Biomedical subjects
R Macdonald
Publications and source records attributed to R Macdonald.
Combined epidural/spinal anaesthesia for caesarean section. Through the needle or in separate spaces?
An evaluation of a 30 gauge spinal needle in a combined epidural/spinal anaesthetic technique for Caesarean section revealed a 25% failure rate of the spinal element. In this unit, no more than 4% of spinal anaesthetics might be expected to fail. One of the reasons for the higher failure rate was that, when using the Tuohy needle as an introducer, the dura was not identified. This prompted us to compare the 'through-the-Tuohy' or needle within needle approach for combined epidural/spinal anaesthesia, with a technique that involved siting the epidural and spinal sequentially in separate spaces. One hundred women requiring elective Caesarean section under spinal anaesthesia were randomised into single or double space groups. The technique failed in 16% of through-the-needle cases, and in 4% of sequential sitings. Combined spinal/epidural anaesthesia for Caesarean section is more successful if each procedure is performed using separate spaces.
Epidural analgesia for labour (intermittent top-ups or continuous infusion).
Explore the source record for details and available documents.
Aspirin and extradural blocks.
Explore the source record for details and available documents.
29-gauge spinal needles.
Explore the source record for details and available documents.
Awareness during caesarean section.
Between 1982 and 1989 over 3000 patients were questioned about recall and dreaming after general anaesthesia for Caesarean section. Some 28 (0.9%) patients were able to recall something of their operation and 189 (6.1%) reported dreams. There was uniform adherence to a rigid anaesthetic protocol up to and including 1985, but a much publicized incident reported from the courtroom stimulated a relaxation of this regimen. Consequently the incidence of awareness decreased from 1.3% to 0.4%, and the incidence of dreaming was also reduced. Recollections of surgery were confined to manipulations, noises and voices. None of our patients complained of pain at the time of interview, although one since has. The inadequacies of the initial protocol and an approach to informed consent are discussed.
An evaluation of a 30-gauge needle for spinal anaesthesia for caesarean section.
A 30-gauge spinal needle was evaluated for Caesarean section, using a combined epidural/spinal technique, in 50 mothers. Spinal anaesthesia failed in six mothers and was inadequate in another six. General anaesthesia was required on one occasion. A 25% overall failure rate suggests that a 30-gauge needle is not a practical proposition for routine clinical practice.
Modern treatment of menorrhagia.
Explore the source record for details and available documents.
Crystal Palace National Sports Centre--London, UK.
Explore the source record for details and available documents.
Analgesia following caesarean section.
Explore the source record for details and available documents.
The epidemiology of Ascaris lumbricoides and other soil-transmitted helminths in primary school children from Ile-Ife, Nigeria.
An epidemiological survey of intestinal helminthiases was conducted on 766 primary school children aged 5-16 years from Ile-Ife, Nigeria. On the basis of stool examinations, the prevalence of Ascaris lumbricoides, Trichuris trichiura, hookworm and Strongyloides stercoralis was 88.5, 84.5, 33.1 and 3% respectively. Intensity of infection was measured indirectly by egg counts for each species of helminth and also by counting worms passed after chemotherapy in the case of A. lumbricoides. The influence of host age and sex on infection levels was assessed. Relationships between the intensities of A. lumbricoides, T. trichiura and hookworm in individual children were identified. After anthelmintic treatment with levamisole, the frequency distribution of A. lumbricoides per host and the relationship between parasite fecundity and worm burden were investigated. Reinfection patterns of A. lumbricoides were assessed at two 6-monthly intervals and even within the narrow age range described, differences were found. In addition, evidence was obtained for predisposition of individuals to heavy or light infection with A. lumbricoides.
Idiopathic myoglobinuria in the early puerperium.
Myoglobinuria is rare in association with pregnancy. We report a case of idiopathic myoglobinuria in the early puerperium in a patient who had a spontaneous vaginal delivery. Acute muscular pain and port wine staining of the urine should alert the clinician.
Future education for the multiply handicapped.
Explore the source record for details and available documents.
Development and evaluation of a community-based pulmonary education system.
Explore the source record for details and available documents.
Benzodiazepines specifically modulate GABA-mediated postsynaptic inhibition in cultured mammalian neurones.
Explore the source record for details and available documents.
The University of South Carolina School of Medicine: a progress report from the Dean.
Explore the source record for details and available documents.
Trabeculectomy.
During a one-year period, 31 trabeculectomies were done in 25 patients. Of these procedures, 27 (87%) were done for chronic open angle glaucoma, three (10%) for congenital glaucoma, and one for chronic open angle glaucoma in an aphakic patient. Our overall success rate was 87%. Complications were few: only two of 31 flat anterior chambers persisted postoperatively. Visual acuity dropped significantly (two lines on the Snellen visual acuity chart) in only one patient.
Trabeculectomy in blacks: a two-year follow-up.
Explore the source record for details and available documents.