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Biomedical subjects

B Williams

Publications and source records attributed to B Williams.

At least 379 records · Page 21Linked to original sources
PubMed1990

How to do an ROI (return on investment).

More and more hospitals are looking to automation through the use of medical information systems to support the achievement of increased profitability for the hospital. Those hospitals who are serious about the acquisition of such systems use return on investment (ROI) analysis as a tool to determine the projected level of profitability improvement offered by planned information systems. The potential level of savings varies widely among the many systems available on the market today. Those systems that have the greater depth of applications and most importantly are designed for direct usage by hospital professionals such as doctors and nurses yield the highest level of savings and profitability. The analysis and examples discussed in this article are based on the use of such a comprehensive medical information system.

Capital Expenditures↗
PubMed1990

Syringomyelia.

Fluid cavities extending beyond several segments within the spinal cord comprise a pathologic entity that is not a disease, but a condition with many possible causes. Hindbrain herniation with or without associated arachnoid thickening is the most common cause, followed by spinal arachnoiditis, especially with paraplegia and also intraspinal tumors. The presentation may be variable, particularly in the hindbrain-related cases, and the final clinical picture is convergent because the pattern of destruction of the cord is determined by planes of weaknesses. It is almost always a surgical condition. The destructive forces are those of fluid cutting into the tissues, and expeditious and careful surgery is often successful, particularly if practiced early. The surgery should be planned to deal with raised CSF pressure and hydrocephalus, then the likely filling mechanism. Suck, the development of pressure differences acting over several seconds and deforming parts of the neuraxis such as a HBH, may provide a filling mechanism. Slosh, the impulsive rapid movement of CSF within the syrinx, both upward and downward, provides a continuing destructive force and may also be partly responsible for filling. Drainage of the syrinx may be a useful supplementary procedure and is conveniently combined with operation on the nonhindbrain-related cases. Drainage in these cases should not usually be at the widest part of the syrinx, tempting though that may be, but should be combined, where possible, with an attempt to correct the filling mechanism present at the site of the pathology. The ideas in this article are simple, but the surgical management of the various problems is not easy. The syringomyelic cord is fragile, neurologic losses are likely to be permanent, as are orthopedic problems such as Charcot's joints and kyphoscoliosis. Future management problems will include cases in which HBH or syringomyelia comes to light as an unexpected finding on MRI. If neurologic deficits are allowed to develop, they are likely to be irreversible and permanently affect the patients.

Cerebrospinal Fluid Pressure↗
PubMed1990

Adrenal dysfunction in patients with renal amyloid.

Amyloidosis is a multi-system disease. Renal involvement often leads to end-stage renal failure, which carries a poor prognosis. This paper reports the adrenal status of 22 patients with renal amyloid who were considered for or who had been commenced on renal replacement therapy. Twelve patients were considered or found to have AA amyloid and the remaining 10 had AL amyloid. Of 16 patients tested, seven demonstrated an abnormal response to a synacthen test. Four patients died at Addisonian crisis and hypo-adrenalism probably contributed to the deaths of a further two patients. Amyloid deposition was found in the adrenal glands in seven patients who died of systemic amyloidosis and renal failure. It is recommended that all patients with renal amyloid should have an assessment of adrenal function performed and if abnormal replacement steroid therapy should be commenced.

Adrenal Gland Diseases↗
PubMed1990

Who might I have been?

We can consider ways in which a given individual, A, might have been different. In many cases such thoughts indeed preserve the identity of A: he might have been born in France, for example if his mother, pregnant with him, had gone to France. But the thought that he might have had different parents altogether (i.e. different from the ones he actually had) seems no longer a thought about A: we are now considering a different person. What underlies this common-sense distinction? An influential view is that the identity of an individual is given by the particular gametes from the union of which that individual is formed. The paper considers: (a) the motivation of the view; (b) its consequences, particularly for population policy, in utero damage and genetic defects, and rights which are possibly associated with these matters; and (c) its problems, particularly with genetic repair and monozygotic twinning. The paper discusses the merits and the dangers of supposing that the common-sense distinction is conventional or baseless; and the related question whether increased understanding of the genome should make us think in terms of types rather than individuals.

Humans↗
PubMed1989

A longitudinal study of the prevalence of voice disorders in children from a rural school division.

