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Biomedical subjects

R Firmin

Publications and source records attributed to R Firmin.

16 recordsLinked to original sources
PubMed2004

Extracorporeal life support for children with meningococcal septicaemia.

OBJECTIVE: To describe the short-term outcome of children with meningococcal sepsis treated with extracorporeal membrane oxygenation (ECMO) in a single centre. DESIGN: Retrospective analysis of case notes. SETTING: The Heartlink ECMO Centre, Glenfield Hospital, Leicester. PATIENTS: Eleven children (8 boys) out of a total caseload of 800 patients were treated for meningococcal sepsis with ECMO. INTERVENTIONS: Extracorporeal membrane oxygenation. RESULTS: All children with meningococcal sepsis treated with ECMO had a Glasgow Meningococcal Septicaemia Prognostic Score (GMSPS) > or = 12 (positive predictive risk of death of approximately 90%). Five children had adult respiratory distress syndrome (ARDS) and six had refractory shock with multi-organ dysfunction syndrome (MODS) at presentation for ECMO. All five children in the ARDS group survived, four of five receiving veno-venous (VV-) ECMO therapy. In contrast, only one of six children with refractory shock with MODS survived, all of whom required veno-arterial (VA-) ECMO therapy. CONCLUSIONS: Most children with meningococcal sepsis and severe ARDS can be successfully treated with VV-ECMO. In contrast, children with refractory shock and MODS die despite treatment with VA-ECMO. This report does not resolve whether ECMO therapy offers any advantage over conventional therapy in treating severe meningococcal sepsis.

Child↗
PubMed2001

Floating thrombus in the aorta.

A review of the literature shows that there are few reported cases of embolism or thrombus in a nonaneurysmal, effectively normal aorta with no other underlying reason for thrombus formation in the aorta. We report a case of a large, floating thrombus in the descending aorta lumen and discuss surgical and management options.

Aorta, Thoracic↗
PubMed1990

Airway function in infants with vascular rings: preoperative and postoperative assessment.

Aortic arch anomalies in infancy often cause intrathoracic airway obstruction. Airway function was assessed as part of the diagnostic evaluation in six symptomatic infants both by plethysmography and using a chest compression technique to obtain partial flow-volume loops. Two infants had normal intrathoracic airway function and their symptoms were unrelated to aortic arch abnormalities. The remaining four had complete vascular rings (three double aortic arch, one pulmonary sling) and had increased expiratory airway resistance (Raw) (mean Raw = 700% predicted) and greatly decreased maximum flow rates at functional residual capacity (VmaxFRC; mean VmaxFRC = 34% predicted) with gross shape abnormalities of the flow-volume loop. Postoperatively airway function was substantially improved (mean Raw = 175% predicted, VmaxFRC = 79% predicted) but some abnormality of flow-volume loop shape remained, suggesting that tracheal dynamics were not completely normal in the early postoperative period.

Airway Obstruction↗
PubMed1990

The effect of propranolol on the cerebral electrical response to deep hypothermia and total circulatory arrest in lambs.

Deep hypothermia with total circulatory arrest is an important technique in the surgical treatment of complex congenital heart defects. The effects of propranolol on cerebral electrical activity in lambs undergoing a 90-minute period of circulatory arrest after initial surface cooling to 26 degrees C and subsequent core cooling to 15 degrees C was studied by means of the cerebral function analyzing monitor. Five of the lambs were pretreated with intravenous propranolol 0.2 mg/kg (group I) and five acted as controls (group II). The surface cooling phase was associated with a continuous decrease in mean electroencephalographic voltage +/- standard error, which decreased from 82.8 +/- 11.8 microV at 37 degrees C to 31.6 +/- 2.4 microV at 26 degrees C in the control group compared with 75.0 +/- 7.4 microV and 63.2 +/- 9.2, respectively, in the propranolol group (p less than 0.05). During the rewarming phase, the latency to (1) initial appearance of electrical activity, (2) continuous recording with the cerebral function analyzing monitor, and (3) maximum voltage and frequency recovery was 2.0 +/- 1, 5.9 +/- 4, and 32.4 +/- 8 minutes in the propranolol group, which was significantly (p less than or equal to 0.01) shorter than in the control group (18.4 +/- 3, 38.2 +/- 5, and 111.0 +/- 9 minutes, respectively). These results suggest that pretreatment with propranolol may play an important part in the brain tolerance to deep hypothermia and circulatory arrest.

