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Biomedical subjects

K R Burgess

Publications and source records attributed to K R Burgess.

At least 19 recordsLinked to original sources
PubMed2002

Sports and training injuries in British soldiers: the Colchester Garrison Sports Injury and Rehabilitation Centre.

OBJECTIVES: To record and analyse the injuries and conditions requiring referral to the Colchester Garrison Sports Injury and Rehabilitation Centre over a three year period, with special reference to type and site of injury, aetiology, and outcome. METHODS: An ongoing prospective study in which data on the diagnosis, cause of injury, and treatment of all patients referred to the Centre was coded and stored on a database. A total of seventeen variables were recorded. SUBJECTS: All patients were trained, serving soldiers in the British Army referred via their General Practitioner to the Sports Injury and Rehabilitation Centre. RESULTS: A total of 3921 referrals were made over the three-year period. The most common specific condition seen was low back pain (22.2%) followed by sprain of the ankle (15.1%). Lower limb conditions, both overuse and traumatic, accounted for over half (55.8%) of all referrals. Military training was the most common cause of all conditions (35.2%) followed by organised or personal sport (28.5%). In addition to medical treatment and physiotherapy, 30% of patients required formal rehabilitation. CONCLUSIONS: This is the first full review of the data collected by the Sports Injury and Rehabilitation Centre. It defines the injury patterns for trained soldiers rather than military recruits. Low back pain is identified as a major cause of morbidity in this population. The review serves as a benchmark in the planning of injury prevention strategies and the establishment of future rehabilitation services.

Adolescent↗
PubMed1999

Ruptured abdominal aortic aneurysm--outcome in a community teaching hospital intensive care unit.

Ruptured abdominal aortic aneurysm (RAAA) is a surgical emergency associated with a high mortality often requiring postoperative intensive care. Our objectives were to assess the outcome of RAAA management in a nontertiary community hospital intensive care unit (ICU) and to compare this with historical data from tertiary hospitals. We also sought to identify variables related to outcome and evaluate the potential of an organ failure score to identify patients at increased risk of death. The study was a retrospective chart review of patients with RAAA over 11 years (1986-1996 inclusive) at Manly District Hospital, a 210 bed community teaching hospital with eight intensive care beds. Forty patients were identified in the study period as having been admitted to ICU after RAAA surgery. There was an overall hospital mortality rate of 47.5% and intensive care mortality rate of 42.5% for successfully operated RAAA. Five variables were significantly different between survivors and non-survivors. These were age, total amount of blood products required, duration of operation, development of hypotension (systolic blood pressure < 90 mmHg) in ICU postoperatively, and APACHE II score at Day 1 ICU. A trend was also found between mortality rate and the number of failed systems after 48 hours intensive care stay. Mortality for a patient with zero failed systems was 38%, one failed system 42%, two 58% and three 67%. Based on these results, management of RAAA in a non-tertiary setting appears appropriate with postoperative care occurring in an ICU where there is adequate equipment and medical and nursing staff experienced in the care of complex critical illness.

Aged↗
PubMed1998

Central sleep apnoea and heart failure (part II).

Central sleep apnoea (CSA) in congestive heart failure is sleep state dependent and occurs typically in stages I and II of non-REM sleep. The pre-requisites are hypocapnia and some prolongation of the circulation time. It is not certain whether abnormalities in after-discharge activity in the brainstem are also important. The presence of CSA in patients with left ventricular dysfunction is a poor prognostic sign and associated with a higher mortality in that group compared to age, sex and ejection fraction matched patients with congestive cardiac failure alone. It is reasonable to speculate that the CSA causes an increase in sympathetic nervous system activity which would maintain afterload at a high level or tend to increase it with time. The application of a high afterload to an impaired left ventricle leads over time to a further reduction in ejection fraction. From other studies, particularly ACE inhibitor studies, it is known that ejection fraction and prognosis are almost linearly related. It could therefore be said that once CSA has developed it may lead to a vicious circle of increasing afterload and further reduction in ejection fraction, causing worsening CSA and further increases in afterload. A number of treatments have been shown to be of benefit: supplemental nocturnal oxygen therapy, acetazolamide and nasal CPAP therapy have all been shown to reduce CSA. In addition nasal continuous positive airways pressure (CPAP) has been shown by two groups in Canada to also improve ejection fraction. The beneficial effects on ejection fraction in particular, persist after the treatment has been withdrawn, which suggests either remodelling of the left ventricular musculature or a resetting of the baseline sympathetic nervous system activity. The impressive increase in ejection fraction due to three months nasal CPAP therapy in one study (an average 35% increase) is both dramatic and exciting for the future. It is reasonable to expect improvement in prognosis for patients with CCF whose ejection fraction rises with CPAP treatment. Finally, only a limited number of studies have been published. Unfortunately the impressive results from Canada have not yet been reproduced in other centres around the world.

