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Biomedical subjects

R F Raper

Publications and source records attributed to R F Raper.

28 records · Page 2Linked to original sources
PubMed1988

Profound reversible myocardial depression after anaphylaxis.

Profound myocardial depression developed in 2 patients after severe anaphylactic reactions following the induction of anaesthesia in 1 case and a bee-sting in the other. Neither patient had pre-existent cardiac disease. In both patients haemodynamic assessment, radionuclide ventriculography, and two-dimensional echocardiography confirmed the clinical impression of profound systolic myocardial dysfunction. Haemodynamic stability was attained by intra-aortic balloon counterpulsation, which was probably life-saving in both cases. Cardiac function improved rapidly although some contractile depression persisted for several days. At follow-up both patients had normal cardiac function with no evidence of underlying heart disease.

Adult↗
PubMed1988

The effects of coronary artery disease on cardiac function in nonhypotensive sepsis.

To assess the effects of coronary artery disease on cardiac function in the presence of sepsis, we compared several hemodynamic indices in two groups of septic patients. Group 1 (n = 69) consisted of patients with nonhypotensive sepsis without coronary artery disease. Group 2 (n = 25) comprised septic patients who had clinical evidence of coronary artery disease. All patients were hemodynamically stable and normotensive at the time of the study. None required inotropic support. While the two groups had similar mean heart rates, mean blood pressures, and biventricular filling pressures, the mean cardiac index was significantly lower in group 2 (3.5 +/- 0.9 L/min/m2 vs 4.4 +/- 1.2; p less than 0.05). This lower cardiac index was related to significantly lower end-diastolic volume indices in group #2, not to differences in contractility between groups. Since the ventricular filling pressures of the groups were similar, the differences in end-diastolic volumes indicate differences in the biventricular compliance. In the presence of hyperdynamic, nonhypotensive sepsis, coronary artery disease was associated with a clinically significant impairment of biventricular compliance, which resulted in a reduction in cardiac output and systemic oxygen transport.

Aged↗
PubMed1985

Combination therapy with ranitidine and pirenzepine for control of intragastric pH in the critically ill.

In a prospective study of pH control for stress ulcer prophylaxis, intermittent iv infusion of the anticholinergic drug pirenzepine maintained the intragastric pH above 4 in only one of 17 ICU patients, while similar administration of the H2-receptor antagonist ranitidine was successful in seven of 32 patients. This difference was not statistically significant. Of 15 patients in whom a maximum dose of 600 mg/day of ranitidine or 90 mg/day of pirenzepine failed to maintain pH, combination therapy was successful in 11, a significant (p less than .01) improvement. We conclude that neither ranitidine nor pirenzepine provides adequate control of pH for stress ulcer prophylaxis when used alone. If used together they are the most effective combination so far described for parenteral control of gastric pH in the critically ill. Regular monitoring of gastric pH is nevertheless essential to allow detection of therapeutic failures.

Adolescent↗
PubMed1985

Osteosclerotic myeloma complicated by diffuse arteritis, vascular calcification and extensive cutaneous necrosis.

Widespread, progressive skin necrosis developed in a 42-year-old male with a 5-year history of osteosclerotic myeloma. Biopsy of the necrotic lesions demonstrated a leucocytoclastic vasculitis with extensive vascular calcification. Radiological investigations demonstrated widespread arterial calcification. Clinical improvement of the established skin lesions followed the institution of a forced calciuresis and parathyroid hormone suppression by induced hypermagnesaemia and phosphate depletion. No further cutaneous necrosis developed. Subsequent treatment with oral immunosuppressive therapy and the diphosphonate, EHDP, has been associated with a complete 18-month remission. The relationship of this apparently unique pathological process to the osteosclerotic myeloma is discussed, together with the rationale for the therapeutic regime instituted.

Adult↗
PubMed1985

Randomized, prospective trial of cimetidine and ranitidine for control of intragastric pH in the critically ill.

Forty-eight critically ill patients in an intensive care unit were enrolled in a prospective study of stress ulcer prophylaxis. The H2-receptor antagonists cimetidine and ranitidine were used, patients being randomized on hospital number. Response was assessed by measuring gastric pH every 2 hours. The drugs were administered by intravenous infusion, and up to three dosage increments fo each of the drugs were titrated against the pH of the aspirated gastric juice. If one drug, in maximum dose, failed to maintain the pH above 4, the other drug was administered at maximum dose. If both drugs failed to achieve control of gastric pH, antacids were administered in an endeavor to ensure patient safety. Cimetidine was successful in maintaining the intragastric pH above 4, for the duration of the intensive care admission, in five of 28 patients. Ranitidine was successful in 10 of 20 patients. The difference between these two groups was statistically significant (p = 0.04). In patients in whom cimetidine therapy failed, ranitidine provided adequate control of pH in four of 13. Cimetidine controlled one of six patients who had failed to improve with ranitidine therapy. Plasma concentrations of both drugs were well above established acid inhibitory concentrations. However, even with much lower plasma concentrations of ranitidine, similar amounts of both drugs were present in the gastric juice, suggesting a possible explanation for the greater efficacy of ranitidine. We conclude that, although ranitidine is more effective than cimetidine, neither of these drugs is adequate for stress ulcer prophylaxis. If they ae used for this purpose in the critically ill patient, regular monitoring of gastric pH is essential to allow detection of therapeutic failures.

Cimetidine↗
PubMed1984

Subacute pulmonary hypertension due to carcinomatous microembolism.

A 43 year old female was admitted to hospital with severe pulmonary hypertension and cardiogenic shock. She had a two week history of dyspnea only. Resuscitative measures proved unsuccessful and she died ten hours after admission. Post mortem examination indicated that the pulmonary hypertension and right ventricular failure were due to endarteritis secondary to widespread carcinomatous microembolism from adenocarcinoma of the lung.

Adult↗
PubMed1984

Resuscitation in acute haemorrhage.

While some of the details of resuscitation of the bleeding patient remain contentious, the basic principles are clear. Adequate resuscitation implies the prompt restoration of tissue oxygenation by achievement and maintenance of airway patency, adequate ventilation, cardiac rhythm and intravascular volume. The choice of fluid for primary resuscitation is considerably less important than the care with which it ought to be administered. The volume of fluid required for primary resuscitation varies and there is no well-defined endpoint against which to titrate fluid resuscitation. However, as the complications and mortality of shock are related to the degree and the duration of shock, definitive (usually surgical) intervention should be undertaken early if the clinical features of shock cannot be readily reversed or if the maintenance of clinically adequate perfusion cannot be achieved with the administration of less than 200 ml of fluid per hour.

Acute Disease↗