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Biomedical subjects

F Hawker

Publications and source records attributed to F Hawker.

11 recordsLinked to original sources
PubMed1992

Circulating immunoreactive inhibin and testosterone levels in men with critical illness.

OBJECTIVE: We aimed to concurrently characterize serial changes in circulating immunoreactive inhibin (irINH) and testosterone (T) as reflections of Sertoli and Leydig cell responses to acute critical illness in man. DESIGN: Blood samples were drawn within 24 hours of admission to an Intensive Care Unit and at weekly intervals thereafter for up to 4 weeks while the patient remained in Intensive Care Unit or after discharge to a general ward. PATIENTS: We studied 13 male subjects with critical illness requiring intensive therapy. MEASUREMENTS: Plasma levels of irINH, T, LH, FSH and sex hormone binding globulin (SHBG) were analysed in relation to (i) the severity of illness as indicated by a sepsis score, acute physiology and chronic health evaluation score, and reverse triiodothyronine (rT3) levels and (ii) the outcome of illness as determined by discharge from Intensive Care Unit and the two-month mortality. RESULTS: Overall irINH levels remained normal and correlated negatively with rT3 (r = -0.63, P = 0.001) but not with sepsis, acute physiology and chronic health evaluation score, or gonadotrophin levels. Neither admission nor serial irINH levels significantly distinguished between the different clinical outcomes. In contrast, T levels were depressed and inversely correlated with both sepsis and acute physiology and chronic health evaluation scores (P less than 0.02), and positively with gonadotrophins (P less than 0.01), but not rT3 levels. Men eventually discharged from the Intensive Care Unit showed a rise, while those remaining showed a fall, in T levels (P = 0.02, time-course interaction). Similarly, T levels were lower in patients who died than in survivors, despite the comparable T levels on admission (P = 0.02, time-course interaction). Despite the fall in T levels, gonadotrophin levels remained inappropriately in the eugonadal range but higher in men who were discharged from Intensive Care Unit (P = 0.02, time-course interaction). FSH but not LH levels were correlated with sepsis score (P = 0.02) but not acute physiology and chronic health evaluation score or rT3. CONCLUSIONS: Sertoli cell function as judged by circulating irINH levels is much less affected by acute critical illness than is Leydig cell function as judged by circulating T levels. The suppressive effect of acute critical illness on Leydig cell function is consistent with a hypothalamic-pituitary lesion.

Acute Disease↗
PubMed1991

Acute and subacute fulminant hepatic failure: the role of liver transplantation.

OBJECTIVES: To report the experience of the Australian National Liver Transplant Unit with patients with fulminant hepatic failure and to describe the role of liver transplantation. PATIENTS: Twenty-seven patients presented with acute or subacute fulminant hepatic failure during the period from January, 1986, to March, 1990. Twenty-two had acute and five had subacute fulminant hepatic failure. The causes were hepatitis B in 10 patients, presumed non-A, non-B (NANB) hepatitis in eight patients, drug-induced hepatic damage in five patients, and Wilson's disease in four patients. There were 13 males and 14 females. Ages were 2-43 years (mean, 23). Twenty patients (74%) were in grade IV encephalopathy on presentation. RESULTS: Six patients (22%) began to improve soon after admission and went on to full recovery. Spontaneous recovery was more frequent in patients with drug-induced hepatic damage (four patients [80%]) and was less frequent in those with hepatitis B (one patient [10%]) and NANB hepatitis (one patient [12%]). The other 21 patients (78%) were considered for orthotopic liver transplantation. Eight (30%) were judged to be unsuitable and went on to early death. Thirteen (48%) were suitable for transplantation. Of these five (19%) died before a liver donor became available and eight (30%) received liver grafts and went on to full recovery. Overall, 14 patients (52%) survived and 13 (48%) died. Patients with Wilson's disease (four [100%]) were most suitable for orthotopic liver transplantation whereas eight (44%) of those with hepatitis B or NANB hepatitis were unsuitable. Of the eight patients receiving liver grafts one had hepatitis B, three had NANB hepatitis and four had Wilson's disease. Five were in grade IV encephalopathy at the time of operation. The mean waiting time for transplantation was 6.4 days. Five patients received ABO blood group compatible grafts and three received ABO incompatible grafts. Of the latter group, two subsequently required secondary orthotopic liver transplantation with ABO compatible grafts. All eight patients who received transplants are alive and well 3-24 months after the operation. No patient has any neurological sequelae. CONCLUSIONS: Orthotopic liver transplantation is a preferred option for patients with fulminant hepatic failure whose condition is not responding to conservative management. ABO incompatible livers transplanted in emergency circumstances may prove life-saving either by functioning successfully or by providing time during which ABO compatible grafts become available.(ABSTRACT TRUNCATED AT 400 WORDS)

