Biomedical subjects
P Gibson
Publications and source records attributed to P Gibson.
Detection and typing of human papillomavirus infection of the uterine cervix by dot blot hybridisation: comparison of scrapes and biopsies.
Paired scrapes and biopsies from 100 women attending a routine colposcopy clinic were examined by dot blot DNA hybridisation for infection with human papillomavirus (HPV) types 6/11, 16, 18, and 31; 51% of the scrapes and 50% of the biopsies were positive for HPV infection. Scrapes detected more HPV 18 (10% vs. 2%, P = less than 0.05) and HPV 31 (7% vs. 3%, not significant) than did the biopsies, but biopsies detected more HPV 16 (42% vs. 33%, not significant). Comparison of the results for each patient revealed that the correlation between scrapes and biopsies was not very close: only 34 patients were HPV-positive by both sampling methods, whereas 67 were positive if the results were combined. This report discusses the implications of these findings.
Intra-arterial digital subtraction angiography in the evaluation of peripheral vascular trauma.
The role of intra-arterial digital subtraction angiography (IADSA) in the evaluation of extremity trauma has not been clearly established. Several potential advantages would make IADSA a preferable study to conventional angiography (CA). This retrospective study analyzed 104 major peripheral arteries with suspected injury. Multiplane IADSA studies were compared with conventional angiography of the same vessel in 97 patients. The arteriograms were evaluated by a physician and a radiologist in a double-blinded fashion. IADSA correlated well with CA. Similar findings comparing both studies were noted in 101 of 104 angiograms (97%) (p less than 0.001) in review by the radiologist and in 100 of 104 (96%) (p less than 0.001) by the surgeon. Only one injury confirmed at surgery was not seen on IADSA; this study was read as equivocal by both examiners. These data confirm that IADSA is a reliable and reasonable study for the evaluation of patients with suspected peripheral arterial injury.
Left heart involvement with cardiac shunt complicating carcinoid heart disease.
The manifestations of carcinoid heart disease are usually right heart failure due to pulmonary and tricuspid valve disease and sometimes high output failure due to peripheral vasodilation. Recently there has been one case report of progressive central cyanosis due to right to left shunting through a patent foramen ovale. We present a similar case where such a shunt developed and was also complicated by significant valvular disease affecting the left side of the heart.
Detection of human papillomavirus DNA in semen from patients with intrameatal penile warts.
Fifteen semen specimens from 10 men with intrameatal penile warts attending a genitourinary clinic were tested by Southern blot hybridisation for the presence of human papillomavirus (HPV) DNA. Five specimens were positive for HPV types 6/11. This observation may have implications for screening of semen used for artificial insemination by donor.
Body dysmorphic disorder: implications for its validity as a DSM-III-R clinical syndrome.
A sample of 258 college students responded to three items in Likert-format designed by the authors to elicit information relating directly to the three criteria for body-dysmorphic disorder described in DSM-III-R (1987). 70% of the participants endorsed some agreement with an item regarding dissatisfaction with some aspect(s) of their bodies. 46% indicated some preoccupation with this aspect of their appearance, and 48% indicated some exaggeration of their perceived body image. Sex differences were significant on all three items. 28% of the sample endorsed all three of the items taken together. These results raise questions about the utility of a diagnosis which, as it is currently defined, could conceivably apply to a large percentage of the population and which disproportionately targets women.
Impedance osteography: a technique to study the electrical characteristics of fracture healing.
