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Biomedical subjects

A Patrick

Publications and source records attributed to A Patrick.

At least 19 recordsLinked to original sources
PubMed2006

Cardiomyopathy in pregnancy and caesarean section: four case reports.

We present the clinical details of four women with cardiomyopathy who required caesarean section. Two women had peripartum cardiomyopathy and two had hypertrophic obstructive cardiomyopathy, one of whom has had two caesarean sections. Those with peripartum cardiomyopathy were more compromised than those with hypertrophic obstructive cardiomyopathy. Co-operation between obstetric and cardiac anaesthetists ensured optimum experience was available. An incremental combined spinal-epidural technique with invasive monitoring was used for three women and one received general anaesthesia. The risks and benefits of different anaesthetic techniques are discussed.

Adult↗
PubMed2000

Choice: ethical and legal rehabilitation challenges.

The concept of choice, which has been inherent in the rehabilitation process since its inception, has evolved into legal mandates and ethical challenges for rehabilitation professionals during the latter part of the 20th century. This article identifies the ethical and legal issues related to choice, summarizes a pilot project on rehabilitation counselors' perceptions of choice, and provides recommendations for rehabilitation professionals in the resolving ethical dilemmas related to choice.

Attitude of Health Personnel↗
PubMed1998

Diagnosis and treatment of prostatitis in Canada.

OBJECTIVES: There is a general consensus among physicians that the present management of chronic prostatitis is dismal. We undertook a survey of Canadian primary care physicians (PCPs) and urologists to determine the degree and source of frustration and to analyze present practice patterns in this disease. METHODS: Five thousand PCPs and all 545 Canadian urologists were asked to complete a comprehensive computer-assisted telephone survey that explored practice characteristics, attitudes, and diagnostic and treatment strategies in the management of prostatitis. Randomization of attribute banks, adherence to questionnaire routing, validation by on-site monitoring, and possible bias were addressed. RESULTS: Completed interviews were obtained from 10% of PCPs and 28% of urologists. PCPs see on average 3.5 (median 2) patients with prostatitis per month and urologists see on average 21.8 (median 11) patients with prostatitis per month. All physicians experience significantly more frustration in treating prostatitis than they do in treating patients with benign prostatic hyperplasia (BPH) and prostate cancer, and they perceive that prostatitis affects patients' quality of life significantly more than BPH and almost as much as prostate cancer. The degree of frustration and unhappiness in dealing with prostatitis is driven by a lack of confidence and comfort in their ability to accurately diagnose and subsequently rationalize treatment. Most PCPs and urologists continue to employ steps in addition to history and physical examination to establish a diagnosis but only a few PCPs and a third of urologists use specific lower urinary tract cultures. Physicians tend to use trimethoprim or trimethoprim-sulfamethoxazole (TMP-SMX) or a fluoroquinolone as their usual first line therapy for chronic prostatitis. The most commonly used therapeutic strategy (40%) for chronic prostatitis was TMP-SMX as first line therapy and a fluoroquinolone as second line therapy. CONCLUSIONS: There is widespread frustration, discomfort, and lack of confidence in both PCPs' and urologists' perceived ability to manage prostatitis. Physicians have expressed a desire for a better understanding of this disease, simpler and clearer diagnostic guidelines, and more rational treatment strategies.

Canada↗
PubMed1998

The in-hospital Utstein style: use in reporting outcome from cardiac arrest in Middlemore Hospital 1995-1996.

The in-hospital Utstein Style was published in April 1997. This new format is used to present the outcome of in-hospital cardiac arrest in Middlemore Hospital, Auckland, NZ, between June 1995 and June 1996. The in-hospital Utstein Style was generally easy to follow, but there were several areas where adjustments may be of benefit. The study shows that there were 140 true arrest calls during this period, with 133 attempted resuscitations. Forty-seven patients had ROSC greater than 24 h, 35 were discharged alive and 30 were alive at 1 year. Of these 30 survivors, 27 had a Cerebral Performance Category of 1.

Cardiopulmonary Resuscitation↗
PubMed1998

Comparison of epidural bolus administration of 0.25% bupivacaine and 0.1% bupivacaine with 0.0002% fentanyl for analgesia during labour.

We have compared analgesia during labour provided by two epidural drug regimens, in a double-blind, randomized, controlled study. Group A received 10-ml bolus doses of 0.1% bupivacaine with fentanyl 2 micrograms ml-1 while group B received 0.25% plain bupivacaine 10 ml. Analgesia provided by both techniques was similar, but women in group A retained motor power in their legs and 60% chose to get out of bed. Duration of labour and time from insertion of the epidural to delivery was similar in both groups, but in group A, duration of the second stage was significantly shorter (P = 0.0003; 95% confidence interval (CI) -1.17, -0.27 h) and the incidence of forceps delivery was lower (P = 0.032). Maternal satisfaction with epidural analgesia, as assessed by VAS, was higher in group A (P = 0.04; 95% CI -0.001, 10.001).

