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Biomedical subjects

G B Smith

Publications and source records attributed to G B Smith.

At least 109 records · Page 6Linked to original sources
PubMed1989

Transcatheter embolization of small bowel anastomosis: a case report and review of the literature.

A 45-year-old woman underwent exploratory laparotomy for recurrent intra-abdominal abscesses subsequent to a sigmoid resection for diverticulitis. Her postoperative course was complicated by massive hemorrhage from a small bowel anastomosis, which was successfully managed with transcatheter embolization. To our knowledge, this report documents only the second recorded successful embolization of a bleeding small bowel anastomosis. In certain high-risk patients, transcatheter embolization may be considered a useful adjunct in the management of gastrointestinal hemorrhage including anastomotic bleeding.

Anastomosis, Surgical↗
PubMed1989

Factors associated with surfactant treatment response in infants with severe respiratory distress syndrome.

In a prospective, randomized study of 18 infants treated with bovine surfactant (surfactant TA, Tokyo Tanabe Co, Tokyo) for severe respiratory distress syndrome, a lasting response was found in 12 infants (66%), a transient response was found in two (11%), and no response was found in four (22%) when arterial to alveolar PO2 ratios were used to define responses during the first 48 hours after treatment. In contrast, three of 23 control infants (13%) had a transient or lasting "response" to sham treatment (Pediatrics 1987;79:31-37). To determine whether maldistribution of surfactant could explain lack of response or a transient response, surfactant TA was mixed with technetium-99m sulfur colloid (approximately 300 mu Ci per infant), and eight infants with severe respiratory distress syndrome were treated six to 58 hours after birth. Scintigraphy of the lungs was performed three to 15 hours after treatment. Although a lasting response was observed in three infants, a transient one in three, and no response in two, no gross maldistribution of the radioactive label was found. Either lung received from 37% to 62% of the total radioactivity. During the past 3 years, in all infants with severe respiratory distress syndrome who were treated with surfactant (n = 29), poor or transient responses were associated with early patent ductus arteriosus and air leaks (pulmonary interstitial emphysema and pneumothoraces). Pathophysiologic conditions associated with respiratory distress syndrome are more likely to explain suboptimal responses after surfactant treatment than gross maldistribution of surfactant in the lungs.

Administration, Inhalation↗
PubMed1988

Predicting successful brachial plexus block using changes in skin electrical resistance.

Skin electrical resistance is determined by the degree of sweating of the skin which is, in turn, related to sympathetic nervous system activity in the area concerned. It is increased when the nerves supplying the area are damaged or blocked by local anaesthetic agents. We have assessed the temporal and spatial relationship between the onset of sympathetic and sensory loss in the hand following brachial plexus block in 44 patients. Skin electrical resistance, measured using a simple ohm meter, has been shown to increase within 2 min of brachial plexus blockade with 1% lignocaine and adrenaline 1:200,000. This increase is an early and reliable indicator of subsequent, and occasionally delayed, sensory loss.

Aged↗
PubMed1988

Mixtures of low molecular weight surfactant proteins and dipalmitoyl phosphatidylcholine duplicate effects of pulmonary surfactant in vitro and in vivo.

Pulmonary surfactant proteins SP-B and SP-C were isolated from lavage fluids of bovine lungs and recombined (lipid/proteins, 9/1, wt/wt) with dipalmitoyl phosphatidylcholine for testing in vitro and in surfactant-deficient adult rats. Using a pulsating bubble surfactometer, we found that inflation pressures of bubbles at minimum radii in these mixtures were 0.34 +/- 0.05 cm H2O (+/- SD, n = 24) after 1 min. These values were not affected by increasing amounts of surfactant protein relative to dipalmitoyl phosphatidylcholine (DPPC). Minimum inflation pressures were similar to those of modified bovine surfactant, surfactant Tokyo Akita (TA) (0.33 +/- 0.05 cm H2O, n = 7). In vivo testing was carried out in adult rats made surfactant deficient by repeated lavage and ventilated with 100% oxygen. Rats received tracheal instillations of either air, DPPC, DPPC/SP-B,C (9:1), or surfactant TA at 50 mg/kg body weight. Surfactant TA and DPPC/SP-B, SP-C mixtures resulted in similar immediate and sustained improvements in arterial oxygenation (308 +/- 66 torr, n = 10 and 312 +/- 101 torr, n = 6 at 30 min posttreatment) that were significantly greater than those of sham (76 +/- 24 torr, n = 17) and DPPC-treated rats (64 +/- 32 torr, n = 7). Rats treated with either DPPC/SP-B,C mixtures or surfactant TA showed similar postmortem static lung compliances (2.3 +/- 0.8 ml/cm H2O/kg, n = 8 and 1.9 +/- 0.4 ml/cm H2O/kg, n = 5, respectively) that were significantly larger than sham (1.3 +/- 0.3 ml/cm H2O/kg, n = 14) and DPPC-treated rats (1.2 +/- 0.2 ml/cm H2O/kg, n = 6).(ABSTRACT TRUNCATED AT 250 WORDS)

1,2-Dipalmitoylphosphatidylcholine↗
PubMed1987

Resuscitation training for medical students in the United Kingdom--a comparison with the United States of America.

