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Biomedical subjects

I Ryder

Publications and source records attributed to I Ryder.

7 recordsLinked to original sources
PubMed2005

Peripartum presentation of an acute aortic dissection.

We report the case of an acute type A aortic dissection occurring in a 35-year-old parturient. The initial diagnosis was missed; a subsequent emergency Caesarean section 3 weeks after presentation was followed by the development of left ventricular failure and pulmonary oedema in the early postoperative period. Echocardiography confirmed the diagnosis of aortic dissection and the patient underwent a successful surgical repair.

Acute Disease↗
PubMed2001

Prevention of spinal cord ischaemia during descending thoracic and thoracoabdominal aortic surgery.

Surgery of the descending and thoracoabdominal aorta has been associated with post-operative paraparesis or paraplegia. Different strategies, which can be operative or non-operative, have been developed to minimise the incidence of neurological complications after aortic surgery. This review serves to summarise the current practice of spinal cord protection during surgery of the descending thoracoabdominal aortic surgery. The pathophysiology of spinal cord ischaemia will also be explained. The incidence of spinal cord ischaemia and subsequent neurological complications was associated with (1) the duration and severity of ischaemia, (2) failure to establish spinal cord supply and (3) reperfusion injury. The blood supply of the spinal cord has been extensively studied and the significance of the artery of Adamkiewicz (ASA) being recognised. This helps us to understand the pathophysiology of spinal cord ischaemia during descending and thoracoabdominal aortic operation. Techniques of monitoring of spinal cord function using evoked potential have been developed. Preoperative identification of ASA facilitates the identification of critical intercostal vessels for reimplantation, resulting in re-establishment of spinal cord blood flow. Different surgical techniques have been developed to reduce the duration of ischaemia and this includes the latest transluminal techniques. Severity of ischaemia can be minimised by the use of CSF drainage, hypothermia, partial bypass and the use of adjunctive pharmacological therapy. Reperfusion injury can be reduced with the use of anti-oxidant therapy. The aetiology of neurological complications after descending and thoracoabdominal aortic surgery has been well described and attempts have been made to minimise this incidence based on our knowledge of the pathophysiology of spinal cord ischaemia. However, our understanding of the development and prevention of these complications require further investigation in the clinical setting before surgery on descending and thoracoabdominal aorta to be performed with negligible occurrence of these disabling neurological problems.

Angiography↗
PubMed2000

Coccydynia: a woman's tail.

OBJECTIVE: To review the literature on coccydynia with specific reference to those cases of pregnancy and birth-related onset. METHOD: Databases (Medline, CINAHL, MIDIRS) were searched using the keywords coccydynia, coccygodynia, coccyx, spine, pelvis, injury, and trauma. The references contained within this review are those which give clear information about clinical cases and are least anecdotal. FINDINGS: Much of the literature is of poor quality when judged by current standards. Where there is no other literature older references remain of interest. There is little information about incidence, prevalence, pathophysiology, methods of differential diagnosis and efficacy of treatment for these women. No qualitative data from women with pregnancy or birth-related coccydynia were identified. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Research into this topic needs to be undertaken if midwives are to be enabled to facilitate early diagnosis and provide care and advice for women with pregnancy and birth-related coccydynia.

Coccyx↗
PubMed1996

Association between oxygen delivery and consumption in patients undergoing cardiac surgery. Is there supply dependence?

We studied the relationship between oxygen delivery (DO2) and consumption (VO2) in twenty patients undergoing cardiac surgery, in order to determine if VO2 was dependent on DO2 (pathological oxygen supply dependence). We measured VO2 from expired gas analysis (VO2G) and compared this to that calculated using the reverse Fick method (VO2F). Both VO2G and VO2F increased after cardiopulmonary bypass (P < 0.001), without change in DO2 (i.e. oxygen extraction ration increased). There was a significant relationship between changes in DO2 and VO2F, both before bypass (r = 0.74, P < 0.001) and after bypass (r = 0.69, P < 0.001), while changes in DO2 and VO2G had no such relationship (pre-bypass: r = 0.38, P = 0.094; post-bypass: r = 0.10, P = 0.68). There was poor agreement between VO2F and VO2G perioperatively. We could not demonstrate supply dependence in elective cardiac surgical patients.

Adult↗
PubMed1995

Pulse oximetry.

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Blood Pressure↗