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Biomedical subjects

I Sheppard

Publications and source records attributed to I Sheppard.

8 recordsLinked to original sources
PubMed1998

Airway obstruction by a child's pacifier--could flange design be safer?

UNLABELLED: The use of pacifiers (dummies or soothers) for infants is prevalent. Rare episodes of an adverse consequence must be taken seriously. We report a case of aspiration of a pacifier by a 6-month-old baby. Nine similar cases were found in the literature since 1966. The details of these cases are outlined and changes to flange design proposed ahead of a new European Union Standard document. CONCLUSION: Pacifier ventilation holes are essential, flanges should have a minimum horizontal and vertical diameter of 43 mm. Rings should be attached to the flange to facilitate removal if aspirated.

Airway Obstruction↗
PubMed1995

A prospective study of day case adenoidectomy.

Adenoidectomy in this country is typically performed as an in-patient procedure requiring an overnight stay in hospital but experience from other countries shows that adenoidectomy can be safely performed as a day case procedure. In Leicester, a prospective study of day case adenoidectomy was initiated in 1991 under carefully monitored conditions. We report on 721 patients entered in the first 3 years. We have so far found day case adenoidectomy to be a safe procedure.

Adenoidectomy↗
PubMed1991

Initial management of open fractures sustained in the M1 aircraft disaster. Nottingham, Leicester, Derby and Belfast (NLDB) Study Group.

There were 83 survivors of the M1 aircrash admitted to hospital; of these, 28 patients sustained a total of 40 open fractures. These open fractures were classified as 19 grade 3, 16 grade 2 and five grade 1. There were six upper limb fractures and 34 lower limb fractures. A high proportion of grade 3 open fractures were identified in this series (47 per cent) and one-half of these occurred at or below the ankle. This reflected the high energy and direction of the forces involved in the aircrash. The early results in terms of the incidence of wound infection (15 per cent), delayed wound healing (7.5 per cent) and skin flap necrosis (7.5 per cent) were similar to other series. The controversy over whether to leave grade 3 wounds open or closed was not clarified by this study, but the closure of grade 3 wounds after internal fixation is to be avoided. This study emphasizes the need for provision of adequate specialist manpower, equipment and resources to manage the unexpected major disaster successfully.

Accidents, Aviation↗
PubMed1985

Differential effect of cimetidine on serum concentrations of carbamazepine and phenytoin.

Cimetidine is an inhibitor of drug metabolism. We studied the effects of cimetidine (1,200 mg/d) on steady-state serum concentrations of carbamazepine and phenytoin in 11 epileptic volunteers. The mean serum carbamazepine concentration was unchanged after 7 days of cimetidine treatment. Five subjects were taking phenytoin concurrently; their mean serum phenytoin concentration was significantly increased after 7 and 10 days of cimetidine treatment and returned to baseline 2 weeks after cimetidine was discontinued. Cimetidine apparently inhibits the clearance of phenytoin but not of carbamazepine in adults on chronic therapy.

Adolescent↗
PubMed1982

Interaction between valproic acid and aspirin in epileptic children: serum protein binding and metabolic effects.

In five of six epileptic children who were taking 18 to 49 mg/kg/day valproic acid (VPA), the steady-state serum free fractions of VPA rose from 12% to 43% when antipyretic doses of aspirin were also taken. Mean total VPA half-life (t1/2) rose from 10.4 +/- 2.7 to 12.9 +/- 1.8 hr and mean free VPA t1/2 rose from 6.7 +/- to 2.1 to 8.9 +2- 3.0 hr when salicylate was present in the serum. The in vitro albumin binding association constant (ka) for VPA was decreased by salicylate, but the in vivo ka value was not affected. The 12-hr (trough) concentrations of both free and total VPA were higher in the presence of serum salicylate in five of six patients. Renal excretion of unchanged VPA decreased in five of six patients, but the VPA carboxyl conjugate metabolite-excretion patterns were not consistently affected. Salicylate appeared to displace VPA from serum albumin in vivo, but the increased VPA t1/2 and changes in VPA elimination patterns suggest that serum salicylate also altered VPA metabolism.

Aspirin↗