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Biomedical subjects

J Kinsella

Publications and source records attributed to J Kinsella.

At least 37 records · Page 2Linked to original sources
PubMed2001

Bipolar scissors versus cold dissection tonsillectomy: a prospective, randomized, multi-unit study.

OBJECTIVE: To evaluate bipolar scissors tonsillectomy by comparing it with traditional cold dissection tonsillectomy. STUDY DESIGN: A prospective, randomized, multi-unit study. SETTINGS: Belfast City Hospital, Royal Victoria Hospital Belfast, and Ulster Hospital Dundonald. PATIENTS: Two hundred consecutive patients undergoing tonsillectomy for recurrent or chronic tonsillitis between March 2000 and September 2000. OUTCOME MEASURES: (1) Intraoperative bleeding, (2) operative time, (3) postoperative pain, and (4) complication rates, including primary and secondary hemorrhage. RESULTS: Seventeen patients were excluded from the study for various reasons. The mean age of the study population was 22 years (range, 10-54 y). Seventy-two percent of patients were female. Twenty-seven percent of patients were children aged 16 years or under. Median intraoperative blood loss was 5 mL for bipolar scissors tonsillectomy and 115 mL for cold dissection tonsillectomy (P < .001). The mean operative time was 13 minutes for bipolar scissors tonsillectomy compared with 20 minutes for the cold dissection method (P < .001). There was no statistically significant difference in the pain scores between the two methods (independent samples t = 1.35; P > .05). The overall primary hemorrhage rate was 2.1%, whereas the overall secondary hemorrhage rate was 16.9%. The hospital readmission rate was 10.3%. The primary and secondary hemorrhage rates were unaffected by the surgical method. CONCLUSIONS: Bipolar scissors tonsillectomy is a safe technique with a similar morbidity to the cold dissection method. Its use is associated with a significant decrease in both surgical time and blood loss compared with the cold dissection method.

Adolescent↗
PubMed2000

Characterization of a histidine rich cluster of amino acids in the cytoplasmic domain of the Na+/H+ exchanger.

We examined the function of a highly conserved Histidine rich sequence of amino acids found in the carboxyl-terminal of the Na+/H+ exchanger (NHE1). A fusion protein containing the sequence HYGHHH (540545) and the balance of the carboxyl terminal of the protein did not bind calcium but bound to an immobilized metal affinity column and could be used to partially purify the exchanger protein. Mutation of the sequence to either HYGAAA or HYGRRR did not affect activity of the intact protein. Mutation to HHHHHH did not affect proton activation of the Na+/H+ exchanger or localization but caused a decreased maximal velocity suggesting that this conserved sequence is important in maximal activity of the Na+/H+ exchanger.

Amino Acid Sequence↗
PubMed2000

The use of a target-controlled infusion of alfentanil to provide analgesia for burn dressing changes A dose finding study.

Burn dressing changes require profound analgesia for a short duration. This study aimed to determine whether an operator-adjusted target-controlled infusion of alfentanil could provide effective analgesia for burn dressing changes. Ten patients with a burn of between 5 and 50% of body surface area were studied. Pain scoring was performed before, during and following the dressing change. Target and effect site concentrations of alfentanil were recorded during and for 15 min after the dressing change. Median baseline visual analogue pain score (VAS) was 22 mm. Median (range) duration of dressing change was 35 (20-75) min. Median (range) VAS during the dressing change was 30 (14-66) mm. All patients were satisfied with their pain relief. There was no respiratory depression or cardiovascular instability. No patient became sedated and there were no episodes of nausea or vomiting. Median (range) total dose of alfentanil was 2.6 (1-10.7) mg. This study supports the efficacy of an operator-adjusted target-controlled infusion of alfentanil to provide analgesia for burn dressing changes.

Adult↗
PubMed2000

An audit of patient perception compared with medical and nursing staff estimation of pain during burn dressing changes.

In order to prescribe appropriate analgesia for burns dressing changes the pain experienced by 30 burned patients during this procedure was recorded. Patients received analgesia prior to their dressing changes according to the current protocol in the burns unit. During the same period the medical and nursing staff in the unit who were involved in prescribing and administering the analgesia for the dressing change, were asked to assess the severity of pain that they thought patients experienced during dressing changes. Patients recorded their worst pain as none or mild in 64% of procedures. In contrast, no surgeon and only one nurse, rated pain as none or mild. The discrepancy between severity of pain recorded by patients and the pain predicted by staff prescribing and administering analgesia has clinical implications.

