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Biomedical subjects

H A Reid

Publications and source records attributed to H A Reid.

At least 19 recordsLinked to original sources
PubMed1979

Bites by the carpet viper in the Niger Valley.

60 people who had been bitten by the carpet viper, Echis carinatus, were seen in four months at Zungeru Health Centre, in North West Nigeria, where snake-bite patients have recently occupied 10% of beds. Health statistics greatly underestimate the frequency, morbidity, and mortality of snake bite in the rural tropics and further studies will probably confirm other areas endemic for E. carinatus within its vast distribution zone. Regular supplies of effective antivenom are crucial to gain a community's confidence in conventional, as opposed to traditional, treatment. Paramedical staff in a rural clinic can be trained in the definitive management and treatment, including successful antivenom therapy, of most snake-bite patients.

Humans↗
PubMed1978

Bites by foreign venomous snakes in Britain.

In 1970-7 17 people in Britain were the victims of 32 bites by foreign venomous snakes. Crotalus atrox caused eight of these bites, Bitis arietans five, and the remaining 19 bites were caused by 12 different species. All the victims were bitten while handling the snake, and 24 bites were incurred by private individuals in their own homes. Poisoning was negligible in 17 of the 32 bites but life-threatening in at least two cases. Thus in the early stages snake bite may be unpredictable as a clinical problem. All victims of snake bite should be observed for at least 12 hours to assess the severity of poisoning and to ensure rational treatment. Local necrosis developed in six cases and resulted in prolonged illness in five of these cases; local incision was carried out and many have been a casual factor. Comprehensive stocks of antivenoms for treating bites by foreign venomous snakes are held by the National Health Services in Liverpool and London. Antivenom is indicated (a) for potentially serious systemic poisoning, as evidenced by hypotension, electrocardiographic changes, neurtrophilia, and acidosis (after viper or elapid bites), abnormal bleeding or non-clotting blood after viper bites; and ptosis or glossopharyngeal palsy after elapid bites; and (b) for bites from snakes whose venom causes local necrosis, to prevent or minimise this unpleasant complication. For effective antivenom treatment intravenous infusion is mandatory.

Adolescent↗
PubMed1978

Changes in coagulation effects by venoms of Crotalus atrox as snakes age.

Venom samples separately collected at monthly intervals from three Crotalus atrox specimens as they aged from 2 to 22 months showed many quantitative changes of biological activities. But more important were qualitative changes of coagulation activity. Up to 8 months the venoms clotted fibrinogen solutions directly. At 9 to 10 months, plasma was clotted but not fibrinogen. Subsequently the venoms no longer clotted plasma. Qualitative venom changes with growth of snakes could explain some of the conflicting reports both on clinical aspects of snake bite in man and on experimental venom work. The findings emphasize the importance for clinicians dealing with snake bite to monitor the clot-quality of their patient's blood--a simple bedside test for defibrinogenation, no-clot indicating zero fibrinogen and speck-clot representing fibrinogen concentrations under 50 mg/100 ml. With strongly defibrinating venoms, non-clotting blood is a very sensitive sign of systemic envenoming. In contrast, the relatively feeble defibrinating activity of juvenile C. atrox venom suggests that, if the blood is non-clotting in C. atrox bites, this indicates the victim has received a potentially lethal or near-lethal dose of venom urgently requiring effective antivenom therapy.

Aging↗
PubMed1977

Micro-ELISA for detecting and assaying snake venom and venom-antibody.

Enzyme-linked immunosorbent assay (ELISA) can detect venom levels down to 1-5 ng/ml. The assay is specific; no cross-reaction of clinical importance was found in a range of 14 different types of venom. Both venom and venom-antibody levels were monitored in mice. Specific antibody was detected in human serum more than 2 years after an accidental bite by Echis carinatus. ELISA should clarify many basic problems of envenoming in man.

Animals↗
PubMed1977

Biliary complications after liver transplantation: with special reference to the biliary cast syndrome and techniques of secondary duct repair.

In 93 consecutive cases of orthotopic liver transplantation, there were 24 example of biliary obstruction and eight of bile fistula formation. Six of the obstructed livers developed biliary cast formation so extensive that the smaller intrhepatic ducts became plugged to an extent that they could no longer have been treated by surgical mena. In each of the six cases, the most important causative factor was neglected obstruction of the large bile ducts with the intrahepatic lesions apparently being late and secondary. Stone and/or cast formation also occurred in other obstructed livers in the presence of bile fustulas, but these deposits were limited to the large ducts where they could have been or were removed. Although homograft bile undoubtedly has increased lithogenicity at certain posoperative times, the data from the present study have shown that biliary sludge formation essentially is always associated with defective bile duct reconstruction, and the observations have underscored the urgency with which reoperation must be considered. Techniques of secondary intervention have been described, with emphasis on conversion of cholecystojejunostomy to choledochojejunostomy. This operation has permitted salvage of homografts in eight of nine trials and the survival of seven patients.

Adolescent↗
PubMed1976

Liver transplantation of Budd-Chiari syndrome.

