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Biomedical subjects

J Rennie

Publications and source records attributed to J Rennie.

At least 19 recordsLinked to original sources
PubMed2006

Anaesthesia for elective inguinal hernia repair in rural Ghana - appeal for local anaesthesia in resource-poor countries.

Local anaesthesia has been identified as the most favourable anaesthesia for elective inguinal hernia repair with respect to complication rate, cost-effectiveness, and overall patient satisfaction. Operation theatre notes in all seven hospitals in the Northern Region in Ghana over the period of 1 year were reviewed. Only 22.4% out of 1038 repairs were performed under local anaesthesia while predominantly spinal and general anaesthesia were used (48.0 and 29.6%, respectively). African surgeons chose local anaesthesia far less frequently than visiting overseas surgeons (15.6 versus 27.7%, respectively). All surgeons in resource-poor countries should be encouraged to use local anaesthesia more frequently for elective inguinal hernia repair. Valuable resources in sub-Saharan African hospitals could be saved, especially if used in combination with outpatient surgery. The technique should be taught in teaching institutions. A simple step-by-step technique is described.

Adolescent↗
PubMed2005

Developmental outcome of the use of etamsylate for prevention of periventricular haemorrhage in a randomised controlled trial.

OBJECTIVE: To compare neurodevelopmental outcome of survivors of the multicentre trial of etamsylate (the iRNN for ethamsylate) for prevention of periventricular haemorrhage in very low birthweight infants. DESIGN: Double blind, single observer, prospective follow up of placebo controlled study. SETTING: Six neonatal intensive care units in the United Kingdom. Neurodevelopmental outcome was assessed in health premises or children's homes. SUBJECTS: 268 of 276 survivors of the original study were seen between 3.5 and 4.2 years of age. All were inborn and weighed 1500 g or less at birth. INTERVENTION: Etamsylate 12.5 mg/kg or placebo six hourly from within one hour of delivery for four days. MAIN OUTCOME MEASURES: McCarthy scales of children's abilities, standardised neurological examination, full physical examination, functional assessment, seven letter Stycar vision test, and audiometry. RESULTS: There was no difference between the groups in neuromotor outcome (cerebral palsy) or in the general cognitive index (GCI) of the McCarthy scales (mean GCI was 93.3 for the etamsylate group (n = 133) and 89.7 for the placebo group (n = 131); p = 0.10). There were more children with GCI < 70 (9 v 19; p = 0.047) or </= 50 (3 v 11; p = 0.03) in the placebo group. Fewer children in the etamsylate group had squints (17 v 30; p = 0.042) or required surgery for patent ductus arteriosus (1 v 8; p = 0.036). CONCLUSIONS: Etamsylate was not associated with a reduction in cerebral palsy. Severe cognitive impairment was reduced, but more children died and the improvement may be because fewer survived with low GCI.

Cerebral Hemorrhage↗
PubMed2002

Cortical visual evoked potentials in very low birthweight premature infants.

OBJECTIVES: To compare the age of onset of the pattern orientation reversal visual evoked potential (OR-VEP) in a group of very low birthweight (VLBW) premature infants with term infants matched for postconceptual age at testing. The OR-VEP measure is used as an indicator of visual cortical functioning because of the specificity of cortical neurones in showing sensitivity to changes of slant or orientation. DESIGN: Results are given for 24 VLBW infants, born at 24-32 weeks gestation weighing less than 1500 g, and 31 infants born at term. The steady state evoked potential to a grating pattern reversing in orientation (between 45 degrees and 135 degrees) at 4 reversals/second and 8 reversals/second was recorded. RESULTS: The VLBW infants with normal neonatal ultrasound results (and normal neurological outcome at 3 years of age) showed a significant OR-VEP with a similar postnatal time course to the term infants. Four premature infants, showing appreciable abnormalities on ultrasound examination, did not show normal onset of the OR-VEP, and all had an abnormal neurological outcome. CONCLUSIONS: This result can be taken to indicate that the onset of cortical function is similar in healthy preterm infants to term infants. The visual development of the premature infants was neither accelerated nor delayed as a result of their extra visual experience. The OR-VEP can be used as a prognostic indicator of early brain development alongside other neurological measures. It may also be a very early indicator of later neurological outcome.

Aging↗
PubMed2001

Review of total hip replacement. The Middlemore Hospital experience, 1980-1991.

AIM: To determine the outcome of 1951 total hip arthroplasties performed between 1980 and 1991 at Middlemore Hospital. METHODS: An independent retrospective review was carried out between 1993 to 1995 giving a minimum follow-up of two years. Useable data were obtained for 96.8% of cases. RESULTS: The overall wound infection rate was 3.4% (n=65), and of these seven (10.8%) required revision. The revision rate for infection for all patients was 1.16% (n=22). The in-hospital dislocation rate was 2.6% (n=49), and of these five (9.8%) required revision. Patient pain, activity and satisfaction were acceptable. Revision was required for 163 patients (8.7%), mainly for loosening. A survival analysis of the commonly used implants at seven years matched results from other studies. (Stem survival: Spectron 99.5%, Charnley 95.6%. Cup survival: Spectron 97.9%, Charnley 98.1%). Analysis of outcome predictors showed that youth and weight both influence the rate of revision. CONCLUSIONS: Results in terms of patient satisfaction and revision rates were comparable with other published series. The wound infection rate was higher than desirable, but not unexpected in view of the number of surgeons involved (73) and the lack of special theatre facilities.

