Audit of colposcopy biopsy sectioning.
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Biopsy↗
Biomedical subjects
R Hughes
Publications and source records attributed to R Hughes.
A prospective study of the psychological impact on patients of first diagnosis of human papillomavirus.
This study assessed the psychological impact of the first time diagnosis of human papillomavirus (HPV) in consecutive clients attending the Hamilton Sexual Health Clinic, and sought to determine whether this changed over time. Clients with a diagnosis other than HPV and those found to have no diagnosis were compared with HPV clients. All participants completed a battery of questionnaires following their initial visit and again at 4 weeks. The battery consisted of the General Health Questionnaire, Illness Attitude Scales, the International Index of Erectile Function or the Brief Index of Sexual Function for Women, and a 6-question test of the client's knowledge of HPV. One hundred and one participants completed the first questionnaires and 47 of those completed follow-up questionnaires. We found those diagnosed with first episode of HPV had considerable psychological difficulties. However these were no different to those associated with other sexually transmitted infections (STIs) or even those with no active diagnosis.
Adolescent↗
Project to impROve management of terminal illnEss (PROMOTE).
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Health Planning↗
Infrared hall effect in high- T(c) superconductors: evidence for non-fermi-liquid hall scattering
Infrared ( 20-120 and 900-1100 cm(-1)) Faraday rotation and circular dichroism are measured in high- T(c) superconductors using sensitive polarization modulation techniques. Optimally doped YBa2Cu3O7 thin films are studied at temperatures in the range ( 15<T<300 K) and magnetic fields up to 8 T. At 1000 cm(-1) the Hall conductivity sigma(xy) varies strongly with temperature in contrast to the longitudinal conductivity sigma(xx) which is nearly independent of temperature. The Hall scattering rate gamma(H) has a T2 temperature dependence but, unlike a Fermi liquid, depends only weakly on frequency. The experiment puts severe constraints on theories of transport in the normal state of high- T(c) superconductors.
Journal Article↗
New Selenium-Based Safety-Catch Linkers: Solid-Phase Semisynthesis of Vancomycin We thank Drs. D. H. Huang and G. Siuzdak for NMR spectroscopic and mass spectrometric assistance, respectively. This work was financially supported by the National Institutes of Health (USA), The Skaggs Institute for Chemical Biology, a fellowship from the George Hewitt Foundation (N. W.), and grants from Schering Plough, Pfizer, Glaxo, Merck, Hoffmann-La Roche, DuPont, and Abbott Laboratories.
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Journal Article↗
Primary colonic lymphoma.
BACKGROUND AND OBJECTIVES: The colon is a rare location for gastrointestinal non-Hodgkin's lymphoma (NHL). This study was undertaken to identify risk factors, presentation, treatment, and prognosis for primary colonic lymphoma (PCL) through review of a large tertiary care hospital system experience. METHODS: A retrospective review of all patients with colonic malignancy and NHL was performed using pathology and cancer registry databases from January 1989 to December 1998. Criteria for inclusion were no evidence of extraperitoneal disease, no leukemic or lymphomatous abnormalities in the blood, and disease confined to the colon. RESULTS: Seven patients met the inclusion criteria (4 male, 3 female; 33-72 years). They represented 1.4% of all NHL, 14% of gastrointestinal NHL and 0.9% of all colonic malignancies diagnosed during this period. Three of the patients had positive serology for human immunodeficiency virus; one was taking steroids chronically for Addison disease. The most common presentation was nonspecific abdominal pain. The lack of specific symptoms delayed diagnosis from 1-12 months. All patients underwent laparotomy with resection. The most common tumor location was the cecum (5/7, 71%). Regional lymph nodes were affected in all but 1 patient. All tumors were B-cell lymphomas (5 small noncleaved cell, 2 large cell). Six of 7 patients received adjuvant chemotherapy. Of the 6 patients available for follow-up four remain alive (12, 19, 23, and 25 months after diagnosis). In both patients who died the disease recurred diffusely. CONCLUSIONS: The colon is a rare location for NHL. Immunosuppression is the most common risk factor. Patients' frequently present with non-specific abdominal pain, this leads to lengthy delays in diagnosis. Most of these tumors are located in the cecal area. Surgery is the most widely utilized form of therapy. Although adjuvant therapy is frequently utilized, its' impact on survival is unclear.
Academic Medical Centers↗
Residual fructose and osmolality affect the levels of pneumocandins B0 and C0 produced by Glarea lozoyensis.
