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Biomedical subjects

H S Holley

Publications and source records attributed to H S Holley.

18 recordsLinked to original sources
PubMed1997

Successful early intervention in air embolism during hysteroscopy.

Hysteroscopy is used as a diagnostic tool for intrauterine pathology. Gas embolism with air or carbon dioxide is a rare but sometimes fatal complication of laparoscopy or hysteroscopy. We present a patient who developed pulmonary air embolism during hysteroscopy that caused a noncardiogenic pulmonary edema in the recovery room. This case report emphasizes that early intervention can prevent life-threatening events associated with pulmonary embolism during hysteroscopy. Pathophysiology of pulmonary gas embolism, as well as that of noncardiogenic pulmonary edema, is discussed. A protocol for the prevention, early detection, and management of this emergency is provided.

Adult↗
PubMed1993

Laparoscopically assisted vaginal hysterectomy in a university hospital: report of 82 cases and comparison with abdominal and vaginal hysterectomy.

OBJECTIVE: The objective of this study was to critically review the indications, outcomes, complications, and costs of laparoscopically assisted vaginal hysterectomy in comparison with abdominal and vaginal hysterectomy. STUDY DESIGN: The operating room log was reviewed to determine the number and route of hysterectomies performed over a 1-year period. The charts of 50 consecutive laparoscopically assisted vaginal hysterectomies and 50 vaginal hysterectomies were reviewed. Charts from 50 selected abdominal hysterectomies were also reviewed. Information on patient characteristics, indications, complications, uterine weights, hospital stay, and patient costs were obtained and analyzed. RESULTS: Of 509 hysterectomies, 82 were performed as laparoscopically assisted vaginal hysterectomies and 73 as vaginal hysterectomies. The patient characteristics and indications of the laparoscopically assisted group more closely matched those of the abdominal hysterectomy group. The complication rate in the laparoscopically assisted group was intermediate between the other two groups, but the hospital stay was significantly less. Patient cost for laparoscopically assisted vaginal hysterectomy was significantly greater than either abdominal or vaginal hysterectomy, in spite of the shortened hospital stay. CONCLUSIONS: Laparoscopically assisted vaginal hysterectomy offers a technique to convert some abdominal hysterectomies into vaginal hysterectomies. It appears particularly useful when an adnexal indication for surgery exists. Uterine leiomyoma does not appear to be an indication for laparoscopically assisted vaginal hysterectomy. The costs are significant because of increased operating time and costs of disposable equipment.

Abdomen↗
PubMed1991

Failure to awaken after general anaesthesia secondary to paradoxical venous embolus.

A patient is presented who failed to regain consciousness after an apparently uneventful nine-hour revision of a total hip replacement. There were no clinically important haemodynamic changes during the operation, and oxygen saturation, capnography and acid base balance were normal throughout. Postop CT of the head showed a large left MCA infarct with midline shift. At autopsy, the patient was found to have a previously unsuspected patent foramen ovale, and a venous embolus in the left internal carotid artery, which probably had originated from the periprostatic venous plexus with a large infarct in the distribution of the left anterior and middle cerebral arteries. The authors conclude that massive paradoxical venous emboli can occur during surgery with minimal haemodynamic changes.

Anesthesia, General↗
PubMed1989

Effects of halothane on the conduction system of the heart in humans.

The effects of 2.0 MAC halothane on atrioventricular conduction times in humans were studied. A real-time recording system for the detection of surface His-Purkinje potentials based on signal averaging techniques was used. Recordings were made in 23 patients before and after the administration of halothane. In 18 patients we were able to measure atrial (P-H) and His-Purkinje (H-V) conduction times (78%). A small but statistically significant decrease in P-H conduction times from 115.3 +/- 3.9 (SEM) to 110.8 +/- 4.2 ms was found (P less than or equal to 0.01). H-V conduction times did not change significantly. Heart rates decreased significantly from 87.6 +/- 2.6 to 74.8 +/- 2.5 beats/min (P less than or equal to 0.01). Systolic blood pressures decreased from 118.9 +/- 3.7 to 103.6 +/- 4.2 mm Hg. It is concluded that the decrease in heart rate and the decrease in atrial conduction time caused by halothane can be explained by interactions of several different mechanisms. The specific combination of slowing heart rate and a decrease of atrial conduction time provides a possible explanation for atrial arrhythmias during the administration of halothane.