Aged↗
PubMed2000

National census of availability of neonatal intensive care. British Association for Perinatal Medicine.

OBJECTIVE: To determine whether availability of neonatal intensive care cots is a problem in any or all parts of the United Kingdom. DESIGN: Three month census from 1 April to 30 June 1999 comprising simple data sheets on transfers out of tertiary units. SETTING: The 37 largest high risk perinatal centres in the United Kingdom. PARTICIPANTS: One obstetric specialist and one neonatal specialist in each centre. MAIN OUTCOME MEASURES: Suboptimal care resulting directly from pressure on service-that is, transfers out of tertiary units (either in utero or after delivery) because the unit was "full" and not because the hospital was incapable of providing the care needed. RESULTS: All units provided data. The number of intensive care cots in each unit was between five and 16. During the three months 309 transfers occurred (equivalent to 1236 per year), of which 264 were in utero and 45 postnatal. Sixty five in utero transfers involved multiple births, hence the census related to 382 babies (1528 per year). There was considerable regional variation. The reason for transfer in most cases was "lack of neonatal beds". CONCLUSIONS: Currently most major perinatal centres in the United Kingdom are regularly unable to meet in-house demand; this has implications for the service as a whole. The NHS has set no standards to help health authorities and primary care groups develop services relating to this specialty; such a step may well be an appropriate lever for change.

Bed Occupancy↗
PubMed2000

Respiratory distress in a neonate with an enlarged thymus.

UNLABELLED: Thymic hyperplasia, although not a rare condition in infancy, is usually asymptomatic. We describe an infant presenting in the perinatal period with marked tachypnoea. An enlarged thymus, demonstrated on chest radiograph and CT, was associated with small-volume, non-compliant lungs. Other causes of pulmonary malfunction and maldevelopment were excluded. CONCLUSION: Thymic enlargement is unusually associated with neonatal respiratory distress but should be considered in the differential diagnosis.

Humans↗
PubMed1999

Thoracoscopic sympathectomy: indications and complications.

In 1942,Hughes performed the first thoracoscopic removal of sympathetic ganglia. Two years later Goetz and Marr reported on cases that had undergone thoracoscopic sympathectomy. In the 1950s, Kux performed more than 1,400 thoracoscopic sympathectomies and vagotomies. Interest in thoracoscopic sympathectomy increased in the 1980s and now it is the treatment of choice for severe axillary and palmar hyperhidrosis.

Journal Article↗
PubMed1998

The natural history of fetomaternal alloimmunization to the platelet-specific antigen HPA-1a (PlA1, Zwa) as determined by antenatal screening.

Immunization against the human platelet antigen (HPA)-1 alloantigen is the most common cause of severe fetal and neonatal thrombocytopenia. Fetal therapy has substantial risks and its indications need better definition. Of 24,417 consecutive pregnant women, 618 (2.5%) were HPA-1a negative of whom 385 entered an observational study. All were HLA-DRB3*0101 genotyped and screened for anti-HPA-1a. Their partners and neonates were HPA-1 genotyped and the latter were assessed by cord blood platelet counts and cerebral ultrasound scans. Anti-HPA-1a was detected in 46 of 387 pregnancies (12.0%; 95% CI 8.7%-15.2%). All but one were HLA-DRB3*0101 positive (odds ratio 140; 95% CI 19-1035; P< .00001). One baby died in utero, and of 26 HPA-1a-positive babies born to women with persistent antenatal antibodies, 9 were severely thrombocytopenic (8 with a count <10 x 10(9)/L, 1 with a large porencephalic cyst), 10 were mildly thrombocytopenic, whereas 7 had normal platelet counts. Severe thrombocytopenia was significantly associated with a third trimester anti-HPA-1a titer >/= 1:32 (P = . 004), but was not observed in babies of women with either transient or postnatal-only antibodies. HPA-1a alloimmunization complicates 1 in 350 unselected pregnancies, resulting in severe thrombocytopenia in 1:1,200. HPA-1a and HLA-DRB3*0101 typing combined with anti-HPA-1a titration allows selection of the majority of pregnancies at risk of severe thrombocytopenia.

Abortion, Spontaneous↗
PubMed1997

Animal rights.

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Animal Rights↗
PubMed1997

Dichorionic twins discordant for intrauterine growth retardation.

A policy of expectant management until 32 weeks of gestation in 29 dichorionic pregnancies discordant for growth retardation resulted in an overall mortality of 24% (95% CI 13.9-37.2%) and a handicap of 2.2% (95% CI 0-12.0%). None of the normally grown co-twins died or was handicapped as a result of iatrogenic prematurity.

Delivery, Obstetric↗