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Biomedical subjects

N Bradbury

Publications and source records attributed to N Bradbury.

10 recordsLinked to original sources
PubMed2000

Reliability of ECG monitoring with a gel pad/paddle combination after defibrillation.

Recent warnings have highlighted the possibility of unreliable monitoring through gel pads and paddles when using manual defibrillators. Occasionally, this causes an apparent asystole to be displayed when the true rhythm is ventricular fibrillation. We investigated this phenomenon in the laboratory using defibrillator-testing devices with two different impedances and with two defibrillators (Physio-Control LIFEPAK 9 and Hewlett Packard XL). After delivery of a 200 J shock, the time taken for the original ECG test signal to return to the defibrillator monitor was measured. Measurements were made after each of a series of ten shocks delivered with each defibrillator and gel pad/ testing device combination. Additional measurements were made using self-adhesive combination defibrillator electrodes. When using a low-impedance testing device with gel pads, on all occasions the initial rhythm reappeared immediately. When using the high-impedance testing device, the post shock rhythm was initially displayed as 'no signal' (Hewlett Packard XL) or 'asystole' (Physio-Control LIFEPAK 9). Over the series of ten shocks, the time to return of the original signal ranged between 24 and 154 s with the Hewlett Packard and 17-61 s with the Physio-Control LIFEPAK 9. The time for return of the signal increased with successive shocks. When using Fast-Patch electrodes, the original test signal always returned immediately. We conclude that after the delivery of a shock, monitoring through gel pads may result in the display of spurious asystole being displayed. This is more likely to occur in the presence of high chest impedance and with an increasing number of shocks delivered through the same gel pads. If defibrillator paddles and gel pads have been used for 'quick-look' monitoring, and 'asystole' is displayed after delivery of a shock, the rhythm should be confirmed immediately with monitoring leads.

Electric Countershock↗
PubMed1999

Clinical features and outcome of septic arthritis in a single UK Health District 1982-1991.

AIMS: To determine the clinical features of a large number of unselected UK hospital patients with confirmed septic arthritis and to determine those features associated with a poor outcome. STUDY DESIGN: Retrospective, case-note survey. SETTING: A single English Health District. PATIENTS: All patients admitted to hospital in Nottingham during the period 1 January 1982 to 31 December 1991 with confirmed septic arthritis were included. OUTCOME MEASURES: Death, osteomyelitis and recorded functional impairment. RESULTS: The spectrum of causative organisms remains similar to that seen in previous studies with the Gram positive organisms Staphylococcus aureus and Streptococci responsible for 74% of cases, gonococcal infections though were less common. Culture of joint aspirates and or blood were positive in 82% of cases, with the Gram stain demonstrating the causative organism in 50% of cases. Pre-existing joint disease was evident in 35% of cases. The mortality remains high at 11.5% with a significant additional morbidity of 31.6%. Multivariate analysis suggests that important predictors of death are: confusion at presentation, age > or = 65 years, multiple joint sepsis or involvement of the elbow joint, and of morbidity are: age > or = 65 years, diabetes mellitus, open surgical drainage, and Gram positive infections other than S aureus. CONCLUSIONS: Septic arthritis continues to be associated with a considerable degree of morbidity and mortality. These results confirm the importance of obtaining synovial fluid and blood for culture before starting antimicrobial treatment. The apparent poorer outcome found with surgical intervention is in line with some previous suggestions but should be interpreted with caution in light of the retrospective nature of this study.

Adolescent↗
PubMed1996

Adolescent disc protrusions. A long-term follow-up of surgery compared to chymopapain.

STUDY DESIGN: This study compared chymopapain with primary surgery in the treatment of 60 radiologically proven adolescent lumbar disc protrusions and symptoms of low back pain and sciatica; the failures of intradiscal therapy were treated by surgical discectomy. OBJECTIVES: To establish whether chymopapain is as good as primary surgery in treating adolescents with proven lumbar disc protrusions. SUMMARY OF BACKGROUND DATA: Symptomatic lumbar disc protrusions are rare in white adolescents; the reported incidence varies from 0.8% to 3.2% of all lumbar disc protrusions. This is the largest study with long-term follow-up in the world literature. METHODS: Forty-two patients between the ages of 13 and 19 years with proven lumbar disc protrusions were initially treated with chymopapain; the failures of intradiscal therapy were treated by surgical discectomy. Eighteen patients were treated with surgical discectomy. After initial review at 1, 3, 6, and 12 months, the patients were assessed using a postal questionnaire and telephone interview at a minimum of 5 years' follow-up (means: 8.5 years for chymopapain group, 7.2 years for surgery group). RESULTS: Full replies were received from 16 of 18 (89%) in the surgery group and 42 of 42 (100%) in the chymopapain group. The long-term outcome is classed as good or excellent in 81% of the surgical group and 64% in the chymopapain group. If chymopapain is used as a first-line treatment, with surgery reserved for the failures, the long-term outcome is good or excellent in 82%. The chymopapain group had a shorter hospital stay. The surgical group were more likely to be unemployed and were less able to perform manual work and less able to engage in sporting activity. CONCLUSIONS: Back pain, radicular pain, and tension signs are common, but neurologic signs are less frequent in this age group. Long-term results of surgery are no better than the results of first-line chymopapain treatment with surgery being reserved for the failures. In 60% to 70% of patients, the morbidity, cost, and hospital stay were lessened. The patient is more likely to be in satisfactory employment after chemonucleolysis than after primary surgery.

Activities of Daily Living↗
PubMed1996

Clavicular nonunion. 31/32 healed after plate fixation and bone grafting.

We report the long-term results in 32 patients with established nonunion of the clavicle; 15 treated with AO Dynamic Compression Plate and autologous cancellous bone graft and 17 treated with an AO reconstruction plate and autologous cancellous bone graft. The patients were followed up for a mean of 8 (4-21) years from injury and 7 (4-12) from non-union operation, both by clinical review and radiographs. 31/32 nonunions united successfully. One fracture which initially failed to unite was replated and subsequently united. 6 compression plates and 7 reconstruction plates were removed for discomfort or cosmesis. None broke. Both plates give equally good results, but we feel that the reconstruction plate is easier to contour to the complex form of the clavicle.

Activities of Daily Living↗
PubMedDate not supplied

Participation in sports after total knee replacement.

Return to regular sports activity was evaluated in a retrospective review of 160 patients who had undergone total knee replacement surgery by a single surgeon (208 knee replacements). Mean age of the patients was 68 years (range, 27 to 87) at surgery and 73 years (range, 33 to 91) at review at a mean follow-up of 5 years (range, 3 to 7). Seventy-nine patients regularly participated in sports, at least once per week, before surgery, and 51 patients regularly participated in sports after surgery. Only eight patients took up sports after surgery who were not regularly involved in sports in the year before surgery. Patients were more likely to return to low-impact activities such as bowls (29 of 32, or 91%) than to high-impact activities such as tennis (6 of 30, or 20% returned). Forty-three of 56 patients (77%) who had participated in regular exercise in the year before surgery returned to sports. Eighty patients did not participate in sports before surgery and 54 of these had coexisting disease that prevented sports. None of these patients returned to sports.

Adult↗