Biomedical subjects
P R Williams
Publications and source records attributed to P R Williams.
Open Forum for Health Information of New Zealand Association Inc.
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Intracavity drainage for bullous, emphysematous lung disease: experience with the Brompton technique.
Twenty two operations have been performed on 20 patients for the relief of symptoms due to bullous lung disease. Open intubation drainage of the bullae was used in all patients, the technique initially devised by Monaldi for the treatment of intrapulmonary tuberculous abscesses having been modified. Three patients died after surgery. Mortality was associated with low preoperative FEV1 (median 350 ml) and higher preoperative arterial carbon dioxide tension (PaCO2) (median 7.8 kPa). Symptomatic improvement was reported by 16 of the remaining 17 patients and was maintained over a median follow up period of 1.6 years. This was accompanied by objective improvement in lung function with a 22% median improvement in FEV1, an 11% median reduction in total lung capacity, and a 26% median reduction in residual volume. In one patient symptoms were unchanged after surgery. The technique described provides a simple method for decompressing bullae by means of a minimally invasive surgical procedure. It also allows for the treatment of further bullae at a later date by closed intubation under local anaesthetic. It has proved a suitable approach for all but those with the poorest lung function and is now our treatment of choice.
Fetal surgery: the social implications of medical and surgical treatment of the unborn child.
Advances in microsurgery provide physicians with the opportunity to correct malformations of the fetus prior to birth. However, these techniques are being developed at a time when the legal status of the unborn is unclear and the rights of pregnant women to determine the nature of their care are not universally recognized. This paper examines some of the social implications of medical and surgical treatment of the fetus. In attempting to clarify the rights of pregnant women in relationship to the rights of the fetus, the authors examine the law related to abortion and the protection of the fetus after it has achieved viability. Ambiguities in the legal interpretations of viability, coupled with societal ambivalence over the rights of women have resulted in confusion. Several cases have been reported in which the courts overrode an otherwise competent woman's refusal of surgery in the interest of the unborn fetus. Thus, legal precedent exists for the judicial suspension of the rights of pregnant women to consent or refuse medical or surgical treatment. This trend in the law may reflect more conservative values regarding the rights of women. At the same time, the benefits to the fetus remains unexamined outside of a medical frame of reference.
Improving the care of asthmatic patients in general practice.
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Effects of long-chain vs medium-chain triglycerides on gastric emptying time in premature infants.
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Neonatal metabolic effects of oral ritodrine hydrochloride administration.
Neonatal hypoglycemia and hyperinsulinemia have been reported following maternal ritodrine administration, but no prospective controlled study of the neonatal metabolic and cardiovascular effects of maternal ritodrine is available. We conducted a double-blind prospective study in 35 patients with preterm labor and/or ruptured membranes. Patients in premature labor received ritodrine (max dose, 350 mcg/min) or a placebo intravenously for 12 hours, and then orally (20 mg every 4 hours) until labor ensued. Patients with ruptured membranes received only oral therapy. Only patients who were maintained on oral therapy for a minimum of 12 hours and who were within 6 hours of their last dose of oral therapy were included in the analysis. Glucose and insulin values in cord blood at 6 and 12 hours of age were not significantly different between the ritodrine and placebo groups. There were no hypoglycemic infants in the ritodrine group. Mean systolic and diastolic blood pressure, heart rate and blood volume were similar for ritodrine and control infants. Although premature infants are at high risk for hypoglycemia it appears from this study that chronic oral ritodrine therapy does not significantly affect neonatal glucose homeostasis.
An evaluation of orally supplemented L-carnitine in premature infants receiving Intralipid 20%.
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Health evaluation of employees occupationally exposed to methylene chloride.
General study design and environmental considerations. Scand j work environ health 9 (1983): suppl 1, 1-7. Recent concern regarding health hazards of methylene chloride stem primarily from the discovery of its metabolism to carboxyhemoglobin. In this report, a research program is described, the purpose of which was to assess potential health effects of methylene chloride exposure in an occupational setting. Particular attention was given to evaluating possible direct and carboxyhemoglobin-mediated effects on the hematopoietic and circulatory systems. The study involved one fiber production plant which used a methylene chloride/methanol mixture and acetone as solvents and a second fiber production plant that used acetone only. The research design included a retrospective cohort mortality study and several health evaluation studies, as well as an environmental assessment of the two plants. Industrial hygiene monitoring indicated that typical methylene chloride exposures ranged from an 8-h time-weighted average of 140 ppm in areas of low methylene chloride use to a corresponding average of 475 ppm in areas of high methylene chloride use and that methanol was present in about a one to ten ratio to methylene chloride. Acetone exposures in both plants ranged from 100 to over 1,000 ppm (time-weighted average).
Does your child health clinic meet the needs of mothers as well as children?
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Recording symptoms and family relationships: a proposal.
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Urine evaporative loss and effects on specific gravity and osmolality.
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Successful peritoneal dialysis in an infant weighing less than 800 grams.
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Total parenteral nutrition in infants and children.
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Glucose determinations in plasma and serum: potential error related to increased hematocrit.
This study reports the effect of increased hematocrit (packed cell volume) on the rate of decrease in plasma glucose during 6 h in blood specimens from seven newborns (cord blood) and heparin-treated blood specimens from eight adults. Mean hematocrits ranged frm 0.43 to 0.75 for the adults and from 0.51 to 0.81 for the infants. The decrease in glucose was related to time and to hematocrit. For example, in adults with a mean hematocrit of 0.43, glucose decreased from 890 +/- 40 mg/L to 570 +/- 30 mg/L (mean +/- SEM) at 6 h, whereas in adults with a mean hematocrit of 0.75, glucose decreased from 890 +/- 40 to 200 +/- 30 mg/L. In infants with a mean hematocrit of 0.51, glucose decreased from 1010 +/- 20 to 480 +/- 70 mg/L at 6 h; infants with a mean hematocrit of 0.81 had blood glucose decrease from 1010 +/- 20 to 50 +/- 30 mg/L. These results indicate that the incidence of hypoglycemia in infants with polycythemia may be overestimated, and emphasize the need for prompt handling of blood samples collected from newborns for glucose determinations.
A study of an urban health centre: factors influencing contact with mothers and their babies.
Some insight into the use of primary care team was provided by a study of encounters with families with infants. The demand for primary care was large, and varied greatly depending on the circumstances of the family. Using statistical models, five possible influences on contact were examined - the presence of other children in the family, distance from the surgery, the family's socioeconomic grouping, maternal age, and maternal depression. Having more than one child and living close to the surgery increased the likelihood of a home visit by the doctor. There were proportionately more visits by the health visitors to first-time mothers who were depressed, and this was unaffected by distance. The baby clinic clinic was a popular meeting place, particularly for first-time mothers, and attendance showed no obvious social class bias. The degree of help sought by mothers, in terms of the number of contacts, appeared disproportionate to the child's physical problems. This indicates that more research is needed into the appropriateness of many contacts, and the extent to which the practice team is the most effective source of help.
The diagnosis and management of benign fibrous ureteric polyps.
The diagnosis and management of benign fibrous ureteric polyps are discussed. A pre-operative diagnosis is suggested by a long history of loin pain or haematuria, both, in a younger patient with the radiological findings of ureteric obstruction or a radiolucent ureteric filling defect. The diagnosis is confirmed at operation by opening the ureter and exposing characteristic fronds of polyps arising from a common base. It is suggested that management should be conservative local excision and not nephroureterectomy, as previously practised.