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H S Moseley

Publications and source records attributed to H S Moseley.

At least 19 recordsLinked to original sources
PubMed1997

Anaesthesia in Barbados.

PURPOSE: To describe the anaesthesia services in Barbados: to present the major challenges confronting the Anaesthesia Department of the government-owned Queen Elizabeth Hospital (QEH): and to describe the Department's approaches to optimise safety and cost-effectiveness of anaesthesia at QEH. SOURCE OF INFORMATION: Authors (KBS, HSLM, RAH), who collectively provided more than 50 yr of anaesthesia at QEH; the Dean (ERW) of the University of West Indies Medical School (Barbados campus); archives of Barbados; and records of QEH. PRINCIPAL FINDINGS: The government of Barbados provides modern health care services to all of its citizens, primarily at QEH. Barbados, however, has tight financial constraints, infrastructural limitations, and a bureaucratic administration that predispose QEH's Anaesthesia Department to unexpected depletions of drugs and disposable supplies, sporadic shortages of personnel and functioning equipment, and occasional quality assurance problems. To deal with such problems, the Anaesthesia Department has implemented several pro-active measures: establishing an audit system to prevent depletion of imported drugs and supplies: training local personnel to maintain equipment: purchasing an oxygen concentrator to reduce oxygen costs: decreasing nitrous oxide use (expensive in Barbados): and initiating its own quality and safety standards. CONCLUSION: Continuous delivery of high quality, cost-effective anaesthesia care requires thoughtful planning by administrators and judicious resource allocations. Health care administrators and clinical departments need to work together closely to establish a framework that enables departments to play a major role in determining how the institution's limited financial resources are best allocated to meet the departmental priorities.

Anesthesia↗
PubMed1996

The role of stereotactic biopsy in assessment of nonpalpable breast lesions.

BACKGROUND: When mammography identifies a lesion suspicious for cancer, stereotactic needle core biopsy (SCNB) and needle localization (NL) surgical biopsy are options for obtaining tissue. This study compared the results of these two biopsy methods in evaluating nonpalpable radiologically suspicious breast lesions. METHODS: Records of 292 women who underwent SCNB or surgical biopsy at two institutions were reviewed over 28 months. The women were separated into two groups, under 50 years of age and 50 years of age and older. RESULTS: A total of 70 women over the age of 50 had stereotactic biopsy. One hundred and three had NL biopsies. The rate of positivity was 37% and 33% for stereotactic and NL biopsy respectively (P = 0.693). A total of 44 women under the age of 50 had stereotactic biopsy. Seventy had NL biopsies. The rate of positivity was 7% and 21%, respectively, for stereotactic and NL (P = 0.082). NL surgical biopsy costs on average $2354.00. SCNB averages $949 including follow-up mammogram. CONCLUSION: SCNB is a cost-effective, accurate method of breast biopsy. This report retrospectively compares SCNB with surgical open biopsy aided by NL. The cost savings occurred primarily in surgeon's fees and anesthesia fees. We found no statistical difference in < 50- or > 50-year-old patients in the frequency of the diagnosis of breast cancer when comparing the two types of biopsies.

Biopsy, Needle↗
PubMed1995

Terminology and the current limitations of time capnography: a brief review.

The carbon dioxide (CO2) trace versus time (time capnography) is convenient and adequate for clinical use. This is the method most commonly utilized in capnography. However, the current terminology in time capnography has not yet been standardized and is, therefore, a potential source of confusion. Standard terminology that is based on convention and logic to represent the various phases of a time capnogram is essential. The time capnogram should be considered as two segments: an inspiratory segment and an expiratory segment. The inspiratory segment is termed as phase ); the expiratory segment is divided into phases I, II, III, and, occasionally, IV. Phase I represents the CO2-free gas from the airways (anatomical dead space); phase II consists of a rapid S-shaped upswing on the tracing due to mixing of dead space gas with alveolar gas; and phase III, the alveolar plateau, represents CO2-rich gas from the alveoli. The physiologic basis of phase IV, the terminal upswing at the end of phase III, which is observed in capnograms recorded under certain circumstances (such as in pregnant subjects and obese subjects) is discussed in detail. The clinical implications of the alpha angle, which is the angle between phases II and III, and the beta angle, which is the angle between phases III and the descending limb of phase 0, are outlined. The subtle but important limitations of time capnography are reviewed; its current status as well as its future potential are explored.

