to be completely safe for mother and fetus. A technique of MR pelvimetry is described which uses gradient-echo sequences. This quick, practical method makes minimal inroads into valuable scanning time, and may therefore be considered a potentially cost-effective alternative to conventional pelvimetry.

Adolescent↗
PubMed1981

A prospective study of 1152 hospital autopsies: I. Inaccuracies in death certification.

Comparison of certified clinical diagnoses with autopsy findings showed that, while the major cause of death was confirmed in 61 per cent. of cases, many diagnoses--both major and contributory--were wrong; many clinical diagnoses were either disproved or relegated to a less important role, and many autopsy findings had not apparently been anticipated. Accuracy was particularly poor in some clinical categories: notably cerebrovascular disease and infections. In these, the diagnosis was more often wrong than right. Thus, death certificates are unreliable as a source of diagnostic data. The clinician's confidence in his major diagnosis bore a fairly close relationship to the frequency of its confirmation. Nevertheless, even when certified as "fairly certain", the major diagnosis was wrong in about one-quarter of these cases. An attempt was made to assess the significance of incorrect diagnoses; one half of these might be clinically significant. Diagnostic accuracy did not improve with the time spent in hospital, and it bore an inverse relationship to the patient's age.

Adolescent↗
PubMed1981

A prospective study of 1152 hospital autopsies: II. Analysis of inaccuracies in clinical diagnoses and their significance.

A further analysis of 1152 hospital autopsies provides data on inaccuracies of specific diagnoses; there are many examples of overdiagnosis and underdiagnosis. All were encountered in a routine hospital autopsy service and their frequency confirms the importance of the hospital autopsy in medical audit. A knowledge of the misdiagnoses which recur frequently could provide guidance in the selection of cases for autopsy.

Abdomen, Acute↗
PubMed1980

Necropsy: a yardstick for clinical diagnoses.

An attempt to obtain necropsies on all deaths from a selected group of clinical units resulted in a necropsy rate of 65% (compared with a normal of 30% in these units). The effect of increasing the necropsy rate was to produce a higher rate of confirmation of clinical diagnoses; nevertheless, 15% of main diagnoses and 42% of causes of death were not confirmed. A large proportion of these were deemed by clinicians in consultations with pathologists to be clinically significant. Of main diagnoses considered certain, 10% were not confirmed. The proportion of diagnostic discrepancies was virtually identical in two groups--those in which the clinicial believed he would normally have requested necropsy, and those in which he would not. Thus clinical confidence in the diagnosis is not an adequate assurance of its accuracy. Although in this survey necropsy was requested on almost all cases, permission was refused in many which may be attributed either to resistance by relatives or to an inadequate approach by the medical staff. The proportion of permissions secured by individual units varied from 50% to 92%. This indicates that the nature of the approach to relatives is the more important factor. As present practices do not adequately allow for the detection of a wide range of misdiagnoses and missed diagnoses it is proposed that a "partial audit" would provide a valuable yardstick; clinicians would be asked to obtain permission for necropsy on an agreed proportion (say, 20%) of deaths over and above those cases in which they are particularly interested and would normally request a necropsy.

Age Factors↗
PubMed1980

Multiple cases of Burkitt's lymphoma and other neoplasms in families in the North Mara District of Tanzania.

In an area of Tanzania in which Burkitt's lymphoma (BL) is endemic, five families are described in which multiple cases of BL were found or BL occurred with other neoplasms. The patients include two brothers and one half-brother with BL, two brothers with BL, a woman with nasopharyngeal carcinoma (NPC) whose daughter had BL, a boy with BL whose sister developed chronic myelogenous leukaemia (CML), and a man with CML whose son developed BL. The two full-sib pairs with BL is significantly more than would be expected to have arisen by chance and the association of BL with NPC and CML among close relatives is remarkable in view of the rarity of the last two neoplasms in the study area. It is suggested that genetic factors may be important. It is suggested that genetic factors may be important in determining susceptibility to the three malignancies in this population, but the possibility that the clustering of cases within families may be due to local environmental factors cannot be excluded.

Adult↗
PubMed1978

Clinical attitudes to the autopsy.

An enquiry into the attitudes of clinical consultants to autopsies was conducted by questionnaire. Responses indicate that most of the consultants accept that the autopsy is important in hospital practice and in teaching. There are, however, marked differences of view on the reasons for doing autopsies, and on the results of autopsies (e.g. in altering diagnoses or revealing unsuspected pathology), differences which influence the freqeuncy with which autopsies are requested. Some clinicians believe that increasing resistance by relatives to granting permission contributes to the falling rates, but this is a minority view. Clinicians also vary in their reactions to the falling rate, some regarding it as worrying while others are not concerned.

Attitude of Health Personnel↗
PubMed1977

Trends in hospital necropsy rates: Scotland 1961-74.

Examination of mortality statistic for Scottish hospitals showed that from 1961 to 1974 necropsy rates fell by almost 0-6% a year; by 1974, the rate over the whole country was 23% of hospital deaths. The fall resulted from a reduction in the number of necropsies and a coincident rise in the number of number of deaths in hospital. The necropsy rate fell with increasing age, was rather lower for women than men, and was lower for some diseases than others. There were considerable inaccuracies in the figures from which these trands were drawn, and these were in turn due to inaccurate recording of clinical and necropsy data. Examination of necropsy returns from the Scottish teaching hospital departments showed that, while a similar fall in necropsy rates was seen in some, there was no consistent pattern.

Adolescent↗
PubMed1977

Primary cancer of the liver in Kenyan children.

In 9 years in Kenya, 34 examples of primary liver cancer wer diagnosed in patients in the first two decades of life. This represents 4.7% of all liver cancers during this period. The larger proportion (29) were hepatocellular carcinoma. In the second decade, there was a notable association with macronodular cirrhosis. Analogy with experimental work suggests that cells in mitotic cycle may be more vulnerable to the effect of environmental carcinogens. Five examples of hepatoblastoma were identified at ages from 2 months to 14 years; none showed the features of "mixed" tumours. The ratio of hepatoblastoma to hepatocellular carcinoma was the reverse of that found in other large series of juvenile hepatic tumours. The histopathological features of these tumours are described and problems of their classification are discussed.

Adolescent↗