Acetaminophen↗
PubMed2000

Minoxidil inhibits proliferation and migration of cultured vascular smooth muscle cells and neointimal formation after balloon catheter injury.

The goal of the study was to investigate the in vitro and in vivo inhibition of minoxidil on smooth muscle cell (SMC) proliferation and migration as well as neointimal formation. The in vitro effect of minoxidil was investigated by Boyden chamber assay and cell-cycle analysis. To evaluate the in vivo effect, we treated the animals with minoxidil in their drinking water before and after balloon catheter injury to carotid artery. Results showed that minoxidil inhibited SMC migration across type I collagen membrane in a dose-related manner (13.5% by 0.01 mg/ml; p < 0.05; 16.8% by 0.05 mg/ml: p < 0.01; 40.4% by 0.25 mg/ml; p < 0.001; and 65.8% by 1.25 mg/ml; p < 0.001). Minoxidil (0.8 mg/ml) increased the number of SMCs in G1 phase (p < 0.05) and decreased the number of SMCs in S phase (p < 0.001). In vivo minoxidil treatment reduced neointimal mass by 31.7% (120 mg/L) and 42.3% (200 mg/L), respectively. Data demonstrate that minoxidil inhibits vascular SMC proliferation and migration both in vitro and in vivo, and therefore may be useful to inhibit SMC hyperplasia that occurs in restenosis and other vascular diseases.

Animals↗
PubMed1999

A simple in vitro method for the evaluation of an ultrasonic nebulizer for drug delivery to intubated, ventilated patients and the effect of nebulizer and ventilator settings on the uptake of fluid from the nebulizer chamber.

Little is known about the performance of ultrasonic nebulizers during different ventilation patterns when these nebulizers are used to deliver drugs to intubated, ventilated patients. A method that enables the performance of an ultrasonic nebulizer to be evaluated is described. We used an in vitro model to examine the performance of the DeVilbiss Ultra-Neb 2000 ultrasonic nebulizer under positive pressure ventilation. Performance was measured at different rates of nebulization and under changing conditions of positive end-expiratory pressure (PEEP), inspiratory flow rate, inspiratory time and minute volume. The volume of saline nebulized was unchanged by variations in positive end expiratory pressure from 0 to 5 cm to 10 cm H2O, in minute ventilation and in inspiratory flow rate. An increase in the inspiratory time resulted in an increase in the volume of saline nebulized and this volume was greater as the power setting of the nebulizer was increased. We conclude that ultrasonic nebulizers may be affected by different patterns of ventilation and that this simple in vitro assessment of nebulizer function in an intensive care setting may be of value prior to nebulizer use.

Aerosols↗
PubMed1999

In-flight medical emergencies: response of anaesthetists who were passengers on commercial flights.

All consultants and trainees in anaesthesia in a large teaching hospital were surveyed. Details of the number of flights per year and details of any medical emergencies in which they had been involved were recorded. The mean number of flights per year was 7.1 domestic and 3.4 international. Of the 45 anaesthetists surveyed, 14 had dealt with emergencies in flight, four had dealt with more than one. The minor emergencies (12) included transient ischaemic attacks, abdominal pain and otitis media. The seven serious events included seizures, angina, hypoglycaemic coma, respiratory arrest and two fatal cardiac arrests. No flights were diverted. On only two occasions were their medical qualifications checked. Requests for documentation were unusual. On several occasions the equipment which was available was inadequate. All doctors that responded were insured in the UK and most stated that they would assist Americans on American airlines. Medical emergencies were more likely on long haul flights.

Abdominal Pain↗
PubMed1999

Analgesic effect of adenosine on ischaemic pain in human volunteers.

This study was designed to measure ischaemic pain during and after infusion of adenosine. In a double-blind, placebo-controlled, crossover study, eight ASA 1 male volunteers received infusion of adenosine 100 micrograms kg-1 min-1 or placebo for 10 min. This was repeated 1 week later with the alternate infusion. Pain measurements were made during tourniquet-induced ischaemia in an exercising arm before infusion, during infusion and for 24 h afterwards. Pain was reduced significantly in the adenosine group compared with the saline group during infusion (median difference 20.8; 95% confidence interval 2.0-40). There was no significant difference in pain after infusion and there were no significant changes in cardiovascular variables. During infusion of adenosine, transient mild chest discomfort, shortness of breath and facial flushing occurred. We conclude that adenosine had measurable effects on ischaemic pain which were not sustained after discontinuation of infusion.

