Biomedical subjects
P Parkinson
Publications and source records attributed to P Parkinson.
The asthma mortality epidemic.
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Urinary oestriol assay for monitoring fetoplacental function.
During the years 1971-1984 urinary oestriol excretion was tested in 51,427 patients (group 1). One or more low oestriol value was found in 10.7% of patients; in this group the stillbirth rate was 6.8 times higher, the neonatal death rate 3.8 times higher, and fetal growth retardation rate 3.5 times higher than in patients with normal oestriol values (all p less than 0.00001). During the years 1985-1989 a further 20,635 patients were tested (group 2) and 7.6% had one or more low oestriol value. The perinatal mortality rate in patients with normal oestriol excretion fell from 0.8% in group 1 to 0.5% in group 2 (p less than 0.005), and in patients with low oestriol excretion from 4.2% in group 1 to 2.4% in group 2 (p less than 0.002). However, patients in group 2 with low oestriol values still had significantly unfavourable results, compared to those with normal oestriol values--stillbirth rate 3.3 times higher, neonatal death rate 4.6 times higher, and fetal growth retardation rate 3.2 times higher (all p less than 0.00001). Intravenous dextrose and aminoacid infusions were given to 967 patients who had persistently low oestriol values in spite of rest in hospital, in an attempt to correct fetoplacental function; the perinatal mortality rate was 0.9% in the 660 (68.3%) who responded favourably, and 9.8% in the 307 (31.7%) who did not respond (p less than 0.0001).
The gay community and the response to AIDS in New Zealand.
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A reappraisal of urinary oestriol excretion as a screening test in pregnancy.
During the years 1971-1982 urinary oestriol excretion was tested in 38,536 patients (group 1). One or more low oestriol value was found in 11.0% of patients; in this group the stillbirth rate was 8 times higher, the neonatal death rate 4 times higher, and fetal growth retardation rate 4 times higher than in patients with normal oestriol values (all p less than 0.001). During the years 1982-1984 a further 12,887 patients were tested (group 2) and 9.5% had one or more low oestriol value. The perinatal mortality rate in patients with normal oestriol excretion fell from 0.8% in group 1 to 0.5% in group 2 (p less than 0.05), and in patients with low oestriol excretion from 4.7% in group 1 to 2.4% in group 2 (p less than 0.01). However, patients in group 2 with low oestriol values still had significantly unfavourable results, compared to those with normal oestriol values--stillbirth rate 4 times higher, neonatal death rate 5 times higher, and fetal growth retardation rate 4 times higher (all p less than 0.001). Although perinatal results have improved, fetal growth retardation and the risk of perinatal death are still identified by urinary oestriol assay.
Homosexuality debate.
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Quality of survival of infants with critical fetal reserve detected by antenatal cardiotocography.
During the 8-year period 1973 to 1980, antenatal cardiotocographic monitoring was performed on 3,006 high-risk pregnancies selected from a total obstetric population of 37,856 patients. A critical fetal reserve was detected in 72 patients (2.3%) whose pregnancies resulted in 20 perinatal deaths and 52 infants who survived the neonatal period; 45 of these infants have been assessed at ages ranging from 2 months to 8 years, 9 months. Growth was below the tenth percentile in 25.0% for weight, 23.3% for length, and 22.5% for head circumference at the review examination. Neurological abnormalities were detected in 12 infants but the abnormality was major in only four, including one who has familial interstitial polyneuropathy. The quality of survival of infants delivered of pregnancies complicated by critical fetal reserve is satisfactory; 93.2% had no neurological impairment likely to interfere with quality of life and indeed 13.5% had superior intelligence. Cardiotocographic evidence of critical fetal reserve does not signify that the fetus is doomed; delivery by cesarean section is indicated if the fetus is viable and has no ultrasonic evidence of untreatable major malformation.
A little boy with an imperforate anus.
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Incidences and types of malformations in newborn infants.
The incidence of fetal malformations in a teaching hospital was determined by prospective study of 10,454 consecutively born infants. One or more major malformation was detected in 424 (4-1%) and one or more minor malformation was detected in 680 (6-5%). Major malformations were more common in stillborn infants (14-1%), in those who died in the neonatal period (36-7%) and in those who were small for dates (8-6%). Small for dates infants were the only group with a significant increase in the incidence of minor malformations (9-7%). The most common major malformations involved the genital organs (17-8%), limbs (14-2%), heart (11-4%) and central nervous system (10-6%). The most common minor malformations involved the skin, hair and nails (67-3%), limbs (7-7%) and genital organs (5-5%). Small for dates infants should be carefully examined to exclude major and minor malformations.
Cardiac responses to thermal, physical, and emotional stress.
We have studied the effect of a short period of exposure to the intense heat of a sauna bath on the electrocardiogram and plasma catecholamine, free fatty acid, and triglyceride concentrations in 17 subjects with apparently normal hearts and 18 persons with coronary heart disease. Similar observations were made on 11 of the 17 normal subjects and on 7 of the persons with coronary heart disease in response to exercise.Exposure to heat was associated with an increase in plasma adrenaline with no change in noradrenaline, free fatty acid, or triglyceride concentrations. Exercise was associated with the expected increase in both plasma noradrenaline and adrenaline concentrations. A heart rate up to 180 beats/min was observed in response to both heat and exercise. Apart from the ST-T changes inherent to sinus tachycardia, ST-T segment abnormalities were frequent in response to heat in both the subjects with normal and abnormal hearts, but little change occurred in the ST-T configuration when the subjects were exercised to produce comparable heart rates. Ectopic beats, sometimes numerous and multifocal, were observed in some subjects of both groups in response to heat, but not to exercise. It seems likely that the net unbalanced adrenaline component of the increased plasma catecholamine concentrations (which is also seen in certain emotional stress situations) is predominantly responsible for ischaemic-like manifestations of the electrocardiogram in susceptible subjects. The observations provide further validation for previously reported studies that it is the increased plasma noradrenaline in response to emotional stress that is associated with the release of free fatty acids and ultimate hypertriglyceridaemia, of probable importance in the aetiology of atheroma.
Terminal care: coping with dying and bereavement.
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