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Biomedical subjects

C Eagle

Publications and source records attributed to C Eagle.

14 recordsLinked to original sources
PubMed2001

Genotyping fetal DNA by non-invasive means: extraction from maternal plasma.

BACKGROUND AND OBJECTIVES: Identification of fetal DNA in maternal plasma may allow genetic analysis without the use of invasive techniques. The aim of this study was to extract DNA from maternal plasma, identify fetal material through the presence of SRY or RHD gene sequences and assess the reliability of these results. MATERIALS AND METHODS: A polymerase chain reaction (PCR) method of a commercial kit was used with primers for SRY or exon 10 of the RHD gene sequence. RESULTS: Multiple plasma samples were collected from 60 women who were evaluable for either SRY or RHD, or both, fetally derived DNA sequences. Fetal DNA was present in the plasma throughout the pregnancies and for some hours or days after delivery. CONCLUSION: Fetal DNA can be reliably detected in maternal plasma from early in pregnancy and normally is cleared within days of delivery.

Adult↗
PubMed1996

Anaesthetic management of a parturient with severe muscular dystrophy, lumbar lordosis and a difficult airway.

PURPOSE: This case describes the management of a 19-yr-old wheelchair bound primigravida with severe muscular dystrophy who presented for Caesarean section after spontaneous rupture of membranes. Anaesthesia was influenced by several features of her systemic disease which were impediments to both neuraxial and general anaesthesia. CLINICAL FEATURES: Other than for a prenatal record and the history obtainable from the patient, little additional medical information was available. Physical examination showed diffuse muscular weakness and an anatomically abnormal airway. Examination of the spine showed slight 10-15 degrees thoracolumbar scoliosis and > 45 degrees lumbar lordosis. Fetal assessment was normal. Echocardiography revealed mildly decreased left ventricular function and was consistent with pulmonary hypertension. After discussion with the patient and her obstetrician, elective Caesarean delivery was deemed the best management. Neuroaxial anaesthesia was at an increased risk of failure due to the profound lumbar lordosis. A plan for awake intubation and general anaesthesia was described to the patient in case regional anaesthesia could not be initiated. A fibreoptic bronchoscope and difficult intubation kit were made available. General anaesthesia was expected to have increased risk of postoperative pulmonary complications, hence epidural anaesthesia was attempted. After difficult catheter insertion, a sensory block was titrated to a T4 level. This was well tolerated by both mother and fetus. A healthy baby was delivered with Apgar scores of 9 and 9. Postoperatively the mother was transferred to the intensive care unit. After 72 hr, the patients respiratory status allowed transfer to the word. CONCLUSION: This case illustrates the use of epidural anaesthesia in the successful management of a severely compromised patient with limb-girdle muscular dystrophy undergoing elective Caesarean section.

Adult↗
PubMed1995

Anaesthetic management of a patient with a descending thoracic aortic aneurysm and severe bilateral bullous pulmonary parenchymal disease.

The anaesthetic management of the surgical repair of a descending aortic aneurysm in a patient with large, bilateral, pulmonary bullae is described. Anaesthesia for descending aortic surgery normally involves unilateral, positive-pressure ventilation, an option which poses some risk of barotrauma in the presence of bilateral bullae. Patients with bullous disease commonly have severe lung disease and thorough preoperative assessment and preparation are necessary. Intraoperatively, bilateral rupture of the bullae could be catastrophic and preparations should be made for this possibility. In order to diminish this risk, a surgical technique including preemptive collapse of the bulla by minithoracotomy and tube drainage, with use of a bronchial blocker to the affected part of the lung may be used. If rupture occurs, then high frequency jet ventilation may be effective. Use of a double lumen endobronchial tube may be advantageous for patients with either unilateral and bilateral bullae. Anaesthesia for patients with bullae should avoid positive-pressure ventilation and nitrous oxide in order to limit the risk of barotrauma from a ball valve mechanism. In this case, the risk of barotrauma was reduced by performing an inhalational induction of anaesthesia and limiting peak inflation pressures during thoracotomy. It was elected to use positive-pressure ventilation through a double lumen endobronchial tube following chest incision. A high frequency jet ventilator was available but not employed. Anaesthetic management was complicated by the presence of pleural adhesions, surgical approach directly through a bulla, and the requirement for one lung ventilation.

Adult↗
PubMed1995

Developing a "clinical presentation" curriculum at the University of Calgary.

Currently, medical curricula are structured according to disciplines, body systems, or clinical problems. Beginning in 1988, the faculty of the University of Calgary Faculty of Medicine (U of C) carefully evaluated the advantages and disadvantages of each of these models in seeking to revise their school's curriculum. However, all three models fell short of a curricular structure based on current knowledge and principles of adult learning, clinical problem solving, community demands, and curriculum management. By 1991, the U of C had formulated a strategic plan for a revised curriculum structure based on the way patients present to physicians, and implementation of this plan has begun. In creating the new curriculum, 120 clinical presentations (e.g., "loss of consciousness/syncope") were defined and each was assigned to an individual or small group of faculty for development based on faculty expertise and interest. Terminal objectives (i.e., "what to do") were defined for each presentation to describe the appropriate clinical behaviors of a graduating physician. Experts developed schemes that outlined how they differentiated one cause (i.e., disease category) from another. The underlying enabling objectives (i.e., knowledge, skills, and attitudes) for reaching the terminal objectives for each clinical presentation were assigned as departmental responsibilities. A new administrative structure evolved in which there is a partnership between a centralized multidisciplinary curriculum committee and the departments. This new competency-based, clinical presentation curriculum is expected to significantly enhance students' development of clinical problem-solving skills and affirms the premise that prudent, continuous updating is essential for improving the quality of medical education.

Alberta↗
PubMed1992

Anaesthesia and education.

A literature review was undertaken to document the status of anaesthetic education in both the peer-reviewed anaesthesia and medical education literature. A search was performed using Silver Platter for the period 1983-91, and the most widely circulated medical education and anaesthesia journals in North America were reviewed in detail. Although anaesthetists are involved in many educational activities, the literature is oriented towards postgraduate training. Common issues include the assessment and selection of residents. Newer methods of evaluation, for example, daily assessment by preceptors, have been described, but work continues to be needed on these and older methods, such as oral examinations. Selection processes may be improved by incorporating psychological and psychomotor measures in the assessment process. A limited number of teaching methods, especially simulators, have been the focus of much interest, while other methods, such as bedside teaching, have received little attention. Programs of recertification or maintenance of competence, which have been announced by certifying bodies, may place new emphasis on the study of the design, effectiveness, and outcome of continuing medical education. In conclusion, the review revealed that there are many opportunities for anaesthetists to conduct educational research into many traditional and new areas of medical education.

Anesthesiology↗
PubMed1984

Caesarean section in a patient with Cushing's syndrome.

Pregnancy is rarely associated with Cushing's syndrome. This case report describes the successful management of a Caesarean section under epidural anaesthesia in a patient with Cushing's syndrome. Maternal and fetal complications are reviewed from an anaesthetic perspective and alternative anaesthetic techniques discussed.

Adult↗