Airway Obstruction↗
PubMed1997

Central sleep apnoea and heart failure (Part I).

Central sleep apnoea (CSA) in congestive heart failure is sleep state dependent and occurs typically in stages I and II of non-REM sleep. The pre-requisites are hypocapnia and some prolongation of the circulation time. It is not certain whether abnormalities in after-discharge activity in the brainstem are also important. The presence of CSA in patients with left ventricular dysfunction is a poor prognostic sign and associated with a higher mortality in that group compared to age, sex and ejection fraction matched patients with congestive cardiac failure alone. It is reasonable to speculate that the CSA causes an increase in sympathetic nervous system activity which would maintain afterload at a high level or tend to increase it with time. The application of a high afterload to an impaired left ventricle leads over time to a further reduction in ejection fraction. From other studies, particularly ACE inhibitor studies, it is known that ejection fraction and prognosis are almost linearly related. It could therefore be said that once CSA has developed it may lead to a vicious circle of increasing afterload and further reduction in ejection fraction, causing worsening CSA and further increases in afterload. A number of treatments have been shown to be of benefit: supplemental nocturnal oxygen therapy, acetazolamide and nasal CPAP therapy have all been shown to reduce CSA. In addition nasal continuous positive airways pressure (CPAP) has been shown by two groups in Canada to also improve ejection fraction. The beneficial effects on ejection fraction in particular, persist after the treatment has been withdrawn, which suggests either remodelling of the left ventricular musculature or a resetting of the baseline sympathetic nervous system activity. The impressive increase in ejection fraction due to three months nasal CPAP therapy in one study (an average 35% increase) is both dramatic and exciting for the future. It is reasonable to expect improvement in prognosis for patients with CCF whose ejection fraction rises with CPAP treatment. Finally, only a limited number of studies have been published. Unfortunately the impressive results from Canada have not yet been reproduced in other centres around the world.

Animals↗
PubMed1994

Impaired ventilatory response to carbon dioxide in patients with chronic renal failure: implications for the intensive care unit.

OBJECTIVES: To compare aspects of ventilatory control and the susceptibility to depressant drugs between patients with chronic renal failure and normal volunteers. DESIGN: Prospective, controlled study. SETTING: Pulmonary function laboratory of a university hospital. PATIENTS: Six patients with chronic renal failure requiring hemodialysis and ten normal, control subjects. INTERVENTIONS: Ventilatory responses to breathing CO2 were studied using a rebreathing method. The effects of triazolam (0.5 mg orally) and meperidine (1 mg/kg, subcutaneously) on these measurements were also studied. MEASUREMENTS AND MAIN RESULTS: Dialysis patients showed definite impairment in the ventilatory response to CO2, which could not be accounted for by differences in respiratory mechanics, muscle strength, or acid-base status. Meperidine impaired ventilatory responses in control subjects and in renal patients, while triazolam had little effect on either group. The effect of the drugs was not proportionately greater in dialysis patients than in control subjects. CONCLUSIONS: Chronic renal failure results in a poorly responsive ventilatory control system, which may make renal failure patients more difficult to wean from mechanical ventilation. Theoretically, these patients may be more vulnerable to disturbances in blood gas homeostasis and subsequent respiratory arrest than other patients in an unmonitored environment.

Adolescent↗
PubMed1993

Maloprim-induced pulmonary eosinophilia.

A 47-year-old woman developed pulmonary eosinophilia from the use of maloprim as malaria prophylaxis. The diagnosis was confirmed by bronchoalveolar lavage (BAL) and transbronchial lung biopsy. Her condition improved with drug withdrawal and steroid therapy. With the increased use of pyrimethamine and dapsone in the treatment of human immunodeficiency syndrome (HIV) infection, this form of drug allergy may become more common.

Antimalarials↗
PubMed1988

Effects of nasal cold receptors on pattern of breathing.

To investigate the effect on the pattern of breathing of cooling receptors in the nose, eight normal male volunteers underwent a steady-state CO2 stimulation by nasal inhalation. The inhaled gas temperature was randomly switched between "warm" (32 degrees C) and "cold" (2 degrees C) at each of three levels of inspired CO2 fraction (FICO2). Breathing cold air through the nose reduced the mean slope of the ventilatory response to CO2 by 27% (P less than 0.05) and the mean intercept at PCO2 of 45 Torr by 6.6 l/min (P less than 0.01). This was due mainly to a reduction in tidal volume (VT). Analysis of the breathing pattern recorded at a high level of minute ventilation (VE) (end-tidal partial pressure of CO2 approximately 52 Torr) showed a reduction of VE that was due almost entirely to a reduction in VT (P less than 0.05) associated with a reduction in inspiratory time (TI) as a fraction of total respiratory cycle time (P less than 0.05) but little change in VT/TI. In a separate experiment conducted with five subjects, there was no significant difference in inspired nasal resistance between warm and cold runs during CO2-stimulated breathing. The results confirm the previous observation that cold air breathed through the nose inhibits ventilation in normal subjects and show that this is not related to an increase in flow resistance. The reduction in ventilation is due to reduction in VT associated with shortening of the duty cycle.