A high total pneumocandin titer (B0 + C0) with a low percentage of the structural isomer pneumocandin C0 was achieved by carrying out fermentations of Glarea lozoyensis at a high residual fructose concentration (125 g/l initial). When the fermentation was carried out at a low residual fructose concentration (40 g/l initial), pneumocandin production increased by 34%. However, a disproportionate increase in the level of pneumocandin C0 synthesized (250% increase vs 30% increase for pneumocandin B0) was observed. Midcycle addition of 150 mM NaCl or 116 mM Na2SO4 to low residual fructose fermentations returned the titer and isomer levels to those seen for the high residual fructose fermentation. The increase in pneumocandin C0 synthesis under low residual fructose conditions appears to be linked to the increase in the synthesis of trans-4 hydroxyproline, with the synthesis of trans-3 hydroxyproline remaining unaffected. This suggests that the formation of pneumocandin C0 is the result of a misincorporation of trans-4 hydroxyproline instead of trans-3 hydroxyproline by the pneumocandin peptide synthetase, and that the amount of trans-4 hydroxyproline formed dictates the frequency of this misincorporation.
Anti-Bacterial Agents↗
Intraoperative echographic localization of iodine-125 episcleral plaque for brachytherapy of choroidal melanoma.
PURPOSE: To report intraoperative echographic localization of iodine-125 episcleral plaque for brachytherapy of choroidal melanoma. METHODS: In a retrospective study, 117 eyes with medium-sized choroidal melanoma in 117 patients not participating in the Collaborative Ocular Melanoma Study underwent iodine-125 episcleral plaque radiotherapy with intraoperative echographic verification of plaque placement between January 1992 and December 1998 at the Bascom Palmer Eye Institute. RESULTS: After initial plaque placement using standard localization techniques, intraoperative echography demonstrated satisfactory tumor-plaque apposition in 76% of eyes (89 of 117). In the 28 eyes (28 of 117, 24%) that required repositioning of the plaque, the extent of misplacement was less than 1 mm in 10 eyes, 1.1 to 3.0 mm in six eyes, and greater than 3 mm in eight eyes. Two eyes had tilting of the plaque, and in two additional eyes, although the plaque covered all tumor margins, the centration was considered suboptimal. Repositioning was necessary in 1 eye with an anteriorly located tumor (1 of 13, 7.7%) and in 20 eyes with peripapillary or posterior pole tumors (20 of 67, 26.3%). Anteriorly located tumors required plaque repositioning significantly less frequently than did posteriorly located tumors (P = .041). Misalignment involved one tumor margin in 23 eyes and two margins in five eyes. The most commonly misaligned margins were the lateral (35%) and posterior margins (26%). In no case was an anterior marginal misalignment documented. At a mean follow-up of 37 months, no tumor-related death or metastatic disease was noted. Two of the 117 patients (1.7%) had local tumor recurrence and underwent enucleation. CONCLUSIONS: Intraoperative echography is an effective adjunct for localization and confirmation of tumor-plaque relationship. This technique facilitates the identification and correction of suboptimal plaque placement at the time of surgery, potentially minimizing treatment failures.
Adult↗
Video-assisted evacuation of empyema is the preferred procedure for management of pleural space infections.
BACKGROUND: Empyema remains a cause of morbidity and mortality. Thoracoscopy has proved its versatility in the management of pleural space disorders. The suitability of video-assisted thoracic surgery (VATS) for decortication in the management of the fibrotic stage of empyema is unclear. METHODS: VATS evacuation of empyema and decortication was performed on seventeen patients presenting with pleural space infections. A retrospective review was performed and constitutes the basis of this report. RESULTS: VATS evacuation of empyema and decortication was successfully performed in 13 of 17 patients. Blood loss was 325 +/- 331 cc. Mean hospital stay was 18 +/- 10 days. Postoperative hospitalization was 11 +/- 7 days. Chest tubes remained in place for 7 +/- 3 days. There were no operative mortalities. CONCLUSIONS: Video-assisted evacuation of empyema and decortication is an effective modality in the management of the exudative and fibrinopurulent stages of empyema. An organized empyema should be approached thoracoscopically, but may require open decortication.
Blood Loss, Surgical↗
A laser plantar pressure sensor for the diabetic foot.
This paper describes the design and development of a high-resolution pressure sensor for use in the field of foot pressure measurement. The device uses an interferometry technique that involves the use of a laser light directed onto a pressure sensitive plate. The pressure plate compresses when a load is applied, and it is this compression which is measured by the interferometry technique. The interference pattern (interferogram) produced represents the pressure distribution across the plate. The interferogram is inputted into the computer using a high pixel CCD camera and video capture card. A fringe analysis program then converts the interferogram into a three-dimensional image of the pressure distribution. A prototype system is described and the initial results show that the system can produce a high resolution image with dynamic capabilities.
