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Biomedical subjects

G Lister

Publications and source records attributed to G Lister.

104 records · Page 6Linked to original sources
PubMed1979

Oxygen delivery in lambs: cardiovascular and hematologic development.

After birth a decrease in hemoglobin concentration occurs while high metabolic demands are imposed on the infant by the extrauterine environment. Using the resting lamb as a model, we studied the mechanisms that are called into play during this period to maintain oxygen delivery. Measurements were made of oxygen consumption, arterial and mixed venous blood oxygen contents, cardiac output, hemoglobin concentration, percent fetal hemoglobin, 2,3-diphosphoglycerate, and hemoglobin oxygen affinity during the first two postnatal months. There was a rapid decrease in hemoglobin concentration after birth and concomitant decrease in hemoglobin oxygen affinity, changes similar to those described in humans. Cardiac output and oxygen consumption were both very high immediately after birth and declined in parallel, so that arteriovenous oxygen content difference was constant. Thus at rest cardiac output varies as a result of the changing need for oxygen. This relationship is independent of hemoglobin concentration or oxygen affinity within the normal range. If, however, oxygen demands were increased, oxygen delivery might be compromised by a limited ability to increase oxygen extraction during the immediate newborn period or when hemoglobin concentration is lowest.

Aging↗
PubMed1978

Intraosseous wiring of the digital skeleton.

One hundred cases of osteosynthesis done by the use of intraosseous wiring are presented. Two techniques of wiring are described, one used in transverse fractures and arthrodeses in which an additional Kirschner wire is employed, the other in which No. 0 monofilament wire can be placed perpendicular to the line of osteosynthesis. Forty-seven fractures were treated and there was union in all cases; 53 arthrodeses were performed, with failure in five, due, it is believed, to a failure to observe the essential elements of the technique, namely the need to obtain congruous bone ends and to maintain all internal fixation until there is clinical evidence of union. Overall, 83.2% of the maximum attainable total active range of motion was achieved in the 100 cases.

Adolescent↗
PubMed1977

Replantation of digits and hands: analysis of surgical techniques and functional results in 71 patients with 86 replantations.

Defining replantation as the restoration of a completely amputated part as opposed to simply restoring circulation to an incompletely severed part, the results of replantation of 86 completely amputated parts in 71 patients performed from January, 1970, to December, 1975, were studied. Twenty-eight, or 32.5 percent, were the result of sharp severances of the part; localized crushing accounted for 56, or 65.1 percent. Two were classified as degloving injuries. Twelve amputations were transmetacarpal, six were at the metacarpophalangeal joints, 14 through the proximal phalanx, 15 at the proximal interphalangeal joint, 21 in the middle phalanx, 13 at the distal interphalangeal joint, and five through the distal phalanx. The technique consisted of bone shortening and fixation and repair of all tendons and nerves if possible. Veins are repaired first, at least two for each artery, and heparinized saline and lidocaine are used locally. Irrigation of the vessels is not done, but an intravenous bolus of 3,000 U. of heparin is given when the anastomoses are completed. Aspirin and low molecular weight dextran are given for 3 to 7 days. For the more distal replantation, heparin may be used. Antibiotics are given. In the total series of 86 completely amputated hand units, 52 were unsuccessful, primarly due to vascular thrombosis and usually on the venous side. In the year 1975 a success rate of 69.2 percent was achieved, whereas in the last 50 replantations, done between Jan. 1, 1976, and Oct. 15, 1976, the success rate was 90 percent. Results improved with more experience in the technique and with more careful selection of patients.

Adolescent↗
PubMed1977

Measurement of oxygen consumption: assessing the accuracy of a method.

We have previously described a flow through system for measuring oxygen consumption in infants and children. Because of the need to assess the accuracy of the system periodically, we have developed a simple procedure for doing so. This procedure also provides a means for troubleshooting if the system is not functioning properly and may be applied to other types of flow-through systems for similar purposes.

Child, Preschool↗
PubMed1977

Electrocardiograph monitor artifacts in a neonatal intensive care unit.

A wide variety of artifacts may be found when monitoring the ECG in a neonatal intensive care unit. Many of the artifacts resemble arrhythmias, and unless they are recognized as artifacts they may lead to serious errors of diagnosis and therapy. Many of the artifacts are caused by patient movement such as seizures, tremulousness, or hiccups. Others may be introduced by the monitor itself or be caused by electrical equipment in the vicinity. A group of ECG tracings is presented to illustrate the various artifacts encountered. Features that distinguish the artifacts from the arrhythmias they mimic are described, as are suggestions for elimination of the artifacts.

Arrhythmias, Cardiac↗
PubMed1976

Microvascular procedures in reconstructive surgery.

The application of microvascular technics to problems in reconstructive surgery has enabled the surgeon to revascularize ischemic digits, replant amputated digits, and to transfer directly composite tissue from one area of the body to another for reconstructive purposes. The success of these procedures is directly dependent upon the ability to perform and maintain patent microvascular anastomoses. Representative cases are reported including the revascularization of an incompletely amputated digit, the replantation of an amputated thumb, the direct transfer of a toe to replace a missing thumb, and the transfer of a groin flap to cover a lower extremity defect. The principles of preoperative management, operative technics, and postoperative care are reviewed.

Adult↗
PubMed1975

The pathology of neonatal osteomyelitis.

The examination of multiple bones from a child who died of complications of septicemia and osteomyelitis elucidated the pathologic processes of infantile osteomyelitis. From a metaphyseal focus, there is spread in several directions. Most important, the infection can spread across the growth plate, along transphyseal vessels, to penetrate the epiphysis. Areas of direct destruction of growth plate were frequent findings, and allowed another route into the epiphysis.

Abscess↗
PubMedDate not supplied

Autonomic dysfunction, peripheral neuropathy, and depression.

A 15-year-old boy with diarrhea, dizziness, dysesthesias, and depression is described. On admission, his blood pressure was 110/84 reclining but less than 40 systolic while standing. Vibratory sensation and nerve conduction velocities were decreased in his lower extremities. CSF protein concentration was normal but sural nerve biopsy demonstrated generalized demyelination. Extensive toxicologic and metabolic screening proved unremarkable. Norepinephrine concentrations in plasma and urine, and CSF concentration of 3-methoxy-4-hydroxy phenylglycol (MHPG) were markedly reduced. The patient demonstrates a combination of autonomic dysfunction, peripheral neuropathy, and affective disorder. This collection of clinical and neurochemical findings represents a previously unreported entity involving a defect of both central and peripheral noradrenergic systems.

Adolescent↗
PubMedDate not supplied

Management of the pediatric patient after cardiac surgery.

The medical management of the child with congenital cardiac disease prior to and following cardiac surgery has made a substantial contribution to the improved morbidity and mortality attributed to surgical advances. This paper provides a framework for understanding the problems that arise in the perioperative period and a systematic approach, by organ system, to monitoring and management of these problems. The discussion is intended to be of general application, focusing on initial stabilization following surgery and the cardiorespiratory, renal, metabolic, hematologic, and neurologic alterations that result from surgery with cardiopulmonary bypass. An approach for the management of the low output state is also provided. Little attempt has been made to focus on problems unique to a specific type of cardiac disease or certain operative approaches. Rather, it is the contention that an understanding of general principles and an appreciation of the common problems will provide adequate preparation for those responsible for the care of the child.

Blood Circulation↗