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Biomedical subjects

R H West

Publications and source records attributed to R H West.

At least 37 records · Page 2Linked to original sources
PubMed1993

Factors affecting outcome in the resuscitation of severely injured patients.

This is a retrospective, hospital based study of the resuscitative management of 40 consecutive, multitrauma patients (Injury Severity Score (ISS) > 25) admitted directly from an inner metropolitan environment over a one year period. The aim was to identify physiological, anatomical and time variables that correlated with an adverse outcome. Such information would facilitate the development of management protocols to improve future care. The clinical management of airways, breathing, circulation and head injury was reviewed in both the pre-hospital and Emergency Department (ED) phases of care. Eleven patients died during the resuscitative phase, 10 from blood loss and one from head injury. Nine patients died during the definitive care phase, seven from head injury and two from multiple organ failure. Scene hypotension (systolic blood pressure < or = 80 mmHg), ED Glasgow Coma Scale < 9, ISS > or = 50, and Revised Trauma Score < or = 4 were variables that correlated strongly with fatal outcomes. The median pre-hospital time was 33 min for those hypotensive in the field. The median ED time was 70 min for hypotensive patients who went to operating theatres. Survival following severe trauma may be increased by avoiding secondary insults in head injured patients and improving the management of haemorrhagic shock. The time frame from accident to operating theatre should be kept under 90 min. Warmed blood, fresh frozen plasma and platelets should be used early in the resuscitation. An early move to definitive control of bleeding should accompany vigorous volume resuscitation.

Blood Circulation↗
PubMed1993

Value of the prospective 'before and after' study as a methodology to evaluate outcome in a trauma centre.

A series of interventions (administrative, clinical and educational) was introduced to improve the quality of trauma care at Royal Prince Alfred Hospital, the designated trauma centre for the Central Sydney Area Health Service (CSAHS). A prospective, 'before and after' study was conducted to assess changes in outcome following the introduction of these measures. The trauma centre survival rate for patients admitted with serious injury (Injury Severity Scores > 15) increased significantly, from 72% in the nine months before trauma centre designation to 89% in the nine months after (P = 0.005). The peer review designated, potentially avoidable death rate did not change significantly over the two study periods, remaining in the 20-30% range. Similarly the unexpected death rate (TRISS) did not change significantly, remaining in the 20-45% range. A trend to a lower trauma centre mortality in those arriving with a systolic blood pressure < or = 90 mmHg was noted. Seven out of 14 patients 'at risk' from exsanguination died in the first 9 months compared with one out of seven in the second 9 months (P = 0.17). An unexpected finding was a change in the degree of injury severity and physiological status in patients arriving at the trauma centre. The Injury Severity Scores were significantly lower (P = 0.008) and the Revised Trauma Scores significantly higher (P = 0.0006) in the latter 9 months of the study. It was concluded that the improved trauma centre survival rate was a reflection of a reduced hospital mortality from haemorrhagic shock in conjunction with a lesser degree of injury severity in patients admitted from the CSAHS.

Adult↗
PubMed1992

Creeping angle-closure glaucoma. The influence of iridotomy and iridectomy.

In 16 patients (30 eyes) with creeping angle-closure glaucoma YAG laser iridotomy or surgical iridectomy was performed as part of treatment. The initial characteristics of the affected eyes (refractive state, intraocular pressure, anterior chamber depth, iris contour, gonioscopic features, extent and severity of synechia formation and result of dark-room testing in six eyes) are recorded, and also the influence on these features of iridotomy or iridectomy. Intraocular pressure was reduced on average by 2.46 mmHg (1.72 mmHg in non-trabeculectomised eyes) (P less than 0.02), and anterior chambers deepened on average by 0.05 mm (P less than 0.05). Extension of peripheral anterior synechiae was recorded in nine eyes.

Adult↗
PubMed1992

The effect of topical corticosteroids on laser-induced peripheral anterior synechiae.