In a mass screening of children ages 6-10 in a rural school division, 203 children were identified as showing a voice deviation. One year later a retesting of 178 of these children showed that 39.9% still showed a voice disorder. Four years later 50 of these children were still available in the same school system; 38% of them still showed a voice disorder. Virtually none of these children were referred to the otolaryngologist for an ENT evaluation or to the speech-language pathologist for voice rehabilitation. Results indicate that, for many of these children, the voice disorders do not "clear up" through maturation alone.

Child↗
PubMed1989

Molecular cloning and sequencing of cDNAs encoding the entire rat fatty acid synthase.

Overlapping cloned cDNAs representing the entire sequence of the rat fatty acid synthase mRNA have been isolated from a cDNA library and sequenced. Authenticity of the cDNA clones was supported by hybridization to fatty acid synthase mRNA and by amino-terminal sequencing of 39 fatty acid synthase CNBr fragments. The full-length fatty acid synthase mRNA is 9156 nucleotides long and includes an 84-nucleotide 5' noncoding region, a 7515-nucleotide coding sequence, and a 1537-nucleotide 3' noncoding region; a second mRNA species containing a shortened 3' noncoding sequence is also transcribed in the rat. The encoded fatty acid synthase subunit contains 2505 amino acids and has a molecular weight of 272,340. Active sites and substrate binding sites were located within the sequence, thus establishing the order of domains on the multifunctional animal fatty acid synthase as condensing enzyme-transferase-dehydrase-enoyl reductase-ketoreductase-acyl carrier protein-thioesterase.

Amino Acid Sequence↗
PubMed1989

The use of calcium carbonate to treat the hyperphosphataemia of chronic renal failure.

This study evaluates the use of calcium carbonate in chronic renal failure. Forty-eight patients (25 male, 23 female, mean age 54.3 years, six pre-dialysis. 12 CAPD, 30 haemodialysis) on phosphate restriction and requiring aluminum hydroxide (mean 2.4 +/- 0.8 g/day) to control serum phosphate, were converted to an equivalent dose of calcium carbonate (2.5 +/- 0.6 g/day). None received vitamin D analogues. Three months post-conversion there was a significant decrease in mean (+/- SEM) serum phosphate (1.86 +/- 0.08 versus 1.66 +/- 0.05 mmol/l P less than 0.01) and serum aluminum (28.3 +/- 5.4 versus 13.2 +/- 3.0 micrograms/l, P less than 0.0001): calcium/phosphate product was unchanged. Post-conversion there was an increase in serum bicarbonate, (20.6 +/- 0.5 versus 22.1 +/- 0.6 mmol/l, P less than 0.01) and serum calcium (2.32 +/- 0.02 versus 2.45 +/- 0.03 mmol/l, P less than 0.0001). No change in serum creatinine, alkaline phosphatase or parathormone occurred. No adverse effects were reported but nine (18%) patients became hypercalcaemic (2.7 to 2.93 mmol/l), eight of whom responded to dose reduction. Hypercalcaemia did not correlate with pre-conversion serum calcium, parathyroid hormone, alkaline phosphatase or aluminium. Calcium carbonate is an effective alternative to aluminium-based phosphate binders. It produces a beneficial increase in serum calcium and bicarbonate and a significant decrease in serum aluminium. Hypercalcaemia is unpredictable but is easily reversible in the majority of patients.

Administration, Oral↗
PubMed1989

Does increasing haemoglobin concentration and haematocrit have a pressor effect in dialysis patients?

The haemodynamic consequences of differing rates of rise of haemoglobin and haematocrit in haemodialysis and CAPD patients were examined. Pre-dialysis mean arterial pressure, weight and haematological indices were recorded in 100 established haemodialysis patients prior to a 2-unit blood transfusion and repeated, pre-dialysis, within 1 week. Haemoglobin rose from 6.7 +/- 0.2 to 9.3 +/- 0.1 g/dl, weight was unchanged, and there was a small fall in mean arterial pressure. Similar indices were recorded, including the mid-arm circumference (MAC) in 100 CAPD patients 1 month after starting CAPD and at the time of maximum haemoglobin within the first year. Haemoglobin rose from 8.5 +/- 0.1 to 10.7 +/- 0.1 g/dl, weight increased slightly, but there was no change in MAC: weight ratio and there was a small fall in mean arterial pressure. In neither group was there a change in antihypertensive medication. In conclusion, increasing the haemoglobin concentration and haematocrit of dialysis patients within the range described in this study did not promote elevated blood pressure.

Adult↗
PubMed1989

Estimates of general practitioner workload: a review.

