Biomedical subjects
Publications and source records attributed to D R Small.
An integrated approach to computerising the urology department has been implemented, using a XENIX multi-user system, with 6 terminals. Standard discharge letters, patient databases and urodynamic reporting programs are the main features. In addition, there are programs for patient history-taking and urodynamics on personal computers not linked at present to the main system.
A system has been developed to acquire a complete urological history using an Apple microcomputer. The system can ask up to 300 multiple choice questions which the patient answers using a light pen. The questions are grouped into blocks for urological symptoms and complicating factors. A printout summarises the history and the recommended further investigations. A copy of this is given to the patient and the referring doctor. The clinician discusses the printout and proposed investigations with the patient. The system has been tested against experienced clinicians and the results are presented. The computer system was evaluated for 26 patients and was found to record all of the important information. The system is now in regular use in the out-patient clinic as the first part of the diagnostic work-up in suitable referrals. This system has shortened waiting times for first appointments. To date 261 patients have used the system. The consultant urologist continues his practice of reading all referral letters and allocating priorities. Conditions requiring immediate physical examination (e.g. testicular swelling) are not suitable for this type of approach.
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Among the male partners of 1074 infertile couples the mean results of semen analysis were sperm count 78 X 10(6)/ml, seminal volume 4.0 ml, proportion of progressively motile sperm 54%, proportion of sperm with normal morphologic features 81.4% and total motile sperm count 152.3 X 10(6) per ejaculate. After excluding 65 couples who chose donor insemination and 300 with known female causes of infertility, the cumulative pregnancy rates in the remaining 709 couples were higher with increasing sperm density and motility and seminal volume, but the higher rates were significant only when these variables were combined into total motile sperm count per ejaculate. The cumulative pregnancy rates were 20% with a total motile sperm count of 9 X 10(6) or less, 37% with a count of 10 to 19 X 10(6) and 52% with a count of 20 X 10(6) or more (p = 0.001). Counts higher than 20 X 10(6) were not associated with a further improvement in pregnancy rates, but variability in the results was high, which suggests that the test should be repeated as necessary to determine the true range. Although standards for these and other seminal variables are ill defined, the total motile sperm count incorporates the most useful prognostic information from semen analysis, and the associated pregnancy rates can help guide clinical decisions.
We have evaluated 123I-heptadecanoic acid for myocardial scintigraphy in the diagnosis of coronary heart disease by comparing the results obtained with it in subject groups with high and low probabilities of disease. We conclude that although some patients in the former group can be identified, the test is neither sufficiently sensitive nor specific for routine clinical use.
Measurements of left ventricular ejection fraction (LVEF) were made using nuclear angiography in 9 newly-diagnosed insulin-dependent diabetic patients at diagnosis and after a period of stable control. Similar measurements were made in a control group of 10 insulin-dependent patients whose control was stable. While mean LVEF did not change significantly in either group, 5 of the newly-diagnosed patients had a significant change in LVEF (both positive and negative). None of the stable diabetic patients had any significant change in LVEF. Analysis of variance of the changes in LVEF in both groups showed a significant difference (p less than 0.002). Abnormal left ventricular function in diabetic patients may be transient, reversible and related to change in diabetic control and need not indicate structural myocardial disease such as cardiomyopathy.