Biomedical subjects
Publications and source records attributed to W Carter.
The author presents an insight into how a general practitioner manages a patient who works as a prostitute. It portrays the medical problems, including screening and management, and highlights the human aspects of the all-important doctor-patient relationship.
A role for eosinophils in the immune reaction has not been yet established. Considering that these leukocytes accumulate in lymphoid organs under glucocorticoid stimulation, we explored the possibility that they participate in the depression of immune reactions induced by these hormones and that they degranulate to exert this action. In this context, we investigated the dose effect of three estrogens on the number and degranulation of spleen red pulp eosinophils and on the percentage of spleen cross sectional area comprising white pulp. Estradiol-17 beta or 4 (OH) estradiol-17 beta increased red pulp eosinophils at low doses: 2 (OH) estradiol-17 beta increased them at a very high dose. The three estrogens degranulated the spleen eosinophils and decreased the lymphocyte containing spleen white pulp. We propose that the decrease in white pulp is a response mediated by agents released from degranulating eosinophils under the action of estrogen. Consequently, both estrogen-induced eosinophil degranulation and estrogen-induced increase in red pulp eosinophil numbers are conditions contributing to a decrease in white pulp volume. All above evidence supports the hypothesis that eosinophils are involved in immunoregulation by diminishing the number of lymphocytes contained in lymphoid organs.
As well as writing prolifically, the Brisbane doctor consults for 36 hours a week in his own practice and holds more than 20 seats on community, local government and AMA committees. He says the key is never to mix business with home. "Most of my income is generated not from general practice but from my other activities. Australian GPs are poorly paid. The government keeps telling people that GPs are ripping them off if they charge more than the medical rebate. The public's image of GPs is very low. The way it works now is that the more ethical you are and the more care you give to your patients, the less you earn." Warwick Carter does not known where his next challenge will lead him. He has three inflexible goals: to remain a GP, to finish his travels around the world, and not to volunteer for anything he does not enjoy.
While negotiation of treatment decisions in the medical visit has long been recognized as an important interviewing skill, limited work has been done to investigate how doctors and patients negotiate what information is relevant in understanding the patient's problem. In this research we tested how the introduction of information reflecting both the patient's and physician's perspective is related to the patient's adherence to physician recommendations for medication. Introduction of information was defined as bi-directional if patients independently offered information or behavior as frequently as they provided the information or exhibited behavior that physicians requested. Thirty random samples of audiotaped dialogue were used to construct estimates of introduction of information during the history, examination, and consultation phases of initial ambulatory care visits of 45 older male patients. The data demonstrate that bi-directional introduction of information during the examination segment explains more than half of the variance in patient adherence to physician recommendations for new medication. These findings support the idea that physician willingness to allow patients to contribute input may contribute to the partnership's arrival at treatment decisions that have meaning for both.
One hundred eighteen male and female adult subjects were entered into a 14-week, double-blind clinical study to compare the effect of a dentifrice containing 0.3% triclosan and 2% of a copolymer of methoxyethylene and maleic acid on plaque formation and gingivitis. The subjects were stratified into two balanced groups according to baseline plaque scores. They then received an oral prophylaxis and were assigned to the use of either a placebo dentifrice or the triclosan/copolymer dentifrice for the next 14 weeks. After 6 weeks' use, the triclosan/copolymer dentifrice provided a 21.34% statistically significant (99% level of confidence) reduction in supragingival plaque deposits, as compared to the placebo dentifrice. The triclosan/copolymer dentifrice also provided a 5.49% reduction gingivitis after 6 weeks' use, as compared to the placebo dentifrice. This reduction was not statistically significant. After 14 weeks' use, the triclosan/copolymer dentifrice provided a 38.80% statistically significant (99% level of confidence) reduction in supragingival plaque deposits, as compared to the placebo dentifrice. The dentifrice containing triclosan and copolymer also provided 50.72% statistically significant (99% level of confidence) reduction in gingivitis, as compared to the placebo dentifrice. When tooth surfaces with the highest degree of plaque formation (i.e. Quigley-Hein score greater than or equal to 3) were examined at 6 weeks, the triclosan/copolymer dentifrice provided a 42.92% statistically significant (99% level of confidence) reduction in supragingival plaque deposits, as compared to the placebo dentifrice.(ABSTRACT TRUNCATED AT 250 WORDS)
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A case of fatal dilated cardiomyopathy induced by esorubicin (ESO) at a total dose of 740 mg/m2, given in 27 doses over 650 days, is reported. The sudden onset, rapid clinical deterioration, and fatal outcome are detailed. The outcome was not predicted by serial rest ejection fractions or clinical signs. The data from animal studies, phase 1 and phase 2 clinical testing, are reviewed, demonstrating the almost complete absence of reports of ESO-induced cardiotoxicity. Studies reviewing ejection fractions and myocardial biopsy scores show that ESO can be cardiotoxic and may produce fatal dilated cardiomyopathy.
The ability of lay persons to learn and retain defibrillation skills using an automatic external defibrillator (AED) was assessed. Thirty-four family members of cardiac arrest survivors were trained in CPR techniques and defibrillation, and evaluated for performance of skills immediately following training and at six-week and three-month follow-ups. All but two were successfully trained to complete three cycles of CPR interspersed with three defibrillatory shocks in an average of four minutes with the first shock delivered in an average of two minutes. Although there were decrements in the speed and quality of performance at each follow-up period (P less than .01), we conclude that most lay persons can learn to operate an AED safely and under simulated conditions provide defibrillatory shocks an average of eight minutes faster than typical response times of emergency medical technicians. These results suggest that AEDs can be placed in many homes of patients at high risk for cardiac arrest.
