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Biomedical subjects

C S Thomas

Publications and source records attributed to C S Thomas.

At least 19 recordsLinked to original sources
PubMed1992

New Zealand suicides 1984-8.

AIMS: to determine regional differences in suicide with special attention to inpatients and prisoners. METHODS: all cases of suicide 1984-8 were identified from coroners' register and age, sex, method of suicide, date of death, place of inquest, occupation and prisoner or inpatient status were recorded. RESULTS: between 1984 and 1988 there were 2019 suicides. Subjects were usually male and hanging was the commonest method of achieving death. Northland-Auckland had the highest regional suicide rate and the highest prison suicide rate; and Wellington-Wairarapa had the lowest regional suicide rate, the lowest prison suicide rate but the highest inpatient suicide rate of the five regions studied. CONCLUSIONS: the high regional and prison rates of suicide in Northland-Auckland were probably because the largest city in New Zealand lies within its boundaries. The high inpatient suicide rate in Wellington-Wairarapa could not be explained by the regional rate, nor by controlling for the number of admissions. This pointed to regional differences in the delivery of psychiatric care.

Adult↗
PubMed1992

Videothoracoscopy: improved technique and expanded indications.

Current videoendoscopic technology and percutaneous techniques of exposure and dissection have been successfully applied to abdominal surgery with favorable results. Application of this technology to our practice of thoracoscopy is the basis of this report. Videothoracoscopy has been performed in 39 patients for the following indications: chronic pleural effusion, interstitial lung disease, mediastinal lymphadenopathy in lung cancer, persistent air leak after decortication, mediastinal mass, recurrent spontaneous pneumothorax, hydropneumothorax with persistent air leak, and pleural-based mass. The technique we employ includes lateral decubitus positioning and double-lumen endotracheal intubation with ipsilateral lung collapse. The videoscope, retractors, and instruments are introduced through separate 10-mm incisions. Percutaneous manipulation of instruments and the videoscope is guided by images produced on television screens without dissection, and if resection is performed, the incision is enlarged to allow specimen retrieval. Procedures performed using this technique include pleural biopsy, partial pleurectomy, lysis of adhesions, lung biopsies, staging lymph node biopsy, lung nodule biopsy, pleural-based mass resection, and mediastinal mass biopsy and resection. This videoendoscopic technique greatly improves visualization of thoracic anatomy, facilitating thoracoscopy and enhancing exploration of the chest. It is preferred over conventional thoracoscopy and, in some patients, reduces the magnitude of operation by avoiding thoracotomy.

Adult↗
PubMed1992

Assessment of impaired left ventricular diastolic function in patients with coronary artery disease, using radionuclide angiography.

Left ventricular (LV) diastolic filling at rest was assessed in 76 patients with coronary artery disease (CAD) and 16 healthy subjects using radionuclide angiography. Peak LV filling rate (PFR), expressed in end diastolic volume per second (EDV/sec), was subnormal in CAD patients (1.95 +/- 0.51 as compared to the normal 3.11 +/- 0.36, P < 0.001) and time to PFR (TPFR) was prolonged (171.1 +/- 79 msec versus 106.6 +/- 25 msec normal, P < 0.001). These indices were also abnormal in 60 patients with normal resting LV ejection fraction (PFR 2.17 +/- 0.48 EDV/sec, TPFR 163.9 +/- 68 msec). Abnormal LV filling at rest (PFR EDV/sec or TPFR 160 msec) was found in 88 percent of all patients with CAD, 85 percent of patients with normal resting LV ejection fraction, and 83 percent of patients without Q waves on resting electrocardiogram. Thus, LV diastolic filling, evaluated non invasively by radionuclide angiography, appears to be abnormal in a high percentage of patients with CAD independent of LV systolic function or previous myocardial infarction.

Adult↗
PubMed1992

Confidentiality in clinical psychiatry.

A brief history of the central role of confidentiality in the doctor-patient relationship is presented. Emphasis is placed on the positions of the American Medical Association and World Medical Association. The dilemma posed by the requirement of balancing the rights of the patient against those of society is portrayed. Particular attention is paid to the role of technology and mass society in exacerbating this tension, and the differences between the rights of confidentiality and those of privilege are offered. Recent court cases are cited to illustrate five legal theories to which a patient can resort in alleging damages for the inappropriate disclosure of confidences, as are others in an effort to show the directions in which American courts are heading. Several suggestions are offered to the clinician in dealing with confidentiality.

Codes of Ethics↗
PubMed1991

Prophylaxis of atrial fibrillation with magnesium sulfate after coronary artery bypass grafting.

