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Biomedical subjects

K Gunning

Publications and source records attributed to K Gunning.

At least 19 recordsLinked to original sources
PubMed2006

Postoperative changes in prothrombin time following hepatic resection: implications for perioperative analgesia.

Disorders of coagulation may occur after uncomplicated hepatic resection in patients who have normal preoperative coagulation profiles and liver function tests. We present a retrospective study performed in a tertiary care university teaching hospital examining changes in liver function tests and coagulation profiles in patients undergoing hepatic resection. Data were obtained for 124 patients. When compared to the preoperative values, prothrombin times were significantly increased throughout the postoperative period. Prolongation of the prothrombin time was related to both duration of surgery and hepatic resection weight. There was no relationship between prothrombin time and patient age. Disorders of coagulation occur after hepatic resection even in patients who have normal preoperative coagulation and liver function tests. This has implications for anaesthetic practice, particularly when considering the use of an indwelling epidural catheter in patients undergoing hepatic resection.

Analgesia↗
PubMed2001

Seasonal variation in admission rates to intensive care units.

Intensive care physicians perceive that there is seasonal variation in the number of admissions to critical care services. There is, however, little published evidence to support this belief. Data were therefore collected from five adjacent critical care units in the eastern region over a period of 8 years, in order to quantify any seasonal variation that may exist. Data on 16 355 critically ill patients were obtained between 1992 and 2000. Analysis showed clear winter peaks; December had a 30% higher admission rate than the quietest month, February. There was a small, but increasing, summer peak. The admission rate also exhibits an increasing linear trend, equivalent to a 6.6% annual increase in admissions per critical care bed. We conclude that there is significant seasonal variation in critical care activity, and that this is important to consider when planning services.

Adult↗
PubMed1999

A comparison of hospital and critical-care activity.

When compared with changes in hospital activity, corresponding fluctuations in critical-care activity are not clear. Therefore, trends in hospital activity were compared with those of the critical-care services and simple patient demographic details. The results suggest that while the size of hospitals remained static, hospital admissions and outpatient attendances increased by 5% each year. During the same period, the number of critical-care beds increased by 21.4%. Despite this increase in capacity, the activity of the critical-care services continued to increase by a similar 5% per annum, indicating a huge surge in critical-care workload. The results indicate that the increase in the rate of activity in hospitals and critical-care services is similar but the workload of the critical-care services is increasing much faster. This suggests that the demand for critical care may be generated from within hospitals.

Age Factors↗
PubMed1997

Heterogeneity in intensive care units: fact or fiction?

Reports and guidelines concerning intensive care practice have been issued recently. However, the introduction of such centrally issued recommendations may be difficult because of marked heterogeneity between intensive care units. This study examined the facilities (number of beds, consultant sessions, nursing establishment), annual workload (number and types of patients admitted) and outcome (intensive care unit mortality) in the (old) Anglia Region. There were significant differences in the distribution of patients' ages, severities of illness, diagnoses, durations of admission and outcomes. Such heterogeneity may make multicentre trials more difficult to conduct and create problems when uniform measures designed to improve intensive care services are being planned.

APACHE↗
PubMed1995

A modified combination technique for performing diagnostic peritoneal lavage.

Existing open diagnostic peritoneal lavage techniques (DPL) use small bore catheters, through a small lower midline incision or infra-umbilical incision. This study evaluated a modified DPL technique using a 10 mm umbilical incision, with open insertion of a 20 French peritoneal lavage catheter. The catheter has 27 radial side holes in the terminal distal 13 cm, and a female Leur lock connector. Warmed saline is infused via a cystoscopy infusion set. The time required to perform a new technique was studied in 10 patients. The median time to catheter insertion was 2.4 +/- 3.8 min, infusion time 0.75 +/- 0.3 min, effusion time 0.3 +/- 1.7 min, and a median total time of 7.6 +/- 4.2 min (median +/- s.d.). There was no complications. This technique of DPL is cosmetically attractive, much quicker than existing techniques and we have found its initial use encouraging.

Abdominal Injuries↗
PubMed1994

The retinoblastoma protein-binding region of simian virus 40 large T antigen alters cell cycle regulation in lenses of transgenic mice.

