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Biomedical subjects

M Black

Publications and source records attributed to M Black.

At least 19 recordsLinked to original sources
PubMed2006

Measuring laparoscopic operative skill in a video trainer.

BACKGROUND: Laparoscopic surgery requires a unique set of technical skills. More experienced laparoscopic surgeons perform certain tasks more efficiently in a video trainer than less experienced laparoscopic surgeons. The presumption is that the experienced surgeon possesses more of the skill required to complete the task. This study sought to determine the degree to which previous laparoscopic operative experience influenced the performance of selected video trainer tasks of varying complexity. METHODS: In this study, 19 general surgery residents with varying levels of laparoscopic operative case experience (as defined by operative case logs) were timed performing five tasks in a video trainer. The tasks were rope pass, peg drop, peg exchange, needle pass, and knot tie. All the residents watched a video demonstration of each skill before testing. None of the residents had previous exposure to video trainers, and no practice was allowed before testing. A composite score for all tasks was calculated for each resident as a measure of overall performance. RESULTS: There was a strong correlation between operative experience and time required for successful completion of each task, with the exception of the rope pass. The magnitude of correlation increased with tasks of increasing complexity. Composite scores were correlated with operative experience. Significant interval improvements in performance were observed for increasing experience up to a level of approximately 100 previous laparoscopic cases. CONCLUSIONS: Overall composite scores and time required for the completion of each individual video trainer task (with the exception of the rope pass) may be an accurate reflection of laparoscopic surgical skill acquired in the operating room. A resident may need as many as 100 laparoscopic cases for full development of a basic skill set in the operating room. A more efficient and safe method of training, such as a validated skills curriculum conducted in a dry lab, is a desirable alternative to developing skill exclusively in the operating room.

Clinical Competence↗
PubMed2005

The impact of past alcohol use on treatment response rates in patients with chronic hepatitis C.

BACKGROUND: Studies have shown that past alcohol consumption reduces response rates in patients with chronic hepatitis C treated with interferon monotherapy. AIM: To clarify the importance of alcohol consumption on response rates in patients undergoing treatment with pegylated interferon and ribavirin. METHODS: In a single centre, prospective study, median daily alcohol consumption (determined by previously validated method) and quartiles of alcohol consumption were calculated. Univariate and binary logistic regression analyses were performed using treatment response status as the dependent variable. RESULTS: Overall, in an intention-to-treat analysis, 34 of 115 patients (30%) responded to treatment. In univariate analysis, black patients, especially those with hepatitis C virus genotype 1, high viral load and low alanine aminotransferase were significantly less likely to respond. Predictors of response by regression analysis included alcohol <30 g/day (OR=3.02, 95% CI: 1.02-8.93; P=0.04), non-genotype 1 status (OR=1.98, 95% CI: 1.03-3.80; P=0.04) and non-black race (OR=2.79, 95% CI: 1.33-5.85; P=0.006). CONCLUSIONS: Median daily alcohol use >30 g/day is associated with failure to respond to pegylated interferon and ribavirin for treatment of hepatitis C. Past alcohol use should be evaluated when considering treatment for hepatitis C.

Adult↗
PubMed2005

Epithelial biology.

The oral mucous membrane has features similar to skin but also differs in several ways. This paper reviews the aspects of epithelial biology necessary for an understanding of the vesiculoerosive disorders.

Animals↗
PubMed2005

Number II. Pemphigus vulgaris.

Pemphigus is a group of potentially life-threatening autoimmune diseases characterized by cutaneous and/or mucosal blistering. Pemphigus vulgaris (PV), the most common variant, is characterized by circulating IgG antibodies directed against desmoglein 3 (Dsg3), with about half the patients also having Dsg1 autoantibodies. There is a fairly strong genetic background to pemphigus with linkage to HLA class II alleles and ethnic groups such as Ashkenazi Jews and those of Mediterranean and Indian origin, are especially liable. Oral lesions are initially vesiculobullous but readily rupture, new bullae developing as the older ones rupture and ulcerate. Biopsy of perilesional tissue, with histological and immunostaining examination are essential to the diagnosis. Serum autoantibodies to either Dsg1 or Dsg3 are best detected using both normal human skin and monkey oesophagus or by enzyme-linked immunosorbent assay. Before the introduction of corticosteroids, PV was typically fatal mainly from dehydration or secondary systemic infections. Current treatment is largely based on systemic immunosuppression using corticosteroids, with azathioprine or other adjuvants or alternatives but newer therapies with potentially fewer adverse effects, also appear promising.

