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Biomedical subjects

D M Linton

Publications and source records attributed to D M Linton.

At least 37 records · Page 2Linked to original sources
PubMed1991

Intensive care management of community-acquired Klebsiella pneumoniae.

The clinical features of 18 patients with Klebsiella pneumoniae requiring intensive care unit (ICU) management are presented. All patients required ventilatory support; 17 were given constant positive pressure ventilation and 10 required greater than 10 cm positive end expiratory pressure. The clinical picture was characteristic: pre-existing medical disease, clinical features of severe pneumonia and copious purulent bronchial secretions, Gram--ve organisms on Gram's stain and lobar consolidation on the chest radiograph were common. Septicaemic shock, confusion and uncompensated metabolic acidosis were the presenting clinical features predicting a poor outcome. Antimicrobial chemotherapy, that combined an aminoglycoside and a third generation cephalosporin to ensure adequate early antibiotic serum levels, may help to improve the prognosis.

Acidosis↗
PubMed1991

Midazolam-induced benzodiazepine withdrawal syndrome.

A case history of a patient who developed severe anxiety and agitation on two occasions after discontinuation of a midazolam infusion is presented. The withdrawal symptoms interfered with effective mechanical ventilation and the patient required the reintroduction of a long-acting benzodiazepine to treat the withdrawal state and to facilitate weaning from mechanical ventilation.

Akathisia, Drug-Induced↗
PubMed1990

Monitoring in motion. An update on the Air Ambulance Service of the South African Red Cross Society (Cape Region).

Since 1966, when 40 patients were transported in a single-engined light aircraft in its first year of service, the Air Ambulance Service of the Cape Region of the South African Red Cross Society has continued to grow annually, providing the people of southern Africa with a remarkable and, in its many ways, unique service. More than 3,300 patients have been transported on more than 2,500 flights in the past 23 years. In June 1988, a Cessna Citation jet aircraft was taken into service and, by 20 January 1989, had already transported more than 148 patients on 102 flights. This aircraft was equipped in Cape Town and has sophisticated life support and monitoring equipment, which enables critically ill patients to be transported over long distances in safety.

Aircraft↗
PubMed1990

Myasthenia gravis.

Myasthenia Gravis is a disorder of neuromuscular function resulting from an immunologically based premature destruction of acetylcholine receptors. The disease is characterized clinically by variable weakness accentuated by repetitive muscular activity and usually responding to the administration of acetylcholinesterase inhibitors. Myasthenia Gravis is a complex disease and requires understanding of the many facets of its natural history and immunological basis to ensure optimal individual patient management. The long-term goal is control of the immunological imbalance; treatment regimens include thymectomy, corticosteroids, azathioprine, and plasmapheresis. The common use of acetylcholinesterase inhibitors provides symptomatic relief during variable daily muscular activity. Disability due to myasthenia gravis is to a large extent reversible and death is preventable. Early recognition of myasthenia gravis and appropriate treatment are often rewarded by remission that may be permanent.

Diagnosis, Differential↗
PubMed1989

Systems for scoring severity of illness in intensive care.

Severity of illness scoring systems are increasingly being used by many intensive care units to predict mortality and to compare results and different therapies. A study was undertaken to evaluate three of these systems--therapeutic intervention scoring system (TISS), acute physiology and chronic health evaluation (APACHE II), and organ failure--in a 2-year prospective analysis in a multidisciplinary intensive care unit. A total of 728 patients with a wide variety of diseases were entered into the study. The relationship between score and mortality in all patients and in specific groups was investigated. The APACHE II system is likely to be the most useful in comparing different therapies and intensive care units, while the organ failure system was more accurate in predicting outcome. No system was precise enough in its predictive powers to make decisions to deny or terminate treatment.

Adolescent↗
PubMed1989

Evaluation of the efficacy and tolerance of intravenously administered imipenem/cilastatin in the treatment of septicaemia.

In an open study to determine the efficacy, safety and tolerance of intravenously administered imipenem/cilastatin (Tienam 500; Logos) in the treatment of septicaemia, 34 patients were given this thienamycin antibiotic in doses ranging from 1.5 g to 2 g daily for an average of 8.6 days (range 3-44 days). Based on clinical assessment, the study drug appeared to be effective in treating the septicaemia in 28 out of 34 patients and bacteriologically assessed eradication of the isolated pathogen was proven in 24 out of 34 patients. The drug appeared to be well tolerated in all but 4 patients, 3 of whom developed mild phlebitis and 1 a skin rash.

Adolescent↗
PubMed1989

Mandatory minute volume weaning in patients with pulmonary pathology.

