Biomedical subjects
M H Hall
Publications and source records attributed to M H Hall.
Epicardial lead failure due to dense scarring: a solution.
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What are the benefits of prenatal care in uncomplicated pregnancy?
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Changes in the law on abortion.
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Identification of high risk and low risk.
Identification of high risk is only moderately successful at the booking visit; most risk factors only give a relative risk of around three, so that most of the high-risk group do not experience the adverse outcome, and most adverse outcomes occur in low-risk women. Risk factors are useful in planning for confinement and extra care, but since new problems can arise at any time and most antenatal admissions are for conditions arising in spite of antenatal care (Chng et al, 1980), some care should be offered to all women. Traditional schedules of care, however, have no scientific justification. Identification of low risk is also fallible and there seems to be an irreducible minimum of unpredictable problems which will arise even in low-risk women. Methods need to be found to reduce the lack of continuity which often results from unscheduled transfers of care.
Determination by near-infrared reflectance spectroscopy of mosquito (Diptera: Culicidae) bloodmeal size.
A method is described for using near-infrared reflectance spectroscopy (NIRS) to quantify the amount of blood present in mosquitoes without killing insect. NIRS is a nonconsumptive, instrumental method for fast, accurate, and precise evaluation of chemical composition of material with little or no preparation. The NIRS method accurately predicted bloodmeal size and bloodmeal disappearance in Aedes aegypti (L.) and Ae. sierrensis (Ludlow) mosquitoes.
Definitions used in relation to gestational age.
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Long-term follow-up of intravesical Epodyl therapy for superficial bladder cancer.
The records of 111 patients with multiple superficial grade 1-2 transitional cell tumours of the bladder treated with intravesical Epodyl and followed up for a mean period of 6.4 years were retrospectively analysed. The study showed that 65% of patients responded completely after 12 weekly instillations and 46% of these remained continuously free of disease for 5 years. An initial complete response to therapy and lower pathological grade seemed to indicate a long-term successful response to treatment. In patients who failed to respond by 1 year, further therapy was of no benefit. Clearance of bladder disease by 1 year carried a 14% risk of subsequent tumour invasion by 5 years. This risk increased to 75% in those who failed to respond by 1 year.
Rest in hospital and twin pregnancy.
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Commentary: confidential enquiry into maternal death.
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Spina bifida occulta and functional disorders of the lower urinary tract.
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Transitional cell carcinoma of the renal pelvis and ureter.
In a retrospective study of 185 patients with transitional cell carcinoma of the renal pelvis and ureter, of whom 127 were treated by total nephroureterectomy and 58 by conservative resection, the survival of those with superficial well differentiated tumours was greater than 90% in each group. When urothelium was left behind after conservative resection, there was a 22% rate of recurrence on the same side but this almost only occurred when the original tumour had been multifocal. Post-operative radiotherapy did not improve survival.
Mode of delivery and future fertility.
A cohort of 22,948 women from a stable homogeneous population who gave birth for the first time between 1964 and 1983 were followed up prospectively. Analysis by mode of delivery showed that of those delivered by caesarean section 23.2% fewer had another pregnancy than those who had a spontaneous vaginal delivery. Women delivered by forceps were in an intermediate group. Miscarriage was more common in women who had been delivered by caesarean section. The relative infertility after caesarean section could not be accounted for by early sterilization, was not associated with maternal height or social status, and was only partly attributable to age.
Cocaine-induced acute aortic dissection.
While cocaine-induced myocardial infarction has been frequently documented, the differential diagnosis of chest pain should include aortic pathology. The successful management of acute aortic dissection secondary to cocaine abuse has not been previously reported to our knowledge. In a 45-year-old man who presented with typical chest pain and wide mediastinum, the successful management of this disease included early and accurate diagnosis and replacement of the aortic valve as well as the torn portion of the ascending aorta.
Is birth weight determined genetically?
Birthweight correlations were analysed among 505 intergenerational pairs of first births to women aged 18-25 identified from a large obstetric data bank. After standardisation for fetal sex, maternal height, gestational age, and proteinuric pre-eclampsia residual correlations of between 0.1402 and 0.1725 were found, suggesting only a small genetic effect. It is concluded that genetic factors play only a small part in determining birth weight.
When a woman asks for a caesarean section.
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Frequency of angiographically significant coronary arterial narrowing in mitral stenosis.
Ninety-six consecutive patients older than 40 years with severe mitral stenosis were retrospectively analyzed to determine the relation of angina pectoris (AP) and coexistent coronary artery disease (CAD). Of the 96 patients, 27 (28%) had angiographically significant CAD, 10 (37%) with AP and 17 (63%) without AP. Of the 96 patients, 21 had AP, 10 (48%) with angiographically significant CAD and 11 (52%) without (CAD). Of 75 patients without AP, 17 (23%) had angiographically significant CAD AP had a specificity of 84% and a sensitivity of 37% in its ability to detect significant CAD. The pulmonary artery systolic, diastolic and mean pressures and the pulmonary vascular resistance did not differ between patients with and those without AP (p greater than 0.05). It is concluded that coexistent CAD is commonly found in patients older than age 40 with severe MS, and is usually clinically silent.
Angina pectoris and coronary artery disease in isolated, severe aortic regurgitation.
Seventy-eight patients with isolated, severe aortic regurgitation (AR) were studied retrospectively to determine the prevalence of angiographically significant coronary artery disease (CAD) and its relation to angina pectoris (AP). Angiographically, significant CAD was present in 29 of 78 patients (37%), and 36 patients (46%) had AP. Twenty-one of 36 patients (58%) with AP and 8 of 42 patients (19%) without AP had angiographically significant CAD. AP as a predictor of significant CAD had a sensitivity of 73%, specificity of 69% and a risk ratio of 3:1. The predictive accuracy of detecting CAD in the absence of AP was 81%. The benefit from concomitant coronary artery bypass grafting at the time of aortic valve replacement for AR has not been clearly demonstrated; therefore, routine coronary angiography is still recommended for all AR patients older than 40 years undergoing aortic valve replacement.