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Biomedical subjects

R J Cuschieri

Publications and source records attributed to R J Cuschieri.

35 records · Page 2Linked to original sources
PubMed1987

Early experience with synchronous aorto-bifemoral and femoro-popliteal bypass grafts.

Over a three-year-period 51 concomitant aorto-bifemoral and femoro-popliteal reconstructions, using prosthetic materials below the inguinal ligament, were carried out in 39 patients, with both aorto-iliac and femoro-popliteal disease, presenting with severe lower limb ischaemia. Thirteen grafts were inserted for rest pain and/or gangrene, while 38 were performed for disabling claudication. There was no perioperative mortality. Cummulative patency for all femoro-popliteal grafts was 53% at 2 years. Limb salvage rates of 84.6% at 2 years were achieved in patients with critical ischaemia. These results suggest that synchronous aorto-bifemoral and femoro-popliteal reconstructions with prosthetic materials can be performed safely in selected patients with acceptable early patency and limb salvage rates.

Adult↗
PubMed1985

Postoperative pain and pulmonary complications: comparison of three analgesic regimens.

In a prospective study, patients undergoing cholecystectomy were randomly allocated to receive (a) intermittent intramuscular morphine (n = 25), (b) continuous intravenous morphine infusion (n = 25) or (c) epidural bupivacaine (n = 25) for postoperative pain relief. Morphine by intravenous infusion provided comparable pain relief to intermittent intramuscular morphine; there was no significant difference in the incidence of postoperative pulmonary complications. Patients receiving epidural bupivacaine for 12 h had better analgesia than patients receiving morphine (P less than 0.001). Arterial oxygen tensions were also significantly higher in the epidural group for the first three postoperative days (P less than 0.05). Epidural analgesia was associated with a significant reduction in the incidence of pulmonary complications (P less than 0.01) and chest infection (P less than 0.05).

Adolescent↗
PubMed1985

The effect of fibrinolytic stimulation by stanozolol on postoperative pulmonary complications.

Platelet aggregation in the lungs is common following abdominal surgery and may contribute to postoperative hypoxaemia. The hypothesis that an anabolic steroid, stanozolol, by preventing fibrinolytic shutdown, would prevent postoperative hypoxaemia was tested. Fifty patients undergoing abdominal surgery were randomly allocated to receive either placebo or stanozolol. Despite preventing fibrinolytic shutdown in most patients, the use of stanozolol did not influence the extent of postoperative hypoxaemia or the incidence of postoperative pulmonary complications. These results suggest that fibrinolysis does not play a significant part in the pathogenesis of postoperative pulmonary dysfunction.

Adult↗
PubMed1985

Transcutaneous electrical stimulation for postoperative pain.

A prospective randomised trial was conducted to assess transcutaneous electrical stimulation in the management of postoperative pain and its effect on postoperative pulmonary function and respiratory complications. Consecutive patients undergoing abdominal surgery were allocated to receive transcutaneous electrical stimulation or 'sham' therapy. There was no significant difference in the amount of postoperative pain as measured by linear analogue pain scales or morphine requirements. Arterial oxygen and carbon dioxide tensions were similar in both groups. There was no difference in the incidence of postoperative chest infection. These results do not support the use of transcutaneous electrical stimulation following abdominal surgery.

Adult↗
PubMed1984

Comparison of morphine and sublingual buprenorphine following abdominal surgery.

In a prospective study, patients undergoing abdominal surgery were allocated randomly to receive intermittent morphine 10 mg i.m. (n = 41) or a single injection of buprenorphine 0.3 mg i.m. followed by sublingual buprenorphine 0.4 mg every 6 h (n = 39) for 3 days following operation. Patients receiving buprenorphine were allowed additional morphine, if required. Pain scores (linear analogue scale) in those patients receiving regular sublingual buprenorphine were consistently less than in those receiving intermittent morphine i.m. Half the patients receiving buprenorphine required no additional analgesia; only 15% required additional analgesia after the first day following operation. Arterial blood-gas analyses showed significant hypoxaemia and significantly greater carbon dioxide tensions in those receiving buprenorphine. These results suggest that a regimen based on the use of sublingual buprenorphine provides pain relief comparable to that provided by intermittent opiates i.m.

Abdomen↗
PubMedDate not supplied

A prospective audit of hospital-acquired deep vein thrombosis and pulmonary embolism.

The incidence of symptomatic deep vein thrombosis and pulmonary embolism acquired in hospital was studied, and the effectiveness of current thromboprophylaxis was assessed in an open study of 8648 admissions to the Doncaster Royal Infirmary between April and July 1994. On admission, all patients were assessed for their likely risk of thromboembolic problems according to THRIFT criteria. Treatment, prophylaxis, complications and outcome were recorded on discharge. A high risk sub-group was followed up for up to 42 days after discharge. The overall rate of clinically apparent hospital-acquired thromboembolic complications was 0.4% (n = 35). The rate of clinically apparent thromboembolic disease in the high risk group was 2.1% (n = 17). The incidence of thromboembolic problems appeared not to be reduce by prophylaxis apparently even when stratified by risk group. These findings suggest that thromboembolic complications may be less common than would be expected from published literature. Thromboprophylaxis as currently practised within our institution does not seem to affect the incidence of deep vein thrombosis or pulmonary embolism, and these results would appear to argue against a 'blanket' policy for pharmacological thromboprophylaxis.

Adolescent↗
PubMedDate not supplied

Vascular complications after total knee replacement.

Arterial complications after total knee replacement are rare. We report 2 patients who presented with ischaemia of the lower limb after ipsilateral total knee replacement. The mechanism of injury and clinical implications are discussed.

Aged↗
PubMedDate not supplied

Severe reversible arterial spasm with ergotamine.

A patient is described with marked unilateral arterial spasm of the proximal vessels and severe ischaemia of the left foot as a result of excessive use of ergotamine tartrate. Treatment with intravenous heparin infusion followed by chemical sympathectomy was successful.

Analgesics, Non-Narcotic↗