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Biomedical subjects

M Kinirons

Publications and source records attributed to M Kinirons.

25 records · Page 2Linked to original sources
PubMed1990

Familial adult medullary cystic disease with spastic quadriparesis: a new disease association.

We present two cases of familial adult medullary cystic disease with spastic quadriparesis, an association not previously described. Previous extrarenal associations of the nephronophthisis-medullary cystic disease complex were reported exclusively in childhood cases. Both patients have undergone successful cadaveric renal transplantation, with no evidence of their renal disease recurring. Further work is needed to elucidate the complex genetics of nephronophthisis.

Abnormalities, Multiple↗
PubMed1989

Heart rate and metabolic response to competitive squash in veteran players: identification of risk factors for sudden cardiac death.

We studied 10 older males during a competitive game and the early post-exercise period to define the metabolic response to squash in veteran players. For comparison, all subjects were also studied during exhaustive treadmill exercise. Squash caused a dramatic increase in heart rate (150%), and circulating levels of noradrenaline (164%), adrenaline (93%), lactate (202%) and free fatty acids (67%). These effects were independent of haemoconcentration. The early post-exercise period (5 min) was characterized by persistent elevation of plasma catecholamines, lactate, and free fatty acids, hypokalaemia and ventricular arrhythmias. The heart rate and metabolic responses to squash were similar in pattern and magnitude to those observed during treadmill exercise, highlighting the strenuous nature of squash as a recreation sport. While these changes may represent appropriate physiological adaptation to exercise in health, each has been implicated in the pathogenesis of fatal ventricular arrhythmias in subjects with ischaemic heart disease. These data support the contention that squash may be an inappropriate form of exercise for older men with coronary artery disease.

Arrhythmias, Cardiac↗
PubMed1988

Clinical findings in 12 patients with MPS IV A (Morquio's disease). Further evidence for heterogeneity. Part II: Dental findings.

Typical dental changes were present in all cases, although they were of variable degree. However, the tooth morphology would appear to be highly specific for MPS IV A, and is not found in MPS IV B (beta-galactosidase deficiency) or the recently delineated MPS IV C (enzyme defect unknown). Thus the dental changes have a very useful diagnostic potential in mild atypical cases of MPS IV A, although they may only be demonstrable radiologically in some such cases.

Adolescent↗
PubMedDate not supplied

Cardiopulmonary resuscitation: doctors and nurses expect too much.

Doctors and nurses in the UK and US have an over-optimistic view of patients' chances of surviving an attempt at cardiopulmonary resuscitation (CPR). If medical staff are to follow the recommendation that they should discuss the pros and cons of CPR with patients and their relatives, they should at least be able to give them realistic expectations of survival; otherwise inappropriate decisions may be made. Resuscitation training programmes should routinely include data on survival from CPR in differing circumstances.

Cardiopulmonary Resuscitation↗
PubMedDate not supplied

Does audit improve DNR decision making?

The use of 'do not resuscitate' (DNR) orders in hospitals has been the subject of considerable comment in both the medical and the lay press. Guidelines have been produced to help make DNR decisions but, as yet, there have been no published accounts of these in practice. We have used audit to accounts of these in practice. We have used audit to develop DNR policy in our hospital, and have reviewed practice after the introduction of guidelines. This led to early consultant involvement in making decisions in 55 of 80 patients (69%) who were assessed as DNR at the time of death or discharge, documentation of reasons for DNR in all 55 of these and documentation of discussion with nurses in 49 (89%). Consultants agreed with DNR decisions made by their juniors in 31 of 34 cases (91%) and changed 'for CPR' decisions to DNR in 24 of 108 (22%). We have demonstrated that audit is an appropriate way to change and develop practice in sensitive areas such as this.

Adolescent↗
PubMedDate not supplied

When can elderly patients be excluded from discussing resuscitation?

Case notes of elderly medical patients were surveyed to determine when "do not resuscitate' (DNR) decisions could legitimately be made without consulting them. Patients were thought to be suitable for exclusion from decisions if morbidity scores indicated that they were unlikely to survive cardiopulmonary resuscitation (CPR) or if they were mentally incompetent. Thirty per cent of all patients were predicted not to survive CPR; another 28% were deemed incompetent. Of those with DNR decisions, 59% were predicted not to survive and a further 24% were incompetent. Discussing resuscitation would have been appropriate with 17% of those with DNR decisions.

Advance Care Planning↗