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Biomedical subjects

W R Pitney

Publications and source records attributed to W R Pitney.

At least 19 recordsLinked to original sources

Comparison of performance of final-year students from three Australian medical schools.

Between 1984 and 1986, 888 final-year medical students from The Universities of Sydney, Western Australia and Newcastle took part in trial examinations that comprised multiple-choice questions, modified essay questions and a patient management problem. Differences in student performance among the schools were small. In 1984 and 1985, Newcastle students performed less well than did Sydney students on multiple-choice questions that were prepared by The University of Sydney, but there was no difference between the schools in 1986. Sydney students performed better than did Newcastle students on the multiple-choice question paper that was prepared by The University of New South Wales in 1984, but in the last two years no differences have been detected between the schools in performance on this paper. The performance on modified essay questions in 1984 suggested that Newcastle students were stronger in behavioural sciences and weaker in pathological sciences than were Sydney students. Sydney students performed less well than did Newcastle students in the patient management problem in 1985, particularly in the area of the use of clinical investigations. On the one occasion of testing that involved students from The University of Western Australia (in 1985), these students performed best of the three schools in the patient management problem, and roughly equally with students from Sydney and Newcastle in the multiple-choice question papers. Differences among the schools usually amounted to less than 10% and might have been accounted for by differences in familiarity with test instruments. We conclude that medical students are likely to graduate from The University of Sydney, Western Australia and Newcastle with similar levels of knowledge of internal medicine. Possible differences in problem-solving ability require further study, particularly in the clinical setting.

Australia↗

Primary extranodal non-Hodgkin's lymphoma.

A total of 52 of 238 patients (22%) with non-Hodgkin's lymphoma presented with disease in a primary extranodal site. The gastrointestinal tract was the commonest site involved (50%) and diffuse large cell was the commonest histological sub-type of the lymphoma (64%). Survivorship analysis of these patients, treated predominantly with chemotherapy, suggests that long-term survival is associated with: low-grade malignancy--median survival greater than 120 months; localized disease or spread of disease confined to the regional lymph nodes--median survival 65.5 months; and the use of aggressive combination chemotherapy for intermediate grade malignancy when the disease is localized or spread is confined to the regional lymph nodes--median survival greater than 110 months.

Adult↗

Assessment of an Australian medical internship.

The work patterns of interns were observed, recorded and analysed into categories descriptive of service and training functions. As would be expected, the service component predominated, while only 7-13% of interns' time could be identified as educative. Interns make little use of formal postgraduate educational sessions and visit the library rarely. They acquire the necessary clinical skills and attitudes to fit them for future practice largely by osmosis and from discussions with residents and registrars. Consultants play only a small role in their education . Non-formal education, which is acquired as part of the service function, has the most potential for effective training. Its unsystematic character, however, may present a problem for both interns and their supervisors since neither may have a comprehensive view of what requires to be learned or what progress is being made. There is a need for interns and their supervisors to identify the learning objectives and experiences which they should attain during each term.

Australia↗

Chemotherapy resolves symptoms and reverses marrow fibrosis in myelofibrosis.

12 patients with symptomatic chronic myelofibrosis were treated with either busulphan or 6-thioguanine. Therapy was without significant side effects and resulted in a reduction in the size of liver and spleen and an improvement in well-being in all cases. In 7 patients the Hb value rose and the extent of marrow fibrosis was reduced in the 5 patients in whom bone marrow examination was repeated after treatment. Chemotherapy is an effective and safer alternative to splenectomy in patients with myelofibrosis with symptomatic anaemia, symptomatic splenomegaly or constitutional symptoms such as fever, weight loss and night sweats.

Aged↗

Heparin-induced thrombocytopenia: association of thrombotic complications with heparin-dependent IgG antibody that induces thromboxane synthesis in platelet aggregation.

Eleven patients in whom thrombocytopenia developed during heparin therapy were studied. Six patient (group 1) had severe thrombocytopenia with delayed onset and five of these patients had thromboembolic complications. A serum factor which induced heparin-dependent thromboxane B2 synthesis, 14C-serotonin release, and platelet aggregation was found in all patients in group 1. The serum factor was shown to be IgG. These findings suggest that the mechanism of the severe thrombocytopenia secondary to heparin therapy is immunological and the associated thromboembolic complications may be attributed to in-vivo activation of the platelet prostaglandin pathway and platelet aggregation induced by the heparin-dependent antibody. The five patients in group 2 had mild symptomless thrombocytopenia with early onset. In this group, the heparin-dependent antibody was not found and the mechanism of the thrombocytopenia is probably a direct action of heparin on platelets.

Adult↗

Non-tropical idiopathic splenomegaly (Dacie's syndrome): report of 5 cases.

