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Biomedical subjects

A J Kirk

Publications and source records attributed to A J Kirk.

At least 19 recordsLinked to original sources
PubMed2000

Oesophageal rhabdomyoma.

Extracardiac rhabdomyomas are rare benign tumours showing striated muscle differentiation. Seventy percent of these lesions occur in the head and neck region. The most common sites for these lesions are the larynx, pharynx, and the floor of the mouth. There has been only one previous report of a rhabdomyoma of the oesophagus; two further cases are described.

Adult↗
PubMed1995

Posterior pericardiotomy reduces the incidence of supra-ventricular arrhythmias following coronary artery bypass surgery.

A prospective study of 100 patients undergoing coronary artery bypass surgery was performed to demonstrate the effectiveness of a posterior pericardiotomy in reducing the incidence of pericardial effusions and, consequently, reducing the incidence of supraventricular arrhythmias in the post-operative period. Pericardial effusion occurred in 4 of 50 patients following a posterior pericardiotomy, whereas effusion occurred in 20 of 50 patients in whom a pericardiotomy was not created (P < 0.0005). Supra-ventricular arrhythmias occurred in 4 patients in the pericardiotomy group and 18 in the group treated without pericardiotomy (P < 0.005). No complications resulted from this procedure. We conclude that pericardiotomy is a simple, safe and effective method for reducing the incidence or pericardial effusion and thereby post-operative supra-ventricular arrhythmias.

Aged↗
PubMed1993

Lung preservation: a review of current practice and future directions.

During the past 10 years, pulmonary transplantation has emerged as a successful mode of surgical therapy for suitable patients with end-stage lung disease. Current preservation techniques of donor lungs for subsequent transplantation include core-cooling and single flush perfusion. The relative merits of these are described. These methods are essentially restricted to 6 hours of ischemia. Research in lung preservation is aimed not only at extending the safe period of ischemia but also at improving the quality of preservation. Areas of interest include the ideal composition of the perfusate, relevant pharmacologic additives, and the best conditions for preservation and harvesting. Advantages and disadvantages of the various animal models are listed in addition to the methods used in assessing the quality of preservation. There have been major advances in experimental lung preservation during the past 10 years, and we are possibly on the threshold of incorporating some of these into clinical practice. Among the most important are the adoption of colloid-based perfusates, the more widespread use of free radical scavengers, and the use of leukocyte depletion.

Animals↗
PubMed1993

Heart-lung transplantation combined with correction of interrupted aortic arch.

We describe a new technique for heart-lung transplantation in a patient with interrupted aortic arch. The operation was performed in a 21-year-old patient with situs solitus, double-inlet left ventricle, transposition of great arteries, type A interrupted aortic arch, and pulmonary hypertension. One-stage correction of interrupted aortic arch was undertaken using recipient ductal and pulmonary arterial tissues. The early postoperative course was uneventful, with clinical and radiological evidence of satisfactory result. We conclude that it is entirely feasible to undertake heart-lung transplantation in the presence of interrupted aortic arch using this technique, which requires no period of circulatory arrest and results in a tension-free anastomosis.

Adult↗
PubMed1991

Anaesthesia for patients with transplanted hearts and lungs undergoing non-cardiac surgery.

Heart and lung transplantation is now accepted as a means of treating some end-stage cardiopulmonary diseases. These patients may present with a wide variety of non-cardiopulmonary conditions requiring anaesthesia and surgery, possibly at a place distant from their original transplant centre. In general, for much elective, acute or even emergency surgery, if the allograft is functioning satisfactorily, these patients should present few problems during anaesthesia, provided the anaesthetist has some understanding of the pathophysiology of the transplanted organ and recognizes the differences (potential and specific to cardiopulmonary transplantation) between such patients and any other subject.

Adult↗
PubMed1991

Post-operative analgesia following thoracotomy in the dog: an evaluation of the effects of bupivacaine intercostal nerve block and nalbuphine on respiratory function.

