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Biomedical subjects

J C McIlwain

Publications and source records attributed to J C McIlwain.

18 recordsLinked to original sources
PubMed1999

Clinical risk management: principles of consent and patient information.

Clinical Risk Management and its integral elements form part of the foundation of 'Clinical Governance'. An important principle within Clinical Risk Management is that of consent and patient information which, in a changing climate of complaint and litigation, means that it is essential that clinicians have a sound understanding of its importance. This paper provides a structured understanding of the background and practice of consent and patient information. With such knowledge clinicians can help patients achieve a better understanding of what they are undertaking, and so reduce the risk of complaint and litigation. This paper discusses the topics of: current indemnification, ethics, law, the information content required for consent, duration of consent, who should take consent, capacity to give consent, mental incapacity, and details of how to perform risk assessment. However, areas applicable to the Mental Health Act have been excluded.

Advance Directives↗
PubMed1996

The posterior cricoarytenoid ligaments and their relationship to the cadaveric position of the vocal cords.

Much debate has occurred over the last century regarding the reason for the cadaveric position of the membranous vocal cord. This study attempts to identify the determining factors of the position of the vocal cord. Serial dissection of 36 cadaveric larynges was carried out and laryngeal measurements taken. The cadaveric position of the vocal cords was correlated to that of the posterior cricoarytenoid ligaments and it was found that the two were directly related. The study shows that the major determinant of the position of the denervated vocal cord is the position of the posterior cricoarytenoid ligament.

Aged↗
PubMed1995

Amylase activity in tracheobronchial secretions of laryngectomized patients.

The alpha-amylase activity in tracheobronchial secretions of 16 consecutive patients with a total laryngectomy was studied. None of these patients had a tracheopharyngeal fistula or pulmonary disorder which might affect the amylase activity. This study proves the presence of amylase in tracheobronchial secretions of laryngectomized patients with a normal lung at a level between x and y and the quantitative analysis of the amylase activity is discussed. The relevance of investigating laryngectomy patients is because of the nature of the surgery the lower respiratory tract is permanently and physically isolated from any other source of salivary amylase. No similar study of the analysis of amylase in normal lung tissue had been reported before. This information may be of value in order to detect salivary aspiration in patients with a tracheostomy or endotracheal intubation if the level in the aspirate is in the order of a-b times greater than that found in normal tracheobronchial secretions. (x = 35 and y = 1125 i.u./l; a = 31.8 and b = 628.6 i.u./l).

Aged↗
PubMed1995

A study of alpha-amylase activity in tracheobronchial secretions of seriously ill patients with tracheostomies.

This study was undertaken to assess any salivary aspiration in seriously ill patients with tracheostomies in an Intensive Care Unit setting. The alpha-amylase activity in the tracheostomies in an Intensive Care Unit setting. The alpha-amylase activity in the tracheobronchial secretions of 15 such patients were analysed to evaluate the incidence of salivary aspiration. None of the patients had clinical or radiological evidence of lung disorder at the time of the commencement of the study. Six out of 15 patients showed very high levels of alpha-amylase activity in their tracheobronchial secretions on Day 3 and all six subsequently developed severe chest infections. The other nine patients showed a low level of amylase activity in their secretions. Two patients in the latter group developed severe pulmonary disease. This study demonstrates that a high level of alpha-amylase activity in the tracheobronchial secretions of tracheotomized, ventilated patients indicates that salivary aspiration may be taking place, and further suggests that progressively increasing levels may indicate the likelihood of a major pulmonary complication developing.

Adult↗
PubMed1995

Tonsillar fossa obliteration and post-operative pain.

Fifty consecutive patients over the age of 15 years undergoing tonsillectomy had one tonsillar fossa obliterated by 2/0 Polydioxanone (PDS II) suture. The opposite side was used as a control. Pain was assessed on a visual analogue scale from the first to tenth post-operative day. Although on the initial post-operative days the pain was more on the sutured side, 41 patients subsequently experienced significant pain relief on that side (P = 0.0001). No complications were encountered due to the tonsillar fossa obliteration. On the 10 day review, the 41 patients indicated in their questionnaire that tonsillar fossa obliteration is a useful procedure to reduce the post-operative pain and would have preferred both sides to be obliterated rather than left to heal by secondary intention.

Adolescent↗
PubMed1994

Removal of nasal foreign bodies with a Fogarty biliary balloon catheter.

Twenty-five children with a range of nasal foreign bodies, which were not easily amenable to anterior instrumental extraction, were considered for this study. These foreign bodies were removed by the use of a Fogarty biliary balloon catheter (Intimax) successfully in 23 children. In two children no foreign body was found. None of the children had any complications. This is a safe procedure which can be performed as an out-patient. Whilst the cost of the catheter may appear expensive, in comparison to the cost of admission for removal of similarly sited foreign bodies under general anaesthesia, the catheter fares favourably.

Ambulatory Care↗
PubMed1993

Tuberculosis of the larynx in a lepromatous patient.

