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Biomedical subjects

J E Stevens

Publications and source records attributed to J E Stevens.

At least 37 records · Page 2Linked to original sources
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↗
PubMed1984

The biphasic pattern of the convulsive property of enflurane in cats.

The nature of the epileptoid state produced by enflurane was examined in the concentration range 2-5% in cats. A biphasic pattern in the convulsant property was revealed. The ease of induction of seizure by repetitive peripheral stimulation, the duration of seizures, and the activation of reticular neuronal firing during seizure activity showed peak values between 3 and 4%, whereas the values were significantly lower both above and below this range. The amplitudes of the somato-sensory evoked potential also showed a biphasic pattern which correlated well with the severity of the epileptoid state as judged by the aforementioned indices. These findings, when compared with evidence on the actions of other convulsant drugs, and with the known depressant actions of enflurane, suggest a combination of depressant and convulsant properties, the balance of which varies depending on the depth of anaesthesia.

Animals↗
PubMed1984

A hypermobility study in ballet dancers.

Hypermobility, using Beighton's mobility score, was present in 9.5% of 377 ballet dancers. Females were more mobile than males. A direct relationship was found between forward flexion and both the duration of dance training and age. This suggests that forward flexion is acquired, and unlike generalized hypermobility, which was found among family members of the hypermobile group. None of the hypermobile dancers studied had evidence of mitral valve prolapse but injuries were significantly more common compared to controls (p less than 0.05). We regard hypermobility as a liability to the ballet dancer.

Adolescent↗
PubMed1983

Effects of nitrous oxide on the epileptogenic property of enflurane in cats.

A method was developed to standardize the induction of seizure activity during enflurane anaesthesia in cats. The effects of nitrous oxide on the epileptogenic property of enflurane were investigated. A potent anticonvulsant action of nitrous oxide was noted, but partial tolerance to this effect rapidly developed. Some evidence of withdrawal hyperexcitability was also detected. The changes induced by nitrous oxide, despite existing enflurane anaesthesia, suggest that these two anaesthetic agents have different sites or mechanisms of actions.

Anesthesia, Inhalation↗
PubMed1981

Calcification of glutaraldehyde-preserved porcine xenografts in young patients.

In a series of 568 patients with glutaraldehyde-preserved porcine xenografts followed for up to 3 1/2 years, calcification and stenosis of the xenograft has proved to be an important cause of valve failure. We have seen this complication only in children and adolescents. Seven of 54 patients under 16 years of age at the time of initial operation have required reoperation for calcification and prosthetic stenosis. Three patients who died had calcified, stenosed prosthesis at autopsy. The calcification has involved all of the cusps of the affected prostheses, and the calcified area often was enclosed by a superficial layer of noncalcified cuspidal tissue. We no longer insert xenograft valves in young patients.

Adolescent↗
PubMed1980

The clinical assessment and management of patients with prosthetic cardiac valves: A review of current practice at the Cardiac Clinic, Groote Schuur Hospital.

This review deals with the clinical assessment and management of patients with prosthetic cardiac valves. The types of prosthesis available are considered, with special reference to those which have been used frequently at Groot Schuur Hospital. The common complications encountered are described, as well as the clinical features of normally and abnormally functioning prostheses. The management of anticoagulant medication, pregnancy, infective endocarditis, systemic embolism and haemolysis in these patients is discussed. Particular emphasis is placed on the urgent referral to a cardiac department of patients with posthetic malfunction or conditions in which there is a potential for the development of malfunction.

Animals↗