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Biomedical subjects

A Ralph-Edwards

Publications and source records attributed to A Ralph-Edwards.

14 recordsLinked to original sources
PubMed2006

Short-term low-dose propofol anaesthesia associated with severe metabolic acidosis.

Propofol-induced metabolic acidosis is well recognised in the paediatric literature, but the existence of such a syndrome in adults remains contentious. In most reported cases, metabolic acidosis complicated prolonged administration of propofol in critically ill patients. We present a case of severe non-fatal reversible metabolic acidosis, without ventilatory depression or hypoxia, related to short-term propofol infusion in an adult during and after coronary artery bypass grafting. We suggest that lactic acidosis occurred in a genetically susceptible patient with an abnormality of mitochondrial function. This report discusses an unusual adverse effect of propofol anaesthesia and sedation and highlights the need for further investigation to define propofol toxicity.

Acidosis↗
PubMed2004

A phase II dose-response study of hemoglobin raffimer (Hemolink) in elective coronary artery bypass surgery.

BACKGROUND: We performed this study to determine the dose-response of hemoglobin raffimer administered in conjunction with intraoperative autologous donation in patients undergoing coronary artery bypass grafting surgery. A secondary objective was to evaluate hemoglobin raffimer for reducing the incidence of allogeneic red blood cell transfusions. METHODS: This was a phase II, single-blind, multicenter, placebo-controlled, open-label study. Patients undergoing coronary artery bypass grafting with cardiopulmonary bypass and intraoperative autologous donation were randomized to receive a single dose of hemoglobin raffimer or control (10% pentastarch). Patients were sequentially enrolled in a dose block of 250, 500, 750, and 1000 mL. RESULTS: Sixty patients received hemoglobin raffimer (n = 30) or control (n = 30). Hemoglobin raffimer was well tolerated. Most (98%) adverse events were mild or moderate in severity. There was an expected dose-dependent increase in the incidence of blood pressure increases and jaundice in hemoglobin raffimer-treated patients. In a dose-pooled analysis of hemoglobin raffimer versus control, increased blood pressure (43% vs 17%), nausea (37% vs 33%), and atrial fibrillation (37% vs 17%) were the most frequently reported adverse events. All serious adverse events were considered unrelated or unlikely to be related to study drug. No hemoglobin raffimer-treated patient required an intraoperative allogeneic red blood cell transfusion, compared with 5 (17%) pentastarch-treated patients (P =.052). This advantage of hemoglobin raffimer was maintained at 24 hours after surgery (7% vs 37%; P =.010) and up to 5 days after surgery (10% vs 47%; P =.0034). CONCLUSIONS: Hemoglobin raffimer was not associated with any serious adverse events in patients undergoing primary coronary artery bypass grafting with cardiopulmonary bypass and intraoperative autologous donation in a dose-response study up to 1000 mL. Hemoglobin raffimer was effective in facilitating decreased exposure or avoidance of allogeneic red blood cell transfusions when used in conjunction with intraoperative autologous donation.

Adult↗
PubMed1994

Infective endocarditis in patients who had replacement of the aortic root.

In 12 patients who had had composite replacement of the aortic valve and ascending aorta, infective endocarditis developed 2 months to 17 years after operation. Six patients had mechanical valves and 6 had biological ones (four homograft and two porcine valves). All patients needed operation because of shock, heart failure, persistent sepsis in spite of adequate antibiotic therapy, or the development of a paravalvular false aneurysm. The predominant microorganism was Staphylococcus. All 6 patients who had mechanical valves were found to have an abscess in the junction between the aortic annulus and the prosthesis; in patients who had biological valves the infection was limited to the leaflets in 3 (one homograft and two porcine valves) and leaflets and annulus abscess in 3 (three homograft valves). Operation consisted of radical resection of tissues suspected of being infected and reconstruction of the left ventricular outflow tract and of the surrounding structures with glutaraldehyde-fixed bovine pericardium. The aortic valve and ascending aorta were replaced with a new valved conduit. An aortic homograft was used in only 1 patient. There was only one operative death due to right ventricular infarction but most patients experienced serious postoperative complications. Operative survivors were followed up from 3 to 156 months (mean, 42 months). One patient died 35 months postoperatively due to bleeding complications of anticoagulation; 1 patient suffered a cardiac arrest at home 2 months after operation, sustained permanent cerebral damage, and died 4 months later. The remaining patients are asymptomatic from the cardiovascular viewpoint.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Massive perirenal and intra-abdominal bleeding after shock-wave lithotripsy: case report.

Complications of extracorporeal shock-wave lithotripsy are rare, with an incidence of symptomatic perinephric hematoma ranging from 0.2% to 0.66%. A 59-year-old man had massive symptomatic retroperitoneal and intra-abdominal bleeding 24 hours after lithotripsy. The hemorrhage was managed successfully by conservative measures, which consisted of packed red blood cells and fresh frozen plasma. The literature on the bleeding complications of lithotripsy is reviewed and the risk factors are identified.

Abdomen↗
PubMed1994

Sudden rupture of an indirect inguinal hernial sac with extravasation in two patients on continuous ambulatory peritoneal dialysis.