Within the black population of South Africa tuberculosis and leprosy are endemic. There is also a significant incidence of laryngeal carcinoma. A patient who presented in acute respiratory stridor to a rural hospital with limited resources is reported. The differential diagnosis and management is discussed in the light of the available literature.

Aged↗
PubMed1991

Subglottic laryngeal closure for aspiration.

Aspiration may be life threatening, particularly in those patients with severe central neurological disease. From such a group of patients, several were identified who had severe laryngeal dysfunction and aspiration. The majority of patients in this subgroup existed in a neurologically vegetative state. In an attempt to reduce the degree of aspiration they experienced, the procedure of subglottic laryngeal closure was performed. Essentially, the operation is designed to isolate the tracheal airway from the incompetent larynx. The aim is to protect the lower airway from pharyngeal contamination. In all 5 patients there was a marked improvement in general and pulmonary health.

Adult↗
PubMed1991

The posterior glottis.

The posterior glottis is an area of the larynx previously referred to by the terms 'posterior commissure' and 'interarytenoid'; these are poorly defined and a new definition of this unique area of the larynx is provided. Within the text is a series of experiments performed on nearly 300 larynges. The posterior glottis was examined in relation to the following: the embryology, the epithelium, mathematical dimensions, gross anatomy, microanatomical structures, submucosal spaces and the spread of carcinoma related to this area. Various significant findings were made. There exists a pharyngoglottic duct which divides the embryonic larynx into anterior (membranous) and posterior (cartilaginous) parts. The epithelium of the posterior glottis in neonates and non-smokers is respiratory in nature and the notion of a laryngeal respiratory function is reinforced by a mathematical analysis of the cross sectional areas of the larynx during inspiration. The presence of a posterior cricoarytenoid ligament which stabilizes the arytenoid is confirmed. The spread of carcinoma to the posterior glottis from the different primary laryngeal and pyriform fossa sites shows differing modes of invasion but in particular a direct extension and connection with the subglottis. The most significant conclusion from these studies is that the posterior glottis is so intimately related to the subglottis that it must be considered as part of the subglottis. The acceptance of this fact, however, requires a new definition of the larynx from that given by the American Joint Committee on Cancer Staging and that of U.I.C.C. The posterior glottis considered as part of the subglottis requires a review of our present understanding of the structure and function of the larynx and in particular the spread of cancer posteriorly.

Adult↗
PubMed1991

Clinical aspects of the posterior glottis: a review.

This paper was undertaken to distill a century of thought on the larynx, specifically in relation to the posterior glottis, an area which has only recently been recognized as a distinct part of the larynx. The review examines the following topics in relation to the posterior glottis: stenosis, granulomata, contact ulceration, reflux laryngitis, cleft larynx, aspiration and cricoarytenoid joint disease. The posterior glottis acts as a "weir" between the pharynx and larynx and so is intimately involved with diseases as they affect one area to the other. An attempt has been made to rationalize the treatments and clinical findings over the past century from the writings of many. Each section analyzes the modern and the older methods of clinical findings and treatment and provides a balance of opinion as to the most appropriate line of management for that condition. The review allows a comprehensive view of the clinical aspects of the posterior glottis to be brought into one document.

Glottis↗
PubMed1989

A historical overview of the aetiology and treatment of laryngeal stenosis.

A review of over a century of publication on laryngeal stenosis reveals much about the aetiology and treatment. The earlier aetiologies of infection and in particular diphtheria of the early part of the twentieth century have given way to more complex and insidious causes. Trauma, particularly from intubation by endotracheal, tracheal or nasogastric tubes, is now the primary cause of simple and complex laryngeal stenosis. The treatments over the past century have been varied and ingenious, ranging from simple dilatation and intubation of the 1800s to galvanocautery, endoscopic scar incision and heated bougienage of the early twentieth century. By the 1930s and 1940s the concept of laryngofissure, scar excision, stenting and skin grafting was the accepted approach to laryngeal stenosis. More recently endoscopic approaches, local flap placement and laser surgery have been advocated. The open approach, however, has stood the test of time. This review presents a comprehensive bibliography and from the reading of these texts a method of classification is presented. This classification is coupled to available modern treatments as described in the literature and so gives the surgeon the available options for the stenosis encountered. The choice remains with the surgeon; however, as in most complex clinical problems there is usually a safe, reliable, dependable procedure, and it is the author's opinion, from this literature review, that the open laryngofissure procedure fulfils these criteria.

Europe↗
PubMedDate not supplied

Management of patients with long-term tracheotomies and aspiration.

The purpose of this study was to develop a management protocol for patients with long-term tracheotomies and aspiration, in order to develop clinical criteria for extubation and reduction of aspiration-related complications. We studied 39 patients with tracheotomies in place for over 3 months, 28 of whom completed management. Patients were classified according to degree of impairment and managed with the aims of avoiding aspiration and performing extubation whenever feasible. Criteria for choosing various management strategies are presented.

Adult↗