Guidelines for health screening projects.
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Biomedical subjects
Publications and source records attributed to R Johnson.
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The problem of how best to treat a patient with instability of the atlanto-axial complex is still somewhat controversial. In this follow-up study of fifty-nine patients, nineteen were treated by a plaster jacket and brace; eleven, by single midline wiring and onlay bone grafts; and thirty, by four circumferential wires around the posterior elements of the axis and atlas with two bone grafts wedged between these elements on each side according to the method described by Brooks and Jenkins. (One patient had both types of fusion.) Although direct comparison of the results of treatment in three groups was not possible because of the many variables that may have influenced the results, the incidence of solid fusion was distinctly higher after the Brooks fusions despite less postoperative immobilization.
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A venographic investigation has been carried out on 50 patients undergoing Charnley total hip replacement. The overall incidence of thrombus formation was 54%. Most of the thrombi formed in the second postoperative week, with a preponderance for the operated side, and were sevenly distributed throughout the venous system. The preoperative assessment both clinical and venographic was of no value in predicting thrombus formation postoperatively. The fact that few thrombi formed in the "sensitive area" indicates that the Charnley technique of arthroplasty and the heat generated using acrylic cement has little part to play in the formation of postoperative thrombi, rather that a generalized hypercoagulable state is induced by the operation.
Self-mutilation and attempted suidcide among adolescent prisoners are explored in relation to concrete coping tests posed in prison and to self-esteem problems posed by failure of external (family) and internal (peer) support systems. Crisis sequences are traced using verbatim excerpts from interviews with self-destructive prisoners and conceptualized in terms of enduring adolescent needs and concerns. Some general observations regarding strategies of intervention with crisisprone prisoners are included.
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So-called "peribronchial cuffing" in acute pulmonary edema appears to be caused by edema involving the bronchila wall as well as the peribronchial interstitial space, and this was confirmed at autopsy in a patient with acute left heart failure. Edema of the bronchial wall indicates transdation from capillaries derived from the bronchial rather than the pulmonary atery, which may well explain all of the radiological manifestations of acute interstitial edema. The possible role of this circulation in the production of acute alveolar edema is also discussed. The significance of the bronchial artery circulation in the production of acute pulmonary edema warrants reevaluation.
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From 1962-73 7,959 total hip replacements were performed by a standardized technique at Wrightington Hospital with 628 (7.89%) non-fatal emboli. Of 603 available for study the effect of different forms of anticoagulant therapy were compared with no therapy. The various antithromboembolic regimens in 295 cases had recurrent emboli in 13 per cent, while without anticoagulant therapy in 308 there were only 3.2 per cent recurrent pulmonary emboli.
Comprehensive studies on body fluid balance on 5 divers were conducted during the Hana Kai II dive (17 days at 18.6 ATA and 7 days of decompression). Daily urine flow increased from about 2000 ml at 1 ATA to 2600 ml at 18.6 ATA, at 31 degrees C. This diuresis was accompanied by a reduction in urine osmolality (from 650 to 500 mOsm) and a slight increase in osmolal clearance. Endogenous creatinine clearance remained at about 173 ml/min throughout the dive. Despite such a sustained diuresis, neither daily water intake nor total body water volume changed significantly. The plasma renin activity changed little, while both plasma aldosterone concentration and urinary aldosterone excretion increased significantly during the first week at 18.6 ATA. The plasma prolactin concentration showed a significant decrease during the first 3 days at 18.6 ATA. The daily excretion of antidiuretic hormone (ADH) decreased significantly (by 40%) 4 days after compression and remained low throughout the rest of the dive. Insensible waterloss at 18.6 ATA was 35% lower than that at 1 ATA. It is suggested that the observed hyperbaric diuresis is due primarily to suppression of ADH as a result of suppression of insensible water loss.
The incidence of pulmonary emboli after a standardized technique of total hip replacement in a series of 7,959 hip arthroplasties operated on between 1962 and 1973 was 1.04% fatal and 7.89% non-fatal. 1,174 had no prophylaxis against embolism with a fatality rate of 2.3% and non-fatal embolism in 15.2%. Phenindione, intravenous heparin and dextran all reduced the complication rate to about 1% fatal and 8% non-fatal but none was statistically better than another. Statistically, plaquenil (hydroxychloroquine sulphate), was as good as any of the other methods used and had few complications. Analysis of the blood groups, pre and post-operative hemoglobin levels, major and revision surgery showed little relationship to the incidence of embolism. The most frequent time of onset of embolism (75%) occurred in the second and third postoperative weeks with only 10% in the first week.