[Insertion of silicone rubber catheters for long-term intravenous therapy].
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Catheterization↗
Biomedical subjects
D Thomson
Publications and source records attributed to D Thomson.
Carbon dioxide output in spontaneously breathing infants during anaesthesia and surgery.
Twenty-eight infants were anaesthetized with halothane, nitrous oxide and oxygen and allowed to breathe spontaneously through a non-rebreathing system during minor paediatric surgery. Carbon dioxide output was correlated negatively with body weight for infants greater than 10 kg, but not for children less than 10 kg. Carbon dioxide output was unchanged compared with before surgery.
Anesthesia, Inhalation↗
Temporary incomplete ischemia of the legs induced by aortic clamping in man: effects on central hemodynamics and skeletal muscle metabolism by adrenergic block.
The hemodynamic changes which occur when clamping and unclamping the aorta during reconstructive surgery might be a threat to the elderly patient with concomitant cardiac disease. In addition, the cross-clamping induces a temporary ischemia of the legs, with severe metabolic derangement after the release of the aortic clamp. We have studied the effect of a intraoperative adrenergic block (phenoxybenzamine plus metoprolol) on the central circulation and the skeletal metabolism in 14 patients undergoing aortic reconstruction to treat occlusive arteriosclerotic disease. Cardiac output, heart rate, arterial and pulmonary artery pressures, and cardiac filling pressures, as well as femoral venous blood flow were studied. Biopsy specimens of the lateral vastus muscle and blood samples from the radial artery and iliac vein were taken before aortic clamping, and before, 30 minutes, four and 16 hours after the aorta was unclamped, as well as five days postoperatively. In addition, intramuscular temperature and pH were measured. Glycogen, glucose, lactate, pyruvate, ATP, ADP, AMP, phosphocreatine (PCr) and creatine (Cr) contents of the muscle and lactate and pyruvate concentrations in iliac venous and radial arterial blood were determined using enzymatic fluorometric techniques. Mean arterial blood pressure (MAP) averaged 80 mmHg before clamping, chiefly because of the low systemic vascular resistance (SVR), and left ventricular stroke work (LVSW) was normal. At clamping MAP, SVR, LVSW, remained unchanged. MAP and LVSW were unaffected even though SVR decreased slightly after the aorta was unclamped and resulted in an increased cardiac output, mainly due to a higher stroke volume. No major change in the pulmonary circulation was observed. During clamping the muscle lactate/pyruvate ratio increased, intramuscular pH and femoral venous blood flow decreased indicating insufficient tissue perfusion. Energy charge (EC), the adenylate (ATP + ADP + AMP) and creatine (PCr + Cr) pools were, however, unchanged. In spite of a restored blood flow to the legs, a severe metabolic derangement of the muscle was observed after declamping, with lowered EC, ATP + ADP + AMP and PCr + Cr indicating cellular damage. No improvement in the condition of the cells was observed 16 hours after operation. In conclusion, we found that by using neurolept anesthesia and an intraoperative adrenergic block in combination with a differentiated fluid therapy the central circulation stabilized and was largely unaffected by the clamping and unclamping procedures. In spite of the improved central hemodynamics no favorable effect on the skeletal muscle metabolism was observed.
Adenosine Diphosphate↗
Temporary incomplete ischemia of the legs caused by aortic clamping in man: improvement of skeletal muscle metabolism by low molecular dextran.
Temporary infrarenal clamping of the aorta during reconstructive surgery induces incomplete ischemia of the leg muscle. After release of the clamp, severe muscle metabolic derangement with loss of high-energy phosphate compounds has been observed, indicating a dysfunction or damage of the muscle cells. In six patients operated on for occlusive aortoiliac disease, low-molecular-weight dextran (LMWD) was peroperatively administered for optimal volume loading and prevention of clotting. No heparin was used. Before, during and after the clamping period the central hemodynamics were monitored, and glycogen, glucose, lactate, pyruvate, phosphocreatine (PCr), creatine (Cr), ATP, ADP and AMP content in the thigh muscle were analyzed using enzymatic fluorometric techniques. Even though ischemia developed during the occlusion, no decline in the adenylate (ATP + ADP + AMP) or creatine (PCr + Cr) pools occurred after the clamp was released, and the energy charge of the adenine nucleotides remained unchanged. It is suggested that LMDX prevents rheologic changes impairing the microcirculation during and after the ischemic period, and thereby improves oxygenation of the muscle tissue upon reperfusion.
Adenosine Diphosphate↗
Rectal premedication in children. Use of diazepam, morphine and hyoscine.
