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Biomedical subjects

J E Stevens

Publications and source records attributed to J E Stevens.

At least 19 recordsLinked to original sources
PubMed1996

Norplant implants in the UK: first year continuation and removals.

Norplant implants are a long-term, reversible hormonal method of contraception consisting of six flexible capsules placed subdermally in the inner aspect of the non-dominant arm. Norplant implants were introduced into the UK in October 1993 although they had been used previously in some countries for up to ten years. The insertion and removal techniques require skills training and therefore it is important to assess early experience with the method. This survey looks at the first year continuation rate of Norplant implants in the UK from a total of 2,129 insertions. From these insertions, 133 removals were documented and described, using a checklist of features. The continuation rate for Norplant implants use was 96.5% at six months and 85.2% at one year. None of the reasons for discontinuation were of a serious nature. The most common reason given was menstrual change (50.4% of all removals, 3% of all women included in the survey), which is in line with other reported studies. Of the removals, 71.5% were reported as straightforward (of these 65.6% were completed within 20 minutes). In the first year of use, Norplant implants were associated with high continuation rates and the removal procedure was, in the majority of cases, completely straightforward.

Capsules↗
PubMed1996

Home hemodialysis--yes, it can be learned.

Sacred Heart Kidney Center has maintained a strong home hemodialysis program in Spokane for the past 34 years. Patients who choose this option consistently lead more independent lives, taking more responsibility for their own care. They have the positive attitude that dialysis is a small part of their lives rather than the core of a life dominated by a schedule at a dialysis center. Sacred Heart's home hemodialysis program fosters independence and self-motivation using a stepwise training process for the patient and partner. A skilled training nurse directs the training at the dialysis center. The nurse's work is enhanced by the entire dialysis team, including the nephrologist, social worker, dietitian, and equipment technician. The patient and partner pass through a series of integrated learning blocks, mastering each at their own pace. This method is an effective and efficient way of leading the patient and partner to competence and independence. Training and follow-up provide the framework for supporting day-to-day dialysis in the patient's home and allow for continued multidisciplinary interventions.

Hemodialysis, Home↗
PubMed1996

Pulmonary embolism following embolization of an arteriovenous malformation.

The case of a 12-year-old girl who suffered a severe intracranial bleed secondary to a large arteriovenous malformation (AVM) is described. Following investigation the appropriate treatment was considered to be embolization of the AVM, under general anaesthesia, using N-butyl cyanoacrylate (NBCA). During the procedure acute desaturation and pulmonary oedema occurred secondary to accidental pulmonary embolization with NBCA. The management of the procedure and subsequent clinical course is reported and available literature reviewed.

Anesthesia, General↗
PubMed1995

Lupus pancreatitis.

Among the many systemic manifestations of lupus is pancreatitis. It may be a part of the multiorgan lupus involvement or it may result as a complication of steroid therapy used in its management. A case of lupus pancreatitis following renal transplantation is presented. The difficulty in differentiating the diagnosis of lupus pancreatitis is illustrated. Emphasis is placed on rapid diagnosis to help decrease the high mortality associated with this disease process.

Adult↗
PubMed1993

Nitric oxide treatment for fulminant pulmonary hypertension.

A 3 year old child with known pulmonary haemosiderosis suffered acute circulatory collapse secondary to raised pulmonary vascular resistance. Nitric oxide inhalation produced a profound improvement in circulatory parameters and gaseous exchange. Nitric oxide may have a therapeutic role in acute pulmonary hypertensive crisis.

Administration, Inhalation↗
PubMed1992

Metabolic acidosis and fatal myocardial failure after propofol infusion in children: five case reports.

OBJECTIVE: To examine the possible contribution of sedation with propofol in the deaths of children who were intubated and required intensive care. DESIGN: Case note review. SETTING: Three intensive care units. SUBJECTS: Five children with upper respiratory tract infections aged between 4 weeks and 6 years. RESULTS: Four patients had laryngotracheo-bronchitis and one had bronchiolitis. All were sedated with propofol. The clinical course in all five cases was remarkably similar: an increasing metabolic acidosis was associated with brady-arrhythmia and progressive myocardial failure, which did not respond to resuscitative measures. All children developed lipaemic serum after starting propofol. These features are not usually associated with respiratory tract infections. No evidence was found of viral myocarditis, which was considered as a possible cause of death. CONCLUSION: Although the exact cause of death in these children could not be defined, propofol may have been a contributing factor.

Acidosis↗
PubMed1990

Fixing CVP catheters.

Explore the source record for details and available documents.

Catheterization, Central Venous↗
PubMed1989

Cardiovascular response during cerebral angiography under general and local anaesthesia.

Nineteen patients with subarachnoid haemorrhage who had cerebral angiography with the new contrast medium iohexol, were randomly allocated to receive either local anaesthesia plus sedation, or general anaesthesia. Arterial blood pressure, PaO2, PaCO2 and patient acceptability were examined. Significant fluctuations in arterial blood pressure occurred in the patients who received general anaesthesia. Local anaesthesia was associated with a stable blood blood pressure, adequate spontaneous ventilation and good patient acceptability. The quality of films obtained was examined and found to be of good or very good diagnostic quality in all cases in both groups of patients. Greater use of local anaesthesia with sedation for angiography is recommended.

Adolescent↗
PubMed1987

The heart in rheumatoid arthritis--a clinical and echocardiographic study.

A clinical and echocardiographic study was carried out in a randomly selected group of 101 patients with rheumatoid arthritis to determine the prevalence of cardiac abnormalities. Adequate two-dimensional assessments were obtained in 84 patients and 77 patients had adequate M mode recordings. Thirty-one patients (37 per cent) had 45 echocardiographic abnormalities. Five patients (6 per cent) had a pericardial effusion. Eleven abnormalities of the mitral valve were noted in 10 patients (13 per cent). Three patients had mitral valve prolapse, one patient with aortic incompetence had flutter on the mitral valve, five patients had mitral annular calcium and one patient had hypertrophic obstructive cardiomyopathy and mitral annular calcification. A reduction in the E-F slope was noted in 12 patients, seven of whom had associated cardiac disease, one patient had a sinus tachycardia and four patients (5 per cent) had a mild reduction without any other cardiac abnormality. Apart from the presence of pericardial effusion in 6 per cent and minor abnormalities of the E-F slope in 5 per cent of patients, all the other significant echocardiographic abnormalities could be related to the presence of associated cardiac disease.

Arthritis, Rheumatoid↗
PubMed1984

Constrictive pericarditis following myocardial revascularization. A case report.

The occurrence of constrictive pericarditis after coronary bypass surgery is rare and clinical manifestations may appear at variable intervals after surgery. Three possible causes have been postulated, all of which were probably involved in the case which we describe. The clinical diagnosis of postoperative constriction is difficult and not often considered. It is best confirmed by means of cardiac catheterization, which shows typical haemodynamic features. Surgical treatment is both difficult and a threat to the coronary bypass grafts, when present. Conservative management with diuretics is preferred unless constriction is severe.

Cardiac Catheterization↗