Adrenal Cortex Hormones↗
PubMed2004

Non-traumatic forensic neuropathology.

The practicing Forensic Pathologist is likely to encounter case material in which either the cause of death or a major contribution to the cause of death is underlying damage to or disease of the central nervous system. While it is good practice in many instances to have a working relationship with a Department of Neuropathology, from which advice and practical help can be sought, there may be instances when the Forensic Pathologist needs to proceed on a basis of a working knowledge of Forensic Neuropathology up to and including how to examine the specimen and take tissue blocks for processing and subsequent histological examination. Some of the more common conditions of the central nervous system such as damage consequent to hypoxia-ischaemia, hypoglycemia and epilepsy, the encephalopathies associated with altered sodium concentration, deficiency due to Vitamin B(1) and various neurodegenerative diseases that manifest as dementia and include Alzheimer's disease, cortical Lewy body disease and the prion disorders, are outlined in this article.

Brain↗
PubMed2004

Results of a feasibility study for a psycho-educational intervention in head and neck cancer.

BACKGROUND: With survival rates for people with head and neck (H&N) cancers static during the past 30 years and the enormous burden of psychosocial impacts they suffer well documented, the testing of psychosocial interventions in this group is a priority. OBJECTIVE: To test the feasibility of providing a psycho-educational intervention for people with H&N cancer. METHODOLOGY: A prospective non-randomised design was used. Subjects were patients with H&N cancer. They were offered the Nucare coping strategies program in one of three formats: small group and one-to-one formats with therapists; and a home format, with material for home use, without a therapist. Outcomes measures (quality of life (QOL) and anxiety and depression) were collected at baseline and following the intervention. Analyses were performed using non-parametric statistics. RESULTS: Of 128 people invited to participate, 66 agreed, 59 completed the intervention and 50 had outcomes data. Following the intervention, there were significant improvements in physical and social functioning and global QOL, and reduced fatigue, sleep disturbance and depressive symptoms. CONCLUSIONS: These data suggest that the intervention is desired by the target group, feasible to deliver after cancer therapy and may have some beneficial effects, although an appropriately designed study is required to confirm this.

Feasibility Studies↗
PubMed2004

Teaching head and neck cancer patients coping strategies: results of a feasibility study.

To test the feasibility of providing a psycho-educational intervention for people with head and neck (H&N) cancer. A prospective non-randomized design was used. Subjects were patients with H&N cancer. They were offered the Nucare coping strategies program in one of three formats: small group and one-to-one formats with therapists; and a home format, with material for home use, without a therapist. Outcomes measures (quality of life (QOL) and anxiety and depression) were collected at baseline and following the intervention. Analyses were performed using non-parametric statistics. Of 128 people invited to participate, 66 agreed, 59 completed the intervention and 50 had outcomes data. Following the intervention, there were significant improvements in physical and social functioning and global QOL, and reduced fatigue, sleep disturbance and depressive symptoms. These data suggest that the intervention may have some beneficial effects, although an appropriately designed study is required to confirm this.

Adaptation, Psychological↗
PubMed2004

Randomised, double blind, placebo controlled trial of interferon, ribavirin, and amantadine versus interferon, ribavirin, and placebo in treatment naïve patients with chronic hepatitis C.

BACKGROUND AND AIM: In this study, we compared the efficacy of triple therapy (interferon alfa, ribavirin, and amantadine) with standard therapy (interferon alfa and ribavirin) in treatment naïve patients with chronic hepatitis C virus (HCV). METHODS: In this prospective, randomised, double blind, placebo controlled, multicentre study, 85 patients (amantadine group) received a three drug regimen of interferon alfa-2b 3 million units three times per week, ribavirin 1000-1200 mg daily in divided doses, and amantadine 100 mg twice daily, and 86 patients (placebo group) received interferon alfa-2b, ribavirin, and identical placebo. Treatment was discontinued at 24 weeks if patients had detectable HCV RNA by polymerase chain reaction (PCR). All patients were followed for 24 weeks after completion of treatment. The primary end point was undetectable HCV-RNA by PCR at 24 weeks (sustained viral clearance) after completion of treatment. RESULTS: At the end of treatment, HCV RNA clearance was seen in 32.9% of the amantadine group and 38.4% of the placebo group (p=0.3). Sustained virological response was seen in 24.7% of the amantadine group and in 27.9% of the placebo group by intention to treat analysis; response rate was 30.4% and 34.8%, respectively, in those who completed 24 weeks of treatment. Poor response was seen in both groups among cirrhotics, African-Americans, genotype 1, and those with a higher viral load. By multivariate analysis, genotype 1, high viral load, and low serum albumin were the only predictors of poor response. Addition of amantadine to the standard regimen did not result in any unexpected side effects. CONCLUSION: Response to triple therapy of interferon alfa, ribavirin, and amantadine was similar to standard therapy of interferon alfa and ribavirin. Our results suggest that amantadine has no role in the management of HCV.

