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Biomedical subjects

T G Williams

Publications and source records attributed to T G Williams.

At least 19 recordsLinked to original sources
PubMed1998

Long-term follow up of patients with toenail onychomycosis after treatment with terbinafine.

The long-term outcome of 111 patients treated with oral terbinafine for toenail onychomycosis with a novel treatment protocol was assessed a median of 138 weeks after entry into the trial. All but three patients had either one or two 12 week courses of terbinafine 250 mg daily. Of the 77 evaluable patients, 72.7% were still classified as responders (i.e. negative mycological culture and at least 3 mm of new unaffected nail growth) on reassessment. The present study shows that a favourable long-term outcome can be achieved in patients who have been treated with at least one 12 week course of terbinafine.

Administration, Oral↗
PubMed1997

Significance of non-dermatophyte moulds and yeasts in onychomycosis.

In a multicentre, randomised, double-blind, 48-week clinical trial, 118 patients with toe-nail onychomycosis were given terbinafine (250 mg daily) or placebo for 12 weeks, followed by 12 weeks of observation. Non-responders were offered 12 further weeks of terbinafine (250 mg daily) from week 28. Each patient had 8-12 consecutive nail specimens collected from the same nail, allowing for an assessment of the fungal nail flora from 1,321 nail specimens. By week 48, the overall mycological cure rate for terbinafine patients was 94%. 64% of patients had an underlying dermatophyte infection with at least 1 non-dermatophyte mould or yeast isolated from at least 1 specimen. These contaminants often overgrow or mask the presence of a dermatophyte. In only 2.5% of all patients was the same non-dermatophyte isolated from 2 or more consecutive specimens, probably representing secondary colonisation which exploits nutrients released by the underlying dermatophyte. The presence of incidental non-dermatophyte contaminants or secondary colonisers did not affect treatment outcome, and in this study treatment of the primary dermatophyte pathogen with terbinafine cleared the nails from infection in all cases. 80% of patients remained mycologically negative after 2 years.

Administration, Oral↗
PubMed1997

Non-dermatophytes in onychomycosis of the toenails.

A multicentre trial for the treatment of dermatophyte onychomycosis of the toenails with terbinafine was carried out in Australia and New Zealand. Between eight and 12 nail samples were obtained from each of the 118 patients in the 48-week trial, and each sample was investigated by direct microscopy and culture for dermatophyte and non-dermatophyte fungi. Patients were randomized to treatment with terbinafine at 250 mg/day or placebo for the first 12 weeks of the study, then non-responders were offered a 12-week course of terbinafine from week 28. All patients had a dermatophyte infection. In 42 patients (36%) microscopy and mycological culture identified dermatophytes alone. In the remaining 76 patients (64%), a non-dermatophyte mould or yeast was also isolated at some stage during the trial, but in only three patients did the same non-dermatophyte persist in two or more successive nail specimens. The presence of a fungal contaminant in addition to a dermatophyte had no apparent effect on the efficacy of treatment with terbinafine. We conclude that non-dermatophyte moulds and yeasts are generally found as contaminating organisms in dermatophyte onychomycosis, secondary to the dermatophytes, and that they do not influence the outcome of treatment.

Adolescent↗
PubMed1996

Restructuring critical care services. Part III: Successful implementation preparation.

Successful implementation in a redesigning organization does not happen without a sound design, good implementation planning and effective leadership. The focus of the implementation preparation must change prior to and after the "go live" implementation date. Implementation preparation requires intentional steps to build systems, communicate effectively and develop operational understanding among clinicians, physicians and management. Early effort should focus on planning for efficient day-to-day operations, development of measurement systems and contingency planning. Immediately prior to and after implementation the focus should be on communication, goal setting, issues prioritization and fact-based issues resolution. After the first couple of months of implementation, the focus should move toward mentoring teams/individuals, building outcome measurement systems, identifying sources of future improvement and transferring more authority as appropriate to teams. Commit to comprehensive implementation preparation. Time spent on implementation preparation will pay large dividends during the challenging times of transitioning your organization to a redesigned world.

Communication↗
PubMed1996

Measuring the potency of pulp mill effluents for induction of hepatic mixed-function oxygenase activity in fish.

