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Biomedical subjects

J Tibballs

Publications and source records attributed to J Tibballs.

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

Successful recanalization of portal vein thrombosis before liver transplantation using transjugular intrahepatic portosystemic shunt.

A frequent complication in patients with end-stage liver disease is portal vein thrombosis (PVT). Although PVT is not considered an absolute contraindication to orthotopic liver transplantation (OLT), more complex surgery is required and patients have more postoperative complications and greater mortality rates. We describe 2 patients who experienced complete PVT either while waiting for liver transplantation or during the workup, resulting in acute deterioration of liver function. Recanalization of the portal vein was successfully performed in both patients using transjugular intrahepatic portosystemic stent shunt (TIPS), and patency was maintained by the addition of anticoagulation therapy. They subsequently underwent successful OLTs and remain well. In conclusion, we believe that TIPS placement can be performed safely in patients with recent PVT, ensuring the patency of the portal vein until OLT.

Budd-Chiari Syndrome↗
PubMed2001

An evaluation of nitric oxide and nitrogen dioxide absorbers and filters.

The absorbance of NO (5-90 ppm) and NO2 (0.5-4 ppm) by a number of absorbers and filters was assessed via bench testing. All absorbers (Sodasorb, Purafil CP, Purafil Select, Sofnolime, Sofnofil and 50/50 mix of Sofnolime/Sofnofil) except Sodasorb absorbed NO almost completely. Only Sofnolime absorbed NO2 completely while Sodasorb and the Sofnolime/Sofnofil 50/50 mix had absorbances between 47% and 90%. The absorbance of four filters (ILF100, ILF150, ILF200 and HgCONO) as well as Sofnolime and the Sofnolime/Sofnofil 50/50 mix was tested in the expiratory port of a Servo 900C ventilator All absorbers and filters produced a change in ventilator pressures. The HgCONO filter Sofnolime and the Sofnolime/Sofnofil 50/50 mix all absorbed NO. At 80 ppm NO, the HgCONO filter had 100% absorbance for four hours while Sofnolime's absorbance was significantly reduced after one hour. All filters and absorbers tested on the ventilator except the Sofnolime/Sofnofil 50/50 mix and the ILF150 filter absorbed NO2 completely for a period ranging from 90 minutes to four hours. We recommend the HgCONO filter and Sofnolime to absorb both NO and NO2. If absorption of NO2 only is required we recommend the HgCONO, ILF100 or ILF200 filters or the Sofnolime absorber.

Absorption↗
PubMed2001

An advisory statement from the Pediatric Working Group of the International Liaison Committee on Resuscitation.

The International Liaison Committee on Resuscitation (ILCOR), with representation from North America, Europe, Australia, New Zealand, Africa, and South America, was formed in 1992 to provide a forum for liaison between resuscitation organizations in the developed world. This consensus document on resuscitation extends previously published ILCOR advisory statements on resuscitation to address the unique and changing physiology of the newly born infant within the first few hours after birth and the techniques for providing advanced life support. After careful review of the international resuscitation literature and after discussion of key and controversial issues, consensus was reached on almost all aspects of neonatal resuscitation, and areas of controversy and high priority for additional research were delineated. Consensus on resuscitation for the newly born infant included the following principles: Personnel trained in the basic skills of resuscitation should be in attendance at every delivery. A minority (fewer than 10%) of newly born infants require active resuscitative interventions to establish a vigorous cry and regular respirations, maintain a heart rate > 100 beats per minute (bpm), and maintain good color and tone. When meconium is present in the amniotic fluid, it should be suctioned from the hypopharynx on delivery of the head. If the meconium-stained newly born infant has absent or depressed respirations, heart rate, or muscle tone, residual meconium should be suctioned from the trachea. Attention to ventilation should be of primary concern. Assisted ventilation with attention to oxygen delivery, inspiratory time, and effectiveness judged by chest rise should be provided if stimulation does not achieve prompt onset of spontaneous respirations and/or the heart rate is < 100 bpm. Chest compressions should be provided if the heart rate is absent or remains < 60 bpm despite adequate assisted ventilation for 30 seconds. Chest compressions should be coordinated with ventilations at a ratio of 3:1 and a rate of 120 "events" per minute to achieve approximately 90 compressions and 30 rescue breaths per minute. Epinephrine should be administered intravenously or intratracheally if the heart rate remains < 60 bpm despite 30 seconds of effective assisted ventilation and chest compression circulation. Common or controversial medications (epineprine, volume expansion, naloxone, bicarbonate), special resuscitation circumstances affecting care of the newly born, continuing care of the newly born after resuscitation, and ethical considerations for initiation and discontinuation of resuscitation are discussed. There was agreement that insufficient data exist to recommend changes to current guidelines regarding the use of 21% versus 100% oxygen, neuroprotective interventions such as cerebral hypothermia, use of a laryngeal mask versus endotracheal tube, and use of high-dose epinephrine. Areas of controversy are identified, as is the need for additional research to improve the scientific justification of each component of current and future resuscitation guidelines.

Environment↗
PubMed2000

Liver transplantation complicated by embedded transjugular intrahepatic portosystemic shunt: a new method for portal anastomosis- a surgical salvage procedure.

A transjugular intrahepatic portosystemic shunt (TIPS) is an increasingly used method of treating variceal bleeding from portal hypertension. Many patients are subsequently listed for transplantation, which may be complicated by malposition of the inferior end of the TIPS stent. This report details such a case and offers a surgical technique to salvage this situation.

Adult↗
PubMed2000

An analysis of the efficacy of bag-valve-mask ventilation and chest compression during different compression-ventilation ratios in manikin-simulated paediatric resuscitation.

