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Biomedical subjects

M D Stoneham

Publications and source records attributed to M D Stoneham.

At least 37 records · Page 2Linked to original sources
PubMed1995

Bilateral first rib fractures associated with driver's air bag inflation: case report and implications for surgery.

A case of bilateral fractures of the first rib occurring in an otherwise fit road traffic accident victim is described. The only other injuries sustained were of the peripheral limbs. The driver's air bag was inflated during the crash, leading to speculation as to whether this may have contributed to the mechanism of injury. The patient was well oxygenated and cardiovascularly stable with no evidence of neurovascular damage to the thoracic aorta or its branches. Aortic arch aortography was not performed before internal fixation of the peripheral fractures was undertaken under general anaesthesia. A review of the indications for angiography in such patients follows. The policy that patients with fractures of the upper first ribs do not require angiography unless there is other evidence of neurovascular damage is supported.

Accidents, Traffic↗
PubMed1995

Facilitation of laryngeal mask insertion. Effects of lignocaine given intravenously before induction with propofol.

The effects of pretreatment with lignocaine administered intravenously on the insertion of the laryngeal mask airway were investigated in 80 unpremedicated, ASA 1 or 2, adult day-case patients in a randomised, double-blind, placebo-controlled trial. Patients received either intravenous lignocaine 1.5 mg.kg-1 or an equivalent volume of sodium chloride 0.9%. Induction of anaesthesia was achieved with propofol given via a syringe driver at a fixed rate of 600 ml.h-1 until the patient dropped a weighted syringe. No opioid or sedative drugs were given prior to induction. Pain on injection of propofol was recorded. Jaw opening, ease of insertion of the laryngeal mask, coughing, gagging and airway patency were all scored on three-point scales immediately after mask insertion re-attempted. This cycle was continued until success was achieved and the number of such cycles recorded. There were no differences between the lignocaine and control groups with respect to induction dose of propofol, degree of jaw opening, or amount of gagging. Laryngeal mask insertion was facilitated by pretreatment with lignocaine administered intravenously, without an alteration in induction dose of propofol (p < 0.05). Coughing and airway obstruction were both significantly reduced by pretreatment with lignocaine, as was the incidence of failure of insertion requiring deepening of anaesthesia (p < 0.05).

Adult↗
PubMed1995

Post-operative analgesia for craniotomy patients: current attitudes among neuroanaesthetists.

As part of an evaluation of post-operative analgesia for craniotomy patients, a postal questionnaire was sent to 183 consultant members of the Neuroanaesthesia Society of Great Britain and Ireland, inquiring about their current practices for post-operative neurosurgical analgesia. Replies were received from 110 neuroanaesthetists in 37 different neurosurgical centres. Intramuscular codeine phosphate or dihydrocodeine was the mainstay of post-operative analgesia for 97% of neuroanaesthetists despite the fact that over half of them thought that analgesia was inadequate. Only four neuroanaesthetists would ever consider using opioids post-operatively because of fears about respiratory depression and sedation, yet all except one used opioids per-operatively. Post-operative analgesia for craniotomy patients is perceived as inadequate by most neuroanaesthetists, yet traditional prejudice against opioid use prevents this being remedied. We suggest that patient-controlled analgesia with morphine could be a safe alternative to codeine phosphate.

Analgesia↗
PubMed1994

Knowledge about pulse oximetry among medical and nursing staff.

Although pulse oximeters are increasingly used to monitor patients on medical and surgical wards, staff seem to receive no specific training in the operation of these devices. We investigated the knowledge of junior doctors and nursing staff about pulse oximetry as used on seriously ill patients in a District General Hospital in Exeter, UK. 30 medical or surgical preregistration house officers or senior house officers and 30 staff nurses answered a structured questionnaire. Questions were asked about the theory behind pulse oximetry, factors affecting readings, "normal" values in various patients, values in hypothetical clinical situations, and what training subjects had received. Responses were scored against standard answers from reference texts. 97% of doctors and nurses did not understand how a pulse oximeter worked and were confused about factors influencing readings. Respondents gave a wide range of acceptable saturation values (eg, 90-100% for a fit adult), thus demonstrating poor understanding of physiological principles. There were serious errors made in evaluating saturation readings in hypothetical clinical situations. Only 1 doctor had received formal training in the use of pulse oximetry. Our survey revealed that junior doctors and staff nurses were untrained in pulse oximetry, lacked knowledge of basic principles, and made serious errors in interpretation of readings. Training is needed for staff who use pulse oximeters.

Adult↗
PubMed1994

A population study of food intolerance.

We did a population study to identify the prevalence of reactions to eight foods commonly perceived to cause sensitivity in the UK. A cross-sectional survey of 7500 households in the Wycombe Health Authority area and the same number of randomly-selected households nationwide was followed up by interviews of positive respondents from the Wycombe Health Authority area. Those who agreed entered a double-blind, placebo-controlled food challenge study to confirm food intolerance. 20.4% of the nationwide sample and 19.9% of the High Wycombe sample complained of food intolerance. Of the 93 subjects who entered the double-blind, placebo-controlled food challenge, 19.4% (95% confidence interval 11.4%-27.4%) had a positive reaction. The estimated prevalence of reactions to the eight foods tested in the population varied from 1.4% to 1.8% according to the definition used. Women perceived food intolerance more frequently and showed a higher rate of positive results to food challenge. There is a discrepancy between perception of food intolerance and the results of the double-blind placebo-controlled food challenges. The consequences of mistaken perception of food intolerance may be considerable in financial, nutritional, and health terms.