This paper reviews four studies sponsored by the Department of Health which have attempted to measure workload in general practice and compares these with data from the general household survey. Despite the considerable differences in the objectives and methods employed by the four studies, they were found to contain remarkably consistent measurements of general practitioner workload. In a 'normal working week' general practitioners spend 38 hours on general medical service duties (including 24 hours of patient contact and five hours of travel to home visits), they see 150 patients or their representatives in surgery, and make 26 home visits. In an 'annual average week', taking into account holidays and sick leave, general practitioners undertake 90% of this workload. The studies show consistently large variations in the workload of general practitioners measured in this way, but fail to identify the key determinants of such variations. The reasons underlying the variation in general practitioner workload will remain unclear until we can distinguish between the expected, measurable variation and the residual, unexplained variation which may be due to the personal preferences of general practitioners.

Appointments and Schedules↗
PubMed1989

Palmar shelf arthroplasty in the rheumatoid wrist. Results of long-term follow-up.

Sixty-three palmar-shelf arthroplasties (so-called pseudofusions of the wrist) that had been performed between 1970 and 1978 in forty-nine patients were evaluated. The length of follow-up averaged eighty-three months (minimum, twelve months for the wrists that fused and twenty-four months for those that did not). Preoperatively, all wrists were painful, with 96 per cent being moderately or severely so. Carpal subluxation was present in 79 per cent of the wrists. Postoperatively, pain recurred in 84 per cent of the wrists, but it was less severe (mild in 48 per cent, moderate in 35 per cent, and severe in 2 per cent). Sixty-eight per cent of the wrists fused spontaneously and were no longer painful. Of the twenty wrists (32 per cent) that did not fuse, 70 per cent were mildly or moderately painful. In patients who have rheumatoid arthritis, we found that palmar shelf arthroplasty was followed by a high rate of delayed spontaneous fusion and an unacceptably high rate of recurrent pain, although the pain was less severe.

Arthritis, Rheumatoid↗
PubMed1988

Do young patients with dyspepsia need investigation?

During 1986, 1386 patients with simple dyspepsia were referred by general practitioners for endoscopy (686) or double-contrast barium meal examination (700) at Leicester General Hospital. 618 (45%) were under the age of 45 years. Abnormal findings were more common in older than younger dyspeptic patients (58% vs 40% at endoscopy, 69% vs 25% by barium meal). Malignant disorders were diagnosed in 5% at endoscopy and 3% at barium meal, but in no patient under 45 years old. The incidence of malignant disorders at endoscopy was analysed for the 6 years 1980-86. Of 707 cases identified, only 13 (1.8%) occurred in patients under 45 years old; all 13 had symptoms suggesting pathology more serious than simple dyspepsia. It can be concluded that young patients with simple dyspepsia are overinvestigated. A majority can be treated safely with antacids and/or histamine receptor type 2 antagonists.

Adult↗
PubMed1988

Regional and temporal variation in oscillatory blood flow in sickle cell disease.

We examined 55 patients with sickle cell anemia (HbSS) and 16 with hemoglobin SC disease (HbSC) to ascertain the presence of periodic microcirculatory flow (PMF) using laser-Doppler velocimetry. Forty-nine percent of patients with HbSS and 12.5% of HbSC patients had PMF on at least one occasion and in at least one site. The presence of PMF could be correlated with an increase in packed cell volume (PCV) and hemoglobin in individuals with HbSS and an increased white blood cell and platelet count in patients with HbSC. PMF may result from complex interactions among perfusion pressure, capillary tone, and the numbers and intrinsic properties of formed blood elements.

Anemia, Sickle Cell↗
PubMed1988

Spumaviruses isolated from sources containing agents of non-A, non-B (NANB) hepatitis do not cause NANB hepatitis.

Serum and liver tissue containing infective non-A, non-B hepatitis virus were shown to contain a retrovirus-like agent that replicated when inoculated into chimpanzee liver cell cultures in vitro. The virus appeared to assemble its core particles in association with tubular structures reminiscent of those characteristically seen in non-A, non-B hepatitis virus-infected chimpanzee liver in vivo, and produced syncytial cytopathic effects in a number of continuous and a primary mammalian liver cells. The agents were neutralized by acute and convalescent sera from human and chimpanzee cases of non-A, non-B hepatitis, as well as by antisera against simian spumavirus type 7, but not type 6. Aluminum chloride failed to abolish viral infectivity. There was no evidence of virus replication or hepatitis in chimpanzees inoculated with a seventh passage of one of the isolates. Thus the data suggest that the isolates are not causally related to non-A, non-B hepatitis, as was previously postulated.

Aluminum↗