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P Marks

Publications and source records attributed to P Marks.

At least 37 records · Page 2Linked to original sources
PubMed1999

Statin prescribing in Nottingham general practices: a cross-sectional study.

BACKGROUND: The aim of the study was to determine the effect of deprivation on variations in statin prescribing in Nottingham general practices. Deprivation is used as a measure of population cardiovascular morbidity and need for statin treatment. The setting was all 118 general practices in contract with Nottingham Health Authority. METHODS: A cross-sectional study was undertaken. Statin prescribing in general practice during 1996 was related to indices of practice deprivation based on enumeration district (ED) level data from the 1991 Census. The relationship between statin prescribing per 1000 patients aged 35-69 and practice deprivation (measured both as Townsend score and as Jarman UPA(8) score) with additional adjustment for practice characteristics (number of partners, training status, total list size, fundholding status) cardiovascular prescribing costs net of lipid prescribing and hospital activity (total and medical admissions and new general practitioner total and medical out-patient referrals) for each practice. RESULTS: The prescription of statins during 1996 varied between nil and 14.1 'statin-years' of prescribing per 1000 patients aged 35-69. There was a significant inverse relationship between the rate of statin prescribing and the level of deprivation of that practice (p < 0.0001). Deprivation, as measured by Townsend index, accounted for 13 per cent of the total variability in statin prescribing, which rose to 19 per cent after adjustment. The prescribing of other lipid lowering agents of the fibrate class was positively associated with statin prescribing (p=0.001) and this association persisted after adjusting for deprivation. None of the other practice characteristics were found to be significantly associated with rates of statin prescribing. CONCLUSIONS: General practices with high deprivation indices serve more deprived populations with a higher prevalence of cardiovascular disease, and may be assumed to have a greater need for statins. Despite this, practices with higher deprivation indices prescribed fewer statins to their patients than less deprived practices. It was not possible to identify whether the more deprived general practices had successfully identified at risk individuals but it is likely that special efforts are needed to increase the uptake of effective health care in their patients.

Adult↗
PubMed1999

Aetiology and outcome in 53 cases of native valve staphylococcal endocarditis.

Within the last 30 years the profile of infective endocarditis has altered considerably with regard to microbiological causation, clinical features, and natural history. A contributory factor has undoubtedly been the development of potent antibiotics and their sometimes indiscriminate use. The increase in intravenous drug abuse in urban centres, the use of immunosuppressive agents, and the use of prosthetic heart valves have also all contributed. Although cardiac surgery in the uninfected heart provides a perfect environment for infective endocarditis, the improved design of prosthetic valves and the enhanced long-term survival and decreased immediate operative risk, means that surgery is viewed as the best option in many cases. In a series of 53 cases of staphylococcal endocarditis from a national endocarditis survey, those risk factors which influenced outcome were analysed. Thirty out of 53 patients had predisposing heart disease. Mortality was 39.6%. Statistical analysis revealed that attributable mortality was significantly associated with skin infection, systemic embolisation, and inappropriate therapy. Interestingly, surgical treatment was associated with better outcome.

Anti-Bacterial Agents↗
PubMed1999

The limping child.

Explore the source record for details and available documents.

Child, Preschool↗
PubMed1998

Native valve staphylococcal endocarditis: etiology, risk factors and outcome in 53 cases.

Fifty-three cases of staphylococcal endocarditis from a national endocarditis survey were analyzed for risk factors and outcome. Thirty of 53 patients had predisposing heart disease (39.6% rheumatic fever) but only 3 were on dialysis, only 2 had central venous catheter, only 2 intravenous drug abuse but 7 had prior cardiosurgery. Mortality was 39.6%. In analyzing risk factors for death, attributable mortality was significantly associated with skin infections (P < 0.05), embolization (P < 0.02), inappropriate therapy (P < 0.005) either because of too short therapy (P < 0.003) or wrong antibiotic combination (P < 0.01). Surgical therapy was associated with better outcome (4.8% deaths vs. 31.2% survivors, P < 0.04).

