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Biomedical subjects

J S Turner

Publications and source records attributed to J S Turner.

17 recordsLinked to original sources
PubMed1991

Oesophageal obstruction during nasogastric feeding.

Although complications of enteral feeding are usually minor, we report an unusual and serious case of oesophageal obstruction after feeding with osmolite, a commonly used polymeric enteral feeding preparation. The patient described underwent rigid oesophagoscopy to remove the feed which had solidified and blocked the entire oesophageal lumen. The procedure resulted in oesophageal perforation which needed surgical repair by thoracolaparotomy and was followed by a difficult postoperative course. In vitro tests showed that all commonly used feeds containing casein (osmolite, ensure, ensure plus, paediasure, fortison, and pulmocare) solidified at a pH of less than 5. Clinifeed (containing dried skim milk) and peptamen (containing peptides) remained liquid at a pH of less than 1. Solidified feed could be liquefied by the addition of pepsin or pancrex V (a pancreatic enzyme formulation). We conclude that solidification could occur in all feeds containing casein and that alternative feeds should be considered in patients with increased gastric acidity. In addition, pepsin or pancrex V could be used to liquefy solidified feed.

Caseins↗
PubMed1991

Acute physiology and chronic health evaluation (APACHE II) scoring in a cardiothoracic intensive care unit.

OBJECTIVE: To evaluate the predictive value of the Acute Physiology and Chronic Health Evaluation (APACHE II) scoring system in cardiothoracic surgical patients. DESIGN: Prospective survey with follow-up to hospital discharge. SETTING: A cardiothoracic surgical ICU in a tertiary referral center. PATIENTS: Eight hundred sixty-nine consecutive patients admitted to the ICU were entered into this study. Data on 12 patients were incomplete. Forty-three patients had nonsurgical diagnoses. Three patients had noncardiothoracic operations. These exclusions left 811 patients for analysis, and all results pertain to these 811 cardiothoracic surgical patients. INTERVENTIONS: Demographic and physiologic data relevant to the APACHE II score were collected on all patients and entered into a microcomputer database for analysis. MEASUREMENTS AND MAIN RESULTS: The following procedures were performed: 65% of patients had coronary artery bypass grafts; 23% had heart valve surgery; 5% had thoracic surgical procedures; and the remainder had a variety of cardiothoracic operations. The mean duration of ICU care was 2.3 days and the mean age was 57 yrs. The mean APACHE II score was 9.5 and the overall predicted risk of dying was 4.59%, with an actual ICU mortality rate of 4.56%. The relationship between the APACHE II score and mortality rate was linear and significant (p less than .001). Patients with an APACHE II score of less than 10 had a mortality rate of 0.93%. Only a score of greater than 30 was uniformly associated with death, and then only in one patient. A chronic disease history, emergency surgery, and a longer ICU stay were significant markers for mortality. CONCLUSIONS: There was a good relationship between the APACHE II score and mortality rate. Low APACHE II scores accurately predicted survival but only very high scores accurately predicted death.

Adolescent↗
PubMed1990

Patients' recollection of intensive care unit experience.

This study evaluates the recall of 100 patients after ICU admission. There was a wide spectrum of race, religion, occupation, and educational levels. The more common diagnoses included asthma, pneumonia, trauma, and adult respiratory distress syndrome. The average Acute Physiology and Chronic Health Evaluation (APACHE II) score was 12.3, and 68% of the patients were mechanically ventilated. The ICU atmosphere was described as friendly or relaxed by 94% of patients. Confidence in doctors and nurses was good. The most frequently reported unpleasant experiences were arterial blood gas sampling (48% of patients) and tracheal suctioning (30 of 68 ventilated patients). Only 6% of patients disliked ward rounds and discussion around the bedside. This study suggests that arterial lines or pulse oximetry could be used to avoid frequent arterial blood gas analyses and that tracheal suctioning should be performed with greater care. The need for better communication with patients is emphasized.

Adolescent↗
PubMed1990

Pneumococcal surface protein A (PspA) is serologically highly variable and is expressed by all clinically important capsular serotypes of Streptococcus pneumoniae.

