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Biomedical subjects

J R Hardy

Publications and source records attributed to J R Hardy.

At least 37 records · Page 2Linked to original sources
PubMed1998

Field evidence for mechanical transmission of rabbit haemorrhagic disease virus (RHDV) by flies (Diptera:Calliphoridae) among wild rabbits in Australia.

Field collected flies were screened for the presence of rabbit haemorrhagic disease virus (RHDV) by applying reverse transcriptase PCR (RT-PCR) in which primers specific to the capsid protein of the virus were used. The virus was detected in flies from locations where rabbit haemorrhagic disease (RHD) was reported and also soon after the release of RHDV in a 'clean' area. Oral and/or anal excretions of flies (flyspots) were found to contain viable virus and oral inoculation of rabbits revealed that a single flyspot was able to cause RHD. We conclude that flyspots are a major potential source of the virus for oral or conjunctival transmission of the virus to rabbits.

Animals↗
PubMed1996

The footballer's fracture.

OBJECTIVE: To describe the typical tibial diaphyseal fracture ("footballer's fracture") and to clarify the circumstances and mechanism of the injury. METHODS: In an attempt to obtain a detailed analysis of the types of injury suffered, and thereby highlight areas for prevention, 100 consecutive adult football players with a tibial diaphyseal fracture were studied prospectively. Details of the circumstances and mechanism of injury were collected using a questionnaire (response rate 85%). Treatments depended on the Gustilo classification, displacement, and axial stability. Long term follow up was performed until clinical healing to define the overall prognosis. RESULTS: 61% of players suffered a fracture of both the tibia and the fibula. Ninety five percent of the tibial fractures were transverse or short oblique and were caused by impact during a tackle. Radiographic evidence of bridging callus was better than a classification of the bony injury for predicting weeks to clinical healing. The delayed union and non-union incidence following this injury is low. One patient suffered symptomatic shortening. One patient suffered symptomatic angulation and two patients with nonunion required bone grafting. CONCLUSIONS: Tibial fracture is an expensive injury. It prevents a young population from being employed and takes up valuable NHS resources. As 85% of players were wearing shin guards, it is likely that improvements in shin guard design could reduce the rate of tibial fracture.

Adolescent↗
PubMed1995

Analysis of survival following treatment of tumour-induced hypercalcaemia with intravenous pamidronate (APD).

The outcome of 114 patients with tumour-induced hypercalcaemia (TIH) treated between January 1992 and June 1993 with intravenous pamidronate (APD) was retrospectively analysed. The median overall survival was 55 days (range 3 days to > 21 months): 86 days if systemic anti-cancer therapy was available and only 35 days if not (P < 0.001). Survival was also significantly better for those who became normocalcaemic post APD (53 days vs 19 days, P < 0.001). There was no survival difference with respect to patient sex, age, tumour type, treatment of bone metastases with radiotherapy, initial calcium level, initial dose of APD or time from tumour diagnosis to first TIH. In those patients in whom systemic anti-cancer therapy is available, treatment with APD improves survival, but in all other patients the primary aim of treatment should be symptom control. This study confirms the dismal prognosis of TIH.

Adult↗
PubMed1995

Symptom relief with MVP (mitomycin C, vinblastine and cisplatin) chemotherapy in advanced non-small-cell lung cancer.

