Search PubMed⌕ Search

Biomedical subjects

S Walton

Publications and source records attributed to S Walton.

At least 55 records · Page 3Linked to original sources
PubMed1995

Developing an epoetin alfa medication protocol to improve patient care and foster collaboration.

This article describes the process undertaken by the nursing staff, management staff, and education department of a community hospital-based outpatient dialysis unit to address the numerous issues related to the management of anemia in their dialysis population. Through good observations and assessments made by the nursing staff, major problems related to anemia management were identified. As a result, staff members developed a medication protocol and a tracking tool to better manage the anemia associated with chronic renal failure. Evaluation of this protocol and tracking tool demonstrated improvement in two clinical patient outcomes and two unit management outcomes.

Anemia↗
PubMed1994

Assessment of left ventricular regional wall motion with blood pool tomography: comparison of 11CO PET with 99Tcm SPECT.

Left ventricular contraction is routinely assessed by radionuclide ventriculography. Although a planar image is conventionally used, tomography has been to improve the detection of wall motion abnormalities. A blood pool image is often used in positron emission tomography on which to superimpose metabolic tracers. Can this image also be used to assess left ventricular contraction? Nine healthy controls, mean (S.D.) age 55 (5) years, and 12 patients, mean (S.D.) age 61 (8) years, with normal, proven or suspected left ventricular damage underwent blood pool tomography with 11CO positron emission tomography (PET) and 99Tcm single photon emission computed tomography (SPECT). A normal value of ejection fraction and range of phase were defined. The normal left ventricular ejection fraction was > or = 37% for PET and > or = 40% for SPECT. The ejection fractions obtained by the two methods in the patient group were positively correlated (r = 0.89, P < 0.001). Abnormalities of left ventricular contraction were detected in nine patients by PET and 10 patients by SPECT imaging. The discrepancy was in a patient with a previous inferior myocardial infarction. Blood pool imaging with 11CO PET can be used to assess left ventricular ejection fraction and regional wall motion.

Carbon Monoxide↗
PubMed1994

Polar map or novel three-dimensional display technique for the improved detection of inferior wall myocardial infarction using tomographic radionuclide ventriculography.

Tomographic radionuclide ventriculography has the potential to be a significant improvement over conventional planar imaging. Although tomographic imaging can now be performed with relative ease, it is little used. This is most probably due to a perceived imbalance between potential clinical benefit and the extra complications of imaging. We investigated this matter by examining a series of 30 patients with isolated inferior or anterior myocardial infarction, identified by cardiac catheterization. Using either radionuclide imaging method, a significant wall motion abnormality was defined as matching (and appropriately located) phase and amplitude values outwith of two standard deviations from control values. These values were obtained from a series of 25 controls and represent construction values used to create a conventional polar map display. Overall detection rates for anterior myocardial infarction were 93 and 100% for planar and tomographic imaging, respectively (ns). For inferior myocardial infarction the rates were 7 and 93%, respectively (p < 0.001). Identical results were found using a novel three-dimensional method of displaying wall motion abnormalities. Tomography is therefore superior to planar imaging for the detection of inferior myocardial infarction but similar to planar imaging for the detection of anterior myocardial infarction.

Cardiac Catheterization↗
PubMed1994

The emerging epidemic of skin cancer.

A study of the incidence of skin cancer over a 14-year period in the North Humberside area of the U.K. indicates a steady rise in the numbers of the four most common types of skin cancer. A steep increase in the incidence of squamous cell carcinoma of the skin compared with that of internal squamous cell carcinoma was also detected. Our findings emphasize the need for continuing public education about both the dangers of UV radiation and measures to reduce exposure.

Adolescent↗
PubMed1994

Comparison of the value of novel rapid measurement of myoglobin, creatine kinase, and creatine kinase-MB with the electrocardiogram for the diagnosis of acute myocardial infarction.

OBJECTIVE: To determine whether serum myoglobin, creatine kinase, and creatine kinase-MB measured at admission by rapid, compact, and easy to use automated quantitative analysers (results within 10 min) helped the early identification of acute myocardial infarction. The results were compared with the data obtained from the electrocardiograms recorded at admission. DESIGN: A prospective study. SETTING: Coronary care unit. PATIENTS: 94 consecutive patients with suspected myocardial infarction. Myocardial infarction was subsequently confirmed in 44 patients and excluded in 50. METHODS: All admission serum myoglobin, creatine kinase, and creatine kinase-MB were measured by clinical staff using analysers in the coronary care unit. An admission electrocardiogram was obtained from all patients. RESULTS: The sensitivity, specificity, and predictive accuracy for diagnosing myocardial infarction were: electrocardiogram 68%, 100%, and 85%; myoglobin 57%, 100%, and 80%; creatine kinase (threshold of 190 U/l) 34%, 98%, and 68%; creatine kinase-MB (threshold of 25 U/l) 43%, 100%, and 73%. When the electrocardiographic and myoglobin data were combined the sensitivity improved to 91%, diagnostic accuracy to 96%, with specificity of 100%. The results for the electrocardiogram and creatine kinase-MB were 80%, 90%, 100% respectively and those for the electrocardiogram with creatine kinase were 80%, 89%, 98% respectively. CONCLUSIONS: Admission myoglobin, creatine kinase, and creatine kinase-MB measurements were not as useful as the electrocardiogram for the diagnosis of acute myocardial infarction. Combining the electrocardiogram and myoglobin data substantially improved the sensitivity and predictive accuracy for the diagnosis of acute myocardial infarction.

