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Biomedical subjects

R S MacWalter

Publications and source records attributed to R S MacWalter.

35 records · Page 2Linked to original sources
PubMed1999

Secondary prevention of stroke.

Stroke is a common disorder and a leading cause of disability and death. Ischaemia is a more common cause than haemorrhage and radiological imaging is required to accurately differentiate these. Some specific risk factors for stroke are non-modifiable--these include age, gender, racial and hereditary factors. Certain risk factors for ischaemic stroke can be identified and modification of these can be used for secondary prevention--examples include hypertension, heart diseases, atrial fibrillation, diabetes mellitus, dyslipidaemia, smoking, excessive alcohol consumption and carotid stenosis. Carotid endarterectomy is valuable in selected patients. In ischaemic stroke and transient ischaemic attack antithrombotic therapy is an option used in secondary prevention. In atrial fibrillation, warfarin should be used where possible in secondary prevention. When warfarin is contraindicated aspirin should be used. In other patients, an antiplatelet regime is appropriate--aspirin is commonly used and is the least expensive regime. Other antiplatelet agents such as dipyridamole, ticlopidine and clopidogrel may have a place. Younger patients with ischaemic stroke may have a thrombophilia state and should be appropriately investigated.

Animals↗
PubMed1999

CT brain scans after acute stroke: how far are we from meeting the Scottish intercollegiate guidelines network (SIGN) recommendations? Results from the year prior to guideline publication.

OBJECTIVE: To determine what proportion of patients admitted to Ninewells Hospital & Medical School in 1996 with acute stroke underwent CT brain scans and in what time frame. To decide if the targets set by the SIGN guidelines can be met, and if not, the reasons for this. DESIGN: Data from the Dundee Ninewells Stroke Register and the Computerised Radiology Information System were used to determine the timing of CT scanning in relation to stroke and admission. Notes were also reviewed to determine why CT scans had not been done in some patients. SETTING: Departments of Medicine and Radiology, Ninewells Hospital & Medical School Dundee. SUBJECTS: All patients admitted with acute stroke in the calendar year 1996. RESULTS: Two hundred and eighty six patients presented with acute stroke in 1996. Of these patients, 250 patients (87%) had a CT brain scan. Eighty three (29%) underwent CT brain scanning within 48 hours of the acute event. A total of 163 (57%) were scanned within a week. Two hundred and thirty three (81%) were scanned within three weeks. Thirty six patients were not scanned after their acute event and the reasons recorded are reviewed. CONCLUSIONS: Less than two-thirds of patients were scanned within the time interval of seven days recommended in the SIGN Guidelines for stroke management. Implementation of the current SIGN Guidelines will therefore, require reorganisation of the service to ensure that all patients receive scans within seven and preferably within two days and may have resource implication.

Adult↗
PubMed1998

The management of acute headache in adults in an acute admissions unit.

There have been no previously published studies about acute admissions with headaches to a medical admissions ward. In our retrospective case-note study of all patients admitted with headaches to the acute medical admission ward of Ninewells Hospital, Dundee over a six-month period, there were 114 admissions with headache (2.4% of all admissions). CT scans were done in 68 (59.6%) and were abnormal in 21 patients. Twenty four patients (21.1%) had serious underlying causes for headaches. Predictors for CT abnormalities are discussed. Eighteen patients had lumbar punctures and six had abnormal results. Most patients were discharged after one day, nine were transferred to the neurosurgical unit and there were two deaths. Deficiencies in record keeping were identified as was a lack of precision in diagnosis. Changes in practice are needed to improve patient care and perhaps national guidelines are required.

Acute Disease↗
PubMed1995

Cyclical etidronate and calcium carbonate (with citrate) supplementation for osteoporosis unmasking primary hyperparathyroidism.

An 88 year old lady undergoing cyclical etidronate and calcium carbonate (with citrate) therapy for vertebral osteoporosis was found to be symptomatically hypercalcaemic at the end of the first cycle of treatment. She had been previously asymptomatic and normocalcaemic, but was subsequently found to have primary hyperparathyroidism. This condition is most prevalent in postmenopausal females--the same patient group at risk of osteoporosis. Serum calcium should be measured after commencing cyclical etidronate and calcium carbonate. If hypercalcaemia is detected primary hyperparathyroidism should be excluded as an underlying, cause.

