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Biomedical subjects

I Beggs

Publications and source records attributed to I Beggs.

At least 37 records · Page 2Linked to original sources
PubMed1996

Cervical spine surgery in patients with rheumatoid arthritis: an appraisal.

OBJECTIVES: To review the outcome of surgery undertaken to stabilise the neck in patients with rheumatoid arthritis performed over a five year period, to compare the results with those of previous reports, and to identify factors that may predict surgical outcome. METHODS: Outcome was assessed at time of discharge from hospital after surgery by review of patients' notes, and at follow up by patient interview, clinical examination, anonymous questionnaire, and cervical spine radiograph. The Ranawat classification of neurological impairment and Steinbrocker functional classification were used. RESULTS: Thirty nine patients underwent 44 procedures; 28 patients were available for review after a mean period of 29.8 months (range 12-65 months). Fourteen patients had preoperative neurological impairment and were available for follow up; 13 returned the questionnaire. Four (29%) had improved Ranawat class, nine were unchanged, and one had deteriorated. Nine (69%) reported a subjective improvement in neurological symptoms by questionnaire, even though the Ranawat class was unchanged in five. Twenty five of the patients reviewed had pain before operation; 21 returned the questionnaire. Pain relief was reported by direct questioning and questionnaire in 76% and 67% of patients, respectively. Overall, 67% felt that surgery had been successful. Surgery was more successful in producing symptomatic relief in patients with neck or radicular pain than in those with neurological deficit, but did prevent progression of neurological symptoms. CONCLUSIONS: Our results are similar to those from other centres. Overall patient satisfaction with surgery was good. Surgery was more likely to produce symptomatic relief in patients with neck or radicular pain before operation than in those with neurological deficit. The greater subjective improvement in neurological symptoms as judged by questionnaire probably reflects the relative insensitivity of the Ranawat classification in detecting change in neurological status; previous reports of poor outcome for patients with neurological symptoms who undergo surgery may in part be a reflection of the insensitivity of this method of assessment. No clear factors emerged which allowed prediction of those patients at greatest risk of operative mortality. In particular, an increased risk of neurological compromise appeared to confer no additional risk of immediate perioperative death. Our data support the suggestion that early surgery to correct symptomatic atlantoaxial subluxation may prevent progression of instability.

Adult↗
PubMed1996

The effect of introducing guidelines for cervical spine radiographs in the accident and emergency department.

OBJECTIVE: To assess the effect of guidelines for x ray requests on requests for cervical spine x rays. SETTING: Accident and emergency (A&E) department of tertiary referral centre. METHODS: Guidelines for all x ray requests were introduced in the (A&E) department of the Royal Infirmary of Edinburgh in February 1992. The effect of the guidelines on requests for cervical spine x rays was assessed by retrospective review of all such x rays taken over two 30 d periods, before and after the introduction of the guidelines. Junior staff had been in post for 3 months during both periods assessed. Films were reviewed for quality by a consultant radiologist. RESULTS: Guidelines reduced the number of inappropriate requests significantly; however, 26% of requests were still unnecessary. The standard of radiography improved but 49% of x rays remained inadequate, usually because the C7/T1 level was not demonstrated on the lateral view. The A&E doctors correctly interpretated the radiographs in 95% of examinations. CONCLUSIONS: Guidelines reduce inappropriate x ray requests. Further improvements can be expected with continued education.

Cervical Vertebrae↗
PubMed1995

Recurrent varicose veins: a varicographic analysis leading to a new practical classification.

The varicograms of 128 legs were reviewed by a panel of two vascular surgeons and a radiologist with a specialist vascular interest. Varicography effectively elucidates the anatomical basis of recurrence. Recurrent varicose veins were associated with (i) technically unsatisfactory surgery at the saphenofemoral junction (66 per cent) and (ii) failure to remove the long saphenous vein in the thigh (60 per cent). A new classification is offered as a basis for comparison of series, audit and surgical training.

Female↗
PubMed1995

Fine needle aspiration in infected hip replacements.

Ninety painful prosthetic hips from 88 consecutive patients underwent fine needle aspiration and the results compared with clinical progress, operative findings and culture. Fourteen of the 15 cases proven to be infected at operation were correctly identified by fine-needle aspiration. The one hip with a false negative aspirate had an arthrogram which showed a cavity suggesting infection. There were three false positive aspirates. One grew a different organism at surgery from the original aspirate. The other two had no growth on surgical culture. Both had had pre-operative antibiotics. Eleven cultures of doubtful significance were repeated or regarded as negative and the patients carefully followed-up. One repeat culture confirmed infection emphasizing the importance of repeating doubtful aspirates. The sensitivity of aspiration is 93%, specificity is 96%. The accuracy is 95% confirming that aspiration is a simple and reliable method of diagnosing infection in hip prostheses.

Adolescent↗
PubMed1995

Bipartite atlas and hypertrophy of its anterior arch. A case report.

On the lateral cervical spine radiographs of a 60-year-old woman complaining of neck pain, diffuse hyperostosis or calcification was present anterior to the anterior arch of the atlas. CT of atlas revealed it to be bipartite and the hyperostosis to be due to hypertrophy of its anterior arch. We report this as a new sign associated with a bipartite atlas.

