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Biomedical subjects

A Batchelor

Publications and source records attributed to A Batchelor.

At least 19 recordsLinked to original sources
PubMed2006

Phaeochromocytomas presenting as acute crises after beta blockade therapy.

OBJECTIVE: Phaeochromocytoma crisis is a life-threatening emergency that may be undiagnosed because of its numerous, nonspecific manifestations. We analysed, retrospectively, the presentation, management and outcome of patients who were admitted to our institution with phaeochromocytoma crises over a 5-year period. RESULTS: Five patients (two males, three females; mean age 34.6 years, range 19-51 years) who presented as emergencies requiring intensive care, with multiple non-specific manifestations and previously undiagnosed pheochromocytoma, were identified. The initial presentation included features of cardiomyopathy (n = 3), atypical pneumonia with myocarditis (n = 1) and acute abdomen (n = 1). Only one of the five cases had a raised blood pressure at the time of the acute presentation. Initiation of beta blockers in four patients was associated with further deterioration in haemodynamic status, labile blood pressure and cardiac arrhythmias, which led to the diagnosis of the underlying phaeochromocytoma. Following intensive supportive therapy and alpha blockade, all five patients recovered and underwent elective surgical removal of phaeochromocytoma, uneventfully. CONCLUSION: Unexplained cardiopulmonary dysfunction, particularly after the institution of beta blockers, should alert clinicians to the possibility of phaeochromocytoma. A high index of suspicion is essential to reduce morbidity and mortality in these patients through early diagnosis and aggressive management.

Acute Disease↗
PubMed2004

Management of iatrogenic lower limb ischaemia in children.

An acutely ischaemic lower limb following femoral artery cannulation in children is a problem infrequently encountered by plastic surgeons in the UK. When such a case presented to us, we performed a search of published literature to guide us to the optimum treatment. This included methods for extraperitoneal exposure of the common iliac artery and vein. We describe the surgical technique that we used to salvage an acutely ischaemic lower limb following femoral puncture and a review of the literature.

Age Factors↗
PubMed2002

Pharmacological salvage of a combined distal bypass and free flap with catheter-directed thrombolysis.

With recent improvements in microvascular techniques, the use of combined distal bypass and free-flap transfer has been advocated for salvaging the critically ischaemic limb in extreme conditions. Distal bypass, however, carries an inherent risk of graft failure due to thrombosis, and this may threaten the viability of the free flap and, indeed, the lower limb. We present the case of a 66-year-old man with acute-on-chronic ischaemia of his left leg and rectus abdominis free flap. Despite a prolonged ischaemic time of 72 h, both were successfully salvaged using catheter-directed recombinant tissue plasminogen activator. This is previously unreported in the literature.

Aged↗
PubMed2001

Peri-operative risk factors for acute lung injury after elective oesophagectomy.

Acute lung injury after oesophagectomy is well recognized but the risk factors associated with its development are poorly defined. We analysed retrospectively the effect of a number of pre-, peri- and post-operative risk factors on the development of lung injury in 168 patients after elective oesophagectomy performed at a single centre. The acute respiratory distress syndrome (ARDS) developed in 14.5% of patients and acute lung injury in 23.8%. Mortality in patients developing ARDS was 50% compared with 3.5% in the remainder. Features associated with the development of ARDS included a low pre-operative body mass index, a history of cigarette smoking, the experience of the surgeon, the duration of both the operation and of one-lung ventilation, and the occurrence of a post-operative anastomotic leak. Peri-operative cardiorespiratory instability (measured by peri-operative hypoxaemia, hypotension, fluid and blood requirements and the need for inotropic support) was also associated with ARDS. Acute lung injury after elective oesophagectomy is associated with intraoperative cardiorespiratory instability.

Analysis of Variance↗
PubMed2001

Circulating endothelial cells in patients with septic shock.

The vascular endothelium has a central role in the control of microvascular tone, and it has been proposed that vascular endothelial damage occurs in septic shock, producing multiorgan failure. We have developed a method of detecting circulating endothelial cells (EC) that provides direct evidence of EC shedding in human sepsis. Human umbilical vein endothelial cells (HUVEC) were seeded in whole blood and recovered by isopycnic centrifugation to validate the technique. Blood samples were subsequently taken from 11 healthy volunteers, nine ventilated intensive care unit (ICU) control patients without sepsis, eight patients with sepsis but without shock, and 15 patients with septic shock. EC were identified by indirect immunofluorescence, using antibodies to von Willebrand factor (vWf) and the vascular endothelial growth factor receptor KDR. Mean HUVEC recovery was 86% for 20 to 100 seeded cells/ml of blood. vWf-positive EC counts per milliliter were significantly higher (analysis of variance [ANOVA], p < 0.0001) in patients with sepsis (16.1 +/- 2.7 [mean +/- SEM]) and septic shock (30.1 +/- 3.3) than in healthy (1.9 +/- 0.5) or ICU controls (2.6 +/- 0.6). KDR-positive EC counts per milliliter were also significantly higher (ANOVA, p < 0.0001) in patients with sepsis (4.2 +/- 1.1/ml) and septic shock (10.4 +/- 1.2/ml) than in healthy (0.7 +/- 0.3/ml) or ICU controls (0.5 +/- 0.2/ml). Cell counts made with anti-vWf antibody were consistently higher than those made with anti KDR antibody, but correlation between the two counts was high (r(2) = 0.93). The number of circulating KDR-positive EC was significantly higher in patients who died of septic shock than in survivors (12.0 +/- 1.6/ml versus 7.1 +/- 1.2/ml, p = 0.026). An increase in circulating EC can be identified during sepsis and septic shock. This supports the hypothesis that endothelial damage occurs in human sepsis.

