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Biomedical subjects

A D Macleod

Publications and source records attributed to A D Macleod.

30 records · Page 2Linked to original sources
PubMed1994

The reactivation of post-traumatic stress disorder in later life.

Forty-five World War II veterans reporting recent reactivation of chronic post-traumatic stress disorder (PTSD) symptoms were clinically assessed in order to determine war pension disability. In the course of these examinations, factors implicated in the exacerbation of their re-experiencing and arousal symptoms were recorded. The most prominent of these factors was that of physical ill health. Retirement, loneliness, comorbid psychiatric illness, anniversaries, service reunions, and alcohol and psychotropic medication usage were other factors. The natural history of chronic PTSD was observed by reviewing the veterans' medical records, which had been commenced at enlistment, prior to active service. The masking of intrusive symptoms in mid-life was usual. A terminal phase of symptomatic reactivation in older age may occur. The indelibility of the memory of fear is demonstrated by these veterans. The reticence to retell the trauma story remains a major obstacle in the study of the mental health sequelae of warfare. War-related psychiatric disorder in the elderly male is easily missed. Direct questioning regarding military service is advisable. The ineffectiveness of the management strategies offered to World War II PTSD sufferers is clearly apparent.

Aged↗
PubMed1993

Effective concentration 50 for propofol with and without 67% nitrous oxide.

The Effective Blood Concentration (EC) of propofol required to prevent response to surgical incision was determined in 65 ASA I or II female patients breathing either 100% oxygen or 67% N2O in oxygen. Propofol was administered via a microcomputer-controlled infusion system programmed to maintain the blood propofol concentration at predetermined target values. The blood propofol concentrations predicted by the micro-computer were validated by measurement of whole blood propofol concentration. Predicted and measured concentrations differed during infusion of propofol, but became similar after discontinuing the infusion for at least 90 s, suggesting that equilibration within the central compartment was incomplete during infusion. The response to the initial incision was observed and probit analysis used to determine the predicted blood concentration at which 50% of patients responded. The predicted EC50 for propofol/N2O/O2 and propofol/O2 was 4.5 micrograms ml-1 and 6.0 micrograms ml-1 respectively, and the measured EC50 propofol/N2O/O2 and propofol/O2 was 5.36 micrograms ml-1 and 8.1 micrograms ml-1, 67% nitrous oxide in oxygen reducing the predicted EC50 by 25% and the measured EC50 of propofol by 33%. The predicted EC may be more representative of the equilibrated concentration in the central compartment and thus reflective of tissue propofol concentrations.

Adolescent↗
PubMed1991

Posttraumatic stress disorder in World War Two veterans.

The clinical presentations of chronic posttraumatic stress disorder of 18 world war two veterans are detailed. This psychiatric sequelae of trauma may be chronic and persistent, as demonstrated by the presence and severity of symptoms 45-50 years after the onset. Early treatment interventions would appear desirable even if not yet conclusively proven to be effective.

Adaptation, Psychological↗
PubMed1991

Comparison of two methods for predicting difficult intubation.

Two methods of predicting difficult laryngoscopy were compared prospectively. Mallampati class and Wilson risk-sum were determined before operation and laryngeal view graded in 675 patients. Both tests identified five of 12 difficult laryngoscopies; twice as many patients were predicted to be difficult by Mallampati classification than by Wilson risk-sum. Inter-observer variation was minimal using Wilson risk-sum, but considerable for Mallampati classification. We prefer the Wilson risk-sum for assessment of the airway, while noting that both tests have poor sensitivities.

Adolescent↗
PubMed1990

Respiratory depression and melancholia.

Presented is the case of the fifty-six year-old asthmatic woman, with a six-month history of a Major Depressive Episode. Following an acute respiratory crisis, requiring assisted ventilation, the depressive symptomatology resolved. The historical administration of treatments of the mentally ill, incorporating acute physiological stress, are commented upon, and hypotheses discussed concerning the possible mechanisms of action of such treatments. The induction of a delirium may be the significant therapeutic event experienced by this patient, and the common event induced by physiologically stressful treatments administered by our psychiatric forebearers.

Adaptation, Psychological↗
PubMed1988

Self-neglect of spinal injured patients.

Self-neglect is a recognised, but poorly emphasised, complication of spinal cord injury, with a prevalence in this study of 9% of a consecutive sample of 400 patients. Self-neglect may be the presenting symptom of problems related to adjustment to disability, a major depressive disorder (DSM III criteria), or a clear and rational wish to die (existential self-neglect). Management is discussed, emphasising the importance of respecting spinal injured patients' autonomy.

Adjustment Disorders↗
PubMed1983

Breath alcohol analysis in the Accident and Emergency Department.

Breath alcohol analysis was undertaken in 1044 consecutive patients aged over 15 years attending the Accident and Emergency (A and E) Department of a rural district general hospital during a 50-day period. 16.5 per cent of all patients had the smell of alcohol on their breath, with 10.2 per cent of the patients recording a breath alcohol level equivalent to a blood level of 80 mg/100 ml or more. One-third of all patients attending between 9 pm and midnight, and almost two-thirds of patients attending between midnight and 3 am had positive breath tests. Positive breath tests were most likely in males, patients with head injuries, with overdoses, in victims of assault and in patients with a depressed conscious level, irrespective of cause. Clinical estimation of intoxication by alcohol may be accurate in the co-operative patient, but in the patient with a head injury or with a depressed conscious level from another cause, this is more difficult. Breath alcohol analysis is rapid, not-invasive, accurate and of clinical value in these and other high-risk patients attending hospital as emergencies.

Adolescent↗
PubMed1983

Calenture-missing at sea?

Calenture is a behavioural phenomenon, the predominant symptom being an irresistible impulse of sailors to jump into the sea from their vessels. The original description of this phenomenon was that of ancient Spanish sailors. Psychiatric descriptions of calenture appeared in the 18th and 19th centuries; subsequent psychiatric literature has, however, made no direct reference to calenture. This article describes calenture from a historical and clinical perspective, with discussion of the phenomenon in terms of modern psychological understanding. Some implications are considered, including the possible association with the nautical term 'missing at sea'.

Delusions↗