Biomedical subjects
Publications and source records attributed to R J Middlehurst.
Kawasaki disease (mucocutaneous lymph node syndrome) is a disease of unknown aetiology characterised by vasculitis which may affect the coronary arteries. Young children are most commonly affected although the disease has been described in adults. We report a case of recurrent Kawasaki disease which presented to an oral medicine clinic, where early recognition prompted appropriate management.
As part of a large pragmatic study, the authors investigated heart rate, blood pressure, dysrhythmic and ischemic responses to lidocaine 2% with a combination vasoconstrictor (noradrenaline 1:50,000 and vasopressin 0.25 IU/mL), and midazolam sedation in a medically compromised population. There were anesthesia-induced physiological changes to both hemodynamics and the electrocardiogram. The use of midazolam significantly ameliorated the sympathoadrenal response to stress, and the greatest hemodynamic and electrocardiographic changes were observed during surgery.
An unusual case of an exophytic spindle-cell carcinoma of the maxilla arising from an area of erythroplakia is presented. The epithelial nature of the spindle cells was demonstrated by electron microscopy and immunohistochemistry. After initial surgery the tumour recurred and was then extensively infiltrative and rapidly destructive. Magnetic resonance imaging (MRI) revealed an invasive tumour of the contra-lateral maxillary antrum suggesting a multicentric origin.
The concentration of cephradine in serum and mandibular bone was assayed in 28 patients undergoing 3rd molar surgery following a single 1 g intravenous injection. Serum and cortical bone samples taken simultaneously, contained mean cephradine concentrations of 42.11 micrograms/ml and 2.61 micrograms/g respectively. These results, when compared with those reported for other bony sites including the femoral head and knee, show a reduced bone penetration with a bone-to-serum ratio of approximately 0.06:1.
In 1987, a Working Party Report from the Royal College of Physicians addressed the record of resuscitation from cardiopulmonary arrest. Their stated aim was to identify groups for instruction and to determine how required skills should be taught and retained. The recommendation for our specialty was brief: '...trained and competent in basic life support with airway adjuncts'. A survey of local practitioners was undertaken, to study their use of general anaesthesia, intravenous sedation, and relative analgesia and to discuss their resuscitation arrangements.
The concentration of cephradine in serum and mandibular bone was assayed in 22 patients undergoing third molar surgery following a single 1-g intramuscular injection. Serum and cortical bone samples taken simultaneously contained mean cephradine concentrations of 12.41 micrograms/mL and 1.25 micrograms/g, respectively. These results, when compared with those reported for other bony sites, including femoral head and knee, show a reduced bone penetration with a bone-to-serum ratio of approximately 0.10:1.
The postoperative pain and swelling that followed the removal of symmetrically impacted mandibular third molars by the split bone and bur techniques was studied in 30 patients. Removal by the split bone technique produced noticeably less pain and swelling. Interdependence was noted between pain and swelling.