Biomedical subjects
C J Wright
Publications and source records attributed to C J Wright.
The fee-for-service system should be replaced.
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Safety-belt injuries in children with lap-belt ecchymosis: CT findings in 61 patients.
We have noted a complex of common injuries in children wearing lap-styled safety belts during vehicular accidents. Sixty-one children who were restrained passengers in motor vehicle crashes had linear ecchymosis across the abdomen and had CT for abdominal trauma. Thirteen children (21%) had a lumbar spine injury, and 14 children (23%) injured a hollow viscus (bowel, 12; bladder, two); five children (8%) had both spine and hollow viscus injuries. Abnormal findings on abdominal CT were recognized retrospectively in three of 13 children with lumbar spinal injury. Lateral radiographs of the spine showed lumbar spinal injury in all cases. Free intraperitoneal air was noted in on three (25%) of 12 children with bowel injury. In eight of those children, CT showed large, unexplained collections of peritoneal fluid. The presence of lap-belt ecchymosis should prompt a careful search for spine, bowel, and bladder injury. Recognition of the limitations of CT diagnosis of these injuries is important to reduce errors in interpretation.
Fatal accident with weight-lifting equipment: implications for safety standards.
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A multicentre trial in spontaneously breathing patients. A comparison of recovery following alfentanil or enflurane.
Recovery from anesthesia and the effect of premedication, induction agent and the individual anesthetist on the measure of recovery was assessed in 707 patients scheduled to undergo short surgical procedures. Patients were randomly allocated to receive either alfentanil or enflurane as a supplement to an induction agent, nitrous oxide/oxygen anesthetic technique with or without premedication. Patients who received alfentanil had a faster immediate recovery than those who received enflurane (p less than 0.001). Total anesthetic time was shorter in the alfentanil group (p = 0.02). For 36 of 37 anesthetists recovery was faster in the alfentanil group compared to the enflurane group. Choice of premedication and induction agent had a significant effect on recovery, thiopentone or lorazepam prolonged recovery time in each group. Although the alfentanil group had a higher incidence of apnoea, movement and vomiting (p less than 0.001), the enflurane group had a higher incidence of coughing (p less than 0.001) and shivering (p = 0.004). Overall the anesthetists assessed the alfentanil technique as excellent or good in more patients than the enflurane technique.
Blood is thicker (and more dangerous) than water.
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Colonoscopy after resection for bowel cancer--is it already too late to answer the question?
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Breast lumps--when is a cyst not a cyst?
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Should the hunt for nonpalpable breast lesions be called off?
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Breast cancer screening: a different look at the evidence.
The data on screening for breast cancer were studied to extract information on rates of biopsy recommendation, detection of benign disease, and mortality. Relative and absolute mortality rates for breast cancer and other causes were calculated. Approximately 5% of women screened have a suspicious result and are referred for further assessment. The reduction in breast cancer mortality rates attributed to screening procedures ranges from 0.049% to 0.144% of the screened population, demonstrating that up to 2041 women must be screened for each woman who will benefit. If women subjected to operation for benign disease are considered to be harmed by the screening program, then the harm/benefit ratio ranges up to 62:1. It is suggested that enough information on the question of cost/harm/benefit is already available to make the decision that mass screening for breast cancer should be abandoned and that the procedure should be reserved for those women with high-risk factors.
Anticoagulant activity and operative blood loss after intrapulmonary heparin.
The safety and efficacy of heparin given by the intrapulmonary route are further assessed in this study. A single dose of heparin (2000 units/kg) was given by intratracheal instillation in dogs and measurements of plasma heparin concentration, whole blood clotting time and partial thromboplastin time made at intervals for 48 h. These values rose progressively and in parallel for 7 h and remained elevated for 48 h. A series of operations was performed on dogs within 3 h of a single dose of intrapulmonary heparin (1500 units/kg). Operations involving minimal dissection (small bowel resection) and extensive dissection (resection of muscle) were performed in two separate groups. Within each group the animals were randomly given heparin or saline. In the limited dissection group there were no differences in operative blood loss, wound healing, or sequential haemoglobin and haematocrit measurements. In the group subjected to muscle resection there was increased postoperative wound drainage and a slightly greater fall in haemoglobin and haematocrit in those given heparin. It is concluded that heparin is absorbed from the lung causing significant changes in coagulation parameters. Even with the relatively high dose of 1500 units/kg, operations were performed with minimal hazard. Intrapulmonary heparin may have important clinical applications after further investigation.
Heparin via the lung.
Only recently has it been realized that heparin is absorbed when administered into the lung. Im mice, rats, dogs and humans a large dose of intrapulmonary heparin has been shown to cause a moderate degree of hypocoagulability lasting from 48 hours to 14 days depending on the species. This study is part of an ongoing program investigating the effects of the intrapulmonary administration of heparin. Heparin, 1500 units/kg body weight was instilled into the lung in a group of 12 dogs and an equal volume of saline was given in a control group of 10 dogs. Various hemodynamic and metabolic measurements were made at intervals. As expected there was a prolonged moderate increase in clotting time, but no significant effects from intrapulmonary administration of heparin were demonstrated by any of the other measurements. Much work has yet to be done before intrapulmonary heparin can be used clinically but it has potential importance in the management of thromboembolic disease.
Pipeline hazards--a simple solution.
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Fibreless diet and diverticulosis.
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Prospects of cure in lymphocyte-predominant Hodgkin's disease.
This report concerns a particular benign histologic variant of Hodgkin's disease, the lymphocyte-predominant category of the Rye classification. The group of 24 cases, all involving localized disease, was first reported in 1960, and is now reappraised, incorporating subsequent data. The interpretations of the original findings are confirmed and elaborated. A characteristic feature had been the long relapse-free and symptom-free survival period, which gave a false impression of security but was followed in some instances by disseminated disease, usually after 5-15 years. The proportion of such cases is now shown to be greater, and the possible quiescent period extended. Cure was suspected in some instances, and can now be considered likely in about half of the cases. The present results include a substantial number of patients who have survived for very long periods and who must be regarded as cured, though careful confirmatory autopsies are still unavailable.
Analgesia following oral surgery for day patients: a clincial comparison of two analgesics.
A single-blind, between-patient study was carried out in 167 patients following oral surgery to compare the effectiveness and tolerance of two combination analgesic preparations; pentazocine (15 mg) plus paracetamol (500 mg) and dextropropoxyphene hydrochloride (32.5 mg) plus paracetamol (325 mg). Assessments of pain and pain relief were made over two periods, initially over the 90 minute period following administration of either preparation and secondly, over the subsequent 3 days following discharge. At the hospital, those patients receiving pentazocine plus paracetamol achieved a greater relief of pain than those receiving dextropropoxyphene plus paracetamol, though the differences did not reach statistical significance. At home, pain relief was very similar for both groups of patients, both preparations being effective and well tolerated.