Showing papers by "Leicester Royal Infirmary published in 1984"
TL;DR: Measurements of heart rate, arterial pressure and skin resistance have been used as indirect indices of the level of sympathetic activity to assess both the efficacy of premedication and depth of anaesthesia.
Abstract: Nociceptive surgical stimulation is accompanied by increased hypothalamopituitary activity which is generally referred to as the stress response to injury. This is manifest by a release of trophic hormones from the hypothalamus which in turn stimulate release of ACTH, TSH, GH, FSH, luteinizing hormone and prolactin in addition to ADH from the pituitary. Consequently, there is increased secretion of cortisol and thyroxine with suppression of insulin and increase in blood sugar concentrations. These responses may be partly attenuated by large doses of opioid analgesic drugs and some local anaesthetic techniques used during general anaesthesia. These endocrine changes have recently been reviewed elsewhere (Kaufman 1982, 1984; Weatherill and Spence, 1984). In addition, increased hypothalamic activity induced by nociceptive stimulation is accompanied by increased traffic in sympathetic efferent tracts. This is manifest by the well known signs which are conventionally used to diagnose unduly light levels of anaesthesia — notably dilatation of the pupils, sweating, tachycardia and hypertension. Thus measurements of heart rate, arterial pressure and skin resistance have been used as indirect indices of the level of sympathetic activity to assess both the efficacy of premedication and depth of anaesthesia. Increased sympathetic tone involves augmented release of noradrenaline by presynaptic sympathetic fibres and also increased secretion of catecholamines from the adrenal medulla. Thus attempts have been made for a number of years to assess sympathetic activity \"directly\" by measurement of plasma catecholamine concentrations. Until recently, assays were not available with sufficient sensitivity to measure resting concentrations of plasma catecholamines. However, with the advent of radioenzymatic assay (REA) and, over the past 5-6 years, high pressure liquid chromatography (HPLC) techniques for measurement of catecholamines in plasma, there has been a large
156 citations
TL;DR: It was shown in 1970 that the frequency of regurgitation had decreased to 7.8% and of this number, 8.6% of patients had aspirated, so it is of vital importance that anaesthetists are aware of the effect of the drugs which they use on the LOS.
Abstract: Since Fyke, Code and Schlegel (1956) first demonstrated the existence of a high pressure zone at the lower end of the oesophagus, there has been increasing interest shown in this structure by anaesthetists. This area is termed the lower oesophageal sphincter (LOS) and is the major barrier preventing regurgitation of acid gastric contents into the oesophagus. This is of considerable concern to anaesthetists, as any regurgitated material may be aspirated into the lungs and produce the acid aspiration (Mendelson's) syndrome. It is of vital importance, therefore, that anaesthetists are aware of the effect of the drugs which they use on the LOS. Regurgitation and subsequent aspiration of gastric contents remains a major cause of morbidity and mortality in clinical anaesthesia. The overall mortality from aspiration has changed little over the past 20 years in the U.K. (Edwards et al., 1956; Lunn and Mushin, 1982). In every published study on deaths attributable to anaesthesia, there have been reports of fatalities resulting from vomiting or regurgitation and subsequent aspiration (Harrison, 1978; HoviViander, 1980). The occurrence of regurgitation has been estimated at 14-26% using older techniques of anaesthesia with ether, cyclopropane and uncuffed endotracheal tubes (Culver, Makel and Beecher, 1951; Berson and Adriani, 1954). Of these 7-16% had evidence of aspiration as judged by the appearance of tracer dye in the trachea at laryngoscopy and bronchoscopy. Using contemporary anaesthetic techniques and the same methodology it was shown in 1970 that the frequency of regurgitation had decreased to 7.8% and of this number, 8.6% of patients had aspirated (Blitt et al., 1970).
130 citations
TL;DR: There was not a significant correlation between analgesia and plasma morphine concentration, and this may result from delay in brain penetration by morphine.