Animals↗
PubMed1987

Directly measured tissue oxygen tension and arterial oxygen tension assess tissue perfusion.

Mean subcutaneous tissue PO2 (PsqO2) measurements were obtained in dogs with an unheated electrode placed in an implanted Silastic tonometer, while PaO2 was increased in increments from 40 to 600 torr during normal, increased, and reduced blood volume. These changes reflect that the mean PsqO2 is approximately 10 torr below the PO2 of venous blood draining that tissue. Since PaO2 was already known, the oxygen content of arterial and venous blood entering and leaving this tissue could be determined by reference to blood-oxygen dissociation curves. Therefore, relative changes in blood flow could be calculated using the Fick principle. After a 20% blood loss, the PsqO2 measured during breathing of room air fell to 20% of baseline, corresponding to an 80% fall in sc blood flow; it remained low until the shed blood was returned despite compensatory changes in cardiac output. Rapid infusion of electrolyte solutions in normovolemic animals produced a temporary increase in local blood flow. Subcutaneous oximetry seems capable of quantifying peripheral perfusion and may be clinically useful.

Animals↗
PubMed1986

Anatomic correction of double-outlet right ventricle with subpulmonary ventricular septal defect (the "Taussig-Bing" anomaly).

Seven patients with double-outlet right ventricle and subpulmonary ventricular septal defect (the Taussig-Bing anomaly) underwent anatomical repair at the arterial level with transfer of the coronary arteries. At the time of operation, patient ages ranged from 6 weeks to 33 months (mean 14.1 months) and weight ranged from 3.7 to 11.5 kg (mean 7.0 kg). Four patients had prior pulmonary artery banding: Two of these four also had coarctation repairs, and one had a Blalock-Hanlon septectomy. Three different patterns of coronary artery distribution were encountered. Five patients had side-to-side great arteries, and two had more or less anteroposterior great arterial relationships. There was one operative death (14.3%: 70% confidence limits 1.9 - 40.7%) resulting from muscular subvalvular right ventricular outflow tract obstruction (RVOTO). There have been no late deaths in the six survivors followed 6 to 31 months postoperatively (mean 14.8 months). One patient required closure of a residual ventricular septal defect (VSD) and infundibular resection for RVOTO 4 months postoperatively. All other survivors are functionally NYHA Class I. Five of the six survivors have undergone postoperative catheterization (mean interval 5.8 months). There was no aortic insufficiency and good ventricular function in all patients. In addition to the patient with the residual VSD, two other asymptomatic patients had mild or moderate RVOTO. Compared with alternative surgical procedures for this anomaly, anatomic correction has the advantages of acceptable operative mortality, use of the left ventricle as the systemic ventricle, no need for extracardiac conduits, and applicability to patients with all variations of coronary artery and great artery anatomy.

Child, Preschool↗
PubMed1984

The dynamic properties of tissue oxygen in healing flaps.

Oxygen delivery to random pattern and musculocutaneous flaps was investigated in a canine model. Oxygen tension was measured in the proximal and distal portions of each flap and in adjacent normal skin by means of a recently developed technique. The effect of delay techniques on tissue oxygen tension was also examined with modifications of the same flap model. All measurements were made over a range of inspired oxygen concentrations (21% to 100%) both before operation and at intervals up to 15 days after operation. Tissue oxygen tensions were significantly higher in the musculocutaneous flaps than in random pattern flaps up to 6 days after operation. They were higher in the proximal portions than in the distal portions in each flap type. This difference was greater in the random pattern flap. Delay techniques prevented the early dramatic decrease in postoperative oxygen tension seen in random pattern flaps. Differences in the pattern of oxygen delivery to random pattern and musculocutaneous flaps may in part explain the greater reliability of musculocutaneous flaps when transposed in the presence of infection.

Animals↗
PubMed1983

Continuous direct tissue oxygen tension measurement by a new method using an implantable silastic tonometer and oxygen polarography.

