Search PubMed⌕ Search

Biomedical subjects

R A Wheeler

Publications and source records attributed to R A Wheeler.

33 records · Page 2Linked to original sources
PubMed1991

Use of the appendix in reconstructive surgery: a case against incidental appendicectomy.

Ignored for years, the appendix is once again being promoted as having useful surgical potential, notably in the management of incontinence. Incidental and prophylactic appendicectomy with their established complications become less easy to justify as the incidence of appendicitis declines. The role of the appendix in reconstructive surgery is reviewed, with particular reference to urinary reconstruction and to the treatment of chronically constipated or faecally incontinent children by use of the antegrade continence enema.

Appendectomy↗
PubMed1991

Urea production and recycling in neonates.

Urea represents 15% of the nitrogen in breast milk, but its functional significance is unclear. We have proposed that the urea may be utilised as a valuable source of nitrogen in neonates. We report the first measurements of urea kinetics in newborn, full-term infants. Six neonates received a continuous nasogastric infusion of 15N15N-urea over 24 hours. Urine was collected every 2 hours and the isotopic enrichment in urea was measured by mass spectrometry. Urea kinetics were calculated by the method of Jackson. The urea production rate was 17.3 mmol/kg/d (range, 15.6 to 19.2), but the urinary urea excretion rate, 3.5 mmol/kg/d (range, 1.2 to 4.9), was only 20% of production. Hence, 80% of urea produced was hydrolysed in the colon and the nitrogen made available for further metabolism. These data show that urinary urea excretion is a poor indication of urea production in the newborn and that there is substantial salvaging of urea nitrogen by the colon.

Body Weight↗
PubMed1991

The retrograde tunnel: a method for the fixation of central venous catheters in the military environment.

Central venous catheters (CVCs) are prone to accidental removal during patient transportation. Of the casualties who require transfer between medical facilities, those with CVC in situ require additional vigilance to prevent loss of the CVC, which continues to occur despite various methods of fixation. The fashioning of a subcutaneous tunnel has become an integral part of the placement of central venous catheters. Several methods have been described, but the long-term CVCs in paediatric practice pose special problems, particularly that of the patients continually testing the CVCs fixation. Using a new polyurethane CVC, a retrograde tunnelling technique has been developed which affords immediate and secure fixation. We propose that this CVC, together with the technique of retrograde tunnelling, is the solution to inadvertent central venous line removal during patient transfer.

Adolescent↗
PubMed1990

Feeding regimens after pyloromyotomy.

In a prospective randomized study three different feeding regimens after operation were compared in 74 babies with infantile hypertrophic pyloric stenosis: gradual regarding of feeds over 48 h (regimen 1), rapid regarding of feeds over 16 h (regimen 2), and initial starvation followed by full normal feeds at 24 h (regimen 3). No significant difference between the treatment groups was found either in episodes of vomiting after operation (regimen 1, 2.9 episodes in 21 patients; regimen 2, 3.6 episodes in 28 patients; regimen 3, 3.6 episodes in 25 patients) or in the mean duration of postoperative hospital stay (regimen 1, 59.3 h; regimen 2, 47.8 h; regimen 3, 56.7 h). We conclude that vomiting following pyloromyotomy is self-limiting and independent of the timetable or composition of the postoperative dietary regimen.

Enteral Nutrition↗
PubMed1990

Surgical presentation of Kawasaki disease (mucocutaneous lymph node syndrome).

Five patients with Kawasaki disease (mucocutaneous lymph node syndrome) are reported whose varied presentations included acute abdominal pain, peripheral arterial aneurysms, digital gangrene and sterile pyuria and whose presenting pathology ranged from hydrops of the gallbladder to enteric pseudo-obstruction. As the complications of the disease can usually be managed without resort to surgery, which is associated with a mortality rate of up to 25 per cent, the recognition of Kawasaki disease will prevent hazardous and unnecessary laparotomy.

Abdominal Pain↗
PubMed1990

Life-threatening complications during anaesthesia in a patient with a ventriculo-atrial shunt and pulmonary hypertension.