Abstract: Sustained-release oral morphine sulphate (MST) 20 mg was administered to 11 healthy volunteers. Mean peak plasma morphine concentration was 14.8 ng ml, and occurred at a mean time of 142.5 min after ingestion. Analgesia by an ischaemic forearm pain test increased to a maximum 40 min after the calculated peak plasma concentration of morphine had been achieved, and remained greater than control values as plasma morphine concentration decayed. However, there was not a significant correlation between analgesia and plasma morphine concentration. This may result from delay in brain penetration by morphine. The mean systemic availability of morphine in the first 7 h after administration of MST was 18.3%
55 citations
TL;DR: The increased plasma noradrenaline levels accompanied by unaltered adrenaline levels suggest that the stimulus exerted by cold does not evoke a generalised stress response, but rather that the sympathetic nervous system is selectively stimulated.
Abstract: SUMMARY
The responses of circulating catecholamines, TSH, thyroid hormones and prolactin to 30 min of acute cold exposure (4°C) were measured in eight normal volunteers over a 2 h period. There was a rise in circulating noradrenaline, TSH, T4 and T3 levels and a fall in circulating prolactin in the subjects studied, but no change in circulating adrenaline levels nor any alteration in the T4/T3 ratio. The thyroid axis of normal individuals can respond rapidly to acute cold exposure. In addition, the increased plasma noradrenaline levels accompanied by unaltered adrenaline levels suggest that the stimulus exerted by cold does not evoke a generalised stress response, but rather that the sympathetic nervous system is selectively stimulated.
48 citations
TL;DR: In this paper, a study of industrial hand injuries describes the nature of commonly encountered injuries, the significance of hand dominance, and the circumstances contributing to the cause of injury, and some recommendations can be made for future prevention and investigation.
Abstract: This study of industrial hand injuries describes the nature of commonly encountered injuries, the significance of hand dominance, and the circumstances contributing to the cause of injury. Although many histories were unique, and the contributory factors correspondingly diverse, some recommendations can be made for future prevention and investigation.
46 citations
TL;DR: Consistent binding patterns have been found for wheat germ agglutinin and peanut lectin, the latter after the use of neuraminidase, and form a useful basis for comparison with the reactivity of malignant breast tissue.
Abstract: Six peroxidase-labelled lectins have been applied to tissue sections of normal, hyperplastic and lactating human breast. The effect of fixation on binding has been assessed by the comparison of specimens treated with a variety of fixatives with frozen material; the effect of trypsin has also been considered. The other objective has been to establish the consistency of lectin reactivity with this non-malignant breast tissue. Fixation has little effect on the binding of wheat germ agglutinin and peanut lectin, although reactivity with the latter was sometimes increased above that seen in frozen material by the use of Bouin's fluid. Trypsinization of formalin-fixed tissue appears to be a prerequisite for staining with soy bean agglutinin and Ulex europeus. The binding of Lotus tetragonolobus and Dolichos biflorus to fixed tissue has been found to be unreliable in comparison to frozen samples. Soy bean agglutinin and Dolichos biflorus, both specific for N-acetyl-D-galactosamine, have binding patterns which vary between specimens and often between themselves. Of the two fucose-binding lectins Ulex europeus has shown a variability of reaction between specimens, whilst Lotus tetragonolobus consistently reacts with ductal and acinar epithelium but with varying intensities. Consistent binding patterns have been found for wheat germ agglutinin and peanut lectin, the latter after the use of neuraminidase. They therefore form a useful basis for comparison with the reactivity of malignant breast tissue.
43 citations
TL;DR: The value of using two lectins with the same major sugar specificity but having different binding affinitics is illustrated in this study, in which differences in behavioural characteristics have been identified between fucose‐containing glycoconjugates having minor structural variations.