Analgesia, Epidural↗
PubMed1997

Combined spinal-extradural anaesthesia for preterm and term caesarean section: is there a difference in local anaesthetic requirements?

In a non-blinded observational study, we have tested the null hypothesis that there is no difference in local anaesthetic requirements for subarachnoid anaesthesia between women presenting for Caesarean section at term or preterm (38-42 and 28-35 weeks' gestation, respectively). Using a combined spinal-extradural technique, 2.25 ml of 0.5% hyperbaric bupivacaine was given, in the sitting position, to 50 women presenting for Caesarean section. In 21 of 25 preterm women, adequate sensory block for surgery did not develop (P < 0.001) and they required supplementary extradural local anaesthetic (median 8 ml of 2% lignocaine with 1:200,000 adrenaline (interquartile range 4-12 ml)); preterm women not requiring extradural supplementation were at the upper end of the gestational range. There was a strong linear correlation between increasing gestation and block height in the preterm group (Spearman rank correlation coefficient = 0.74; 95% confidence intervals 0.49, 0.88). All women in the term group developed adequate anaesthesia with the subarachnoid dose alone. Onset of anaesthesia was slower in the preterm group (median 15 vs 5 min) with a lower incidence of hypotension (P = 0.0005).

Adult↗
PubMed1995

Cigarette smoking and free radical activity in young adults with insulin-dependent diabetes.

Cigarette smoke is potentially capable of generating a high free radical load in the body and many patients with diabetes are smokers. This study was designed to investigate the relationship between long-term smoking and free radical activity in young adult insulin-dependent diabetic patients with no evidence of macrovascular disease. Eight-five patients (48 male) aged 17-40 years were studied. Mean duration of diabetes was 10.5 years (0.08-33) and 39 were cigarette smokers. All had normal serum creatinine levels. The free radical markers measured were: thiobarbituric acid reactive substances, glutathione peroxidase, and superoxide dismutase. No significant differences in thiobarbituric acid reactive substances, glutathione peroxidase, or superoxide dismutase, were found between the diabetic smokers and non-smokers. Also no difference was found comparing the diabetic patients with 40 non-diabetic control subjects (20 smokers). Persistent albuminuria was present in 16 patients (10 microalbuminuria) and free radical marker concentrations in these subjects were similar to the normoalbuminuric patients. This data suggests that any increase in free radical activity due to cigarette smoke is adequately scavenged in young adults with diabetes who are free of significant macrovascular disease.

Adolescent↗
PubMed1994

Simpson-Golabi-Behmel syndrome: disproportionate fetal overgrowth and elevated maternal serum alpha-fetoprotein.

Simpson-Golabi-Behmel (SGB) syndrome is an X-linked condition with pre- and postnatal overgrowth, characteristic facies, and visceral and skeletal anomalies. We report an affected male who presented at 16 weeks' gestation with elevated maternal serum alpha-fetoprotein (MSAFP). Fetal measurements at 20 and 31 weeks' gestation were disproportionate, with marked macrosomia but a low head to abdominal circumference ratio and normal femur length. Fetal overgrowth with elevated MSAFP may prove to be useful markers for the prenatal diagnosis of SGB syndrome.

Abnormalities, Multiple↗
PubMed1993

A real headache.

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Adrenal Gland Neoplasms↗
PubMed1992

Renal acidosis, thyroiditis, hemolytic anemia: an autoimmune link?

Distal renal tubular acidosis (DRTA) is characterized by a urine of inappropriately high pH in the presence of a metabolic acidosis. Female patients with DRTA may have associated autoimmune disorders. We have described a patient with DRTA, followed by acute thyroiditis and autoimmune hemolytic anemia within 2 years. This combination of autoimmune diseases has not been described previously. These conditions are likely linked by an autoimmune pathogenesis. Clinicians are advised that some patients with DRTA may subsequently have features of any autoimmune disorder as the natural history of the disease.

Acidosis, Renal Tubular↗
PubMed1987

A lethal multiple pterygium syndrome with apparent X-linked recessive inheritance.

We describe three male fetuses with a lethal multiple pterygium syndrome (LMPS). The family was ascertained when the first pregnancy of healthy, unrelated Scottish parents ended with a miscarriage at 23 weeks gestation. The macerated male fetus had a cystic hygroma, cleft palate, and webbing of the neck, elbows, and thighs. Radiographs showed lack of modeling of long bones, with broad ribs and clavicles, hypoplastic radii and ulnae, abnormal jaw angle, and dislocated femoral heads. Two other fetuses with similar anomalies were born to a first cousin of the propositus. These three male fetuses with a similar lethal multiple pterygium syndrome born to mothers who are second-degree relatives through the female line suggest X-linked recessive inheritance of LMPS in this family.

Abortion, Induced↗
PubMed1984

AIDS on Trinidad.

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Acquired Immunodeficiency Syndrome↗