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H Young

Publications and source records attributed to H Young.

At least 19 recordsLinked to original sources
PubMed2006

Brain tissue water content in patients with idiopathic normal pressure hydrocephalus.

Relatively little is known regarding the water content of brain tissue in idiopathic normal-pressure hydrocephalus (NPH) patients. The objective of our study was to determine absolute water content non-invasively in hydrocephalic patients, particularly in the anterior and posterior ventricular horns and in the periventricular white matter. Ten patients who were diagnosed and treated for idiopathic NPH in our clinic were selected for study. Magnetic resonance imaging (MRI) techniques were used to obtain anatomical image slices for quantitative brain water measurements. Apparent diffusion coefficient measures were also extracted from regions of interest. To our knowledge, this is the first study to confirm that periventricular lucency seen on MRI represents increased water content in the extracellular space that is markedly elevated prior to shunting.

Aged↗
PubMed2006

What is the impact of change in diagnostic test method on surveillance data trends in Chlamydia trachomatis infection?

OBJECTIVE: To describe the impact of change from culture to more sensitive nucleic acid amplification testing (NAAT) tests on the detection of Chlamydia trachomatis in a genitourinary medicine (GUM) clinic population. METHODS: Data were collected between January 1992 and December 2003 on results of C trachomatis tests on male and female attenders at the Lothian GUM clinic (n = 81 590). Routine diagnosis switched from culture to NAAT methods in September 1998. Association of test result with age, sex, year of test, and test type was analysed using logistic regression. RESULTS: 6.1% (95% CI: 5.7% to 6.5%) of women and 7.1% of men (95% CI: 6.7% to 7.5%) tested positive with culture and 9.9% of women (95% CI: 9.4% to 10.3%) and 11.1% of men (95% CI: 10.7% to 11.5%) tested positive with NAATs. This corresponds to a 56% increase for men (95% CI: 47% to 66%) and 62% for women (95% CI: 50% to 67%). Logistic regression showed that a positive test result was strongly associated with test type with or without adjustment for year of test, sex, and young age. CONCLUSIONS: The significant increase in chlamydial infections detected following a change from culture to NAATs has important implications for interpretation of trends ascertained from surveillance data. Not all of this can be a direct effect of enhanced sensitivity and there may be indirect effects that improve ascertainment of existing infections. As more laboratories switch to NAATs similar patterns of stepwise increases in positive results are expected and trend analysis based on such surveillance data might thus show an artefactual rise in chlamydia infection rates. Accumulated surveillance data should therefore include timing of introduction of NAAT, so as to take account of under-ascertainment by previous methods.

Adult↗
PubMed2006

The significance of voiding interval before testing urine samples for Chlamydia trachomatis in men.

OBJECTIVE: To investigate the effect of time since last urination on chlamydial positivity rates in men. METHODS: Prospective study on men attending a genitourinary medicine clinic who were asked for the last time of their urination before obtaining their urine sample for testing for Chlamydia trachomatis with the Cobas Amplicor polymerase chain reaction (PCR) assay. RESULTS: Of the total of 1649 men studied, 621 (37.6% (95% CI 35.3% to 39.9%)) had a voiding interval of less than 2 hours. There was no statistical evidence of a difference in the positivity rate of chlamydial infection among men with a voiding interval of less than 2 hours (106/621, 17.1%) and that of men with a voiding interval of 2 hours or longer (170/1028, 16.5%); difference in proportions 0.5% (95% CI to 3.2% to 4.3%), p = 0.779. CONCLUSION: Voiding interval does not have a significant impact on the performance of the Cobas Amplicor PCR assay in men.

Adolescent↗
PubMed2006

Syphilis.

Explore the source record for details and available documents.

Biological Assay↗
PubMed2006

Genital infection in male partners of women with chlamydial infection.

