Exploring new strategies for facial recall.
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Biomedical subjects
Publications and source records attributed to G Davies.
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"Veterinary Investigation Diagnosis Analysis" II is a computerised recording system for all the diagnoses made at 33 Government diagnostic laboratories in Great Britain. It was created in 1975 and the records of 150,000 specimens are stored on it each year. The system depends on an agreed list of 393 possible diagnoses (101 cattle, 96 sheep, 72 pigs, 71 birds and 53 for other species). Diagnostic records are sent each month to a computer centre which produces an annual record of all diagnoses made and a monthly record of the number of submissions and financial charges. The computer file can be interrogated from a terminal at the epidemiology unit Weybridge and the diagnostic records are available to research workers.
Using a new method of measuring whole blood clotting time, we have confirmed the findings of others, that blood clots faster when diluted with saline. A prospective trial was designed to test the hypothesis that intravenous saline peroperatively causes hypercoagulation and increases the risk of venous thrombosis. Sixty patients admitted for routine laparotomy were randomly allocated to either a group receiving intravenous fluids during or after operation (Wet), or a group receiving no intravenous fluids (Dry). The Wet patients became significantly more haemodilute and hypercoagulable than the Dry (P < 0.001), and these changes correlated. A postoperative deep vein thrombosis occurred in 30 per cent of the Wet patients, but in only 7 per cent of the Dry (P < 0.05). The need for intravenous fluids during uncomplicated surgery is probably unproved, and their greater use may have contributed to the increasing prevalence of venous thromboembolism.
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Myocardial scintigraphy with 201Tl was performed at rest in a selected group of 36 patients with unequivocal clinical and electrocardiographic evidence of old myocardial infarction. The scintigraphic findings were correlated with electrocardiographic pattern, and with regional left ventricular wall motion and the severity of coronary artery disease defined by contrast angiography. Detection was dependent on the extent of the infarct but was independent of QRS morphology and of the severity of coronary disease. When positive, 201Tl scintigraphy was often a more precise method than the electrocardiogram for localising and delineating the extent of the infarct. Furthermore, the perfusion defect corresponded in location and extent to abnormalities of left ventricular wall motion. The site or severity of coronary artery disease could not be determined from the 201Tl scintigram.
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Three cases of acute urinary retention without local urological causes are described. A diagnosis of sacral myeloradiculitis of viral origin appeared more likely than a first episode of multiple sclerosis. The literature is reviewed and a protocol for the investigation of such patients is suggested.
A case of missed stone at cholecystectomy and choledochotomy is described. The theoretical and practical aspects of postoperative cholangiography are discussed. Optimal contrast dilution and radiographic factors are suggested.
Patients who underwent radiographic phlebography were studied to determine the frequency of postphlebographic venous thrombosis. In a group of 23 patients who had negative phlebograms performed with standard contrast agent (60% sodium methylglucamine diatrizoate), nine had positive 125I-fibrinogen leg scans. On repeat phlebography, three had confirmed deep vein thrombosis, six overall developed deep or superficial thrombosis, and three had positive scans without demonstrable thrombi. In a second group of 34 patients studied with the contrast material diluted to 45%, only three developed positive scans, one due to deep venous thrombosis and two to superficial thrombosis. There was also a reduction in the incidence of postphlebographic symptoms of pain, tenderness, and erythema, but no apparent sacrifice in diagnostic accuracy.
A videotape educational program was produced for use in adults with asthma. The program provided an overview of lung function, the physiologic abnormalities and treatment of asthma, and the approach to common problems encountered by the patients. Its benefits were examined in a randomized controlled study. The efficacy of the program in 62 patients whose mean duration of illness was 17 years was assessed by comparing the level of knowledge of the experimental group immediately after viewing the tape with that of the controls, who had not seen it; the experimental group scored significantly higher than the control group. Retention of knowledge attributed to the program was assessed after a mean interval of 16 months. The knowledge test score of the experimental group was found to have decreased to the level of the control group. The main areas in which the experimental group lost knowledge were self-care and drug therapy for asthma. The medical status of the two groups did not change appreciably over the period of the study.
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We compared respiratory variables in 441 grain elevator workers with 180 civic outside laborers in Thunder Bay. The grain handlers had a lower frequency of both positive skin reactions to pollens and molds and a family history of asthma, which suggests that they may have been self-selected for a decreased tendency to develop allergic respiratory disease. There was a higher frequency of cough and rales and a small decrease in forced vital capacity and forced expiratory volume in one sec among the grain handlers, as compared to the civic workers matched for smoking. However, these differences between grain and nongrain workers were small in comparison to those between smokers and nonsmokers. There was no clear indication of a worsening of respiratory functions that could be attributed specifically to duration of employment as a grain elevator worker.
The colorimetric method for the determination of methylmalonic acid by coupling with diazotised p-nitroaniline has been re-examined. Extraction of the diazotised product into amyl alcohol and tetra-methyl ammonium hydroxide considerably increases its stability and sensitivity and reduces background absorbance. Preliminary solvent extraction and ion-exchange chromatography are desirable but can be accomplished simply and quickly using very small quantities of urine. In this form, the method is very reliable and gives recoveries of about 95% and a coefficient of variation of about 7%.
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