Biomedical subjects
Publications and source records attributed to M Flanagan.
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1. The validity and reliability of many commonly used risk assessment scores in inconclusive. 2. Particular risk assessment scores appear to be more suitable for specific clinical settings, therefore selection and use of individual scoring systems requires careful consideration. 3. Use of risk assessment scores can assist selection of patient support surfaces, but such tools should be an adjunct to clinical decision-making rather than a replacement. 4. Further research is required to investigate the relationship between predictions of risk status and the selection of appropriate patient support surfaces.
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Field collected Culicoides brevitarsis Kieffer and C. wadai Kitaoka were fed on sheep that had been artificially infected with a field-isolate of either bluetongue virus serotype 3 (BLU3), BLU9, BLU16, or BLU23. Feeding rates averaged 11.9% but were variable. Survival of midges during incubation tended to be enhanced by the addition of antibiotics and fungicide to the diet. Attempts to transmit virus to sheep by the bite of these two species were unsuccessful. Both C. brevitarsis and C. wadai had infection rates of between 1.3 and 1.5% for BLU16 and BLU23. The infection rate for BLU3 in C. wadai was low at 0.07% whereas those for BLU3 in C. brevitarsis and BLU9 in both species could not be calculated because of insufficient virus isolations. The relatively high infection rates for BLU16 and BLU23 suggest that both C. brevitarsis and C. wadai are capable of circulating these viruses in the field.
AIM: To assess the effectiveness of subcutaneous sumatriptan (4 mg) in the acute treatment of migraine. METHODS: A randomised, double-blind, placebo controlled study was conducted in four New Zealand centres. On developing an acute attack of migraine, patients attended a centre where they were given either sumatriptan 4 mg or placebo by subcutaneous injection. Headache severity and clinical disability were measured over a 2 hour period. RESULTS: Fifty-one patients, aged 19-58 years with common or classical migraine were treated. Twenty-eight patients received 4 mg sumatriptan and 23 patients received placebo. Pretreatment headache severity was graded moderate in 76% and severe in 24%. Thirty-two percent of patients were sufficiently disabled to require bed rest and a further 48% had severe impairment of working ability. Sumatriptan was significantly more effective than placebo in relieving or reducing headache severity after 30 minutes. Sixty-four percent improved on sumatriptan compared to 27% on placebo. Functional disability, nausea, vomiting and photophobia were also greatly reduced. Adverse effects occurred in 17% of patients receiving placebo, and 82% receiving sumatriptan, the commonest being injection site reactions. CONCLUSION: Subcutaneous sumatriptan 4 mg is an effective and well-tolerated acute treatment in adult patients with moderate to severe common or classical migraine. The efficacy rate of 64% is lower than that found in recent controlled studies using a higher dose.
Viraemic blood from an ox naturally infected with Australian bluetongue (BLU) virus serotype 16 was passaged twice in sheep. Twelve 2- to 4-years-old Merino ewes, negative in a bluetongue agar gel immunodiffusion test, were inoculated with viraemic blood from the second sheep passage. They were examined for 18 days and compared with a control group. Significant changes in haematological measurements, namely packed cell volume, total white cell count and lymphocyte count, and in plasma enzyme concentrations, namely aspartate transaminase and creatine kinase, occurred in the infected sheep. All infected sheep became sick. The antibody response, and clinical and necropsy findings were consistent with other reports of mild to moderate disease with Australian BLU serotypes.
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1. Instrumentation and technique for microsurgical reconstruction of small arteries are described. 2. Two cases are reported in each of which an obstruction was removed from the middle cerebral artery for early hemiplegia. 3. The work presented is of a preliminary nature. No conclusions can be drawn as to ultimate value. Further clinical trial seems justified.
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Of 1,235 individual birds from 130 species tested for haemagglutinating virus and/or NDV antibody in far northern Queensland, none gave a positive response. On available evidence pittas and rainforest pigeons are considered the species most likely to bring virulent NDV into Australia followed by gulls and night herons which move between dense seabird breeding colonies and other avian communities. Both can easily be monitored by strategic sampling along migratory pathways or at breeding islands. Wild parrots, waterfowl and migratory waders appear to present a minimal threat.