Rectal premedication with diazepam, morphine and hyoscine has been used in 20 healthy children undergoing minor surgery. Satisfactory sedation was achieved in the majority of children and the anticholinergic effects were also adequate. Peak plasma levels of diazepam and morphine were reached within 30 minutes, and the plasma levels decreased after 2 hours. No adverse effects on ventilation were seen during anaesthesia.
Anesthesia, Inhalation↗
Renal interstitial cell granularity in dogs with renal hypertension.
Hypertension was induced in dogs by the partial occlusion of one renal artery. After 12 days of hypertension the interstitial cells in the medulla of kidneys from hypertensive animals were examined by electron microscopy, and the appearance compared with interstitial cells from normal dogs. The osmiophilic granules in the cells were classified into dark and light forms, and the numbers of each counted in at least 70 cells per kidney. It was not possible to quantify the number of interstitial cells in each renal medulla. The kidneys with partially occluded renal arteries had an increased total number of granules per cell (4.93 +/- 0.51) compared with normal kidneys (0.79 +/- 0.14), and the great majority of these were dark granules (95.3% and 79.5%, respectively). In contrast the contralateral untouched kidneys had a significantly reduced number of granules per cell (0.58 +/- 0.14), and only a small proportion of the total were dark granules (31.1%). The actual number of light granules per interstitial cell was significantly increased in the untouched kidney compared with normals.
Animals↗
Operational audit--the respiratory department.
Although our operational audit involved evaluating the cost effectiveness and efficiency with which procedures or functions are performed, our focus remained on the actual operational problem as defined in our criteria. The pre-determined standards, on which our criteria statements were based, provided the yardstick for measurement. Our assessment and Treatment Plan for patient care was audited, followed by a review of our policy and procedure compliance and the application of managerial systems and controls. Although the total impact of this audit tool on astute clinical care, management, judgement, and educational needs is yet to be addressed, we believe we have taken an important step in the direction of quality control through the initiation of an evaluation system in the Respiratory Department.
Concurrent Review↗
Incidences of fatal postoperative pulmonary embolism after prophylaxis with dextran 70 and low-dose heparin: an international multicentre study.
A total of 4352 patients were admitted to a prospective' randomised multicentre trial comparing the prophylactic efficacy of dextran 70 and low-dose heparin against fatal pulmonary embolism after elective operations for general, orthopaedic, urological, and gynaecological conditions. Out of 3984 patients correctly admitted, 1993 were allocated to receive dextran 70 and 1991 to receive low-dose heparin. Withdrawal of prophylaxis because of bleeding or technical difficulties occurred more often in the heparin group, but allergic reactions were more common in the dextran group. Of the 75 patients who died within 30 days after operation, 38 had been given dextran and 37 low-dose heparin. Necropsy was performed in 33 and 32 of these cases respectively. In six patients in each group pulmonary embolism was the sole or a contributory cause of death. Of these, five patients in the dextran group and two in the heparin group had received a full course of prophylaxis. There was no statistically significant difference between the two treatment groups in the incidence of fatal pulmonary embolism after a full course of prophylaxis.
Aged↗
Mesangiocapillary glomerulonephritis in lambs: the ultrastructure and immunopathology of diffuse glomerulonephritis in newly born Finnish Landrace lambs.
Renal biopsies were obtained by laparotomy from eight newborn C3 deficient Finnish Landrace lambs, and examined by light, electron and immunofluorescence microscopy. The capillaries of all glomeruli contained numerous neutrophils and peripheral capillary walls were thickened and refractile at high magnifications. Almost continuous subendothelial electron-dense deposits were seen in peripheral capillary walls. Large amounts of C'3, and small amounts of IgM and IgA were also seen in these sits. No IgG was seen in these glomeruli. Four lambs died within 96 hr of birth. The remaining four lambs all had severe clinical mesangiocapillary glomerulonephritis (MCGN) by 21 to 42 days after birth. Amounts of C'3, IgM and IgA in glomeruli had increased by comparison with amounts at birth, and IgG was present in the deposits. It was concluded that the processes ultimately expressed as MCGN in these lambs were initiated before birth.
Animals↗
Acute interstitial nephritis associated with gentamicin and lincomycin therapy.
A case of acute oliguric renal failure following gentamicin and linocomycin therapy is described. Renal biopsy showed an acute interstitial nephritis. This was associated with high serum gentamicin levels and the later development of ototoxicity. Withdrawal of antibiotics and conservative measures was followed by rapid recovery of renal function. Attention is drawn to the association between gentamicin and lincomycin therapy and the development of an acute interstitial nephritis.
Acute Disease↗
Age reporting by the elderly and the nineteenth century census.
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Demography↗
Early hemodynamic and respiratory changes following tourniquet release - influence of large doses of methylprednisolone.