Calcinosis↗
PubMed1994

Recurrent varicose veins: assessment of the saphenofemoral junction.

Thirty-six consecutive unselected patients, who had apparently previously undergone saphenofemoral ligation for primary uncomplicated long saphenous varicosities and who had then re-presented with recurrent thigh varices emanating from the groin, underwent preoperative clinical assessment, hand-held Doppler and duplex ultrasonographic examination and varicography to establish the presence or absence of saphenofemoral incompetence as the cause of recurrence. All patients underwent reexploration of the saphenofemoral junction (SFJ) via a lateral approach. Twenty-six patients had an intact SFJ (type I recurrence) and ten had varices arising from either a thigh perforator, or from abdominal or perineal veins (type II recurrence). Clinical examination alone was poor at distinguishing type I from type II recurrence. Doppler ultrasonography was sensitive (88 per cent) but non-specific (40 per cent). In contrast, duplex scanning was insensitive (42 per cent) but extremely specific (100 per cent) and accurate, with a positive predictive value of 100 per cent. Varicography also had a specificity and positive predictive value of 100 per cent, a sensitivity of 73 per cent and in addition provided a precise anatomical 'road-map'. A combination of clinical examination and hand-held Doppler ultrasonography seems to be the most appropriate first-line method of preoperative assessment in these patients. Duplex ultrasonography, if available, will provide additional useful information about both the SFJ and the presence of thigh perforators. Contrast examination may be reserved for patients who have equivocal results on non-invasive investigations, who have had more than one previous groin operation or who have, in addition, deep venous disease.

Adult↗
PubMed1993

Recurrent varicose veins: correlation between preoperative clinical and hand-held Doppler ultrasonographic examination, and anatomical findings at surgery.

A consecutive series of 118 patients (148 legs) presenting with recurrent varicose veins underwent preoperative clinical and hand-held Doppler ultrasonographic examination by a single observer. The presence of saphenofemoral, mid-thigh perforator and saphenopopliteal reflux was noted. Ultrasonography markedly improved the accuracy of clinical assessment at all three potential sites of reflux compared with operative findings. Of 71 patients undergoing repeat groin dissection, only 20 (28 per cent) had a tied saphenofemoral junction, 31 (44 per cent) had intact major tributaries and 52 (73 per cent) had an intact long saphenous vein (LSV) in the thigh. There was a positive association between mid-thigh perforator reflux giving rise to recurrent varices and the presence of an intact LSV in the thigh. Of 45 legs with saphenopopliteal reflux, only four had previously undergone saphenopopliteal ligation, suggesting that most short saphenous varicosities had either appeared after or had not been recognized at the time of primary surgery. This study indicates that even an experienced vascular surgeon can have difficulty in assessing the presence or absence of recurrent deep to superficial reflux by means of clinical examination alone and that Doppler ultrasonographic examination is mandatory. Recurrence continues to be associated with persistent or recurrent incompetence at the site of previous inadequate surgery.

Adult↗
PubMed1990

Accident and emergency reporting in UK teaching departments.

A survey of 44 UK training departments shows that trainee radiologists commence accident and emergency (A & E) reporting after an average of 10.2 months in radiology and perform a considerable proportion of the A & E reporting workload. Most respondents consider that they supervise junior staff but only 11 departments directly check their work and only two departments offer supervision to staff with more than 2 years' experience. All A & E radiographs are reported in 79.9% of hospitals and the other hospitals operate selective reporting policies. The delay between the radiographic examination and the radiology report reaching the A & E department is less than 48 hours in about two-thirds of departments when the examination is performed Monday to Friday, but exceeds 48 hours in two-thirds of departments when it is performed at weekends. Misinterpretation of radiographs is one of the commonest errors in A & E. Improved supervision of less experienced trainees is required. Consultants should contribute and one should be responsible for this area. Radiological conferences are important and the secretarial services require major improvement.

Accidents↗
PubMed1986

Idiopathic hyperphosphatasia with dermal pigmentation. A twenty-year follow-up.

Hyperphosphatasia, or hereditary bone dysplasia with hyperphosphatasaemia, is a rare genetic disorder which is characterised by failure to transform woven into lamellar bone. Clinical, radiological and histological features establish the diagnosis, fractures, deformities, diffuse sclerosis on radiographs and high serum alkaline phosphatase being characteristic. We report the case of a 27-year-old man with follow-up at the same hospital for 20 years. Attempts at treatment with calcitonin and disocium etidronate (EHDP) failed, but stapling of the growth plates at the knee was successfully performed. Transverse "brittle" fractures of the humerus, lower leg and ribs healed normally, but internal fixation and late bone grafting were required for a subtrochanteric stress fracture of the femur at the age of 24 years. At present the patient has no clinical problems and leads a normal life.

Adult↗
PubMed1984

Mucocele of the appendix presenting as a sigmoid mass.

Mural tumours of the colon are rare and may be difficult to distinguish from extrinsic lesions. We report a case of an apparent intramural sigmoid tumour due to a mucocele of the appendix and discuss the radiological diagnosis of mural tumours of the large bowel.

Aged↗