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Biomedical subjects

A Henderson

Publications and source records attributed to A Henderson.

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

Charts of fetal size: 2. Head measurements.

OBJECTIVE: To construct new size charts for fetal head circumference, biparietal diameter and other head dimensions. DESIGN: A prospective, cross sectional study. SETTING: The routine ultrasound department of a London teaching hospital. SUBJECTS: The fetuses of 663 women seen in the routine antenatal booking clinic whose ultrasound and menstrual dates agreed within 10 days. METHODS: Fetuses were scanned once only for the purpose of the study at gestations between 12 and 42 weeks, when up to 20 dimensions were measured. For each measurement separate regression models were fitted to estimate the mean and standard deviation at each gestational age. Centiles were derived by combining these two regression models, assuming that the measurements have a normal distribution at each gestational age. RESULTS: A total of 594 fetuses had their biparietal diameter measured and their head circumference measured directly. Both head diameters were recorded for 587 fetuses and the circumference was also derived from these, as was the cephalic area. New charts are presented for biparietal diameter (both outer-outer and outer-inner), head circumference (directly measured and derived from diameters). The directly measured head circumferences were consistently (by about 1%) greater than those derived from measurement of the head diameters. The new charts are compared with previously published charts that are in wide use. Charts for occipitofrontal diameter, cephalic index and cephalic area are also presented. CONCLUSIONS: We have constructed new size charts for the fetal biparietal diameter and for head circumference, both measured directly and derived from head diameters. We have demonstrated the difference between the size charts constructed from these two sets of values and hence the importance of using the appropriately derived chart when assessing the head circumference. The differences between the new charts for biparietal diameter and head circumference and previous ones may be largely due to methodological differences.

Anthropometry↗
PubMed1994

Charts of fetal size: 3. Abdominal measurements.

OBJECTIVE: To construct new size charts for fetal abdominal circumference and area. DESIGN: A prospective, cross sectional study. SETTING: The routine ultrasound department of a London teaching hospital. SUBJECTS: The fetuses of 663 women seen in the routine antenatal booking clinic whose ultrasound and menstrual dates agreed within 10 days. METHODS: Fetuses were scanned once only for the purpose of the study at gestations between 12 and 42 weeks, when up to 20 dimensions were measured. Separate regression models were fitted to estimate the mean and standard deviation as functions of gestational age. Centiles were derived by combining these two regression models, assuming that the measurements have a Normal distribution at each gestation. RESULTS: A total of 610 fetuses had their abdominal circumference measured directly. Abdominal diameters were recorded for 425 fetuses and the circumference was also derived from these, as was the abdominal area. New charts for abdominal circumference (directly measured and derived from diameters) are presented. The directly measured circumferences were consistently (by about 3.5%) greater than those derived from measurement of the abdominal diameters. The new charts are compared with previously published charts that are in wide use. A chart for abdominal area is also presented. CONCLUSIONS: We have constructed new size charts for the fetal abdominal circumference, both measured directly and derived from abdominal diameters. We have demonstrated the difference between the size charts constructed from these two sets of values and hence the importance of using the appropriately derived chart when assessing the abdominal circumference. The differences between the new charts and previous ones may be largely due to methodological differences.

Abdomen↗
PubMed1994

Charts of fetal size: 4. Femur length.

OBJECTIVE: To construct a new size chart for fetal femur length. DESIGN: A prospective, cross sectional study of fetuses scanned once only for the purpose of the study at gestations between 12 and 42 weeks. SETTING: The routine ultrasound department of a London teaching hospital. SUBJECTS: The fetuses of 663 women seen in the routine antenatal booking clinic whose ultrasound and menstrual dates agreed within 10 days. RESULTS: Femur length was measured on 649 of the 663 fetuses. A linear-cubic regression model was fitted to estimate the mean and a separate linear regression to estimate the standard deviation. Centiles were derived by combining these two regression models, assuming that the measurements have a normal distribution at each gestational age. A new chart for femur size is presented and compared with previously published data. CONCLUSIONS: We have constructed a new size chart for fetal femur length taking into consideration the increasing variability with increasing gestational age. We have compared our chart with other published data, and believe that the differences seen may be largely due to methodological differences.

