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Biomedical subjects
Publications and source records attributed to A H Williams.
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We present a case of invasive pulmonary aspergillosis when a blood culture isolate of Aspergillus fumigatus in an unusual medium was considered to be a genuine isolation. Early institution of appropriate therapy was successful.
Teicoplanin, a new glycopeptide antibiotic, has been used to treat twelve patients with bacterial endocarditis due to Gram-positive organisms. Teicoplanin has activity against Gram-positive bacteria similar to vancomycin but therapeutic levels are maintained by a single daily dose, given as an intravenous bolus. Of six patients with native valve infections, two cases, due to viridans streptococci, were successfully treated with teicoplanin alone and two others, caused by Streptococcus faecalis, were cured by combinations including teicoplanin. One of these patients sustained high tone hearing loss during treatment. The remaining two patients were drug addicts with endocarditis due to Staphylococcus aureus which recurred despite repeated multiple therapy. Of six prosthetic valve infections, antibiotic combinations including teicoplanin cured three cases, caused by streptococci. Infection persisted or treatment was curtailed in three cases of Staphylococcus epidermidis endocarditis. In this small open study, teicoplanin appeared as effective as vancomycin in the treatment of endocarditis but had the considerable advantage of ease of administration.
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Teicoplanin was used to treat 94 hospital in-patients of confirmed or presumed Gram-positive infections over a period of 12 months. Eighty-five patients were subsequently found to be evaluable; 31 had soft tissue infections, 10 endocarditis, 8 urinary tract infections, 12 septicaemias, 2 chest infections, 7 osteomyelitis or septic arthritis, and 15 were immunosuppressed patients with infected Hickman line site infections. The cure rate of the 85 evaluable episodes was 90% (76 cured). Teicoplanin was well tolerated intravenously and intramuscularly. Adverse reactions occurred in five patients. One patient suffered high tone hearing loss, two patients suffered transient rash, one developed a drug fever and one patient who had concomitant gentamicin developed vestibular damage. It is concluded that teicoplanin is a relatively safe and effacacious treatment for Gram-positive infection.
Seventy-five hospital inpatients with bacteriologically confirmed urinary tract infections were allocated to treatment with ciprofloxacin 100 mg, ciprofloxacin 250 mg or co-trimoxazole 960 mg, all given orally twice a day for five days. The patients were generally elderly, with many complicating factors including indwelling catheters; 24% of the infections were caused by Pseudomonas aeruginosa. The cure rates at 28 days were 94%, 88% and 87%, respectively. Side effects were few and minor. Ciprofloxacin appears to be an effective and safe orally-administrable treatment even for complicated urinary tract infection.
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In August/September 1984 a survey of the 267 course organizers in post in England and Wales was carried out. Eighty-two per cent replied to a questionnaire asking for details about their work and personal status. All 16 regions in England and Wales completed a questionnaire about levels of staffing and remuneration of those involved in general practice postgraduate education. The results show that there are considerable variations between regions in the role and responsibilities of course organizers, in their training, and in the facilities that are provided for them. The majority of course organizers reported a workload greater than the number of sessions for which they were remunerated. The effects of these factors on recruitment, tenure of post, and job satisfaction are discussed. Recommendations are made for improving the situation, including the removal of course organizer pay from the scale of trainers' pay, so that there can be flexibility in the number of sessions which can be held, improvement in training and certain facilities, and the implementation of national and local job descriptions.
The minimal inhibitory concentrations (MICs) of nalidixic acid, pipemidic acid, cinoxacin, oxolinic acid, flumequine, pefloxacin, acrosoxacin, amifloxacin, norfloxacin, enoxacin, ofloxacin and ciprofloxacin were determined for a range of clinical isolates. MICs were determined using an agar dilution technique in Mueller-Hinton agar supplemented with 10% lysed horse blood. The inoculum used was approximately 10(4) colony forming units, contained in 10 microliters Mueller-Hinton broth, which was applied to the agar plates using a multipoint inoculator. Following inoculation, plates were incubated in conditions appropriate for the organisms under investigation. The MIC of each antimicrobial for each isolate examined was determined as the lowest concentration of the antimicrobial which completely inhibited growth of the inoculum. The minimum concentrations required to inhibit the growth of 50% (MIC50) and 90% (MIC90) of the organisms examined were also determined. All of the more recently synthesised 4-quinolones showed considerably greater activity than the parent compounds, nalidixic acid, pipemidic acid and cinoxacin, against the range of organisms used in this study. Ciprofloxacin and ofloxacin were the two most active of the 4-quinolones examined.
An automated system for comprehensively monitoring glaucoma patients is described. This economic and practical microcomputer data system has been designed to be thoroughly 'clinician oriented' through the collaborative efforts of ophthalmological and computer specialists. It incorporates novel and efficient methods for transferring both automated and manually recorded perimetry data into analysable digital form. The system is inexpensive, simple to use, maintains safe records, allows thorough analysis of patient data, and can considerably reduce the administrative load on ophthalmological clinics.
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Over a period of 18 months, trainees in the West Midlands were given a multiple choice questionnaire at the start of the general practice year to assess their factual knowledge in 14 areas of medicine and were given the opportunity to take the same test six months later. Sixty-five trainees who completed the test twice are the basis of the study, and their results are compared with 99 trainers who completed the paper once. In the pre-training test, the trainees' scores were significantly lower than their trainers' in total and in most individual subjects. In the mid-training test, the trainees' knowledge of most subjects had improved significantly over the six months. These results indicate that the teaching and assessment of factual knowledge should not be dismissed as unimportant in general practice training.
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Mature Merino ewes (n = 228) were fed rations at levels of either 5, 10, 15, 20, 30 or 40 g/kg daily from day 1 until day 35 after mating. Embryos were then removed from single ovulating ewes and, after being weighed and measured, were dissected and embryo liver weights were obtained. Plasma samples were taken from all ewes on days 5, 10, 15, 20, 27 and 35 after mating and later analysed for glucose concentrations. During the 35-day treatment period, mean liveweight changes of ewes ranged from -6.9 to 5.5 kg in groups receiving the lowest and highest levels of nutrition respectively. Although there were no significant differences in the percentages of ewes pregnant at day 35 the weight and size of embryos, including embryo liver weight, varied with the level of nutrition. Mean wet weights (+/- s.e.m.) of embryos from ewes receiving rations at the rate of 10 g/kg daily and those receiving 30 g/kg daily were 1.67 +/- 0.04 g and 1.91 +/- 0.04 g respectively (difference significant at P less than 0.01). Plasma glucose concentrations of the ewes increased with increasing level of ration and decreased with time.
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