Resuscitation training for medical students and junior doctors in the United Kingdom and United States was compared using questionnaires sent to medical schools in both countries. A marked deficiency in the provision of cardiopulmonary resuscitation training has been demonstrated in the United Kingdom; however, in the United States, the availability of uniform certifiable teaching is now widespread. Suggestions for the improvement of training in the United Kingdom are expected to increase medical student proficiency in cardiopulmonary resuscitation. The need for training in basic and advanced resuscitation prior to graduation from medical school is stressed.

Curriculum↗
PubMed1987

Histamine levels and cardiovascular responses during splenectomy and splenorenal shunt formation in a patient with systemic mastocytosis.

Systemic mastocytosis is a rare disorder characterised by the infiltration of many tissues by abnormal numbers of mast cells. Life-threatening episodes of bronchospasm and hypotension are common in response to a variety of triggers which cause mast cell degranulation. We present the case history of a patient with severe mast cell disease who successfully underwent splenectomy and portocaval anastomosis. Peri-operative therapy was directed towards mast cell stabilisation, and histamine-releasing drugs were avoided. Cardiovascular data, together with blood histamine levels and thrombin times, indicated that mast cell degranulation did not occur. A review of the current literature concerning mast cell disease as it relates to anaesthesia is presented and suggestions for the safe management of such cases are given.

Adult↗
PubMed1986

Placement of double-lumen endobronchial tubes. Correlation between clinical impressions and bronchoscopic findings.

Double-lumen endobronchial tubes were placed "blindly" in 23 patients undergoing thoracotomy. Clinical criteria suggested satisfactory positioning in all cases; however, subsequent fibreoptic bronchoscopy revealed malposition in 48%. Bronchoscopic findings included the inability to view the bronchial cuff, narrowing of the bronchial lumen of the tube at the level of the cuff and herniation of the cuff over the carina. The potential hazards associated with these findings are discussed.

Adult↗
PubMed1986

Beta-blockers in the severely and profoundly mentally retarded.

The authors present data from four different institutions from open clinical trials of propranolol in 19 mentally retarded patients with IQs less than 50. When customary forms of treatment had failed, propranolol was initiated. A table showing changes in the patients' behavior is included. Twelve patients demonstrated a pronounced improvement in self-abusive and aggressive behavior, four made moderate gains, and three were considered unchanged. The authors postulate that at least some aspects of the behavioral improvement were due to the peripheral anxiolytic action of the beta-blockers. Contrary to other reports of using higher doses (greater than 520 mg/day range), the authors used a mean dose of 120 mg/day and consider the duration of time spent on the medication as a crucial factor in its effectiveness.

Adrenergic beta-Antagonists↗
PubMed1986

A possible diurnal variation in trazodone clearance.

Diurnal variations in drug metabolism that have clinical consequences have been described for several drugs used in internal medicine but have not been reported for antidepressants. The long half-lives of most antidepressants may obscure such variations. Trazodone hydrochloride has a short half-life compared with other commercially available antidepressants. The authors measured serum levels of trazodone 11 hours after both 9 a.m. and 9 p.m. equal doses of the medication in individuals who had been on these doses for more than 3 days. For patients on other medications in addition to trazodone, serum levels were significantly higher at 8 a.m. than at 8 p.m. (N = 7, P less than 0.01) and approached significance for patients on trazodone alone (N = 8, P = 0.06). Induction of hepatic microsomal enzymes by the other medications may have exaggerated the tendency for trazodone to show diurnal variations in serum levels.

Adolescent↗
PubMed1985

Temazepam in fast dispensing dosage form as a premedication for children.

Forty-seven children aged between four and 11 years received temazepam 0.5 mg/kg in a novel fast dispensing dosage form. The preparation was well accepted and associated with few side-effects. Satisfactory sedation and anxiolysis was obtained in over 93% of patients. The relative merits of a variety of routes of administration of premedicant drugs for children are discussed and the advantages of buccally administered formulations for this age group are presented.

Administration, Oral↗