Cross-Sectional Studies↗
PubMed1994

Acetylcysteine as a cytoprotective antioxidant in patients with severe sepsis: potential new use for an old drug.

OBJECTIVE: To stimulate debate regarding a potential new use for acetylcysteine as a cellular antioxidant in severely septic patients with systemic inflammatory response syndrome (SIRS). DATA SOURCES: A MEDLINE review of published animal, human, and laboratory studies relating to the cytopathogenic effects of active radicals in SIRS and the protective effects of acetylcysteine and glutathione. STUDY SELECTION: Few studies were available so all studies pertinent to the objective were reviewed. DATA EXTRACTION: Clinical and basic science data from the available trials of the effects of acetylcysteine on active radical production or active radical cell injury were extrapolated to predict the effect of acetylcysteine on human sepsis. DATA SYNTHESIS: Severe sepsis is a major cause of SIRS. Much of the cellular injury associated with SIRS is mediated by active radicals produced by inflammatory cells that overwhelm endogenous antioxidants. Reduced glutathione is a crucial intracellular antioxidant that becomes depleted during SIRS. Regeneration of glutathione can be achieved by acetylcysteine, which unlike glutathione itself penetrates cells. In animal models of sepsis and lung injury, acetylcysteine mitigates the cytopathologic effects of SIRS. In humans, clinical benefit has been demonstrated in the SIRS of established fulminant hepatic failure. CONCLUSIONS: The data do not as yet lead to any firm conclusions regarding the value of acetylcysteine in the management of SIRS in severe sepsis. The animal and human studies are, however, sufficiently encouraging to warrant formal trials to test the hypothesis that acetylcysteine therapy has a cytoprotective effect in sepsis.

Acetylcysteine↗
PubMed1993

Fatal brown snake (Pseudonaja textilis) envenomation despite the use of antivenom.

OBJECTIVE: To report two cases of fatal brown snake envenomation in adults despite the use of appropriate antivenom. CLINICAL FEATURES: Two men, aged 42 and 39, one with a history of hypertension, suffered fatal brown snake envenomation in Queensland. One believed he had been stung by a wasp. Both developed cardiorespiratory failure within one hour of the bite, followed by coagulopathy and pulmonary oedema. One patient developed fulminant multiorgan failure. INTERVENTION: Both patients died despite the administration of large doses of appropriate antivenom and full supportive care. CONCLUSION: Brown snake bites remain extremely dangerous despite the availability of specific antivenom. In severe cases associated with myocardial depression and gross coagulopathy, death may occur rapidly despite the use of conventional doses of antivenom. In such patients the antivenom requirement may be much greater than is currently recommended.

Adult↗
PubMed1993

Lignocaine metabolism and liver function testing in primary graft failure following orthotopic liver transplantation.

OBJECTIVE: To report the use of lignocaine and the measurement of its metabolite, monoethylglycinexylidide (MEGX), as a dynamic test of liver function. CLINICAL FEATURES: The conversion of lignocaine to MEGX has been used serially as a test of liver function in a liver transplant recipient for whom retransplantation was necessary because of primary non-function (PNF) of the initial graft. MEGX concentrations were markedly depressed with individual episodes of PNF, cardiac failure and rejection in this patient. CONCLUSION: The test provided useful additional supportive information in assessment of the patient and management of intercurrent problems following liver transplantation.

Female↗
PubMed1993

Experience with 732 acute overdose patients admitted to an intensive care unit over six years.

OBJECTIVE: To determine the outcome in patients with acute overdose requiring admission to the Intensive Care Unit (ICU). DESIGN: Prospective survey of all overdose admissions to an ICU over a six-year period ending January 1991. SETTING: Tertiary referral adult teaching hospital. PATIENTS: 732 consecutive patients with acute overdose. OUTCOME MEASURES: Death rate, use and duration of mechanical ventilation, type of compound taken and compounds associated with a fatal outcome. RESULTS: The 732 patients represented 13.8% of all admissions and 6% of the available ICU bed-days. Comparison with all admissions to the Emergency Department for acute overdose over a 27-month period ending April 1990 indicated that 22% of these patients were admitted to the ICU. Among the patients admitted to the ICU, tricyclic antidepressants, benzodiazepines and alcohol were the most frequently used compounds. More than one compound had been taken by 46.8% of the patients. Mechanical ventilation was required in 79.5% of the patients and 14 (2%) died. CONCLUSIONS: Acute overdose is a common cause of admission to the ICU but has a mortality rate of only 2%. In contrast to the overdoses taken by survivors, patients taking fatal overdoses are more likely to have taken a large dose of a single drug, or a non-medicinal compound.