Adolescent↗
PubMed1988

No evidence for hypothalamic cooling during nasal cold air breathing in man.

To test the hypothesis that the reduction of ventilatory response to CO2 during nasal breathing of cold air is due to cooling of the hypothalamus, four adult male volunteers breathed either cold air (3 degrees C) or warm air (33 degrees C) through the nose by means of a face mask. Ventilation was increased to a mean of 30 l/min by increasing inspired CO2 concentration, which was adjusted so as to match ventilation in the two conditions. Cold air through the nose reduced the ventilatory response to CO2 so that with cold, higher inspired CO2 concentrations were required to produce the same ventilation as during warm air breathing. Rectal temperature was used as a measure of "core temperature", and tympanic membrane temperature as an indirect index of brain temperature. A hand immersion water calorimeter was used to measure the peripheral vascular response to hypothalamic regulatory changes. There was no measurable change in hand heat loss, rectal, or tympanic membrane temperature. This suggests that the depressant effect of cold air breathing is mediated by skin and mucosal temperature receptors connected to the respiratory centres rather than by direct cooling of the hypothalamus.

Body Temperature↗
PubMed1987

Fat embolization and pulmonary infiltrates after bone marrow transplantation.

Pulmonary interstitial infiltrates developed in a 22-year-old female after bone marrow transplantation (BMT) for acute lymphoblastic leukemia (ALL) in second remission. She was receiving prednisone for graft versus host disease (GvH). There was some evidence of cardiac failure, but the primary diagnosis was that of cytomegalovirus (CMV) pneumonia, which resolved. Recurrent infiltrates were associated with the appearance of fat emboli in the pulmonary capillaries. There was little histological evidence of CMV pneumonitis, although other tests confirmed persistent infection. The patient recovered after further treatment directed at CMV infection and cardiac failure with a modest reduction in steroid dose. Most previous descriptions of pulmonary fat embolization (PFE) in immunocompromised patients have been derived from autopsy studies, and the majority of patients have received steroid therapy. The present case illustrates that PFE may complicate or contribute to the picture of interstitial pneumonitis (IPN) in the BMT recipient and that this syndrome may be reversible.

Adult↗
PubMed1987

Miliary pattern as presentation of leiomyomatosis of the lung.

A 30-year-old woman presented with progressive dyspnea on exertion and a rapidly-growing uterine mass. Chest x-ray examination revealed a miliary interstitial nodular pattern in both lung fields. Transbronchial biopsy yielded lung tissue containing multiple nodules of smooth muscle, consistent with benign metastasizing leiomyoma. Subsequent hysterectomy revealed an atypical cellular leiomyoma. We wish to emphasize the need for chest x-ray examination in the workup of uterine tumors in women of reproductive age.

Adult↗
PubMed1987

Thermal degradation products from an ethylene methacrylic acid copolymer-partial metal salt as the cause of industrial bronchitis.

A self-employed physician developed industrial bronchitis due to the inhalation of fumes arising from the heating of a molded ethylene methacrylic acid copolymer-partial metal salt (Surlyn) in the basement of his home. Symptoms resolved following removal from exposure. A number of known irritants are given off as degradation products of Surlyn ionomer resin, including acrolein, aldehydes, and methacrylic acid. This case is unusual because of the nature of exposure and an unexpected fall in forced expiratory volume in 1 second after provocation testing.

Anesthesiology↗
PubMed1984

Diaphragm function and respiratory response after upper abdominal surgery in dogs.

Decreased diaphragm activity has been demonstrated after cholecystectomy in humans (Am. Rev. Respir. Dis. 127: 431-436, 1983). To investigate the mechanism(s) of postoperative diaphragm dysfunction we have established a dog model. Three groups of mongrel dogs were studied under general anesthesia: six dogs received no surgery (control); nine dogs underwent upper abdominal surgery (cholecystectomy); and six dogs underwent lower abdominal surgery (pseudoappendectomy). Diaphragm function was assessed by changes in transdiaphragmatic pressure swings, the ratio of changes in gastric to esophageal pressure swings, and the ratio of changes in abdominal to rib cage diameters during quiet tidal breathing. In the upper abdominal surgery group there were significant postoperative decreases in all parameters of diaphragm function and an increase in minute ventilation and respiratory frequency. However, there were no significant postoperative changes in the parameters of diaphragm function in the control or lower abdominal surgery groups. These studies establish that general anesthesia is not responsible for the reduced diaphragm activity seen postoperatively and that diaphragm function is not affected by lower abdominal surgery in dogs.

