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Biomedical subjects

I Williams

Publications and source records attributed to I Williams.

At least 73 records · Page 4Linked to original sources
PubMed1993

Sodium cromoglycate via inhaler and Autohaler.

One hundred and eighty-one children with asthma were entered into a randomized, controlled, crossover study comparing sodium cromoglycate via a metered dose inhaler (MDI) and a breath-actuated inhaler (Autohaler). There were no significant differences in pulmonary function tests (FEV1, FVC, PFER), symptom scores and bronchodilator use between the two devices. However both patients' and clinicians' opinions of sodium cromoglycate effectiveness were significantly better (P < 0.01) for the Autohaler. Autohaler was also thought to be easier to use (P < 0.001) and better for co-ordination of actuation with inhalation (P < 0.001). The Autohaler is as efficacious as the metered dose inhaler used by good co-ordinators. It seems to be the significantly better device with respect to ease of use, actuation and co-ordination which may aid compliance.

Adolescent↗
PubMed1993

Epstein-Barr virus infection of HIV-seropositive individuals is transiently suppressed by high-dose acyclovir treatment.

OBJECTIVE: To assess whether oral acyclovir can eliminate persistent Epstein-Barr virus (EBV) infection and thereby prevent EBV-associated lymphoma development in HIV-seropositive homosexual men. METHOD: Persistent EBV infection was examined in a group of 21 HIV-seropositive homosexual men before, during and after treatment with oral acyclovir at a dose of 800 mg every 6 h (10 individuals) or with a placebo (11 individuals). RESULTS: In 13 individuals, EBV was isolated from the oropharynx before and after treatment (seven cases from the acyclovir-treated group and six from the placebo-treated group). A significant reduction in virus isolation occurred during treatment in the acyclovir-treated group, but not in the placebo-treated group. In seven cases in whom EBV shedding was detected before and after treatment, the EBV strain isolated was identical throughout the study, even when acyclovir had abolished detectable shedding for the duration of the treatment. In two other cases more than one strain was detected. On examination of the EBV type present, 89% of a group of 18 patients consistently shed type A virus, 5.5% type B virus and 5.5% showed evidence of co-infection with both virus types. This compares with figures of 100, 0 and 0%, respectively, in a control group of HIV-seronegative individuals. CONCLUSIONS: High-dose acyclovir therapy does not eliminate persistent EBV infection from the oropharynx of healthy HIV-seropositive individuals and therefore would not necessarily prevent lymphoma development. Our results suggest that infection by type B EBV, and co-infections of both A and B type, are more common in HIV-seropositives than HIV-seronegatives.

Acyclovir↗
PubMed1992

Interleukin 6: insights to its function in skin by overexpression in transgenic mice.

Interleukin 6 (IL-6) is a cytokine that mediates a wide range of inflammatory and immune responses. Its expression is elevated in inflammatory or immunodeficient diseases, including psoriasis, rheumatoid arthritis, and AIDS. To explore the role of IL-6 in skin, we utilized a human keratin 14 (K14) promoter to express IL-6 in the basal cells of stratified squamous epithelia of transgenic mice. Mice expressing the K14-IL-6 transgene were smaller than normal and exhibited retarded hair growth. Surprisingly, IL-6 expression did not lead to enhanced epidermal proliferation, but it did result in a thicker stratum corneum, with an otherwise seemingly normal program of differentiation. IL-6 expression did not lead to leukocytic infiltration, making it unlikely that it has direct proinflammatory activity in skin. Based on this study, one role of IL-6 relevant to host defense may be to enhance the stratum corneum, thereby providing increased protection from injurious stimuli or infection. If IL-6 plays additional roles in the skin, it is likely to act synergistically with factors that IL-6 alone cannot induce.

Animals↗
PubMed1991

The value of routine microbial investigation in community-acquired pneumonia.

The way in which microbiological investigations are used in routine clinical practice and the value of such tests in directing antibiotic prescribing, was studied in adults admitted to hospital with a diagnosis of community-acquired pneumonia. One-hundred and twenty-two consecutive patients admitted to one teaching and one district general hospital were studied between April 1988 and March 1989. Blood cultures were performed in 81% of cases, sputum was examined in 45% and complete serological tests were performed in 28%. No causative pathogen was found in 74% of cases and results of microbial tests directed a change in antibiotic therapy in only 8% of cases. Routine microbial investigation of all adults admitted to hospital with community-acquired pneumonia is unhelpful and probably unnecessary. We suggest a strategy for microbial investigation linked to initial illness severity to replace the current haphazard approach.

Adult↗
PubMed1991

Ocular acyclovir delivery by collagen discs: a mouse model to screen anti-viral agents.