Acute Disease↗
PubMed1991

Liver dysfunction in critical illness.

Abnormal liver function commonly accompanies critical illness. Ischaemic hepatitis occurs with shock and is characterised by elevated plasma aminotransferase concentrations. 'ICU jaundice' occurs later in critical illness, especially after trauma and sepsis. The major biochemical abnormality is conjugated hyperbilirubinaemia. The clinical setting suggests that hepatic ischaemia and hepatotoxic actions of inflammatory mediators are the major aetiological factors. Massive blood transfusion, effects of nutritional support and drug toxicity may contribute. Both the presence and degree of jaundice are associated with increased mortality in several nonhepatic diseases. It is proposed that Kupffer cell phagocytic depression associated with liver dysfunction permits systemic spread of endotoxin and inflammatory mediators and thus predisposes to multiple organ failure. Immunosuppression, metabolic abnormalities, impaired drug oxidation and myocardial depression may contribute to the poor prognosis. There is no specific treatment, but prompt resuscitation, definitive treatment of sepsis and meticulous supportive care will likely reduce the incidence and severity.

Animals↗
PubMed1988

Endocrine changes in the critically ill.

The onset of critical illness is associated with profound changes in the endocrine system. Stress hormones, particularly the catecholamines, mediate characteristic compensatory responses which increase the probability of survival in the short term. However, adverse metabolic effects may occur when the stress response is prolonged. This article describes the hormonal response to critical illness.

Catecholamines↗
PubMed1986

CSF-CK activity.

Explore the source record for details and available documents.

Creatine Kinase↗
PubMed1986

The quality of life of chronic patients in a state hospital and in community residences.

Amidst the controversy about the effects of deinstitutionalization, the well-being of the chronic mentally ill in different treatment settings remains unclear. This study examined objective and subjective quality-of-life experiences of four groups of chronic patients categorized according to whether they were inpatients of a state hospital or residents of a supervised community residence and whether their current length of stay had been less than or greater than six months. Regardless of length of stay, the community residents perceived their living conditions more favorably, had more financial resources, and were less likely to have been assaulted in the past year than the inpatients. The study illuminates the problematic living conditions of state hospitals and the benefits of appropriately designed community-based residences for the chronic mentally ill.

Adolescent↗
PubMed1985

Increased vascular permeability: a major cause of hypoalbuminaemia in disease and injury.

The rate of loss of albumin to the tissue spaces (measured as transcapillary escape rate) rose by more than 300% in patients with septic shock, and the average increase within 7 h of cardiac surgery was 100%. The transcapillary escape rate in cachectic cancer patients was twice that of a group of healthy individuals. The rate of loss of albumin to the tissue spaces is normally 5%/h, which is more than 10 times the rates of synthesis and catabolism, and these large rate increases indicate that increased vascular permeability is an important cause of the lowered concentration of albumin commonly seen in acute and chronic disease.

Capillary Permeability↗
PubMed1978

Interpersonal factors in suicide attempts: a pilot study in Christchurch.

Attempted suicide is a behavioural pattern with complex psychological and sociological determinants, many of which have been extensively studied in recent years. The basic facts of its changing incidence, its demography, and its place within a broader spectrum of self-destructive behaviour are well established but authorities are still divided on many issues related to its aetiology, its function in the individual and the kinds of services required for its clinical management. (Kessel 1965, Anderson 1974, Weissman 1974, Henderson and Williams 1974). The study reported here was designed partly to define the characteristics of a group of patients for whom clinical services were being planned and partly as a pilot study to develop a methodology for a more extensive controlled study which we hope to carry out next year. The preliminary findings are sufficiently interesting to report now.

Adolescent↗