Abstract: Tissue sections from 80 human breast carcinomas have been examined for evidence of binding of the two fucose-specific lectins, Lotus tetragonolobus and Ulex europeus I, with enzymes utilized as an indicator system. Both single-staining and double-staining methods (Lotus tetragonolobus-peroxidase and Ulex europeus I-alkaline phosphatase) have been employed. In contrast to normal breast in which there is consistent reactivity of all epithelium with Lotus tetragonologus a variable loss of binding has been found within carcinomas. Surprisingly, this bears no relationship to tumour differentiation; nor does it correlate with local lymph node metastasis. Ulex europeus I has a variable reactivity with carcinomas, as it does with normal breast epithelium, and this likewise has no correlation with differentiation. However, a relationship has been found between specific patterns of binding and axillary lymph node status. The value of using two lectins with the same major sugar specificity but having different binding affinities is illustrated in this study, in which differences in behavioural characteristics have been identified between fucose-containing glyco-conjugates having minor structural variations.
37 citations
TL;DR: The "tie-over" dressing is commonly used in plastic surgical practice and a simple, cheap and effective refinement of this established technique is described, consisting of a flanged disc over which can be slipped a "neoprene" sealing ring.
36 citations
TL;DR: The finding of note has been that of the significant association between heterogeneity of cellular reactivity to WGA and the presence of axillary lymph node metastasis, but a lack of correlation between virtual absence of reactivity and nodal metastasis.
Abstract: The binding of peroxidase-labelled wheat germ agglutinin (WGA) to a series of 125 human breast carcinomas has been studied. Routine fixation and processing has been shown to have no deleterious effect on reactivity. In contrast to the homogeneous binding of WGA to normal and hyperplastic human breast previously reported, the binding of WGA to breast carcinomas exhibits heterogeneity. This is of two forms: (1) in relation to cell reactivity, which is significantly correlated to tumour differentiation, with fewer cells reacting in those carcinomas showing loss of histological differentiation; (2) with regard to the interaction between WGA and specific saccharides of cellular glycan-components, binding to sialic acid appearing to be of significance to varying degrees in some carcinomas but not in others nor, as previously reported, in normal breast. The alteration in WGA-saccharide interaction is an indicator of the heterogeneity of the carbohydrate chains of glycoproteins within neoplastic cells of the same tumour and between carcinomas. The other finding of note has been that of the significant association between heterogeneity of cellular reactivity to WGA and the presence of axillary lymph node metastasis, but a lack of correlation between virtual absence of reactivity and nodal metastasis.
35 citations
TL;DR: Tension on anastomoses can be reduced by care in the administration of neostigmine, and possibly by the use of pethidine rather than morphine for analgesia during and after operation.
Abstract: Many factors influence the outcome after surgery of the bowel. However, care in anaesthetic and postoperative management may help to reduce the frequency of complications. Such care can be directed at maintenance of or improvement in oxygen delivery to the bowel by the avoidance of hypoxia, hypocapnia and hypovolaemia, and by careful selection of drugs and techniques used during anaesthesia. Tension on anastomoses can be reduced by care in the administration of neostigmine, and possibly by the use of pethidine rather than morphine for analgesia during and after operation. Postoperative ileus may be affected by sedative and analgesic therapy.
35 citations
TL;DR: Tissue amyloid P component in normal skin from fetuses and children was studied using direct, fluorescent, immunohistochemical techniques on frozen sections and its role appears to be age or maturity related.
Abstract: The presence of tissue amyloid P component in normal skin from fetuses and children was studied using direct, fluorescent, immunohistochemical techniques on frozen sections. Tissue amyloid P is not detected in fetuses or in children up to the age of 2 years but from the age of 4 years upwards it is readily detected and invariably present. Though the function of human amyloid P is unknown its role appears to be age or maturity related.
TL;DR: This work describes two cases of polyarthritis, one secondary to pulmonary tuberculosis, the other secondary to tuberculous infection of the elbow joint, which rapidly subsided with chemotherapy.