Discs 1.6 mm in diameter trephined from corneal collagen shields were used to deliver acyclovir (ACV) to the cornea of mice inoculated with herpes simplex virus type 1 (HSV-1). In the first minute after application to the cornea, there was a 23% decrease of ACV in the discs. After the first minute, ACV clearance from the discs appeared to be exponential with a half-life of 21 minutes. Treatment given 3 times a day reduced HSV-1 titer in tear film, corneal tissue, and trigeminal ganglia. This animal model should be useful to conserve novel potential anti-viral drugs undergoing initial screening.

Acyclovir↗
PubMed1991

The cost of monitoring medical care in Pennsylvania.

We estimated the cost of the Health Care Cost Containment Act in Pennsylvania to be over $19 million; the yearly direct cost of KePRO activities to be over $14 million; and compliance costs for peer review to possibly be as large as $27 million, based on our high estimate. We also found that medical records, utilization review and administrative departments in Pennsylvania hospitals have collective annual budgetary expenditures of close to $2.4 billion. In addition, we estimated Pennsylvania physicians to spend from $14 million to $17 million each year on administrative and fiscal activities related to reimbursement. Our cost estimates for non-clinical expenditures were based on the best data available at the time, though in many cases this data was crude. However, we believe that this data is a useful starting place for a dialogue about the cost and effectiveness of these programs. In reporting the cost of these activities it was not our intent to judge the value of any individual program. Instead we hope that we have taken a first step in the process of collecting cost data so that actual costs for non-clinical activities can be appropriately evaluated. Future studies of non-clinical expenditures should not only include direct program expenditures but also the economic impact on providers in complying with the mandates. Finally, efforts to reduce duplicate and unproductive regulatory programs will be necessary in working toward a cost-efficient system. Legislative efforts, such as the Physician Regulatory Relief and Improvement Act (H.R. 4475 and S.B 2051), aimed at the so called "hassle factor" will be helpful.

Cost Control↗
PubMed1990

[Conscious and unconscious awareness during anesthesia--how deep is the patient's sleep?].

A review is given over the aspects of awareness during general anaesthesia. Traditional clinical signs for evaluating depth of anaesthesia can be supplemented by objective methods such as EEG, cerebral function monitor and sensory evoked potentials. However, it has been difficult to establish the practical applications of these methods. Awareness can be graded from the obvious form, with recall of intraoperative events, to an unconscious form where the memory can be activated through special psychological techniques. We discuss the possibility of using unconscious perception of auditory signals for positive instructions to patients under anaesthesia.

Anesthesia, General↗
PubMed1989

Finger clubbing.

Reflectors can be made easily and used to illuminate areas of the photograph that are in shadow, so giving the equivalent of an extra light source. Choosing the correct background guards against colour cast and distracting shadow.

Adult↗
PubMed1989

Pain avoidance in rheumatoid arthritis.

Forty-eight patients with rheumatoid arthritis were compared to 52 pain-free controls in terms of tolerance/avoidance and rated intensity of cold pressor pain. The patients had lower thresholds and tolerated the cold pressor pain for a shorter period, although not significantly so. However, the patients rated the novel nociceptive cold stimulus as significantly more painful. The results demonstrate that arthritis patients report novel pain experiences as being more painful, which necessitates special attention to their post-operative analgesic demands needs. Tolerance/avoidance of the cold pressor pain had different correlates in the more and less chronic patient groups, and was respectively related to the affective and sensory qualities of the pain stimulus. The results confirmed qualitative similarities between different chronic pain populations, suggesting that chronicity of the pain problem may be a more important factor in determining pain experience and pain-related behaviours than the specific locus of the pain.

Adult↗
PubMed1989

Reversible zidovudine-induced pure red-cell aplasia.

The treatment of patients with AIDS and AIDS-related complex (ARC) with zidovudine is limited by major haematological toxicity. In an open study of the use of zidovudine, 10 out of a total of 81 patients developed a severe anaemia within the first 3 months of treatment. In five of these 10 patients the mean cell volume did not increase but remained within the normal range. Bone marrow examination of three of these five showed a pure red-cell aplasia. In all five patients the anaemia resolved on discontinuation of the drug and in three that were re-challenged, the anaemia recurred. Zidovudine-induced anaemia has usually been reported as macrocytic and megaloblastic, but in our experience erythroid aplasia appears to be a major cause of anaemia occurring within the first 3 months of treatment. The earliest sign is anaemia with a stable or only a slight increase in the mean cell volume (MCV).

Acquired Immunodeficiency Syndrome↗
PubMed1989

An acceptable exercise test to study microalbuminuria in type 1 diabetes.

