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Biomedical subjects

R K Firmin

Publications and source records attributed to R K Firmin.

At least 55 records · Page 3Linked to original sources
PubMed1995

Changes in "inflammatory" mediators and total body water during extra-corporeal membrane oxygenation (ECMO). A preliminary study.

We studied six patients (5 paediatric, 1 neonate) treated with ECMO to quantify changes in inflammatory mediators (neutrophil elastase (NE), free radical activity (FR), interleukin 8 (IL8)) and total body water (TBW). Blood samples were taken before instigation of ECMO, 4, 12, 24 hours post-ECMO and daily for six days. FR activity was quantified using the oxidised IgG FI/UV ration. NE and IL8 levels were measured by ELISA. TBW was assessed by electrical bioimpedance. Statistical analysis was made using repeated measures analysis of variance and modified t-test where appropriate. Results are presented as mean +/- standard error of the mean. FR activity increased 4 hours after instigation of ECMO (IgG FI/UV 32.1 +/- 3.2 from 24.1 +/- 3.0 p = 0.005) and remained elevated. NE also increased by 4 hours (94.8 micrograms/L +/- 8.9 to 678 micrograms/L +/- 153.4, p = 0.005) but returned to pre-ECMO values by day 6. IL8 levels rose after ECMO (from 98 pg/ml +/- 39, to 24 pg/ml +/- 117.4) although no statistical difference was noted over time due to the large variation between subjects (p = 0.009). TBW (% pre-ECMO body weight) fell by 24 hours (from 118.6 +/- 12.6 to 96.5 +/- 8.2 p = 0.0004). This study demonstrated that ECMO stimulates an 'inflammatory' response to extracorporeal perfusion (increased FR, NE) but despite this, results in a reduction in total body water. The complex relationship between the inflammatory response to prolonged extracorporeal perfusion and its effect on tissue oedema merits further investigation.

Analysis of Variance↗
PubMed1994

Bronchopulmonary infection with Moraxella catarrhalis in infants requiring extracorporeal membrane oxygenation.

Moraxella (formerly Branhamella) catarrhalis is now a well-recognized pathogen of the upper and lower respiratory tract. Four pediatric cases of life-threatening pneumonia requiring extracorporeal membrane oxygenation are presented. M. Catarrhalis was isolated within 48 hours of admission in three of the cases and within 24 hours of an acute deterioration in the fourth. We conclude that M. catarrhalis is either a significant pathogen in its own right, a marker of severe disease, or a secondary invader.

Child, Preschool↗
PubMed1994

Varicella pneumonitis: a role for extra-corporeal membrane oxygenation?

Pneumonitis is the most serious complication of varicella zoster infection and may be fatal despite antiviral therapy and assisted ventilation. We report two cases of varicella pneumonitis which were complicated by severe pneumonitis. Both patients deteriorated on maximal ventilatory support and were then given extra-corporeal membrane oxygenation (ECMO) and recovered. One patient subsequently developed lymphoma and the other was found to have an immunoglobulin subclass deficiency. ECMO should be considered for patients with varicella pneumonitis who do not respond to conventional treatment. Those with severe pneumonitis should be investigated for underlying immunodeficiency.

Adult↗
PubMed1994

Pathological complications of non-survivors of newborn extracorporeal membrane oxygenation.

The pathology was reviewed of the early deaths identified from the first 50 neonates treated with extracorporeal membrane oxygenation (ECMO) during its introduction to the UK. Fifteen neonates died during or shortly after ECMO between August 1989 and June 1992. Data on 12 are presented (three did not have a postmortem examination). The clinical diagnoses at referral for ECMO were as follows: persistent pulmonary hypertension of the newborn (six infants), primary congenital pneumonia (one infant), community acquired pneumonia (two infants), birth asphyxia (one infant), respiratory distress syndrome (one infant), and meconium aspiration syndrome (one infant). In our group, at necropsy, five had significant haemorrhage (three intracranial, one pulmonary, one pericardial and intraventricular). Three of five infants with evidence of haemorrhage also had signs of sepsis. Six infants had evidence at necropsy of systemic sepsis, five showed evidence of severe anoxic brain injury, and four infants had cerebellar haemorrhages. Three infants had evidence of myocardial ischaemia. It is difficult to discriminate between the relative influence of the primary diagnosis, the mode of treatment, and the severity of presentation in the genesis of this pathology. It is likely that the extent and severity of some of the findings represent a pathological progression that would have been interrupted by the death of the patient, had ECMO not been instituted.