The occurrence of a fracture in a limb is accompanied by large changes in the electrical characteristics of the region. Resistivity of bone is more than a hundred times that of bone. The relative permittivities of the two are also different. The fracture site is also known to be electronegative. Electrical Impedance Imaging is capable of reconstructing a two dimensional (2D) representation of the average distribution of amplitude and phase in a three dimensional (3D) region. The spatial resolution in impedance imaging is low, yet the technique is sensitive to properties that are rapidly changing in growing tissues. Though the reconstructed image is an average of a thick slice, this may be of some advantage in impedance osteography precluding the need for imaging multiple planes to cover the extent of the fracture. We used the Aberdeen Impedance Imaging System which uses the 4 electrode technique in a split array, and a current of 1 milliampere on a carrier of 10 kHz to collect a number of data sets. The averaged data sets were used to reconstruct images by the Equipotential backprojection method. In this pilot study we concentrated on the real part of the complex impedance to produce images of log resistivity. The a-priori assumption of bilateral symmetry of human limbs allowed us to reconstruct equivalent regions of the normal and fractured limbs by inverting the electrode array. We obtained static images of the distribution of log resistivity when we used a homogeneous distribution as a reference, and a differential image comparing the fractured to the normal limb. The three patients in our study were at different clinical stages of fracture healing as confirmed by radiography. Our results show the feasibility of using the technique to study and monitor fractures during the healing process.
Valvular surgery in Western Australia: a 15-year review.
Between 1970 and 1984, 1138 patients underwent the insertion of 1300 prosthetic heart valves in Western Australia; 56% received an aortic-valve replacement; 34% received a mitral-valve replacement and 10% had more than one valve replaced. Mechanical valves were used in 93% of patients before 1977, in 20% of patients between 1978 and 1982 and in 70% of patients from 1983 onwards. The 30-day mortality was 18% before 1973 and has been below 6% since 1974. The over-all, 15-year actuarial survival rate was 67%; this was not affected by age, sex, race, valvular position or the type of prosthesis. Both the 30-day mortality and 15-year survival rates were significantly worse in patients who underwent multiple valvular replacements (13% and 54%, respectively) or reoperation (16% and 58%, respectively). The major causes of death were cardiac failure and myocardial infarction (65%); endocarditis (13%); cancer (6%); and thromboembolism and bleeding (6%). The hazard rate for reoperation was low and fairly constant in patients with mechanical valves, but increased markedly after four years in patients with tissue valves. Although our experience so far suggests that survival rates are not affected by the choice of prosthesis, this may not be so in the future, as more patients with tissue valves undergo reoperation and so become exposed to an increased risk of mortality.
Extension of pulmonary tuberculosis after fibreoptic bronchoscopy.
Two cases are described in which the diagnosis of pulmonary tuberculosis was suspected on both clinical and radiological grounds. Sputum smear and culture were negative for acid fast bacilli. Consequently a bronchoscopy and bronchial washings from the affected lobe were undertaken. While this procedure achieved a positive diagnosis of pulmonary tuberculosis, it also resulted in a significant extension of the disease.
Steady state parenteral kinetics of fluconazole in man.
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Multilesion coronary angioplasty: clinical and angiographic follow-up.
Determination of the restenosis rate after multilesion percutaneous transluminal coronary angioplasty is an important consideration in defining expanded indications for the procedure. Of 209 patients who underwent successful multilesion coronary angioplasty, 55 symptomatic and 74 asymptomatic patients were restudied an average of 7 +/- 4 months after dilation. The restenosis rate was 82% (45 of 55) in the symptomatic patients and 30% (22 of 74) in the asymptomatic patients (p less than 0.001). Only 4% of the asymptomatic patients had restenosis at more than one dilation site. When only patients who developed a restenosis were considered, the restenosis occurred at more than one dilation site in 47% (21 of 45) of the symptomatic group versus 14% (3 of 22) of the asymptomatic group (p less than 0.05). When all recurrent stenoses were examined, the severity of the luminal narrowing was greater than or equal to 70% in 64% (45 of 70) of the stenotic lesions in the symptomatic patients versus 31% (8 of 26) of the stenotic lesions in the asymptomatic patients (p less than 0.05). Proximal left anterior descending coronary artery disease, increased length of the stenotic narrowing, male gender and diabetes were associated with an increased incidence of restenosis by multivariate analysis. Patient-related variables were not predictive of multilesion restenosis. In conclusion, the majority of patients are clinically improved after multilesion coronary angioplasty. Recurrent symptoms after multilesion coronary angioplasty are frequently associated with multilesion restenosis and a more severe degree of restenotic narrowing. Restenosis at more than one dilation site is uncommon in the asymptomatic patient.(ABSTRACT TRUNCATED AT 250 WORDS)
Driving impairment caused by episodic brain dysfunction. Restrictions for epilepsy and syncope.