A modified test for studying the response of urinary albumin excretion (UAV) to exercise in diabetic patients is described. It is designed to produce a standardized increase in pulse rate (by 90-110%) rather than a standardized workload. Thirty-three normotensive Type 1 diabetic patients with normal pre-exercise UAV (less than 10 micrograms min-1) on the day of the test were compared with 25 non-diabetic subjects matched for age and sex. The patients developed a significantly greater increase in the median UAV (p less than 0.05) and systolic blood pressure (p less than 0.01) during exercise, despite the use of lower workloads (p less than 0.05). During exercise, the albumin excretion in the patients was not related to their heart rate, blood pressure, workload or fall in blood glucose; nor was it related to duration of diabetes, glycosylated haemoglobin or insulin dose. An exercise UAV greater than 15 micrograms min-1 was found in 10 of the 33 patients; it was significantly correlated (p less than 0.01) with the frequency of previous overnight microalbuminuria (greater than 10 micrograms min-1), and was associated with a greater progression of microalbuminuria (p less than 0.05) over a mean period of 24 months. Retinol-binding protein excretion rate was also measured as an indicator of proximal tubular function and did not increase in either group.

Adult↗
PubMed1989

A method for intratracheal instillation of endotoxin into the lungs of mice.

A detailed method is presented for the intratracheal instillation of fluids into the lungs of mice. Using 125I-albumen it was determined that 25-50 microliters of volume gave almost equal distribution to all lobes of the mouse lung. Extremely low levels of endotoxin given intratracheally (12.5-25 ng) resulted in a dramatic increase in the neutrophil content of the lung. The increase started in less than 4 h, reaching levels of 7 x 10(5) by 18 h and was maintained at elevated levels for at least 48 h. This neutrophil count represented more than 90% of the cell population of the lung.

Animals↗
PubMed1989

The beige mouse: role of neutrophil elastase in the development of pulmonary emphysema.

Mutant beige mice and normal C57 black mice were given endotoxin intratracheally (IT) once a week for 10 weeks. The objective was to establish whether repeated recruitment of neutrophils to the lung, at levels that induced lung injury to normal mice, would be ineffective in producing lung lesions in neutrophil elastase-deficient beige mice. Endotoxin (25 mg) given IT causes a rapid influx of neutrophils into the lungs of both the C57 black and beige mice, reaching a maximum after 18 h and remaining elevated for at least another 30 h. After 10 weeks of endotoxin instillation the normal C57 black mouse lungs showed evidence of lung injury. There were histological signs of alveolar wall damage, and the mean linear intercepts (Lm) were increased 30% in the endotoxin-treated group. The specific compliance of the lungs from the endotoxin-treated mice was slightly increased. Beige mice, on the other hand, showed no histological or morphological evidence that the neutrophil influx produced lung injury. There was, however, a notable difference in the histological appearance of the control beige lungs compared to control C57 blacks. Beige lungs appeared normal at birth but apparently do not undergo normal alveolarization during neonatal development. Adult lungs have fewer alveoli with smooth terminal air ducts lacking the normal complement of alveolar struts. There was not indication of copper deficiency or problems in elastin synthesis or structure in the beige mice. The results of these studies support a preeminent role for elastase in neutrophil-induced lung lesions.

Aging↗
PubMed1986

Diverticular disease (adenomyomatosis) of the gallbladder: a radiological-pathological survey.

Seventy consecutive gallbladders removed at surgery were examined radiologically and pathologically. Fifteen (21%) of the operative specimens showed naked-eye changes of adenomyomatosis. The main conclusions drawn from this study are that this abnormality is present in a much higher proportion of gallbladders removed at surgery than is generally realised, and that the pathogenesis is primarily an abnormality of muscle contractions, with a strong similarity to diverticular disease of the colon. Diverticular disease of the gallbladder might well be the most appropriate name for this condition. The results of a post-operative clinical assessment of patients with diverticular disease are also presented. But this represents a small number of patients and larger, perhaps multicentre, surveys would be required in order to assess the clinical significance of this interesting abnormality.

Adult↗
PubMed1986

Remedial surgery for the adolescent with cerebral palsy: a 10-year survey of the numbers, types and results of operations on pupils at the Thomas De La Rue School, Tonbridge, Kent.

The Thomas De La Rue School caters for adolescents with cerebral palsy, many being severely disabled. Over the 10-year period (1967-77) out of a total of 355 pupils, 97 underwent surgery, a total of 147 operations, 145 orthopaedic, being performed, the majority on the lower limbs. The pupils involved, their parents, teachers and house-parents were invited to complete a questionnaire concerning the effectiveness of the operations, the anxieties and psychological problems resulting from surgery, and the effect on schooling. The results are discussed.

Adolescent↗