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Biomedical subjects

I M Ledingham

Publications and source records attributed to I M Ledingham.

At least 91 records · Page 5Linked to original sources
PubMed1978

Shock.

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Blood Vessels↗
PubMed1977

The pulmonary manifestations of septic shock.

Septic shock carries a high mortality. It is manifest haematologically by thromobocytopaenia and other coagulation disturbances. The radiological manifestations are various degrees of pulmonary oedema, usually affecting the lower zones, without evidence of pulmonary hypertension. Radiological signs are always preceded on accompanied by thrombocytopaenia.

Adult↗
PubMed1977

Necrotizing fasciitis.

The author's experience of fourteen patients with necrotizing fasciitis is reviewed. The pathognomonic feature of this condition is an extensive necrosis of subcutaneous tissue caused by a vicious cycle of infection, local ischaemia and reduced host defence mechanisms. The diagnosis can only be confirmed by immediate exploratory incision. The reported mortality of 30-40% reflects the inadaquacy of conservative surgery in the treatment of this serious condition. Mortality can be reduced by early recognition followed by radical excision of the necrotic fascia and overlying skin. The preservation and subsequent use of the excised skin has the advantage of economy in the use of donor areas and reduction in morbidity. Hyperbaric oxygen therapy does not halt the spread of the necrotizing process and is not a substitute for radical surgery.

Bacterial Infections↗
PubMed1977

Effect of angiotensin-converting enzyme inhibitor (SQ 20881) on the plasma concentration of angiotensin I, angiotensin II, and arginine vasopressin in the dog during hemorrhagic shock.

The effect of an angiotensin-converting enzyme inhibitor on the circulating levels of angiotensin I, angiotensin II, and arginine vasopressin was studied in dogs subjected to hypotensive hemorrhagic shock. In dogs subjected to hemorrhage but not given the inhibitor, angiotensin II rose 20-fold (from 69 to 1,343 pg/ml of plasma), whereas in dogs subjected to hemorrhage but pretreated with the inhibitor, angiotensin II rose only 2-fold (from 92 to 171 pg/ml of plasma). In the pretreated dogs angiotensin I rose 30-fold (from 108 to 3,232 pg/ml of plasma). There was no statistically significant difference between the vasopressin levels found in the untreated dogs and the levels found in dogs given the inhibitor (1,016 and 1,095 pg/ml of plasma). Of the 15 dogs in the untreated group, five died before retransfusion was completed (four of cardiac failure and one of cardiac arrhythmia); none of the 10 dogs in the inhibitor-treated group died. These observations suggest that the very high levels of angiotensin II observed following severe hemorrhage do not contribute significantly to the increased secretion of vasopressin and that the inhibitor protects against death, possibly by suppressing the very high blood levels of angiotensin II observed following this type of experimental hemorrhagic shock.

Angiotensin II↗
PubMed1976

Heart failure in experimental refractory shock.

Severe haemorrhagic shock was studied in a series of animal experiments. Reduction in myocardial oxygen and substrate utilisation in association with cardiac failure was demonstrated when the duration of shock was prolonged. The probable aetiological factors included ischaemia and the presence in the blood of certain vasoactive and metabolic depressant substances. It was concluded that the process leading to irreversible shock was multi-factorial in origin but failure appeared to play an important role.

Angiotensin II↗
PubMed1975

Effects of ambulance transport in critically ill patients.

Two groups of critically ill patients were transferred by ambulance from other hospitals to a central intensive therapy unit. The effect of transport was reviewed retrospectively in 46 patients and prospectively in 20 patients. Of the 46 patients reviewed retrospectively six became hypotensive, six became hypertensive, and seven developed delayed hypotension. One patient developed fits and six out of 13 patients had a rise in arterial PCO-2 of 1-6-4-1 kPa (12-31 mm Hg). Of the 20 patients reviewed prospectively, one patient became hypertensive due to overtransfusion, one had a fit, but none became hypotensive. Three out of four cases of delayed hypotension were related to starting intermittent positive pressure ventilation. Arterial PCO-2 fell in one patient and arterial PCO-2 rose in two, each change being related to changed oxygen therapy or narcotics. There were no changes in other cardiovascular or respiratory indices, body temperature, or urine production. Earlier transfer, resuscitation before transfer, continuing medical care during the journey, and hence a slower smoother journey seemed to be important factors in the management of these patients. Our findings, may have important implications in the future regional organization of the care of critically ill patients.

Adult↗
PubMed1975

Diagnosis, clinical course and treatment of acute dermal gangrene.

Twenty patients with acute dermal gangrene following surgery, trauma or sepsis are described. In 12 the skin became gangrenous secondary to a necrotizing process affecting the subdermal fascia, and in 8 the condition arose primarily in the skin. In the first group mortality was high unless radical excision of the necrotic fascia was performed at an early stage; in 3 of the recent patients the overlying skin was removed, defatted and stored for later grafting. In the second group, incision and adequate drainage combined with antibiotics seemed to suffice. Hyperbaric oxygen was of dubious value in the first group but appeared to contribute to arrest of the lesion in the second group.

Acute Disease↗
PubMed1975

Septic shock.

The problems associated with septic shock are highlighted, including those which arose during a 3-year prospective study. Mortality in the first year of the study was 71 per cent, falling to 38 per cent in the third year. The reasons for this fall are detailed. The pattern of survival times changed over the 3 years, giving rise to the longer term complications such as stress bleeding, multiple organ failure and superadded infection.

Acid-Base Equilibrium↗
PubMed1975

A comparison of methods for the measurement of cardiac output and blood oxygen content.

A comparison has been made between the recently introduced thermal dilution method for measurement of cardiac output and the standard dye dilution technique. Two relatively new methods of measurement of blood oxygen content, one involving the measurement of oxygen tension after release of oxygen by carbon monoxide, and the other the measurement of current flow upon reduction of oxygen in a galvanic cell, have been compared with a standard indirect method of measurement of blood oxygen content. All three new methods fulfilled the criteria of accuracy and simplicity and compared favourably with the standard methods. Of the two new methods for measurement of oxygen content, that involving reduction of oxygen in a galvanic cell was superior by virtue of compactness and speed of operation.

Animals↗