The potential loss of driving privileges is a major concern of patients with epilepsy and other episodic brain illness. The extreme variation from state to state in reporting requirements and the duration of restrictions illustrate the legal ramifications of uncertain medical advice. We studied the reliability of various methods of predicting recurrences, including electroencephalograms, familial data, and epidemiologic data and concluded that we should offer more flexible, detailed guidelines. These ought to encourage regulators, colleagues, and patients and would perhaps increase highway safety through better compliance. Episodic changes in cognition unrelated to epilepsy or syncope remain a quagmire. When the most reliable risk factors are listed in tabular form, the result appears complex, but such a guideline should be fairer, easier to administer, and often more lenient than the present simplistic, arbitrary codes found in most states.
Acquired immunodeficiency with disseminated cryptococcosis.
A 9 year old Portuguese boy presented with severe wasting and a disseminated cryptococcal infection that resolved after massive doses of intrathecal and parenteral antifungal agents. Clinical and laboratory findings were consistent with AIDS. Apart from neonatal blood transfusions, there were no identified risk factors for HTLV III infection.
Alteration of "jetlike" laminar flow after percutaneous transluminal angioplasty of saphenous vein bypass graft stenosis.
Coronary angiography in a patient with a stenosis in a saphenous vein graft 7 years after surgical anastomosis demonstrated a striking angiographic "jetlike" laminar flow pattern. Both the severe stenosis and "jet" appearance were markedly altered after percutaneous transluminal coronary angioplasty (PTCA). We believe this unusual angiographic finding represents visual evidence of a pressure gradient and severe disturbance of laminar flow across the lesion, which was improved after PTCA.
Treatment of homozygous familial hypercholesterolaemia: an informative sibship.
In a family in which both parents had the heterozygous form of familial hypercholesterolaemia four of the children had the homozygous form. The three oldest homozygous children, two of whom did not receive any treatment and in one of whom treatment did not lower the plasma cholesterol concentration, developed xanthomas in early childhood and died aged 3, 9, and 10 years. The fourth homozygous child was treated with diet and drugs from the age of 1 and at the age of 15 had no xanthomas, no clinical evidence of heart disease, and a virtually normal coronary angiogram. His plasma cholesterol concentration was reduced by about 30% but remained considerably raised. It is concluded that treatment, if started before atherosclerosis develops, can delay the onset of atheroma and coronary heart disease even though normal plasma cholesterol concentrations are not achieved.
Food hypersensitivity made life threatening by ingestion of aspirin.
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Effect of the nitroimidazole Ro 03-8799 on the activity of chemotherapeutic agents against a murine tumour in vivo.
The effect of the 2-nitroimidazole Ro 03-8799 (8799) on the activity of 11 chemotherapeutic agents against the anaplastic MT tumour in mice has been determined by soft agar cloning. The 8799, whilst producing little cytotoxicity by itself, potentiated the cytotoxic actions of the alkylating agents melphalan and cyclophosphamide, and the nitrosoureas BCNU, CCNU and MeCCNU. This potentiation was influenced by the time interval between the administration of 8799 and the chemotherapeutic agents, and also by the site of tumour implantation. However, 8799 did not potentiate the cytotoxicities of the compounds CBDCA, cisplatin, adriamycin, vincristine, 5-fluorouracil and bleomycin. A review is included of the reported in vivo effects of nitroimidazoles on the chemotherapeutic agents investigated here.