Carbon Dioxide↗
PubMed1995

Anaesthetic management of a child with Bartter's syndrome.

We report the anaesthetic management of an eight-year-old asthmatic boy with Bartter's syndrome who had bilateral orchidopexy with caudal epidural analgesia. Bartter's syndrome is a rare congenital disorder characterized by hypokalaemic hypochloraemic metabolic alkalosis, hyperaldosteronism, hyperreninaemia and hyperplasia of the juxtaglomerular apparatus of the kidneys. Characteristically, although these patients are normotensive they may be hypovolaemic. They may have unstable baroreceptor responses and show marked resistance to vasopressors. Hence, fluid, acid-base and electrolyte imbalances along with haemodynamic instability pose particular problems in their anaesthetic management. Previous case reports have described the management of these patients with general anaesthesia, our patient had his orchidopexy with caudal epidural analgesia using plain bupivacaine 0.5%. The patient was haemodynamically stable throughout surgery and was comfortable with caudal analgesia as the sole anaesthetic. Hypovalaemia, acid-base status and electrolyte imbalance were treated before instituting caudal epidural analgesia. We present this case report which describes the anaesthetic considerations in the light of the pathophysiology of Bartter's syndrome.

Anesthesia↗
PubMed1994

Leiomyoma of the seminal vesicle.

Leiomyoma of the seminal vesicle is exceedingly rare, with only a few cases reported in the literature. To our knowledge we present the first case of primary leiomyoma of the seminal vesicle to be evaluated by magnetic resonance imaging using a rectal coil.

Aged↗
PubMed1992

An evaluation of two methods of limb salvage in extremity soft-tissue sarcomas.

Between 1983 and 1990, 38 sequential patients with stage II to III soft-tissue sarcoma of the extremities, as defined by the American Joint Committee on Cancer, were treated. Eighteen patients were treated with intra-arterial doxorubicin hydrochloride, limb salvage surgery, and radiation (group A). Twenty patients in group B were treated with cisplatin, isolated limb perfusion, limb salvage surgery, and radiation. The study was not randomized, but all patients were treated prospectively using one of the two protocols. The two groups were similar demographically and had similar lengths of survival without disease. There was only one local recurrence in the series, and this occurred in a group B patient who underwent perfusion with the lowest dose of cisplatin. Regional perfusion with either intra-arterial doxorubicin hydrochloride or cisplatin combined with limb salvage surgery and postoperative radiation are highly effective in preventing local recurrences and preserving functional extremities in patients with soft-tissue sarcoma. There was no difference in results between these two methods.

Adolescent↗
PubMed1992

Inspiratory valve malfunction in a circle system: pitfalls in capnography.

Capnography is a useful technique in monitoring the integrity of anaesthetic equipment such as the malfunctioning of unidirectional valves in circle system. However, the lack of a precise mechanism in existing capnographs to identify the start of inspiration and the beginning of expiration in the capnograms, makes the analysis of the carbon dioxide waveforms during inspiration difficult and thus results in inaccurate assessment of rebreathing. We report a case where, during the malfunction of the inspiratory unidirectional valve in the circle system, the capnograph failed to detect the presence of substantial rebreathing. Critical analysis of the capnogram recorded during the malfunction revealed that there was substantial rebreathing which was underestimated by the capnograph as it reports only the lowest CO2 concentration rebreathed during inspiration in such abnormal situations.

Anesthesia, Closed-Circuit↗
PubMed1991

MR imaging in fibromatosis: results in 26 patients with pathologic correlation.