The aim of the present study was to examine the prevalence of infection among male contacts of women with endocervical chlamydiae. The study population consisted of men who attended the Department of Genitourinary Medicine at Edinburgh Royal Infirmary as named contacts of women with endocervical chlamydiae. The diagnosis of Chlamydia trachomatis was based on a polymerase chain reaction. Of 632 male contacts of 404 infected women, 155 (24%) attended the clinic, and 147 had satisfactory tests for chlamydiae; 64 (44%) men had chlamydial infection. A greater proportion of symptomatic men (14/22) were infected compared with asymptomatic men (50/125) (P<0.02). Symptomatic men attended the department earlier (median 0.0 days) than asymptomatic male contacts (median 11 days) (P<0.05). A greater proportion of male contacts of women with one partner (105/254) attended the clinic than those of women with two or more partners (42/112). Better counselling policies for chlamydial infection are needed to ensure improved rate of diagnosis and treatment of male contacts.

Chlamydia Infections↗
PubMed2006

Dramatic increase in a single genotype of TRNG ciprofloxacin-resistant Neisseria gonorrhoeae isolates in men who have sex with men.

In 2003, episodes of gonorrhoea caused by ciprofloxacin-resistant strains increased to 15.3% from 11% in 2002. This was coincident with a marked increase in strains characterized as serogroup WI, ciprofloxacin-resistant bearing the tetracycline resistance plasmid. Molecular typing of these strains, using Neisseria gonorrhoeae multiantigen sequence typing (NG-MAST) revealed 71% (34/48) were of the same sequence type, ST338, accounting for 4.1% (34/824) of all strains in 2003. Epidemiological data demonstrated that transmission of ST338 was associated with men who have sex with men (MSM; 23/27), acquisition within the UK (22/26) and having two or more partners in the previous three-month period (18/27). The combined use of highly discriminatory typing and epidemiological surveillance helps to identify successful transmission networks.

Anti-Infective Agents↗
PubMed2006

Non-chlamydial non-gonococcal urethritis or undiagnosed chlamydial urethritis?

The aim of this study is to investigate the prevalence of sexually transmitted infections (STI) in the partners of men with non-chlamydial, non-gonococcal urethritis (NCNGU). Observational study of the sexual partners of men with NCNGU diagnosed in the Department of Genitourinary Medicine, Edinburgh between 1 June 2002 and 31 December 2003. The diagnosis of chlamydial infection was based on ligase chain reaction (LCx) between June 2002 and March 2003, and on polymerase chain reaction (PCR) thereafter. Gonococcal infection was diagnosed with culture method.Sexual partners of 99 (25%) of the 403 heterosexual men diagnosed with NCNGU were screened. Chlamydial infection was detected in 19 (19%) of the female sexual partners. Higher proportion of female partners of symptomatic men (15/51) had chlamydial infection compared with that of partners of asymptomatic men (4/48) (P < 0.005).NCNGU may be related to false-negative results of chlamydial diagnostic tests. Screening and treatment of sexual partners of men with NCNGU is therefore necessary.

Adolescent↗
PubMed2006

Clinical correlates of rectal gonococcal and chlamydial infections.

As few studies have compared the clinical features of rectal gonorrhoea in men who have sex with men with or without concurrent chlamydial infection, this longitudinal study was undertaken to address this issue. The cohort consisted of 129 men with rectal gonorrhoea, 34 of whom had concurrent chlamydiae. Symptoms of proctitis in men with rectal gonorrhoea with or without concurrent chlamydial infection were significantly higher than in men with isolated chlamydial infection (27% versus 10% [chi2=17.55; P<0.0001]). There was, however, no significant difference in the prevalence of symptoms between those with rectal gonorrhoea only (28%) and those with concurrent chlamydiae (23%); chi2=0.11; P>0.05). The median prepatent period or rectal gonorrhoea (21 men) was 5.0 days (interquartile range 11.0 days).

Chlamydia Infections↗
PubMed2006

The sensitivity of syphilis assays in detecting different stages of early syphilis.

