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Biomedical subjects

R W Walker

Publications and source records attributed to R W Walker.

At least 19 recordsLinked to original sources
PubMed2003

Intra-articular fractures of the distal radius: a prospective randomised controlled trial comparing static bridging and dynamic non-bridging external fixation.

This prospective randomized trial compared a non-bridging external fixator with a bridging external fixator system for the treatment of severe comminuted intra-articular fractures of the distal radius. The results did not demonstrate a statistically significant difference in the radiological and clinical outcomes achieved with these two treatments.

Activities of Daily Living↗
PubMed2002

Incidence and prediction of falls in Parkinson's disease: a prospective multidisciplinary study.

OBJECTIVES: To accurately establish the incidence of falls in Parkinson's disease (PD) and to investigate predictive risk factors for fallers from baseline data. METHODS: 109 subjects with idiopathic PD diagnosed according to the brain bank criteria underwent a multidisciplinary baseline assessment comprising demographic and historical data, disease specific rating scales, physiotherapy assessment, tests of visual, cardiovascular and autonomic function, and bone densitometry. Patients were then prospectively followed up for one year using weekly prepaid postcards along with telephone follow up. RESULTS: Falls occurred in 68.3% of the subjects. Previous falls, disease duration, dementia, and loss of arm swing were independent predictors of falling. There were also significant associations between disease severity, balance impairment, depression, and falling. CONCLUSIONS: Falls are a common problem in PD and some of the major risk factors are potentially modifiable. There is a need for future studies to look at interventions to prevent falls in PD.

Accidental Falls↗
PubMed2000

Stroke mortality in urban and rural Tanzania. Adult Morbidity and Mortality Project.

BACKGROUND: Most data for stroke mortality in sub-Saharan Africa are hospital based. We aimed to establish the contribution of cerebrovascular disease to all-cause mortality and cerebrovascular disease mortality rates in adults aged 15 years or more in one urban and two rural areas of Tanzania. METHODS: Regular censuses of the three surveillance populations consisting of 307,820 people (125,932 aged below 15 years and 181,888 aged 15 or more) were undertaken with prospective monitoring of all deaths arising in these populations between June 1, 1992 and May 31, 1995. Verbal autopsies were completed with relatives or carers of the deceased to assess, when possible, the cause of death. FINDINGS: During the 3-year observation period 11,975 deaths were recorded in the three surveillance areas, of which 7629 (64%) were in adults aged 15 years or more (4088 [54%] of these in men and 3541 [46%] in women). In the adults, 421 (5.5%) of the deaths were attributed to cerebrovascular disease, 225 (53%) of these in men and 196 (47%) in women. The yearly age-adjusted rates per 100,000 in the 15-64 year age group for the three project areas (urban, fairly prosperous rural, and poor rural, respectively) were 65 (95% CI 39-90), 44 (31-56), and 35 (22-48) for men, and 88 (48-128), 33 (22-43), and 27 (16-38) for women, as compared with the England and Wales (1993) rates of 10.8 (10.0-11.6) for men and 8.6 (7.9-9.3) for women. INTERPRETATION: We postulate that the high rates in Tanzania were due to untreated hypertension. Our study assessed mortality over a single time period and therefore it is not possible to comment on trends with time. However, ageing of the population is likely to lead to a very large increase in mortality from stroke in the future.

Adolescent↗
PubMed2000

Acute-onset painful upper limb multifocal demyelinating motor neuropathy.

We report three patients who presented with acute onset of shoulder and upper arm pain followed within a few days by predominantly distal upper limb weakness. Nerve conduction studies showed severe and unequivocal focal motor conduction block in the forearm and/or upper arm along with slowing of motor conduction and prolonged F wave responses. Only very mild changes in sensory nerve conduction were found. One patient made partial clinical improvement after 17 months, and there was a significant improvement in the degree of motor conduction block and the motor conduction velocities. A second patient remained unchanged after 5 months. Idiopathic brachial neuritis (IBN) typically presents acutely with brachialgia and acute or subacute non-progressive weakness. Multifocal motor conduction block in nerves in the arm or forearm has not been described in patients with IBN. Multifocal motor conduction block restricted to the upper limbs has been described in focal chronic inflammatory demyelinating polyneuropathy (CIDP) and in multifocal motor neuropathy with multifocal motor conduction block (MMNCB). However, both these conditions have hitherto usually been described as largely painless chronic progressive disorders with a subacute onset. Our patients, with features overlapping MMNCB/CIDP and IBN, represent an as yet unreported clinical variant.

Action Potentials↗
PubMed2000

The laryngeal mask airway in the difficult paediatric airway: an assessment of positioning and use in fibreoptic intubation.

The laryngeal mask airway (LMA) was used in 34 children who presented with difficult airways and difficulty in intubation. All 34 children were a grade 3 or grade 4 Cormack and Leehane view at conventional laryngoscopy. The laryngeal mask airway was used as part of the anaesthetic technique. It was either used as the method of airway maintenance during a short procedure or as an aid to fibreoptic intubation. The results of its use in this group of patients showed that overall a good airway was obtained in 73% of patients and an adequate airway in 27%, and in no patient was a poor airway obtained. The fibreoptic positioning of the LMA, taken from the distal aperture of the laryngeal mask airway showed that, overall, in 29.5% of patients a full view of the glottis (grade 1) was obtained, in 29.5% of patients a partial view of the glottis (grade 2) was obtained and in 41% a view of the epiglottis only (grade 3) was obtained. In no patient was a view excluding the epiglottis obtained. In children with a mucopolysaccharide disorder, the number of children who had a grade 3 view increased to 54%. Children with a disorder other than mucopolysaccharidosis had a grade 3 view in only 17% of cases. Children with mucopolysaccharidoses had a grade 1 view in only 14% of cases compared with 58% in the group with other disorders. Of the 34 patients, 21 patients were intubated on 31 separate occasions. There were no failures. The complications of the fibreoptic intubation technique described are outlined.

