PubMed Health⌕ Search

Biomedical subjects

W H Reid

Publications and source records attributed to W H Reid.

At least 19 recordsLinked to original sources
PubMed1992

The use and reliability of psychiatric diagnosis in forensic settings.

The clinical professional encounters conflict whenever he or she enters the courtroom. The psychiatrist's approach must not be simply diagnostic or simply legal. We cannot shed our clinical identity; indeed, the court depends on our clinical identity and expertise in its search for the truth. The psychiatric expert must be able to translate his or her findings for the court, but these findings must come from clinical experience, not some solely legal perspective. The legal system needs our knowledge about the interfaces of mental illness, function, and behavior. After we provide our opinions, however, the legal issues must be left to the lawyers and the final determinations left to the judge or jury.

Criminal Law↗
PubMed1991

Increased airways reactivity after smoke inhalation.

13 fire victims who required treatment after smoke inhalation underwent lung function assessment within 3 days of injury and 3 months later. Initial airways hyperreactivity improved over this period, but FEV1 and airways specific conductance did not change significantly. There was a strong correlation between exposure carboxyhaemoglobin concentration (an indicator of smoke exposure) and initial airways specific conductance (r + 0.79; p = 0.006). Airways obstruction after smoke inhalation in house fires may be more common and more persistent than is generally recognised. Early lung function tests would allow the incidence of pulmonary complications after smoke inhalation and the potential benefits of early use of inhaled antiinflammatory drugs to be assessed.

Adult↗
PubMed1991

Alveolar macrophage chemotaxis in fire victims with smoke inhalation and burns injury.

In vitro migration of alveolar macrophages was studied in 24 fire victims and 19 controls; all subjects were cigarette smokers. Unstimulated (P = 0.01) and stimulated migration towards casein-(P = 0.01) and zymosan-activated serum (P = 0.002) of macrophages from smoke inhalation patients (SI) (n = 19) was increased when compared to control subjects (CS). Migration of alveolar macrophages from patients with burns without smoke inhalation (burns only, BO) was not increased. Patients with smoke inhalation and no burns (smoke only, SO) (n = 9) had increased migration when compared to controls but this was not statistically significant. Patients with smoke inhalation and burns (SB) (n = 10) had increased unstimulated migration (P = 0.01) and increased migration towards casein (P less than 0.005), ZAS (P less than 0.002) and F-met-leu-phe (P less than 0.05) when compared to controls (CS). Lavage fluid from the fire victims displayed chemotactic activity towards normal human neutrophils and its analysis for the components of the complement cascade proved positive (Clq, Clr, Factor B and C3). These data suggest that activation of alveolar macrophages may contribute to the development of pathophysiological changes in patients with smoke inhalation (SI) and particularly those with smoke inhalation and burns (SB).

Burns↗
PubMed1990

Q-switched ruby laser treatment of tattoos; a 9-year experience.

Nine years of clinical experience of the application of the Q-switched ruby laser to the removal of tattoos is presented. This laser achieves optimal removal of blue/black amateur tattoos by its selective interaction with the dermal suspensions of pigment which constitute the tattoos. The scar free cosmesis thus achieved is a considerable improvement on non-specific laser techniques whereby the laser is absorbed to a comparable degree in both pigmented and non-pigmented tissue. Long-term results are analysed and it is noted that a variety of professional tattoos may also respond to treatment. The mechanisms and appearance are discussed and correlated with short-term healing processes. It is found that power densities in the range 1200-2800 GW/m2 are most suitable. Appropriate dosimetry can be witnessed by the appearance of opaque intradermal vacuoles corresponding to the vaporization of the tissue water surrounding the pigment suspensions. Treatment by Q-switched ruby laser offers a viable scar-free option for a wide range of dark tattoos, leading to a more acceptable clinical outcome in most cases than other current therapies.

Dermatologic Surgical Procedures↗
PubMed1990

Changes in alveolar macrophage, monocyte, and neutrophil cell profiles after smoke inhalation injury.