The ideal chest compression and ventilation ratio for children during performance of cardiopulmonary resuscitation (CPR) has not been determined. The efficacy of chest compression and ventilation during compression ventilation ratios of 5:1, 10:2 and 15:2 was examined. Eighteen nurses, working in pairs, were instructed to provide chest compression and bag-valve-mask ventilation for 1 min with each ratio in random on a child-sized manikin. The subjects had been previously taught paediatric CPR within the last 3 or 5 months. The efficacy of ventilation was assessed by measurement of the expired tidal volume and the number of breaths provided. The rate of chest compression was guided by a metronome set at 100/min. The efficacy of chest compressions was assessed by measurement of the rate and depth of compression. There was no significant difference in the mean tidal volume or the percentage of effective chest compressions delivered for each compression-ventilation ratio. The number of breaths delivered was greatest with the ratio of 5:1. The percentage of effective chest compressions was equal with all three methods but the number of effective chest compressions was greatest with a ratio of 5:1. This study supports the use of a compression-ventilation ratio of 5:1 during two-rescuer paediatric cardiopulmonary resuscitation.

Cardiopulmonary Resuscitation↗
PubMed1999

Resuscitation of the newly born infant: an advisory statement from the Pediatric Working Group of the International Liaison Committee on Resuscitation.

The International Liaison Committee on Resuscitation (ILCOR), with representation from North America, Europe, Australia, New Zealand, Africa, and South America, was formed in 1992 to provide a forum for liaison between resuscitation organizations in the developed world. This consensus document on resuscitation extends previously published ILCOR advisory statements on resuscitation to address the unique and changing physiology of the newly born infant within the first few hours following birth and the techniques for providing advanced life support.

Delivery Rooms↗
PubMed1999

Transjugular liver biopsy in the 1990s: a 2-year audit.

BACKGROUND: In view of the changing nature of transjugular liver biopsy, we performed an audit of the safety, adequacy and clinical impact of such biopsies in our centre over a 2-year period from 1995 to 1997. METHODS: One hundred and fifty-seven transjugular biopsies were carried out in 145 patients, with prothrombin time >5 s over control and/or platelet count <50 x 10(9)/L and/or gross ascites. RESULTS: Major complications were two (1.3%) capsular perforations, which were easily plugged with coils without sequelae. Biopsy sample was adequate for histological diagnosis in 90%, inadequate in 6% and technically unsuccessful in 4% of cases. Mean biopsy size was 14.8+/-7.7 (1-51) mm. Adequacy did not differ between cases with and without cirrhosis. Transjugular biopsy had a clinical impact (specific diagnosis or influence on patient's management) in 50% of acute liver disease, 62% of chronic liver disease and 87% of transplant patients (P<0.001). In chronic liver disease, it had a significantly greater clinical impact in cases trying to establish the stage rather than diagnosis (84% vs. 35%, P<0.001). CONCLUSIONS: Transjugular liver biopsy is a safe procedure for high-risk patients providing an adequate liver sample even in cirrhosis. It has a clinical impact in more than 80% of transplant patients and for staging chronic liver disease, but in only 50% (acute) or 35% (chronic) of liver disease when a diagnosis is sought.

Adolescent↗
PubMed1999

Unintentional poisoning hospitalisations among young children in Victoria.

OBJECTIVES: To describe the epidemiology of unintentional childhood poisoning hospitalisation in Victoria, Australia, in order to monitor trends and identify areas for research and prevention. METHODS: For children under 5 years, all Victorian public hospital admissions, July 1987 to June 1995, due to unintentional poisoning by drugs, medicines, and other substances were analysed. Similar cases were also extracted from the database of the Royal Children's Hospital intensive care unit, Melbourne for the years 1979-91. Log linear regression modelling was used for trend analyses. RESULTS: The annual average childhood unintentional poisoning rate was 210.7 per 100,000. Annual rates for males consistently exceeded those for females. The most common agents were those acting on the respiratory system and on smooth and skeletal muscles (muscle relaxants, cough and cold medicines, antiasthmatics), aromatic analgesics (paracetamol), and systemic agents (including antihistamines). Further investigation is justified for cardiac agents, some respiratory agents, and asthma medications. CONCLUSIONS: Childhood poisoning hospitalisation rates have not decreased in Victoria over recent years. A focused, agent specific approach, as well as a series of generic measures for the prevention of poisoning to children under 5 is advocated. The ongoing surveillance, collection and analysis of data, in addition to research on specific poisoning agents are essential components of any prevention strategy.

Child, Preschool↗
PubMed1999

An advisory statement from the Pediatric Working Group of the International Liaison Committee on Resuscitation.

The International Liaison Committee on Resuscitation (ILCOR), with representation from North America, Europe, Australia, New Zealand, Africa, and South America, was formed in 1992 to provide a forum for liaison between resuscitation organizations in the developed world. This consensus document on resuscitation extends previously published ILCOR advisory statements on resuscitation to address the unique and changing physiology of the newly born infant within the first few hours after birth and the techniques for providing advanced life support. After careful review of the international resuscitation literature and after discussion of key and controversial issues, consensus was reached on almost all aspects of neonatal resuscitation, and areas of controversy and high priority for additional research were delineated. Consensus on resuscitation for the newly born infant included the following principles: Common or controversial medications (epinephrine, volume expansion, naloxone, bicarbonate), special resuscitation circumstances affecting care of the newly born, continuing care of the newly born after resuscitation, and ethical considerations for initiation and discontinuation of resuscitation are discussed. There was agreement that insufficient data exist to recommend changes to current guidelines regarding the use of 21% versus 100% oxygen, neuroprotective interventions such as cerebral hypothermia, use of a laryngeal mask versus endotracheal tube, and use of high-dose epinephrine. Areas of controversy are identified, as is the need for additional research to improve the scientific justification of each component of current and future resuscitation guidelines.

Documentation↗