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Biomedical subjects

P Cullen

Publications and source records attributed to P Cullen.

102 records · Page 6Linked to original sources
PubMed1975

Treatment of flail chest. Use of intermittent mandatory ventilation and positive end-expiratory pressure.

For the past two years we have treated patients with flail chest injuries and concomitant respiratory failure with intermittent mandatory ventilation (IMV) and positive end-expiratory pressure (PEEP). Prior to 1972 these patients were treated with controlled mechanical ventilation (CMV) until gross flailing ceased and inspiratory force and vital capacity measurements were adequate. We retrospectively studied the charts of 37 consecutive patients to compare the length of mechanical ventilatory support of patients managed by conventional CMV with those ventilated with IMV and PEEP. The mean ventilation time of patients treated with IMV and PEEP (5.1 +/- 4.7 days) was significantly less than that of the patients treated with CMV (18.8 +/- 14.4 days) (P less than .001).

Accidents, Traffic↗
PubMed1975

HL-A antigen frequencies in myeloma.

The frequency of HL-A antigens was determined in 63 myeloma patients and in 83 normal subjects. HL-A5 was more frequent among patients (15.9%) than among controls (3.6%). This association was significant at the 0.05 level, but the significance did not survive multiplication by the number of antigens under study. The relationship of these findings to previous work on myeloma is discussed, together with the problems of defining components of the 4c antigenic group.

Adolescent↗
PubMedDate not supplied

Results from a new renal transplantation unit.

158 kidneys, 9 from living related donors and 149 from cadavers, have been transplanted in the first 42 months of the establishment of a transplant unit at Oxford. Patients' ages ranged from 11 to 56 (mean 35) years. Azathioprine and prednisolone alone were used for immunosuppression, and a minimum-transfusion policy was in operation throughout. After cadaveric transplantation actuarial patient-survival is 70% and 68%, respectively, at the same intervals. 85% of patients who had a functioning graft are fully rehabilitated. Matching for HLA-DR, pregraft blood-transfusions, and the finding that a transplant could be performed in the presence of a positive B-cell crossmatch have proved to be the most significant of the many factors examined both prospectively and retrospectively. The function of the unit is based on dialysis and transplantation for all patients in end-stage renal failure, with transplantation being considered the first line of treatment for patients under the age of 56. The results of transplantation reported here, which have been achieved with conventional immunosuppressive therapy and minimum-transfusion policy, might be considered a standard against which modifications of the practice of renal transplantation can be compared.

Adolescent↗
PubMedDate not supplied

An issue of conflicting rights: nursing student charged with drug trafficking.

One semester before graduation, a nursing student was charged with a class A felony for drug trafficking. The nurse administrator recommended to university administration that the student be suspended from all clinical activity until charges were resolved. Initially, a summary action was issued by university administration to support this recommendation. A summary disciplinary action allows for temporary suspension of a student charged with misconduct when the student's presence threatens harm to the student or any other person. However, after legal review, the summary action was rescinded based on the complexity of conflicting interests and rights that required consideration and protection. The law provides some guidance but lacks the specificity to move an issue like this from equivocal to unequivocal in a short time frame. Consequently, the student was allowed to complete the program. Shortly after commencement, the graduate was convicted. In retrospect, it was found that ample case law exists allowing for a more aggressive defense of a summary action then had been taken. As pointed out in Krasnow v. Virginia Polytechnic Institute (1976), standards of student conduct established by a university may prohibit action that interferes with the mission or functions of the institution, and these standards may go beyond standards established by criminal law and may require greater ethical or moral behavior. Being prepared for situations such as the one presented here requires that schools have in place clearly defined policies and procedures that assure due process, allow for disciplinary action, reduce time and energy required to resolve conflicts, and assure consistent and fair outcomes.

Civil Rights↗
PubMedDate not supplied

Pressure immobilisation bandages in first-aid treatment of jellyfish envenomation: current recommendations reconsidered.

OBJECTIVE: To evaluate whether applying pressure equivalent to that of pressure immobilisation bandages (PIB) causes release of additional venom from discharged jellyfish nematocysts. DESIGN: In-vitro experiment--the venom beads released from electrically activated Chiropsalmus sp. nematocysts were viewed under direct microscopy before and after applying 40 mmHg pressure (replicating the pressure of PIB); and saline washings of discharged nematocysts before and after applying pressure were tested for toxicity (time to ventricular standstill after injecting into live prawns). RESULTS: Applying 40 mmHg pressure caused the venom beads to visibly increase in size, consistent with pressure expressing further venom from the discharged nematocysts. First washings of the nematocyst shafts before compression produced ventricular standstill in prawns within 60 seconds (n=3); second washings did not produce standstill during 540 seconds of observation (n=3); and washings after applying 40 mmHg pressure showed a return of toxicity, with ventricular standstill in all prawns within 180 seconds (n=3). CONCLUSION: Discharged nematocysts are by no means empty and harmless. Applying pressure results in further release of nematocyst venom. The currently recommended practice of applying PIB in the initial treatment of patients stung by a jellyfish may exacerbate the envenomation, and thus should not be recommended.

Animals↗