Ceri Phillips

Publications of Ceri Phillips

• Clinically practical blood volume assessment with fluorescein-labeled HES.

  Authors: E J Massey, Pamela de Souza, George Findlay, Mark Smithies, Sanjoy Shah, Paul Spark, R G Newcombe, Ceri Phillips, C A J Wardrop, G T Robinson

  Transfusion. 03/2004; 44(2):151-7.

  BACKGROUND: Standard techniques for measuring blood volume (BV) entail administering radioactivity and human albumin. This is laborious, expensive, and impractical in acute settings. An alternativeBACKGROUND: Standard techniques for measuring blood volume (BV) entail administering radioactivity and human albumin. This is laborious, expensive, and impractical in acute settings. An alternative method suitable for widespread routine application was assessed. STUDY DESIGN AND METHODS: Seventy-nine ambulant outpatients and 18 intensive care unit (ICU) patients were prospectively recruited. Measurements of RBC volume (RCV) and plasma volume (PV) were performed with radiochromium-labeled RBCs (51Cr), radioiodinated albumin (125I), and fluorescein-labeled HES (FITC-HES). Small molecules overestimate PV because of vascular endothelial dysfunction (ED) and increased capillary permeability; a reference value for PV was therefore derived with the RCV and Hct. RESULTS: Mean PV with 125I dilution was 230 mL (SD, 185 mL) greater than that with FITC-HES in outpatients. This difference was more exaggerated, 345 mL (SD, 371 mL), in ICU patients likely to have ED. Both the PV measured with FITC-HES and the 125I dilution correlated closely with the PV derived with RCV and Hct (r = 0.950 and 0.925, respectively) in the ICU patients. CONCLUSION: FITC-HES estimates PV more accurately than 125I. FITC-HES should replace radioactive tracers for assessing BV. Comparing the estimates of PV with molecules of differing molecular weights may have clinical utility as an indicator of ED.

• The use of brain natriuretic peptide as a screening test for left ventricular systolic dysfunction- cost-effectiveness in relation to open access echocardiography.

  Authors: Victor Sim, David Hampton, Ceri Phillips, Su-Neng Lo, Sanjeev Vasishta, John Davies, Micheal Penney

  Family practice. 11/2003; 20(5):570-4.

  BACKGROUND: Heart failure due to left ventricular systolic dysfunction (LVSD) has a high prevalence in the adult population but is difficult to diagnose accurately on clinical grounds in theBACKGROUND: Heart failure due to left ventricular systolic dysfunction (LVSD) has a high prevalence in the adult population but is difficult to diagnose accurately on clinical grounds in the community. Early diagnosis is important as effective treatments are available to reduce morbidity and mortality. Echocardiography is widely used to assess heart failure; however, this technology is relatively expensive and of limited availability. A potential diagnostic aid in primary care is the measurement of plasma brain natriuretic peptide (BNP). OBJECTIVE: This study was performed to assess the value of BNP measurement as a selective pre-screen for breathless patients referred for open access echocardiography. METHODS: BNP was measured by radioimmunoassay with prior extraction in 83 breathless subjects (age range 37-87 years, mean 72). Standard echocardiography was performed and left ventricular systolic function was assessed. RESULTS: The prevalence of LVSD was 31% in this group. At cut-off values chosen to give negative predictive values for LVSD of >98% (BNP = 19 pg/ml), the sensitivity, specificity and positive predictive value for BNP were 100, 49.1 and 46.9%. Using this BNP threshold as a pre-screen for echocardiography would make a net saving of pound 964.20 without compromising the diagnostic accuracy. CONCLUSION: BNP measurement appears to have a significant cost-effective benefit for the selection of patients for echocardiography.