Biomedical subjects
S Faulkner
Publications and source records attributed to S Faulkner.
Hypoplasia of the left ventricle: rare cause of postoperative mortality in tetralogy of Fallot.
Severe left ventricular hypoplasia in tetralogy of Fallot is a rare complication. A case history of a 3 year old child who died after attempted repair of tetralogy is presented. Left ventricular end-diastolic volume was 26 ml/m2 (only 45 percent of predicted normal) after repair with normal filling pressure and no evidence of tamponade. Clinical examination, chest X-ray film, electrocardiogram and qualitative assessment of a preoperative left ventriculogram were not useful in assessing this degree of left ventricular hypoplasia; quantitative determination of left ventricular volumes is required for this purpose. When left ventricular end-diastolic volume is less than 55 percent of predicted normal, a shunt procedure may be indicated as an initial procedure with subsequent repair 1 to 2 years later, after left ventricular enlargement.
Prolongation of anesthetic action by BNPP (bis-[p-nitrophenyl] phosphate).
Bis-[p-nitrophenyl] phosphate, BNPP, an enzyme inhibitor of the organophosphate class, has been used to inhibit the enzyme, carboxylic ester hydrolase EC 3.1.1.1. Esterases play a major role in the rapid metabolism of propanidid in vivo; in fact, the short duration of action of this intravenous anesthetic agent is due to this rapid hydrolysis. The duration of anesthesia with propanidid alone in healthy mongrel dogs was 10.1 +/- 2.1 (SEM) minutes. When the dogs were pretreated with BNPP, propanidid anesthesia time was prolonged to 38.2 +/- 7.9 (SEM) minutes. Measurements of serum propanidid concentration demonstrated that prolonged high levels of propanidid were associated with the extended anesthesia time. Therefore, BNPP can significantly alter the anesthetic action of propanidid by inhibition of the enzyme system responsible for the rapid hydrolysis of the agent. The experimental model used in the present study provides a means for investigation of effects of certain drugs when their metabolism is impaired.
Prolonged respiratory support in animals using veno-venous bypass and a spiral coil membrane respirator.
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Idiopathic subglottic stenosis.
A 2 1/2-year-old child was found to have subglottic stenosis with no obvious etiology. He initially responded well to dilatation, injection of triamcinolone and intermittent stenting of the airway, but four months later developed a marked, unyielding subglottic stenosis requiring tracheostomy. He had a gradual good response to dilatations and injections with triamcinolone and acquired a good subglottic lumen. However, he developed a recurrence following an episode of croup. Systemic steroids were added to the regimen leading to gradual resolution of the stenosis and successful decannulation. The embryogenesis of subglottic stenosis and the correlation with the known anatomy and histology are discussed. Subglottic stenosis may be congenital, traumatic, inflammatory, neoplastic or neurogenic. An additional group of patients has no obvious etiology and are classified as idiopathic. Treatment consists of various combinations of stents, systemic and intralesional steroids, dilatations and various operative procedures in the more refractory cases.