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Biomedical subjects

A P Rankin

Publications and source records attributed to A P Rankin.

6 recordsLinked to original sources
PubMed2001

Necrotizing fasciitis and non steroidal anti-inflammatory drugs: a case series and review of the literature.

AIMS: To assess two years experience of necrotizing fasciitis in the Department of Intensive Care Medicine (DICM), Middlemore Hospital, and to investigate a possible link with non steroidal antiinflammatory drugs (NSAID's). METHODS: A retrospective chart review of patients with soft tissue infections admitted to the DICM between January 1998 and December 1999. RESULTS: There were 24 cases of soft tissue infection, of which thirteen had necrotizing fasciitis. In the latter group, nine were diabetics, and three had elevated glycosylated haemoglobin. Seven were obese and twelve had two or more comorbities. Five were taking NSAID's. Wound swabs and/or tissue biopsies were positive in eleven patients, but only three had positive blood cultures. Mortality was 6/13 (46%). The seven survivors had a mean of 5.7 operations and a mean hospital stay of 39 days. CONCLUSIONS: The literature contains scattered anecdotal case reports linking NSAID's and necrotizing fasciitis. Plausible biological mechanisms exist to explain how these drugs might predispose to serious infection and how they may mask signs and symptoms, therefore delaying diagnosis. In this series, less than half the patients were taking NSAID'S Diabetes and other co-morbidities were frequently found. The role of NSAIDS remains unclear.

Adult↗
PubMed1993

Grading asthma severity: using the APS component of the Apache II system.

OBJECTIVE: Measurement of severity is fundamental to the description and comparison of case series, treatment regimens and disease outcomes. This study examines the Acute Physiology Score (APS) as a severity measure of an acute "life-threatening" asthma attack. DESIGN: The APS in the emergency department (ED) and ICU, demographic, treatment and outcome variables were prospectively studied. Relationships between severity, treatment and progress were investigated. In addition, patients were stratified according to ED APS and differences between the participating hospitals were examined. SETTING: Emergency Departments and Intensive Care Units of two New Zealand hospitals. PATIENTS: 64 admissions to the ICUs following an acute episode of asthma. INTERVENTIONS: Standard management of acute asthma as practised at the two participating hospitals. MEASUREMENTS AND RESULTS: Both the treatment delivered (intravenous salbutamol, sodium bicarbonate and IPPV) and the rate of improvement as defined by change in APS between the ED and the ICU were found to be strongly related to ED APS. Similarly, the length of stay in the ICU correlated with the ICU APS. Stratification on the basis of ED APS allowed small but significant differences in patient physiologic derangement, dose of salbutamol, use of IPPV and incidence of complications to be detected between patients at the two hospitals. CONCLUSION: This prospective study involving two hospitals validates the APS as a method for measuring the severity of an acute asthma attack. It demonstrates how correction for severity can be used to compare treatment and outcome variables in different case series.

Adolescent↗
PubMed1990

Theophylline poisoning--a review of 64 cases.

Sixty-four cases of theophylline poisoning were reviewed. All but two cases represented international self poisoning. The majority of patients were young females who presented acutely after ingestion of sustained release preparations prescribed for asthma. Serum theophylline levels (mean 365 mumol/l, SD 177) indicated a high risk of toxicity. Electrolyte and metabolic abnormalities (hypokalaemia, hypomagnesaemia, hypophosphataemia, hyperglycaemia, acid-base disturbances and leucocytosis) were common. Serum potassium, serum glucose, leucocyte count and length of stay in the intensive care unit all correlated strongly with maximum serum theophylline level (p less than 0.001). The low incidence of life-threatening manifestations of severe toxicity (hypotension, serious arrhythmias or seizures) and excellent outcome, contrasts with many previous reports. The results support the use of a management regimen which emphasizes intensive supportive therapy and restricts the use of charcoal haemoperfusion.

Adolescent↗
PubMed1984

Management of fifty cases of chest injury with a regimen of epidural bupivacaine and morphine.

Epidural bupivacaine and morphine were administered to fifty patients who had suffered traumatic injuries to the chest. Forty-three of these patients made satisfactory recoveries without requiring any ventilatory support. Six patients were ventilated, one because of cardiovascular complications of myocardial infarction, two because of inadequate analgesia, and three because of respiratory failure. Three patients died. Serious side-effects were not common. One patient developed respiratory depression which required withdrawal of morphine, and one patient developed an epidural space infection.

Adolescent↗