Regulation of the cell cycle is a critical aspect of cellular proliferation, differentiation, and transformation. In many cell types, the differentiation process is accompanied by a loss of proliferative capability, so that terminally differentiated cells become postmitotic and no longer progress through the cell cycle. In the experiments described here, the ocular lens has been used as a system to examine the role of the retinoblastoma protein (pRb) family in regulation of the cell cycle during differentiation. The ocular lens is an ideal system for such studies, since it is composed of just two cell types: epithelial cells, which are capable of proliferation, and fiber cells, which are postmitotic. In order to inactivate pRb in viable mice, genes encoding either a truncated version of simian virus 40 large T antigen or the E7 protein of human papillomavirus were expressed in a lens-specific fashion in transgenic mice. Lens fiber cells in the transgenic mice were found to incorporate bromodeoxyuridine, implying inappropriate entry into the cell cycle. Surprisingly, the lens fiber cells did not proliferate as tumor cells but instead underwent programmed cell death, resulting in lens ablation and microphthalmia. Analogous lens alterations did not occur in mice expressing a modified version of the truncated T antigen that was mutated in the binding domain for the pRb family. These experimental results indicate that the retinoblastoma protein family plays a crucial role in blocking cell cycle progression and maintaining terminal differentiation in lens fiber cells. Apoptotic cell death ensues when fiber cells are induced to remain in or reenter the cell cycle.

Animals↗
PubMed1992

Different effects of prostacyclin and phentolamine on delivery-dependent O2 consumption and skin microcirculation after cardiac surgery.

Inadequate tissue oxygen uptake autoregulation has been reported during the first hours after extracorporeal circulation for cardiac surgery. In the present study, we examined whether a dependence of oxygen consumption (VO2) on oxygen delivery (DO2) can be detected 24 hr after cardiac surgery using two different vasodilating agents. Cardiac output in triplicate was measured by thermodilution. Oxygen saturation of arterial and mixed venous blood was measured using a CO-oximeter. Oxygen consumption was assessed from the reverse Fick equation. In addition skin blood flow was assessed continuously by laser Doppler flowmetry. To investigate the VO2/DO2 relationship in 15 patients an increase in cardiac output and DO2 of at least 15% was achieved by systemic vasodilatation with iv prostacyclin (5-10 ng.kg-1.min-1) or phentolamine (5-10 g.kg-1.min-1). Infusion of phentolamine produced a 29 +/- 2% (mean +/- SE) increase in DO2 which was associated with a 20 +/- 6% increase in VO2. In contrast, prostacyclin produced a 22 +/- 3% increase in DO2 without change in VO2. Phentolamine did not alter skin microvascular blood flow, whereas prostacyclin increased skin microvascular blood flow by 33 +/- 3%. The results of the present study demonstrate a supply-dependency of VO2 in clinically stable patients 24 hr after cardiac surgery, suggesting the presence of an inadequate tissue O2 uptake autoregulation. The type of the vasodilator used to increase DO2 seems to play an important role in detecting such a supply-dependency of VO2, as well as changes of skin blood flow.

Adult↗
PubMed1992

Xanthine derivative HWA 138 attenuates hemodynamic and oxygen uptake dysfunction secondary to severe endotoxin shock in sheep.

Continuous E. coli endotoxin infusion in five awake sheep produced hypodynamic shock characterized by decreased cardiac output, increased pulmonary vascular resistance (PVR), leukopenia, high plasma levels of lactate, thromboxane B2 (TXB2) and 6-keto-prostaglandin F1 alpha (6-k-PGF1 alpha), and a pathological oxygen delivery-consumption relationship, i.e., a dependence of oxygen consumption on oxygen delivery, leading to death within 8-9 hr. Pretreatment with the xanthine derivative HWA 138 in six sheep prevented the endotoxin-induced fall in cardiac output and oxygen delivery, attenuated the increase in PVR and plasma 6-k-PGF1 alpha, and prolonged survival to 13-19 hr in five of the six sheep. The xanthine derivative had no effect on endotoxin-induced leukopenia, nor on the increase of plasma lactate and TXB2 levels. Although in the HWA 138 treated animals oxygen consumption increased significantly (by 59 +/- 17% at 8 hr), this increase was only transient, and at a level that was most probably insufficient to meet the increased metabolic requirements of this model. We conclude that pretreatment with HWA 138 attenuates endotoxin-induced hemodynamic and oxygen uptake disturbances and prolongs survival in this animal model of severe endotoxin shock.