Pain following thoracotomy reduces pulmonary ventilation in man and a similar effect is believed to occur in animals. The effects of two analgesic regimens on arterial blood gas parameters were studied in dogs following thoracotomy. Post-Operative analgesia was provided with intermittent nalbuphine, either alone or in combination with an intercostal nerve block using bupivacaine. Arterial blood gas analysis was carried out at 4, 8 and 16 h post-operatively, both before the administration of nalbuphine and again 30 min later. Animals which received nalbuphine alone had a significant rise in arterial oxygenation following administration of this analgesic. This effect was not observed at 4 and 8 h post-operatively in dogs which had an intercostal block with bupivacaine, but was seen at 16 h post-operatively when it could be anticipated that the effects of bupivacaine would have waned. These results suggest that intercostal block with bupivacaine can provide analgesia for over 8 h, and that the duration of action of nalbuphine in controlling post-operative pain in the dog is probably less than 4 h.

Animals↗
PubMed1991

Assessment of blood flow through the lung using laser Doppler flowmetry.

The value of laser Doppler flowmetry in measuring blood flow through the lung was assessed comparing it with flow measured by electromagnetic flowmetry. This was an experimental laboratory-based prospective study performed in an approved University animal research facility. Ten beagle dogs were used. Simultaneous measurement of pulmonary blood flow by laser Doppler flowmetry and electromagnetic flowmetry was carried out at varying degrees of pulmonary artery constriction. There was a linear relationship between the two methods of assessing blood flow (regression equation: y = 0.9x + 5.5; p = .00001) using a least-squares, best fit, straight line analysis (160 data points). The results of this study demonstrate that laser Doppler flowmetry provides an accurate indicator of pulmonary blood flow, which in practice is both simple and reproducible.

Animals↗
PubMed1990

Successful surgical management of bronchial dehiscence after single-lung transplantation.

A case of bronchial dehiscence despite bronchial omentopexy is described in a patient nine days after single-lung transplantation. Rethoracotomy was undertaken as soon as the diagnosis was established before superinfection occurred. Necrotic bronchus was excised, with the anastomosis sited distally on the donor bronchus. The omentum was necrotic, and the new anastomosis was wrapped with a vascularized pedicle of pericardium. Six months after this procedure, the patient remains well.

Anastomosis, Surgical↗
PubMed1989

Cyclosporine-associated hypertension in cardiopulmonary transplantation. The beneficial effect of nifedipine on renal function.

In a retrospective review of fifty heart, lung, and heart-lung recipients receiving cyclosporine, forty-six (92%) were hypertensive. This hypertension was managed with either prazosin (n = 29) or nifedipine (n = 17). Renal function was assessed by creatinine clearance estimation and found to be significantly better in those patients receiving nifedipine. (creatinine clearance = 60 ml/min [SEM 5.7] vs. 49 ml/min [SEM 2.7]; P less than 0.05). This observation suggests that nifedipine should be the drug of choice for the treatment of cyclosporine-associated hypertension in cardiac and pulmonary transplant recipients.

Adult↗
PubMed1988

Endogenous digoxin-like immunoreactive substance in patients undergoing coronary surgery. Preliminary report.

Perioperative digoxin concentrations were measured in 20 unselected adult patients undergoing coronary surgery. None of the patients were receiving treatment with digoxin. A digoxin-like immunoreactive substance was found in 16 patients postoperatively. This substance, if pharmacologically active, may have important clinical implications in the management of patients after open heart surgery.

Adult↗
PubMed1987

Concomitant cor triatriatum and coronary sinus total anomalous pulmonary venous connection.

Successful repair of the rare anomaly of concomitant cor triatriatum and coronary sinus total anomalous pulmonary venous connection in a neonate is described. The presence of pulmonary venous obstruction or cardiomegaly, or both, in a child with total anomalous pulmonary venous connection should alert to the possibility of a coexistent cor triatriatum.

Cor Triatriatum↗