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Biomedical subjects

W J Russell

Publications and source records attributed to W J Russell.

At least 127 records · Page 7Linked to original sources

The role of adrenal medullary catecholamine release in the response to a cold pressor test.

We studied the effects of a cold pressor test on the plasma catecholamine levels of ten patients undergoing coronary angiography, to determine whether the pressor changes were related to adrenergic activity. To investigate the relative contribution of adrenal medullary catecholamine release, we subjected two adrenalectomised volunteers to the same test. Arterial blood was assayed for dopamine (DA), adrenaline (A) and noradrenaline (NA). We found significant rises in the levels of all three catecholamines in the angiography patients, accompanied by a significant elevation in arterial blood pressure. In both the adrenalectomised patients a rise in blood pressure was seen but no significant rise in plasma catecholamines could be demonstrated. We postulate that although adrenal medullary catecholamine release occurs in response to the cold pressor test, the blood pressure elevation is independent of such adrenal activity. Sampling radial arterial blood may not reflect changes in plasma levels of peripherally released NA.

Adrenal Medulla↗

Lorazepam as a premedicant for regional anaesthesia.

In a double-blind controlled trial of male patients undergoing transurethral resection of the prostate, oral lorazepam was assessed against a placebo. The same anaesthetist performed all spinal blocks and made all assessments. The patients who received lorazepam had substantial amnesia for the operation and were drowsier, but remained cooperative during the procedure. Patient anxiety as assessed by the anaesthetist and as recalled by the patient was decreased, although anxiety assessment by linear analogue was the same for both groups. Lorazepam significantly increased the patient acceptability of spinal anaesthesia.

Aged↗

Screening for lung cancer in a fixed population by biennial chest radiography.

All screening radiographs of the chest and other medical records of 107 patients with histologically proved lung cancer in a fixed population were reviewed to assess the efficacy of biennial chest radiography in detecting lung cancer. Radiographic abnormalities caused by tumors were initially detected in 58 patients (54%); the other 49 (46%) were detected radiographically in subsequent examinations. Thirty-six of the 40 solitary tumors were less than or equal to 4.0 cm in diameter when detected. There were no symptoms in 76% of cases, possibly associated with the predominance of peripheral adenocarcinomas. Routine 36 X 43-cm radiographs, postero-anterior stereoscopic and lateral projections, and comparison with previous radiographs facilitated detection of relatively small tumors in asymptomatic patients. The corrected 5-year survival rate from the time of detection was 20%.

Adenocarcinoma↗

The effects of suxamethonium and D-tubocurarine on the pressor and plasma catecholamine responses to tracheal intubation.

Changes in mean arterial pressure (MAP) and plasma catecholamine concentrations in response to endotracheal intubation were examined in 8 patients who had received d-tubocurarine and 10 who had received suxamethonium. MAP fell after induction of anaesthesia and administration of the relaxant by a mean of 11 mmHg in those who had received suxamethonium and 19 mmHg in those who had received d-tubocurarine (p less than 0.05 for each). MAP rose sharply when the trachea was intubated, by a mean of 29 mmHg for the suxamethonium group, and 35 mmHg for the curare group (p less than 0.001 for each). A significant rise in plasma noradrenaline was also noted after intubation in each group, 51% (p less than 0.01) for the suxamethonium group and 28% (p less than 0.05) for the d-tubocurarine. The results suggest that the fall in MAP after administration of d-tubocurarine does not attenuate the pressor response associated with intubation.

Adult↗

Ossification of thoracic ligamenta flava.

Although ligamentum flavum ossification (LFO) often occurs in normal persons, there are no reports of its detection on lateral chest radiographs made during screening examinations. Review of 1,744 consecutive lateral chest radiographs identified LFO in 6.2% of males and 4.8% of females. LFO occurred mainly at the intervertebral segments from T9-T10 through T12-L1. Most prevalent was the hook-shaped LFO, protruding inferiorly from the inferior facets into the projections of the intervertebral foramina. Though LFO can cause severe neurologic symptoms, none of the affected persons in this study reported such symptoms. LFO was first visualized radiographically when the subjects were 20-40 years old, and it may be a physiologic condition. The LFO in these cases existed independent of thoracic posterior longitudinal ligament ossification, diffuse idiopathic skeletal hyperostosis, and degenerative osteoarthritis.

Adult↗

The stability of coagulation factors in stored blood.

The complete coagulation profile of citrate phosphate dextrose (CPD) stored blood has been studied during 21 days storage at 4 degrees C. Ten donations were studied at zero, one, seven, 14 and 21 days. One donation contained small clots and was studied separately. Activities of factors I, II, IX, XII or XIII did not deteriorate significantly. Slight, but clinically unimportant deterioration occurred in factors VII, X and XI. There was marked deterioration in activities of factor V, and factor VIII, the levels decreasing from 1.0u/ml at day zero to 0.51 to 0.30 respectively at day 21. The donation which contained small clots had more marked decreases in factors V and VIII from the first day. The general stability of coagulation factors suggests that even massive blood replacement is unlikely to result in clinically significant coagulation defects.

Anticoagulants↗

Ossification of the thoracic posterior longitudinal ligament in a fixed population. Radiological and neurological manifestations.

