Biomedical subjects

R G Harris

Publications and source records attributed to R G Harris.

12 recordsLinked to original sources

PubMed1999

Management of stroke in Auckland Hospital in 1996.

AIMS: To review the management of stroke in Auckland Hospital; compare current management with practice in Auckland in 1991/92; and determine how many patients may be suitable for treatment with aspirin or tissue plasminogen activator (t-PA). METHODS: Retrospective review of case notes for all patients over the age of 15 years presenting during four months in 1996 with symptoms and signs of an acute stroke. Subarachnoid haemorrhages were excluded. RESULTS: There were 184 stroke events (135 ischaemic strokes, 26 intracerebral haemorrhages, 23 unspecified strokes) in 179 patients. The time between the onset of symptoms and arrival in hospital was available for 109 patients: the overall median time was three hours, two hours for intracerebral haemorrhages, three hours for ischaemic strokes, four hours for unspecified strokes. Most patients (78%) were admitted to a general medical ward. Only 10% of the patients managed on a non-neurological ward were referred to a neurologist. Computed tomography (CT) was obtained in 88% of the patients. The median time from the onset of symptoms to CT was 19 hours (11 hours for intracerebral haemorrhages, 21 hours for ischaemic strokes). Only 11 patients (10%) were scanned within three hours of the onset of symptoms. Of the 135 patients who had an ischaemic stroke, 36% were treated with aspirin and 6% with heparin in the first 48 hours. Thirty-two patients (17%) died in hospital, 87 (47%) returned home, 37 (20%) were transferred to a rest home or private hospital and 28 (15%) were transferred to other places. CONCLUSIONS: Compared with 1991, the rate of CT scanning after a stroke increased from 42% to 88%. At present, no more than 5% of all patients presenting with a stroke are suitable for consideration of treatment with t-PA. Routine treatment with aspirin in the first 48 hours could be achieved without other major changes in management.

Acute Disease↗

PubMed1991

Unit dose calendar packaging and elderly patient compliance.

A controlled trial of the effect of a unit dose system of tablet/capsule calendar packaging (Webster-Pak) on the rate of successful self medication both in hospital and after discharge to the community has been completed in a geriatric assessment and rehabilitation unit. Eighty-four elderly patients, 45 using calendar packs (study), and 39 using conventional bottles or packs (control), were followed for three months after discharge. There was a significant improvement in patient compliance in the study group over controls on discharge (86.7% vs 66.7%), 10 days (68.8% vs 41.0%), one month (64.4% vs 38.5%) and three months (48.9% vs 23.1%) after discharge. Unit dose packaging is a cost effective method of improving the delivery of medicine in elderly patients, and should be available as part of the health budget.

Aged↗

PubMed1989

The response to treatment with pituitary growth hormone: the New Zealand experience.

Ninety-four growth hormone deficient New Zealand children were treated with thrice weekly intramuscular injections of human pituitary growth hormone (GH) from 1979 to 1985 and the results from 43 children were analysed in detail. Their height velocity was mean (SD) 4.0 (1.9) cm/yr immediately prior to treatment and 8.5 (3.1) cm/yr in the first year of treatment. In each of the first three years of treatment the height velocity was significantly increased (p less than 0.001), but there was a significant decline in height velocity between the first and second, and second and third years. Nevertheless each year of treatment gave a highly significant gain in relative height. Bone age did not advance more rapidly than chronological age during the first two years of treatment, but did so subsequently. The response to GH, as assessed by the increase in relative height, was negatively correlated with the relative height at the start of treatment and with the maximum pretreatment plasma GH response to insulin hypoglycaemia. There was no correlation with pretreatment relative height velocity or aetiology of GH deficiency. Height velocity improved in five of 14 children treated with thyroxine after starting GH. Discontinuation of GH for one year in 34 children resulted in a highly significant reduction in growth rate from 7.5 (2.4) cm/yr to 2.5 (2.0) cm/yr, however four prepubertal children continued to grow at a rate exceeding 4 cm/yr.

Age Determination by Skeleton↗

PubMed1988

Extravesical subtrigonal injection of 50 per cent ethanol for detrusor instability.

Urinary incontinence with detrusor instability often is refractory to pharmacological therapy as well as other conservative modalities. We report the results obtained from 10 patients with detrusor incontinence who underwent extravesical subtrigonal injection of 50 per cent ethanol. Postoperatively, 9 of the 10 patients had conversion to detrusor stability and 6 had an acontractile bladder. Of the 10 patients 9 had an excellent result for at least 10 months postoperatively with 1 patient requiring 2 additional treatments to convert to detrusor stability. Complications included fistula formation in 3 patients, requiring primary closure in 2 and ileal diversion in 1. Of the 10 patients 7 remain dry or vastly improved at a mean of 24 months of followup.

Administration, Intravesical↗

PubMed1987

The Kock pouch: initial experience and complications.

The modified Kock continent internal reservoir procedure has been performed on 15 patients at our medical center since December 1984: 13 underwent simultaneous anterior exenteration for pelvic malignancy, 1 had conversion from an ileal conduit and 1 underwent cystectomy for refractory interstitial cystitis. There was no operative mortality. There were 3 early complications: a urinary leak from the pouch in 2 patients that required re-exploration to close the defect, and an enteric-Kock pouch fistula in 1 that required resection of the small bowel fistula and repair of the pouch defect. All 3 patients are doing well. The late complication in 3 cases was urinary incontinence of the efferent nipple valve with difficulty in catheterization of the stoma. Two patients have undergone revision with a new efferent nipple valve added on to the pouch and creation of a new stoma. One patient is completely dry and continent, 1 has tolerable intermittent leakage and refuses a further operation, and 1 is awaiting revision. Although the initial experience is small, we are encouraged by these results and believe that this procedure is an alternative form of urinary diversion for the properly selected patient.

Adult↗

PubMed1979

Single-dose fasting bioequivalence assessment of erythromycin stearate tablets in man.

The bioequivalence of film-coated erythromycin stearate tablets produced by five different manufacturers was evaluated in a balanced incomplete block design involving the five formulations given to 30 fasted subjects over a 3-week study period. Serum levels of erythromycin activity were determined microbiologically. Statistical analysis of variance was performed on the observed bioavailability parameters: maximum serum concentration (Cmax), time to maximum serum concentration (Tmax), and area under the serum concentration-time curve (AUC). There was no statistical difference between formulations for the Tmax parameter. Formulation differences were found, however, based on the analysis of variance of the Cmax and AUC parameters. Two products, although not significantly different from one another, showed significantly greater Cmax and AUC values than the other three products.

Adult↗

PubMed1973