Biomedical subjects
Publications and source records attributed to P Fleming.
Oculo-facio-cardio-dental (OFCD) syndrome is a rare X-linked dominant syndrome characterized by canine teeth with extremely large roots (radiculomegaly), congenital cataract, dysmorphic facial features and congenital heart disease. A case of mother-daughter vertical transmission of OFCD is reported. Dental findings were important in confirming the diagnosis in the mother.
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Patients express concerns about the safety of donated blood. Do they have similar concerns about potential 'blood substitutes' and does the way information is presented on these options alter patients' perceptions? A two (informational frame: gain or loss) by four (transfusion type: human donor blood, human haemoglobin, bovine haemoglobin or perfluorocarbon emulsion substitutes) by three (patient group: adult haemophiliac/leukaemia patients, relatives/friends of haemophiliac/leukaemia patients and controls) between-subjects design was used. There were 82 patients, 118 relatives/friends and 263 controls from the UK. Blood substitutes were perceived as being significantly less safe than donor blood. Perceptions of safety were greater when transfusion information (regardless of transfusion type or patient group) was presented as gains rather than losses. Different demographic and psychological factors predicted perceived safety (e.g. sex) and perceived risk (e.g. age and experience).
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BACKGROUND: After striking changes in rates of sudden unexplained infant death (SIDS) around 1990, four large case-control studies were set up to re-examine the epidemiology of this syndrome. The European Concerted Action on SIDS (ECAS) investigation was planned to bring together data from these and new studies to give an overview of risk factors for the syndrome in Europe. METHODS: We undertook case-control studies in 20 regions. Data for more than 60 variables were extracted from anonymised records of 745 SIDS cases and 2411 live controls. Logistic regression was used to calculate odds ratios (ORs) for every factor in isolation, and to construct multivariate models. FINDINGS: Principal risk factors were largely independent. Multivariately significant ORs showed little evidence of intercentre heterogeneity apart from four outliers, which were eliminated. Highly significant risks were associated with prone sleeping (OR 13.1 [95% CI 8.51-20.2]) and with turning from the side to the prone position (45.4 [23.4-87.9]). About 48% of cases were attributable to sleeping in the side or prone position. If the mother smoked, significant risks were associated with bed-sharing, especially during the first weeks of life (at 2 weeks 27.0 [13.3-54.9]). This OR was partly attributable to mother's consumption of alcohol. Mother's alcohol consumption was significant only when baby bed-shared all night (OR increased by 1.66 [1.16-2.38] per drink). For mothers who did not smoke during pregnancy, OR for bed-sharing was very small (at 2 weeks 2.4 [1.2-4.6]) and only significant during the first 8 weeks of life. About 16% of cases were attributable to bed-sharing and roughly 36% to the baby sleeping in a separate room. INTERPRETATION: Avoidable risk factors such as those associated with inappropriate infants' sleeping position, type of bedding used, and sleeping arrangements strongly suggest a basis for further substantial reductions in SIDS incidence rates.
The radial nerve penetrates the lateral intermuscular septum of the arm before dividing into deep and superficial branches. It may be encountered in both anterior and posterior approaches to the humerus. An ability to accurately predict the point at which the nerve pierces the septum would be valuable during surgery in the arm, and would facilitate planning an approach to exploring the radial nerve after fractures of the distal humeral shaft. It would, in particular, make minimally invasive surgical techniques less dangerous. We dissected 20 cadaver upper limbs to establish whether the radial nerve enters the anterior compartment of the arm at a predictable level. We found that in almost every case the radial nerve entered the anterior compartment at a point within 5 mm of the junction of the distal and middle thirds of a line joining the lateral epicondyle of the humerus to the most lateral point of the acromion process of the scapula. This has not previously been described, and we believe is a useful aide-de-memoir to predicting the level at which the radial nerve penetrates the lateral intermuscular septum.
By the time children are 5 years old more of their life will have been spent asleep than awake. Sleep medicine is therefore especially relevant in paediatrics. However, one recent survey showed that paediatricians' knowledge of sleep medicine is poor and that few paediatricians enquire about sleep as part of their general consultation.1
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BACKGROUND: Footballers constitute a unique group of patients with tibial shaft fractures. They tend to have excellent general health and well developed musculature in the leg, and their fractures are generally closed injuries caused by low velocity trauma. However, little has been reported on the outcome after tibial shaft fractures in this group. OBJECTIVE: To identify patterns of injury, response to treatment, and functional outcome in such a group. METHOD: Fifty consecutive tibial shaft fractures in adult footballers treated at Merlin Park Regional Hospital over a five year period were analysed. RESULTS: Most of the fractures were type A injuries (AO/ASIF classification). The incidence of complications was low. All patients reported good or excellent satisfaction with their outcome. However, only 54% of patients returned to playing competitive football. CONCLUSION: Tibial shaft fractures in amateur footballers are associated with good results when traditional outcome criteria are used, but many patients do not regain their previous level of function.