Adult↗
PubMed2002

Sudden unexplained death in adults caused by intracranial pathology.

Sudden unexplained deaths as a result of intracranial lesions in adults are an important component of medicolegal practice and are best examined as a combined effort by a forensic pathologist, or a histopathologist experienced in coroner's necropsies, and a neuropathologist. Analysis of case material on file in the University of Glasgow's departments of forensic medicine and science, and neuropathology showed that the principal causes were sudden unexplained death in epilepsy (SUDEP), intracranial haemorrhage, either natural or after trauma, purulent meningitis or an abscess, and tumours. The mechanisms of death are considered to be the rapid increase of intracranial pressure caused by bleeding into the various compartments of the brain, or an acute obstructive hydrocephalus, and in cases where death is very rapid, autonomic and/or neurochemical dysfunction.

Adult↗
PubMed2001

Drug related deaths in the Strathclyde region of Scotland, 1995-1998.

The misuse of drugs, both illicit and prescribed has increased dramatically in the west of Scotland over the last few decades. Consequently, the number of drug related deaths has risen as a direct result. Since, discrepancies exist between data collected by the Department of Forensic Medicine and Science, University of Glasgow and official statistics, this project, was funded to investigate all known drug related deaths that occurred within the Strathclyde region of Scotland in an effort to improve the accuracy of statistics and the dissemination of information pertaining to them. Changes in medical treatment, legislation and patterns of drug taking were noted and the effects of these on the year-by-year death tolls evaluated.

Adolescent↗
PubMed2001

Passive smoking and lung cancer: a cumulative meta-analysis.

OBJECTIVE: To review the epidemiological evidence for the association between passive smoking and lung cancer. METHOD: Primary studies and meta-analyses examining the relationship between passive smoking and lung cancer were identified through a computerised literature search of Medline and Embase, secondary references, and experts in the field of passive smoking. Primary studies meeting the inclusion criteria were meta-analysed. RESULTS: From 1981 to the end of 1999 there have been 76 primary epidemiological studies of passive smoking and lung cancer, and 20 meta-analyses. There were 43 primary studies that met the inclusion criteria for this meta-analysis; more studies than previous assessments. The pooled relative risk (RR) for never-smoking women exposed to environmental tobacco smoke (ETS) from spouses, compared with unexposed never-smoking women was 1.29 (95% CI 1.17-1.43). Sequential cumulative meta-analysed results for each year from 1981 were calculated: since 1992 the RR has been greater than 1.25. For Western industrialised countries the RR for never-smoking women exposed to ETS compared with unexposed never-smoking women, was 1.21 (95% CI 1.10-1.33). Previously published international spousal meta-analyses have all produced statistically significant RRs greater than 1.17. CONCLUSIONS: The abundance of evidence in this paper, and the consistency of findings across domestic and workplace primary studies, dosimetric extrapolations and meta-analyses, clearly indicates that non-smokers exposed to ETS are at increased risk of lung cancer. IMPLICATIONS: The recommended public health policy is for a total ban on smoking in enclosed public places and work sites.

Developed Countries↗
PubMed2001

Results of steroid-based therapy for the hepatitis C-autoimmune hepatitis overlap syndrome.