Blood Chemical Analysis↗
PubMed1994

Abnormal pulmonary function and juvenile onset diabetes mellitus.

The metabolic and microcirculatory abnormalities associated with insulin-dependent diabetes mellitus involve most organ systems, including the lung. The adverse effects of diabetes mellitus on the function of the respiratory system are minor compared to the morbidity sustained by the cardiovascular, renal, neural, and ophthalmic systems. Nevertheless, physicians should be aware that some indices of pulmonary function may be abnormal in diabetic patients, independent of the more commonly recognized respiratory risk factors.

Adult↗
PubMed1993

Spitz nevus.

BACKGROUND: The Spitz nevus is a rare form of benign nevus, which may be confused with malignant melanoma. METHODS: We reviewed the clinical and histologic features of 29 cases of Spitz nevus, of which 20 were dealt with by our department of dermatology at the Hull Royal Infirmary between 1969 and 1990. The other nine cases were from the records of our pathology department dated between 1979 and 1991, of which seven of the lesions were excised by the surgeons and two by the general practitioners. RESULTS: In all the cases, the final diagnosis was established histologically. In three cases, there were difficulties histologically in excluding the diagnosis of malignant melanoma. All the lesions were solitary, and none of the lesions recurred following excision despite the possibility of incomplete excision in some cases. CONCLUSIONS: We found the size of the lesion and the age of the patient important factors to consider in the diagnosis of Spitz nevus. The small number of cases we encountered over a period of 22 years in a department that serves a population of around 500,000 emphasises the rarity of the condition.

Adolescent↗
PubMed1993

Study of left and right ventricular function in Romano-Ward syndrome.

OBJECTIVE: To examine left and right ventricular contraction in Romano-Ward syndrome: does abnormal myocardium affect the predisposition to arrhythmia? DESIGN: Tomographic radionuclide ventriculography was performed after the red blood cells were labelled conventionally with stannous pyrophosphate and technetium-99m. SETTING: Department of Nuclear Medicine, Aberdeen Royal Infirmary. PATIENTS: Eight subjects from two families known to have Romano-Ward syndrome, four of whom (two from each family) had had symptoms. RESULTS: The five subjects from family 1 had normal left ventricular contraction; two had subtle abnormalities of right ventricular phase. in family 2 all three subjects had abnormal left ventricular contraction (reduced amplitude in three, abnormal phase in two). All had subtle abnormalities of right ventricular phase. CONCLUSION: Abnormal right or left ventricular myocardium may be partly or wholly responsible for the repolarisation changes seen on the electrocardiogram of these families or may act as an ectopic focus to start ventricular tachycardias in a susceptible heart.

Adult↗
PubMed1993

First myocardial infarction in patients under 60 years old: the role of exercise tests and symptoms in deciding whom to catheterise.

OBJECTIVE: To determine the role of exercise tests and assessment of angina in the detection of potentially threatening disease in young patients with infarcts. DESIGN: Elective readmission of patients at a mean (SD) of 60 (30) days after acute myocardial infarction for assessment of angina, treadmill exercise tests, and cardiac catheterisation. SETTING: Cardiology department of a teaching hospital. PATIENTS: 186 consecutive survivors, aged under 60 years and discharged from the coronary care unit after a first myocardial infarction. MAIN OUTCOME MEASURES: Coronary arteriography, presence of angina, result of exercise tests, and referral for revascularisation. RESULTS: 31% of patients had either two vessel disease (with proximal left anterior descending involvement), three vessel disease, or left main stem disease. 49% of all patients had angina. Of the 173 patients who had an exercise test 34% had 1 mm and 24% had 2 mm of exercise induced ST depression. Thirty percent had no angina and a negative exercise test: after a mean (SD) follow up of 16 (4) months none of this symptom free sub-group had died, had experienced a further myocardial infarction, or had been referred for revascularisation. 79% of patients with either two vessel disease (with proximal left anterior descending involvement), three vessel disease, or left main stem disease had either angina or a 1 mm ST depression during the exercise test. CONCLUSION: Patients without cardiac pain after myocardial infarction and without ST changes during an exercise do not need arteriography.

Adult↗
PubMed1993

Systemic lambda light-chain deposition presenting with predominant cardiac involvement.