Orthotopic liver transplantation was accomplished in a 22-year-old woman dying of the Budd-Chiari syndrome. She is well and has normal liver function 16 months postoperatively. In view of the good early result, it will be appropriate to consider liver replacement for this disease in further well-selected cases.

Adult↗
PubMed1976

Effectiveness of Zagreb antivenom against envenoming by the adder, Vipera berus.

Rhesus monkeys injected subcutaneously with 2, 3, or 4 mg Vipera berus venom per kg body-weight all died in shock. With 1 mg/kg the monkey had severe systemic and local effects taking 12 days to resolve. Five monkeys each recieved 4 mg/kg (a triple-lethal dose) and Zagreb antivenom was injected intravenously 1-4 hours after venom injection. The contents of 2 ampoules (10-8 ml) up to 3 hours later saved the monkeys; at 4 hours later the monkey died. But when the antivenom dose was raised to 16-2 ml 4 hours after venom, it saved the monkey. In addition to saving life, the antivenom greatly reduced the local venom effects. It is suggested that the results justify giving Zagreb antivenom to patients with severe adder-bite poisoning; and it should also be considered in adults to minimise morbidity from local effects.

Adult↗
PubMed1976

Adder bites in Britain.

Ninety-five cases of adder bite that have occurred in Britain over the past 100 years are reviewed. Most bites occurred in men who foolishly picked up the adder. Three-quarters of the victims reached hospital within two hours of the bite. When venom is injected the early symptoms include local swelling and discoloration, vomiting, diarrhoea, and early collapse, which often resolves spontaneously. In severe poisoning persistent or recurrent shock is the main feature. Children recover quickly but adults may take weeks or months to recover, during which there may be considerable disability in the bitten limb. Deaths are rare: only 14 deaths from poisoning were recorded in the past 100 years. In England and Wales only one death from adder bite was recorded in 1950-72, but there were 61 deaths from bee or wasp stings. In most cases simple symptomatic treatment is enough, but all patients should be carefully monitored. With persistent or recurrent shock Zagreb antivenom is indicated; and it should also be considered in adults seen within two hours of the bite to minimise morbidity from local effects.

Adolescent↗
PubMed1976

Meckel's diverticulitis due to Schistosomiasis mansoni.

An unusual case of schistosomal Meckel's diverticulitis is presented. Parasites were subsequently found in either stool or rectal biopsies of three siblings. The possibility of serious sequels makes the early diagnosis of Schistosomiasis mansoni often by simple stool and rectal biopsy examination particularly valuable.

Biopsy↗
PubMed1976

Orthotopic liver transplantation in ninety-three patients.

During the 11 1/2 year period ending 13 months ago, 93 consecutive patients were treated with orthotopic liver transplantation. Fifty-six of the recipients were 18 years old or younger, and the other 37 were adults. The most common indications for operation were biliary atresia, primary hepatic malignant tumor, chronic aggressive hepatitis and alcoholic cirrhosis. There has been a gradual improvement in results throughout the period of study, although to a satisfactory level. Twenty-seven of the 93 patients survived for at least one year after liver replacement with a maximum of six years, and 16 are still alive after 13 to 71 months. The 11 late deaths after one to six years were caused by chronic rejection, biliary obstruction, recurrence of hepatoma, systemic infection or hepatitis of the homograft. Rejection of the liver as judged by classical histopathologic criteria played a surprisingly small role in the heavy over-all mortality, accounting for less than 10 per cent of the deaths. Technical or mechanical problems, especially those of biliary duct reconstruction, were a far greater cause of failure, as were systemic infections. Six of the 37 adult recipients had lethal cerebrovascular accidents during, or just after, operation. When abnormalities of liver function developed in the postoperative period, the nearly automatic diagnosis of homograft rejection, in retrospect, proved to have been wrong in most instances. Further development of liver transplantation depends upon two kinds of progress. There must be reduction of operative and early postoperative accidents and complications by more discriminating patient selection, purely technical improvement and better standardization of biliary duct reconstruction. The second area will be in sharpening the criteria for the differnetial diagnosis of postoperative hepatic malfunction, including the liberal use of transhepatic cholangiography and needle biopsy. Only then can better decisions be made about changes in medication or about the need for secondary corrective surgical procedures.

Adolescent↗
PubMed1975

Antivenom in sea-snake bit poisoning.

Among a series of 101 patients bitten by sea-snakes in Malaya in the years 1957-64, 80% were fishermen. Bathers and divers are occasionally bitten. Before sea-snake antivenom became available the mortality-rate (despite the high toxicity of sea-snake venom) was only 10%; however, of 11 with serious poisoning, 6 died. Subsequently 10 patients with serious poisoning received specific sea-snake antivenom; 2 patients, admitted moribund, temporarily improved but died, and 8 patients recovered dramatically. In serious poisoning the suitable dosage of intravenous sea-snake antivenom is 3000-10,000 units; in mild poisoning 1000-2000 units should suffice.

Adult↗