Adult↗
PubMed1999

Developing clinical learning sites for undergraduate nursing students.

As health care continues to evolve and take on new shapes, perioperative procedures more often are occurring in nonhospital settings and with fewer opportunities for nursing intervention. Believing that nursing education must prepare nurses at the undergraduate level to provide quality and meaningful perioperative care, nursing specialists and educators at Emory University, Atlanta, developed two new clinical learning sites that allow undergraduate nursing students to learn from preceptors in advanced perioperative roles. These learning sites encourage students to develop and use critical thinking skills that are imperative to perioperative care.

Ambulatory Surgical Procedures↗
PubMed1996

Clinical manifestations of carcinoid disease.

Carcinoid tumors are relatively uncommon tumors and their presentation is varied. For these reasons, a high index of suspicion is necessary in order to consider the diagnosis. It is important to separate the "syndrome" from the primary tumor. It is obviously more effective to diagnose the tumor itself before the syndrome manifests itself, usually as a result of metastatic disease. Since the tumors are characteristically slow-growing, the physician may be misled into thinking the patient has functional problems rather than a tumor. Some data and guidelines are given for focusing on the signs and symptoms of carcinoid disease.

Carcinoid Tumor↗
PubMed1996

Catastrophic circulatory collapse following re-expansion pulmonary oedema.

Re-expansion pulmonary oedema is a recognised but rare complication following the rapid drainage of a large pleural effusion or pneumothorax [1,2], usually occurring on the side of re-inflation. The pathogenesis of the pulmonary oedema is poorly understood but is thought to be due to micro-vascular shearing resulting in neutrophil activation and adhesion to the vascular endothelium resulting in increased micro-vascular permeability [3-7]. Few reports appear in the literature of invasive haemodynamic monitoring following this catastrophe. We describe a patient who sustained fatal pulmonary oedema arising in the contralateral lung, with pulmonary flow catheter data documenting the initial circulatory collapse following the aspiration of a massive pulmonary effusion.

Adult↗
PubMed1996

Octreotide therapy in carcinoid disease.

Octreotide therapy is expensive, but at present it and other somatostatin analogues appear to offer the best opportunity of controlling the symptoms of flushing and diarrhoea. It may also have other properties affecting general well-being. The question of whether it changes tumour growth remains unanswered and there is no convincing evidence that it alters survival. In all published studies the numbers of patients are small and there have been no control groups. However, since no other drug has yet proved effective against flushing, the somatostatin analogues, including octreotide, remain the treatment of choice for the symptomatic control of the carcinoid syndrome. Octreotide is of great therapeutic value pre-operatively and intra-operatively and it is essential that all operating theatres have this drug available for immediate use. Surgical debulking, if feasible, provides the best outcome potential in carcinoid disease. Present evidence suggests that the place of octreotide and other somatostatin analogues is in controlling the symptoms of the disease rather than its progress and in ensuring cardiovascular and respiratory stability during surgical procedures.

Antineoplastic Agents, Hormonal↗
PubMed1993

Serum albumin and prealbumin as predictors of clinical outcomes of hospitalized elderly nursing home residents.

OBJECTIVE: To investigate the prevalence of hypoalbuminemia and hypoprealbuminemia in hospitalized, elderly, skilled nursing facility residents and to correlate these findings with clinical outcomes. DESIGN: Prospective cohort study. SETTING: A 300-bed community hospital. PARTICIPANTS: Eighty-one hospitalized, skilled nursing facility patients, average age 83.1 years. INTERVENTIONS: None. OUTCOME MEASURES: Serum albumin and prealbumin (transthyretin) were measured at admission, mid-week, 1 week, and 1 month. Patients were followed for 90 days for the outcomes of length of hospitalization and mortality. RESULTS: The prevalence of hypoalbuminemia was 99% and of hypoprealbuminemia, 79%. Both means dropped significantly from admission to midweek nadirs of 25 g/L for albumin and 14 mg/L for prealbumin. Severe hypoalbuminemia at mid-week predicted mortality (RR = 4.1 95%, CI 2.0-8.5) and extended length of hospitalization (RR = 5.2 95%, CI 2.8-9.8). Severe hypoprealbuminemia predicted extended hospitalization (RR = 3.2, CI 1.5-6.7) but not mortality. CONCLUSIONS: Hypoalbuminemia and hypoprealbuminemia are very common in this clinical setting and vary in parallel fashion over time. Severe hypoalbuminemia was a stronger predictor than hypoprealbuminemia of 90-day mortality and extended length of stay. Serum albumin on admission was not as strong a predictor of outcomes as serum albumin at mid-week.