Anesthesia, Endotracheal↗
PubMed2000

Dorsal dislocation of the capitate.

We report a case of dorsal dislocation of the capitate and third metacarpal, and discuss the possible classification of this pattern of injury.

Adult↗
PubMed2000

Age specific prevalence of impairment and disability relating to hemiplegic stroke in the Hai District of northern Tanzania. Adult Morbidity and Mortality Project.

OBJECTIVES: To determine the age specific prevalence of impairment and disability relating to hemiplegic stroke in one rural area of Tanzania. METHODS: During the yearly house to house census of the study population of 148 135 (85 152 aged 15 and over) in August 1994, specific questions were asked to identify those who might be disabled from stroke. People thus identified were subsequently interviewed and examined by one investigator. In those in whom the clinical diagnosis of stroke was confirmed a more detailed interview and examination relating to risk factors and recovery was carried out. RESULTS: One hundred and eight patients, 61 men and 47 women, were identified with a median age of 70 (range 18-100). Median age at first stroke was 65 years. The age specific rates in this study were lower than previous studies in developed countries. All were cared for at home although 23 (21%) were bedbound. CONCLUSIONS: Although prevalence of impairment and disability related to stroke in this population as a whole was low this is mainly explained by the age structure, with less than 6% being aged 65 and over. Age standardised rates for stroke with residual disability were about half those found in previous studies in developed countries. Death from stroke in Africa may be higher but data are limited. With the demographic transition stroke is likely to become a more important cause of disability in sub-Saharan Africa.

Adolescent↗
PubMed2000

Evaluation of pressure beneath a split above elbow plaster cast.

It has previously been shown that splitting a plaster cast after manipulation of, or surgery on, a limb leads to a decrease in pressure beneath the cast by accommodating the swelling that may occur. However, it is not known whether the axis along which the cast is split influences the amount of swelling that can occur before a critical pressure is reached. We investigated this with reference to above elbow plaster casts.

Casts, Surgical↗
PubMed1999

A bronchogenic cyst in an infant causing tracheal occlusion and cardiac arrest.

A 3-month-old infant treated for 3 weeks for suspected bronchiolitis, developed episodes of profound desaturation. A lateral X-ray showed displacement and compression of the trachea. Respiratory arrest, from which she was successfully resuscitated, occurred just before MRI scan. The mass was removed at thoracotomy and a histological diagnosis of a bronchogenic cyst was made. Mediastinal masses in babies are relatively rare, and the situation in which they present with acute respiratory distress may prove extremely challenging to the anaesthetist. Bronchogenic cysts are difficult to diagnose pre-operatively and awareness may assist in the peri-operative management of these infants.

Anesthesia, General↗
PubMed1999

Tears at bedtime.

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Acetaminophen↗
PubMed1998

Long QT syndrome.

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Anesthesia↗
PubMed1997

Dementia with lewy bodies: a study of post-synaptic dopaminergic receptors with iodine-123 iodobenzamide single-photon emission tomography.

Dementia with Lewy bodies (DLB) can at present only be diagnosed with certainty by neuropathological examination. Diagnosis during life remains at best probable, based on the presence of symptoms known from autopsy studies to be frequently associated with DLB. The greatest practical clinical problem lies in distinguishing DLB and Alzheimer's disease (AD). In DLB there is a considerable degeneration of nigral neurones with depletion of striatal dopamine. In contrast, AD is not associated with significant changes in dopamine metabolism. Iodine-123 iodobenzamide single-photon emission tomography (IBZM-SPET) measures post-synaptic dopamine D2 neuroreceptor availability in the corpus striatum, but is nevertheless a method for assessing the integrity of the nigrostriatal dopaminergic pathway. Sixteen clinically diagnosed DLB patients, 15 normal controls and 13 AD patients underwent IBZM-SPET. All subjects were scanned 1.5-2 h after intravenous injection of 185 MBq of 123I-IBZM. Circular regions of interest were employed to calculate radioactivity ratios in each hemisphere as follows: caudate nucleus/frontal cortex, putamen/frontal cortex and caudate nucleus/putamen. The DLB patients had significantly lower left caudate/putamen ratios (95% confidence intervals: DLB 0.893-0.965, AD 0.972-1.175, controls 1.031-1.168) than either controls or AD patients, and significantly lower right caudate/putamen ratios (95% confidence intervals: DLB 0.926-1.019, AD 0.954-1.103, controls 1. 027-1.144) than controls. Our data suggest that patients with DLB diagnosed by clinical criteria have changes in striatal post-synaptic D2 receptors. This may be of value in distinguishing DLB from AD during life.

Aged↗
PubMed1997

A fibreoptic intubation technique for children with mucopolysaccharidoses using the laryngeal mask airway.

Children with mucopolysaccharidoses present the anaesthetist with both a difficult airway and often an impossible intubation using conventional techniques. A technique for airway management and tracheal intubation is described utilizing the Brain laryngeal mask airway, the fibreoptic bronchoscope, a guide wire and a ureteral dilator. Two case reports of children with mucopolysaccharidoses are presented who were managed successfully with this technique. The advantages of the technique are discussed.

Adolescent↗