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J Watters

Publications and source records attributed to J Watters.

6 recordsLinked to original sources

The changing epidemiology of osteomyelitis in children.

We reviewed 275 cases and calculated the prevalence of bacteriologically or radiologically confirmed acute haematogenous osteomyelitis in children under 13 resident in Greater Glasgow during 1970 to 1990. In the 20-year period there was a fall of over 50%, mainly involving cases of long-bone infection, and those due to Staphylococcus aureus. There was a reduced incidence of complications. The proportion of cases involving long bones decreased from 84% to 57%, and those of Staphylococcus aureus infection from 55% to 31%. These changes, in what is becoming a rare disease, need to be known to ensure early diagnosis and adequate treatment, particularly of subacute non-staphylococcal infection at unusual sites.

Child

Alkalinisation of prilocaine for intravenous regional anaesthesia. Suitability for clinical use.

Eighty unpremedicated patients undergoing day-case hand surgery under intravenous regional anaesthesia were randomly allocated to receive, in a double-blind study, either 40 ml 0.75% prilocaine hydrochloride, with 5 ml 8.4% sodium bicarbonate or 5 ml 0.9% saline. The alkalinised group had significantly less pain on injection (p = 0.0045), during surgery (p = 0.0074) and 5 minutes after the tourniquet was deflated (p = 0.0027). The time elapsed between insertion of the block and commencement of surgery was not affected.

Adolescent

School refusal.

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Absenteeism

A group for sexually abused young children: unravelling the web.

This paper describes clinical material from a group for young sexually abused children. The group work combines both an educational and dynamic approach drawn from previous models. The group was clearly structured and ran over nine weeks in conjunction with a parallel caregivers' group who were informed each week of the main themes. The caregivers were also involved in evaluating the effectiveness of the therapy by completing questionnaires which recorded symptomatology. A statistical analysis based on the questionnaires showed a significant reduction in problems reported by the caregivers before and after the group therapy. The authors recommend that such therapeutic work be combined with formal evaluation in the future to assess the effectiveness of different approaches with a view to clarifying which aspects are responsible for promoting positive change.

Anger

Ultrasound detection of choledocholithiasis: prospective comparison with ERCP in the postcholecystectomy patient.

The role of ultrasound as a screening test for choledocholithiasis was prospectively assessed by comparing the results of upper abdominal ultrasound with direct cholangiography in 59 unselected symptomatic postcholecystectomy patients. Ultrasound detected duct stones in 13 of 29 patients (sensitivity, 45%) and their absence in 29 of 30 (specificity, 97%). A positive ultrasound diagnosis of choledocholithiasis was correct 13 times out of 14 (predictive value, 93%) whereas a negative diagnosis was correct on only 29 of 45 occasions (predictive value, 64%). No significant learning effect was seen. Intestinal gas obscuring the distal common duct was the most important factor limiting the ability of ultrasound to detect duct stones. Duct stones were present in 25 of 35 patients shown to have a dilated common duct on ultrasound, and in 4 of 24 with nondilated ducts; the predictive value of duct dilatation at ultrasound for duct stones was therefore 71% and that of nondilatation in excluding stones was 83%. Dilated intrahepatic bile ducts were demonstrated at ultrasound in only 17% of patients with choledocholithiasis. We conclude that ultrasound cannot reliably diagnose or exclude bile duct stones and is an inadequate screening test for the symptomatic postcholecystectomy patient.

Adult

Bioavailability of methotrexate: implications for clinical use.

The absorption of oral methotrexate in syrup form has been compared in six patients with that of an identical IV dose (50 mg/m2). There was variable absorption amongst the group with respect to maximum levels achieved and the time taken to reach those levels. The area under the time-concentration curve was always smaller when the drug was given orally than after IV administration. A total of 33 patients receiving methotrexate for a variety of tumour types were followed for response to treatment and toxicity. A significantly longer methotrexate half-life (t1/2) was found in nine partial responders (9.2 +/- 1.6 h) than in the nonresponders (3.8 +/- 0.7 h). Severe methotrexate toxicity was not seen though occasional mucositis, conjunctivitis, and diarrhoea occurred in seven patients. The side effects could not be predicted from the dose, the bioavailability data, or the serum creatinine. Measurements of serum and urine methotrexate levels are useful in the assessment of absorption and bioavailability of the drug the prediction of tumour response.

Administration, Oral