PURPOSE: To assess the influence of different topical steroid agents and a non-corticosteroid medication after Argon laser trabeculoplasty (ALT) on the development of peripheral anterior synechiae (PAS) and the reduction of intraocular pressure (IOP). METHOD: In two separate prospective, randomised, group-controlled studies, topical fluorometholone 0.1% (FML Liquifilm) was compared with dexamethasone 0.1% (Maxidex) (Study A), or naphazoline hydrochloride 0.1% (Albalon) (Study B) after ALT for chronic open-angle glaucoma, with particular reference to the formation of PAS and the IOP response. RESULTS: In Study A (N = 109) eyes treated with Maxidex had a significantly higher incidence of PAS than those treated with FML - 45% compared with 22%, P < 0.05 (normal deviate test). In Study B (N = 75) the incidence of PAS was equal in eyes treated with FML or Albalon (23%). In the two studies combined (N = 184), the development of PAS was associated with a significantly lower mean response of IOP to ALT - 1.47 mmHg compared with 3.22 mmHg, 0.01 < P < 0.05 (Student t-test). CONCLUSION: The incidence of PAS after ALT is significantly higher with the post-laser use of Maxidex than with FML, and is the same for Albalon as for FML. The therapeutic benefit of ALT is significantly reduced if PAS develop.

Administration, Topical↗
PubMed1991

Ocular surface and lacrimal disturbances in chronic graft-versus-host disease: the role of conjunctival biopsy.

Forty-four patients (21 male, 23 female) were studied following bone marrow transplantation (BMT): 40 after allogeneic, one after syngeneic and three after autologous transplantation. Diffuse punctate conjunctival and corneal epitheliopathy was seen in 27 (61%), reduced or disordered tear film in 26 (59%), acquired lacrimal outflow obstruction in three (7%) and posterior subcapsular lens opacities in five (12%) patients. Conjunctival histology showed abnormal features, including those of graft-versus-host disease (GVHD) in 41 patients. Of these, 28 (64%) had clinical and laboratory features of GVHD and six patients with no systemic evidence of GVHD had conjunctival histology specific for GVHD. We conclude that after BMT, subclinical changes of GVHD are very common in the periocular tissues and may be universal in long-term survivors following allogeneic BMT. Some minor conjunctival changes are more likely to be due to the primary disease or the transplant conditioning regimen. Conjunctival biopsy is useful in demonstrating low-grade GVHD or GVHD confined to the ocular structures and may be diagnostic in some cases.

Adolescent↗
PubMed1988

Acute primary ischemic iris atrophy.

Five patients are described with acute primary ischemic iris atrophy with almost complete loss of the normal radial vessels of the iris and fine microneovascularization. The atrophy of the iris was marked with a thin atrophic stroma, widely dilated pupil, and extensive loss of pigment from the posterior surface of the iris. The condition is of unknown etiology but occlusion of the greater vascular circle of the iris is possible. Iris angiography showed an almost total loss of the radial vessels of the iris with some patchy microneovascularization. In recent cases, the onset was acute and all patients had a raised intraocular pressure (IOP) except one who had already undergone a drainage operation. There was an accompanying low-grade uveitis or cyclitis in the chronic stage in all cases. The condition was unilateral and the posterior segment of the eye was normal so that good visual function was possible if the accompanying cataract and glaucoma were appropriately managed.

Acute Disease↗
PubMed1988

Argon laser trabeculoplasty five years on.

The results of argon laser trabeculoplasty (ALT) in a series of 252 patients are presented with follow-up of up to five years. The procedure is effective in chronic open-angle glaucoma (COAG), ocular hypertension and pseudoexfoliative (PXF) glaucoma. Most cases were treated initially over 180 degrees of the angle and repeat treatment of the remaining 180 degrees usually resulted in an additional fall in IOP which was maintained at two, three and four year follow-up with only a small number of these retreated cases having no fall on later follow-up. ALT was not very effective in further lowering IOP in eyes with IOP controlled to a low level before treatment or in low tension glaucoma. It was effective in most of a number of miscellaneous glaucomas including pigmentary glaucoma. Apart from the immediate high rise in IOP the main complication was a late high rise in IOP which was serious in degree and appeared mainly in PXF but also in two cases of ocular hypertension. The presence of a concomitant fall in IOP in the fellow untreated eye is important and probably due to better compliance with treatment. Almost all cases required medical treatment for glaucoma which could not be ceased after ALT. ALT should be seen as an adjunct to, but not a substitute for, medical treatment.

Adult↗
PubMed1987

Betaxolol eye drops as a safe medication to lower intraocular pressure.