Aged↗
PubMed1993

Potentiation of the hypoglycaemic response to glipizide in diabetic patients by histamine H2-receptor antagonists.

In a randomised placebo controlled study, two groups of six maturity onset diabetic patients stabilised on glipizide were given cimetidine (400 mg) or ranitidine (150 mg) 3 h before a standardised meal. In comparison with placebo, both cimetidine and ranitidine significantly reduced the post-prandial rise in blood glucose by a mean of 40% and 25% respectively producing glucose levels of less than 3 mmol l-1 (lowest 1.5 mmol l-1) in four patients. Both drugs also significantly increased plasma glipizide AUC by approximately 20%. Caution should be exercised when initiating treatment with H2-receptor antagonists in diabetics receiving sulphonylurea hypoglycaemic agents.

Aged↗
PubMed1989

Biologic variation of common hematologic laboratory quantities in the elderly.

Analytic, within-subject, and between-subject biologic variations were estimated for leukocytes, erythrocytes, hemoglobin, hematocrit, mean cell volume (MCV), mean cell hemoglobin (MCH), mean cell hemoglobin content (MCHC), platelets, and a three-component differential count (lymphocytes, monocytes, and granulocytes in terms of both concentration and percentage of leukocytes) in cohorts of 12 male and 12 female healthy elderly subjects. The assays were performed with an Ortho ELT-800 automated analyzer. The estimates of within-subject biologic variation were similar to published data on young subjects, indicating that this aspect of homeostasis is not compromised in the elderly. The data were used to derive objective analytic goals; goals were surpassed except for assays of erythrocytes, hematocrit, and the derived MCV, MCH, and MCHC. The changes required for serial results to be significantly different were determined and found to be generally valid because most quantities have no heterogeneity of within-subject variation. All quantities had significant individuality; in consequence, conventional population-based reference values are of limited utility, and screening using reference limits will not detect latent or early disease in many subjects.

Aged↗
PubMed1989

The differential diagnosis of polycythaemia--a bone marrow study (the bone marrow in polycythaemia).

Bone marrow sections from posterior iliac crest aspiration and/or trephine specimens have been examined in 39 patients with true polycythaemia, along with a variety of other clinical and laboratory data. The emphasis has been on objective assessment of cellularity and megakaryocyte concentration in a prospective four year study. In patients with untreated primary polycythaemia mean cellularity was 87.0% and 86.4% for aspirate and trephine specimens compared with 55.5% and 48.7% for secondary cases and 48.3% and 45.5% for controls. Eighty per cent of primary polycythemia patients had moderate to marked megakaryocytic hyperplasia. We conclude that, in the presence of an elevated red cell volume, marrow cellularity of greater than 75%, particularly when accompanied by megakaryocytic hyperplasia, of iliac crest aspirate or trephine specimens is sufficient per se to establish a diagnosis of polycythaemia rubra vera.

Bone Marrow Cells↗
PubMed1989

Biological variability of 26 clinical chemistry analytes in elderly people.

Analytical, within-subject, and between-subject components of variation were estimated for 26 clinical chemistry analytes from duplicate analyses of 10 specimens collected from 27 healthy elderly subjects over a period of 20 weeks. Within-subject variations were similar to those generated previously by us in younger subjects. We conclude, therefore, that homeostasis is not compromised by age alone, and biological variability does not increase simply with age. All analytes except serum water had marked individuality, showing that conventional population-based reference values are of limited utility. The critical differences required for two results to be significantly (P less than or equal to 0.05) changed are not the same as those that prompt action by clinicians. Although heterogeneity of within-subject variation does exist, we believe that the critical differences generated will be useful in routine clinical decision making.

Adult↗
PubMedDate not supplied

Cerebral Haemorrhage. Parenchymal intracranial haemorrhage.

While there have been substantial improvements in the management of patients with cerebral infarction and there are likely to be further improvements over the next decade, the same may not be true for cerebral haemorrhage. Diagnostic facilities and neurosurgical techniques have improved but not all patients are benefiting from these. The current literature is reviewed. Further controlled trials of the utility of modern neurosurgical techniques are urgently required as at present no therapeutic intervention holds out hope for these patients other than optimum medical management. The main focus must be on prevention.

Age Distribution↗