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Biomedical subjects

J Farrell

Publications and source records attributed to J Farrell.

At least 37 records · Page 2Linked to original sources
PubMed1997

Complications associated with insertion of jugular venous catheters for hemodialysis: the value of postprocedural radiograph.

It is routine in hemodialysis units to require a chest radiograph after the insertion of an internal jugular line for venous access before dialysis is commenced. There are two principal reasons for this: (1) to ensure that no procedural complications have occurred and (2) to verify correct catheter placement. Knowledge of the time delay involved may prompt nephrologists to opt for femoral access (with increased hemodialysis recirculation and need for repeated line placement). The benefit of the postprocedural chest radiograph has never been evaluated in the hemodialysis population. We retrospectively reviewed the data on internal jugular access placement from two large nephrology training centers. Over a 36-month period, 460 internal jugular dialysis catheters were placed in 312 patients. Wherever possible, 15-cm lines were used for the left internal jugular vein and 12-cm lines for the right internal jugular vein. Ultrasound guidance was used in 105 cases (22.8%). There were a total of 90 (19.6%) clinical complications in 62 patients (13.5%). These consisted of carotid artery puncture (n = 35, 7.6%) and hematoma (n = 55, 12%). All of these patients had a normal post-internal jugular chest radiograph. Carotid artery puncture did not occur if ultrasound guidance was used. There was no case of associated pneumothorax. Of the 370 line insertions in 250 patients in whom it was believed clinically that no complication had occurred, the chest radiograph only showed unsuspected line malposition in four cases (1.08%). Routine chest radiographs rarely contribute to the diagnosis of any procedural complications and are of little value after internal jugular access placement, especially if it is believed clinically that no complication occurred.

Adult↗
PubMed1997

Ultrasound-guided cannulation versus the landmark-guided technique for acute haemodialysis access.

BACKGROUND: The correct placement of large-bore venous catheters plays an important role in the management of haemodialysis patients. Whilst the procedure for landmark-based placement of these catheters is well known, the technique is not without significant morbidity and mortality. Complications include arterial puncture, haematoma, and pneumothorax. The procedure may be further complicated in these patients by venous thrombosis and abnormal vein position from multiple previous attempts at venous access. METHODS: Data on the use of ultrasound guidance versus anatomical landmarks for the placement of internal jugular vein (n = 69) and femoral vein (n = 30) dialysis access was retrospectively analysed over a 13-month period. Data collected included age, sex, duration on dialysis, number of vein cannulation sets required, number of attempts for successful cannulation, salvage of failed cannulation using landmark-based technique by ultrasound guidance, and the complication rate. RESULTS: Internal jugular vein cannulation using ultrasound was ultimately successful in 96.7% compared to 82% in the landmark group. The vein was entered on the first attempt in 83.3% of patients with ultrasound compared to 35.9% of the landmark group (P < 0.0001). Seven patients in whom the landmark technique was unsuccessful had access placed under ultrasound guidance. There were fewer carotid artery punctures in the ultrasound group (7.7 versus 0%, P = n.s.). In the femoral vein group, the vein was entered on the first attempt in 85.7% of patients with ultrasound compared to 56.25% of the landmark group (P = n.s.). CONCLUSIONS: The use of ultrasound guidance is associated with fewer complications and is more likely to lead to cannulation of the vein at the first attempt in haemodialysis patients.

Carotid Artery Injuries↗
PubMed1997

Managing TMD.

Explore the source record for details and available documents.

American Dental Association↗
PubMed1997

Beta 2-microglobulin amyloidosis in chronic dialysis patients: a case report and review of the literature.

Dialysis-related amyloidosis secondary to beta-2-microglobulin (beta 2m) deposits is a common complication of long-term dialysis patients and is responsible for significant morbidity with potential mortality. Beta 2m amyloid has a propensity to deposit in the osteoarticular tissues, particularly in large bones close to the joint spaces, and in synovial membranes and carpal tunnel tissue. Older age at the onset of dialysis and the duration of dialysis are two important risk factors for development of this disease. The high-flux, more biocompatible membranes have been shown to remove and adsorb beta 2m more efficiently than the cellulosic membranes. This study presents the case of a chronic dialysis patient who developed recurrent arthritis of the left knee, followed by carpal tunnel syndrome; biopsy of the patient's knee showed very large aggregates of beta 2m amyloid deposits in the tendon sheets. A brief review of the literature on this subject is also presented.

Amyloidosis↗
PubMed1997

Paracetamol-induced pancreatitis and fulminant hepatitis in a hemodialysis patient.

The occurrence of hepatotoxicity and acute renal dysfunction following an acute paracetamol overdose has been well documented. Acute pancreatitis, however, has been rarely described. We would like to report a hemodialysis patient who developed acute pancreatitis and hepatic failure from acute paracetamol toxicity. To our knowledge, this represents the first description in a dialysis patient of paracetamol induced pancreatitis. Given the frequency of paracetamol usage in these patients, we believe that it is important to consider this diagnosis in patients with unexplained acute pancreatitis, particularly if there is associated hepatic dysfunction.

Acetaminophen↗
PubMed1996

Hydration of single-stranded phosphodiester and phosphorothioate oligodeoxyribonucleotides.

