Biomedical subjects
Publications and source records attributed to J Osborne.
Many factors should be considered before one makes a decision to perform surgery, and it is the practitioner's responsibility to make certain the client makes an informed decision. This article considers the various factors of importance in the decision-making process.
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There is much controversial evidence that children gain weight to a significant extent following tonsillectomy, usually associated with a general improvement in health. One hundred and nine consecutive children undergoing tonsillectomy in Dundee for recurrent tonsillitis had their weight recorded pre-operatively, and twelve months after surgery were re-weighed and a symptom chart completed. The results showed the patients were generally not underweight before surgery as their median weight was on the 55th. percentile. Most parents reported an improvement in their child's appetite with a reduction in the number of sore throats after surgery. Their weights following surgery had increased by an average of 20 per cent over what would normally have been expected, but this increase in weight was not confined to underweight children, but to the entire group.
Absorption profiles were obtained from women following the administration of ointment containing 20, 30 and 40 mg of progesterone to the nasal mucosa. There were no significant differences in area-under-curves between groups receiving the drug in one nostril but when 40 mg doses were divided between two nostrils there was a significantly greater area-under-curve suggesting that the area of mucosa applied with the drug is more important than dosage.
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We have shown that adenoid tissue contains large amounts of the inflammatory mediator histamine. Children with fluid present in both ears at operation were found to have increased amounts of histamine in their adenoid tissue compared to a group with no signs or symptoms of SOM. Also mouth breathing and nasal obstruction were associated with adenoid histamine content whereas other signs and symptoms were not. No significant differences in adenoid weight were seen between SOM and non SOM patients. Histamine, both free and cell-associated, was found in nasopharyngeal secretions and middle-ear fluid although the source and mechanism of release has not yet been identified. We suggest that the benefits of adenoidectomy in children with SOM may possibly come from removing a potential source of inflammatory mediators in the vicinity of the Eustachian tube.
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Delayed hypersensitivity skin testing, a prognosticator of sepsis in severely injured patients, has been reported to have varied usefulness following thermal trauma. Skin tests were immediately and sequentially performed with six recall skin-test antigens on 69 patients with burns on greater than 25% of their total body surface area (TBSA). Skin tests were also immediately and sequentially performed with the same recall skin-test antigens on 42 patients with less than 25% of TBSA burned, as controls. In addition, calorie intake was recorded for all patients. Of the 69 patients with greater than 25% of TBSA burned, nine were normal, 13 were relatively anergic, and 47 were anergic. Of the patients in the less than 25% group, 13 were normal, 16 were relatively anergic, and 13 were anergic. In evaluating these data, we concluded that totally anergic patients are no more likely to die of sepsis than are normally responsive patients, nor are they more likely to have sepsis than normal and relatively anergic patients.
This study was designed to identify the DRG distribution of discharged Medicare patients during a given period of time in two similar hospital sites. Additionally, drugs costs (both total and average) for each patient in these DRGs were determined and analyzed as to similarity between the two sites as well as significance in terms of percentage of DRG total reimbursement rate. The assumption that DRGs would be homogeneous for drug costs was not found to be true in this study. Percentage of total reimbursement attributed to drug costs for DRG categories studied (less than 4%) was consistent with previously acquired data in established DRG prospective payment programs. Average drug cost was not found to be a reliable indicator for comparison of drug utilization, either within DRGs or between hospital sites. Length of stay emerges as the primary focus for future efforts in drug utilization reviews and cost control programs. A model for future DRG-based drug utilization reviews is proposed.
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The head circumferences of 74 term, normal babies were measured, together with the head circumferences of their parents. Maternal head circumference had a significant effect on that of the newborn infant but paternal head circumference had not. An equation is given for estimating the expected head circumference of a newborn infant, provided the birthweight and maternal head circumference are known.
The normal range for the urinary N-acetyl-beta-D-glucosaminidase/creatinine ratio was determined in 82 children. The range was found to vary with age, and the distribution was found to be logarithmic. This test should help to detect renal tubular disease in children; it gave abnormal results in some of these children.
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Ultrasound scanning was used to determine whether bladder emptying is complete when a newborn baby micturates. Residual urine was detected in 6 females and 9 males while one female emptied her bladder completely. The residual volume was estimated in 11 subjects and ranged from 3.9 to 13.9 ml. Incomplete bladder emptying cannot be the main factor in explaining the sex incidence of urinary tract infection in neonates.
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