Biomedical subjects
Publications and source records attributed to P Grech.
We report a case of infectious osteitis pubis following a first trimester abortion in a female seropositive for the human immunodeficiency virus (HIV). Joint aspiration yielded Pseudomonas aeruginosa and the patient was successfully treated with oral ciprofloxacin.
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The investigation of vascular impotence requires a simple, reliable and non-invasive method of estimating penile arterial supply. A method for measuring flow to the dependent portion of the penis has been developed using technetium-labelled red blood cells (99mTc-RBC). Its use, in conjunction with the intracavernous injection of papaverine, was investigated in 32 patients with various causes of impotence. Intracavernous papaverine was administered and a pneumatic cuff was inflated around the base of the penis both to isolate the penile circulation and to prevent dispersion of papaverine. The remaining blood pool was labelled with 99mTc-RBC. A gamma camera was used to produce a time-activity curve for the penis following release of the cuff. Penile blood flow was calculated from the initial gradient of the time-activity curve. Papaverine-stimulated penile blood flow was significantly greater in patients without evidence of arterial insufficiency. None of the subjects with arterial disease achieved flows greater than 20 ml/min/100 ml, while flow in patients without arterial disease exceeded this value. Flow estimation without the use of papaverine was not able reliably to discriminate between the 2 groups. There was no difference in papaverine-stimulated blood flow between impotent subjects with veno-sinusoidal leakage, in the absence of arterial disease, and a control group who achieved full erection with papaverine. It was therefore possible, by assessing the response to papaverine and measuring arterial blood flow, to distinguish between arterial insufficiency, veno-sinusoidal leakage and non-vascular causes of impotence. The method requires little skill and can be modified for use with inexpensive equipment.
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OBJECTIVE: To determine the frequency of an abnormal bleeding time in patients with cirrhosis and to relate this to known factors that affect primary haemostasis and to the severity of liver disease. DESIGN: Prospective clinical and laboratory study in patients admitted for complications or investigations of liver disease. SETTING: Royal Free Hospital hepatobiliary and liver transplantation unit. SUBJECTS: 100 Consecutive inpatients aged 17-74 with various forms of cirrhosis, including alcoholic, biliary, autoimmune, viral, and cryptogenic. At least 10 days had elapsed since any episodes of bleeding, resolution of sepsis, or alcohol intake. No patient was taking any drug known to affect primary haemostasis. MAIN OUTCOME MEASURES: Bleeding time as measured with the Simplate double blade template device. A bleeding time longer than 10 minutes was considered abnormal. Other measures were platelet count, prothrombin time, partial thromboplastin time, packed cell volume, and blood urea, serum bilirubin, and serum albumin concentrations, all measured on each subject at the same time by standard laboratory methods. RESULTS: A weak but significant correlation existed between the bleeding time and the platelet count (rs = 0.483; p less than 0.001). There were significantly lower platelet counts, longer prothrombin times, and higher blood urea and serum bilirubin concentrations in the 42 patients with bleeding times of 10 minutes or more compared with the 58 patients with bleeding times less than 10 minutes. Multiple linear regression analysis showed that the bilirubin concentration as well as the platelet count was independently correlated with the bleeding time. The combination of a platelet count greater than 80 x 10(9)/l and a prothrombin time less than 17 seconds (usually taken as safe limits for performing routine liver biopsy) did not predict a normal bleeding time. Ten of 39 patients fulfilling these criteria had a prolonged bleeding time. CONCLUSIONS: Prolonged bleeding time is common in patients with cirrhosis, even in those with prothrombin times and platelet counts within "safe limits" for invasive procedures. The severity of liver disease as assessed by the bilirubin concentration plays an important part in determining the bleeding time in cirrhosis. The bleeding time should be measured when assessing patients for invasive procedures who have a raised bilirubin concentration or poor hepatic function, even if the platelet count and prothrombin time are considered adequate.
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Percutaneous aspiration needle biopsy forms a simple method of obtaining histological material from solitary peripheral lung lesions. A new method for separating and preparing the material for histological examination is described. The results in 50 cases are recorded with a positive diagnosis in 46. The number of symptomatic complications with this technique is low. The clinical place of the biopsy in management is discussed.
A technique for percutaneous aspiration needle biopsy is described and discussed. It is concluded that it forms a simple and easy way of obtaining histological material and it can be carried out in most radiological departments.
Transbronchial lung biopsy under fluoroscopic guidance was attempted in 14 patients with discrete peripheral lesions and histological evidence of pathology was obtained in five (37.7%). The difficulties and limitations of the procedure are discussed. The radiation hazard to both patient and bronchoscope are assessed. From this study it is concluded that aspiration needle biopsy is preferred in the investigation of patients with peripheral lung lesions.
In a series of 241 amniograms, there were two cases of fetal tissue damage resulting from the subcutaneous injection of contrast material. Details of these two cases are given and the damage sustained illustrated. Measures designed to prevent such complications are outlined, together with recommendations for its management, should such a complication occur.
In a five year retrospective study of 70 patients, the roentgenologic and surgical assessments of carcinoma at the gastroesophageal junction have been compared to the histologic findings of the resected specimens. Although the lesion was demonstrated roentgenologically in all patients, no reliable indication of its limits could be obtained, and spread was seriously underestimated by both preoperative barium studies and direct examination at operation. It is suggested that the lack of roentgenologic evidence may have encouraged an inadequate surgical approach and, thus, contributed to incomplete resection and the high immediate mortality. There is, at present, no satisfactory method by which spread can be defined, either before or at operation, and neither the preoperative barium studies nor his operative assessment should influence the surgeon to limit the resection.