Betaxolol, a cardioselective beta 1-adrenergic antagonist, was used in a clinical trial in nine patients with glaucoma and chronic obstructive airways disease to assess its patient acceptance, and its effect on intraocular pressure, respiratory function, corneal and tear function. Betaxolol was well tolerated by all patients with no adverse symptoms. It significantly lowered intraocular pressure (p = 0.03) with no significant change in respiratory function (forced expiratory volume in one second (FEV1), mean mid expiratory flow rate (MMEFR) and vital capacity). Although there was a tendency to decreased wetting with Schirmer 1, decreased break-up time and increased corneal staining with Rose Bengal, this was not statistically significant in this small series. We confirmed the previously reported efficacy and safety of betaxolol in patients with glaucoma and airways disease with satisfactory patient acceptance.

Adrenergic beta-Antagonists↗
PubMed1987

Therapeutic response interactions between timolol maleate and dipivefrin hydrochloride.

Twenty-one patients on long-term treatment with topical timolol maleate and dipivefrin hydrochloride were studied to assess the effect of each agent when used in combined therapy. The two agents are partially additive in most patients, but the relative contribution of each agent varies widely in individual patients and in separate diagnostic categories.

Aged↗
PubMed1986

The risks of precipitating acute angle-closure glaucoma with the clinical use of mydriatic agents.

The risks of precipitating acute angle-closure glaucoma is always present when eyes have shallow anterior chambers, and early recognition of angle-closure glaucoma is important to prevent permanent loss of vision. Two groups of patients with acute angle-closure glaucoma are presented: in the first the attack was immediately preceded by the use of a mydriatic agent and in the second a mydriatic agent had been used previously without incident but the patient later presented with a spontaneous acute attack. A shallow anterior chamber, and in particular inequality of anterior chamber depths of greater than 0.2 mm, were important indicators of susceptibility to angle closure, which is more common in women than in men. Where there is a risk of angle closure, tropicamide 0.5% appears to be the safest mydriatic agent and should be followed by the administration of a miotic agent in susceptible individuals. The need to carry out a peripheral iridectomy in the other eye is stressed, irrespective of the age of the patient. A case of acute glaucoma after the use of oral drops that contained belladonna for nasal allergy further highlights the risks of the use of systemic mydriatic agents in susceptible individuals.

Acute Disease↗
PubMed1984

Solitary silent venous papillary loops and ocular hypertension.

A series of 24 eyes in 23 patients is described showing solitary silent venous papillary loops. These loops are usually associated with a considerable degree of ocular hypertension, presenting when this hypertension is being investigated. They are silent, usually with no previous ocular history, single with a large diameter, affecting veins at the optic disc and not extending into the vitreous. The optic disc is cupped, but usually not more than 0.6 disc diameter, there is good central vision and either a full visual field or only early field loss. Fluorescein angiography shows the loops to be competent with no evidence of any other retinal vascular abnormality. Rarely loss of central vision may occur due to progression to advanced glaucoma. The condition is distinct from prepapillary vascular arterial papillary loops, neovascularization at the optic disc and optociliary shunt vessels. It is also distinct from the venous collateral vessels which develop at the optic disc after acute central or branch retinal vein occlusion. These collaterals are usually multiple, the accompanying ocular hypertension is of lesser degree, cupping of the disc and field loss are usually much more advanced and, while visual acuity may be normal, it is often grossly reduced. On fluorescein angiography all these cases of venous collaterals after retinal vein occlusion showed evidence of other retinal vascular dysfunction. Solitary silent venous papillary loops appear to develop from venules on the optic disc as a bypass to a low grade venous occlusion which is seldom clinically manifest. They form a distinct entity with a good prognosis if the accompanying ocular hypertension is carefully controlled.

Aged↗
PubMed1983

Drop attack in glaucoma. The Melbourne experience with topical miotics, adrenergic and neuronal blocking drops.