An 82 year old woman with suspected Bence Jones myeloma developed intractable fluid retention presumed secondary to cardiac failure. In addition she experienced angina pectoris, and required permanent cardiac pacing for symptomatic sinus bradycardia. Postmortem studies revealed prominent myocardial and renal deposits of lambda light-chains which were Congo Red negative, and had a non-fibrillar ultrastructure. Non-amyloidotic light-chain deposition is uncommon, and a rare cause of cardiac disease. Previous work regarding possible pathogenetic mechanisms, clinical and laboratory features and treatment is reviewed.

Aged↗
PubMed1993

Improved detection of abnormal left ventricular wall motion using tomographic radionuclide ventriculography compared with planar radionuclide and single plane contrast ventriculography.

Tomographic radionuclide ventriculography is a technique which could have major advantages over conventional planar imaging, such as better assessment of ventricular wall motion abnormalities. This possibility was therefore investigated in 100 consecutive patients undergoing routine cardiac catheterization. Following angiography, planar blood pool images were conventionally acquired and tomographic imaging performed using the Aberdeen Section Scanner. All derived wall motion data were subsequently analysed in an objective and blinded manner. The mean age was 56 (range 33-71) and 79% were male. 67 patients had experienced prior myocardial infarction, 27 were categorized as having significant and six insignificant coronary artery disease. The detection rates for patients with prior myocardial infarction were 95% for angiography, 57% for planar imaging and 90% for tomography. Even taking patients with only prior anterior myocardial infarction, the detection rates were 94%, 63% and 91% respectively. For those residual patients with significant coronary artery disease, the rates were 7%, 0% and 59% respectively. Overall for the detection of patients with significant coronary artery disease, the sensitivity was 70%, 40% and 81% respectively. Patients with insignificant coronary artery disease did not demonstrate any abnormalities using any method. These results demonstrate that tomography and angiography have similar detection rates in the presence of significant coronary artery disease and both are superior to planar imaging.

Adult↗
PubMed1992

Esophageal involvement in Behçet's disease. Is endoscopy necessary?

Twenty patients who were diagnosed as having Behçet's Disease between 1976 and 1990 were asked to attend the dermatology department so that their diagnosis could be reviewed in the light of recently established criteria for the diagnosis of Behçet's disease. Ten patients fulfilled the diagnostic criteria, nine of whom agreed to participate in this endoscopic study. Nine patients underwent upper gastrointestinal endoscopy, three of whom had dyspepsia alone, two had dysphagia and dyspepsia, one had symptoms of acid regurgitation, and the remainder were asymptomatic at the time of endoscopy. One patient had evidence of grade 1 reflux esophagitis, one had an incidental pyloric canal ulcer, and one patient who had severe dysphagia on presentation was found to have a high esophageal stricture with accompanying ulceration. Behçet's disease rarely affects the esophagus but when present can cause marked esophagitis with consequent stricture formation. Since the incidence of esophageal involvement was low (11%), we conclude that unless the patient had marked esophageal symptoms there is no indication for routine endoscopy of patients with Behçet's disease.

Adult↗
PubMed1992

Endolymphatic delivery of IL2 in patients with melanoma and lymphoma.

UNLABELLED: During this phase I/II study, enodolymphatic cannulae were placed in the iliac lymphatics under general anaesthesia. IL2 was then infused via this route at escalating doses until the highest tolerated dose was achieved; then, continuous infusion was maintained for 2 to 3 weeks. Seven patients with advanced cancer (3 lymphoma, 4 melanoma), resistant to all other modalities of treatment received such therapy. Most patients tolerated 4 to 5 x 10(6) u/day of IL2 for 2 to 3 weeks with less toxicity as compared to the equivalent dosage given intravenously. No severe perioperative morbidity was experienced. One melanoma patient had a minor clinical response. Changes in circulating lymphocyte numbers and cytotoxicity demonstrated a systemic effect of endolymphatic IL2 therapy. CONCLUSIONS: The endolymphatic administration of IL2 is associated with less toxicity than the intravenous route but still achieves a systemic effect; a lower tumour burden may prove more responsive to this therapy.

Adult↗
PubMed1992

Extensive and fatal basal cell carcinoma: a report of three cases.

Three cases of basal cell carcinoma (BCC) with extensive invasion are described. The first two patients had meningeal and cerebral involvement with exposure of their dural meninges following full thickness skull erosion. The third patient had bilateral orbital and optic nerve involvement resulting in complete blindness. All three patients subsequently died from their disease.

Aged↗
PubMed1992

Pyoderma gangrenosum: associations revisited.

Fourteen cases of pyoderma gangrenosum were seen over a period of 24 years at the Hull Royal Infirmary Dermatology Department. Several associated conditions were found. Seven cases were associated with rheumatoid arthritis of which five were sero-positive, including one with Felty's syndrome. One case was associated with both ulcerative colitis and psoriasis; one with polycythemia rubra vera; two patients had diverticular disease including one who also had rheumatoid arthritis; one had positive syphilis serology. In three cases there was no significant associated disease identified. Ten out of the fourteen cases were women, indicating a female preponderance by a ratio of about 2F:1M; a figure similar to that stated by Seitzinger. The age of presentation ranged from 30 to 80 years.

Adult↗