Biomedical subjects
R McGlone
Publications and source records attributed to R McGlone.
Laparoscopic training for theatre personnel.
Many theatre units have begun to liaise with surgeons and with manufacturers to train theatre personnel to work as part of a team carrying out laparoscopic surgery. Indeed, some courses are already well established. This short article describes the experience of one theatre unit of such a training programme.
Use of Ames SG10 Urine Dipstick for diagnosis of abdominal pain in the accident and emergency department.
In a prospective study of 1112 patients presenting to the Accident and Emergency Department with abdominal pain; the SG10 Ames Urine Dipsticks were shown to be a valuable screening test for the detection of infected urine. Introducing this technique would reduce by at least 37% the number of urgent requests for microscopy of midstream urines (MSUs). Dipstick testing however was not a reliable screening test for microscopic haematuria.
Reducing the pain of intradermal lignocaine injection by pH buffering.
The effect of pH on the pain of administration and efficacy of 1% lignocaine was investigated in a prospective, double-blind, randomized study of 20 adult volunteers. Onset and spread of anaesthesia by intra-dermal injection were not altered, but there was a significant reduction in pain scores with a higher pH. Overall, pain scores appear to be more dependent on the speed of injection rather than alteration of pH.
Do we need to cross-match blood in closed fractures of the shaft of the femur?
A total of 50 patients with isolated closed fractures of the shaft of the femur are presented. Eleven per cent of the blood specimens were merely grouped and saved on arrival, and the remaining 39 (78 per cent) were crossmatched between 2 and 6 units. Overall, 138 units of blood were crossmatched and only 16 units were used (11.5 per cent), none of them actually in the accident and emergency department. We can find no record of blood being given for resuscitation. The use of blood appeared to depend on the occurrence and timing of operation. We suggest that local policy for crossmatching blood for such patients takes into account the orthopaedic surgical plan, but that the routine instruction to cross-match blood on arrival be abandoned.
Muscle relaxants and Bier's block.
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Trigeminal pain due to whiplash injury.
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The use of muscle relaxant to supplement local anaesthetics for Bier's blocks.
In searching for the 'ideal' muscle relaxant for use with intravenous regional anaesthesia, muscle relaxation was assessed with and without the addition of Atracurium to Bier's Block in four volunteers. This was followed by a clinical study of 36 patients with wrist fractures to confirm the drug's safety and examine the possible clinical advantages of using a muscle relaxant. The addition of 2 mg of Atracurium to the Bier's Block improved the ease of reduction (P less than 0.025) and the quality of analgesia (P less than 0.05) (Mann-Whitney U test). The authors conclude that the addition of Atracurium to a Bier's Block is useful in selected patients with a wrist fracture.
Hypnozoites in Bradford.
We present two paediatric cases of a condition that should be considered when a child of an immigrant family presents to the A&E department with a pyrexia with no obvious focus of infection.
Posterior dislocation of shoulder and bilateral hip fractures caused by epileptic seizure.
A case in which a patient with normal bone texture suffered a posterior shoulder dislocation combined with bilateral sub-capital femoral neck fractures during an ictal episode and in which the diagnosis of bilateral hip fractures was delayed is described.
Femoral nerve block in the initial management of femoral shaft fractures.
The aim of this study was to demonstrate that the under-used technique of femoral nerve block (F.N.B.) (Berry, 1977) has excellent analgesic action for femoral shaft fractures when performed by junior staff. It had no recorded side effects and was used in all age groups for fractures at all levels along the femoral shaft. Twenty-seven consecutive patients were studied as they presented in an accident room, all received a femoral nerve block (10 ml 1% Lignocaine with 1:200,000 adrenaline) from unsupervised junior accident and emergency staff instructed in the technique. Each case was subsequently followed up, and both the delay before the onset of analgesia and total duration of analgesia, together with its efficacy, were assessed. A further F.N.B. using a different agent (10 ml 0.5% bupivacaine) was performed and the same parameters were assessed. Both agents gave effective analgesia of varying duration at all levels of fracture site.
Sarcoidosis presenting with pathological fracture of a metacarpal.
We describe a patient who presented with pathological fracture of the fifth metacarpal which on further investigation, was found to be due to Sarcoidosis. There is no previous record of the condition presenting in this way, with a pathological fracture.
Measuring anti-convulsant levels in the accident and emergency department.
A prospective study involving 57 epileptic adults who presented to the Derbyshire Royal Infirmary Accident and Emergency Department with fits has shown that 57% were in the sub therapeutic ranges.