Search PubMed⌕ Search

Biomedical subjects

M J Richards

Publications and source records attributed to M J Richards.

At least 55 records · Page 3Linked to original sources
PubMed1992

Diphtheria: another risk of travel.

A 19-year-old woman presented with cellulitis of her foot 10 days after returning from Bali. Swabs of a central necrotic area grew toxigenic Corynebacterium diphtheriae biotype gravis. The patient was treated with parenteral penicillin and made a complete recovery. Diphtheria immunisation should be regularly updated for travellers to the tropics. Clinical and laboratory recognition of this infection is essential for appropriate public health measures to be undertaken.

Adult↗
PubMed1992

Cancer presentation in the emergency department: a failure of primary care.

Emergency departments are intended to be the location of entry into the health care system for patients with acute problems, such as injuries and myocardial infarctions. In contrast, cancer should optimally be detected during periodic health examinations, either through screening procedures or by early detection from signs and symptoms which prompt a routine visit to a primary care physician. This study was undertaken to describe patients who present to an emergency department with urgent symptoms and signs, are hospitalized, and subsequently diagnosed with cancer (ED group). One hundred twenty-nine patients were retrospectively studied. When compared with patients diagnosed in a primary care setting (tumor registry patients), the ED group was significantly older, more often male, had a significantly lower survival rate, and more frequent metastatic disease at diagnosis (P less than .001). The ED group accounted for 5.3% of the new tumor registry patients for the study years. Only 3.1% of the ED group had no insurance, and 21% reported no personal physician. Strategies are needed for patients and physicians to reduce the number of late-diagnosed cancer cases presenting in emergency departments.

Aged↗
PubMed1990

Total i.v. anaesthesia with propofol and alfentanil: dose requirements for propofol and the effect of premedication with clonidine.

We determined in 51 healthy patients undergoing body surface surgery the dose requirements for propofol, as part of a total i.v. anaesthesia technique with an alfentanil infusion. After premedication with temazepam, patients received alfentanil 50 micrograms kg-1 followed by an infusion of 50 micrograms kg-1 h-1. Patients were anaesthetized with a loading dose of propofol followed by a three-stage infusion designed to reach one of five preselected blood concentrations of propofol. The motor response to the initial surgical incision was noted and probit analysis was used to derive the ED50 (2.94 mg kg-1 h-1; 95% confidence limits: 2.35-3.37 mg kg-1 h-1) and ED95 (4.98 mg kg-1 h-1; 95% limits: 4.13-8.8 mg kg-1 h-1) for the final propotol infusion rate under these conditions. Whole blood concentration!of propofol at the time of the incision was related linearly to the inf!sion rate and the EC50 and EC95 (probit analysis) were derived as !.44 (95% confidence limits 0.62-1.87) and 4.05 (95% confidence lim!ts 2.78-30.5) micrograms ml-1, respectively. Post-operative recovery was!rapid, uncomplicated and uneventful. In a subgroup of eight patients,!the addition of clonidine 0.6 mg to the premedication significantly decreased the requirement for propofol (P less than 0.05) during surgery, but resulted in prolonged recovery times.

Administration, Oral↗
PubMed1989

Preinduction atropine or glycopyrrolate and hemodynamic changes associated with induction and maintenance of anesthesia with propofol and alfentanil.

Total intravenous anesthesia by infusions of propofol and alfentanil may be associated with decreases in heart rate and blood pressure. The effects of two vagolytic agents on these hemodynamic changes were studied in 24 ASA physical status 1 patients undergoing body surface surgery. Patients were randomly allocated to receive atropine 10 micrograms/kg, glycopyrrolate, 5 micrograms/kg, or 0.9% sodium chloride, intravenously, 5 min before induction of anesthesia with loading doses of alfentanil, 50 micrograms/kg and propofol 1 mg/kg. Anesthesia was maintained with infusions of alfentanil 50 micrograms.kg-1.hr-1, and propofol 10 mg.kg-1.hr-1 for the first 10 min, 8 mg.kg-1.hr-1 for the next 10 min, and 6 mg.kg-1.hr-1 thereafter. Patients given glycopyrrolate before anesthesia had significantly higher arterial pressures than did patients receiving either atropine or saline, even though heart rates increased equally after glycopyrrolate and atropine.

Adult↗
PubMed1989

Breast cancer detection awareness project in Wisconsin: 1987-1988.

In May 1987 and 1988, the American Cancer Society (ACS) sponsored Breast Cancer Detection Awareness (BCDA) programs throughout Wisconsin. These programs were made possible by the cooperative efforts of many ACS volunteers, hospitals, clinics, and physicians. The Wisconsin Radiological Society and the Division of Health were also involved in the planning efforts. In 1987, a total of 10,207 women were screened at 100 facilities, and 75 carcinomas were detected. In 1988, of 8,802 women screened at 102 facilities, 52 carcinomas were detected.

Breast Neoplasms↗
PubMed1987

Subacute pulmonary melioidosis in a temperate climate.