Adenosine↗
PubMed1998

Anti-B4-blocked ricin: a phase II trial of 7 day continuous infusion in patients with multiple myeloma.

This phase II trial was undertaken to determine the toxicities, response rate, pharmacokinetics and frequency of human anti-mouse antibody (HAMA) and anti-ricin antibody (HARA) when the B-cell restricted immunotoxin anti-B4-bR was administered to patients with previously treated multiple myeloma (MM). Five patients with MM were scheduled to receive a 7 d continuous infusion of anti-B4-bR. The initial four patients received therapy at 40 microg/kg lean body weight (LBW)/d. Two patients received a 7 d infusion, one patient received 6 d, and another patient 5 d of therapy. The fifth patient was treated for 7 d at a lower dose of 30 microg/kg LBW/d because of the side-effects observed in the initial patients. Pharmacokinetic studies demonstrated a peak serum level >2.6 nM in three of the patients. Side-effects of therapy included hepatic transaminase elevations, myalgias, thrombocytopenia, nausea, vomiting, decrease in performance status, and capillary leak syndrome. One patient developed HAMA and two patients HARA. One patient developed neurologic toxicity with akinetic mutism, and died following therapy. No patient demonstrated a significant decline in M-component during therapy. We concluded that anti-B4-bR can be administered by continuous infusion to patients with multiple myeloma, although immunotoxin levels >3 nM were associated with increased incidence of toxicity and required dose adjustment. Future trials using anti-B4-bR in MM will be needed to determine the optimal dose and administration schedule in this patient population, and to determine whether there is evidence of biologic activity.

Adult↗
PubMed1998

Influence of timing of morphine administration on postoperative pain and analgesic consumption.

We have investigated if a pre-emptive dose of morphine, given 30 min before skin incision, influenced postoperative pain and morphine consumption after hysterectomy. In a prospective, randomized, double-blind, placebo-controlled clinical study, patients received morphine 0.3 mg kg-1 at induction of anaesthesia or 30 min later at skin incision. The primary endpoint was defined as 24-h morphine consumption via patient-controlled analgesia. We could not demonstrate any difference between the two groups in morphine consumption or pain scores, and we conclude that there was no evidence of pre-emptive analgesia in this study.

Adult↗
PubMed1998

Molecular identification of a component of delayed rectifier current in gastrointestinal smooth muscles.

Kv2.2, homologous to the shab family of Drosophila voltage-gated K+ channels, was isolated from human and canine colonic circular smooth muscle-derived mRNA. Northern hybridization analysis performed on RNA prepared from tissues and RT-PCR performed on RNA isolated from dispersed and selected smooth muscle cells demonstrate that Kv2.2 is expressed in smooth muscle cells found in all regions of the canine gastrointestinal (GI) tract and in several vascular tissues. Injection of Kv2.2 mRNA into Xenopus oocytes resulted in the expression of a slowly activating K+ current (time to half maximum current, 97 +/- 8.6 ms) mediated by 15 pS (symmetrical K+) single channels. The current was inhibited by tetraethylammonium (IC50 = 2.6 mM), 4-aminopyridine (IC50 = 1.5 mM at +20 mV), and quinine (IC50 = 13.7 microM) and was insensitive to charybdotoxin. Low concentrations of quinine (1 microM) were used to preferentially block the slow component of the delayed rectifier current in native colonic myocytes. These data suggest that Kv2.2 may contribute to this current in native GI smooth muscle cells.

4-Aminopyridine↗
PubMed1997

An investigation of the effect of ondansetron on time to induction of anaesthesia with thiopentone and propofol.

In two consecutive, randomized, double-blind studies the effect of ondansetron on the time to induction of anaesthesia with propofol and, subsequently, thiopentone was assessed. In each study 40 patients received either ondansetron 8 mg or placebo immediately before induction of anaesthesia with a standardized dose of propofol (2.5 mg kg-1) or thiopentone (5 mg kg-1). Times to induction of anaesthesia were determined by assessing loss of verbal response, motor power and eyelash reflex. There was no difference in either study in times to induction of anaesthesia between immediate pre-treatment with ondansetron or placebo. Side effects were minor and of similar incidence in the ondansetron and placebo groups.

Adult↗
PubMed1996

PDGF receptor-to-nucleus signaling of p91 (STAT1 alpha) transcription factor in rat smooth muscle cells.