Infrared spectroscopy was used to identify hydration-sensitive structural differences between single- stranded phosphorothioate (PS) and phosphodiester (PO) oligodeoxyribonucleotides. Spectra were recorded in the mid-infrared region, 500-1800 cm-1, at relative humidities between 0 and 98%; the PS and PO spectra are substantially different. The hydration effects on spectral bands in these single-stranded oligodeoxyribonucleotides is markedly different from such behavior in double- and triple-stranded oligodeoxyribonucleotides. A strong absorption occurs at 656 cm-1 in the phosphorothioate sample which is completely absent from the PO spectra. Gravimetric measurements were carried out on one PS and one PO sample to monitor and confirm hydration. The calculated BET adsorption constants [Brunauer, S., Emmett, RH. and Teller, E. (1938) J. Am. Chem. Soc., 60, 309-319] are 1.2 and 1.4 water molecules per nucleotide in the first hydration layer of PS and PO respectively. While the gravimetric data indicate that the single-stranded oligodeoxyribonucleotides hydrate very similarly to duplex DNA, the mid-infrared conformational marker bands are strikingly different from those observed for duplex DNA. In particular, the Vas of the phosphate group (PO2) at 1222 cm-1 in the single-stranded PO spectra is independent of relative humidity.

Base Sequence↗
PubMed1996

Long-term successful management of refractory congestive cardiac failure by intermittent ambulatory peritoneal ultrafiltration.

Despite advances in the pharmacological management of cardiac failure, some patients remain refractory to this therapy. However, improved understanding of the physiology and technique of peritoneal dialysis has recently allowed ambulatory peritoneal ultrafiltration to be applied to the treatment of patients with intractable heart failure. We report the management of three such patients with New York Heart Association (NYHA) class IV cardiac failure, each with a left ventricular ejection fraction < 20%. They had become unresponsive to maximum pharmacological management with inotropes, diuretics and ACE inhibitors. All patients had biochemical evidence of pre-renal azotemia. Initially, patients received aggressive ultrafiltration by continuous veno-venous haemofiltration (CVVH) or one- to two-hourly peritoneal dialysis exchanges until they achieved an optimal dry body weight. Once stabilized, they were converted to an intermittent ambulatory peritoneal ultrafiltration (IAPU) regimen of one to three exchanges per 24 h according to their individual needs. During an 18 +/- 10-month follow-up, their duration of hospital confinement was reduced by 85% and all three patients improved from class IV to class II cardiac failure. IAPU may have a useful role in the long-term management of intractable heart failure in a selected group of patients.

Chronic Disease↗
PubMed1996

Quality assurance. Establishing a district-wide enuresis service.

When two authorities merged there was a need to unify and redefine two previously separate services. A steering group including the school nurse co-ordinator agreed the aims, objectives and standards for the new service. Clients (age range 5-18) see a CMO at the first visit and thereafter a school nurse. Rigorous audit of outcomes has enabled the service to demonstrate its effectiveness.

Adolescent↗
PubMed1995

Malignant and normal T cells show random use of T-cell receptor alpha chain variable regions in patients with cutaneous T-cell lymphoma.

Cutaneous T-cell lymphoma (CTCL) is a malignancy of mature T lymphocytes, most of which express alpha/beta type T-cell receptors (TCRs). The cause of CTCL is unknown, but hypotheses postulating chronic stimulation of TCRs by superantigen or by a leukemogenic virus have been proposed. Either mechanism might produce bias in the TCR variable (V) region types used by the malignant cells. To determine if TCR alpha use is restricted in CTCL, we used reverse transcription and the polymerase chain reaction to determine V alpha and V beta usage by malignant cells purified from the peripheral blood of leukemic patients with CTCL. Usage of alpha chain V region segments appeared totally random; malignant lymphocytes isolated from each of six patients used different V alpha regions. As has been previously reported, no bias was found in beta chain V region usage either. In addition to productive (in frame) TCR V region mRNAs in malignant cells from each patient, we detected non-productive (out of frame) beta chain transcripts in these cells in two of six patients, and non-productive alpha chain transcripts in five of six. Residual normal peripheral blood lymphocytes from these patients showed a random, polyclonal or oligoclonal pattern of V region usage. We conclude that there is no bias in V region usage in CTCL, making it unlikely that interactions between superantigen or virus and the TCR V regions play a role in the pathogenesis of CTCL.

Aged↗
PubMed1995

Renal failure associated with alternative medical therapies.

Because the kidney is the major excretory organ for drugs and toxins, it is especially susceptible to damage from such agents. While alternative medical therapies appear to be on an increase worldwide, there have been few case reports regarding their nephrotoxicity. However we have recently observed three patients who developed irreversible renal impairment, which we believe was due to such therapies.

Acute Kidney Injury↗
PubMed1994

Delayed postoperative paraplegia with hypotension in adult revision scoliosis surgery.

The clear and reversible relationship of spinal cord function to postoperative hypotension is illustrated in a case of revision scoliosis surgery in an adult patient. The correlation of spinal cord monitoring by both magnetic cortical motor evoked potentials and spinal somatosensory evoked potentials to the clinical status is shown, and the importance of close postoperative observation of the adult revision case is emphasized.

Adult↗
PubMed1994

School nursing. Profile of five-year-olds in six primary schools.

The health of 295 five-year-olds was screened by a school nurse at six primary schools in a socially deprived area of Wakefield, West Yorkshire, between September 1991 and August 1992. 64% of children were reported by their parents to have a medical condition, mainly asthma and other chest-related conditions (40%), ENT problems (32%) and eczema (19%). The poor health of children identified in this report highlighted the need to strengthen the school nursing service, and improvements are now under way.

Child Welfare↗
PubMed1993

Anterior mediastinal fibrosis with superior vena caval obstruction complicating the synovitis-acne-pustulosis-hyperostosis-osteomyelitis syndrome.

A syndrome of predominantly palmo-plantar pustular psoriasis associated with anterior chest wall (sternoclavicular, manubriosternal) inflammation has previously been described. In this case, a further patient is reported where chest wall involvement is complicated by anterior mediastinal fibrosis and superior vena caval obstruction.

Fibrosis↗