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Biomedical subjects

D A Watters

Publications and source records attributed to D A Watters.

At least 55 records · Page 3Linked to original sources
PubMed1990

Strength of the colon wall in diverticular disease.

Studies of the aetiology of diverticular disease of the colon have been focused on intraluminal pressure for almost three decades. It is only relatively recently that the mechanical properties of the wall of the colon have been examined. The tensile strength and elasticity of the colon decline with age and this is the most marked in the left colon which is the narrowest and thickest part. This review discusses the case that the mechanical properties of the bowel wall are key factors in the development of diverticular disease. The potential role of high fibre diets in reducing the pressure changes which may stress the colon wall in this disease is also considered.

Aging↗
PubMed1990

Central venous pressure monitoring for the critically ill in Zambia.

The safety and value of central venous pressure (CVP) monitoring in 100 critically ill patients in Zambia was studied prospectively. There were six complications related to insertion, the only serious one being a hydrothorax which was recognized and treated. One patient developed catheter-related septicaemia. CVP measurement altered proposed fluid management in 19 cases, determined management in 31 in whom fluid status was uncertain and confirmed fluid therapy in 50. Additional benefits of central venous catheterization were drug infusion in 33 patients and venous access in 53. Technical problems during monitoring occurred in 54 cases and were due to kinking of the catheter, blockage or inadvertent removal. In our circumstances the risks of cannulation of central veins seem justified in selected patients but good nursing supervision of patients is necessary.

Adolescent↗
PubMed1989

A clinical sickness score for the critically ill in Central Africa.

Scoring systems provide a means for comparing results, ensuring consistent standards and evaluating changes in therapy. The APACHE II system depends partly on the results of laboratory tests which are not normally available in Central Africa. The aim of this study was to develop a scoring system based only on clinical observations. Six hundred and twenty-four consecutive admissions to the intensive care unit (ICU) were allocated a clinical sickness score (CSS) according to pulse rate, blood pressure, respiration rate, urine output, Glasgow Coma Scale, temperature and age. CSS was significantly associated with outcome, there being no significant difference between actual and predicted outcomes calculated by logistic regression analysis. There was a significant difference between mean scores for survivors and non-survivors in all diagnostic groups except diabetes. The proportional change in score from admission was also significantly associated with outcome on each subsequent day in ICU. The CSS provides an objective measure of illness severity for critically ill patients in Africa.

Developing Countries↗
PubMed1989

Non-traumatic coma in Zambia.

A series of 170 patients with non-traumatic coma seen over a 16-month period is reported. The Glasgow coma scale significantly correlated with outcome (P less than 0.001). The diagnosis was also important in determining outcome. Hospital mortality was lowest in patients with cerebral malaria (22.7%), eclamptic coma (36.4%), and organophosphorous poisoning (30.4%). A diagnostic approach to non-traumatic coma is outlined and the management of the different causes is discussed. Most hospitals in tropical Africa should be able to diagnose up to 90% of cases with non-traumatic coma and simple therapy is likely to be effective in the majority of cases.

AIDS Serodiagnosis↗
PubMed1988

Outcome of mechanical ventilation in Central Africa.

The outcome of mechanical ventilation is reported in a prospective series of 200 patients managed in an intensive care unit in Zambia. Fifty two patients survived (26%), and 46 patients were subsequently discharged from hospital (23%). Ten patients died in whom a complication of ventilation was a factor. Patients not expected to survive by the authors had a 96.3% mortality whereas patients with a chance of survival had a mortality rate of 58.8%. Two diagnostic groups were found to have a high mortality: head injury (85.1%) and non-traumatic coma (76.4%). This series is compared with similar series from developed countries and recommendations are made for the institution of mechanical ventilation in the developing world.

Coma↗
PubMed1987

Training doctors and surgeons to meet the surgical needs of Africa.

An audit of the operations performed and the use of anaesthesia over one year at the University Teaching Hospital, two provincial hospitals, and five district or church hospitals in Zambia was carried out. The aim of the audit was to determine what proportion of operations required full surgical training and to collect information on which recommendations for training surgeons in central Africa could be based. Of the 21,245 operations performed, 18,401 (86.4%) were found not to be complex, and the procedures could be taught to non-surgeons. General anaesthesia was used often, but if more doctors were trained to give local and regional anaesthesia more necessary surgery could be performed.

Africa↗
PubMed1985

Nutritional parameters in urban and rural Zulus.

