Biomedical subjects
Publications and source records attributed to P McDonald.
We report the fourth case of a patient recognised with Raine syndrome, a distinct lethal sclerosing bone dysplasia, and we describe the association with intracranial calcification demonstrable by ultrasound and CT.
Thirty-five children aged from 1 day to 16 years (median 5 years) with solid pelvic tumours were investigated with US, CT and MR. All three methods gave similar estimates of tumour size. For defining location of the tumours, the pelvis was divided into three midline compartments (anterior, middle and posterior) and a right and left lateral compartment. CT and MR were accurate and equally reliable in determining the tumour location, US was less accurate. Evaluation of confinement to organ of origin was uncertain, regardless of imaging modality. Tissue characteristics with CT and MR did not contribute to the differentiation of the various tumour types, and contrast medium enhancement did not improve the discrimination. Compartmental localization was equally well assessed by CT and MR and, together with sex, was found to correlate with the tumour type.
The analgesic efficacy and duration of action of tenoxicam, an injectable non-steroidal analgesic with a long elimination half-life, were studied in day case laparoscopy in a double-blind randomised prospective parallel placebo-controlled trial. Tenoxicam 20 mg or saline was given intravenously at induction of anaesthesia in 67 women undergoing day case investigative laparoscopy for infertility or abdominal pain. Outcome measures were time to first analgesia, pain levels at 2, 4 and 24 h plus postoperative analgesic consumption in hospital and at home. The study showed no statistically significant difference in any of these measures between the two groups. Tenoxicam 20 mg intravenously immediately pre-operatively cannot be recommended for day case surgery on the basis of this study.
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Eighteen children aged 6 months to 12 years with 20 solid renal tumours: 13 Wilms' tumours (WT), 2 clear cell sarcomas of the kidney, 1 malignant rhabdoid tumour of the kidney and 2 cases of bilateral nephroblastomatosis with Wilms' tumour underwent evaluation with US, CT and MR imaging. Contrast-enhanced CT and non-enhanced MR were equally accurate in determining the size and origin of the tumour but were unreliable in separation of stages I, II and III. US could only accurately assess the size of the tumours. MR characteristics varied somewhat between WTs and non-WTs but contrast-enhanced MR imaging might be useful for separation of WTs from nephroblastomatosis.
OBJECTIVE: To determine what proportion of health promotion activities reported by the patient is recorded in the general practice notes and to compare these methods of assessing health promotion with audio tape analysis. DESIGN: Secondary analysis of data obtained in a controlled trial of differing appointment lengths. After each consultation the medical record was examined and the patient invited to completed a questionnaire. A subsample of consultations was audio taped. SETTING: Nottinghamshire. SUBJECTS: 16 general practitioners from 10 practices. This report includes 3324 consultations with patients aged > or = 17, with data on measurement of blood pressure and advice about smoking and alcohol. RESULTS: Data from questionnaire and medical notes were available for 2281 consultations. Advice on smoking was recorded in the notes in 30.9% of cases in which a patient reported it (for alcohol and measurement of blood pressure, 44.4% and 82.7% of cases respectively). In 516 cases analysis of audio tape and review of records was performed. Advice on smoking was recorded in the patient's notes in 28.6% of cases in which it was detected on audio tape (for alcohol, 31.1% of cases). In 335 consultations data from audio tape and questionnaire were available. Advice on smoking was reported by patients in 73.9% of cases in which it was detected on audio tape (for alcohol, 75.0% of cases). CONCLUSIONS: Review of the medical record is a reasonably accurate method of assessing measurement of blood pressure in the consultation but would lead to significant underestimation of advice about smoking and alcohol.
The association of congenital camptodactyly, familial arthropathy and coxa vara is a rare but recognized clinical entity. The radiological manifestations were reviewed in five patients. In the hips, coxa vara, short broad femoral necks and intraosseous cysts were demonstrated in all patients. Abnormal modeling of the acetabulum, increased joint space, effusion, small iliac wings and intraosseous herniation of fluid were found in four out of five patients. Somewhat flat, slightly irregular femoral heads were seen in three patients. In the knees, effusion was demonstrated in all five patients and thick cartilage in three. The elbow, wrist and ankle joints showed abnormal modeling with evidence or suspicion of intraarticular fluid in the majority of patients. Flexion deformities of the fingers were seen in all patients.
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This paper reports the interview research which formed the basis for a large recently completed study of sexuality and pregnancy by questionnaire. Semistructured interviews were conducted with 25 couples who presented at a large hospital antenatal clinic in the first trimester. Of these couples, 15 participated in second trimester interviews and 12 couples were interviewed between 38 and 40 weeks' gestation. The results showed a substantial decline in sexual interest amongst women that was not matched by their male partners but was reflected in a marked reduction in frequency of intercourse. The range of sexual activities also diminished during pregnancy. The majority (19 or 76%) regularly practised oral sex and 3 men (12%) regularly practised anal intercourse. A key observation is that 7 males (28%) did not always achieve orgasm during sexual intercourse per se.
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The accuracy of an optimized three-point transformation method and its usefulness for integrating multiple independent coordinate systems has been described. Such integration can be implemented to accomplish complex stereotactic procedures which may require the use of multiple image data sets and combinations of frame-based and frameless stereotactic systems. This report details the application of an optimized transformation for intracranial lesion biopsy and/or resection, radiofrequency pallidotomy for treatment of Parkinson's disease, and fractionated stereotactic radiosurgery in a total of 68 patients. For approach to intracranial lesions, a noninvasive definition of image coordinate systems with multiple radiodense scalp markers was cross-registered with a standard stereotactic guidance system. This method allowed for elective acquisition of stereotactic image sets without requiring head frame fixation until the time of the operative procedure. In planning pallidotomy procedures, spatial cross-registration of CT and MR image coordinates were performed to target the posteroventral pallidum. CT coordinates were defined by the standard picket fence algorithm while MR images were referenced with multiple scalp markers. The addition of MR data sets improved anatomic resolution in the regions of the basal ganglia and commissures. Fractionated radiosurgery was accomplished by cross-registration of CT, MR, and plain radiographs using BRW localizers coupled with multiple scalp markers. A daily check of target positioning was performed with the BRW angiograph localizer. The average calculated error was 2.83 mm with a standard deviation of 1.66 mm which remained within the average scan slice thickness of 3.63 mm. In all cases surgical targets were reached without complication.(ABSTRACT TRUNCATED AT 250 WORDS)
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The clinical skills of the medical profession can be used to identify unsuspected HIV infection in a cost-effective way. However, other strategies are needed to optimise the detection of HIV infection and achieve the benefits to patients and the community that result from detection.
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