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Biomedical subjects

L Parsons

Publications and source records attributed to L Parsons.

At least 55 records · Page 3Linked to original sources
PubMed1991

Prevalence and prognostic significance of silent and symptomatic ischemia after coronary bypass surgery: a report from the Coronary Artery Surgery Study (CASS) randomized population.

The prevalence and prognostic significance of postoperative myocardial ischemia, as detected by exercise testing, were prospectively assessed in 174 patients from the Coronary Artery Surgery Study (CASS) randomized surgical population who had exercise testing before and 6 months after coronary artery bypass graft surgery. Whereas the prevalence of symptomatic ischemia significantly decreased postoperatively (52% vs. 6%, p less than 0.001), the frequency of silent myocardial ischemia did not change (30% vs. 29%). Survival at 12 years after bypass surgery based on the 6-month postoperative exercise test results was significantly better for the 112 patients with no ischemia (80%) than for the 51 patients with silent ischemia (68%) or the 11 patients with symptomatic ischemia (45%). These data show that coronary artery bypass graft surgery diminishes the overall prevalence of symptomatic but not silent ischemia and that both silent and symptomatic ischemia adversely affect the postoperative prognosis of these patients.

Coronary Artery Bypass↗
PubMed1991

A technique for evaluating cast foam positioning and immobilization devices used in breast cancer radiotherapy.

Patient setup reproducibility when Alpha Cradles* are used is not well documented. A simple technique is described that localizes longitudinal and transverse planes in breast setups utilizing 4 mm lead-sphere markers embedded in a modified HS-2 Alpha Cradle. The markers are positioned in the cradle coincident with the projected simulator central axis crosshair when the x-ray beam is directed vertically down through a setup point on the patient. A reference film recording patient position relative to the Alpha Cradle is taken through the setup point at the end of the simulation procedure. On the treatment machine, the images of the lead markers on the portal film, taken through the same setup point, indicate longitudinal and transverse planes. These planes are then used to correlate and quantitate the reproducibility of the original reference planes. This technique is easily initiated, and when used in conjunction with a careful analysis of conventional treatment portal films, is very useful in determining the accuracy of patient repositioning in the Alpha Cradle, and precise field placement. Results of a study utilizing a modified HS-2 Alpha Cradle will be presented.

Breast Neoplasms↗
PubMed1991

Homeless families in Hackney.

A retrospective study of medical records in Hackney and Tower Hamlets showed that the health of infants and school-children in temporary accommodation was impaired. Perhaps the most striking result was the high proportion of low birthweight in all four groups (10-25%). Of particular concern is the finding that 25% of babies living in Bed and Breakfast (B&B) hotels were born with a weight less than 2,500 g. Amongst other findings was that a third of the infants 'born and bred' in B&B accommodation and their Tower Hamlets controls had been below the 10th centile at some time in their lives. The immunisation rates, however, were good. In the study of school-children, the school medical officer found that 30% of the children in B&B hotels were considered not to be in normal health compared with 20% of Finsbury Park residents. Ten percent of the children in B&B were considered not to have normal development and 47% of these had been referred for further investigation compared with 25% of the local residents. In contrast with the infants, the immunisation rates were poor. While it is not possible to infer any causal relationship from this study, it must be questioned whether these high risk children should be living in temporary accommodation for prolonged periods of time.

Child↗
PubMed1990

Socio-economic and ethnic factors in stillbirth and neonatal mortality in the NE Thames Regional Health Authority (NETRHA) 1983.

All stillbirths and neonatal deaths occurring in the North East Thames region were studied in 1983. This report describes the socio-economic and ethnic differences in that cohort. The stillbirth and neonatal mortality rates of babies born to fathers of social class V (16.8 per 1000 total births) was almost double that of social class I fathers (8.6 per 1000 total births). The most marked social class gradient was seen in the macerated stillbirth groups. Of particular concern was the extremely high stillbirth and neonatal mortality rate for women born in the Indian subcontinent. This was most evident in Pakistani women who had a stillbirth plus neonatal mortality rate of 17.3 per 1000 total births, almost twice that of the women born in the UK (9.0 per 1000 total births). Again, as with social class, macerated stillbirths appeared to contribute disproportionately to the excess mortality. Mortality rates were aggregated into four birthweight specific groups. Asian women had higher mortality rates in the higher birthweight groups, whereas in the lower birthweight group their babies did slightly better. This study indicated that the special needs for working class and ethnic minority mothers within NE Thames were not being met, and the Regional Health Authority was strongly recommended to review services to these groups.

Adult↗
PubMed1989

How accurate is fine-needle biopsy in malignant neoplasia of the pancreas?

The accuracy of fine-needle aspiration biopsy of the pancreas in 77 patients was studied, in 47 by the percutaneous route and in 30 under direct vision at the time of operation. Seventeen (49%) of 35 pancreatic malignant neoplasms were detected percutaneously and 13 (65%) of 20 at surgery. The predictive value of a positive test was 100% in both situations. The sensitivity of the percutaneous test was 57%; the sensitivity of the test done at operation rose to 72%. No complications were encountered. The test, when positive, can be relied on in surgical decision making but is of limited value when negative. Our findings are essentially similar to those of others who have reported their experience in the literature.

Adenocarcinoma↗
PubMed1989

Death certification in fractured neck of femur.