Adolescent↗
PubMed1988

Computerized Anesthesia Personnel System.

CAPS, (Computerized Anesthesia Personnel System), is a personnel management system for a large anesthesia department. It is written in BASIC for the IBM PC or IBM-compatible computer using 2 or more 5 1/4 inch disk drives or a hard disk. CAPS is designed to facilitate assignment of up to 30 attending anesthesiologists, 40 residents, 15 CRNAs, 5 interns, 5 anesthesia assistants, and up to 15 medical students to the operating room schedule. The system supports part-time personnel, regular laboratory/office/reading days, and resident rotations inside the operating suite, outside the operating suite, and to secondary hospitals. CAPS generates an availability list each day, listing all persons available for the operating room and the rotations and call days assigned. It then lists all persons not available that day and the reason for the absence. CAPS also tracts vacation, meeting, administrative and compensatory time for all members of the department, and maintains an absence record for each person listing sick times and all other absences. CAPS generates a weekly staffing list showing days each person is available to the operating room and the total number of attendings, residents, CRNAs, and assistants available each day. This article discusses why the program was developed, how it was designed, and how well it has met the objectives of the designers.

Anesthesia Department, Hospital↗
PubMed1985

Anaesthesia equipment malfunction.

Anaesthetic equipment was studied to determine whether the accuracy was improved and failure rate decreased by routine maintenance and calibration by a biomedical technician. Each piece was evaluated, and then repaired and rechecked at intervals by the same technician. Equipment failures were divided into three types: first, equipment that was completely nonfunctional; second, equipment that was functional but inaccurate; and third, equipment that was functional and accurate but needed minor repairs. The percentage of equipment failures in each group was compared on initial evaluation and after 6 months. Of the 311 pieces of equipment, 40% needed repair at the time of the initial survey; 80% was nonfunctional, and 18% was functional but inaccurate. After six months on a maintenance schedule, only 15% of the equipment needed repair, 3% was nonfunctional, and 6% was functional but inaccurate. The difference between the total percentage of equipment failure initially and after six months was statistically significant. After a regular maintenance, calibration, and checkout schedule by a biomedical technician was instituted, there was a significant improvement in the accuracy of the equipment and a reduction in the percentage of equipment needing repair.

Anesthesiology↗
PubMed1984

Microcomputers for computer-assisted instruction in anesthesia.

This article discusses the suitability of microcomputers and microcomputer languages for computer-assisted instruction. The advantages and disadvantages of using computers in general and microcomputers in particular for CAI are presented. Programming techniques for different types of CAI programs are discussed. Finally, we have summarized several articles on CAI in anesthesia and have concluded that CAI programs are an effective method of presenting certain types of instruction in the specialty.

Anesthesiology↗
PubMed1967

Regional distribution of pulmonary ventilation and perfusion in obesity.

Five women and three men, all obese and weighing 95 to 140 kg, were studied by routine pulmonary function tests and by a radioactive xenon technique, while seated upright at rest, to measure the regional ventilation and perfusion distribution in the lung. In four subjects in whom the expiratory reserve volume averaged 49% of predicted normal, the ventilation distribution as measured with (133)xenon was normal. In the remaining four subjects, in whom the expiratory reserve volume was reduced to less than 0.4 L and averaged only 21% of predicted values, the distribution of a normal tidal breath was predominantly to the upper zones. In all subjects the perfusion distribution was predominantly to the lower lung zones but was slightly more uniform than in normal nonobese subjects. During tidal-volume breathing, therefore, in four subjects the ventilation and perfusion distribution was substantially normal, whereas in the remaining four perfusion was maximal in the lower zones, to which ventilation was significantly reduced. These findings show that there may be significant ventilation/perfusion abnormality on a regional basis in obese subjects, this abnormality bearing a close relationship to the reduction in expiratory reserve volume, a finding predictable from recently published data on normal nonobese subjects (1). The abnormalities of ventilation/perfusion relationships that were demonstrated in four of the eight obese subjects could cause a reduction in arterial oxygen tension during resting tidal ventilation.

Adult↗