Biomedical subjects
Publications and source records attributed to J Filshie.
Hickman lines may be used for long-term venous access in patients having chemotherapy, bone marrow transplantation, parenteral nutrition, or in others needing prolonged venous access. This article describes the technique of percutaneous insertion, some of the problems that may be encountered at insertion, and ways of minimizing these problems.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
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1. The absolute bioavailability of morphine from oral aqueous solution, a controlled release oral tablet (MST-Continus) and a controlled release buccal tablet has been investigated in six healthy volunteers. 2. Analysis of plasma samples for morphine and its active metabolite morphine-6-glucuronide (M6G) was by means of a differential radioimmunoassay technique. Absolute bioavailability for morphine was estimated to be 23.9% after oral solution, 22.4% after MST-Continus and 18.7% after the buccal tablet. Maximum plasma morphine concentrations were seen at 45 min (oral solution), 2.5 h (MST) and 6 h (buccal). 3. There was no difference in the amount of M6G appearing in plasma after intravenous, oral or buccal administration but the mean ratio of AUCs for M6G: morphine in plasma after intravenous morphine was 2 : 1 compared with 11 : 1 after oral and buccal morphine.
Current non-drug treatment of neuropathic pain with stimulation techniques and nerve blocking techniques is reviewed. Many specific methods including electrical nerve stimulation, acupuncture, sympathetic blockade, epidural and intrathecal blocks, neurosurgical and psychological techniques are described. The move away from destructive procedures to non-destructive methods is noted. Shortcomings in the methods available highlight the fact that further study in this field is necessary.
We describe the first use of Hickman-Broviac catheters in 20 children under the age of 4 years for repeated daily general anaesthesia for radiotherapy. These children received a total of four hundred and eighty two general anaesthetics. The advantages and disadvantages of using Hickman-Broviac lines are discussed.
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The anaesthetic management of 217 donors undergoing 236 operative procedures to donate bone marrow for allogeneic transplantation or for autologous grafting is described. The procedures were those performed between November 1979 and the end of October 1982.
35 patients were treated for acute myeloid leukaemia or acute lymphoblastic leukaemia with allogeneic bone-marrow grafts from a parent, child, or sibling who was mismatched at the major histocompatibility complex (MHC). 11 of these patients are alive at least 6 months after grafting, 5 of them after more than 2 years. Of the 15 patients aged under 20 at the time of the graft, 8 are alive and well 6 months to 3 years later. Cyclosporin A was given to all patients after grafting. 1 patient died of acute graft-versus-host disease and in 2 other cases this was a major factor in their death. Graft failure caused the death of 2 patients. 4 patients died of recurrent leukaemia. A fatal complication in 12 patients was pulmonary oedema, often associated with convulsions, intravascular haemolysis, and renal failure. Some of these patients had viral or bacterial infections, but in the majority the syndrome was not associated with demonstrable infection. This syndrome, in which the essential lesion appears to be vascular, was much more common in recipients of mismatched than matched grafts. 3 others died from lung disease in which infection was a factor.
One hundred and nineteen patients with leukaemia have received CSA as prophylaxis against acute GVHD following sibling MHC matched (84) or family member mismatched bone marrow transplants (35). four recipients of matched transplants (3%) died of acute GVHD, a marked improvement on our previous results using methotrexate (26 patients; 27% died of GVHD). Thirty-five patients received mismatched transplants, 15 were under the age of 20 years and eight are alive and in remission, the longest survivor being one at 2 1/2 years after transplant.
Twenty-eight patients with advanced life-threatening metastatic malignant melanoma were treated with high dose (140-260 mgm-2) intravenous melphalan and autologous bone marrow. Cyclophosphamide "priming" 300 mgm-2 i.v. was given to 19 patients one week previously and this resulted in clinical but not histological evidence of amelioration of gastrointestinal toxicity. In 11 patients (43%) there was evidence of tumour response to treatment and in 2 patients complete remissions were observed. However in most patients, responses were short-lived and no patient lived longer than 17 months from start of treatment or 24 months from first recorded evidence of distant metastatic disease.
Twelve patients have undergone unilateral coeliac plexus block using needle localisation by computed tomography and the technique is described. Computed tomography has the advantage that the needle route to the coeliac axis can be accurately planned, avoiding damage to other organs. In this study nine out of twelve patients had significant pain relief. Most success was achieved in patients with carcinoma of the pancreas.
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