Adult↗
PubMed1997

Technique for arthroscopic suture fixation of displaced tibial intercondylar eminence fractures.

Our modification of the technique for arthroscopic reduction and suture fixation of displaced fractures of the intercondylar eminence of the tibia is described in this report. The advantages of this technique include no retained hardware, ability to treat comminuted (type IV) injuries, and technical simplicity. In combination with a relatively aggressive postoperative rehabilitation program, the treatment of six adults with this technique is described.

Adult↗
PubMed1996

A biomechanical analysis of joint contact forces in the posterior cruciate deficient knee.

The approach to the posterior cruciate deficient knee is controversial. The purpose of this study is to document the biomechanical changes in the static cadaveric knee model with simulated physiological loads. Nine fresh cadaveric knees from young donors (aged under 45 years) were mounted on a materials testing machine. Loading was carried out at 0 degrees, 30 degrees and 60 degrees to 1.5 kN with low-pressure sensitive Prescale film (Fuji; Tokyo, Japan) inserted through arthrotomies into the medial and lateral compartments. Computerized analysis of the imprints on the film was then carried out. Tests were then repeated after cutting the posterior cruciate ligament (PCL). Results demonstrate a statistically significant posterior subluxation of the tibia on the femur at 60 degrees flexion. This causes a significant increase in contact pressure and pressure concentration on the medial compartment of the knee after cutting the PCL. This may help explain the long-term degenerative changes observed in the medial femoral condyle after cutting the PCL.

Adult↗
PubMed1996

The A1 syndrome: a clinical entity?

We report two patients in whom suprasellar extension of pituitary tumours resulted in a motor deficit, in one case as the clinical presentation and in the other one as a consequence of trans-sphenoidal surgery. We emphasize the importance of the involvement of the initial segment of the anterior cerebral artery in pituitary tumours.

Adenoma↗
PubMed1996

Fos is required for EGF stimulation of the gastrin promoter.

Gastrin gene expression is regulated by developmental cues, pH, and inflammation. These processes are mediated by various extracellular ligands, e.g., growth factors, cytokines, and neuropeptides that also stimulate c-fos gene expression. Therefore, to determine whether Fos is required for stimulation of the gastrin promoter, a c-fos sense expression vector was coexpressed with a gastrin reporter construct in a GH4 rat pituitary cell line. We found that epidermal growth factor (EGF) and tumor necrosis factor-alpha (TNF-alpha) transiently stimulate an increase in Fos protein that precedes stimulation of the gastrin promoter. However, the induction mediated by TNF-alpha was weaker than that mediated by EGF, indicating minimal overlap of the signaling pathways activated by EGF and TNF-alpha. Accordingly, overexpression of c-fos mRNA facilitated primarily EGF rather than TNF-alpha induction of the gastrin promoter. Expression of the c-fos gene in the absence of ligand did not stimulate the gastrin promoter. Thus c-fos gene expression is required but is not sufficient for induction of the gastrin promoter by EGF.

Animals↗
PubMed1995

Failure of macrophage activation in experimental obstructive jaundice: association with bacterial translocation.

Bacterial translocation from the gastrointestinal tract and macrophage activation are central to current theories of sepsis. The relevance of both in obstructive jaundice is unclear. The effect of bile duct ligation for 7 days on bacterial translocation to mesenteric lymph nodes and on macrophage activation in a rat model was examined. Compared with an incidence of zero in sham-ligated controls, bile-duct ligated rats had a 67 per cent incidence of Gram-negative colonization of mesenteric lymph nodes. This was associated with a significant (P < 0.001) decrease in macrophage tumour necrosis factor, superoxide anion and nitric oxide production compared with that in sham controls. Spontaneous bacterial translocation occurs in experimental obstructive jaundice and is associated with marked suppression of macrophage activation. This suggests a mechanism whereby jaundiced patients may be more susceptible to persistent infection but relatively protected against uncontrolled sepsis.

Animals↗
PubMed1995

Cardiac ischaemia induces vagally mediated lower oesophageal sphincter relaxation.

