Search PubMed⌕ Search

Biomedical subjects

J A Clarke

Publications and source records attributed to J A Clarke.

At least 37 records · Page 2Linked to original sources
PubMed1995

Disablement resulting from motorcycle crashes.

This retrospective study describes the nature and severity of disablement resulting from motorcycle crashes (both traffic and non-traffic). Two hundred and fifty motorcycle crash victims were randomly selected from the total population of motorcycle crash victims (n = 1510) who had received compensation for disablement in the year ending 31 March 1990. Information on the nature and extent of disablement was obtained from official accident compensation files and coded according to the International Classification of Impairments, Disabilities, and Handicaps. Extremity injuries predominated, especially to the lower limb. The majority of these were fractures. Most commonly impairments occurred in the areas of 'skeletal', 'disfiguring' and 'generalized' impairment. Mechanical impairment of a limb was reported in 68% of cases, often with associated disfigurement. Disability mostly involved problems with locomotion and problems coping with physical stresses at work. Occupational handicap was the most common handicap reported, with mobility handicap the next most common. The shortcomings of this study included its retrospective design and the variable quality of the information on disablement. It was most likely, though, that these factors contributed to an underestimation of disablement in the study group.

Accidents, Traffic↗
PubMed1994

Firework related injury in New Zealand.

AIMS: In March 1992 a private members Bill was introduced into parliament which sought to place tighter restrictions on the sale of fireworks. The primary purpose of this research was to document the nature and extent of firework related injury in New Zealand for the purpose of preparing a submission on this Bill. METHODS: Firework related injuries were examined in relation to the legislative history of fireworks control in New Zealand to ascertain if existing regulations had been effective in reducing firework injuries and whether there was justification for greater control. RESULTS: Between 1979 and 1992 (inclusive) 237 persons were admitted to hospital for treatment of injuries related to fireworks. The overall incidence rate for this period was 0.52 per 100,000 persons per year. Eighty five percent of all events involved males. Children (< 15 years) comprised 68% of the victims with the 10-14 year age group having the highest rate of injury, at 2.5 per 100,000 persons per year. CONCLUSIONS: The authors concluded that, on the basis of morbidity, it may be premature to impose a complete ban on the public sale of fireworks (as is proposed in the Bill). The current legislation could well be supported though, by extending the ban on the types of fireworks publicly available to include skyrockets.

Accidents↗
PubMed1994

Investigation of HIV-infected macrophage neurotoxin production from patients with AIDS dementia.

The mechanism for AIDS dementia may involve the production of toxic cytokines. Since macrophage/microglia are the infected cells in the brain, we were interested in the production of some of the same cytokines by HIV-infected macrophages from patients with AIDS dementia. HIV-infected macrophages from 11 patients with AIDS dementia were cultured and evaluated for p24, cytomegalovirus (CMV) DNA, and the production of interleukin 6 (IL-6), tumor necrosis factor alpha (TNF alpha) and other neurotoxic factors. The percentage of HIV macrophage infectivity did not correlate with the severity of dementia nor did the presence of CMV. The production of IL-6 and an unidentified neurotoxin did not correlate with HIV macrophage infectivity suggesting that these soluble factors are strain specific. Production of TNF alpha by HIV-infected macrophages was relatively low (< 1-35 pg/ml) and may not be a significant factor in toxicity.

AIDS Dementia Complex↗
PubMed1994

Audit of emergency throughput in a regional plastic surgery unit.

A prospective study of emergency admissions to a regional plastic surgery unit was performed to investigate the extent and causes of delay between injury and operation. Details of 52 consecutive admissions, excluding those to the burns unit, were collected over a 50-day period. The mean delay between the injury and start of operation was 16.9 h (range 4.33-52.75 h). For patients referred from other hospitals in the region (n = 35) the mean delay between referral and admission was 3.64 h (range 0.5-17 h). This delay was 1.06 h (range 0-4.0 h) for those referred from the on-site accident and emergency department (n = 17). These results show that there is an excessive delay in treating these patients, but that transfer times to a regional centre contribute relatively little to the overall delay. The cause of this delay in the majority of cases was identified as lack of theatre availability. As a consequence of this 38% of operations took place after 2300 hours. If late-night operating was reduced, delay would worsen unless a second emergency theatre was made available between 1700 and 2300 hours, or emergency cases replaced elective ones on routine operating lists.

Emergencies↗
PubMed1993

The use of cerium nitrate-silver sulphadiazine as a topical burns dressing.