Thirty two fire victims with smoke inhalation, with or without burns, and 26 control subjects had bronchoalveolar lavage performed. Cell yields and differential cell counts were assessed. All patients and controls were cigarette smokers. Patients with smoke inhalation (SI) injury generally showed higher total bronchoalveolar lavage (BAL) cell yields, and this was significant on repeat lavage from 12 patients. The increase was almost entirely due to an increase in the proportion of neutrophils in patients with smoke inhalation alone (S) and those with cutaneous burns as well as smoke inhalation (S + B). On sequential lavage of 12 patients with smoke inhalation (SI) the proportion of neutrophils had increased; this was significantly higher than on initial lavage. Using various macrophage markers, the proportions of macrophage subgroups were determined. There was an increase in UCHM1 and RFD9 positive cells in each subgroup: the increase in UCHM1 positive cells was significant in patients with burns as well as smoke inhalation, and the increase in RFD9 positive cells was significant in patients with smoke inhalation alone. Assessment of the role of such cells in the development of acute lung injury (such as adult respiratory distress syndrome) may be important in our understanding of the mechanisms entailed.

Bronchoalveolar Lavage Fluid↗
PubMed1990

Access to care: clozapine in the public sector.

Clozapine holds great clinical promise for some chronic schizophrenic patients. However, limitations on access to the drug by the largest subgroup who need it, the indigent, are causing frustration for patients, their families, physicians, and public-sector mental health systems. The drug is available only through the manufacturer's proprietary monitoring system; many public-sector professionals and agencies feel that the system is overpriced, is unfairly exclusive, and has thus far kept the drug out of reach of most patients who need it. Arguments that patient improvement will lead to dollar savings in the long run seem overly optimistic. The ethical issue of access to treatment remains. The author discusses these and related issues and reports early experience from several public mental health systems.

Agranulocytosis↗
PubMed1990

Management of congenital arteriovenous malformations.

Over a 6-year period, 12 patients with 14 congenital arteriovenous malformations were considered for a staged approach to include afferent vessel ligation (AVL) and/or intra-arterial embolization (IAE) and surgical excision where possible. Patients were followed for a period ranging from 3 to 60 months. Two patients had localized lesions which were completely excised. Five patients were treated by IAE followed by excision with a successful outcome in four. One patient had a transmetatarsal amputation for failed IAE. Two patients had both IAE and AVL before excision of the lesion. In one patient AVL alone was followed by a recurrence. Two patients with multiple lesions were kept under observation. It would appear that IAE and excision of an arteriovenous malformation can achieve cure or excellent palliation in most patients.

Adolescent↗
PubMed1989

Serious assaults by inpatients.

Forty-nine hospital wards in the United States and Canada were surveyed during specified periods for one year to document assaults by inpatients on staff or other patients. Nine (5.7%) of the 158 assaults by adult psychiatric inpatients were sufficiently severe to require medical treatment. Four others occurred on the only children's service studied. Only one (2.6%) of 39 assaults on adult nonpsychiatric units required medical care. Injuries were rarely serious, with only four assaults in any setting leading to bedrest or missed workdays. The overall rate of assault (assaults per bed per year) on 27 adult psychiatric units was 1.36; for assaults requiring treatment, the rate was 0.08. The rate of assault of any kind on 22 adult nonpsychiatric units was 0.28 assaults per bed per year.

Adolescent↗
PubMed1988

Role of pulmonary alveolar macrophage activation in acute lung injury after burns and smoke inhalation.

Bronchoalveolar lavage cells from 42 fire victims and from 18 patients who were smokers attending for diagnostic bronchoscopy (controls) were assessed morphologically and by chemiluminescence. 10 of the victims had inhaled smoke only; 15 had cutaneous burns only; and 17 had combined injury. The combined injury group had significant increases in polymorphonuclear leucocytes and macrophages, especially mature forms, compared with controls. These increases were higher than those expected from the individual injuries. The combined injury group had significantly greater spontaneous chemiluminescence than controls, again greater than that expected by the individual injuries. The chemiluminescence response to stimulation by opsonised bacteria was significantly higher in the combined injury group than in controls, but significantly lower than that in the smoke inhalation only group. The size of the alveolar cellular response to smoke and cutaneous burns suggests that lung damage follows from excess release of inflammatory mediators, exhaustion of the reserve of mature phagocytes and consequent reduced ability to fight bacteria, or both.

Acute Disease↗
PubMed1988

Patient-controlled analgesia for burn patients: a preliminary report.

