Biomedical subjects
Publications and source records attributed to S Armistead.
A profile of 333 patients admitted to the intensive therapy unit, Waikato Hospital, over one year ending 30 June 1990, is presented. A close costing of a representative sample of 30 of those patients was done. The average cost of their intensive care stay was $2948 per patient. Twenty-four of the patients cost an average $2200 and the other six cost an average $5700.
Twenty-four patients underwent cricothyroidotomy at Guy's Hospital between 1977 and 1981. Of these, 13 died during admission or shortly after discharge as a result of their primary disease and three were unsuitable for further examination. The eight remaining patients were examined to assess the effect of cricothyroidotomy on the laryngeal function of voice production. Assessment was made both subjectively and objectively by laryngography. Objective findings were correlated with structural changes seen by indirect laryngoscopy. Six of the eight patients examined had both subjective and objective disturbance of voice production. We report our experience with the surgical procedure of cricothyroidotomy which, in addition to a high incidence of vocal disturbance, includes one case of subglottic stenosis secondary to granulation tissue.
Two hundred and fifty patients were admitted to a prospective randomized trial of single dosage prophylaxis against wound infection after appendicectomy. There were 12 exclusions, 72 patients received placebo, 81 received 600 mg i.m. clindamycin phosphate and 85 received 1 1 g i.m. cefazolin sodium, the agent being given in the anaesthetic room. Clindamycin produced a significant reduction in the overall rate of wound infection from 33 per cent in the controls to 17 per cent. In cases with a gangrenous or perforated appendix the infection rate in controls was 78 per cent; this was reduced to 44 per cent by a single dose of clindamycin. Cefazolin significantly reduced the number of aerobic organisms isolated from wound infections, but did not significantly reduce the incidence of wound infection. We conclude that anaerobic organisms are more important than faecal aerobic organisms in the pathogenesis of wound infection after appendicectomy.
The manufacturing methods and quality control procedures for two cardioplegic solutions are described. Procedures for preparing individual bottles or batches of two cardioplegic solutions (one with and one without albumin) and a carbonate-bicarbonate buffer solution are described. Final buffered cardioplegic solutions with albumin are stable for seven days. Cardioplegic solutions without albumin and buffer are stable for 30 days. The chemical and physiological factors affecting the content and preparation of cardioplegic solutions used during intracardiac surgery are reviewed. Because consistency is attained more readily, and because control procedures, including quarantining, are applied more readily to batch production of cardioplegic solutions, it is advised that this method be used.
The following case report is of a middle aged man with a progressive neurologic disability who was brought to our emergency department. Caregivers could no longer manage him once he lost the ability to ambulate and became incontinent. At that time his neurologic and hematologic parameters were fairly typical of cobalamin deficiency. We are reporting this case to emphasize that cobalamin deficiency is not always due to pernicious anemia in the elderly or the malnourished alcoholic. Deficiency from uncommon causes can manifest at any age and result in severe morbidity.