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Biomedical subjects

J Cleland

Publications and source records attributed to J Cleland.

At least 73 records · Page 4Linked to original sources
PubMed1989

The World Fertility Survey: an appraisal of methodology.

"In the first half of the article, a broad account of content and procedures is given. In conduct of individual surveys, the achievements of the World Fertility Survey were based on thoroughness rather than technical superiority. The later aspects of the program, including analysis, archiving, and data dissemination, were more innovative and represent models of excellence for similar future enquiries. In overall terms, the program is judged to be an expensive success. In the second half of the article, two methodological issues are discussed in more detail: the collection of retrospective birth histories and the translation of survey instruments into local languages." Comments by Anthony G. Turner (pp. 768-9), Kweku T. de Graft-Johnson (pp. 769-70), Burton Singer (pp. 771-2), and Joel E. Cohen (pp. 772-4) are appended.

Birth Rate↗
PubMed1988

Cyclical Cushing's syndrome presenting as short stature in a boy with recurrent atrial myxomas and freckled skin pigmentation.

A young male patient demonstrated unusual features of Cushing's syndrome, atrial myxomas and freckled skin pigmentation. At 4.5 years of age he presented with intermittent swelling of his face and abdomen associated with weight gain and mild hypertension. A left atrial myxoma, suspected from routine physical examination, was surgically removed at 6.1 years of age. The initial mild symptoms clinically thought to be due to Cushing's syndrome, persisted intermittently without any consistent biochemical abnormality. At 10 years of age height velocity decreased and at 12 years early osteoporosis was observed radiologically. Repeated dexamethasone tests revealed a paradoxical increase in cortisol and corticotrophin from normal basal levels. Further investigation showed a cyclical pattern of hypercortisolism. The removal of a pituitary microadenoma failed to correct the features of Cushing's syndrome or prevent intermittent hypercortisolism. At 15.3 years a second left atrial myxoma was removed. This was followed by bilateral adrenalectomy. Histologically the features were consistent with primary pigmented nodular adrenocortical disease. This is the first patient described with cyclical Cushing's syndrome as part of this unusual complex of disorders.

Child, Preschool↗
PubMed1988

Massive pulmonary embolism; the place for embolectomy.

Untreated massive pulmonary embolism is associated with a high mortality. Pulmonary embolectomy has been largely superceded by thrombolytic therapy, but there are cases in which pulmonary embolectomy remains the treatment of choice. We present three case reports and discuss the merits of the various treatments available for massive pulmonary embolism. The primary treatment of massive pulmonary embolism should be thrombolytic therapy, but for patients who are at risk of haemorrhage following surgery, who are in cardiogenic shock despite medical treatment, or fail to improve following cardiac arrest, then pulmonary embolectomy remains the treatment of choice.

Aged↗
PubMed1988

Acute sphenoid sinusitis: management strategies.

Acute sphenoid sinusitis is an uncommon disease with a significant morbidity. This paper reviews 14 patients presenting with acute sphenoid sinusitis between 1978 and 1987. Fifty-seven percent of patients had signs of neurological or ophthalmological complications, and 29% were left with permanent disabilities. Delay in diagnosis and treatment resulted in a morbidity of 80%. The organism most commonly cultured was Staphylococcus aureus, followed by Streptococcus pneumoniae. Haemophilus influenza, and other streptococci. While a trial of medical therapy for 24 hours is warranted in uncomplicated cases, we recommend surgical drainage of the sinus if medical therapy fails, and for all patients with complications.

Adolescent↗
PubMed1986

Combination of verapamil and beta blockers in systemic hypertension.

The efficacy and safety of verapamil and propranolol were examined in 14 hypertensive patients (mean age 51.2, range 30 to 65) in a double-blind, randomized, crossover study of verapamil, 360 mg, propranolol, 240 mg, these 2 formulations in combination and placebo, each given for 4 weeks. Supine blood pressure, heart rate, atrioventricular conduction (PR interval) and left ventricular function were measured. All treatments reduced diastolic blood pressure (mean +/- standard deviation) (p less than 0.001): placebo to 106.6 +/- 8.1 mm Hg; propranolol to 93.8 +/- 7.7; verapamil to 89.8 +/- 7.8; the combination to 84.1 +/- 6.1, but the effect of the combination was significantly greater than that of either drug alone (p less than 0.05). Heart rate at rest (placebo, 80.2 +/- 12.2 beats/min) was reduced by propranolol (63.3 +/- 9.4, p less than 0.001), but not by verapamil (79.0 +/- 8.9). However, the addition of verapamil to propranolol led to a further reduction in heart rate (56.9 +/- 8.4, p less than 0.005). PR interval was prolonged significantly by the combination (185.5 +/- 35.3 ms) when compared with placebo (154.0 +/- 22.7); propranolol (159.1 +/- 21.2) and verapamil (165.5 +/- 32.4) (p less than 0.005 for each). The active drugs increased end-diastolic dimension and end-systolic dimension. For each variable, the effect of the combination was statistically significant (p less than 0.01). Fractional shortening was not altered significantly by any of the treatments. Thus verapamil plus propranolol is a very effective antihypertensive combination but heart rate, atrioventricular conduction and left ventricular function may be affected adversely, necessitating careful monitoring of therapy.