Ninety-nine consecutive consenting patients were prospectively entered into a randomized, double-blind, placebo-controlled trial to determine the efficacy of postoperative magnesium therapy on the incidence of cardiac arrhythmias after elective coronary artery bypass grafting. No patient had documented or suspected arrhythmias preoperatively. Forty-nine patients received 178 mEq of magnesium given over the first 4 postoperative days, and 50 patients received only placebo. The clinical characteristics of both groups were similar. The preoperative mean serum magnesium concentration was similar in both study (1.90 mEq/L) and placebo (1.90 mEq/L) groups. The mean postoperative serum magnesium concentration in study patients was significantly elevated over postoperative days 1 through 4 when compared with preoperative levels (p less than 0.001). The postoperative mean serum magnesium concentration in control patients declined and remained significantly depressed through postoperative day 3 (p less than 0.001), but increased to preoperative levels by postoperative day 4. The mean serum magnesium concentration was significantly greater in the study patients as compared with the control patients over postoperative days 1 through 4 (p less than 0.001). Although there was no significant difference between groups with respect to episodes of ventricular arrhythmias, there was a significant decrease in the number of episodes of atrial fibrillation in the group receiving magnesium therapy (p less than 0.02). There were no recognized adverse effects of magnesium therapy. Prophylactic magnesium administration seems to lessen the incidence and severity of atrial fibrillation after coronary artery bypass grafting.

Adult↗
PubMed1991

Internal mammary artery graft at reoperation: risks, benefits, and methods of preservation.

To determine the effect of a prior internal mammary artery (IMA) graft on coronary artery bypass reoperation (CABR), we reviewed our experience with 410 consecutive patients: 313 received only saphenous vein grafts at initial coronary artery bypass grafting (CABG), and 97 received at least one IMA graft at CABG. Cardiac catheterization data before CABG were available in 110 patients (56 received only saphenous vein grafts, 54 received at least one IMA graft), allowing comparison of left ventricular function at CABG and CABR. Injury of the IMA graft occurred in 5 patients (1 death), but presence of an IMA graft was not an independent predictor of morbidity or mortality. Overall, the incidences of complications and deaths were higher in patients with saphenous vein grafts than in patients with IMA grafts, though not significantly so. Internal mammary artery grafts better preserved cardiac function: patients with IMA grafts had worse left ventricular function before CABG but better left ventricular function before CABR than patients with saphenous vein grafts. Left ventricular function deterioration from before CABG to before CABR was significantly less in patients with IMA grafts. We conclude that the risk of CABR is not increased by a previously constructed IMA graft and that left ventricular function is better preserved at CABR when an IMA graft was constructed at the initial operation.

Confounding Factors, Epidemiologic↗
PubMed1991

Association between cigarette smoking and coronary arterial disease in patients in India: how quantitative is it? An assessment by selective coronary arteriography.

With a view to study the association between smoking and coronary arterial disease, and to identify any quantitative relationship, we undertook a cross sectional analysis of 1105 consecutive male patients investigated by selective coronary arteriography to confirm or exclude coronary arterial disease. Pattern and distribution of disease were evaluated in 3 groups of patients who never smoked; who smoked less than 5 cigarettes per day; and who smoked 6 to 60 or more cigarettes per day. Suitable statistical tests, including adjusting for confounders, were carried out. The prevalence of disease was higher amongst smokers even after adjustment for confounders. The number of cigarettes smoked, and whether the smokers had quit, made no difference to the angiographic appearance or extent of disease. There was no difference in the distribution and severity of disease amongst smokers and non-smokers. Rate ratio of disease amongst smokers in India was higher in those patients between 26 and 45 years of age than in other age groups. Smoking could be identified as a risk marker/risk factor that accelerated the disease process in those prone to develop the disease. It may be advantageous to initiate public health and preventive measures directed specifically at the group aged between 26 to 45 years, and later to address all others who smoke.

Adult↗
PubMed1991

The management of confidentiality in Egypt.

Patient confidentiality is an important issue for treating clinician regardless of the cultural background. Though cultural and religious issues may have an impact on the confidentiality standards. This article discusses the confidentiality standards in Egypt citing the laws and ethical codes governing them. This is followed by a research study in which a questionnaire containing ten vignettes representing different common themes confronted by the practicing clinician was completed by forty-one Egyptian psychiatrists. They checked off categories representing alternatives they might choose dealing with the themes. Each respondent received a score. The scores were compared with those of American and Israeli psychiatrists who participated in a similar study. There were no statistically significant differences though Egyptian and Israeli psychiatrists appear to be somewhat more inclined to break confidentiality. However, significant differences were found to exist for some of the vignettes between the three groups.

Adult↗
PubMed1989

Severity of withdrawal in subjects exposed to a combination of alcohol and minor tranquillisers.

Fifty patients suffering from the alcohol dependence syndrome were detoxified over a 10-day period using a reducing regime of chlordiazepoxide. Twenty-four had been consuming minor tranquillisers together with alcohol prior to admission. The severity of the withdrawal syndrome was assessed daily but no differences were found between the 26 who had taken alcohol alone and the 24 who had taken a combination of alcohol and drugs. Four from each group had a transient hallucinosis and none had fits.

Adult↗