The role of chemotherapy in the palliation of patients with advanced stage (IIIB and IV non-small-cell lung cancer (NSCLC) remains controversial. We have carried out a chemotherapy study emphasising symptom relief, a topic not normally discussed in previous similar studies. A total of 120 patients with locally advanced or metastatic non-small-cell lung cancer (NSCLC) were treated with a moderate-dose palliative chemotherapy regimen consisting of mitomycin C 8 mg m-2 i.v. on day 1 (alternate courses), vinblastine 6 mg m-2 i.v. on day 1 and cisplatin 50 mg m-2 i.v. on day 1 (MVP), repeating every 21 days for a maximum of six courses. Thirty-eight of 118 assessable patients (32%) achieved an objective response. Patients with locally advanced disease (stage IIIB) had a significantly better response rate (52%) than those with metastatic disease (25%) (P < 0.01). In 76 out of 110 (69%) patients, with tumour-related symptoms including 24 out of 31 patients (78%) with locally advanced disease, symptoms completely disappeared or substantially improved. In only 15 patients (14%) did symptoms progress during treatment. Symptomatic improvement was achieved after one course of chemotherapy in 61% and after two courses in 96% of responding patients. The schedule was well tolerated. Only 19% developed WHO grade 3/4 nausea/vomiting, and only 3% developed significant alopecia. Other toxicities were minimal. MVP is a pragmatic inexpensive chemotherapy regimen that offers useful symptom palliation in patients with advanced NSCLC and merits a 1-2 course therapeutic trial in such patients. The schedule should also be assessed as primary (neoadjuvant) chemotherapy before radical radiotherapy for locally advanced NSCLC in a randomised trial.

Adult↗
PubMed1995

Dynamisation of tibial fractures.

We studied the effect of 'dynamisation' on tibial fractures in six patients treated by the Dynamic Axial Fixator. In the early stages, peak cyclic movement at two to four weeks averaged 0.75 mm (0.19 to 1.02) on the medial side of the bone and 0.86 mm (0.21 to 1.25) on the lateral side. The amount of movement correlated with the applied load and the fracture stiffness. After unlocking the fixator column at six weeks, progressive closure of the gap averaged 1.3 mm (0.1 to 3.5). Cyclic movement is produced by early weight-bearing with the fixator column locked. Progressive closure occurs after unlocking the column, and is often associated with a reduction in cyclic movements. The effects of dynamisation on movement at the fracture site should be defined separately, in terms of cyclic movement and of progressive closure.

Adult↗
PubMed1994

Palliative care.

Though many of the treatment strategies used in palliative care have never been subjected to clinical trial, it has been argued that advances in palliative care have outstripped those in many other specialties. This article is not a comprehensive review of therapeutic options, nor even of recent advances in this topic, but concentrates on the latest developments and controversies in the pharmacological treatment of four frequent and important symptoms: neuropathic pain, anorexia and cachexia, intestinal obstruction, and breathlessness. It is difficult to perform blinded, randomised trials in patients with advanced disease and poor performance status, yet it is these patients who may gain most from the adoption of new well evaluated treatment strategies.

Anorexia↗
PubMed1994

Prediction of survival in a hospital-based continuing care unit.

Prediction of survival can be relevant in palliative care in those units with selective admission policies and limited resources, for planning patient management and in discharge planning for those patients expected to go home. In this study, factors most predictive of prognosis were identified. Those factors shown to have no effect on survival included the performance of investigations or procedures, anti-cancer therapy, morphine dose on admission and original admitting ward. Patients admitted primarily for pain control had a significant survival advantage over those patients admitted for palliation of some other symptom. Actual survival correlated well with predicted outcome. Factors most predictive of relative risk of death in a multivariate analysis were dyspnoea, decubitus ulcers, predicted outcome, interventions and a diagnosis of lung cancer. When symptoms alone were analysed, dyspnoea and immobility carried the highest relative risk of death.

Adult↗
PubMed1993

Serum ionised calcium and its relationship to parathyroid hormone after tibial fracture.

The changes in serum adjusted ionised calcium and parathyroid hormone (PTH) were prospectively studied in 32 patients with isolated tibial fractures, treated conservatively. We measured serum albumin, adjusted total calcium, phosphate, pH, adjusted ionised calcium and PTH at intervals until the fractures had healed. The mean ionised calcium adjusted for pH fell within 24 hours of injury, and then rose to a peak at between four and six weeks. These changes cannot be explained by changes in serum pH or PTH. The restoration of normal ionised calcium levels after fracture coincided with the period when the callus was being calcified. Analysis of the changes in ionised calcium, phosphate and PTH suggests that PTH levels alter in response to changes in ionised calcium levels. PTH is highest immediately after fracture and lowest, often not recordable, at six weeks. The cause of the changes in the ionised calcium level has yet to be elucidated.

Adolescent↗