A 6-year-old patient with hydrocephalus who underwent revision of a ventriculo-atrial shunt is described. Anaesthesia was complicated by the occurrence of systemic hypertension and arterial hypoxaemia. The patient was subsequently found to have pulmonary hypertension secondary to recurrent pulmonary thromboembolism. The pathophysiological mechanisms for the patient's deterioration are discussed and the anaesthetic management of children with pulmonary hypertension is outlined. It is concluded that patients with a ventriculo-atrial shunt who present for surgery should be screened carefully for the presence of pulmonary hypertension.

Anesthesia, General↗
PubMed1986

Gastric neurofibroma in an adolescent.

A 14-year-old white girl with a large, bleeding, ulcerated mass of the stomach was treated with surgical excision. Histologically, the mass was a plexiform neurofibroma. These tumors are uncommon, especially in the pediatric age group, and are best treated by surgical resection.

Adolescent↗
PubMed1981

Proposed standards for professional health sciences library services in hospitals of New York State.

Hospital libraries are considered to be the basic unit of the medical information system. A major statewide effort was begun in 1978 to introduce and support legislation in the New York State Legislature which would encourage hospitals to establish and maintain libraries that meet minimum services standards. Included in this legislation is the concept that the Commissioner of Education in consultation with the Commissioner of Health shall have the power to establish standards for hospital libraries. The Ad Hoc Committee for the Promotion of Hospital Library Services, Western New York Library Resources Council, proposes The Standards for Professional Health Sciences Library Services in Hospitals of New York State to clarify and to strengthen existing hospital library standards. These standards differ specifically from the Joint Commission on Accreditation of Hospitals standards in that they place equal and specific emphasis on eleven points: administration, qualifications of library staff, continuing education of library staff, requirement for a library advisory committee, required library services, required library resources, library space requirements, library budget, library network and consortium membership, documentation of library policy, and continued evaluation of the needs of the hospital for library service. Detailed interpretations are provided. An appendix describes the qualifications of a hospital library consultant.

Libraries, Hospital↗
PubMedDate not supplied

Retrograde tunnel: a method for the fixation of long-term pediatric central venous catheters.

The fashioning of a subcutaneous tunnel has become an integral part of the placement of central venous catheters (CVC). Several methods have been described, but the long-term CVCs in pediatric practice pose special problems, particularly that of the patients continually testing the CVC's fixation. A polyurethane CVC is used that has not been previously described in pediatric usage and a retrograde tunneling technique has been developed which affords immediate and secure fixation.

Catheterization, Central Venous↗
PubMedDate not supplied

Cuff Cath: an initial experience of cuffed polyurethane central venous catheters in children.

The tendency of medium- and long-term silicone central venous catheters (CVCs) to block, fracture, and become displaced has led to the evaluation of a polyurethane CVC, Cuff Cath (Viggo Spectramed, Swindon, Wilts, United Kingdom) as a possible alternative because polyurethane is smoother and stronger. We report the first prospective study of polyurethane cuffed CVCs in children. Sixty Cuff Caths were placed in 53 children, mean age 4.7 years (range, 4 days to 16.3 years), mean weight 15.6 kg (range, 3.1 to 58 kg). All CVCs were tunnelled (mean tunnel length, 12 cm; range, 5 to 20 cm) and inserted either into the subclavian vein (n = 28) or internal jugular vein (n = 32). In a total of 6363 catheter days (mean, 111 days per patient; range, 15 to 364 days), three (5%) CVCs had to be removed because of sepsis and one (2%) because of blockage. All other Cuff Caths remained patent to infusion and blood sampling. No Cuff Caths were pulled or fell out, fractured, or migrated. This study demonstrates significant advantages of polyurethane compared with previous series using silicone CVCs with respect to blockage, fragmentation, and dislodgement. A prospective, randomized, controlled trial of Cuff Cath compared with a silicone CVCs in children is required.

Adolescent↗