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Biomedical subjects

A D Woolf

Publications and source records attributed to A D Woolf.

At least 91 records · Page 5Linked to original sources
PubMed1994

Measurement of hand bone mineral content by dual energy x-ray absorptiometry: development of the method, and its application in normal volunteers and in patients with rheumatoid arthritis.

OBJECTIVES--To develop a method of measuring hand bone mineral content (BMC) by dual energy x ray absorptiometry (DXA); to apply this method of measuring hand BMC to normal volunteers to ascertain causes of variability; and to measure hand BMC in patients with rheumatoid arthritis (RA) of varying duration and severity. METHODS--The x ray beam of the Hologic QDR 1000 dual energy x ray absorptiometer was hardened by introducing a perspex-aluminium plate and the analysis software altered to allow for the small tissue bulk of the hand compared with the torso. Ninety five volunteers (46 men age 24-81 and 49 women age 20-83) had scans of both hands. Eight volunteers were assessed repeatedly to establish reproducibility and effect of hand position. Fifty six patients (22 men, 34 women, age range 25-86 years) with RA of differing duration and severity, had hand BMC measurement by DXA. RESULTS--The precision of BMC measurement was 2.3% with no additional variation due to hand position. Hand dominance had no significant effect on BMC. In men, hand BMC correlated with height (r = 0.57, p < 0.0001), weight (r = 0.58, p < 0.0001), forearm span (r = 0.5, p = 0.0006) and hand volume (r = 0.66, p < 0.0001). In women hand BMC correlated with height (r = 0.66, p < 0.0001), weight (r = 0.4, p = 0.003), forearm span (r = 0.3, p = 0.03) and hand volume (r = 0.49, p = 0.0008). After correcting for all these variables, male volunteers had significantly higher hand BMC than female volunteers (p = 0.01) and patients with RA had lower hand BMC than normal volunteers (total hand BMC in male volunteers 90.9 gms, 95% CI 86.9-95, in male patients 81.7 gms, 95% CI 73.7-89.6, p < 0.004, total hand BMC in female volunteers 62.2 gms 95% CI 59.8-64.5, female patients 52.3 gms, 95% CI 48.1-56.5, p < 0.005). In patients with RA, the hand BMC showed an inverse correlation with age (r = -0.44, p = 0.01), disease duration (r = -0.62, p = 0.0003), Larsen's grades (r = -0.62, p = 0.0002) and modified Sharp's method score (r = -0.69, p < 0.0001) in female patients only. CONCLUSIONS--A new, sensitive and reproducible technique of measurement of hand bone mineral content by DXA, has been developed and this method has been applied to normal volunteers and patients with RA. Hand dominance had no significant effect on hand BMC. After correcting for physical size, men have higher hand BMC than women. Hand BMC inversely correlates in women patients with disease duration and other validated methods of assessing radiological outcome in RA. Longitudinal studies are needed to establish its role in monitoring disease progression.

Absorptiometry, Photon↗
PubMed1994

Age and sex influences on fall characteristics.

OBJECTIVE: To investigate age and sex influences on fall characteristics. METHODS: A total of 1243 subjects (517 males and 726 females) aged 50 years and over and drawn from population based sampling frames were invited to complete an interviewer administered questionnaire concerning descriptive characteristics of falls experienced in the previous four months. Information collected included details about the part of the body to strike the ground, direction of the fall, level of trauma and whether or not injury or fracture was sustained. RESULTS: One hundred and seventy two subjects reported a fall in the previous four months. Restricting analysis to the 142 subjects who fell from a standing height or less, females aged 50-64 years were more than twice as likely to fall onto their hand compared with older females (odds ratio (OR) = 2.2; 95% confidence interval (CI) 0.8 to 6.2) and at all ages (50+) were more than three times as likely to fall on their hip compared with males (OR = 3.4; 95% CI 1.0 to 11.5). Compared with older males, males aged 50-64 were more likely to fall sideways (OR = 5.1; 95% CI 1.5 to 17.4) and less likely to fall forwards (OR = 0.4; 95% CI 0.1 to 1.1). CONCLUSION: There is a potentially clinically important variation in fall type by age and sex. In particular, this variation might explain patterns of occurrence of hip and Colles' fracture.

Accidental Falls↗
PubMed1994

Poison centers, poison prevention, and the pediatrician.

The first poison centers were established in the United States in the early 1950s, stimulated by an American Academy of Pediatrics' survey of office-based pediatric practices which ascertained that its members had no place to turn for ingredient information on medications and household products. With the help of the Academy, pediatrician Dr. Edward Press, the Illinois Department of Health, and several community hospitals, the first poison center emerged. Over the subsequent 40 years, remarkable progress has occurred in the fields of clinical toxicology, poison control, and poison prevention. Yet despite these accomplishments, challenging clouds are appearing on the horizon which threaten these gains. This commentary, by the authors who have viewed and participated in a large part of the history of this progress, will focus on these major accomplishments with an emphasis on (a) poison prevention utilizing the pre-event (primary prevention), (b) the event (secondary prevention), and (c) the postevent (tertiary prevention) model.