Continuous ambulatory peritoneal dialysis (CAPD) is commonly used to treat patients suffering from end-stage renal failure. This method can be used on a long-term basis and in the short term for patients awaiting renal transplantation. Inguinal hernias are a potential source of morbidity for these patients. Therefore, when patients with inguinal hernias require long-term peritoneal dialysis, the hernia should be repaired if the patient's medical status will allow it. The authors report on two patients maintained on CAPD who experienced rapid enlargement and perforation of a previously undiagnosed asymptomatic inguinal hernia. The hernia was repaired successfully, without complication, in both cases.

Adult↗
PubMed1992

Diet Coke or not?

Explore the source record for details and available documents.

Carbonated Beverages↗
PubMed1992

Pulmonary Complications in Obesity Surgery.

Massively obese patients undergoing abdominal surgery frequently develop pulmonary complications. The basis of this predilection, syndromes and suggestions to reduce risk are discussed.

Journal Article↗
PubMed1992

A Jejuno-ileal Bypass Patient Presenting with Recurrent Renal Stones due to Primary Hyperparathyroidism.

In the past, jejuno-ileal (JI) bypass operations were performed for the treatment of massive intractable obesity. This procedure is known to be complicated by numerous malabsorptive syndromes, occasionally resulting in electrolyte abnormalities and oxalate renal calculi. Recurring renal stones and oxalate nephropathy are cause to reverse the JI bypass. However, investigation of recurring renal stones should be done to exclude causes that are not secondary to the bypass procedure itself. We present a patient 13 years post JI bypass with recurring renal calculi due to primary hyperparathyroidism.

Journal Article↗
PubMed1992

Diet Coke or Not?

Many obese patients are attempting to diet. Furthermore, many gastric restrictive procedures permit the ready flow of liquids, and the individual may want to be assured that the liquid is in the "non-calorie" form. Many obese patients have diabetes, and an incorrect or misrepresented beverage can result in elevated plasma glucose with a disruption in glycemic control. The studies below have been extended for orange-flavored carbonated beverages (Orange Crush, Fanta Orange, etc.) with the same findings-no color change with the diet drink and immediate brown color change with the regular drink on the Diastix.

Journal Article↗
PubMed1992

Management of papillary carcinoma arising in thyroglossal-duct anlage.

Cysts of the thyroglossal duct are common congenital abnormalities. They present as asymptomatic midline cervical swellings. The risk of malignant change is low; only 103 cases have been reported in the world literature, 85% of which were papillary adenocarcinomas. The appropriate treatment for this condition remains controversial. The authors describe three patients who had papillary carcinoma contained within a thyroglossal-duct rest. All were treated by cyst resection and thyroid suppression, but without thyroidectomy and radioactive thyroid ablation. Postoperatively, all patients remained disease free, with no recurrence at follow-up ranging from 10 to 29 years. Isolated papillary carcinomas arising from primitive thyroid remnants, associated with a palpably normal thyroid gland at surgery and a negative thyroid scan, can be treated adequately by excising the thyroglossal mass.

Carcinoma, Papillary↗
PubMed1992

Bleeding gastric and duodenal ulcers: endoscopic therapy versus surgery.

From a retrospective review of 156 patients with actively bleeding peptic ulcers, 61 patients had gastric ulcers and 95 patients had duodenal ulcers. Patients presented with hematemesis or melena or a combination of the two. Forty patients with gastric ulcers and 53 patients with duodenal ulcers were in shock. Twenty-five patients with gastric ulcers underwent surgery. Bleeding was controlled in all patients, but in the postoperative period five patients died of myocardial infarction, pulmonary embolism or septic multisystem organ failure. Of 36 patients who underwent endoscopic epinephrine sclerosis of the bleeding gastric ulcer, hemorrhage was controlled in 34. Two patients required reoperation for bleeding after surgery; both survived. Fifty patients with duodenal ulcers had surgery. Bleeding was controlled in all patients, but in the postoperative period 10 died of myocardial infarction and multisystem organ failure. Of 45 patients who underwent endoscopic sclerosis, bleeding was controlled in 40. Five patients required reoperation for bleeding after surgery; all survived. The authors conclude that endoscopic sclerosis should be the initial treatment for actively bleeding gastric and duodenal ulcers. If bleeding continues or recurs then surgery should be carried out.

Adult↗
PubMed1983

Nucleosome DNA repeat length and histone complement in a fungus exhibiting condensed chromatin.

Fungal chromatins are reported to exhibit unusually short nucleosomal DNA repeat lengths. To test whether this is a phylogenetic feature of fungi or rather is correlated with an apparent absence of condensed chromatin in the organisms studied, we have examined the chromatin organization and the complement of basic nuclear proteins in the fungus Entomophthora, an organism which exhibits marked chromatin condensation. Micrococcal nuclease digestion of Entomophthora chromatin revealed a nucleosomal DNA repeat length of 197 +/- 1.2 base pairs (bp). This repeat length is 20-40 bp longer than that reported for any fungus. Entomophthora nucleosomes exhibited an HI-like protein which was much less basic than the HI histones reported for higher eukaryotes but which was similar in basicity to the HI histone reported for the fungus Neurospora. However, the nucleosomal DNA repeat length of Neurospora chromatin is reported to be unusually short, whereas that of Entomophthora was found to be typical of the repeat lengths observed for chromatins of higher eukaryotes. Thus, repeat length, at least in fungi, would not appear to be directly determined by the basicity of the fungal cognate of histone HI.

Amino Acids↗