A bioassay protocol was optimized for measuring the potency of effluents or waterborne chemicals for inducing mixed-function oxygenase (MFO) activity of rainbow trout (Oncorhynchus mykiss). Measurements of ethoxyresorufin O-deethylase (EROD) can be made with an established endpoint assay using large volumes of reagents and tissue. However, a new kinetic microplate assay offers significant savings in time, reagents, and sample volumes. Data are distributed lognormally and must be log transformed before statistical analyses. EROD activity increases with exposure time to pulp mill effluent, and a 4-d exposure provides a near-maximal response. Optimum fish size conforms to standard practices in fish toxicology; loading rates should not exceed 1 g of fish per liter of test solution per day. Feed should be withheld from test fish 48 h before testing to reduce the variance of measured activity, and anaesthetizing fish with MS-222 does not affect their response to MFO inducers. Pulp mill effluents do not lose their potency during 2-3 wk of exposure at temperatures ranging from -20 to 13 degrees C, whether stored in plastic or glass. Steel containers were associated with slight losses in potency. Bioassays of MFO induction in fish exposed to liquid effluents are practical and conform to standard practice for testing the lethality of waterbone chemicals. The results are sufficiently precise that differences among means based on live fish per treatment can be discriminated statistically when activity changes by threefold or more.

Analysis of Variance↗
PubMed1994

Rigorous management of insulin-dependent diabetes mellitus during pregnancy.

The effect of rigorous management of insulin-dependent diabetes mellitus (IDDM) during pregnancy on the perinatal outcome was assessed by comparing 78 prepartum gravid patients with IDDM managed prospectively with 78 matched controls. The diabetic women were treated with insulin by either infusion pump or split-dose therapy, with the goal of normalization of the fasting blood sugars and hemoglobin Hb A1c values. Differences in the perinatal outcome were evaluated by either chi-square or analysis of variance. Of the women with IDDM, 14% where White class B, 43% class C, 26% class D, 17% classes R and F. The mean Hb A1c value in the first half of pregnancy was 8.49% +/- 2.30%, and 7.34% +/- 1.79% in the second half. Women with IDDM had higher rates of premature delivery (31% vs. 10%, P = 0.003), pre-eclampsia (15% vs. 5%, P = 0.035), and cesarean section (55% vs. 27%, P = 0.002). Complications of infants born to diabetic mothers included large size for gestational age (41% vs. 16%, P = 0.0002), hypoglycemia (14% vs. 1%, P = 0.0025), hyperbilirubinemia (46% vs. 23%, P = 0.0002), and respiratory distress (12% vs. 1%, P = 0.008). The Apgar scores and mortality were similar. Congenital malformations occurred in 7.7% of infants of diabetic mothers and 1.3% of controls (P = 0.05). The maternal Hb A1c level did not correlate with the infant size for gestation. Although the improved medical management of IDDM has decreased neonatal mortality, significant perinatal complications persist.

Adolescent↗
PubMed1994

Death of a classified worker probably caused by overexposure to gamma radiation.

This paper describes the case of an industrial radiographer who was seriously overexposed to gamma radiation. The exact circumstances of this exposure were not established but it was concluded that he was repeatedly irradiated probably to a total average whole body dose of at least 10 Gy over several years. Also, a much larger dose to a hand required its partial amputation. He developed myelodysplasia, which progressed to acute myeloid leukaemia from which he died. Karyotypic examination of the leukaemic blasts showed changes very similar to those associated with secondary leukaemia that may develop after radio or chemotherapy. The paper describes his medical case history, the investigation of his workplace, and the attempts to estimate his radiation dose by chromosomal analysis of blood lymphocytes and electron spin resonance of dental enamel and bone.

Acute Disease↗
PubMed1992

Duodenal perforation after laparoscopic cholecystectomy.

A case is reported of duodenal perforation complicating laparoscopic cholecystectomy performed by laser dissection. The importance of investigating a patient with persistent shoulder-tip pain following this technique to exclude a subphrenic abscess is emphasised.

Cholecystectomy, Laparoscopic↗
PubMed1989

Meconium aspiration syndrome: intrapartum and neonatal attributes.