Our aim was to determine the sensitivity of the Murex ICE enzyme immunoassay (EIA) as a screening test for early syphilis and to determine how many additional cases of infection were detected by performing additional tests when requested on clinical grounds. This was an observational study on consecutive patients diagnosed with syphilis in the Department of Genitourinary Medicine, Edinburgh between January 1st 2004 and April 1st 2005. Additional tests were performed on sera that gave a positive or equivocal EIA on screening as well as by clinical request on sera from contacts of syphilis, and those with clinical signs of syphilis. Additional tests included a Venereal Diseases Research Laboratory (VDRL) carbon antigen test, a Treponema pallidum particle agglutination (TPPA) test, INNO-LIA line immunoblot assay, and an EIA specific for anti-treponemal IgM.A total of 105 patients were diagnosed with syphilis: primary (50), secondary (26), early latent (8), and of unknown duration (21). The TPPA was the most sensitive test in primary syphilis and had a sensitivity of 96% (48/50), which was significantly higher (P <0.05) than the sensitivity of 84% (42/50) for the screening EIA: seven of the EIA negatives were detected by EIA-IgM, six by TPPA, five by immunoblot, and two by VDRL. EIA-IgM was negative in six primaries; all were positive by TPPA and immunoblot. We conclude that, in order to maximize the serological detection of primary syphilis a specific EIA-IgM test and a TPPA test should be performed whenever there is a clinical suspicion of primary infection. This is particularly important when an EIA such as Murex ICE is used as a single screening test as it is less sensitive than the TPPA in primary infection.

Cardiolipins↗
PubMed2005

APOE, vascular pathology, and the AD brain.

OBJECTIVE: To use neuropathologic data to examine the association between APOE genotype and cerebrovascular lesions commonly found in Alzheimer disease (AD), as well as neuritic senile plaque (SP) and neurofibrillary tangle (NFT) burden. METHODS: The sample comprised brains from 96 men and 3 women who fulfilled NIA-Reagan criteria for intermediate to high likelihood of AD. Region-specific and global measures of gross cerebrovascular disease, arteriolosclerosis, white matter lesions, microinfarcts, amyloid angiopathy, neuritic SP, and NFT burden were compared among those who had at least one APOE-epsilon4 vs those who did not. Pairwise rank-order correlations between measures were calculated. The association between APOE epsilon4 status and measures of vascular and AD pathology, adjusting for age at death, sex, brain weight, and Braak stage, were evaluated. RESULTS: APOE-epsilon4 was not associated with gross cerebrovascular pathology. Compared to those who were negative, brains from epsilon4 individuals had a greater degree of small vessel arteriolosclerosis (p = 0.04) and perivascular macrophage infiltration (p = 0.06), but not other markers of small vessel disease or white matter myelin loss. Microinfarcts in the deep nuclei were associated with epsilon4 (p = 0.009), whereas cortical and subcortical microinfarcts were not. There was a trend toward association between APOE genotype and amyloid angiopathy (p = 0.08), and epsilon4 was associated with neuritic SP burden, but not NFT. CONCLUSION: APOE-epsilon4 is associated with small vessel arteriolosclerosis, microinfarcts of the deep nuclei, neuritic senile plaque density, and amyloid angiopathy in patients with autopsy-proven Alzheimer disease (AD). These results suggest a role for epsilon4 in some of the microvascular changes commonly found in AD and are consistent with a potential amyloidogenic role for epsilon4.

Age Factors↗
PubMed2005

The epidemiology of ciprofloxacin resistant isolates of Neisseria gonorrhoeae in Scotland 2002: a comparison of phenotypic and genotypic analysis.

OBJECTIVES: To characterise all isolates with reduced susceptibility or resistance to ciprofloxacin received by the Scottish Neisseria gonorrhoeae Reference Laboratory (SNGRL) in 2002 using N gonorrhoeae multi-antigen sequence typing (NG-MAST); to compare NG-MAST with conventional typing and to describe the epidemiology of ciprofloxacin resistant gonorrhoea in Scotland in 2002. METHODS: Isolates were characterised on receipt by auxotyping and serotyping (A/S typing), and antibiotic susceptibility testing, and retrospectively by NG-MAST. Epidemiological data were requested for all isolates in the study. RESULTS: The 106 isolates were separated into more sequence types (ST) than A/S classes (44 versus 17). All isolates within a sequence type had the same serotype, were homogeneous with respect to ciprofloxacin resistance category, but were sometimes heterogeneous with respect to auxotype or plasmid borne resistance to penicillin. Combined NG-MAST and epidemiological data revealed sustained transmission of several gonococcal strains predominantly within Greater Glasgow and Lothian. Clusters of isolates were associated with transmission within the United Kingdom, whereas isolates with unique STs were associated with foreign travel (p < 0.0001). CONCLUSIONS: NG-MAST is more discriminatory than A/S typing. Ciprofloxacin resistant gonococcal isolates in Scotland are heterogeneous, with endemic spread of some strains occurring predominantly in Greater Glasgow and Lothian.