Fracture of the neck of the femur is a major public health problem within the elderly population of most industrialised countries whose health services are increasingly being taken up with its management. Moreover, within Britain, there is evidence of a real increase in its incidence even allowing for the ageing of the population. A condition whose aetiology is still far from clear (and where no strategy for prevention can therefore be formulated), and which is of such importance to the planning and provision of services demands detailed investigation and careful monitoring. Mortality data are an important part of epidemiological studies of disease problems and, in Britain, in resource allocation through the Resource Allocation Working Party (RAWP) formula. In this study, a cohort of 2,631 elderly patients, resident in the largest health district in the country, and admitted to hospitals over a seven year period with the diagnosis of fractured neck of femur, was assembled. Hospital records were linked to national mortality data to determine whether patients had died and, where this was so, to record underlying cause of death. A total of 930 deaths occurred within the study cohort but only 52 were certified as dying from fractured neck of femur; even amongst those who died in the hospital to which they were admitted with the fracture, less than a fifth of deaths were attributed to the fracture as underlying cause. Diseases of the circulatory system accounted for almost half of all underlying causes of death and bronchopneumonia a further 20%. These findings suggest a gross undercertification of fractured neck of femur as a cause of death in the elderly and are consistent with other studies. They may be explained by a failure of junior hospital doctors to understand the importance of accurate certification of cause of death and a misguided attempt to reduce the burden to coroners of having to consider each death from this cause.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1987

Pharmacoarteriography in the evaluation of impotence.

Progress in diagnosis and therapy of impotence is handicapped by the absence of a validated and objective method for evaluating the vascular system; a gold-standard for vasculogenic impotence is needed. Prior experience has indicated that conventional arteriography in unanesthetized patients is unreliable in evaluation of the penile arterial supply. We have improved our arteriographic methods by the routine application of selective pudendal injections, vasodilation pharmacoangiography with nitroglycerin and papaverine, and direct magnification. Experience in 37 impotent patients demonstrates marked improvement in the quality of visualization of distal vessels, and the frequent presence of functional vasoconstriction of medium and small arteries that can be distinguished from organic disease only with vasodilators. We believe these angiographic methods will improve the criteria against which other diagnostic and therapeutic methods can be objectively assessed.

Adult↗
PubMed1987

Penile pharmacocavernosography and cavernosometry in the evaluation of impotence.

Within the past few years, veno-occlusion of the corpora cavernosa has become generally recognized as an essential prerequisite for adequate penile erection. Veno-occlusive incompetence is suspected to be a frequent cause of impotence. Our recent experience with cavernosography in two normal volunteers and 36 impotent patients indicates that angiography is reliable in evaluating the competence of the veno-occlusive mechanism only if both pharmacocavernosography (PCG) and pharmacocavernosometry (PCM) are applied. Twenty minutes after intracavernosal (IC) injection of a mixture of 60 mg. papaverine and one mg. phentolamine (regitine), 100 ml. of diluted radiographic contrast medium are infused at the rate of one or two ml./sec. while pressure is recorded, and radiographic films are exposed at the rate of one every eight to 15 seconds. PCM and PCG of the corpora cavernosa indicated the overall degree of competence of the cavernosal veno-occlusive mechanisms, and the sites of veno-occlusive incompetence; non-pharmacologic studies were unreliable in these regards. During non-pharmacologic infusion in normals, pressures rose to 40 to 45 mm. Hg, and free efflux could be visualized from multiple venous systems. After pharmacologic injection in normals, all venous channels closed, and pressures rapidly rose toward or above 200 mm. Hg, at which time the infusion was stopped. Veno-occlusive incompetence was defined angiographically when more than minimal efflux occurred during pharmacocavernosography from any venous system. The incompetence could involve the deep penile system, the deep dorsal system, or the spongiosal system, alone or in combination. Severe veno-occlusive incompetence was considered diagnostic of venogenic impotence, and was defined manometrically when IC pressures failed to exceed 100 mm. Hg during infusion of 100 ml. of fluid at 2 mm./second after IC papaverine and phentolamine injection. We believe these angiographic methods will improve the criteria against which other diagnostic and therapeutic methods can be assessed.

Adult↗
PubMed1986

Do wet suits affect swimming speed?

A randomised cross-over trial was conducted to see if wet suits increase swimming speed--a question which has been fiercely debated in the fat-growing endurance sport of Triathlon. Sixteen swimmers volunteered to undertake two 30 minute swims, one with and one without a wet suit. With wet suits the subjects swam an average of 24.9 lengths of a 66 m pool. Without wet suits they swam 23.2 lengths. A 95% confidence interval for the difference is from 0.8 to 2.6 lengths (p less than 0.001). This result suggests that regulations about the use of wet suits must be agreed internationally to ensure equal competition whilst promoting the health and safety aspects of sport.

Adult↗
PubMed1982

Aid posts in Enga Province.

In Papua New Guinea (PNG) primary health care in rural areas is principally provided by aid post orderlies (APO's). During 1979-80, all 110 aid posts in Enga Province were visited; 20% were found to be unstaffed. All APO's were from the province and about 50% were providing satisfactory service. Aid posts were judged on standard of cleanliness, daily patient attendance, number of inpatients, number of family planning consultations provided weekly and on the attendance record of TB and leprosy patients. Aid posts usually had sufficient supplies of basic drugs. Despite the presence of a good APO training school in Enga, the standard of graduates was very variable and some of the best APO's in the province had minimal training over 30 years previously. Tribal warfare in Enga continues to be a threat to the delivery of primary health care.

Community Health Workers↗