We have considered the effectiveness of miotics (pilocarpine 2% and ecothiopate iodide (Phospholine Iodide) 0.125 or 0.25%), adrenaline (Eppy/N 1%) or adrenaline precursors (dipivalyl epinephrine or dipivefrin hydrochloride (Propine) 0.1%) and neuronal blockers (timolol maleate (Timoptol) 0.5%) in 165 patients in the clinical situation. All drops were effective in lowering intraocular pressure with an average fall of 6.6 mmHg for timolol (160 eyes), 8.21 mmHg for pilocarpine (79 eyes), 5.77 mmHg for dipivalyl epinephrine (57 eyes), 7.23 mmHg for adrenaline (17 eyes) and 10.5 mmHg for ecothiopate iodide (16 eyes). In chronic simple open-angle glaucoma, ocular hypertension and pseudoexfoliative glaucoma, pilocarpine and timolol were almost equally effective while dipivalyl epinephrine and adrenaline were also effective, but more as additive therapy, though dipivalyl epinephrine may be useful on its own in ocular hypertension. In low-tension glaucoma timolol and dipivalyl epinephrine together seemed best, while in secondary glaucomas all were effective at times, but ecothiopate iodide was best in aphakic glaucoma and fluorometholone (FML Liquifilm) 0.1% was important in inflammatory glaucoma. Side effects were frequent with dipivalyl epinephrine and timolol, with respiratory disease a strong contraindication to timolol.

Echothiophate Iodide↗
PubMed1983

Timoptol--three years on. A study of timolol maleate drops over a longer period.

A group of 130 patients with chronic glaucoma has been followed from one to more than three years on timolol maleate drops; this confirms that these drops remain effective in long-term therapy through added therapy is usually needed. Of 54 patients originally controlled by timolol alone or in combination, only four were not controlled more than three years later, though some needed further additional therapy. Of 35 patients followed for two to three years, only six could not be controlled by timolol alone or in combination; and of 41 followed for one to two years, 18 were controlled on timolol alone while 23 needed additional therapy. Attention is drawn to side effects including a mild keratopathy and in particular the occurrence of bronchospasm or other severe respiratory disease in 10 patients, not all of whom had a previous history of respiratory disease. Great care should be exercised with timolol in the presence of present or past respiratory disease as the complication is not generally recognised and it falls to the ophthalmologist to act to stop the drop.

Drug Therapy, Combination↗
PubMed1983

Experience with dipivalyl epinephrine. Its effectiveness, alone or in combination, and its side effects.

Dipivalyl epinephrine was as effective as adrenaline as an eyedrop for glaucoma. It was responsible for fewer side effects, through side effects did occur. It had an additive effect when used with timolol maleate and, in 12 of 14 patients on long-term medication with both drugs, a rise of pressure of 3 mmHg or more occurred when dipivalyl epinephrine was stopped. As sole therapy dipivalyl epinephrine was effective in chronic simple open-angle glaucoma, ocular hypertension and pseudoexfoliative glaucoma, and may be useful on its own in the latter two conditions. In low-tension glaucoma it seemed the best therapy when combined with timolol. Headache and ocular pain were uncommon but prominent side effects.

Drug Therapy, Combination↗
PubMed1983

Laser trabeculotomy or trabeculoplasty. Early experience with a new non-invasive surgical technique for glaucoma.

A series of 38 laser trabeculoplasty operations in 32 eyes of 29 patients is described. An average fall of 5.32 mmHg intraocular pressure was obtained; if secondary glaucomas were excluded the average fall was 7.39 mmHg. If a fall of 10 mmHg or more is considered a good result then eight eyes obtained a good result, five of these eyes having pseudoexfoliative glaucoma. A fall of 3-9 mmHg was considered a moderate result and 12 eyes obtained this, 11 of them having chronic simple open-angle glaucoma, the other being the only other case of pseudoexfoliative glaucoma in the series. Five eyes with chronic simple open-angle glaucoma and seven eyes with secondary glaucoma all obtained no significant fall. It is stressed that in chronic simple open-angle glaucoma there was often only a small fall or no fall at all, so that it seems unwise to temporize if there is a high uncontrolled pressure in this condition. Great care is also needed in advanced chronic simple open-angle glaucoma because of the occasional occurrence of a high rise of pressure soon after operation. The procedure works well in pseudoexfoliative glaucoma.

Glaucoma↗
PubMed1983

Management of quinine toxicity.

The clinical findings, investigations, and course of three patients who ingested quinine sulphate or bisulphate tablets and suffered severe visual loss are described. Methods and control of treatment for these patients are discussed, and the assessment of the effectiveness of treatment, and its relationship to the visual outcome are considered.

Adult↗
PubMed1983

Combined trabeculectomy and cataract extraction.

A small personal series of patients with chronic open-angle glaucoma who underwent combined trabeculectomy and cataract extraction is analysed with regard to the effect of the operation on the control of intraocular pressure. The results support the regular use of the operation as an effective means of reducing intraocular pressure.

Aged↗