The early hemodynamic and respiratory response 5 and 15 minutes after tourniquet release in 26 patients operated upon for osteoarthrosis of the knee was studied. Fourteen randomly selected patients received 30 mg/kg of methylprednisolone before releasing the tourniquet, while 12 patients served as control. Cardiac output remained unchanged in the steroid group, but fell significantly in the control group, while mean arterial pressure fell to the same level in all patients. Systemic vascular resistance was lowered in all patients but significantly more so in the steroid group, who also had lower pulmonary vascular resistance. Pa02 fell significantly in all patients after tourniquet release implying pulmonary microembolism. The oxygen consumption increased after tourniquet release in the steroid group, which together with the lower systemic vascular resistance indicates a better nutritive blood flow in the leg. The lower pulmonary vascular resistance in steroid patients resulted in a higher pulmonary capillary flow which however went to non- or poorly ventilated parts of the lung, seen as an increased intrapulmonary shunt. The shunt was unaffected in the control group. The improved leg and pulmonary blood flow indicates a beneficial effect of steroids on patients with fractures in combination with ischaemia.
Aged↗
Skeletal muscle metabolism and central hemodynamics during temporary incomplete ischemia induced by aortic clamping in man.
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Adult↗
Metabolic changes in blood and skeletal muscle in reconstructive aortic surgery.
The declamping shock has been attributed to reactive hyperemia with pooling of blood in the legs, metabolic acidosis following lactate accumulation in the ischemic leg muscles and hyperkalemia. We have studied eight patients undergoing arterial reconstruction with temporary aortic occlusion, in six cases because of obstructive arteriosclerotic disease and in two cases for aortic aneurysm. Muscle biopsies from the lateral vastus muscle as well as blood samples from the iliac vein, the superior caval vein and the radial artery were taken before clamping of the aorta, just before declamping, and 20 minutes after restitution of leg blood flow. ATP, ADP, AMP, phosphocreatine (PCr), creatine (Cr), glycogen, glucose, lactate, pyruvate and NH4+ from the immediately frozen muscle biopsies as well as lactate and pyruvate in the iliac vein and central venous blood were determined with an enzymatic, fluorometric technique. Only one patient reacted with a temporary hypotension at declamping. Arterial pH was unaffected during the operation, and no hyperkalemia was noted. During clamping of the aorta an increased lactate/pyruvate ratio in muscle indicated tissue hypoxia. Energy charge (EC) was, however, unchanged and the adenylate pool was maintained possibly due to a decrease in PCr. In spite of the restitution of blood flow after declamping of the aorta, no normalization of the metabolic state was seen, not even 20 minutes after the release of the clamp. EC was still unchanged but a significant decrease of both the adenylate and creatine pools was seen. These findings might indicate a damage of the mitochondria and the cellular membranes in skeletal muscle after temporary arterial occlusion.
Adult↗
Artificial ventilation in children during anaesthesia using a tidal volume ventilator.
Standards for artificial pulmonary ventilation at ventilatory frequencies of 15 and 20 cycles per min, (PETCO2 4 +/- 0.5 kPa), were defined in 16 children with healthy lungs and body weights between 2.6 and 22.6 kg. A tidal volume ventilator and balanced anaesthesia were used during abdominal surgery. At f = 20 cycles/min an approximately direct proportionality existed between tidal volume and body weight (VTpat = 12.3 . kg b.w.--2.1, r = 0.99). The mean value VTpat per kg b.w. was 12.1 +/- 1.4 ml/kg. At f = 15 cycles/min, a linear relationship between tidal volume and kg b.w. was recorded (VTpat = 14.6 . kg b.w. + 16, r = 0.97). The mean value VTpat per kg b.w. was 15.9 +/- 1.5 ml/kg. A significant decrease in total compliance was recorded during the initial part of the surgical procedure. A rectilinear relationship existed between total compliance and kg b.w. (CTOT = 11.2 . kg b.w.--12.5, r = 0.95). The mean value CTOT per kg b.w. was 9.7 +/- 0.54 ml/kPa/kg at f = 20. The endotracheal peak pressure maintained a fairly constant pressure level independent of the initial pressure within the ventilator, the tidal volume and the body weight, a phenomenon explained by the hypothesis that the proportional increase in total lung volume and functional residual capacity in the older children compensated for the higher pressures.
Abdomen↗
Incidence and treatment of chlamydia trachomatis genital infection in Belfast.
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Chlamydia Infections↗
Partial lipodystrophy with nephrotic syndrome.
A patient with nephrotic syndrome in association with partial lipodystrophy is reported. The features of partial lipodystrophy are well recognized and the renal lesion is a mesangiocapillary glomerulo-nephritis of a dense deposit type with an associated depression of C3. This type of kidney involvement is becoming increasingly recognized as common in the syndrome of partial lipodystrophy.
Adolescent↗