Injuries to the sciatic nerve are an occasional complication of surgery to the hip and acetabulum, and traction is frequently the causative mechanism. In vitro and animal experiments have shown that increased tensile strain on peripheral nerves, when applied for prolonged periods, impairs nerve function. We have used video-extensometry to measure strain on the human sciatic nerve during total hip replacement (THR). Ten consecutive patients with a mean age of 72 years undergoing primary THR by the posterior approach were recruited, and strains in the sciatic nerve were measured in different combinations of flexion and extension of the hip and knee, before dislocation of the hip. Significant increases (p = 0.02) in strain in the sciatic nerve were observed in flexion of the hip and extension of the knee. The mean increase was 26% (19% to 30%). In animal studies increases of this magnitude have been shown to impair electrophysiological function in peripheral nerves. Our results suggest that excessive flexion of the hip and extension of the knee should be avoided during THR.
We reviewed the perioperative records of haemophiliac patients who underwent total knee replacement (TKR) over the period 1990-1999 and followed up the surviving patients. Nine knees were replaced in eight patients. Seven of the nine patients did not require blood transfusion. Mean perioperative haemoglobin drop was 2.9 g/dl. There were no significant complications. All surviving patients (eight TKRs) were reviewed clinically using a standard scoring system. The mean follow-up period was 51 months. All patients scored excellent (>90/100) in the functional category. The frequency of haemarthroses fell significantly from the rate experienced prior to TKR, and pain scores were zero.
In recent years the study of infant care practices within the sleeping environment has proved to be the single most important set of observations for reducing the risk of Sudden Infant Death Syndrome (SIDS). To further reduce the number of deaths and resolve the debate on safe infant care practice, a closer scrutiny of this environment is required. However, anecdotal observation from uncontrolled death-scene investigations and a reluctance to diagnose SIDS because of adverse social conditions or circumstantial evidence at the time of death is undermining future research. To investigate SIDS now means investigating the wider umbrella of all Sudden Unexpected Deaths in Infancy (SUDI) because of the potential for misdiagnosis. In trying to find out why SIDS infants die we have increasingly been forced to search for why infants survive in the first few months of life and it is this comparative component of epidemiological observation that has saved so many lives. A death-scene investigation is vital to any planned future investigation of SIDS but equally essential is a sleep-scene investigation of surviving infants to put any findings into context. SIDS infants are no longer scattered across the social strata and the cot is not the only environment in which they are found, social deprivation and use of the parental bed are now more discernable. Future studies should therefore reflect these changes with a second control group of surviving infants more closely matched to the type of environment in which SIDS infants might be found.
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The creation of health promoting workplaces is a key development in contemporary workplace health. This paper focuses on the issue of workplace violence and the efforts which must be made to address its prevention and to deal with its consequences as a contribution towards developing a health promoting workplace. A critical overview of the issue as it is currently addressed in the international literature is a precursor to the formulation of an inclusive definition of workplace violence. This forms the basis for a framework for the development and implementation of workplace violence policies. The framework takes account of needs assessment, policy formulation in terms of prevention, incident management and reporting, and post-incident support strategies. The needs for effective education and training and good internal and external communications are also explored. The paper concludes by highlighting the necessity for workplaces to take seriously the need for a coherent and well-planned workplace violence strategy.
Benign cementoblastoma is an odontogenic tumour of mesenchymal origin. It usually presents as a distinct lesion with characteristic radiographic and histopathologic features. The tumour is attached to the roots of the teeth and commonly occurs in the posterior mandible. The case of a 19-year old female with a benign cementoblastoma is presented. The clinical histopathologic and therapeutic aspects of the tumour are described.
Short stature and developmental delay may be observed in many genetic conditions and well-defined syndromes. A 7-year-old girl presented with the non-specific findings of subtle dysmorphism, short stature and developmental delay. Although a genetic syndrome was suspected, a definitive diagnosis was not made until the dental findings of KBG syndrome were recognised, namely grossly enlarged maxillary permanent central incisors and hypodontia.
We assessed the utility of expert oral examination as a part of the diagnostic evaluation of patients with suspected Crohn's disease. Of 45 patients with newly diagnosed CD, 25 had been examined by a dentist. Twelve (48%) of these had oral CD lesions. Mucosal tags constituted the most frequent form of oral lesion (8/12). Of 8 oral biopsy specimens, 6 (75%) contained non-caseating granulomas. Patients with oral CD had more oral symptoms, presented for diagnosis sooner, and were more likely to have other upper gastrointestinal inflammation than those without oral lesions. Oral manifestations of CD are common in children; therefore, expert oral examination may be useful during diagnostic evaluation of children with suspected inflammatory bowel disease.