This study evaluates mandatory minute volume (MMV) weaning in patients with pulmonary pathology. When weaning criteria were fulfilled, 22 patients were randomised to MMV and 18 to a control intermittent mandatory ventilation (IMV) group. With IMV weaning the ventilator rate was decreased by two breaths per minute at 3-4 hourly intervals during daylight hours. In the MMV group a target of 75% of the ventilator minute volume was set. All weans were considered complete four hours after the cessation of mechanical support, and were deemed successful if no further ventilation was required. The success rate was 86% in the IMV and 89% in the MMV group. MMV weaning was rapid (4.75 + 1.5 hrs) and proved less demanding on the ICU staff by providing a safe trial of spontaneous respiration, while retaining the facility for partial ventilation.

Adult↗
PubMed1988

Imipenem/cilastatin in the treatment of severe nosocomial pneumonia.

Imipenem/cilastatin (Tienam 500; Logos) 1 g, administered intravenously every 8 hours, was evaluated in an open clinical trial in 35 patients with severe nosocomial pneumonia. In 84.4% of cases there was a favourable clinical response; microbiological success was achieved in 63.3% and partial success in 20% of patients. The majority of Gram-negative and Gram positive organisms were sensitive to imipenem, including those resistant to the aminoglycosides. Although colonisation was frequent, superinfection was uncommon. Imipenem was well tolerated in these critically ill patients, many of whom had renal and other organ failure. The wide spectrum of antimicrobial activity and minimal side-effects made it a useful agent in patients with severe nosocomial pneumonia.

Adolescent↗
PubMed1987

Treatment of acute self-poisoning in a respiratory intensive care unit. A 5-year review.

A study of 103 cases of drug-related suicide attempts admitted to the Respiratory Intensive Care Unit, Groote Schuur Hospital, over a 5-year period (1980-1984) was carried out. This group constituted 4.8% of all patients admitted to this hospital with acute self-poisoning. The majority of patients made an uneventful recovery (survival rate 91.7%). No association was found between initial admission status and ultimate recovery. Haemoperfusion was useful in treating patients with severe barbiturate poisoning.

Adolescent↗
PubMed1987

Isoniazid poisoning. A report of 2 cases.

Isoniazid (INH) is used in most prophylactic and therapeutic antituberculosis regimens because of its effectiveness and low cost. Despite the vast amounts of this drug dispensed in the RSA, INH overdose appears to be rare. Acute INH poisoning requires recognition and specific therapy to prevent mortality. Two patients with INH overdose recently treated successfully in the Groote Schuur Hospital Respiratory Intensive Care Unit are described. The pharmacology of INH, clinical features of INH poisoning and the intensive care management are discussed.

Adolescent↗
PubMed1987

Nosocomial infections in a respiratory intensive care unit.

A total of 250 consecutive admissions to an open-plan respiratory ICU were analyzed prospectively to identify the incidence of secondary hospital-acquired infections and possible predisposing factors. Despite preventative measures and a restricted antibiotic policy, 23.6% of patients developed secondary infections. Patients admitted after multiple trauma were the only diagnostic category of patients who showed a significantly increased incidence of secondary infections. The length of hospitalization and number of patients who had intubations or tracheostomies was higher in the group with secondary infection; the causal relationship was difficult to establish. Patients who were not intubated or tracheostomized did not develop secondary infection. Prior administration of antibiotics did not appear to influence the incidence of secondary infection. There was a significant increase in secondary infections in patients with a higher therapeutic intervention scoring system score. The predominant pathogens cultured were highly resistant Gram-negative organisms, particularly Acinetobacter sp. and Pseudomonas sp. Staphylococcus aureus was the most common Gram-positive pathogen. The ICU course was probably prolonged by the complication of nosocomial infection, which may have contributed to the deaths.

Adolescent↗
PubMed1986

Ceftriaxone therapy in adults with severe lower respiratory tract infections.

Ceftriaxone, a third-generation cephalosporin with a wide spectrum of antimicrobial activity and a long half-life of 8 hours permitting administration every 24 hours, was evaluated in 33 patients with severe lower respiratory tract infections. Twenty-nine patients showed a favourable clinical response and 2 failed to respond to therapy. In 2 patients the clinical response was impossible to assess. In 19 of the 23 patients in whom it was possible to assess bacteriological response, there was a favourable outcome. Serum ceftriaxone levels were well maintained above the minimal inhibitory concentrations of sensitive organisms for the entire dosage interval whether the drug was given by intramuscular or intravenous injection. There were no side-effects that could be attributed to ceftriaxone, which was highly effective in the immediate treatment of both community and nosocomial acquired severe lower respiratory tract infections.

Adult↗