Animals↗
PubMed1991

Time course of plasma and pulmonary lymph endothelin-like immunoreactivity during sustained endotoxaemia in chronically instrumented sheep.

1. Endothelin, a novel vasoconstrictor 21-residue peptide isolated from the supernatant of cultured porcine endothelial cells, has been shown to be increased in plasma in a variety of cardiovascular disease states, including acute myocardial infarction, acute renal failure and essential hypertension. We determined the time course of plasma and pulmonary lymph endothelin-like immunoreactivity in relation to the progressive deterioration of cardiopulmonary function in an ovine septic shock model leading to multi-organ failure syndrome and death within 42 h of a continuous intravenous infusion of Escherichia coli endotoxin (40 ng min-1kg-1). 2. Plasma and pulmonary lymph endothelin-like immunoreactivity were measured by r.i.a. using a specific antiserum raised in rabbits against porcine endothelin-1. Endothelin-like immunoreactivity was further determined in lung tissue and the thoracic duct lymph of endotoxin-treated sheep by reversed-phase h.p.l.c. In control instrumented conscious sheep not infused with endotoxin, there were no significant changes in any of the measured cardiopulmonary and biochemical variables, with plasma and pulmonary lymph endothelin-like immunoreactivity remaining below the detection limit (less than 1 pg/tube) throughout the 72 h study period. 3. Conscious sheep receiving endotoxin showed a major hypotensive septic syndrome, including persistently decreased systemic blood pressure, systemic vascular resistance, stroke volume, left ventricular stroke work, associated with sustained pulmonary vasoconstriction and protein-rich pulmonary oedema (greater than five-fold increase in pulmonary lymph flow and protein clearance), and marked lactic acidosis, leading to the death of animals within 14-42 h despite institution of mechanical ventilation and adequate intravascular volume replacement.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1991

Elevated plasma endothelin-1 concentrations are associated with the severity of illness in patients with sepsis.

Plasma immunoreactive endothelin-1 concentrations were determined by radioimmunoassay in 11 septic patients during the first 24 hours after the development of the sepsis syndrome in 15 nonseptic postoperative patients studied 24 hours after open heart surgery and in 14 healthy volunteers. Mean endothelin-1 plasma concentrations were significantly (p less than 0.001) increased in septic patients (19.9 +/- 2.2 pg/mL, mean +/- standard error) compared to concentrations found in postoperative cardiac patients (11.9 +/- 0.7 pg/mL) or in healthy volunteers (6.1 +/- 0.3 pg/mL). In septic patients elevated plasma concentrations of endothelin-1 were inversely correlated with cardiac index (r = -0.80, p less than 0.005) and positively correlated the severity of illness as documented by APACHE II score (r = 0.74, p less than 0.01) and plasma creatinine levels (r = 0.80, p less than 0.005). No such correlations were found in postoperative cardiac patients. These results indicate that endothelin-1 concentrations are correlated with the severity of illness and depression of cardiac output in patients with sepsis.

Adult↗
PubMed1991

Evaluation of the effect of perineuronal morphine on the quality of postoperative analgesia after axillary plexus block: a randomized double-blind study.

A randomized, double-blind study was performed on 50 patients scheduled for elective hand and forearm surgery under axillary plexus block to evaluate the effect of perineuronal morphine on the quality of postoperative analgesia. Patients were divided into two groups. In group A (n = 25) 5 mg of preservative-free morphine in 1.0 mL of 0.9% saline was added to the local anesthetic solution (20 mL of 1% plain lignocaine, 20 mL of 0.5% plain bupivacaine). They also received an intramuscular placebo injection of 1.0 mL of 0.9% saline in the upper thigh. In group B (n = 25), 1.0 mL of 0.9% saline was added to the local anesthetic solution and patients received an intramuscular injection of 5 mg of preservative-free morphine in 1.0 mL of 0.9% saline in the thigh. The addition of morphine to the local anesthetic solution for the axillary block did not shorten the onset time of the block, improve the quality of postoperative pain relief, or provide longer lasting analgesia than that obtained with intramuscular morphine.

Adolescent↗