Anti-Infective Agents↗
PubMed2005

The outcome of oropharyngeal gonorrhoea treatment with different regimens.

Little is known of the efficacy of different antibiotics for the treatment of oropharyngeal gonorrhoea in routine clinical practice. The aim of the study was to investigate the treatment outcome of oropharyngeal gonorrhoea with different antibiotics. Case-notes of culturally proven oropharyngeal gonorrhoea diagnosed between January 1998 and January 2003 were reviewed for the antibiotic of choice and the result of test-of-cure (TOC) seven and 14 days after treatment. Of 117 episodes of pharyngeal gonorrhoea, 77 episodes (66%) were followed up with one TOC and 25 (21%) had two TOC. Treatment failure was recorded in 10% (8/77) of episodes: the failure rate was 28% (4/14) in patients treated with amoxicillin 3 g/probenecid 1 g stat and 11% (4/35) in those treated with ciprofloxacin 500 mg stat. The failure rate in treating pharyngeal gonorrhoea supports the need for a pharyngeal TOC culture as part of routine follow-up for patients infected at this site. As only 66% of patients had a TOC culture, efforts should be made to increase the number of patients having a TOC.

Amoxicillin↗
PubMed2005

Evaluation of the serodia Treponema pallidum particle agglutination, the Murex Syphilis ICE and the Enzywell TP tests for serodiagnosis of syphilis.

We evaluated the Treponema pallidum haemagglutination assay (TPHA), a treponemal test, with three other treponemal tests, the Serodia T. pallidum particle agglutination assay, the Murex Syphilis ICE IgG + IgM enzyme immunoassay (EIA) and the Enzywell TP IgG + M EIA (a new rapid EIA) for use in conjunction with the rapid plasma reagin test (RPR), a non-treponemal test, for serodiagnosis of syphilis. In all, 124 serum samples were found reactive with RPR and/or TPHA after testing by the routine laboratory protocol. Twenty-three (18.5%) of them were positive only by RPR test and were evaluated as biologically false-positive, 16 were positive only by the TPHA and 84 by both the RPR and TPHA tests; one sample was non-specific (heterophile reaction) in the TPHA. Agreements of the TPHA with the Serodia TPPA, the Murex Syphilis ICE and the Enzywell TP tests were 96.7%, 100% and 99.1%, respectively. We conclude that each one of the tests, the Serodia TPPA, the Murex Syphilis ICE and the Enzywell TP, is an appropriate substitute for screening for serodiagnosis of syphilis.

Antibodies, Bacterial↗
PubMed2005

Concurrent gonococcal and chlamydial infections among men attending a sexually transmitted diseases clinic.

The aim of this retrospective study was to determine the prevalence of Chlamydia trachomatis co-infection in men with gonorrhoea attending a sexually transmitted diseases clinic in Edinburgh, Scotland. During the study period, there were 660 cases of culture-proven gonorrhoea. Chlamydial DNA was detected in the urethra in 79 (31%; 95% confidence interval [CI], 25-37%) heterosexual men who have sex with women (MSW); the median age was significantly lower than those with gonorrhoea alone (24.0 versus 30.0; P <0.0005). The prevalence of urethral chlamydial infection among MSW was significantly higher than among men who have sex with men (MSM) (32 [12%; 95% CI, 8-16%] of 268 MSM) (chi2 = 27.21; P <0.001). Sixteen (24%; 95% CI, 14-34%) of 68 MSM with rectal gonorrhoea had concurrent rectal chlamydial infection. The high prevalence of concurrent gonorrhoea and chlamydiae therefore warrants empirical treatment and/or testing for chlamydia in all men with urethral gonorrhoea.

Adolescent↗
PubMed2005

Glucose metabolism in brain tumours can be estimated using [18F]2-fluorodeoxyglucose positron emission tomography and a population-derived input function scaled using a single arterialised venous blood sample.