Acute Kidney Injury↗
PubMed1994

False aneurysm of the right ventricular outflow tract after total correction of tetralogy of Fallot: diagnosis by echocardiography and successful repair by neck cannulation for cardiopulmonary bypass.

A case of false aneurysm related to the left side of the heart with a connection to the right ventricular outflow tract was found by echocardiography after complete repair of tetralogy of Fallot. Cardiopulmonary bypass was established by cannulating the right internal jugular vein and the ipsilateral common carotid artery. The aneurysm was then excised and the right ventricular outflow tract reconstructed by direct sutures.

Aneurysm, False↗
PubMed1994

Childhood pulmonary alveolar proteinosis. Extracorporeal membrane oxygenation with total cardiopulmonary support during bronchopulmonary lavage.

Partial cardiopulmonary bypass with extracorporeal membrane oxygenation to allow bilateral bronchopulmonary lavage in pulmonary alveolar proteinosis has been described. However, this technique is complicated by a very low arterial PO2 and cardiovascular embarrassment. Total cardiopulmonary support avoids these problems and was successfully used in a 2 1/2-year-old girl.

Cardiopulmonary Bypass↗
PubMed1994

Prolonged suction drainage prevents serous wound discharge after cardiac surgery.

A series of 180 patients was randomised to two groups after median sternotomy performed for cardiac surgery in order to evaluate the effect of suction drainage on serous wound discharge. In group A all wounds were drained using two conventional mediastinal drains, while in group B one suction drain and one conventional mediastinal drain were employed. Five patients developed serous wound discharge in group B compared with 14 in group A (chi 2, P < 0.02). There were no significant differences between the rates of major wound infection (group A, n = 1; group B, n = 1) or the incidence of postoperative pericardial effusion assessed by echocardiography (group A, n = 10; group B, n = 5).

Adult↗
PubMed1993

Salvage of postoperative pulmonary hypertensive crisis using ECMO via cervical cannulation in a case of truncus arteriosus.

The survival of patients with truncus arteriosus beyond one year of age is rare without surgical treatment [3 . Early surgery may be associated with a mortality but is still preferable, as the risks of established pulmonary hypertensive disease complicate delayed surgery [2]. We report the successful salvage of a pulmonary hypertensive crisis 24 h after corrective surgery in a late presenting patient using extracorporeal membrane oxygenation (ECMO) via cervical cannulation. Post-operative pulmonary hypertensive crises may present a difficult management problem. Extracorporeal membrane oxygenation is therapeutic in these circumstances in addition to providing life support. Cervical cannulation remains the method of choice in the postoperative cardiac patient.

Catheterization↗
PubMed1993

The effect of surgical preparation and in-vitro distension on the intrinsic fibrinolytic activity of human saphenous vein.

The objective of this study was to assess the effect of distension on the intrinsic fibrinolytic activity of human saphenous vein during its preparation for use as a bypass conduit prior to coronary artery surgery. Fibrinolytic activity was studied using fibrin plate techniques and Chromogenic assays for extractable tPA and uPA. Samples were obtained from patients undergoing routine coronary surgery. Fibrinolytic activity was compared in control vein (untouched) vein that had been prepared for use as a bypass conduit (surgical dissection, ligation of side branches and careful but uncontrolled manual distension) and segments of dissected vein distended in vitro to pressures of 230 or 120 mmHg. Uncontrolled distension and distension to 230 mmHg impaired fibrinolytic activity as determined by areas of lysis on fibrin plates (p < 0.05), (p < 0.005), tPA activity (p < 0.005) (p < 0.005) and uPA activity (p < 0.05), (p < 0.005). Distension to 120 mmHg had no effect on the fibrinolytic activity of human saphenous vein. Impaired fibrinolytic activity caused by uncontrolled distension of saphenous vein prior to its use as a vascular conduit may contribute to early vein graft thrombosis and can be avoided using controlled distension to < 120 mmHg.

Female↗
PubMed1993

Intrahepatic leiomyosarcoma of the inferior vena cava with extension into the right atrium.

