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Biomedical subjects

J Lumley

Publications and source records attributed to J Lumley.

At least 127 records · Page 7Linked to original sources
PubMed1990

Methods of delivery and resuscitation of very-low-birthweight infants in Victoria: 1982-1985.

This article describes the patterns of delivery and resuscitation for very-low-birthweight infants who were born in Victoria from 1982 to 1985. Caesarean delivery rates increased from 15% to 30% for infants of birthweights of 500-999 g, and from 39% to 52% for infants of birthweights of 1000-1499 g. In level-III hospitals, the proportion of live-born infants who did not receive active resuscitation fell from 32% to 18% for those who weighed 500-999 g, and from 28% to 15% for those who weighed 1000-1499 g. Time trends over the four years showed the management of very-low-birthweight infants to be in a state of rapid transition in all birth settings. At the same time there was a fall in the still-birth rate of infants of birthweights of 500-999 g. Still-births rates for infants of birthweights of 1000-1499 g remained unchanged, as did neonatal mortality rates in both weight groups.

Apgar Score↗
PubMed1990

Propofol for long-term sedation in the intensive care unit. A comparison with papaveretum and midazolam.

Thirty-seven patients with a wide range of illnesses were studied during mechanical ventilation of the lungs in an intensive care unit. Fifteen were sedated with a continuous propofol infusion, with analgesia provided by bolus doses of papaveretum. Twelve received a continuous infusion of papaveretum, supplemented by bolus doses of midazolam. The level of sedation was assessed every four hours and measurements were made of haemodynamic and respiratory variables. Levels of sedation were generally satisfactory in both groups. Six patients who received propofol required the use of muscle relaxants, because of their strong respiratory drives, to achieve synchronisation with the ventilator. There was no significant difference in respiratory or haemodynamic variables between the groups, but several patients required inotropic support because of their disease. There was no evidence of inhibition of adrenal steroidogenesis in the propofol group. Propofol can be a useful sedative agent in the intensive care unit, but sedative regimens should be tailored to individual patient requirements.

Adolescent↗
PubMed1990

Intermittent high frequency ventilation. Clinical evaluation of a new mode of ventilation.

In this first clinical study of a new mode of ventilation, called intermittent high frequency ventilation (IHFV), a comparison was made in ten patients after myocardial revascularization, between normal ventilation, high frequency ventilation (HFV) and IHFV at 15, 60, 100 and 160 breaths per min (b.p.m.). During IHFV the ventilation was interrupted for 3 s 7 times per min. The measured mean trapped gas volumes were 219 ml at 60 b.p.m. and 716 ml at 160 b.p.m. At 160 b.p.m. during IHFV, the mean, mean airway pressures, pulmonary artery (PAP) and capillary wedge pressures and the Paco2 were decreased, while the cardiac output increased. When the Paco2 was maintained constant, IHFV also allowed a reduction in the mean peak and mean airway pressures. This new mode of ventilation can prevent sustained increases in the lung volume and provide a reduction in intrapulmonary pressures. It also permits the measurement of the trapped gas volume and end-tidal CO2 gas concentrations several times a minute for the clinical management of patients during high frequency ventilation.

Evaluation Studies as Topic↗
PubMed1990

Through a glass darkly: ultrasound and prenatal bonding.

Prenatal ultrasound scans are believed to enable mothers to form an early affectionate bond to their child, to provide a reassuring image of the fetus, and to promote improvements in mothers' health behaviors on the behalf of the fetus. Observational studies suggest that scans done early may slightly improve maternal-fetal bonding but that those done after quickening are not associated with attachment. Short-term effects on maternal health behaviors, including less smoking, less drinking of alcohol, and more visits to dentists, were detected in a randomized trial when detailed information was given during the scan. This trial also suggested that women's anxiety was actually increased during scans, and then allayed by positive feedback from the operator. Not all women considered scans reassuring in one interview study, and other authors found that mothers' interpretations of scans depended on their personal and social circumstances. As used in everyday practice, ultrasound scans are not always accompanied by feedback, and when feedback occurs it is sometimes in the form of slips of the tongue, incorrect diagnoses, identification of structures that cannot be deciphered, and language that is unfamiliar and alarming to mothers. This "diagnostic toxicity" of ultrasound scans of the fetus has not been studied.

Female↗
PubMed1989

Alcohol consumption, cigarette smoking and fetal outcome in Victoria, 1985.

The aims of this study were to document the extent of cigarette smoking and alcohol consumption by Victorian women during pregnancy and relate the use of cigarettes and alcohol to various measures of pregnancy outcome. The study found that 24 per cent of women smoked during pregnancy and smoking was more common amongst younger women; 99.5 per cent of women drank, on average, less than two standard drinks per day and older women were more likely to be drinkers than younger women; 3.6 per cent of women reported at least one episode of binge drinking during pregnancy. There was an increasing trend in the proportion of low birthweight (less than 2500 g) infants with increasing use of tobacco and a dose-dependent reduction in mean birthweight. Drinkers were less likely to have a pre-term or low birthweight infant than abstainers and babies born to drinkers had a higher mean birthweight than babies born to abstainers. The results of our study did not suggest that drinkers were at increased risk of delivering an infant with a congenital malformation, however heavy drinking was very uncommon in the studied population.

