Biomedical subjects
Publications and source records attributed to A Barker.
We report two cases of urethral duplication presenting with profound infravesical obstruction at birth. In both cases, left-to-right crossed renal ectopia was also present.
A case of prune belly syndrome which was managed by left ureterostomy and right nephrectomy during the neonatal period is reported. The patient also had anorectal agenesis with rectovesical fistula, urethral atresia and patent urachus. When the patient was 14 years of age, the urinary diversion was converted to a continent diversion by an antireflux ureteroneocystostomy of both the left and the right ureter together with a right cutaneous ureterostomy. The patient manages very well by clean intermittent catheterization of the right ureterostomy and is fully continent.
Products of the bacterium Pseudomonas aeruginosa have been shown to slow the beating of human respiratory tract cilia in vitro. We have tested the effects of two of these compounds, pyocyanin and 1-hydroxyphenazine (given as a bolus dose dissolved in 2 microliters Ringer solution), on tracheal mucus velocity of radiolabeled erythrocytes in anesthetized guinea pigs. 1-Hydroxyphenazine (200 ng) caused a rapid slowing of tracheal mucus velocity (maximum fall 47% at 20 min) with recovery by 1 h. The effect of pyocyanin was slower in onset, 600 ng causing 60% reduction in tracheal mucus velocity at 3 h, and no recovery occurred. A combination of pyocyanin and 1-hydroxyphenazine produced an initial rapid slowing equivalent to the same dose of 1-hydroxyphenazine given alone, but the later slowing attributed to pyocyanin was greater than the same dose administered alone. This study demonstrates one mechanism by which products of P. aeruginosa may facilitate its colonization of the respiratory tract.
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Dressings of the raw nailbed tend to adhere and to be difficult and painful to remove. We have compared three types of dressing: polyurethane sponge, paraffin-gauze and replacement of the finger-nail. Assessment of adherence and pain showed that replacement of the nail had significant advantages over the other dressings.
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In the Beta Blocker Heart Attack Trial, a double blind, randomized, controlled study, patients taking propranolol (180 or 240 mg/day) initiated 5-21 days post myocardial infarction had 26% fewer deaths than those taking placebo over a 25 month (mean) followup. Detailed analysis of the circumstances surrounding the BHAT deaths failed to reveal any striking difference between propranolol and placebo in the type of clinical event preceding death, the incidence and type of acute and prodromal signs and symptoms, the location of death, the activity preceding death or the percentage of deaths that were sudden or instantaneous, suggesting that propranolol may exert an "across the board" effect and improve survival by a combination of mechanisms. An unexpected finding was that the protective effect of propranolol appeared to occur during the hours of 10 p.m. to 7 a.m.
A prospective study of hypospadias management is reported in this paper. Over a period of 4 years, 88 children with hypospadias were operated on according to a set schedule of age and anatomical defect. An analysis of these cases is presented and as a result of the study, recommendations regarding the timing and type of surgery according to defect are made. The report emphasizes the importance of early operation (less than 18/12 of age) using one stage procedures, and proposing that hospital stay can be shortened considerably by sending patients home with their catheters in situ.
The value of the Radial Head-Capitellum view has been assessed in a series of 28 consecutive cases of radial head fracture. Additional useful information was obtained in 21% of cases. The Radial Head-Capitellum view may be a valuable additional view in assessing radial head trauma.
A combined interprofessional effort of optometry and psychology/gerontology results in a valuable practice management program for eye care offices. Through this program, staffs can use sensory deprivation training to improve their handling of patients in the optometric environment.
A prospective study of the accuracy of interpretation of radiographs by casualty officers and radiologists is presented. The casualty officers readings were correct in 83% of cases, and the radiologists' in 95%. There was agreement of interpretation in 83% of the examinations. This study indicates that there are clinical and economic benefits when the radiologist's report is available before the patient leaves the hospital. Delayed reporting of films is considered to be less satisfactory but is still of value as it increases the detection of clinically significant abnormalities and also clarifies most of the 10% of studies about which the casualty officer is uncertain. Where a delayed reporting system is practised, a25% reduction in radiologist's workload would be achieved by reporting only those films considered by the casualty officer to be "normal" or "uncertain". Attempts to reduce workload still further by not reporting any films will increase the number of patients poorly managed in casualty.
A prospective study of 500 patients was performed to determine the reasons for requesting radiographs in an accident and emergency department. Most examinations were requested either to confirm a clinically suspected abnormality or because of difficulty in excluding a significant bone injury on clinical grounds alone. Several requests were also made to reassure the patient. Medicolegal reasons were relatively few, and those made purely because the doctor feared litigation probably accounted for only 5% of requests. Undue emphasis on the medicolegal aspects of accident and emergency radiography in the United Kingdom is unhelpful in that it directs attention away from the real reasons for x-ray referral. Although a reduction in the number of x-ray examinations is desirable on the grounds of expense and radiation exposure it is likely to be obtained only by improving experience and acumen in the clinical assessment of injuries.
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Cells of monolayer cultures are fused by high concentrations of polyethylene glycol (PEG) with a molecular weight of approximately 1500. This process is independent of extracellular ca++ions. PEG changes transiently the surface membrane and leads to fusion only after replacing it by normal medium. Before the final fusion of two cells, the onset of ionic coupling via longer lasting pseudopodial contact can be measured. Only cells that are synchronous in the secretory and pseudopodial response to PEG may fuse with each other.
This paper reports chemotactic studies on human polymorphonuclear leukocytes using prostaglandins, prostaglandin precursors and prostaglandin metabolites in vitro. Chemotaxis could not be demonstrated when arachidonic acid, prostaglandins D2, E1, E2, F2alpha, and the prostaglandin metabolites 15 keto E2, 15 keto F2alpha were incubated with polymorphonuclear leukocytes using the Boyden millipore technique.