Biomedical subjects
I J Smith
Publications and source records attributed to I J Smith.
Intravenous indomethacin for patent ductus arteriosus.
Intravenous indomethacin was given to 36 neonates with a patent ductus arteriosus who where receiving ventilatory support for respiratory distress syndrome. Permanent closure of the ductus arteriosus occurred in 21 (58%) infants and in this group the mean 24 hour plasma indomethacin concentration was 0.37 micrograms/ml. Partial success was achieved in 6 (17%) infants (mean 24 hour indomethacin concentration 0.34 micrograms/ml) but in 9 patients (mean 24 hour indomethacin concentration 0.29 micrograms/ml) there was no clinical change. Although the mean 24 hour indomethacin concentration was lower in the group with no clinical change, this was not statistically significant. Five of the 21 patients in whom there was permanent closure of the ductus required more than one dose of indomethacin. The possible effects of birthweight and age at indomethacin treatment were difficult to separate because of the high negative correlation between these two variables. The chance of closure was enhanced significantly if the patient had either a birthweight of at least 1 kg or the age at indomethacin treatment did not exceed 10 days, or both. Six hour but not 24 hour indomethacin concentrations were higher in patients with a high birthweight treated at an early age.
Treatment of severe localized pulmonary interstitial emphysema by selective bronchial intubation.
A pre-term infant being ventilated for respiratory distress syndrome developed severe localized pulmonary interstitial emphysema which was successfully treated by selective bronchial intubation.
Vitamin E in retrolental fibroplasia.
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Radiation under phototherapy and its relationship to clinical effectiveness in moderately severe neonatal jaundice.
Radiation under four commercially available phototherapy units was measured over the visual spectrum and demonstrated that between 69 and 87 per cent of the radiation was irrelevant to the photodegradation of bilirubin. When infants with moderately severe physiological jaundice were exposed to three of the same phototherapy units under the same conditions there was no demonstrable difference in the apparent rate of decline of serum bilirubin or in length of treatment required.
An immunohistochemical study of the projections of somatostatin-containing neurons in the guinea-pig intestine.
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Cysteamine, methionine, and penicillamine in the treatment of paracetamol poisoning.
60 patients with paracetamol poisoning have been treated with intravenous cysteamine, L-methionine, or D-penicillamine and the incidence and severity of hepatic necrosis compared with those observed in 70 patients receiving supportive therapy only. Of 31 patients with 4-hour plasma-paracetamol concentrations greater than 250 mug/ml given supportive therapy 22 sustained severe liver damage, 3 died in hepatic failure, and 4 developed acute renal failure. None of 23 similarly poisoned patients given cysteamine within 10 hours of ingestion suffered severe liver damage or renal failure and none died. Cysteamine was partially effective at 10-12 hours, but ineffective 12 hours or more after ingestion. Liver damage was absent or mild in 17 patients given L-methionine within 10-12 hours of ingestion but severe in 3 treated within 10 hours. Of 5 patients treated with D-penicillamine, 1 developed severe liver damage with acute renal failure. It is concluded that cysteamine prevents severe liver damage after paracetamol poisoning if given within 10 hours in adequate dosage.
Rural health, family practice, and area health education centers: a national study.
The National Area Health Education Center (AHEC) Program and the family practice specialty were both created around 1970, in part to help meet the health care needs of medically underserved populations. Because these two entities share the common goal of alleviating physician shortages in rural areas, a study was conducted to determine the nature and extent of their interaction. Questionnaires were mailed to all AHEC projects and all nonmilitary family practice residency programs. Response rates were 100% and 79%, respectively. Elective rural rotations (usually preceptorships) are offered by 135 (49%) residencies, but only 84 (31%) require them. Fourteen (64%) AHEC projects interact with family practice residencies; however, only 9% (15/167) of the programs in those states utilize AHEC resources. The authors conclude that additional rural rotations could be offered to family practice residents by taking advantage of under-utilized resources of the National AHEC Program.