Child↗
PubMed1994

Toxicity associated with severe inhalational and dermal exposure to dimethylacetamide and 1,2-ethanediamine.

We present the case of a worker who was accidentally exposed (inhalational and dermal routes) to the chemicals dimethylacetamide and ethylenediamine for 90 minutes in a confined space. Clinical effects included delirium, hallucinations, skin burns, cellulitis, bilateral conjunctivitis, hepatitis, secondary coagulopathy, rhabdomyolysis, and a grade 2 esophagitis. Urinary monomethylacetamide levels 6 days after the exposure were 61 ppm.

Accidents, Occupational↗
PubMed1993

Cholestyramine as an adsorbent in acute lindane poisoning: a murine model.

STUDY OBJECTIVES: To compare the effectiveness of single-dose cholestyramine versus single-dose activated charcoal in preventing clinical toxicity after acute lindane ingestion. DESIGN: CD-1 mice received lindane by enteral (gavage) and parenteral (intraperitoneal) routes, followed by enteral administration of either cholestyramine (2.25 g/kg) or activated charcoal (2.25 g/kg), with subsequent observation for convulsions and death. MEASUREMENTS: The doses of lindane at which 50% of mice developed convulsions (CD50) and at which 50% of mice died (LD50) were established and compared among control, charcoal-, and cholestyramine-treated groups. RESULTS: For lindane administered by gavage, the differences in the CD50 and LD50 between the control and the activated charcoal groups were not statistically significant. However, a significant difference did exist in both the CD50 and the LD50 between the group receiving cholestyramine and the control group and between the cholestyramine and activated charcoal groups. After IP administration of lindane, the difference in CD50 or LD50 among control, activated charcoal, or cholestyramine groups was not significantly different. CONCLUSION: In the murine model, cholestyramine is more effective than activated charcoal in preventing absorption of lindane, thus preventing convulsions and death. These data support the need for clinical studies to determine whether cholestyramine may be a more effective treatment than activated charcoal for acute lindane ingestions in human beings.

Acute Disease↗
PubMed1993

Clinical activities: an audit of rheumatology practice in 30 European centres.

As part of a larger EURORITS' study of rheumatology practice across Europe an audit of the diagnoses of all rheumatology inpatients (IPs), all new (OP/N) and review (OP/R) outpatients, seen during the month of January 1991 was undertaken simultaneously in 30 rheumatology units in 19 European countries. Wide variations in case-mix, bed numbers and usage, as well as staffing levels were seen. This was in part due to the type of unit, some acting as national referral centres, while others performed a regional or district role, and also as a consequence of differences in referrals and in clinical practice. The 'median European unit' had four consultants, four trainees, two research fellows (clinical), and two research fellows (scientific), and admitted 66 patients to its 31 beds during the month. Inflammatory joint disease accounted for 60, 32 and 71% of IPs, OP/Ns and OP/Rs, respectively. This survey, being the first of its kind, has provided insight into the problems of eliciting and analysing such disparate data, which will be of value in future similar exercises.

Aftercare↗
PubMed1993

Successful treatment of life-threatening propionitrile exposure with sodium nitrite/sodium thiosulfate followed by hyperbaric oxygen.

Propionitrile, a substituted aliphatic nitrile commonly used in the chemical manufacturing industry, is capable of generating cyanide. However, there are few reports of human intoxication involving propionitrile. We report two workers at an organic chemical manufacturing plant who were overcome by fumes while treating a waste slurry into which unreacted propionitrile was discharged by mistake. One victim was comatose, acidotic, and hypotensive; his blood cyanide level was later measured at 5.0 micrograms/ml. He responded to sodium nitrite/sodium thiosulfate therapy by regaining consciousness. Continued symptoms were treated with hyperbaric oxygen at 2 atmospheres for a total of 4 hours. The second victim, who complained only of nausea, dizziness, and headache and who never lost consciousness, was treated with sodium nitrite/sodium thiosulfate. His measured blood cyanide concentration was 3.5 micrograms/ml. The ambient concentration of propionitrile in air samples at the work site shortly after the exposure was 77.5 mg/m3. In occupational situations in which workers exhibit rapidly progressive symptoms of headache, dizziness, collapse, and coma, and where substituted nitriles are known to be on site, acute cyanide poisoning should be strongly considered. Because of continued endogenous generation of cyanide from the metabolism of the parent compound, hyperbaric oxygen may be a valuable adjunctive therapy to consider, in addition to the immediate use of the cyanide antidote kit, in cases of poisoning by propionitrile or other substituted nitrile compounds. We urge the Occupational Safety and Health Administration to adopt workplace standards for the maximum ambient air concentrations for propionitrile.

Adult↗
PubMed1993

Epidemiology of drug overdose in children.

Childhood drug overdoses are a continuing important public health problem. Although drug overdoses are no longer the important cause of childhood mortality they once were, such poisonings account for highly frequent and unacceptable instances of childhood injuries. These poisonings exact a high cost from society. They result in many emergency department visits and hospitalisations, with the attendant indirect costs of suffering, parental anxiety, and lost days of work or school. Childhood drug overdoses are preventable; those children and families at highest risk show identifiable characteristics, and the medications which pose the greatest hazard to children have already been identified. These injuries divert expensive and scarce medical resources from society's other health problems. Thus, clinicians must do more to prevent childhood drug overdoses whenever possible.