Adolescent↗
PubMed1994

High altitude headache: treatment with ibuprofen.

Up to half of those who ascend rapidly to altitudes of over 3,000 m may experience symptoms of acute mountain sickness (AMS) and of these some 95% may suffer from high altitude headache. We report the first controlled trial specifically to assess an oral drug therapy for this common symptom. Subjects were 21 members of mountaineering expeditions to similar altitudes in the Bolivian Andes and the Himalayas in Nepal. The study was of a randomized, placebo-controlled, double-blind, within-patient crossover design. Ibuprofen was significantly superior to placebo both in reducing headache severity and in speed of relief (a mean difference of 94 min in time to no/minimal headache). Only 14% of subjects who initially took ibuprofen felt the need for further medication compared to 83% of those who took placebo first (p = 0.02). Of the 11 subjects completing both phases of the crossover, 8 (73%) favored ibuprofen while the remainder had no preference (p = 0.004). No attributable adverse effects occurred. The results suggest that ibuprofen is a safe and effective treatment for high altitude headache.

Altitude Sickness↗
PubMed1993

The nasopharyngeal airway. Assessment of position by fibreoptic laryngoscopy.

Artificial nasopharyngeal airway position and performance were assessed in 120 anaesthetised adult patients. Using a fibreoptic laryngoscope mean distances from nares to larynx were measured at 209 mm (SD 11) in males and 180 mm (SD 11) in females; those from nares to epiglottis were 159 mm (SD 12) in males and 140 mm (SD 11) in females. Nasopharyngeal airways were frequently misplaced, 60% lying beyond the tip of the epiglottis and 13% lodged in the vallecula. Forty-two percent of subjects had clinical evidence of respiratory obstruction. Nasopharyngeal airway compression in the nasopharynx and obstruction by the tongue and soft palate were common causes of respiratory obstruction. Regression analysis revealed that nares-epiglottis length correlated significantly with subject height (t = 3.9, p = 0.0002), but not with three external measurements made around the head and neck. Head flexion and extension resulted in comparatively little relative movement of the nasopharyngeal airway. Nasopharyngeal airway length and diameter should be standardised to optimise performance.

Adolescent↗
PubMed1993

Acclimatization to altitude: effects on arterial oxygen saturation and pulse rate during prolonged exercise at altitude.

Changes in the arterial haemoglobin-oxygen saturation (SaO2) of the blood, in the blood pressure and in the heart rate, were monitored in subjects performing static exercise at an altitude of 3,600 metres before and after an acclimatization period of 28 days during an expedition to the Bolivian Andes. It was found that acclimatised subjects could maintain their SaO2 during prolonged exercise better than non-acclimatised subjects. The pulse rate of acclimatised subjects was consistently lower at the same work level than that of non-acclimatised subjects. Acclimatised subjects were able to reach higher levels of exercise than when they had first arrived at altitude. These data imply that acclimatization to altitude improves the delivery of oxygen to the tissues. The mechanism of this is not certain, but it may be concerned with a reduction in the degree of ventilation-perfusion inequality of the lung which occurs on exposure to high altitude.

Acclimatization↗
PubMed1992

Prolonged resuscitation in acute deep hypothermia.

A case report is described with successful outcome of prolonged cardiopulmonary resuscitation in a 30-year-old man suffering from acute deep hypothermia. His lowest temperature recorded was 23 degrees C. Continuous external cardiac massage was required for a total of 4.5 h whilst rewarming was instituted. The patient eventually left hospital with no permanent sequelae. A review of hypothermia follows, emphasising some important management principals and pitfalls.

Acute Disease↗
PubMed1991

Stress fractures of the hip in Royal Marine recruits under training: a retrospective analysis.

At the Commando Training Centre, Royal Marines (CTCRM), a retrospective analysis of the occurrence of one form of stress fracture--that of the hip--has shown that this fracture is a significant cause of morbidity in the recruits. Most fractures presented in the last few weeks of training, which may reflect the increasing workload that the training involves. Two different fracture sites are identified, but there is no discernible difference in presentation or outcome between them. The condition may be easily misdiagnosed as a more trivial injury. A careful history and examination, and a low threshold for radiographic and scintigraphic investigation are important for diagnosis, and to avoid the catastrophic failure of the fracture seen in one of our patients.

Adolescent↗
PubMed1985

Oxytocin and sexual behaviour in the male rat and rabbit.

In male New Zealand white rabbits, it was shown that oxytocin but not vasopressin concentrations in plasma were markedly raised after ejaculation. In male Wistar rats, oxytocin infused into the internal carotid artery reduced the number of intromissions made before ejaculation but had no other significant effect. Infusion of oxytocin into the third ventricle increased the latencies to the first mount and intromission and lengthened post-ejaculatory refractory periods. It is suggested that oxytocin released into the periphery during coitus, while not essentially involved in ejaculation, may exert effects on the genital periphery. Behavioural effects of centrally administered oxytocin suggest that it may play a role in the neural mechanisms underlying post-ejaculatory refractoriness.

Animals↗