Gastro-oesophageal reflux and coronary artery disease frequently coexist. Direct stimulation of myocardial vagal receptors impairs lower oesophageal sphincter (LOS) function but the effect of cardiac ischaemia has not been examined. Eight adult mongrel dogs were studied under general anaesthesia. Each underwent occlusion of the left circumflex coronary artery before and after bilateral cervical vagotomy. Blood pressure, heart rate and LOS responses were measured. Median (range) LOS tone was significantly reduced by coronary artery occlusion, from 9 (6-14) to 6 (3-8) sphinctometer units (P < 0.01). This was accompanied by a reduction in heart rate (P < 0.05) and blood pressure (P < 0.01). After bilateral cervical vagotomy the same ischaemic insult produced no significant alteration in LOS tone or heart rate. These data suggest a direct vagal reflex to explain the high incidence of gastro-oesophageal reflux in patients with coronary artery disease.

Animals↗
PubMed1995

Arthroscopic Bankart repair with the Suretac device. Part I: Clinical observations.

Although arthroscopic Bankart repair has become an accepted surgical stabilization technique for anterior shoulder instability, the failure rate remains unacceptably high. Little information is available concerning healing of the Bankart repair. The purpose of this article is to clarify this issue by analyzing a cohort of 15 patients who underwent a "second-look" arthroscopy to evaluate and treat pain or recurrent instability following arthroscopic Bankart repair with the Suretac device (Acufex Microsurgical, Mansfield, MA). "Second-look" arthroscopy was performed at an average of 9 months following the index surgical procedure. The reasons for this second surgery were recurrent instability in 7, pain in 6, and pain and stiffness in 2. In the 7 patients with recurrent instability, the Bankart repair was found to be completely healed in 3 (43%), partially healed in 1 (14%), and had recurred in 3 (43%); however, 6 of 7 were observed to have lax capsular tissue. In 4 of these cases, retrospective review of the index surgical procedure showed that a technical error had been made during the repair. Two cases had biopsy of the repair site on "second-look" at 6 to 8 months, and this showed residual polyglyconate polymer debris surrounded by a histiocytic infiltrate. In the remaining 8 cases with stable shoulders, the Bankart repair had completely healed in 5 cases (62.5%) and partially healed in 3 cases (37.5%). The higher failure rate with this approach compared with open approaches appears to result from improper patient selection and errors in surgical technique. There is some question concerning healing strength of the Bankart repair, although complete healing of the Bankart does not seem to be a prerequesite for shoulder stability. Success of the procedure might be expected to improve by selecting only patients with unidirectional, posttraumatic, anterior instability who are found to have a discrete Bankart lesion and well-developed ligamentous tissue.

Adult↗
PubMed1995

Arthroscopic Bankart repair with the Suretac device. Part II: Experimental observations.

Arthroscopic Bankart repair using the Suretac device (Acufex Microsurgical, Mansfield, MA) was developed as an alternative to both the staple and suture repair techniques. While offering some technical advantages compared with these other approaches, it's technical limitations and pitfalls have only been described anecdotally based on the clinical experience of several surgeons. The purpose of this study was to define these limitations and pitfalls. Eight cadaver shoulders underwent arthroscopic Bankart repair using the Suretac device after first arthroscopically creating a Bankart lesion. These shoulders were then dissected to reveal the placement of the Suretacs and the adequacy of the Bankart lesion repair. Glenoids were transected in the transverse plane and embedded in clear methylmethacrylate to show placement of the Suretac device relative to the articular surface. There were several technical errors that occurred: (1) Inadequate abrasion of the anterior and inferior juxta-articular scapular neck; (2) inadequate superior and medial shift of the inferior glenohumeral ligament before placement of the lowest Suretac, (3) medial placement of the Suretac relative to the articular margin; and (4) insufficient capture and compression of capsular tissue by the Suretac device. This procedure is technically difficult and careful attention must be paid to each step of preparation and repair. Recognition of the common errors may help the surgeon to avoid these pitfalls in the clinical situation.

Arthroscopy↗