Adult↗
PubMed1993

Use of monoethylglycinexylidide as a liver function test in the liver transplant recipient.

The hepatic conversion of lignocaine to monoethylglycinexylidide (MEGX) has been used as a real time monitor of liver function in liver transplant recipients. Data are reported for the first 4 weeks after transplant in 50 consecutive orthotopic liver grafts in 47 adults. The MEGX concentration was significantly depressed by approximately 50% in those patients in whom there was a complicated clinical course (excluding steroid-sensitive rejection) after transplantation, compared with patients in whom major complications did not occur. The MEGX concentration in the recipients after transplant was independent of the donor MEGX concentration, but, in addition to the patient's clinical status, was strongly influenced by the recipients pretransplant biochemical profile, being inversely related to the pretransplant bilirubin concentration. MEGX concentrations < 25 micrograms/L in the first 36 hr after revascularization were predictive of greater morbidity and mortality.

Adolescent↗
PubMed1993

The resource implications of severe necrotizing pancreatitis treated by necrosectomy.

This study reviews the resource utilization of patients admitted to the Intensive Care Unit (ICU) with severe necrotizing pancreatitis treated by early necrosectomy. For 21 patients there was a total of 221 abdominal operations, 2365 hospital days, 565 ICU days and 1185 days of parenteral nutrition. The mortality rate was 43%. The treatment for patients with necrotizing pancreatitis is 10 times more resource intense than other admissions to the ICU. The implications of necrotizing pancreatitis treated by necosectomy in the context of a Diagnosis-Related Groups Prospective Payment model of hospital funding are discussed.

Adult↗
PubMed1993

Streptococcus milleri liver abscess presenting as fulminant pneumonia.

A case of a young man who developed a Streptococcus milleri liver abscess secondary to an occult colonic foreign body, which presented as fulminant community acquired pneumonia, is reported. The isolation of Streptococcus milleri, a normal member of the gastrointestinal flora, from an abscess, blood or sputum should prompt a search for pathology, foreign bodies or silent perforation in the gastrointestinal tract.

Adult↗
PubMed1993

Spontaneous Clostridium perfringens lung abscess unresponsive to penicillin.

Clostridial necrotising pneumonia is a rare complication of aspiration, bronchial tumour or foreign body, pulmonary infarction, trauma and debilitating medical conditions. Although spontaneous clostridial pneumonia has been reported previously, close scrutiny of those case reports suggests that most of the patients had a recognised predisposing cause. We report a case of true spontaneous Clostridium perfringens pneumonia complicated by septic shock, pneumothorax and pulmonary necrosis. The patient responded poorly to conventional treatment with benzylpenicillin, and although the addition of metronidazole produced dramatic resolution of the sepsis, lobectomy was required to effect cure.

Clostridium Infections↗
PubMed1993

Patterns of visual spatial inattention and their functional significance in stroke patients.

The relationship between patterns of visual spatial inattention and activities of daily living (ADL) performance was investigated in 64 Chinese patients with right brain lesions, using the Klein-Bell ADL Scale and the Random Chinese Word Cancellation Test. The result showed that patients demonstrating hemi-inattention were significantly worse in ADL performance than patients with nonlateralized inattention or patients with normal attention, but that the latter two groups did not differ from each other. Although ADL performance was also found to be significantly related to somatosensation, motor status, and visual factors, after controlling the effects of these variables by partial correlation, hemi-inattention still was highly related to ADL performance. Independence in dressing, mobility, and elimination appeared to be more adversely affected by hemi-inattention than were bathing/hygiene, eating, and telephone use.

Activities of Daily Living↗