Biomedical subjects
Publications and source records attributed to S B Johnston.
In summary, a patient with multiple coronary aneurysms and operative therapy is described and 17 previously reported similar cases are reviewed. The proper type of operation for this condition is as yet unclear, but, nevertheless, the reported cases and our case with operative therapy have done well postoperatively despite a variety of procedures performed.
A prospective study of liver enzymes and other measurements following repeat administrations of halothane or enflurane was carried out in patients undergoing minor urological operations. The patient populations were similar with respect to frequency of factors which might influence liver function, social habits, drug therapy and time intervals between administrations. Sixty-three received two or more administrations of halothane and 66 received two or more administrations of enflurane, both drugs given with nitrous oxide in oxygen. There was a greater frequency of increased enzymatic activity following repeat administrations of halothane than following enflurane and the average alanine aminotransferase and gamma glutamyl transpeptidase concentrations were increased to a greater degree following halothane than enflurane. There was no change in the eosinophil count and no significant postoperative morbidity. Change in alanine aminotransferase, lactate dehydrogenase and gamma glutamyl transpeptidase occured more frequently in obese patients receiving halothane.
Five hundred patients receiving one of three different formulations of etomidate were observed on the 2nd and 3rd days after operation for possible venous sequelae. The total frequency of sequelae was 8% or more, the greatest being with the propylene glycol formulation (23%). Formulation of the drug and total dose employed were the most important factors influencing venous sequelae, which were not related to pain on injection.
Preliminary analysis of a yet incomplete prospective study of liver enzyme changes following anaesthesia shows less changes following repeated administration of enflurane than of halothane.
Three formulations of etomidate were evaluated in unpremedicated patients undergoing minor gynaecological procedures. There was a high frequency of pain on injection (up to 50%) and excitatory phenomena (up to 95%) with all formulations. The frequency of excitatory phenomena was significantly greater than that after methohexitone. Recovery was rapid, but emetic sequelae were frequent and significantly more marked than after methohexitone.
Three cases of combined heart and kidney transplantation are presented. All three patients suffered from end-stage kidney disease, one chronic glomerulonephritis, two diabetic nephropathy. Ages of the patients were 22, 30, and 39 years, respectively. Two of the patients had the diagnosis of dilated cardiomyopathy and the third had ischemic heart disease. Patient follow-up is from 6 to 30 months. None of the patients have had a heart rejection and only one has had a kidney rejection. Cardiac and renal function remain excellent in all three patients. Glomerular filtration rates range from 53 to 77 ml/min. These three cases are compared with other reported cases in the literature. Combined heart and kidney transplantation may be of benefit in selected persons.