Adolescent↗
PubMed1993

Radiopacity of household deodorizers, air fresheners, and moth repellents.

Household deodorizers and moth repellents are common agents implicated in many childhood poisonings. Their ingredients usually include either paradichlorobenzene or naphthalene compressed into a solid ball or another shape, sometimes with added essential oils and fragrances. Because medically naphthalene is a more important toxin than paradichlorobenzene, with hematologic and nervous system effects, clinicians often seek to discern which product has been ingested. We discovered fortuitously that a mothball swallowed by a retarded adult was radiopaque, and so designed an in vitro experiment to study the radiopacity of a variety of household deodorizers and products. Of 10 products screened for radiopacity by two radiologists, those containing paradichlorobenzene were consistently strongly radiopaque; those containing naphthalene were radiolucent. A third alternative ingredient which is used in some toilet bowl deodorizers, cetrimonium bromide, was also radiopaque. Radiopacity of paradichlorobenzene or cetrimonium bromide-containing products did not dissipate with time. We speculate that the halogen within the chemical structure of these compounds accounts for their radiopacity. We conclude that paradichlorobenzene-containing commercial products can be distinguished clinically from those containing naphthalene by the performance of an abdominal radiograph.

Administration, Oral↗
PubMed1992

The use of digoxin-specific Fab fragments for severe digitalis intoxication in children.

BACKGROUND: Because life-threatening digitalis intoxication is unusual in children, treatment with digoxin-specific-antibody Fab fragments (Fab) has rarely been reported. We describe the efficacy of Fab in the treatment of children with severe digitalis intoxication. METHODS: Twenty-nine children with intoxication due to digoxin (28) or digitoxin (1) received Fab at 21 participating hospitals between 1974 and 1986. Data were gathered about the patients' medical illnesses, doses and serum concentrations of digitalis, responses to Fab therapy, and outcomes. RESULTS: In the infants and young children with acute digoxin intoxication, the digoxin doses ranged from 0.30 to 0.96 mg per kilogram of body weight; two adolescents had severe intoxication after doses of only 0.20 and 0.26 mg per kilogram. The serum digoxin concentrations ranged from 3.0 to greater than 100 ng per milliliter (mean, 13.8). Atrioventricular block (present in 22 patients [76 percent]) was the most common sign of toxicity. All the patients in this series had severe disturbances of cardiac rhythm, hyperkalemia (mean serum potassium concentration, 5.4 mmol per liter), or both. In 27 patients (93 percent), digitalis toxicity resolved after the administration of Fab. Of the 19 patients for whom data were available on the timing of the response to Fab, 15 responded within 180 minutes. Three patients required retreatment with Fab. Seven died of complications unrelated to the administration of Fab. CONCLUSIONS: We recommend that Fab be used in the treatment of digitalis poisoning in infants and young children who have ingested greater than or equal to 0.3 mg of digoxin per kilogram, who have underlying heart disease, or who have a serum digoxin concentration of greater than or equal to 6.4 nmol per liter (greater than or equal to 5.0 ng per milliliter) in the elimination phase; and who also have a life-threatening arrhythmia, hemodynamic instability, hyperkalemia, or rapidly progressive toxicity. Adolescents, who are more sensitive to the toxic effects of digoxin than younger children, may require treatment with Fab after ingesting lower doses.

Acute Disease↗
PubMed1992

Reliability of data sources for poisoning deaths in Massachusetts.

The authors analyzed poisoning-related deaths in Massachusetts from 1986 and 1987 recorded in three datasets: poison center records, death certificate, and state medical examiner's office records. While 714 such deaths were found, 551 of these were prehospital deaths recorded within the medical examiner's office but not by the poison center. The poison center was not consulted in over 47% of the poisoning deaths occurring in Massachusetts hospitals. Conversely, 15% of deaths were reported to the poison center but were not found either in death certificate or medical examiner records. Concordance between all three datasets for recording the 163 poisoning-related hospital deaths was only 17%. The authors conclude that reliance on a single data source underestimates and potentially misrepresents both the numbers and types of poisoning deaths occurring in the state. They also believe the files of the medical examiner are an underappreciated, rich source of data concerning out-of-hospital deaths due to poisonings and intoxications. Their findings suggest that the regional poison center is an underused resource for the management of seriously poisoned patients. There is a need for a better working relationship between poison centers and area hospitals so that all serious intoxications and poisonings are reported to the poison center in a timely fashion.

Carbon Monoxide Poisoning↗
PubMed1992

Intentional infantile ethylene glycol poisoning presenting as an inherited metabolic disorder.

A 6-month-old girl was hospitalized on three occasions for irritability, vomiting, acidosis, and hypotonia. During the third hospitalization hyperglycinemia and urinary glycolic acid were detected. Ethylene glycol was discovered in the infant's blood and bottled formula. Clinicians must consider ethylene glycol intoxication as a cause of recurrent infantile metabolic acidosis.

Acidosis↗