TL;DR: Platelet alpha-adrenoceptor status was examined in patients with myeloproliferative disorders and normal controls by means of radioligand binding studies with 3H-yohimbine and in vitro platelet function tests and a group of 'adrenaline insensitive' MPD patients found to be identical to normal controls.
TL;DR: Findings are consistent with the hypothesis that the inner renal medulla produces a vasodepressor that influences blood pressure in normal rats, and also lowers blood pressure when two-kidney, one-clip hypertension is reversed surgically.
Abstract: The rat renal papilla was selectively destroyed by 2-bromoethylamine hydrobromide; increasing doses produced a graded severity of histological damage, polyuria and a reduction in urinary prostaglandin E2 excretion. Destruction of at least half of the papilla caused significant hypertension, but plasma renin concentration and plasma creatinine did not change. After graded medullary damage Goldblatt two-kidney, one-clip hypertension was induced. Four weeks later the severity of hypertension was similar in medulla-damaged and medulla-intact groups. When Goldblatt two-kidney, one-clip hypertension was reversed by removal of the renal artery clip, the blood pressure fall was less when the inner renal papilla was ablated than when it was intact, although plasma renin concentration and sodium balance were similar. The final blood pressure was similar to that observed in normal rats treated with 2-bromoethylamine compared with their respective controls. These findings are consistent with the hypothesis that the inner renal medulla produces a vasodepressor that influences blood pressure in normal rats, and also lowers blood pressure when two-kidney, one-clip hypertension is reversed surgically.
TL;DR: An unusually severe adverse reaction to carbamazepine is described, in which the patient developed features suggestive of a lymphoma while taking the drug.
Abstract: An unusually severe adverse reaction to carbamazepine is described, in which the patient developed features suggestive of a lymphoma. A pseudo-lymphoma syndrome has been well documented with phenytoin (Saltzstein & Ackerman, 1959). However, to date there has only been one report of this complication with carbamazepine (Taylor, Smith & Hern, 1981), although this drug has been in wide clinical use for many years. We are therefore reporting a patient who developed an illness with features suggestive of a lymphoma whilst taking carbamazepine.
TL;DR: It was unable to demonstrate any modification of basal or TRH-stimulated TSH and prolactin levels by the oral administration of either ketanserin or zimelidine, suggesting that 5-HT has no significant role in the physiological release of either TSH or prolact in euthyroid individuals.
TL;DR: The data demonstrate a number of difficulties in attempting to measure platelet responsiveness by electrical impedance and re-emphasise the need for caution in interpretation of in vitro platelet aggregation studies in terms of their clinical relevance.
TL;DR: It is concluded that the lower (3H)yohimbine binding capacities in sucrose prepared membranes appears to be due to the occupancy of receptor sites by residual norepinephrine in a pseudo non competitive manner.
TL;DR: No similar peak in adrenaline concentration occurred after infiltration with prilocaine/octapressin solutions but with both solutions there was a small increase in plasma noradrenaline and adrenaline concentrations 10 minutes after infiltration, at the time of surgical stimulation.
Abstract: Summary
Plasma catecholamine concentrations were measured in 19 patients allocated randomly to receive submucous infiltration with 4 ml of either 0.5% lignocaine with adrenaline 1:200 000 or prilocaine 0.5% with octapressin 0.03 iu per ml. Venous blood samples were obtained before and at 2, 5, and 10 minutes following infiltration. Plasma adrenaline increased from 0.35 to 1.72 p mol/ml at 2 minutes infiltration with the former solution whilst there was little change in plasma noradrenaline concentration. No similar peak in adrenaline concentration occurred after infiltration with prilocaine/octapressin solutions but with both solutions there was a small increase in plasma noradrenaline and adrenaline concentrations 10 minutes after infiltration, at the time of surgical stimulation.
TL;DR: In similar unpublished studies with preservative-containing morphine solution (IOrng/ml diluted to I mg/ml with 5% dextrose), a trace of apomorphine could be detected after twenty-four hours storage in a plastic syringe, so it would seem advisable to change such infusions every 24 hours.