Prompt identification of cardiac arrest by emergency dispatchers can save valuable time and increase the likelihood of successful resuscitation. The authors reviewed 516 cardiac and 146 non-cardiac calls to identify features of a probable cardiac arrest call. The results indicate that information about sex, location, and activity is of little use in the identification of cardiac arrest. When the patient is over 50 years old and the caller is emotional, the possibility of cardiac arrest is high, suggesting that questions about consciousness and breathing should be asked immediately. Additional information can be obtained or telephone cardiopulmonary resuscitation (CPR) instructions can be given after dispatch of an emergency vehicle.
The authors assessed the prevalence and demography of depressive symptoms, their association with specific chronic diseases, and their influence on health service use in a large sample of elderly men seen in a primary care setting. Twenty-four percent of respondents reported clinically significant depressive symptoms; the prevalence of major depressive disorders was estimated at 10%, but only 1% reported receiving mental health treatment by a specialist. Self-reported marital separation or divorce and physical disability affecting employment were strongly associated with high depression scores, whereas the normative stresses of aging (widowhood, retirement, social isolation) were not. Only chronic lung disease was differentially associated with high depression scores, and this effect was weak. The authors discuss the implications of these findings for the design of comprehensive health services for the elderly with chronic disease.
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Based on the position of the thumb metacarpal, 102 burned thumb contractures in children were classified into four categories: adduction, opposition, extension and flexion. The contractures were further classified as mild, moderate or severe, based on the amount of motion lost. All thumbs were surgically released. Coverage was obtained with local flaps or Z-plasties, skin grafts or a combination of local flaps and skin grafts. Factors influencing the results were as follows: Classification category: Extension contractures generally did poorly, whereas flexion contractures did well. Severity of contracture: The more severe the contracture, the worse the final results. Complexity of contracture: Contractures with a subluxated or dislocated joint did not do as well as those with undisturbed bony alignment. Type of surgical release: There was a trend towards better results when skin grafts (as opposed to local flaps) were used, especially in the treatment of moderate and severe contractures.
Multiple interferon (IFN) alpha genes characterize divergent animal species, yet human interferon alpha (HuIFN-alpha) genes are closely related in nucleotide sequence. Either the IFN-alpha genes derived from common ancestor sequences after divergence of these animals, or the HuIFN-alpha genes that have been studied underwent concerted evolution. Evidence suggesting that concerted evolution did occur to some unknown extent raises doubts about the important conclusion of recent divergence of the HuIFN-alpha gene family.
The first prototypes of an abdominal phantom have been constructed. The phantom is intended for eventual use in training diagnostic ultrasound personnel and in demonstrating commercial equipment. It is constructed from plastics believed to be stable and approximately tissue-equivalent at room temperature. Abdominal structures are formed from a dispersion of a polystyrene butadiene plastic in mineral oil. Polyvinyl chloride particles are incorporated to provide the desired attenuation coefficients and scattering levels. B-scans of the phantom produced realistic images, although problems associated with scanning technique and somewhat high phantom attenuation were noted. Very useful phantoms should result from relatively simple improvements in construction techniques.
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The CSF pressure-volume (P-V) function was evaluated before and after cardiac arrest in 15 cats. The CSF volume change was produced by bolus loading (loading rate, greater than 0.1 mL/s) of the CSF space. Comparison of the CSF P-V function before and after cardiac arrest was made over a CSF pressure range of 5 to 46 mm Hg and for a CSF volume change of up to 9% of total CSF volume. After cardiac arrest, all CSF P-V curves were well described by the mathematical model konwn to be valid under normal physiological conditions. In eight animals, there was no significant difference between the prearrest and postarrest P-V functions. For the seven animals demonstrating a significant difference between prearrest and postarrest P-V data, all but one of the postarrest P-V curves were within the normal range. These results suggest that the shape of the CSF P-V curve is not substantially altered by cardiac arrest. We conclude that under normal circumstances material properties of brain tissue are the most important factors in determining the configuration of the CSF P-V curve and that under normal circumstances cerebral hemodynamic factors do not affect the shape of this curve.
For rapid changes in cerebrospinal fluid volume an exponential relationship was demonstrated between CSF pressure and CSF volume in 15 cats. This relationship was valid over a CSF pressure range from 7 to 50 mm Hg and for acute increases of up to 9% to total CSF volume (approximately 13 ml for humans). Our data agree well with previous reports for the cat. A similar relationship has been shown in the dog and in humans. It has been claimed that, given the equations for CSF bulk flow and the exponential relationship between CSF pressure and CSF volume, one can calculate CSF outflow resistance by observing the decay of CSF pressure after a bolus injection into the CSF space. This claim was evaluated in an additional 18 cats. In these animals CSF outflow resistance calculated by the bolus method was compared with resistance calculated by a steady-state infusion method over the CSF outflow resistance range of 74 to 293 mm Hg/ml min-1. Resistance calculated by the bolus method underestimated resistance calculated by the steady-state method, and this underestimate grew larger with increasing resistance. The bolus technique is therefore not a valid method for determining CSF outflow resistance. The explanation offered for these results is that the decay of CSF pressure after a bolus injection into the CSF space occurs not only because of runoff of the injected volume of CSF but also because of "pressure relaxation" of the brain parenchyma around the CSF space. The phenomenon of pressure relaxation was not considered in developing the equation for calculation of CSF outflow resistance by the bolus technique. The time dependency of pressure relaxation allows for a fundamental element of hysteresis within the CSF space. A method of quantifying this element of hysteresis is suggested.