Fibromatoses are a diverse group of soft-tissue lesions that have been inconsistently categorized and treated. The purpose of our study was to establish the range of appearances of fibromatoses on MR images and perform a pathologic correlation to explain the variable signal-intensity patterns. During a 3-year period, 26 patients with deep fibromatoses were examined with MR. The MR images were evaluated for signal-intensity characteristics, and findings were correlated retrospectively with the pathologic diagnoses. The results showed that the MR appearance of fibromatoses is similar to that of other soft-tissue lesions, and the signal intensities vary greatly from lesion to lesion and within lesions themselves. The fibromatoses were either hyperintense, isointense, hypointense, or of mixed signal intensity relative to adjacent skeletal muscle. The hypointense areas appear to be zones of hypocellularity and dense collagen deposition. Microscopically all of the lesions invaded adjacent structures, but the MR appearances of the margins varied and were judged to be well demarcated (n = 14), intermediate (n = 5), or poorly demarcated (n = 6). Our experience shows that fibromatoses have a variable MR appearance no different from that of other soft-tissue lesions, and this variability reflects the composition and cellularity of the lesions.

Adult↗
PubMed1990

Malignant melanoma metastatic to the thyroid as initial evidence of disseminated disease.

A 48-year-old Caucasian male with a 3 mm sub-ungual right middle finger melanoma underwent cisplatin forequarter perfusion, ray amputation, and ipsilateral axillary node dissection. Two months post-operatively he presented with a thyroid mass as initial evidence of disseminated disease. Subsequent workup also demonstrated pulmonary metastases. A total thyroidectomy radical neck dissection and multi-agent chemotherapy has controlled the disease in his neck. As far as we are aware, this is the first case report of malignant melanoma metastatic to the thyroid. The potentially beneficial role of surgery in the management of metastatic melanoma and the relation of melanoma to the hormonal axis is discussed.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1990

Problems in diagnosis and management of desmoid tumors.

Thirty-two primary desmoid tumors occurred in 29 patients. The median patient age was 32 years, and 55% of the patients were females. An antecedent history of trauma at the tumor site was elicited from 28% of patients. Thirty-one of 32 primary tumors were completely excised at initial presentation. Five tumors were treated with adjuvant radiotherapy. The overall recurrence rate for primary and recurrent lesions was 60%. The recurrence rate in children (88%) was more than twice that found in adults (38%). A single recurrence did not significantly increase the likelihood of a subsequent recurrence. Greater than 90% of all recurrences took place within 3 years of treatment. The rate of recurrence was not clearly influenced by the status of histologic margins, although this was examined in less than half the tumors. Desmoid tumors are aggressive neoplasms that exhibit a strong propensity for local recurrence. They should be treated as low-grade malignancies with documentation of histologic margins and close clinical follow-up within the framework of a tumor registry.

Abdominal Muscles↗
PubMed1989

Brunner's gland hyperplasia.

Brunner's gland adenomas are uncommon benign duodenal tumors. They are an infrequent cause of upper gastrointestinal hemorrhage and duodenal obstruction but can occasionally mimic duodenal malignancy in their presentation. Conservative endoscopic or surgical resection followed by a regimen of antacids and H2 antagonists is the treatment of choice.

Adenoma↗
PubMed1988

Pharmacokinetics, toxicity, and short-term results of cisplatin hyperthermic isolated limb perfusion for soft-tissue sarcoma and melanoma of the extremities.

Fifty-nine patients with melanoma or soft tissue sarcoma of the extremities underwent hyperthermic isolated limb perfusion utilizing cisplatin and wide local excision. Doses of cisplatin ranged from 0.75 to 2 mg/kg. The mortality and morbidity rates were 0 and 6.8 percent, respectively. Pharmacokinetic studies indicate that cisplatin is rapidly bound to perfused tissues and remains bound for 1 month. Maximum tumor response in sarcomas occurs 1 to 2 weeks after perfusion, compared with 1 month after perfusions with l-phenylalanine mustard and actinomycin D. Local and regional recurrence rates were 0 and 3.4 percent, respectively, at 1 year. Further studies of hyperthermic limb perfusions with cisplatin are warranted.

Adult↗