Biomedical subjects
J Lumley
Publications and source records attributed to J Lumley.
A randomized trial of weekly cardiotocography in high-risk obstetric patients.
A randomized clinical trial of once-weekly antenatal fetal heart rate monitoring in 539 high-risk patients could find no benefit of monitoring in terms of perinatal mortality, morbidity or Apgar score. The previously well-documented association between abnormal antenatal fetal heart rate traces and low Apgar score was confirmed. A detailed case review showed that in this population monitoring was irrelevant to almost all of the 13 perinatal deaths.
Preschool siblings at birth: short-term effects.
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Continuous intravenous infusion of disoprofol (ICI 35868, Diprivan). Comparison with Althesin to cover surgery under local analgesia.
Disoprofol has been used to induce and, by continuous infusion, to maintain a light level of general anaesthesia in 100 patients undergoing surgery with the aid of a regional block. Its effects have been compared with 100 patients anaesthetised in a similar manner with Althesin. Disoprofol proved to be a very satisfactory agent for use by this method and apart from an appreciable incidence of pain on injection the number of complications was small and comparable to those found with Althesin, which caused more involuntary movements. Recovery was particularly rapid and clear-headed following disoprofol, and occurred highly significantly more quickly than after Althesin. Disoprofol, however, will not be marketed in the present formulation which has Cremophor EL as the solubilising agent.
Birth centre confinement at the Queen Victoria Medical Centre. I. Obstetric and neonatal outcome.
A review of hte first 175 confinements at the Queen Victoria Medical Centre Birth Centre is presented. The design, structure and function of hte Birth Centre is described and the safety of the programme demonstrated. Seventy-four pregnancies (42%) accepted for Birth Centre confinement required transfer because of antepartum or intrapartum complications. There were satisfactory obstetric and neonatal outcomes in all pregnancies. The first year's experience has allowed a reassessment of the risk factors, which will permit greater use of the Birth Centre without any increases risk to mothers or babies.
Hypothalamic-pituitary function in the "brain-dead" patient.
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Better perinatal health. Australia.
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Prolongation of suxamethonium following plasma exchange.
Repeated plasma exchange was used in the treatment of a 70-yr-old woman with Wegener's granulomatosis. Two days following the last exchange, the plasma cholinesterase was 14% of normal and there was a prolonged response to the action of suxamethonium.
Initial experience with Minaxolone. A water-soluble steroid intravenous anaesthetic agent.
Minaxolone has been used to induce anaesthesia, and in incremental doses to supplement nitrous oxide, in 100 patients undergoing minor surgical procedures. Half the patients received a small dose of fentanyl before induction. Minaxolone proved to be a satisfactory induction agent. The commonest complications were an increase in muscle tone and involuntary muscle movements, which in some patients occurred in the recovery period: their incidence was reduced by fentanyl. There was a notably low incidence of nausea and vomiting.
Respiratory effects of Minaxolone.
The respiratory effects of induction of anaesthesia with Minaxolone 0.4 mg/kg were studied following premedication with either atropine alone, lorazepam and atropine or papaveretum and hyoscine. There was no significant difference in the incidence of apnoea in the three groups. Those who received non-narcotic premedication showed a significant increase in respiratory rate, but the minute volumes in these patients did not differ significantly from control values in the third minute after injection of minaxolone. In those who received papaveretum and hyoscine, there was no change in respiratory rate and a highly significant reduction in minute volume.
ICI 35868 (Diprivan): a new intravenous induction agent. A comparison with methohexitone.
ICI 35868 (Diprivan) has been used as an induction agent in patients undergoing minor gynaecological surgery and as the sole anaesthetic agent during bronchoscopy, and its effects were compared with those of methohexitone. The new agent proved to be satisfactory, although induction of anaesthesia was significantly longer than following methohexitone. complications were similar with both drugs. ICI 35868 deserves full investigation as an intravenous anaesthetic agent.
Patterns of life after graduation.
The integration of work and family life is problematic for many doctors. Most of us received little help in resolving the relevant issues during our own formal education. This paper describes a series of informal meetings which were organized for the fifth-year medical students to provide information about possible patterns of work, and to encourage discussion and comment. Areas of particular concern turned out to be postgraduate training, parenting, and the dual-career family. The project was only partly successful.
Amniotic fluid embolism. A report of three cases.
Three patients showing the typical features of amniotic fluid embolism are described. Two survived the insult, while in the third the diagnosis was confirmed by post-mortem histological examination of the lungs.
Methohexitone and etomidate for bronchoscopy.
General anaesthesia for bronchoscopy has been provided with either methohexitone or etomidate, with and without fentanyl. Recovery was faster following methohexitone and there was no statistically significant difference in the incidence of complications. Inclusion of fentanyl in the technique did not confer any benefits with either drug.
Changes in ionized calcium and other plasma constituents associated with cardiopulmonary bypass.
Plasma concentrations of calcium fractions, proteins, phosphate and magnesium were measured before, during and after cardiopulmonary bypass in 15 patients undergoing cardiac surgery. When calcium chloride was added to a pump priming solution which contained little or no blood, the concentrations of all calcium fractions were significantly greater after bypass than before, with a mean ionized calcium concentration of 1.52 mmol litre-1 plasma water, 30 min after completion of bypass. This iatrogenic hypercalcaemia was increased significantly by the administration of more than 10 mg kg-1 calcium chloride in the first 30 min after bypass. Other plasma constituents showed the dilutional effect of the pump prime during bypass and only the magnesium concentration failed to return towards normal values after operation.
Induction of labour.
The only justification for adding to the extensive literature on induction of labour is to bring together relatively inaccessible but relevant data for the general reader. Some of these data refer to current practice, and some to patients' experiences. The conflicting value systems of some doctors and some patients are also discussed. The writer, a self-confessed armchair critic, makes some suggestions about ways of reducing disagreement about elective induction of labour.