The aim of this study was to assess simplified methods for deriving input functions for estimating glucose metabolism using 18F-FDG-PET. Nine glioma patients underwent paired 18F-FDG-PET scans as part of a phase II study and the data used to estimate the metabolic rate of glucose (MRGlu) using a population-derived input function (arterial data from 14 scans) scaled using a single arterial blood sample taken at 20 min. Paired studies were performed in four further glioma patients with stable disease at least four months following radiotherapy to determine whether scaling the population-derived input function using a 20-min arterialised venous or venous sample further simplified the method. The heated hand method was used to obtain arterialised venous blood that approximated arterial blood. In the 9 phase II glioma patients, there was a good, statistically significant correlation between the MRGlu values estimated using the individual arterial input functions and the single arterial sample scaled population-derived input functions (r(2)=0.88, p<0.001, n=36). Blood samples collected during three scans on two of the stable disease patients showed no significant difference between the arterialised venous and arterial plasma concentrations of 18F (p>0.1, n=15) when the degree of arterialisation of the blood was monitored and maintained using a thermocouple. A significant difference was found between the plasma arterial and venous levels of 18F. There was an excellent correlation between MRGlu estimated using an arterial input function and a population-derived input function scaled using a single arterialised venous blood sample (r(2)=0.98, n=12). The method was reproducible with less than 4.4% variation between repeat tumour scans. Therefore, a population-derived input function scaled using a single arterialised venous blood sample at 20 min can be used for estimating MRGlu using 18F-FDG PET in glioma patients.

Arteries↗
PubMed2004

Living arrangements and place of death of older people with cancer in England and Wales: a record linkage study.

The main objectives of the study were to (1) see whether the household circumstances of people aged 50 years and over with cancer, and trends in these, differ from those of the rest of the population and (2) whether living arrangements and presence and health status of a primary coresident are associated with place of death among older people dying of cancer and those dying from other causes. The design included prospective record linkage study of people aged 50 years and over included in a 1% sample of the population of England and Wales (the Office for National Statistics Longitudinal Study). The main outcome measures comprised family and household type, and death at home. The household circumstances of older people with cancer were very similar to those of the rest of the population of the same age and both showed a large increase in living alone, and decrease in living with relatives, between 1981 and 1991. The primary coresident of cancer sufferers who did not live alone was in most cases a spouse, with much smaller proportions living with a child, sibling or other person. In all, 30% of spouse, and 23% of other, primary coresidents had a limiting long-term illness. Compared with people who lived alone in 1991, odds of a home death among those dying of cancer between 1991 and 1995 were highest for those who lived with a spouse who had no limiting long-term illness (odds ratio (OR) 2.52, 95% confidence interval (CI) 2.15-2.97) and raised for those living with a spouse with a long-term illness (OR 2.14, CI 1.79-2.56) and those living with someone else who was free of long-term illness (OR 2.13, CI 1.69-2.68). Higher socioeconomic status, both individual and area, was positively associated with increased chance of a home death, while older age reduced the chance of dying at home. The changing living arrangements of older people have important implications for planning and provision of care and treatment for cancer sufferers.

Aged↗
PubMed2004

[Free fibula transfer. Analysis of 76 consecutive microsurgical procedures and review of the literature].

Since its introduction by Taylor in 1975, microvascular free fibula transfer has become the gold standard in osseous reconstructions requiring vascularized bone transfer. Various modifications of the free fibula have been described in the literature. We reviewed a series of 76 free vascularized fibula transfers during a 7-year period. Data was retrospectively analyzed with respect to type of procedure and outcome, general surgical complications, and flap-related (specific) complications. Of all 76 free fibula flaps, 47 cases healed uneventfully (62%). Interestingly, 53% of all extremity reconstruction cases had at least one of the above complications, whereas in maxillofacial cases the complication rate was only 25%. Complete osseous consolidation at the time of evaluation was confirmed in 58 patients (76%). Complete flap failure occurred in four patients (5%). The complication rates reflect the complexity of the procedures and appear strongly related to the underlying disease and predisposing medical risk factors. Time will tell if advances, e.g., in the field of tissue engineering, will eventually replace autologous vascularized bone transfer.

Adolescent↗