Reportedly, ossification of the posterior longitudinal ligament (OPLL) usually involves the cervical spine and often accompanies other ligamentous ossification such as diffuse idiopathic skeletal hyperostosis (DISH). It is considered serious because it sometimes causes severe radiculomyelopathy; however, the present study, based on a fixed population sample, revealed that OPLL of the thoracic spine is nearly always asymptomatic. The prevalence of thoracic OPLL was 0.6%, with three times as many women as men being affected, compared with cervical OPLL which occurs predominantly among men. No marked radiculomyelopathy was observed, nor definite evidence of neurological involvement due to thoracic OPLL. DISH was rare, especially among women.

Adult↗

Platelet counts in stored donor blood.

Platelets were counted in eight units each of one- and three-day-old blood. Counts were done both before and after the blood had passed through a standard 170 micron filter. In the one-day-old blood, platelet counts were within the normal range. The mean count was 237,000 platelets/microlitre. Platelet counts on three-day-old blood were lower, but generally still within the normal range. The mean count was 183,000/microlitre. Only a few platelets were retained by the filter in the transfusion set; about 90% of platelets passed the filter in both the one- and three-day-old blood. It appears that whole blood, anticoagulated with citrate/phosphate/dextrose (CPD), and stored under Australian blood bank conditions retains platelets in sufficient numbers for at least the first three days to be clinically significant. However, it remains to be determined whether satisfactory platelet activity can be expected during this time.

Blood Preservation↗

Pulmonary extraction of catecholamines in critically ill patients.

Plasma catecholamine concentrations in blood obtained simultaneously from the pulmonary and radial arteries of ten critically ill patients have been measured. The mean mixed venous concentrations of noradrenaline, adrenaline and dopamine were extremely high, noradrenaline 11.3 pmol/ml (SD 11.6), adrenaline 2.7 pmol/ml (SD 3.0) and dopamine 7.1 pmol/ml (SD 12.3). An appreciable drop in the concentrations occurred as the blood passed from the pulmonary artery to the radial artery (mean fall 24.1, 29.7 and 45.8% respectively). Four patients receiving a therapeutic dopamine infusion were also studied and demonstrated similar trends in catecholamine concentrations. The results suggest a substantial pulmonary clearance mechanism for all three catecholamines.

Aged↗

Fresh autologous blood transfusion and platelet counts after cardiopulmonary bypass surgery.

The effect of fresh autologous blood transfusion on platelet count and blood requirement in the early postoperative period is examined in a control group and in patients receiving early and late autologous replacement. Withdrawal of blood in the autologous groups appeared to enhance platelet numbers as the autologous groups had higher mean platelet counts than the control group immediately after bypass, in spite of having lower mean haematocrit. After bypass all groups showed a progressive rise in platelet count with time. A substantial part of the rise was explained by haemoconcentration resulting from fluid shifts but there was also an increase in the total circulating platelet numbers. There was no difference in postoperative blood loss between the three groups. Autologous blood replacement hastens the postoperative rise in platelet count but does not alter the postoperative blood loss.

Blood Transfusion, Autologous↗

Computed tomography of posterior longitudinal ligament ossification: its appearance and diagnostic value with special reference to thoracic lesions.

An earlier review of the lateral chest radiographs of 8,610 Hiroshima and Nagasaki Adult Health Study subjects revealed 48 persons with posterior longitudinal ligament ossification (PLLO) in the thoracic region. Seven additional PLLO cases detected outside that observation period brought the total to 55. Among them, 15 patients with neurological signs and/or the greatest degree of thoracic PLLO were selected for computed tomography (CT) of the spine in the present study. Computed tomography proved extremely valuable in identifying the location, shape, and severity of PLLO. In two cases, CT differentiated some lesions previously regarded to be PLLO as actually due to hypertrophic margins of vertebral bodies. Possible explanations are included for the development of the laminated or tandem type PLLO, and PLLO that is located laterally rather than in midline.

Aged↗

Position of patient and respiratory function in immediate postoperative period.

Respiratory function was studied in 19 patients placed in both the supine and sitting positions in the early postoperative period. Although the sitting position was expected to improve respiratory function, no such advantage was found; instead, a small but statistically significant deterioration in arterial oxygenation was found in most patients when sitting up. It is concluded that no respiratory benefit should be expected from sitting patients up in the early postoperative period.

Adolescent↗

Changes in plasma catecholamine concentrations during endotracheal intubation.

The changes in arterial pressure and arterial concentrations of noradrenaline, adrenaline and dopamine were monitored in 16 patients undergoing endotracheal intubation. Significant increases in mean arterial pressure and plasma noradrenaline were noted. The increases in arterial pressure were associated with increases in noradrenaline concentrations. Adrenaline and dopamine concentrations did not change significantly following intubation. The results suggest a predominantly sympathetic response during intubation and the need for prophylaxis in patients at risk.

Adult↗

Calculating clocks in clinical anaesthesia.

The modern electronic calculating clocks make possible a new approach to timing rates and events in clinical anaesthesia, particularly the accurate timing of short intervals such as respirator cycles and pulse rates. It also allows alarm reminders for set time intervals.

Anesthesia↗

Sparks, low voltage sources and flammable anaesthetics.

Battery operated laryngoscopes have two types of switching, one of which could cause an external spark. Laryngoscopes normally supply 2.8 volts and 0.67 amps, which theoretically gives ample energy for ignition of a cyclopropane/oxygen mixture. Attempts were unsuccessful to ignite a stoichiometric mixture of 17% cyclopropane in oxygen by breaking resistive circuits having up to 5.8 volts and 9.2 amps. It appears extremely unlikely that the common battery-powered laryngoscope can ignite a flammable mixture by sparking when being switched off.

Anesthetics↗