Previous reports of cases of melioidosis that were seen in nonendemic areas of Australia describe recrudescences of latent infection. We describe the case of a patient who presented in the cooler climate of Melbourne with a probable primary, subacute pulmonary infection with Pseudomonas pseudomallei. This case illustrates several points that bear consideration in the management of atypical pneumonia and, more specifically, pulmonary melioidosis. Historical and occupational clues are easily missed or unrecognized, while a persistent growth of gentamicin-resistant Pseudomonas species should arouse suspicion. Septicaemic melioidosis carries a poor prognosis, and treatment should be early and aggressive; use of the newer, third-generation cephalosporin agents should be considered. Given active support in a well-equipped intensive care unit, together with appropriate antibiotic therapy, patients may eventually be cured of this infection, but a high mortality rate is still encountered.

Anti-Bacterial Agents↗
PubMed1987

Otocerebral mucormycosis--a case report.

Mucormycosis is an often fatal infection caused by ubiquitous organisms of the order Mucorales. Infection is most commonly seen in the immunocompromised host, particularly in the setting of diabetic ketoacidosis. The most common presentation is with rhinocerebral involvement. We here report a case of otocerebral mucormycosis occurring in an elderly man with maturity onset diabetes who was not acidotic. The unusual site of infection delayed diagnosis until the pons had been invaded by the infecting organism which was demonstrated as a hypodense area on CT scan. Consequently radical excision of infected tissue was not feasible and the patient died. At post-mortem examination there was extensive infection and infarction of the parotid gland, inner ear and pons associated with arterial invasion by the fungus and septic cavernous sinus thrombosis. The case is described to demonstrate the existence of other modes of neurological presentation of mucormycosis apart from the well recognized rhinocerebral form. Early diagnosis is the key to successful therapy.

Aged↗
PubMed1984

Aetiology of fatal viral hepatitis in Melbourne. A retrospective study.

In the period from January 1971 to June 1983, 46 of 5477 patients (0.84%) admitted to Fairfield Hospital, Melbourne, with acute viral hepatitis died of fulminant hepatic failure. The case-fatality rate for patients with hepatitis A was 0.14%; for patients with hepatitis B, 0.84%; and for patients with non-A non-B (NANB) hepatitis, 2.29%. The highest case-fatality rates were observed in patients with post-transfusion hepatitis B (18.8%), and in patients with NANB hepatitis aged less than 5 years (50%) and 40 years and over (10%).

Adolescent↗
PubMed1978

Cerebellar medulloblastoma. An analysis of four cases of extraneural metastasis.

In four of 28 patients (14%) with medulloblastoma who were treated at the University of Wisconsin, Madison, over a 20-year period, extraneural metastases developed. In an effort to delineate the causal factors involved in extraneural metastases, salient features of patients with metastases and without metastases were compared. Suboccipital craniectomy, radiation therapy, and patient longevity were not well correlated with metastases. However, subarachnoid tumor spread was a consistent precursor. A ventriculoatrial shunt may have been a factor in one patient and a serious infection that preceded diffuse metastasis may have been a factor in another patient. Half of the patients with metastases were found to have the desmoplastic variety of medulloblastoma while only one of 24 patients without metastases had this tumor type.

Cerebellar Neoplasms↗
PubMed1977

Review of local soft tissue recurrence of breast cancer irradiated with and without actinomycin-D.

Between 1962 and 1973, regionally recurrent breast cancer was treated in 156 patients by irradiation alone or irradiation with concurrent actinomycin-D. Thirty-two patients were entered into a randomized trial, and 124 patients were retrospectively reviewed. Local control with irradiation alone was achieved in 48 of 80 patients (60%) and in 60 of 76 patients (79%) treated with irradiation and actinomycin-D (p less than .05). Results were remarkably similar in the randomized and retrospective series.

Breast Neoplasms↗
PubMed1976

The rare problem of late recurrence in neuroblastoma.

Two-year disease-free survival is considered highly predictive of therapeutic success with neuroblastoma and death from neuroblastoma greater than 5 years after diagnosis is a rare event. We report of an unusual case of death from neuroblastoma 20 years after diagnosis; a literature review and discussion of this rare phenomenon of late recurrence is also included. Five additional cases of late recurrence, defined as greater than 5 years after diagnosis, were found in the literature with adequate detail to be reviewed. Advanced disease was present at diagnosis in five of six cases; three of six had disseminated disease. No age or sex differences were noted. A peculiar tencency for recurrence during the teenage years, preceded by a long disease-free interval, was also present in all cases, perhaps a reflection of maturational alterations in the immune system or hormonal changes that previously had suppressed extensive disease. This phenomenon of late recurrence in neuroblastoma, albeit rare, adds another facet to the clinical behavior of an enigmatic and therapeutically unyielding childhood tumor.

Adrenal Gland Neoplasms↗
PubMed1976

Radical partial renal irradiation. an alternative to partial nephrectomy in bilateral Wilms' tumor.

A 6-year-old girl with simultaneous bilateral Wilms' tumor was treated with a radical nephrectomy on the side of more extensive involvement, followed by postoperative renal bed irradiation (3500 rads over 32 days) and radical partial renal irradiation (4000 rads over 35 days) to the contralateral disease. Concurrent and subsequent adjuvant actinomycin-D and vincristine were given. She has remained disease-free for over 5 years after primary therapy, with satisfactory renal function. This case report suggest that radical partial renal irradiation may be an alternative to partial nephrectomy in the management of the lesser involved kidney in some patients with bilateral Wilms' tumor.

Child↗