Anthropometric, biochemical and haematological nutritional parameters were measured in 103 (65 men, 38 women) Durban Zulu adults (urban) and 109 (41 men, 68 women) Tugela Ferry Zulu adults (rural). Men conformed to an ideal weight for height whereas women were 18% overweight in Tugela Ferry and 30% so in Durban. Mean arm muscle circumference in men was between the 10th and 20th centiles. Other nutritional parameters were similar to those accepted internationally as normal. In particular the serum albumin level was normal in both urban and rural Zulus. There was little change in the parameters with age except that hand grip as measured by dynamometry fell with age (P less than 0,05). Serum albumin levels fell with age in women (P less than 0,01) but not in men. Nine mothers of babies suffering from kwashiorkor showed normal nutritional profiles.

Adolescent↗
PubMed1985

Nutritional assessment by hand grip dynamometry.

Hand grip dynamometry was studied in 109 normally nourished and 26 malnourished patients. The grip strength was 37,5 +/- 9,9 kg/m2 in normal men, 30,5 +/- 14,4 kg/m2 in men with carcinoma of the oesophagus (starvation-adapted) and 22,0 +/- 9,2 kg/m2 in catabolic men (P less than 0,001). Normal women had a grip strength of 31,6 +/- 7,5 kg/m2 compared with 22,3 +/- 7,0 in catabolic women (P = 0,083). Hand grip dynamometry fell with age (r = 0,69 men; r = 0,57 women), although the correlation was only statistically significant in women (P less than 0,05). There was a strong correlation between right and left hand grip (r = 0,84 men; r = 0,86 women), but hand grip did not correlate well with other indices of nutritional status. Although hand grip dynamometry is a quick, easy and reproducible test, and grip strength is reduced in malnutrition, it cannot replace other tests of nutritional status.

Adolescent↗
PubMed1985

Total parenteral nutrition by peripheral venous infusion in patients with oesophageal carcinoma.

The safety and efficacy of pre-operative intravenous feeding using a peripheral venous infusion technique was evaluated in 15 black patients with oesophageal carcinoma. Energy requirements were based on individual energy expenditure at rest calculated from oxygen consumption and the respiratory quotient. Patients received 7 600 non-protein kJ and 9,4 g nitrogen daily for 14 days. Although no measurable improvements in nutritional status were noted after intravenous feeding, peripheral venous alimentation using the dual energy system proved an effective method of preventing progressive weight loss and depletion of the lean body cell mass. The infusion technique was safe and without serious metabolic or infectious complications. Total parenteral nutrition by peripheral venous infusion is a viable alternative to the central venous approach in patients with oesophageal carcinoma when their clinical and metabolic status demands early establishment of a positive nitrogen balance.

Adult↗
PubMed1985

Mechanical properties of the rat colon: the effect of age, sex and different conditions of storage.

The mechanical properties of the rat colon were studied in old and young Sprague-Dawley rats which were also grouped by sex. Different storage media were used. Rings of colonic tissue were submitted to pulls on an Instron 1026 tensiometer. Gender did not affect the properties of the young rat colon. The rat colon has a tensile strength of around 50 g/mm2 (which places it between the dog and the cat). It increased in strength from proximal to distal, though the rectum was weaker than the colon. The pre-strain of the rat colon was 10% and it was capable of stretching to 200% of its original dimensions. The strength and ability to stretch fell with age, although it initially increased, in the first year of life. Physiological saline at 4 degrees C preserved the burst strength, percentage elongation, hysteresis and Young's modulus between 25 and 100 g stress for up to 1 week. Young's modulus between 125 and 200 g fell progressively with each day of storage. Stress relaxation rose in the first 24 h and thereafter remained constant. Salt appeared to be a good long-term storage medium. Irradiation of the colons before storage did not affect the mechanical properties.

Animals↗
PubMed1985

Mechanical properties of the colon: comparison of the features of the African and European colon in vitro.

The tensile properties of the colon have been examined using methods which gave repeatable results. They showed little change after storage in salt for up to five weeks. The burst strength remained unchanged along the length of the colon. The tensile strength fell distally, as the thickness of the colonic wall increased. The width at burst decreased distally as did the internal diameter. The visco-elastic property of stress relaxation was constant in all regions. The tensile property of the colon was well developed at birth, but fell with age as did the width at burst and the internal diameter. Stress relaxation was unaffected. Because there may be a mechanical abnormality of the colonic wall in diverticular disease and as Europeans are prone to this condition while Africans are not commonly affected, European and African colons were compared. The tensile strength in a Kampala group was greater than in an Edinburgh one, but fell significantly in both groups with age. The width at burst was greater in the Kampala group, but also declined with age. Stress-relaxation was similar in both groups. In view of the similar properties in childhood of colons from Edinburgh and Kampala, the strength of the adult African compared with European colons may derive later from environmental factors such as diet. There were, however, no differences between the colons with and without diverticular disease in European subjects over the age of 50 years.

Adolescent↗