Abstract: The experience with morphine infusions for sedation and pain relief after cardiac surgery in this hospital has been similar to that described by Dr Bray (Anaesthesia 1983; 38: 10768). However, we have used 0.5 mg/kg morphine sulphate (with preservative) diluted to 50 ml with 5% dextrose starting at 2 ml/hour. We have not been aware of vein irritation although frequently the infusion is run through a central vein. A dilute solution might be more preferable to the use of preservative-free morphine, despite the increased fluid load. Significant deterioration occurs when preservative-free morphine (0.2 mg/ml) is left in a plastic syringe for as little as twenty minutes with the probable formation of apomorphine.’ In similar unpublished studies with preservative-containing morphine solution (IOrng/ml diluted to I mg/ml with 5% dextrose), a trace of apomorphine could be detected after twenty-four hours storage in a plastic syringe, so it would seem advisable to change such infusions every 24 hours.
TL;DR: It seems probable that where unbalanced reciprocal translocations are associated with Prader-Willi syndrome, they will almost invariably be presumptive segregants of the tertiary monosomic form of 3:1 disjunction.
Abstract: A case of Prader-Willi syndrome (PWS) associated with a de novo unbalanced 15q;17q reciprocal translocation presumptively resulting from the tertiary monosomic form of 3:1 meiotic disjunction is described Twenty-three similar unbalanced translocations have been identified from the literature The 24 karyotypes are characterised by having 45 chromosomes, monosomy for the pericentromeric region of chromosome 15 (range pter----q11 to q21), and little monosomy of the recipient (non-15) chromosome Two-thirds of the cases with these karyotypes have phenotypic features of PWS It seems probable that (i) where unbalanced reciprocal translocations are associated with PWS, they will almost invariably be presumptive segregants of the tertiary monosomic form of 3:1 disjunction and (ii) the majority of cases found with this type of karyotype, particularly it appears when de novo in origin, will be associated with phenotypic features of PWS
TL;DR: The results suggest that the renal effects of frusemide are different in healthy elderly subjects as compared to the young, and the delayed and reduced peak response is consistent with fewer nephrons in the elderly kidney.
Abstract: The effect of IV frusemide was studied in six healthy young (mean age 26.5 years, range 21–33) and six healthy old (mean age 72.8 years, range 66–80) volunteers. A 24-h urine collection before frusemide showed no difference in volume and sodium excretion, although the old excreted less potassium. Creatinine clearance was significantly reduced in the older subjects. After frusemide, 20 mg IV, the pattern of sodium and water excretion over a 5-h period was different in the two groups. The peak effect was greater in the young and occurred within the first 30 min, but was delayed to between 30 and 60 min in the old. Thus in the young the time for 50% of the total sodium and water to be excreted was half that in the old. This delay in sodium and water excretion was related to baseline creatinine clearance. However, the total water, sodium and potassium excreted in the 5 h after frusemide did not differ in the two groups. These results suggest that the renal effects of frusemide are different in healthy elderly subjects as compared to the young. The delayed and reduced peak response is consistent with fewer nephrons in the elderly kidney.
TL;DR: The radial artery is one of the less frequently involved siteS5 and disease of this artery is likely to be underdiagnosed and has also a tendency to recur if the cystbearing area is not completely removed.
Abstract: Since its first description in 1947’’ less than 100 cases of cystic adventitial arterial disease have been reported, clinical and radiological diagnosis described and theories proposed for its etiology. The radial artery is one of the less frequently involved siteS5 and disease of this artery is likely to be underdiagnosed .6 It has also a tendency to recur if the cystbearing area is not completely removed.5
TL;DR: The present understanding of the relationship between alpha 2-adrenoceptor occupation and platelet aggregation may be incorrect, according to the results of a comparison with the efficacy of adrenaline induced aggregation in platelet rich plasma.
