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N J Everitt

Publications and source records attributed to N J Everitt.

At least 19 recordsLinked to original sources
PubMed1999

Effect of prolonged infusion on vein calibre: a prospective study.

Infusion thrombophlebitis is common and is the principal limitation to intravenous nutrition (IVN) via a peripheral vein, yet its precise pathogenesis is unclear. Prospective observations were performed on patients in whom a hypertonic, acidic, nutritional emulsion was infused via fine-bore polyurethane catheters placed in peripheral veins. B mode ultrasound was used to determine vein calibre and proved to be a useful means for serial examination during intravenous infusion. Contrary to previous reports, no evidence of venospasm was observed. It is suggested that previous evidence of venoconstriction is erroneous and that other mechanisms are responsible for thrombophlebitis.

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PubMed1997

Ultrasonographic investigation of the pathogenesis of infusion thrombophlebitis.

BACKGROUND: Thrombophlebitis frequently complicates intravenous infusion, but its precise pathogenesis remains unclear. METHODS: Serial B mode ultrasonographic imaging was used to detect intraluminal thrombosis when intravenous nutrition was delivered via fine-bore catheters inserted into peripheral veins. RESULTS: Thrombus was detected in 14 of 22 catheterized veins. There were nine episodes of clinical phlebitis; each was associated with intravenous thrombosis. Venospasm was not observed. The time at which thrombus was first detected varied from within 24 h to more than 15 days after catheterization. Detection of intravenous thrombosis within 24 h of catheter insertion was associated with early catheter complications. Early thrombus tended to be found close to the site of venepuncture, whereas late thrombus was found at the catheter tip, where the hypertonic feed was delivered. DISCUSSION: Ultrasonographic imaging was a useful technique for investigation of infusion thrombophlebitis. Two patterns of thrombosis were observed: distal early thrombosis and proximal late thrombosis. Information acquired may help in the design of novel catheters and strategies to reduce the incidence of thrombophlebitis.

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PubMed1997

Influence of fine-bore catheter length on infusion thrombophlebitis in peripheral intravenous nutrition: a randomised controlled trial.

Previous studies indicated that the risk of thrombophlebitis associated with continuous infusion of intravenous nutrition (IVN) via peripheral veins was reduced when fine-bore catheters, inserted to 15 cm, were used in place of standard intravenous cannulas. An explanation has not been identified, but may be owing to the greater length of the catheters. A randomised controlled study was performed in which a standard nutritional solution was infused via 22G polyurethane catheters inserted to a length of either 5 cm or 15 cm. Catheters were reviewed twice each day and removed when complications occurred, or when IVN was no longer required. There was no significant difference in median time to thrombophlebitis or extravasation, or in daily risk of thrombophlebitis, between insertion lengths. Survival proportions were similar for each length at all times. Catheters inserted into cephalic veins were more prone to thrombophlebitis or extravasation (nine episodes, 14 catheters) than catheters inserted into basilic veins (five episodes, 24 catheters, P = 0.009). The survival proportion was at all times greater when catheter tips lay in basilic veins. Thus, the risk of thrombophlebitis or extravasation was not influenced by the length of catheter within the vein. However, the vein in which the catheter tip lay appeared to influence the development of morbidity.

Adult↗
PubMed1997

An alternative database for the computerised surgical logbook.

A computerised surgical logbook has many advantages, but some may find the prospect of database design daunting. In this paper the author hopes, by description of his own logbook, to encourage the computer-wary. Jargon is explained, and the fundamental steps necessary to create a computerised logbook are outlined. Consideration is given to coding of operative procedure, and to the future of computerised logbooks in training.

Database Management Systems↗
PubMed1995

Influence of laparoscopic and conventional cholecystectomy upon cell-mediated immunity.

Surgery, trauma and anaesthesia induce a state of transient immunosuppression. Laparoscopic cholecystectomy has several well documented clinical advantages over traditional cholecystectomy and provokes a lower acute phase response, thought to be a result of the smaller wound size. The influence of laparoscopic cholecystectomy (21 patients) and conventional open cholecystectomy (13 patients) upon components of the cell-mediated immune system was investigated. Cell-mediated immunity was studied by in vitro assays of T lymphocyte proliferation to different mitogens, and by natural killer cell cytotoxicity using a standard 51Cr release assay. Blood samples were taken before and 24 h after the start of the operation. In the sample taken after operation there was significant depression of T lymphocyte proliferation to phytohaemagglutinin (stimulation index 149.4 versus 33.3, P < 0.002), staphylococcal enterotoxin B (85.2 versus 52.6, P = 0.01) and toxic shock syndrome toxin (48.4 versus 14.8, P = 0.08) in the group of patients who underwent open surgery, but not in the group treated by laparoscopic surgery. There was a small but statistically insignificant decrease of natural killer cell cytotoxicity in both groups of patients. These findings suggest that laparoscopic cholecystectomy causes less depression of cell-mediated immunity than open cholecystectomy.

Adult↗
PubMed1995

Psychiatric consequences of radical curative surgery for gastric cancer.

Radical resection of gastric cancer offers the best hope of cure, but carries the risk of significant psychological morbidity in addition to the well-documented physical complications. In the case presented, recognition of clinical depression after thoracoabdominal gastrectomy enabled successful psychological intervention.

Anxiety↗
PubMed1993

Evaluation of current practices in routine preoperative crossmatching for transurethral resection of the prostate.

Increasing demand for blood during elective surgery has led to attempts to rationalize routine preoperative crossmatching to those operations when there is a reasonable (greater than 30%) chance of it being required. Results of a questionnaire returned by 86% of the urology units in Great Britain show that 41% continue to crossmatch 2 units of blood before transurethral prostatectomy. A review of 301 transurethral prostatectomies performed with preoperative grouping and saving of blood showed that only 11% of the patients required transfusion. The need for transfusion was significantly associated with presentation in chronic or acute on chronic retention (p < 0.01), and the operative factors of weight of resection (p < 0.0001) and degree of hemostasis (p < 0.001). Therefore, a policy of routine preoperative blood grouping and saving is safe, and could be widely adopted, leading to financial saving and a decrease in wastage of blood that becomes too old to use.

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