Adult↗
PubMed1988

The survival of extremely-low-birthweight infants in Victoria: 1982-1985.

A population-based survey of mortality in extremely-low-birthweight (500- to 999-g) infants was carried out in Victoria for the years 1982 to 1985. No increase in the number of extremely-preterm births occurred during that time. The still-birth rate fell from 498 still births per 1000 births in 1982-1983 to 403 still births per 1000 births in 1984-1985. The neonatal mortality in 1982-1985 was 638 deaths per 1000 live births, with no significant decline from that of the 1978-1981 cohort. The small increase in neonatal survivors was not associated with any change in the postneonatal death rate. Delivery in a level-3 unit was associated with a significantly better outcome. Multiple births made a major contribution to the extremely-low-birthweight group of infants.

Birth Weight↗
PubMed1988

Fatal envenomation by Chironex fleckeri, the north Australian box jellyfish: the continuing search for lethal mechanisms.

A child with severe envenomation by Chironex fleckeri presented in cardiac arrest at a hospital between 15 and 20 min after the sting was sustained. Resuscitation was not successful. Objective confirmation of C. fleckeri as the cause of death is described. Four metres of tentacle contact in this case represents the smallest-measured fatal C. fleckeri sting that has been recorded so far. The mechanism of this death was toxic and not allergic. The available clinical information suggests direct myocardial interference, but does not exclude a respiratory hypoxic element. A more widespread venom-induced functional disruption of the cell membrane is postulated, with a resultant dysfunction in several vital organ systems that were acting in concert. Early, vigorous and sustained resuscitation that is performed as a first-aid measure offers the best hope of prehospital survival after a massive C. fleckeri sting, which is the most explosive envenomation process that is presently known to humans. In-hospital resuscitation from unresponsive circulatory arrest should now involve intravenously-administered verapamil (or its equivalent) and additional box-jellyfish antivenom, while the patient is being monitored.

Animals↗
PubMed1988

A DNA polymorphism of the apolipoprotein C-III gene in extracoronary atherosclerosis.

1. A genetic polymorphism of apolipoprotein (apo) C-III was studied in 49 Caucasian patients with extracoronary atherosclerosis demonstrated by angiography. 2. Twelve patients (24%) possessed an uncommon allelic variant of the apo A-I/C-III gene cluster compared with two (4%) in 50 healthy controls (P less than 0.01). 3. Of 27 patients with carotid atherosclerosis, 22% had the uncommon genotype (P less than 0.02), and in aorto-femoral atherosclerosis (n = 22) 27% possessed the uncommon variant (P less than 0.01). 4. When normotriglyceridaemic subgroups (n = 32) with arterial disease were studied the difference in genotype frequencies persisted, 22% having the uncommon allele (P less than 0.01), suggesting that such genetic variants have effects independent of circulating levels of plasma lipids.

Alleles↗
PubMed1988

The tip of the iceberg: a validation study of the Victorian Congenital Malformations/Birth Defects Register.

Among 1500 children under 4 years of age admitted consecutively to two paediatric teaching hospitals in Victoria in 1985 the prevalence of birth defects was 20%. Fewer than half of these defects had been notified to the Victorian Congenital Malformations Register. Only chromosomal anomalies and, to a lesser extent, major structural malformations present at birth were adequately ascertained. The implications for birth defects monitoring and for service planning are discussed.

Child, Preschool↗
PubMed1988

Cutaneous light microscopic and ultrastructural changes in a fatal case of jellyfish envenomation.

A 5-year-old male suffered fatal envenomation from a jellyfish subsequently identified as Chironex fleckeri. Contact with the tentacles of the jellyfish had produced characteristic whiplash-like weals on the skin. At autopsy, skin from these areas was taken and later studied by light microscopy and electron microscopy. Both studies identified numerous nematocysts penetrating the epidermis and papillary dermis in the region of the sting.

Animals↗
PubMed1987

Propofol infusion for sedation in the intensive care unit: preliminary report.

Propofol (2,6,di-isopropylphenol) was given by continuous intravenous infusion to provide sedation after cardiac surgery in 30 patients and its effects compared with those of midazolam given to a further 30 patients. Propofol infusion allowed rapid and accurate control of the level of sedation, which was satisfactory for longer than with midazolam. Patients given propofol recovered significantly more rapidly from their sedation once they had fulfilled the criteria for weaning from artificial ventilation and as a result spent a significantly shorter time attached to a ventilator. There were no serious complications in either group. Both medical and nursing staff considered the propofol infusion to be superior to midazolam in these patients. These findings suggest that propofol is a suitable replacement for etomidate and alphaxalone-alphadolone for sedating patients receiving intensive care.

Blood Pressure↗
PubMed1987

The use of epidural bupivacaine for the relief of childbirth pain.

Epidural anaesthesia is now a widely used method for pain relief in childbirth, particularly using the drug Bupivacaine. There are nevertheless differing opinions in the research literature about the advisability of its routine use. While it is clearly very effective in relieving labour pain, there are some consistent, troublesome patterns; for example, a strong association between epidural use and other interventions, such as instrumental delivery. Further, there are no clear answers from the research to date concerning the risks and benefits of epidural anaesthesia for infant and mother. Answers could be provided by randomized clinical trials, but meanwhile a conservative approach to its use is recommended for uncomplicated labours.

Anesthesia, Epidural↗