Aged↗
PubMed1992

Delayed increase of extracellular arginine, the nitric oxide precursor, following electrical white matter stimulation in rat cerebellar slices.

Amino acid levels were measured in perfusates from biplanar slices of rat cerebellum installed in a Krebs-filled three-compartment chamber. The two lateral compartments housed the white matter and a section containing parallel fibres respectively. The central compartment housed cortical structures, including the Purkinje cell and granule cell bodies. This arrangement allows selective electrical stimulation of the parallel fibre or mossy fibre pathways, recording of the evoked responses to such stimulation and collection of the perfusion medium passing through the central chamber for amino acid analysis using high-pressure liquid chromatography (HPLC). Both, 2-Hz and 5-Hz stimulation of white matter caused a delayed increase in arginine levels in the perfusate. Since L-arginine is the physiological precursor of nitric oxide, a neuronal messenger in the brain, the data suggest that physiological stimuli can result in the release of this precursor, possibly to supply the nitric oxide synthase.

Afferent Pathways↗
PubMed1992

Enhancement of human T cell responses to allogeneic stimuli by factor VIII concentrates.

The effect of factor VIII concentrate, from commercial and National Health Services manufacturers, on in vitro lymphocyte proliferative response to allogeneic stimulator cells was investigated. Factor VIII preparations 'purified' by ion exchange or by monoclonal antibody affinity had no effect in this assay but lymphocyte proliferation in response to allogeneic cells was markedly and consistently enhanced by some intermediate purity factor VIII concentrates and, to a lesser extent, by a factor IX preparation. These preparations did not stimulate lymphocyte proliferation in the absence of other mitogens. The co-mitogenic factor(s) present in intermediate purity factor VIII was not identified. However, enhanced proliferation was not due to factor VIII itself, nor to albumin or fibronectin. The clinical relevance of the immunomodulatory activity of intermediate purity factor VIII concentrates in vitro is discussed.

Cell Division↗
PubMed1991

Trans-ACPD-induced Ca2+ signals in cerebellar Purkinje cells.

A combination of intracellular recording and fluorometric measurements of cytosolic calcium [( Ca2+]i) was used to locate changes in [Ca2+]i induced by the specific metabotropic glutamate receptor (mGluR) agonist trans-D,L-1-amino-1,3-cyclopentanedicarboxylic acid (t-ACPD), in Purkinje cells of rat cerebellar slices. Under voltage-clamp conditions, application of t-ACPD (100 microM) induced an inward current accompanied by a large increase in [Ca2+]i located primarily in the soma but also, to a lesser degree, in restricted parts of the dendrites. In contrast, elevations of [Ca2+]i associated with calcium spikes were confined to the dendrites and inward currents of a similar amplitude induced by (RS)-alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA), an agonist of ionotropic glutamate receptors, did not raise [Ca2+]i.

Animals↗
PubMed1991

Experience with tissue expansion vaginoplasty.

In vaginal agenesis, a vagina can be treated by tissue expansion vaginoplasty. We have performed 17 such procedures. One procedure was abandoned because of infection of the temporary implant. In four women the first stage had to be repeated: in one the implant was placed too superficially, in another it did not provide adequate expansion, in a further instance the implant became infected and the fourth woman received a surgical wound to her labia. The second stage was successful in all 16 women who now have a vagina lined with viable epithelium. The vaginal length was satisfactory in all but one. Two women complained of a vaginal discharge due to hair at the vaginal vault, two women developed postoperative haematomas and one experienced introital stenosis. The disadvantage of the procedure is that it requires two operative stages and involves a prolonged hospital stay but it is not technically complex and results in a full length vagina that does not require dilatation.

Adolescent↗
PubMed1991

The free-flap vaginoplasty; a new surgical procedure for the treatment of vaginal agenesis.

The ideal operation for a young woman born without a vagina would be a one stage procedure, creating a functionally normal vagina without cosmetically unattractive scars, without the need for subsequent dilatation, stents or obturators. This goal was achieved with a free flap vaginoplasty using a full thickness skin graft taken from the scapula region. The blood supply of the graft was maintained by microvascular anastomosis of the graft pedicles to vessels in the groin. The operation has been performed in three young women who were born with uterine hypoplasia and vaginal agenesis. We experienced no unexpected complications, the procedure was well tolerated and left our patients with a good length, fully functional vagina. However, the operation is a major undertaking and needs to be performed by those with expertise in plastic surgery as well as in gynaecology.

Adolescent↗