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Biomedical subjects

A Williams

Publications and source records attributed to A Williams.

At least 559 records · Page 31Linked to original sources
PubMed1985

Economics of coronary artery bypass grafting.

To decide whether the number of operations for coronary artery bypass grafting should be increased, maintained at the present levels, or decreased we need to know how cost effective they are relative to other claimants on the resources of the National Health Service. For this purpose effectiveness is taken to be the effect on life expectancy adjusted for the quality of life. In an assessment of the cost per quality adjusted life year gained coronary artery bypass grafting rates well for cases of severe angina and extensive coronary artery disease. The cost, however, rises sharply for less severe cases. Bypass grafting seems to compare favourably with valve replacement for aortic stenosis and implantation of pacemakers for heart block; it is distinctly better than heart transplantation and the treatment of end stage renal failure but is probably less cost effective than hip replacement. If the number of operations for coronary artery bypass grafting were to increase it would be a fairly strong claimant only if restricted to the most severe cases. The data on which these judgments are based are crude and in need of refinement. The methodology is powerful, far reaching, and open to comment.

Angioplasty, Balloon↗
PubMed1985

Inborn alcoholism.

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Acetaldehyde↗
PubMed1985

The nature, meaning and measurement of health and illness: an economic viewpoint.

Health can be seen as a capital asset, subject to depreciation due both to the passage of time (ageing) and to 'wear and tear'. It is valued for the flow of pain-free time and energy it offers us, and we can increase the quantity and quality of this 'flow' by appropriate care and maintenance, which may take the form of adopting a healthy life style or in seeking health care. The valuation of health (as a capital stock) can then be seen as the valuation of the time profile of the stream of pain-free time and energy we expect to get out of it. This in turn depends on the uses to which this time and energy can be put. Its use in paid work is relatively easily valued but unpaid work (especially work in the home) continues to be a source of difficulty, both in principle and in practice, in the search for appropriate money values. Leisure time is still more difficult, though for those in paid work whose remuneration is sensitive to the work/leisure balance, foregone net earnings at that margin may be used in the marginal value of leisure time. But the appropriateness of any valuation depends on the use to which it is to be put, and it is important to distinguish whether it is to reflect 'individual' or 'group' values, and whether it is for ex post compensation associated with some particular event, or for use in ex ante decision making where it is not known who the particular gainers and losers will be.

Decision Making↗
PubMed1985

When the client is pregnant: information for counselors.

This article explores the issues raised by methadone maintenance during pregnancy with a focus on intervention techniques for the drug counselor. Establishing and maintaining the appropriate dose of methadone is discussed. Prenatal care issues are reviewed and the counselor is suggested as a liaison with traditional sources of prenatal care and education. Postpartum experiences in the intensive care nursery are presented and recommendations about breast feeding offered. Specific activities are suggested for the drug program.

Adult↗
PubMed1985

The myelodysplastic syndrome: analysis of laboratory characteristics in relation to the FAB classification.

A detailed study of 43 newly diagnosed cases of myelodysplastic syndrome (MDS) shows that many of the morphological features of blood and bone marrow are common to the different FAB groups. In addition, there is no clear distinction between the groups with regard to CFU-E, BFU-E or CFU-GM colony growth in vitro or ferrokinetic assessment of erythropoiesis in vivo. The interrelationships between all the parameters we have studied have been examined and there is little correlation between erythroid colony formation in vitro, the percentage erythroblasts in the bone marrow, erythroid output measured by ferrokinetics and the peripheral blood reticulocyte count, all of which appear to measure different aspects of erythropoiesis. Reduced erythroid colony growth and a high degree of ineffective erythropoiesis in vivo are common in all groups and appear to be an early manifestation of abnormal function. Decreasing marrow iron turnover is more closely related to increasing numbers of marrow blast cells than any other index of erythropoiesis.

Adult↗
PubMed1985

Bronchopulmonary disease in coeliac patients.

This paper describes the necropsy changes in a patient with coeliac disease and respiratory disease and the pulmonary biopsies from 13 other coeliac patients with physiological evidence of a parenchymal lung disorder. Postmortem examination showed partial fibrous obliteration of small airways and dilatation of larger airways, and the biopsies suggested similar changes in the other patients. We were unable to find any evidence of granulomatous or primary interstitial lung disease.

Aged↗
PubMed1985

Disseminated cryptococcosis in a patient receiving chronic haemodialysis.

Systemic infection with Cryptococcosis neoformans is described in a young man receiving maintenance haemodialysis. The organism was identified in thin sections of a cervical lymph node using resin embedding and silver staining. There were no predisposing factors other than uraemia. His clinical infection responded to the combination of oral 5-flucytosine and a total of 2.5 g of intravenous amphotericin B. He remains free of relapse after 30 months.