To identify the fetus and newborn at risk for meconium aspiration syndrome the perinatal characteristics of 238 infants delivered through meconium-stained amniotic fluid were prospectively examined. All infants with meconium-stained amniotic fluid were routinely suctioned with a DeLee apparatus before tracheal intubation and suctioning. The type and presence of meconium in the trachea, neonatal breathing before intubation, and Apgar scores were recorded in the delivery room. Intrapartum fetal monitoring data were collected for 80% (190/238) of the mothers and umbilical artery pH for 74% (177/238) of the newborns. Despite suctioning with a DeLee apparatus and endotracheal suctioning, meconium was present in the trachea in 87/238 (37%) and meconium aspiration syndrome developed in 22 (9.2%). A total of 73% of newborns who had meconium aspiration syndrome were delivered through thick meconium. Thick meconium, the presence of fetal tachycardia, and absence of intrapartum fetal cardiac accelerations identified the fetus at high risk for meconium aspiration syndrome. The presence of these monitoring findings and thick meconium should alert obstetricians to the possibility of a fetus that requires intervention. Low umbilical artery pH, Apgar scores less than 5, and meconium in the trachea further characterized the newborn at high risk for meconium aspiration syndrome. The combination of these findings may best identify the infant delivered through meconium-stained amniotic fluid who requires close observation for meconium aspiration syndrome.

Amniotic Fluid↗
PubMed1989

Respiratory distress during total parenteral nutrition.

We report on a patient who developed fatal respiratory distress two days after starting parenteral feeding for malnutrition complicating Crohn's disease. Post mortem examination revealed pulmonary collapse secondary to mediastinal leak of the infusion fluid due to an undiagnosed erosion of the vascular catheter tip through the brachiocephalic vein.

Aged↗
PubMed1987

The relationship between cadmium, zinc, and birth weight in pregnant women who smoke.

It is universally accepted that smoking during pregnancy results in decreased infant birth weight. However, the mechanism for decreased birth weight is not completely understood. This study tested the hypothesis that the cadmium/zinc interaction in the maternal-fetal-placental unit of the mother who smokes could be related to birth weight. Thiocyanate was used as the index of smoking status and atomic absorption spectroscopy was used to determine trace elements. Results show that cord vein red blood cell zinc and maternal whole blood cadmium levels are significant predictors of infant birth weight when variance that is due to clinical factors and thiocyanate is controlled with stepwise multiple regression techniques (n = 202). Bivariate correlation techniques showed that the factors affecting birth weight were different in the smoking and nonsmoking groups. For example, in nonsmokers (n = 125), the cord vein red blood cell zinc level was positively related to birth weight. In smokers (n = 77), maternal whole blood cadmium, placental cadmium, and placental zinc levels were negatively related to birth weight; the ratio of placental zinc to placental cadmium and the cord vein red blood cell zinc level were positively related to birth weight. The results suggest that increased maternal cadmium and decreased cord vein red blood cell zinc levels in infants of smokers may be significant clinically since increased maternal whole blood cadmium and decreased cord vein red blood cell zinc levels are both significantly related to decreased birth weight.

Birth Weight↗
PubMed1987

Neonatal complications following in utero exposure to intravenous ritodrine.

Intravenous administration of ritodrine for tocolysis has been associated with maternal cardiovascular and metabolic changes. Studies with other tocolytic agents, such as isoxsuprine, have shown an increased neonatal morbidity among infants born soon after failure of such therapy. We examined the potential side effects of maternal intravenous ritodrine therapy in 58 neonates born within 12 h following discontinuation of maternal medication. 'Low dextrostix' was significantly greater in the ritodrine exposed neonates (p less than 0.05) than in the controls. It occurred within a mean 1.0 +/- 0.5 h following birth. The mean 1 min and 5 min Apgar scores, neonatal pH, bicarbonate levels, hypotension and neonatal mortality were comparable in the ritodrine-exposed and control groups of neonates. The occurrence of any of the neonatal morbidity variables, including 'low dextrostix' was not related either to the total dose of ritodrine used or to the interval between drug discontinuation and delivery. Administration of ritodrine by the standard protocol to stop preterm labor is not associated with any significant increase in neonatal morbidity.

Female↗
PubMed1985

The diagnosis of aortic graft-enteric fistulae by computed tomography.

A number of techniques have been used to diagnose aortic graft-enteric fistulae. These are reviewed and their value assessed. Three patients are described in whom the diagnosis was correctly made from characteristic appearances seen on a computed tomography (CT) scan. Further experience may show that CT scanning has an important role in the detection of this condition.

Aged↗