Vascular smooth muscle cells (VSMC) are the predominant cell type in the media of a normal artery. Injury to the vessel wall leads to platelet deposition and the release of numerous factors, including PDGF, which exerts its biological effects by binding to specific surface receptors on the smooth muscle cell membrane. We demonstrate that PDGF-stimulated smooth muscle cells activate the STAT (signal transducers and activators of transcription) family of proteins in addition to other signaling pathways (e.g., RAS-RAF-MAP Kinase). We show that the transcription factor p91 (STAT1 alpha) is rapidly activated by PDGF in VSMC and specifically binds to the regulatory elements SIE or GAS. We hypothesize that signal transduction by p91 plays an important role in VSMC, especially after injury with the release of growth factors such as PDGF.

Animals↗
PubMed1996

Use of invasive cardiovascular monitoring in patients with burns greater than 30 per cent body surface area: a survey of 251 centres.

A survey of the use of invasive cardiovascular monitoring in patients with burns greater than 30 per cent body surface area was performed. Questionnaires were sent to a total of 251 burns units in the UK, USA, Canada, Australia and New Zealand. The overall response rate was 68 per cent. Most centres reported that they managed less than 20 of these patients each year. Fifty-five per cent of centres used central venous pressure monitoring in more than half of their patients. In contrast, only 8 per cent of burn units used pulmonary artery catheters in over half of their patients. Few centres described the use of predetermined goals to direct therapy associated with PA catheter insertion.

Australia↗
PubMed1996

A comparison of ibuprofen arginine with morphine sulphate for pain relief after orthopaedic surgery.

In a randomized, double-blind, double-dummy, single-dose, parallel-group study, oral ibuprofen arginine (400 mg) was compared with intramuscular (i.m.) morphine sulphate (5 or 10 mg) for post-operative pain relief after orthopaedic surgery in 120 patients. The study medication was administered post-operatively at the time when each patient first requested pain relief for moderate to severe pain. Assessment of pain intensity and pain relief was made using standard visual analogue scales and verbal rating scores. In all three groups, there was a reduction in pain compared with baseline, measured by visual analogue scales and verbal rating scores, at all time points up to completion of the study at 240 min. For example, visual analogue scales decreased by 35 (10-52) mm at 1 h in the morphine 5 mg group, 24 (12-39) mm in morphine 10 mg group and 21 (8-38) mm in the ibuprofen arginine group (median and inter-quartile range). Verbal rating scores showed a similar pattern. Comparing the groups over the whole study period using the sum of pain intensity differences showed no significant differences in pain experience between the groups. Assessment of total pain relief also showed no significant differences. The incidence and types of side effect seen were similar in the three groups.

Administration, Oral↗
PubMed1996

Influence of dose and timing of administration of morphine on postoperative pain and analgesic requirements.

In a randomized, double-blind study, we have investigated the effect of dose and timing of administration of morphine on postoperative pain and analgesic requirements in 60 patients undergoing hysterectomy, with or without salpingo-oophorectomy. Patients were allocated randomly to one of three groups: during standardized general anaesthesia, group post received morphine 0.15 mg kg-1 i.v. at peritoneal closure after hysterectomy; group pre-low received morphine 0.15 mg kg-1 on induction of anaesthesia; and group pre-high received morphine 0.3 mg kg-1 on induction of anaesthesia. Median postoperative morphine consumption (first 24 h) from a PCA system was 68 mg (group post), 56 mg (group pre-low) and 43 mg (group pre-high), and total perioperative morphine consumption (induction of anaesthesia to end of 24 h after surgery) was 77 mg (group post), 65 mg (group pre-low) and 63 mg (group pre-high). Pain scores (at rest and on movement) were similar in the three groups. A large dose of morphine 0.3 mg kg-1 i.v. on induction of anaesthesia significantly reduced postoperative PCA morphine requirements compared with the smaller dose (0.15 mg kg-1) administered at induction or peritoneal closure, in patients undergoing hysterectomy, with or without salpingo-oophorectomy.

Adult↗
PubMed1995

A metabolic complication of severe burns.

A 32-year-old male was referred to intensive care with possible respiratory sepsis 15 days after sustaining 73 per cent TBSA electrical burns. Investigation revealed previously undiagnosed hyperosmolar non-ketotic diabetic coma. The aetiology, pathogenesis and management of this recognized complication of major burns is discussed. An interesting feature of this case is recovery from 73 per cent burns, severe hyperosmolar non-ketotic diabetic coma and a serum osmolality of 429 mosmol/kg, each of which carry a high mortality probability.

Accidents, Occupational↗