We present a case of leiomyosarcoma of the intrahepatic inferior vena cava extending into the right atrium, that has been successfully palliated by removal of the obstructing tumour under conditions of full cardiopulmonary bypass and circulatory arrest. Lesions of this kind have previously thought not to be amenable to surgery. Although resection was incomplete, successful palliation may be achieved facilitating this technique.

Heart Atria↗
PubMed1993

Extracorporeal life support in paediatrics.

Extracorporeal membrane oxygenation (ECMO) is a life support technique based on modifications of heart-lung bypass technology. It is used to support severe but potentially reversible pulmonary or cardiopulmonary failure. There is increasing use of the technique for neonates and a return of interest in its use for adults. The number of non-neonatal paediatric patients receiving pulmonary support with ECMO worldwide is, however, small, and survival rates average less than 50%. Initial experience in 15 patients aged 3 months to 5 years with a high survival and low morbidity is reported.

Child, Preschool↗
PubMed1993

Aspects of psychological and social morbidity in patients awaiting coronary artery bypass grafting.

OBJECTIVES: To assess anxiety, depression, and social adjustment in patients awaiting coronary artery bypass surgery. DESIGN: Patient completed questionnaire study. SETTING: Regional cardiothoracic centre. PATIENTS: 109 questionnaires were sent to patients on the waiting list of two cardiothoracic surgeons. Sixty eight (62%) were returned and 15 (22%) of the respondents were women. There was no difference in the response rates for men (53/84) 63% and women (15/25) 60%. MAIN OUTCOME MEASURES: Anxiety and depression were assessed by the hospital anxiety and depression (HAD) scale. Social functioning was assessed by several nine point rating scales on which patients indicated how their work, family relationships, social activities, private leisure activities, and home management were impaired. Patients also indicated the severity of their cardiac symptoms on a questionnaire based on the New York Heart Association classification for the assessment of the functional state of patients with heart disease. RESULTS: On the HAD scale 19 (28%) patients scored in the clinically significant range for anxiety. Time spent on the waiting list was positively and significantly related to anxiety (p = 0.05). Thirty two (47%) patients scored in the clinically significant range for depression. Time spent on the waiting list was positively and significantly related to depression (p = 0.005). Positive and significant relations were found between time spent on the waiting list and impairment of work (p = < 0.0001), family relationships (p = < 0.0001), private leisure activities (p = < 0.0001), and social activities (p = 0.004). No correlation was found between any of the above variables and the indicated level of clinical symptoms. CONCLUSIONS: This study documents previously unreported associations between the time patients wait for coronary artery surgery and levels of anxiety, depression, and social functioning. Conclusions regarding the causes of these symptoms cannot be made from this small population of patients but these results do suggest that these associations should be studied further.

Anxiety↗
PubMed1993

Early results of combined carotid endarterectomy and coronary artery bypass grafting in patients with severe coronary and carotid artery disease.

The management of patients with carotid artery disease who require coronary artery bypass grafting (CABG) remains controversial. Several published series from the USA (including one with prospective randomization) advocate a combined approach of carotid endarterectomy (CEA) followed immediately by coronary artery bypass surgery. However, experience of combined carotid endarterectomy and coronary bypass grafting has not been previously reported by a centre from the United Kingdom. Between 1986 and 1991 we performed this combined procedure on 18 patients who required myocardial revascularization and had co-existing severe (> 70%) carotid stenosis. Sixteen patients (89%) had angina and 11 patients (61%) had symptomatic carotid artery disease. The perioperative mortality was 5.5% and the ipsilateral perioperative stroke rate was 5.5%. These early results are encouraging and suggest that further evaluation of combined carotid endarterectomy and coronary artery bypass surgery is warranted.

Adult↗
PubMed1993

The management of cardiac trauma by general surgeons in non-cardiothoracic units.

Cardiac trauma requiring immediate surgical intervention is usually thought of as a rare event. However, our recent experience at Leicester Royal Infirmary suggests that this clinical situation is on the increase, and has highlighted potential problems in the management of these patients. It is essential that all units that may have to deal with these patients have the necessary facilities and equipment to perform an emergency thoracotomy in the Accident and Emergency department, and that the medical and nursing staff involved have been properly trained to deal with these life-threatening emergencies.

Adolescent↗