Infection remains the major cause of morbidity and mortality following the shock phase in the burn patient. Measures to reduce the risk of wound infection and subsequent sepsis include early excision where possible, and the use of topical antimicrobial creams such as silver sulphadiazine. Studies from the USA and Europe suggest the addition of cerium nitrate to this commonly used agent may improve its efficacy. We present the findings of a pilot study which investigated the action of a commercial preparation of cerium nitrate/silver sulphadiazine mixture (Flammacerium, Duphar B. V. Holland) on 20 patients considered unsuitable for surgery. There were no episodes of cellulitis or septicaemia. Flammacerium was noted to produce an adherent eschar that was easy to shave and which received split skin grafts well.

Administration, Topical↗
PubMed1993

Ecstasy and Whizz at a rave resulting in a major burn plus complications.

A patient who sustained a major burn following abuse with Ecstasy and Whizz is described. His progress was complicated by hyperpyrexia, acute renal failure and convulsions, all of which have been recently recognized as potential side-effects of Ecstasy abuse. This report further highlights the dangers of substance abuse.

3,4-Methylenedioxyamphetamine↗
PubMed1993

Utility of Scottish morbidity and mortality data for epidemiological studies of motor neuron disease.

OBJECTIVES: To determine the accuracy of (1) hospital discharge data and (2) death certificates, coded as motor neuron disease (MND). DESIGN: Comparison of data from The Scottish Motor Neuron Disease Register (SMNDR) with routinely collected Scottish Hospital In-Patient Statistics (SHIPS) and death certificate coding. SETTING: Scotland UK. PATIENTS: 1) 379 adults (> 15 years) discharged for the first time from a Scottish hospital in 1989-90 and (2) 281 deaths in the same period assigned to the International Classification of Diseases (ICD)-9, category 335 (MND). MAIN OUTCOME MEASURES: The sensitivity and positive predictive value of a diagnosis of MND as retrieved by (1) the Information and Statistics Division of the Common Services Agency for the Scottish Health Service for morbidity data and (2) the Registrar General's office for mortality data, using the SMNDR as the 'gold standard'. RESULTS: (1) Thirty per cent of adult patients identified as having MND by SHIPS did not have this disease and 23% of patients with MND did not appear on SHIPS. The sensitivity of a diagnosis of MND, as retrieved by SHIPS, was 84% and the positive predictive value was 70% overall. Miscoding of patients with pseudobulbar palsy caused by cerebrovascular disease was the major source of false positive error. The incidence of adult onset sporadic MND was over estimated by SHIPS by a factor of 1.6. (2) Mortality data were more accurate, with a false negative rate of 6% and a positive predictive value of 90%. CONCLUSIONS: Coded hospital discharge data are an inaccurate record of a diagnosis of MND and cannot, in their present form, be used as a reliable measure of disease incidence in Scotland. Greater care is required in the preparation of discharge summaries and coding if these data are to be useful for health care planning and epidemiological research. SHIPS is, however, an important source of information to achieve a complete sample of patients with MND. There is also a problematic false positive rate for mortality data but this source more closely approximates true incidence.

Adolescent↗
PubMed1993

A morphological study of the size of the vascular compartment of the carotid body in a non-human primate (Cercopithecus ethiopus), and a comparison with the cat and rat.

The carotid bodies from 5 adult non-human primates (mean body weight 2.9 kg) were perfusion-fixed at normal arterial blood pressure with 3% phosphate-buffered glutaraldehyde. Serial 5-microns sections were cut, stained, and, using an interactive image analysis system, determinations were made of the volumes of the carotid body and of its vascular and extravascular compartments. The total volume of the carotid body was, on average 0.21 mm3, the total vascular volume contributing 9.7%. The small vessels (5-12 microns diameter) comprised 5.4% of the total volume of the carotid body, or about 56% of the vascular compartment; these estimates were similar to values obtained for the cat and rat. The mean small vessel endothelial area, per unit of extravascular volume (which is assumed to consist largely of type 1 and 2 cells) was 61.8 mm-1 in the primate and 69.7 mm-1 in the cat. A value was not available for the rat. Estimates of the carotid body tissue specific blood flow were 31, 61 and 104 ml/min/100 g organ tissue in the primate, cat and rat, respectively. It was emphasised that these values were not to be confused with estimates of carotid body specific blood flow based on values for total organ blood flow and the dissected weight of the organ.

Animals↗
PubMed1993

An evaluation of a program to reduce home hot tap water temperatures.