We describe 5 patients, aged 22-69 years, with massive splenomegaly of unknown origin an features of hypersplenism. Splenectomy corrected the cytopenia(s) and abolished the symptoms in each case; the histological features of the spleen were non-specific and included congestive changes and lymphoid hyperplasia. 2 of these patients developed non-Hodgkin's lymphoma (NHL) 2 and 6 years after spenectomy. A total of 46 cases of splenomegaly of unknown origin have been reported from UK, USA, and Australia so far, and in 9, NHL developed 8 to 80 months after splenectomy. The questions relating to the pathogenesis of splenomegaly and the subsequent development of NHL remain to be answered. We propose that this 'entity' be known as Dacie's syndrome, after Sir John Dacie who characterised it in 1969.

Adult↗

Prognostic factors in myelofibrosis.

The prognostic significance of spleen size, hemoglobin level (Hb), platelet count and hemopoietic cellularity of the bone marrow was assessed in 33 patients with myelofibrosis. Of these 4 parameters, only the Hb (P less than 0.01) and bone marrow cellularity (P less than 0.001) were found to be useful indicators of prognosis. Patients with Hb greater than 10 g/dl had a median survival greater than 110 mth while those with Hb less than 10 g/dl had a median survival of 22.5 mth; patients with hemopoietic hypercellularity in the bone marrow had a median survival greater than 110 mth while those with a normo- or hypocellularity had a median survival of 20.5 mth. There was significant correlation (P less than 0.01) between the marrow cellularity and the Hb level; 71% of patients with a normo- or hypocellular marrow had Hb less than 10 g/dl, while 79% of those with a hypercellular marrow had Hb greater than 10 g/dl.

Adult↗

Platelet dysfunction in myeloproliferative syndromes.

The most common abnormality of the platelets in 43 patients with a variety of myeloproliferative syndromes was impaired or absent aggregation when stimulated with collagen and adrenaline. Eight unselected cases studied in more detail showed a normal prostaglandin synthesis pathway as evidenced by normal aggregation with arachidonic acid and the production of normal amounts of malonyldialdehyde. Mixing experiments with aspirin-tested platelets showed correction of the abnormal adrenaline and collagen responses and confirmed that the nature of the defect was different from that induced by aspirin. Stimulation of "myeloproliferative" platelets with thrombin after blocking the prostaglandin pathway with aspirin resulted in reduced aggregation, indicating either a deficiency of the storage pool of adenine nucleotides in the platelets or an abnormality of a membrane receptor for thrombin.

Aspirin↗

Anuric renal failure due to encasement of the ureters by lymphoma--ureteric obstruction without dilatation.

A case of anuric renal failure due to encasement of the ureters by tumour is described in a patient with advanced non-Hodgkin's lymphoma. In this patient as well as in two previously reported cases, the IVP showed delayed pyelogram and increasingly dense nephrogram on delayed films with little or no dilatation of the collecting systems. These radiographic features in a patient with extensive intra-abdominal tumour should strongly suggest the possibility of this unusual form of obstructive uropathy. Correct diagnosis in these cases may enable the administration of effective palliative treatment for the renal failure.

Acute Kidney Injury↗

Myelomatosis in aplastic anaemia--a true association or fortuitous occurrence?

A patient with aplastic anaemia subsequently developed multiple myeloma. This unusual association may have been coincidental but a possible link is discussed. Should similar cases occur, it is important that they be documented, as more experimental and clinical evidence is necessary before lymphoid malignancies are related to bone marrow injury.

Aged↗

Is the incidence of deep vein thrombosis following myocardial infarction decreasing?

A trial was undertaken to compare the effectiveness of the antiplatelet drug, flurbiprofen, and subcutaneous heparin in the prevention of deep vein thrombosis following acute myocardial infarction. The original aim of the study could not be fulfilled as the incidence of isotopically-determined venous thrombosis in the group of control patients was only 9.5%. The incidence in all three groups was too low to assess the effectiveness of flurbiprofen prophylaxis. It is suggested that the low incidence may be related to the recent practice of early physiotherapy and ambulation in coronary care units. The patients who developed venous thrombosis were, on average, a little older than those who did not. No differences were observed in blood viscosity, plasma antithrombin III concentration or mean coronary prognostic index. The low incidence of venous thrombosis following acute myocardial infarction suggests a need to reassess the practice of prophylactic anticoagulant therapy in this condition.

Antithrombin III↗

The reticulin content of bone marrow in acute leukaemia in adults.

Marrow reticulin was studied by trephine biopsy in 44 patients with adult acute leukaemia at presentation and subsequently during the course of their illness. The findings indicate that: (1) an increase in marrow reticulin is common at presentation in patients with both acute lymphoblastic and acute non-lymphoblastic leukaemia; (2) effective anti-leukaemic therapy results in resolution of some or all of the increased marrow reticulin and is not contraindicated, even in patients with a marked increase in marrow reticulin; and (3) reappearance of an increase in marrow reticulin may be a sign of relapse of the leukaemia.

Acute Disease↗