Adult↗
PubMed1986

Heart failure associated with infective endocarditis. A review of 40 cases.

Thirty one (78%) of 40 consecutive patients (aged 13-79, mean 44 years) with infective endocarditis had congestive heart failure at presentation. Twenty six (65%) had had rheumatic heart disease and 17 (43%) patients had prosthetic valves. Eight (20%) patients had undergone dental procedures within three months of presentation. Blood cultures were positive in only 22 (55%) of the patients. In nine (41%) of them streptococci of the viridans group were isolated and in seven (32%) patients endocarditis was due to Staphylococcus aureus. Eight patients had Q fever endocarditis. Sixteen patients required operation because of haemodynamic deterioration while they were in hospital; 11 patients had native valves and five had prosthetic valves. Seven had emergency operations and were pyrexial at that time. Four of the seven died in hospital. Of the 12 who were alive and well after surgery only two required further surgery two and three years after the initial operation. Twelve (30%) of the 40 patients died in hospital; in 10 death was mainly due to left ventricular failure or congestive heart failure. All patients died who had renal failure (four cases), myocardial infarction (two cases), complete heart block (one case), or ventricular fibrillation (two cases) before operation. Six (33%) of the 18 patients with culture negative endocarditis died. Two of the four patients seen and treated more than 12 weeks after the onset of symptoms died, as did three of the five patients with prosthetic valves who required surgery while in hospital. Three patients with neurological complications survived and only two (29%) of the seven patients with blood cultures that were positive for Staphylococcus aureus died. Of these 40 high risk patients optimal antibiotic treatment and early surgery for haemodynamic difficulty ensured that 28 (70%) were discharged from hospital alive and well.

Adolescent↗
PubMed1984

Angiotensin II levels, hemodynamics, and sympathoadrenal function after low-dose captopril in heart failure.

The angiotensin converting enzyme inhibitor captopril improves the altered hemodynamics in many patients with chronic heart failure, but the first dose may precipitate hypotension. Ten patients with chronic heart failure were studied, nine with high plasma concentrations of renin and one with a low concentration. Frequent measurements of plasma concentrations of angiotensin II, renin, and catecholamines were made over 60 minutes after a small dose (6.25 mg) of captopril and related to concurrently measured hemodynamic variables. Captopril caused a decrease in systemic and pulmonary artery pressure and an increase in cardiac index, and these changes coincided with reductions in the plasma concentrations of angiotensin II and increases in plasma concentrations of renin. The hemodynamic changes were accompanied by reductions in the plasma concentrations of norepinephrine but transient increases in plasma concentrations of epinephrine in patients in whom vasomotor syncope developed. The patient with a low plasma renin concentration showed little hemodynamic response to the drug. It is concluded that vasomotor syncope occurs quite frequently in patients with severe chronic heart failure after captopril in a small dose and is associated with a selective increase in epinephrine secretion from the adrenal medulla.

Aged↗
PubMed1984

The individuality of teenage mothers and its implication for intervention strategies.

An exploratory longitudinal research project of teenage mothers and their infants was carried out, involving intensive study of a small number of cases. Four case studies from the research are presented which illustrate the tremendous differences between teenage mothers, their support systems and the need for and success of intervention. The cases also show the need to individualize support to teenage mothers and suggest that routine structured classes on child development and parenting skills are not always necessary or sufficient. The cases also suggest that there are at least three types of teenage mother-infant pairs each of which will require a different level of intervention, ranging from Level I to Level IV. A plea is made for the individualization of services to teenage mothers depending on the strengths, emotional capacities and needs of the mother and her infant.

Adolescent↗
PubMed1984

Aortobronchial fistula: a late complication of division of the persistent ductus arteriosus.

An 11-year-old girl had nearly fatal hemoptysis due to false aneurysm and aortobronchial fistula following ductus division 9 years previously. Silk suture material was implicated as a causative agent in association with dilation of the aortic isthmus. To our knowledge, no previous report of this complication exists in the literature. Twenty-two cases of false aneurysm have been described, 86.3% following ligation. The use of elective hypotension during ligation and monofilament suture during division may prevent this serious late complication in the future.

Aorta, Thoracic↗
PubMed1984

Echocardiographic features in spontaneous disruption of implanted tissue aortic valves.

The echocardiographic features were recorded in three patients with spontaneous disruption of implanted tissue aortic valves. Two of the patients had xenografts, and one had a homograft. Aortic regurgitation had developed in all three spontaneously in the absence of active infective endocarditis. In each case there was severe disruption of the valve. Similar echocardiographic features have been found, usually in association with infective endocarditis or with myxomatous degeneration of the aortic valve. They have not previously been reported in association with implanted tissue aortic valves.

Adolescent↗