OBJECTIVE: Overlap syndromes in which persons manifest clinical, histological, or immunological features of both hepatitis C infection and autoimmune hepatitis are well described. The discordant forms of treatment for hepatitis C and autoimmune hepatitis have made medical management of these patients difficult. We report our experience in using corticosteroids as first line therapy for the hepatitis C-autoimmune hepatitis overlap syndrome. METHODS: Seven patients with this overlap syndrome (diagnosis based on the presence of serum hepatitis C antibody by RIBA and serum hepatitis C RNA by polymerase chain reaction, and serum hypergammaglobulinemia, elevated ANA or ASMA titers, or histological findings consistent with autoimmune hepatitis) were treated with prednisone with or without azathioprine or cyclosporine, and followed for a median duration of 44.5 months. RESULTS: Five patients (71%) showed improvement of median serum ALT level from 162 U/L to 38 U/L (p = 0.04) and median serum gamma-globulin from 2.1 g/dl to 1.4 g/dl (p = 0.04) by 6 months of therapy. The mean modified histological activity index score also decreased from 11.4 +/- 2.5 to 6.6 +/- 2.6 (p = 0.04) by at least 1 yr of therapy. One patient discontinued prednisone while taking azathioprine and experienced a rebound elevation of serum ALT that did not respond to retreatment with prednisone. Antiviral therapy was subsequently administered and resulted in biochemical and virologic response. Hepatitis C virus RNA remained detectable in all other patients. CONCLUSION: Corticosteroids are beneficial as a first line therapy for some patients with the hepatitis C-autoimmune overlap syndrome, resulting in appreciable biochemical and histological response but without viral eradication.

Adult↗
PubMed2001

Early events in macrophage killing of Aspergillus fumigatus conidia: new flow cytometric viability assay.

Detailed investigations of macrophage phagocytosis and killing of Aspergillus fumigatus conidia have been limited by technical difficulties in quantifying fungal uptake and viability. In order to study early events in cell pathogen ingestion and killing, we developed a new flow cytometry assay that utilizes the fungus-specific viability dye FUN-1. Metabolically active A. fumigatus conidia accumulate orange fluorescence in vacuoles, while dormant or dead conidia stain green. After incubation within THP-1 cells, recovered conidia are costained with propidium iodide (PI) to discriminate between dormant and dead cells. Flow cytometric measurements of FUN-1 metabolism and PI uptake provide indicators of conidial viability, dormancy, and death. Conidial phagocytosis and killing are also assessed by measurement of green and orange FUN-1 fluorescence within the THP-1 cell population. Compared to previously described methods, this assay has less error introduced by membrane permeability changes and serial dilution of filamentous fungal forms. Results suggest that the THP-1 cells kill conidia rapidly (within 6 h) after exposure. Conidia that are preexposed to human serum are ingested and killed more quickly than are nonopsonized conidia.

Aspergillosis, Allergic Bronchopulmonary↗
PubMed2001

A review of gunshot deaths in Strathclyde--1989 to 1998.

The case files of the Department of Forensic Medicine and Science at the University of Glasgow were searched for deaths involving gunshot injuries for the years 1989 to 1998. Seventy-one such deaths were identified. These were overwhelmingly males (93%) with a median age of 31 (range 17-80 years). Information surrounding the deaths was retrieved from sudden death reports compiled by the Strathclyde Police and the deaths were classified as suicide, homicide or accident. Fifty-one of the 71 deaths (72%) were classified as homicide, 17 deaths (24%) as suicide with insufficient information in three cases. The number of deaths for each year for suicides remained relatively constant at between nought and three cases per year, but figures for homicides varied at between three and ten cases per year, with a pronounced increase in the last four years of the study. The median age of the suicide cases was higher (50 years) than the homicide cases (30 years). The weapon used was predominately a shotgun in the suicide cases (accounting for 65%), but in homicide rifled weapons were the preferred weapons (59%). The site of injury was predominately the head in suicides, with a wider distribution in homicides, 32 per cent involving the head and 33 per cent also involving the chest. Alcohol intoxication was associated with a greater number of homicides than suicides. Homicides were noted to occur most frequently during the evening and early hours of the morning. The majority of suicides occurred at the victim's home address, while 72 per cent of homicides took place in the city of Glasgow.

Adolescent↗
PubMed2001

The role of dihydrocodeine in causing death among drug users in the west of Scotland.

There has been a wealth of information relating to the role of methadone in fatalities over the past decade. However, a dearth exists in the literature of deaths involving dihydrocodeine, a substitute that is being increasingly prescribed by general practitioners for drug harm reduction purposes. Over the past five years in the Strathclyde region of Scotland there has been an increase in the number of drug related deaths involving dihydrocodeine with the largest increase occurring in the latter two years. This in combination with a general acceptance for this drug as a substitute for methadone amongst general practitioners highlights its potential abuse factor which is addressed in this paper. As the number of methadone deaths in relation to the total number of accidental drug related deaths per annum decrease, those related to dihydrocodeine are shown to be increasing.

Adolescent↗