TL;DR: There was a marked correlation between the degrees of change in body temperature and circulating thyrotrophin levels respectively during warming and manipulation of the diurnal rhythm of body temperature brings about inverse alterations in the thyrotrophic rhythm.
Abstract: 1. The diurnal rhythms of body temperature and serum thyrotrophin (TSH) levels in euthyroid individuals behaved inversely to one another. 2. An artificially induced rise in the body temperature of these individuals was accompanied by a fall in serum thyrotrophin levels, the amplitudes of their respective rhythms decreasing simultaneously. 3. There was a marked correlation between the degrees of change in body temperature and circulating thyrotrophin levels respectively during warming. 4. In normal subjects manipulation of the diurnal rhythm of body temperature brings about inverse alterations in the thyrotrophin rhythm.
TL;DR: A case is reported in which a diver suffered a massive pneumoperitoneum with no evidence of either the gastrointestinal or pulmonary barotrauma.
Abstract: Spontaneous pneumoperitoneum is a recognized if unusual condition complicating gastrointestinal and pulmonary barotrauma. We report a case in which a diver suffered a massive pneumoperitoneum with no evidence of either of the above.
TL;DR: The pattern of outcomes reflected the role that each type of care played in the care of the elderly, and these are discussed.
TL;DR: Although those carcinomas with a staining pattern akin to non‐malignant tissue have a lower incidence of lymph node metastasis it has been the heterogeneous reacting group rather than the weak staining and negative tumours which has shown a higher rate of axillary lymph nodes metastasis.
Abstract: An indirect immunofluorescent method has been used to study the distribution of the membrane protein beta 2-microglobulin in normal, benign and malignant human breast tissue. A uniform staining of epithelial cell membranes has been found in all normal and benign tissues, with only a minor variation in the intensity of reaction between samples. In contrast the carcinomas have shown a variety of reactions, with some behaving in a manner similar to the normal and benign breast tissue, others being heterogeneous with regard to intensity of staining and the remainder having a weak or a negative reaction. The immunohistochemical behaviour of the carcinomas has paralleled the degree of histological differentiation, with poorly differentiated carcinomas showing little reactivity. A comparable relationship with lymph node status has not been found. Although those carcinomas with a staining pattern akin to non-malignant tissue have a lower incidence of lymph node metastasis it has been the heterogeneous reacting group rather than the weak staining and negative tumours which has shown a higher rate of axillary lymph node metastasis. The prognostic significance of this finding is at present uncertain and can probably only be assessed from information about patient survival.
TL;DR: In this paper, the replacement of a surgically avulsed nail as a splint and dressing with "Superglue" is reported, which provides a painless cover for the sterile matrix and facilitates the dressing of finger tip injuries.
Abstract: The replacement of a surgically avulsed nail as a splint and dressing with “Superglue” isreported. It provides a painless cover for the sterile matrix and facilitates the dressing of finger tip injuries.
TL;DR: The effects of pancuronium and vecuronium on the lower oesophageal sphincter pressure were studied in 24 healthy patients anaesthetised with 0.5% halothane in nitrous oxide and oxygen.
Abstract: The effects of pancuronium and vecuronium on the lower oesophageal sphincter pressure were studied in 24 healthy patients anaesthetised with 0.5% halothane in nitrous oxide and oxygen. Following pancuronium 0.1 mg/kg intravenously, there was a significant increase in barrier pressure from a control value of 2.0 (SEM 0.14) kPa to 3.0 (SEM 0.27) kPa 1 minute after injection (p less than 0.05). This increase was sustained throughout the 15 minute period of recording and was accompanied by a significant increase in heart rate (p less than 0.001). Following administration of vecuronium 0.1 mg/kg intravenously there was an initial modest, though not significant increase in barrier pressure. This increase was significant (p less than 0.05) at 15 minutes. There were no cardiovascular changes following vecuronium.