The use of preoperative computed tomographic (CT) scans of the chest in carcinoma of the esophagus to associate preoperative staging with postoperative survival is controversial. Thirty-two patients who underwent esophagectomy and reconstruction were examined with respect to a variety of variables available on preoperative evaluation, including lesion width on CT scan, lesion length on CT scan, and barium esophagogram. Each variable was evaluated for its ability to predict the presence of extraesophageal spread of tumor, as determined pathologically by logistic regression analysis. Lesions greater than 3.0 cm in width by CT scan were associated with a significantly higher incidence of extraesophageal spread. Tumor location, gender, histologic grade, presence of in situ lesions, vascular invasion, eosinophilia, nodal metastases, and preoperative chemotherapy had no predictive value for survival. Duration of survival was affected by the presence of esophageal spread of disease and lesion width. These results indicate that preoperative CT scanning can predict extraesophageal spread of tumor, and this is associated with overall survival.
The chest radiographs (CXRs) of 110 patients with mediastinal Hodgkin's disease (HD) were reviewed to determine the incidence, degree, and significance of mediastinal abnormalities following treatment. Residual mediastinal abnormalities were defined as either minimal or measurable, and occurred in 64% of all patients at the completion of treatment, but were more common in those with bulky mediastinal disease at presentation (40 of 48, 83%). Fifty-one patients with a mediastinal abnormality at the end of treatment had follow-up films available. Partial or complete regression of the abnormality occurred by 1 year in 30 of these patients (59%). Over a median follow-up of 80.5 months, there were more relapses (13 of 70, 19%) in patients with residual abnormalities following treatment than in those where the mediastinum was considered normal (four of 40, 10%). Measurable abnormality was associated with a higher relapse rate (six of 25, 24%) than minimal abnormality (seven of 45, 16%), but none of these differences were statistically significant. the subsequent relapse rate for patients with persisting abnormality at 1 year was 14%, compared with 17% for patients in whom regression had occurred and 14% in whom the mediastinum had always been considered normal. Considering the whole group, the presence of a mediastinal abnormality following treatment did not predict for relapse, but for the 34 patients treated by chemotherapy (CTR) alone, a residual abnormality was associated with a significantly higher relapse rate (P = .029). We conclude that following mediastinal radiotherapy (XRT) administered either alone or combined with CTR, residual mediastinal abnormalities do not indicate the need for further treatment. However, following CTR alone, such abnormalities may signify persisting disease and we recommend that XRT be considered for these patients.
Cerebral infarction and hemorrhage are well-known cerebrovascular complications of eclampsia. A 30-year-old woman with eclampsia developed bilateral posterior parietal and occipital hemorrhages 4 hours after computed tomography demonstrated lucencies indicative of ischemia or infarction within the same regions. The association between infarction and hemorrhage has not been previously documented by computed tomography in eclampsia. Review of the pathophysiological mechanisms and associated risk factors has prompted a more aggressive prophylactic therapeutic approach.
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Two wide-bore capillary columns are evaluated for their applicability to the purge-and-trap technique and GC/MS analysis of 34 volatile organics. Neither column is able to completely resolve all 34 compounds, as is also typical of the packed column; however, the analysis is faster than with the packed column (18 to 21 min compared to 30 min), and the column effluent is introduced directly into the mass spectrometer without requiring an open-split interface. Method precision, as assessed from the instrument response at a concentration of 50 micrograms/L per component, is better than +/- 5% for 41% of the compounds using the VOCOL column (diphenyl dimethyl polysiloxane with crosslinking moieties) and for 53% of the compounds using the 007 column (95% methyl 5% phenyl silicone). The instrument response is linear from 20 to 200 micrograms/L for most compounds, and the amounts loaded to either column without serious distortion of the peak shape or resolution can be as high as 5 micrograms per component. Because the VOCOL column resolved more compounds than the 007 column within approximately the same analysis time, this column is further tested for performance with groundwater samples.
Three patients developed methaemoglobinaemia after eating meat contaminated with excessive nitrites. Diagnosis was delayed in the first two mild cases but was promptly made in the third most severely affected case.
A short account of the industrial process used to produce kaolin is given. The chest radiographs of 68 selected cases of kaolinosis were reviewed and the radiological appearances are presented. We also describe two cases of Caplan's syndrome occurring in kaolinosis.