Abdomen↗
PubMed1984

Reducing ventilatory response to carbon dioxide by breathing cold air.

To study the effect of cooling of nasal receptors on breathing we had 10 normal male volunteers rebreathe through their noses 8% CO2 in oxygen at "warm" (23 to 30 degrees C) and at "cold" (-4 to 10 degrees C) temperatures. In order to further examine the effect of nasal receptors on the control of breathing, 11 subjects had their nasal response to CO2 measured at the warm temperature before and after topical nasal anesthesia. To exclude an increase in nasal resistance as the cause of the reduced response to CO2, 10 subjects had their nasal resistance measured before and after nasal rebreathing of cold 8% CO2 in oxygen. To also exclude increased bronchial resistance, forced expiratory volume in one second (FEV1) was measured in 12 subjects before and after nasal breathing of cold oxygen for 3 min. The mean ventilatory response to CO2 was reduced from 3.0 +/- 1.6 L/min/mmHg to 2.5 +/- 1.1 L/min/mmHg (p less than 0.05) by the cold air. Topical nasal anesthesia increased the response to CO2 at the warm temperature from 2.4 +/- 0.7 to 2.7 +/- 0.9 L/min/mmHg. The effect of nasal breathing of 8% CO2 in oxygen at the cold temperature was to reduce nasal inspiratory resistance at 1 L/s from 4.3 +/- 3.0 cm H2O L/s to 2.6 +/- 1.0 cm H2O L/s (p less than 0.05). Expiratory resistance at 1 L/s fell from 3.7 +/- 1.5 cm H2O L/s to 2.4 +/- 0.7 cm H2O L/s (p less than 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1983

Study of serum levels, venous irritation and gastrointestinal side-effects with intravenous erythromycin lactobionate in patients with bronchopulmonary infection.

Sixteen patients with bronchopulmonary infection received 500 mg erythromycin lactobionate by intravenous infusion every 8 h for 2 days. The duration of infusion was either 30 (8 patients) or 60 min (8 patients). An inline filterset (0.22 micrometer) was included in the intravenous administration set in 4 patients of each infusion group. Serum erythromycin levels were obtained before and at various times for 8 h after the first and fourth doses and before and immediately after the other doses. The incidence and severity of venous irritation and gastrointestinal side-effects were assessed. Mean (S.D.) peak erythromycin levels for the 30 min infusion were 26.31 (6.89) micrograms/ml (first dose) and 26.85 (6.11) micrograms/ml (fourth dose) and for the 60 min infusions, 23.96 (7.91) micrograms/ml (first dose) and 23.65 (6.55) micrograms/ml (fourth dose). Venous irritation was experienced by 12 patients, ranging from localized discomfort to thrombophlebitis, but the severity was significantly reduced by inline filtration (P less than 0.005). Gastrointestinal side-effects were reported by 8 patients and 1 patient withdrew because of severe abdominal pain and nausea. These symptoms were usually relieved by spasmolytic agents and possibly could be explained by high concentrations reaching the gut wall either by biliary excretion or direct transport from blood and stimulating smooth muscle motility.

Aged↗
PubMed1981

Funnel-web spider (Atrax robustus) antivenom. 2. Early clinical experience.

This paper describes the successful use of funnel-web antivenom in two severe cases of envenomation from bites by a male funnel-web spider, Atrax robustus. Rapid resolution of the syndrome occurred in both cases. Although the first patient, a 49-year-old man, may have slowly recovered without antivenom, it is unlikely that the other patient, a three-year-old boy, would have survived without antivenom therapy. In both cases the duration of hospitalisation was dramatically reduced.

Antivenins↗
PubMed1981

Penetration of piperacillin into bronchial mucosa and sputum.

Bronchial mucosal biopsies were obtained during fibreoptic bronchoscopy in 12 patients receiving a new semisynthetic penicillin, piperacillin. The piperacillin levels estimated in bronchial mucosa exceeded those required to eradicate organisms associated with acute bronchitis, Haemophilus influenzae and Streptococcus pneumoniae, and compared favourably with those required for activity against a wide variety of anaerobic and Gram-negative organisms including Pseudomonas aeruginosa. Sputum and serum piperacillin levels were obtained from eight patients with bronchial disease receiving a five to seven day course (8 to 16 g/day). Sputum/serum level ratios were constant for the two dosages (10.7% for 8 g/day; 14.3% for 16 g/day) suggesting a diffusion transfer process, although the presence of pus in the sputum appeared to facilitate penetration. Seven patients achieved sputum levels exceeding those required for activity against Haemophilus influenzae and Streptococcus influenzae, and four for Pseudomonas aeruginosa. This study provides pharmacolinetic support of the use of piperacillin in bronchopulmonary infection.

Aged↗