Pneumococcal surface protein A (PspA) has been shown previously to elicit antibodies protective against pneumococcal infection and to be necessary for full pneumococcal virulence in mice. The protein was originally defined by the two mouse monoclonal antibodies Xi64 and Xi126, which together recognized PspA on 14% of pneumococcal isolates. Some PspA molecules reacted with both antibodies, but most reacted with only one or the other. In the present study we demonstrated that PspA is produced by all pneumococci, confirming our hypothesis that there are variants of PspA which are not detected by Xi64 and Xi126. We produced a rabbit antiserum and five additional monoclonal antibodies specific for PspA for these studies. The rabbit antiserum reacted with each of 95 pneumococcal isolated tested, comprising 16 capsular serotypes. One or more of the seven monoclonal anti-PspA antibodies reacted with 95% (53 of 57) of pneumococcal isolates tested. The specificity of the monoclonal and polyclonal antibodies to PspA was confirmed in two ways: (i) by detection of molecules on wild-type pneumococci that are identical in molecular weight to those detected in Western blots (immunoblots) with Xi64 and Xi126 and (ii) by the use of mutants of Streptococcus pneumoniae that fail to produce PspA or that produce a truncated form of PspA. By using the seven monoclonal antibodies, we observed 31 PspA types among the 57 isolates. When the 53 strains reactive with the monoclonal antibodies were analyzed by capsular type as well as by serologic type and molecular weight of PspA, we observed 50 different clonotypes of pneumococci.

Animals↗
PubMed1989

Systems for scoring severity of illness in intensive care.

Severity of illness scoring systems are increasingly being used by many intensive care units to predict mortality and to compare results and different therapies. A study was undertaken to evaluate three of these systems--therapeutic intervention scoring system (TISS), acute physiology and chronic health evaluation (APACHE II), and organ failure--in a 2-year prospective analysis in a multidisciplinary intensive care unit. A total of 728 patients with a wide variety of diseases were entered into the study. The relationship between score and mortality in all patients and in specific groups was investigated. The APACHE II system is likely to be the most useful in comparing different therapies and intensive care units, while the organ failure system was more accurate in predicting outcome. No system was precise enough in its predictive powers to make decisions to deny or terminate treatment.

Adolescent↗
PubMed1989

Metabolic responses to gradual cooling in chicken eggs treated with thiourea and oxygen.

1. Late prenatal chicken embryos in eggs injected with saline showed a feeble homeothermic metabolic response to gradual cooling. This response was absent in thiourea-treated eggs. This suggests that the incipient homeothermic metabolic response before paranatal life may be attributed to thyroid development. 2. The compensatory metabolic response disappeared in embryos exposed to a hypoxic environment, while it was augmented in eggs in pure O2, decreasing as ambient temperature fell. 3. These results may indicate that the homeothermic metabolic response in late embryos is O2-conductance-limited and power-limited as previously suggested.

Animals↗
PubMed1989

Respiratory failure in leptospirosis.

We report on four cases of leptospirosis with pulmonary manifestations as their presenting features. With adequate supportive therapy the prognosis is good. Leptospirosis should be considered in the differential diagnosis of pulmonary haemorrhage.

Adolescent↗
PubMed1976

Penetrating injuries of the laryngotracheal area.

Penetrating injuries of the laryngotracheal area require immediate maintenance of an adequate airway and prompt surgical exploration and repair. Two basic principles are illustrated by case reports: repairing major vessels before doing the laryngotracheal repair and using adjacent tissues to repair traumatic defects. We suggest a team approach at operation.

Adolescent↗
PubMed1975

A practical approach to the patient with vertigo: an outline of diagnosis and management for the nonspecialist.

A careful history is the most important part of a medical examination for vertigo, especially to establish whether it is acute, chronic or recurrent. If the patient spontaneously volunteers ear complaints, such as fullness, tinnitus, or hearing loss, the cause is probably otologic and deserves immediate referral. If no otologic complaints are volunteered, the whole body becomes a source of investigation. All nonvital drugs should be withheld while the vertigo study is progressing. A complete physical examination and blood profile should be carried out. Roentgenograms of the skull and chest should be obtained. Accurate diagnosis and proper management are possible only with prolonged follow-up. Unnecessary expense, inconvenience, and discomfort for the patient can be avoided by a screening audiogram to identify unilateral hearing loss. All unilateral hearing loss should be investigated thoroughly in order to diagnose serious retrocochlear disease early.

Acute Disease↗
PubMed1975

Pseudomonas aeruginosa meningitis following stapedectomy.

Meningitis is a rare complication following stapedectomy. Most cases are preceeded by a fistula in the oval window. Although fatalities have been reported, most cases respond to parenteral and intrathecal antibiotics if diagnosed and treated early. Gram-positive organisms are the usual pathogens, but Gram-negative organisms may be found, especially as a superinfection following antibiotics administered prophylacticly or for the treatment of otitis media or mastoiditis. A case of Pseudomonas aeruginosa meningitis five weeks after stapedectomy, successfully treated with gentamicin, is reported. The discussion included the diagnosis of post-stapedectomy fistula and meningitis and current trends in treatment.

Audiometry↗