Biomedical Engineering↗
Abdominal aortic aneurysm: the role of clinical examination and opportunistic detection.
OBJECTIVES: to investigate the method of discovery of abdominal aortic aneurysms (AAA) in a district general hospital setting. DESIGN: retrospective study. MATERIALS AND METHODS: we analysed 198 patients with an AAA who presented to our unit over a 3-year period. The method of initial diagnosis, size of the AAA and whether this was palpable, irrespective of the method of detection, were recorded. RESULTS: ninety-five (48%) were discovered clinically, 74 (37.4%) during a radiological investigation, and 29 (14.6%) at laparotomy. Of the 74 AAAs first detected radiologically, subsequent physical examination showed that 28 (37.8%) were in fact palpable and missed at presentation. The average size of those discovered clinically (6. 48+/-1.32 cm) was larger than those found radiologically (5.37+/-1. 44 cm, p<0.001) or at operation (5.43+/-1.48 cm, p=0.039). The average diameter of the palpable AAAs was also greater than that of the non-palpable AAAs (6.42+/-1.24 cm vs. 4.86+/-1.38 cm, p<0.001). CONCLUSIONS: opportunistic detection of a clinically unsuspected aneurysm during clinical examination or investigation for another reason is the most common way the diagnosis of an AAA is made. Almost half of the aneurysms were diagnosed clinically, but physical examination also missed more than a third of those detected radiologically. Despite technological advancement, clinical examination still plays a paramount role in the detection of AAAs. Larger AAAs are usually palpable and more likely to be detected on clinical examination.
Aged↗
Contribution of dietary protein to sulfide production in the large intestine: an in vitro and a controlled feeding study in humans.
BACKGROUND: Hydrogen sulfide is a luminally acting, bacterially derived cell poison that has been implicated in ulcerative colitis. Sulfide generation in the colon is probably driven by dietary components such as sulfur-containing amino acids (SAAs) and inorganic sulfur (eg, sulfite). OBJECTIVE: We assessed the contribution of SAAs from meat to sulfide production by intestinal bacteria with use of both a model culture system in vitro and an in vivo human feeding study. DESIGN: Five healthy men were housed in a metabolic suite and fed a sequence of 5 diets for 10 d each. Meat intake ranged from 0 g/d with a vegetarian diet to 600 g/d with a high-meat diet. Fecal sulfide and urinary sulfate were measured in samples collected on days 9 and 10 of each diet period. Additionally, 5 or 10 g bovine serum albumin or casein/L was added to batch cultures inoculated with feces from 4 healthy volunteers. Concentrations of sulfide, ammonia, and Lowry-reactive substances were measured over 48 h. RESULTS: Mean (+/-SEM) fecal sulfide concentrations ranged from 0.22 +/- 0.02 mmol/kg with the 0-g/d diet to 3.38 +/- 0.31 mmol/kg with the 600-g/d diet and were significantly related to meat intake (P: < 0.001). Sulfide formation in fecal batch cultures supplemented with both bovine serum albumin and casein correlated with protein digestion, as measured by the disappearance of Lowry-reactive substances and the appearance of ammonia. CONCLUSION: Dietary protein from meat is an important substrate for sulfide generation by bacteria in the human large intestine.
Adult↗
Impact of radionuclide ventriculography prior to elective abdominal aortic reconstruction.
We evaluated how preoperative radionuclide ventriculography (RNV) influences the clinical management of 96 patients referred for elective infrarenal abdominal aortic surgery. Of these, 11 had aortoiliac occlusive disease and 85 an abdominal aortic aneurysm. In 89 patients (93%), there was a known history or clinical evidence of coronary artery disease prior to RNV. The scan was abnormal in half the patients. There were 56 patients with left ventricular ejection fraction (LVEF) > 50% and 40 with LVEF < or = 50%. The LVEF ranged between 10% and 88% with a mean of 52.8+/-14.1%. There was normal wall motion in 56 patients and wall abnormalities were present in 40, including four LV aneurysms. After initial assessment, 19 patients did not proceed to surgery for a variety of reasons. Cardiology consultation was requested in 11 patients, six of which were delayed or turned down for surgery mainly on cardiac grounds. Only one of these underwent cardiac catheterization. Of the remaining 77 patients who underwent surgery, 15 were seen by a cardiologist and one was delayed in order to optimize his cardiac status. No patient underwent prophylactic coronary angioplasty/stenting or revascularization preoperatively. In addition, based on the RNV results and in conjunction with the clinical findings, six patients had pulmonary artery catheters inserted either the night prior to operation (n = 3) or after induction to anaesthesia (n = 3). This is the largest reported British series of cardiac testing using RNV prior to abdominal aortic surgery. Coronaryartery disease is very common amongst such patients. RNV influences our decision-making and patientselection. An abnormal result may alter the clinical management, lead to a cardiology referral (26/96, 27% in this series) and have anaesthetic implications.