The introduction of patient-controlled analgesia for burn patients is reported. It has been used for 18 postoperative patients and five patients with acute thermal injury. The system has been found to be easy to use. Wide variations in patient morphine consumption have been seen. Patient-controlled analgesia may have a role in the management of pain associated with burns.

Adolescent↗
PubMed1988

Physical assaults in a psychiatric unit of a general hospital.

The authors collected data concerning assaults, assaultive patients, and victims in a psychiatric unit during a 12-month period and compared them with data from a control group of patients. Thirty-seven assaults by 25 patients were recorded. Fourteen of the victims were patients and 23 were members of staff. The assaultive group contained a significantly higher proportion of schizophrenic patients than did the control group and significantly larger numbers of patients from lower socioeconomic classes, patients admitted involuntarily under a section of the Mental Health Act, and patients with a history of assaults.

Adult↗
PubMed1988

Clinical evaluation of the violent patient.

Violence is a generic behavior whose evaluation must consider medical, emotional, social, and environmental factors. The evaluation setting should allow privacy (but not isolation), security (but not constriction), comfort (but not fragility), and respect (but not vulnerability). In addition to one's routine complete history, a very complete description of events and feelings before, during, and after the violent episode is critical. Organic causes and correlates of violent behavior must be carefully sought. Evaluation of future risk of violence is difficult but often necessary. The environment in which the patient will be placed, time limits of the prediction and stability of the patient's clinical condition are important factors. Acute risk is greater when certain conditions, such as acute psychosis, persecutory delusions, or intoxication, are present in an already-violent patient. The legal aspects of evaluation are briefly discussed, including basic recommendations for documenting one's good-faith efforts to weigh the risks and benefits of clinical actions and adhering to applicable laws.

Diagnosis, Differential↗
PubMed1987

Mechanisms leading to hypogonadism in men with burns injuries.

A profound and persistent depression of serum testosterone concentrations was found in 19 men with burns injuries. This could not be explained by changes in sex hormone binding globulin capacity, hyperprolactinaemia, classical primary testicular failure, or a hypogonadotrophic state. Pulsatile release of luteinising hormone was found in control subjects but was absent or diminished in burnt patients with low serum testosterone concentrations. In addition, these patients showed reduced biological activity of luteinising hormone as measured by bioassay even though normal concentrations of luteinising hormone were detected by radioimmunoassay. The temporary hypogonadism after burns injury and possibly in other clinical states may be related to hypothalamic dysfunction, which leads to abnormal generation of luteinising hormone releasing hormone and non-pulsatile secretion of luteinising hormone of reduced biological activity.

Adult↗
PubMed1987

The preclinical evaluation of the water vapour transmission rate through burn wound dressings.

The control of evaporative water loss, following burn injury, is of major importance to the overall condition of the patient, whether this control is by natural eschar or by a dressing. It is therefore important to preclinically determine the water vapour transmission rate of these dressings, firstly to make comparisons between different materials and secondly to screen prototype materials, under controlled conditions. A preclinical (in vitro) technique is described and the results are given for several commercially available dressings which encompass foam, film and hydrogel material categories.

Bandages↗
PubMed1987

An in vitro assessment of wound dressing conformability.

An in vitro assessment technique has been developed to determine the conformability of wound dressings. The technique employed is based on an inflation technique which provides a measurement of the minimum radius of curvature which a specific dressing will adopt under pressure. A pressure of 40 mmHg was chosen as this had been shown to be the maximum tolerable pressure before the occurrence of tissue breakdown. This radius is then matched to the natural radii of the body surfaces and an assessment of conformability can be made. A series of commercially available dressings have been assessed with respect to their conformability, and to the enhancement of their conformability due to viscoelastic creep behaviour.

Bandages↗
PubMed1987

Evaluation of gaseous transmission (O2 and CO2) through burn wound dressings.

The rates of transmission of oxygen and carbon dioxide through various burn wound dressing materials were determined. The British Standard Vacuum technique was used to determine the Gas Transmission Rate (GTR) of hydrophobic dressings. A Gas to Liquid technique was used to determine the GTR of hydrophilic (water containing) dressings. All the materials tested showed greater GTR values for carbon dioxide than for oxygen. The role of the transmission characteristics of the dressings to influence the wound healing environment is discussed.

Bandages↗