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Biomedical subjects

J Tinker

Publications and source records attributed to J Tinker.

At least 19 recordsLinked to original sources
PubMed1989

Continuous high volume venous-venous haemofiltration in acute renal failure.

Continuous, high volume, venous-venous haemofiltration was used as renal support in 28 critically ill patients with acute renal failure. Fifteen patients survived and were subsequently discharged from the ITU. Although haemofiltration was highly effective in reducing the blood urea and serum creatinine, only survivors demonstrated a significant increase in arterial pH (medians before and at two days 7.28 and 7.49 respectively, p less than 0.005) with a reduction in severity of their illness (median APACHE II scores before and at two days 23 and 16, p less than 0.005). Patients who died remained severely ill and acidotic (median APACHE II scores before and at two days 26 and 28; median arterial pH values 7.32 and 7.31 respectively) and by day two of treatment, marked differences between the patient groups in APACHE II scores, mean arterial pressure, arterial pH and urine flow rate had developed. Haemofiltration with the correction of acute uraemia alone does not necessarily lead to a reduction in the severity of illness which in the critically ill more frequently reflects other organ dysfunction.

Acute Kidney Injury↗
PubMed1988

The therapeutic value of vasodilator prostaglandins in multiple organ failure associated with sepsis.

There is considerable evidence from animal and human studies of sepsis and acute lung injury that prostacyclin and PGE1 may have a beneficial effect on tissue perfusion with a reduction in the severity of tissue damage associated with these disorders. As yet, there are no good data from controlled clinical trials that these agents improve survival and it is not clear whether in the future such data will be forthcoming. Nevertheless, using various physiological end-points, both prostaglandins seem to be beneficial in sepsis and when used in combination with the whole process of Intensive Therapy, may contribute to the survival of some cases. Although the assessment of combinations of agents designed to inhibit mediator release might be more useful, it remains to be seen whether the relatively insensitive controlled clinical trial, with survival as its endpoint, is the appropriate tool for assessing efficacy in the ITU. Perhaps, the 'consensus' approach has something to offer in this situation!

Critical Care↗
PubMed1987

The effects of vasodilation with prostacyclin on oxygen delivery and uptake in critically ill patients.

We hypothesized that inadequate oxygenation of peripheral tissues may be unrecognized in critically ill patients and may worsen their prognosis. To test this hypothesis, we measured oxygen delivery to tissues, oxygen uptake, and the extraction ratio (uptake/delivery) before and during a 30-minute infusion of a vasodilator, prostacyclin (5 ng per kilogram of body weight per minute), in 27 critically ill patients with acute respiratory failure. Prostacyclin produced an increase in oxygen delivery (median value before vs. during infusion, 375 vs. 492 ml of oxygen per minute per square meter of body-surface area, P less than 0.001) that was similar in the 14 patients who survived and the 13 who died. This increase in oxygen delivery was associated with a significantly greater increase in oxygen uptake in the patients who died as compared with the survivors (median increase, 19 vs. 5 percent, P less than 0.001). In the survivors, the oxygen extraction ratio fell (median change, -17 percent; range, -27 to -6 percent) and the mixed venous oxygen tension increased. In the patients who died, the extraction ratio rose (median change, 11 percent; range -24 to +40 percent) and the mixed venous oxygen tension did not change. These data suggest the presence of a substantial oxygen debt in patients who subsequently die. Inadequate tissue oxygenation, which may be difficult to recognize, appears to be an important mechanism contributing to the development of irreversible multiple organ failure and subsequent death in some patients with acute respiratory failure.

Acute Disease↗
PubMed1986

A second open letter to the General Medical Council.

In an open letter to the General Medical Council this independent group, drawn from several branches of the profession, expressed the belief that undergraduate medical education was failing in two respects; first, in the extent to which it equips doctors with the capacity to think critically for themselves; and secondly, in the degree to which it inculcates a broad and sensitive outlook towards the health of both individuals and communities. A remedy for both lies, in our opinion, in the better co-ordination of the different stages of medical education. Particularly important in this context is the period immediately after graduation. We therefore welcome the attention which the General Medical Council's Education Committee is now paying to this second stage. We welcome also the view which it has expressed that it is necessary to continue a broad education into the period when the qualified doctor is assuming responsibility for patient care. In this second letter we propose and discuss six aims for this period; and changes in educational organization needed if these aims are to be fulfilled.

Clinical Clerkship↗
PubMed1985

The haemostatic effects of hydroxyethyl starch (HES) used as a volume expander.