Aged↗
Outcome and utilization differences for older persons with stroke in HMO and fee-for-service systems.
OBJECTIVES: To compare treatment and outcomes for older persons with stroke in Medicare health maintenance organizations (HMOs) and fee-for-service (FFS) systems. DESIGN: Inception cohort stratified by payer and followed for 1 year. SETTING: Six HMOs and five FFS systems with large Medicare populations in the West, Midwest, and Eastern United States. PARTICIPANTS: A total of 429 randomly selected stroke patients receiving rehabilitation in nursing homes or rehabilitation hospitals (RHs) from June 1993 to June 1995. MEASUREMENTS: Improvement in activities of daily living (ADLs) during rehabilitation, and ADL recovery, community residence, and utilization until 12 months after stroke. Outcomes were adjusted for premorbid function, marital status, comorbid illness, posthospital function, cognition, psychological problems, and stroke deficits. RESULTS: At baseline, HMO patients were more likely to be married, and less likely to be blind or have psychiatric diagnoses. HMO patients had shorter hospitalizations (P < .001), were less likely to be admitted to RHs (13% vs 85%, P < .001), and received fewer therapy and physician specialist visits (P < .001) but more home health visits (P < .001). During rehabilitation, FFS patients made greater improvement in ADLs (difference, 0.73 ADLs; 95% CI, .37-1.09). At 1 year, there was no difference in ADL recovery (difference, -0.24 ADL; 95% CI, -0.64-0.16), but FFS patients were more likely to reside in the community (adjusted OR, 1.8; 95% CI, 1.1-3.1), and HMO patients were more likely to reside in nursing homes (adjusted OR, 2.4; 95% CI, 1.1-5.5). CONCLUSION: Study findings suggest that short-term functional outcomes and eventual community residence rates are poorer for Medicare HMO patients with stroke than for stroke patients receiving FFS care, consistent with the lower intensity of rehabilitation (in nursing homes vs RHs) and less specialty physician care.
Aged↗
Monitoring aggression and problem behaviors in inpatient neuropsychiatric units.
The Problem Behavior Recording System (PBRS) is a computer-based monitoring system for tracking aggression and other problem behaviors among inpatients on neuropsychiatric units. The authors describe the system and compare it with other tracking systems. In 1997 a total of 405 aggressive incidents on an aggressive-ambulatory neuropsychiatry unit were recorded on the PBRS, whereas only 112 incidents, or 28 percent, were documented in hospital incident reports. In a further analysis, nursing notes in the charts of three patients were examined for a three-month period; 34 aggressive incidents were documented, compared with 41 PBRS entries for the same patients. The chart review took nearly three hours to complete, compared with less than five minutes for the PBRS analysis.
Aggression↗
Illicit drug injectors' strategies for cleaning needles and syringes: findings from qualitative research.
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Adolescent↗
Primary stenting for chronic total occlusion of the infrarenal aorta.
PURPOSE: To present a rare case of chronic total occlusion of the infrarenal aorta treated with a self-expanding endoluminal stent implanted without preliminary dilation. METHODS AND RESULTS: A 68-year-old woman presented with severe bilateral buttock and thigh claudication. Angiography revealed total occlusion of the infrarenal abdominal aorta and relatively normal iliac vessels. Via a right groin puncture and a 9-F sheath, a 14-mm x 5-cm self-expanding Wallstent was deployed in the abdominal aorta and expanded with an angioplasty balloon. Completion angiography showed successful recanalization of the aorta with satisfactory distal flow. Palpable distal pulses were restored, and the patient's symptoms were alleviated. She remained asymptomatic until her death from a major stroke 11 months after aortic stent implantation. CONCLUSIONS: Primary stenting may be considered a viable alternative to conventional surgery in selected patients with total infrarenal aortic occlusion.
Aged↗
"Friendships are a big part of it": social relationships, social distance, and HIV risks.
Social distance, or how close or distant individuals consider others, is an important influence on drug injectors' HIV risk behavior. Qualitative in-depth interviews with a vignette were employed with a sample of drug injectors in England to explore the influence of social distance on HIV risk behavior. Analysis of these data distinguish between close and distant relationships in sexual behavior in the community and in drug-injecting behavior inside prison. These findings help to expose the constituents of social distance in relation to drug injectors' perceptions of HIV risk, which are discussed throughout this paper.
Adolescent↗