A new method of tissue oxygen tension measurement that is suitable for human use has been described. An implanted Silastic tube tonometer is combined with polarographic oxygen electrodes. The techniques of preparation, insertion, and measurement have been described. The advantages and disadvantages of this method have been considered in relation to established methods of tissue oxygen tension measurement. The method is suitable for clinical use and can be used to aid clinical decision-making.

Oxygen↗
PubMed1983

The effect of alpha-adrenergic blockade on cardiac performance and tissue oxygen delivery during excision of pheochromocytoma.

To establish criteria for administration of the optimal dose of alpha-adrenergic receptor blocking drugs, we studied cardiac performance and tissue oxygen tension in three patients who underwent excision of pheochromocytoma. Subcutaneous oxygen tension was measured by the method of Niinikoski and Hunt. Cardiac function was assessed by thermodilution cardiac output, systemic and pulmonary arterial blood pressures, and continuous two-dimensional transesophageal echocardiography of a cross section of the left ventricle at the level of the papillary muscles. Despite large changes in cardiac output and systemic, pulmonary, and wedge pressures, intraoperative tissue oxygen tensions and ejection fractions remained normal (even at times of peak catecholamine excretion and very abnormal wedge pressures). Studies of healthy animals that received no alpha-adrenergic receptor blocking drugs showed major decrements of tissue oxygen in response to modest doses of epinephrine. We conclude that progressive administration of alpha-adrenergic receptor blocking drugs does not absolutely protect the patient from major changes in blood pressure during operation for pheochromocytoma, but that cardiac performance and oxygen supply to the tissues are unimpaired.

Adrenal Gland Neoplasms↗
PubMed1980

Prophylactic povidone iodine in minor wounds.

A total of 628 patients requiring sutures for minor wounds in an accident and emergency unit was included in a controlled trial using povidone iodine dry powder spray (Disadine DP) as prophylaxis against wound infection. In patients with injuries of the forearm and hand there was a statistically significant reduction in infection rate (P less than 0.02). Povidone iodine spray was found to be an effective, simple to use, not toxic, antiseptic prophylactic agent.

Clinical Trials as Topic↗
PubMed1978

Emergency geriatric surgical admissions.

The emergency surgical work load created by patients aged 80 and over in a district hospital was assessed and the results of treatment examined. Over one year 248 patients aged 80 or over were admitted as emergencies, and the overall mortality rate was 21.8%. When terminal disease was excluded mortality rate was 12.5%. These elderly patients had an average length of stay in the acute surgical ward of 14.7 days compared with a mean of 8.4 days for all patients, and all but seven patients were discharged to their original place of referral.Elderly patients do exacerbate the bed shortage in acute surgical wards because they tend to stay longer than younger patients, but these elderly surgical patients imposed only a small load on the inpatient geriatric services, as 78% were discharged straight to their own homes and a further 17% went home after a period on the surgical convalescent wards.

Aged↗
PubMed1978

A case of rhabdomyosarcoma of the right ventricle.

A patient is described who presented with symptoms suggesting pericarditis and cardiac tamponade, and who was found at necropsy to have a rhabdomyosarcoma of the right ventricle. The presenting features of right ventricular tumours are discussed and some useful pointers to the correct diagnosis suggested.

Adult↗
PubMedDate not supplied

Paediatric cardiology in a sub-regional cardiothoracic unit.

The aim of this study was to examine the pattern of referrals the number of admissions, cardiac catheterisations and surgical procedures-including outcome-in infants and children referred to a sub-regional cardiothoracic unit during a 6-year period. The unit is served by one paediatric cardiologist and four general cardiothoracic surgeons, two of whom undertake paediatric surgery. Referrals were received from within the Trent Regional Health Authority, and from three other health Regions. During the study period 2,097 infants and children were admitted to the unit with cardiac disease, and 730 underwent cardiac surgery. The proportion of admissions undergoing surgery increased significantly with time, as did the neonatal and infant surgical procedures and infant surgical procedures. Overall, the surgical mortality did not alter with time, and was comparable to the national average. The results show an increase in the demand for cardiac investigations and surgery, and this was most evident in infants, particularly for open procedures. This unit serves a large population with proven needs, and the number of children treated falls within the range of existing supra-regional centres. The combination of available expertise, and a cost-effective patient outcome measure, should place such units in a category of high priority for resource allocation.

Cardiac Surgical Procedures↗