Hydroxyethyl starch (HES 450.000/0.7; Hespan 6.0 g/100 ml) was compared with standard crystalloid solutions in postoperative volume replacement in 20 patients undergoing routine orthopaedic surgery. The HES group showed no clinical evidence of haemorrhage and no laboratory evidence of significant haemostatic defects as assessed by standard coagulation tests, platelet aggregation and fibrinogen concentrations. There was a slight shortening in the thrombin time and a smaller increase in post-operative FVIII RAg and FVIII RCof levels in the HES group. HES is a safe and effective volume expander for postoperative use.

Adolescent↗
PubMed1985

Factors relating to the development of hypertension after cardiopulmonary bypass.

Paroxysmal hypertension after cardiac surgery is a phenomenon of physiological and clinical significance. The possible preoperative and intraoperative factors that may predict its occurrence were studied in 81 consecutive patients undergoing coronary artery surgery (n = 58) or valve replacement (n = 27), of whom 45 (56%) developed postoperative hypertension. Hypertension occurred significantly more often in those patients who received beta adrenergic blocking agents preoperatively and who underwent coronary artery surgery. Patients with hypertension had significantly higher mean left ventricular ejection fractions preoperatively (52%) than those without (41%) and required phentolamine significantly more often and isoprenaline significantly less often intraoperatively. It is suggested that the significance of preoperative beta adrenergic blockade, the type of operation, and the intraoperative requirement for phentolamine in patients who developed post-operative hypertension may indicate the role of enhanced sympathetic activity and disturbance of cardiac receptors during surgery. Preoperative myocardial performance and the method of myocardial protection during surgery are likely to influence the occurrence of the hypertensive phenomenon.

Adrenergic beta-Antagonists↗
PubMed1985

Stress ulceration in the critically ill patient.

Stress ulceration is common in patients receiving intensive care. Its cause is ill defined, life threatening complications are rare but the use of H2 antagonists and antacids in prophylaxis is widespread. The development of haemorrhage and perforation appears to be related to a group of risk factors of which sepsis may be the most important.

Antacids↗
PubMed1982

Measurement of transcutaneous PCO2 in critically ill patients.

Transcutaneous carbon dioxide tensions (tcPCO2) measured with a heated electrode were compared with arterial carbon tensions (PaCO2) in 28 patients. Seventy-eight observations were made. At a skin electrode temperature of 44 degrees C the tcPCO2 was significantly higher than PaCO2 but changes in PCO2 detected by both measurements were closely correlated. The correlation coefficient between tcPCO2 and PaCO2 was 0.92 (P less than 0.001). The 90% response time of the electrode in vitro was less than 1 min, and in vivo stabilization of the recording occurred in less than 15 min. It was found that the transcutaneous PCO2 electrode can be employed usefully in intensive care monitoring of adult patients especially when weaning them from artificial ventilation.

Adult↗
PubMed1980

Amino acid acylation: a mechanism of nitrogen excretion in inborn errors of urea synthesis.

Treatment of a patient deficient in carbamyl phosphate synthetase with benzoate or phenylacetic acid resulted in an increase in urinary nitrogen, which could be accounted for by the respective amino acid acylation product, hippurate or phenylacetylgultamine. Benzoate treatment of four hyperammonemic comatose patients led to clinical improvement and a return of plasma ammonium levels toward normal.

Adolescent↗
PubMed1980

Inotropic drugs in acute circulatory failure.

The use of inotropic drugs in patients requiring acute circulatory support is reviewed. A knowledge of their various peripheral effects is essential if the appropriate drug is to be used. The place or pressor amines, digitalis, salbutamol and glucagon in the treatment of patients with poor tissue perfusion is limited. Of the catecholamines, adrenaline causes excessive renal vasoconstriction and peripheral gangrene, noradrenaline increase myocardial work and diminishes peripheral perfusion and isoprenaline distributes blood away from the vital organs, namely: brain, kidneys, heart and mesentery. Dopamine is a useful agent as it enhances renal blood flow in low doses and is not excessively chronotropic. Dobutamine has not yet been shown to have significant advantages over other inotropes and requires further examination.

Adrenergic alpha-Agonists↗
PubMed1979

Characteristics of transcutaneous oxygen tension monitors in normal adults and critically ill patients.

The performance characteristics of two transcutaneous PO2 monitors were detailed in eleven healthy adults and eighteen critically ill patients (twelve following cardiopulmonary bypass). There was no significant difference in their performance when blood was used as the calibrating medium. In critically ill patients they proved to be of value for recording short term trends in arterial PO2 rather than for measuring absolute values.

Adult↗