Children are more likely to be hospitalised because of burns from hot liquids than from contact with fire and flames. Many of these hot liquid burns are from contact with hot tap water, usually in the home. Hot tap water burns to young children can be prevented completely by lowering the delivery temperature of the hot tap water. This study reports on the evaluation of a program designed to lower the temperature of home hot tap water in Dunedin, New Zealand. In conjunction with a national media campaign, the program provided an educational intervention to households with young children. Before and after measures were made and comparison groups were used to determine the effect of the intervention on tap water temperatures. Mean tap water temperature was 64.2 degrees C at baseline and 61.2 degrees C at follow-up. The proportion of households with water temperatures above 70 degrees C decreased by 50 per cent between baseline and follow-up while the proportion below 60 degrees C increased from 33 per cent to 47 per cent. The group receiving the intervention did not differ significantly from the comparison groups. There were significant decreases in tap water temperature across all groups, but the majority of households still had temperatures above 55 degrees C at the end of the study.

Burns↗
PubMed1992

A case for revising the 'weight gain during pregnancy' guidelines for Australian women.

In 1989, an average weight gain during pregnancy of 14 kg was determined for a sample of 1,253 public patients at the Royal Women's Hospital, Brisbane. This greatly exceeded the weight gain of 10 to 12 kg which was recommended by the hospital and which is based on United States of America (US) data. The finding prompted a comparison of characteristics of Brisbane mothers (weight gain during pregnancy, age, prepregnant weight, height, birth-weight of infant, etc) with the characteristics of mothers in two large US studies. Significant differences were found to exist with Brisbane women being taller, heavier in body mass, more overweight and gaining less weight during pregnancy than the US women. Unexpectedly, the birth-weight of infants was neither more nor less than reported for the American studies. Further studies to gain more information about Australian women during their pregnancies should be undertaken.

Adolescent↗
PubMed1991

Medial fasciocutaneous flap of thigh for release of post-burn groin contractures.

Post-burn groin contractures, though uncommon, cause some patients distressing symptoms which are difficult to treat. Recurrence of contracture and symptoms is common and multiple operations are often required to control symptoms. We describe the use of the medial thigh fasciocutaneous flap for release of these contractures. Six flaps have been raised in four patients and symptomatic relief has been excellent in three. There have been no contracture recurrences.

Adolescent↗
PubMed1991

Quantitative studies of the vasculature of the carotid body in fetal and newborn sheep.

Resetting of the hypoxic sensitivity of the carotid chemoreceptors from the fetal to the adult arterial PO2 range follows the rise in PO2 which occurs after birth. The mechanism of this resetting is unknown. To study whether it is accompanied by a change in the carotid body microvasculature, 2 pairs of carotid bodies from fetal sheep (145 days gestation) and 2 pairs from 7-8 days-old lambs were examined. The ratio of the area of small vessels (6-16 microns diameter) or of larger vessels (greater than 16 microns diameter) to the total area of individual lobules of the carotid body was measured, using a semi-automatic image analysis system. This quantified the number and total cross-sectional area of small vessels and of larger vessels in 20 sections of 5 microns thickness taken at random from 200-350 sections cut from each carotid body. When the carotid bodies of the fetus and neonate were compared, the neonates showed increases in the percentage of the lobule area occupied by both small and large vessels, but the difference was only significant in the case of the larger vessels. There was no difference in the ratio of the area occupied by smaller vessels to the extravascular area of the lobule. Our results do not support the idea that the post-natal resetting of chemoreceptor sensitivity from the fetal to the post-natal range is accompanied by a change in the perfusion of the carotid body chemoreceptor cells.

Animals↗
PubMed1990

The application of clinical guidelines for skull radiography in the Accident and Emergency department: theory and practice.

Clinical guidelines for the selection of patients with head injuries for skull radiography, based on those formulated by the Royal College of Radiologists, were introduced into the Accident and Emergency department at the Manchester Royal Infirmary. Before the guidelines were implemented 94 skull X-rays were obtained per 1000 new casualty attenders. After implementation the rate of skull radiography initially fell by 40%, but thereafter slowly increased so that 12 months later it had returned to the pre-implementation level. During the first and second 6 months of the study reductions of 37% and 17%, respectively, were achieved. Although the overall annual reduction was only 27% an estimated saving of almost 10,000 pounds was made. Although clinical guidelines for skull radiography can reduce the number of skull radiographs without detriment to the care of the head-injured patient, their constant use is difficult to sustain. The application of clinical guidelines needs regular monitoring. Referring clinicians and radiologists need to be strongly motivated if such guidelines are to find a useful place in clinical management.

Adult↗
PubMed1990

Tuberculous dactylitis in childhood. The need for continued vigilance.

A case of tuberculous dactylitis in a 3-year-old Chinese boy is presented and the radiographic findings and differential diagnosis discussed. Although this is a rare condition, the diagnosis should be considered when a member of the immigrant community presents with an unusual bony lesion.

Bone and Bones↗