Adult↗
PubMed1985

Sleep apnoea in infancy.

Serial polygraphic sleep studies were carried out in 86 index infants (33 'symptomatic', 24 siblings of infants with the sudden infant death syndrome (SIDS), 29 'near-miss' for SIDS) and 11 healthy controls. Brief (greater than or equal to 3 less than 6 sec) or prolonged (greater than or equal to 6 sec) obstructive apnoea was observed only in index caes, and coincided with symptoms due to associated illnesses (usually respiratory). Their prevalence was comparable in 'symptomatic' and 'near-miss' groups--39% and 35% respectively. Prolonged (greater than or equal to 20 sec) central apnoea was seen only in pre-term 'near-miss' infants. Dips in transcutaneous oxygen tension greater than or equal to 15 mmHg occurred during sleep in 17% of 'symptomatic' infants and 19% of 'near-miss' cases, usually in association with obstructive or central apnoea. Diminution or disappearance of these abnormalities following clinical recovery from 'minor' illnesses suggested that they were the result of such illnesses.

Electrocardiography↗
PubMed1985

Cerebral and ocular toxicity induced by desferrioxamine.

Seven patients with rheumatoid disease were given the iron-chelating drug desferrioxamine (DFX) to evaluate its possible anti-inflammatory effects. Two of these patients, who also received the anti-emetic prochlorperazine, lost consciousness for 48-72 h and then fully recovered. Electroencephalography showed abnormalities of the type associated with metabolic disturbance. One of these patients showed pyramidal features and subsequently developed an optic neuropathy and pigmentary retinopathy. Analysis of his cerebrospinal fluid showed a decrease in loosely-bound (catalytic) iron and increase in loosely-bound (catalytic) copper, total iron and products of lipid peroxidation, with values approaching normal as the symptoms resolved. Subsequent in vivo/vitro studies clearly demonstrated that the neurological effects were due to a synergistic action of desferrioxamine and prochlorperazine, probably resulting in exceptional fluxes of intra/extra cellular iron/copper disturbing noradrenergic and serotonergic systems. Two other patients who did not receive prochlorperazine, developed retinal problems which later improved, one after only 15 g of desferrioxamine. Our observations suggest a new model for metabolic encephalopathy studies and provide insight into the mechanisms of pigmentary retinopathy.

Adult↗
PubMed1984

MPTP parkinsonism.

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1-Methyl-4-phenyl-1,2,3,6-tetrahydropyridine↗
PubMed1984

Vecuronium in renal failure.

Neuromuscular blockade during surgery was provided with vecuronium in 24 adult patients in end-stage renal failure and in 21 normal patients who served as controls. Dose response curves were constructed which showed that the effective doses required to produce 50, 90 and 95 per cent neuromuscular blockade in patients with renal failure were 27.5, 43 and 49 micrograms X kg-1 respectively. These were not significantly different from the doses of 31, 49 and 57 micrograms X kg-1 in the normal patients. Repeated small doses of 0.01 mg X kg-1 had a significantly longer duration of action and were associated with some cumulation in the renal failure group. Recovery from the block occurred rapidly after neostigmine, was no different in renal failure and was not associated with recurarization. It is concluded that, when given to subjects in renal failure, vecuronium offers advantages over established agents such as shorter duration of action and easy reversibility.

Adult↗
PubMed1984

Approaches to the measurement of explanation and information-giving in medical consultations: a review of empirical studies.

Many 'sociological' and 'medical' reasons for informing and not informing patients in medical consultations have been given. This paper reviews and evaluates various empirical attempts to support arguments about the relationship between information-giving and outcomes. It suggests that more attention has been paid to examining the way information is given than to the information itself. When information has been examined this has been in relatively 'empiricist' ways, ignoring the issue as to how illuminating it might be. The paper concludes both that we know very little about the causes and consequences of information exchanged in medical consultations and that we are unlikely to do so unless different approaches are attempted.

Consumer Behavior↗
PubMed1984

Serotonin and forskolin enhance both magnitude of contraction and relaxation rate of Aplysia dorsal extrinsic muscle independently of acetylcholine receptor.

Hexamethonium bromide (Hex. Br.) blocks acetylcholine (ACh) elicited contractions but not electrically elicited contractions of isolated preparations of Aplysia californica dorsal extrinsic muscle. Serotonin (5-hydroxytryptamine, 5-HT) enhances both magnitude and relaxation rate of ACh and electrically elicited contractions. In the presence of Hex. Br., 5-HT still exhibits its modulatory effects on electrically elicited contractions. Forskolin enhances both magnitude and relaxation rate of ACh and electrically elicited contractions. Forskolin (10(-5) M) increases the cyclic AMP content of the accessory radula closer and dorsal extrinsic muscles.

Acetylcholine↗