PubMed Health⌕ Search

Biomedical subjects

S Deane

Publications and source records attributed to S Deane.

14 recordsLinked to original sources
PubMed2006

Obesity and the pulmonologist.

Obese children have more respiratory symptoms than their normal weight peers and respiratory related pathology increases with increasing weight. Some will need specialist assessment (box 1). Obesity produces mechanical effects on respiratory system performance. Breathlessness, wheeze, and cough are not related to increased airway responsiveness and may respond more to weight loss than bronchodilator therapy. A significant number of obese children have signs and symptoms of obstructive sleep apnoea largely related to the effect of obesity on upper airway dimensions. It seems likely that unless action is taken soon, increasing numbers of children will experience preventable respiratory morbidity as a result of nutritional obesity.

Asthma↗
PubMed1996

Intraabdominal pressure and gastric intramucosal pH: is there an association?

This study evaluated the potential association between increased intraabdominal pressure (IAP) and abnormally low gastric intramucosal pH (pHi) (</= 7.32) in postoperative patients and assessed its effect on patient outcome. Altogether 73 patients undergoing major abdominal surgery over a 9-month period were studied prospectively. All underwent gastric tonometry and intravesical IAP measurements three time daily. An IAP of >/= 20 mmHg and a pHi of </= 7.32 were considered abnormal. The development of the following complications were also documented: hypotension [mean aortic pressure (MAP) < 80 mmHg], abdominal sepsis, renal impairment, and death. The median APACHE II score was 16 (range 5-34). Twenty-two patients had upper gastrointestinal (GI) surgery, 27 lower GI surgery, and 24 aortic surgery; 44 of these patients underwent emergency surgery. Abnormal pHi (</= 7.32) occurred in 36 patients while on the intensive care unit. Compared to patients with normal pHi, abnormal pHi patients were 11.3 times (3.2-43.5) [odds ratio +/- 95% CI] more likely to have an increased IAP. Abnormal pHi was significantly associated with hypotension (chi2 = 6.8;p = 0.009), sepsis (chi2 = 3.7;p = 0.06), renal impairment (chi2 = 28.3;p = 0. 0000001), relaparotomy (chi2 = 4.1;p = 0.04), and death (chi2 = 9. 7;p = 0.002). This study demonstrated a significant clinical association between increased IAP and abnormal pHi. An abnormally low pHi was associated with poor outcome.

Abdomen↗
PubMed1996

The gene for gamma-glutamylcysteine synthetase from Thiobacillus ferrooxidans has low homology to its Escherichia coli equivalent and is linked to the gene for citrate synthase.

The gene for gamma-glutamylcysteine synthetase (gshA) from Thiobacillus ferrooxidans was isolated from a family of cosmids by its ability to complement an Escherichia coli gshA trxA double mutant which was unable to grow on minimal medium lacking glutathione. The predicted sequence of the gamma-glutamylcysteine synthetase was found to have only 18% amino acid sequence identity to the equivalent enzyme from E. coli. In spite of this low sequence homology, concentrations of GSH in a cell extract prepared from the E. coli gshA trxA mutant containing the cloned gene were almost as high as in a cell extract prepared from a wild-type E. coli strain. The gshA gene was found to be physically and transcriptionally linked to the T. ferrooxidans gene for citrate synthase (gltA). The T. ferrooxidans and E. coli citrate synthases shared 37% amino acid sequence identity and the cloned T. ferrooxidans citrate synthase gene was able to complement an E. coli gltA mutant.

Amino Acid Sequence↗
PubMed1996

Is penetrating injury on the increase in south-western Sydney?

BACKGROUND: Few Australian studies describe the epidemiology of penetrating trauma. This study describes the incidence and demographic features of penetrating injuries with emphasis on trends and severity analysis. METHODS: Case analysis was performed utilizing data from the Liverpool Hospital Trauma Registry (1989-94), NSW Department of Health Hospital Separations (1991-93), and the NSW Bureau of Crime Statistics (1991-93) with reference to the Liverpool and Fairfield Local Government Areas (LGA). RESULTS: The Trauma Registry revealed 251 of penetrating trauma. The median age was 26 years (interquartile range 21-33). Ninety-one per cent of the victims were male. Fourteen per cent of patients had an Injury Severity Score (ISS) > 15. Sixty-five per cent of cases were stab injuries and 20% gunshot injuries with the abdomen being the most commonly injured site. Twenty-one per cent of patients underwent laparotomy, 1.6% thoracotomy and 1.2% thoracotomy and laparatomy. There were 10 (4%) deaths. Trends in incidence of penetrating trauma and violent crime involving weapons were analysed. Static trends were observed for the annual incidence of penetrating trauma from the Liverpool Hospital Trauma Registry. Separations for penetrating trauma from Liverpool and Fairfield hospitals showed a slightly increasing trend. Violent crimes involving weapons in the Liverpool and Fairfield LGA showed a static trend. Nevertheless, separations for penetrating trauma and rates of violent crimes involving weapons were higher in south-western Sydney than metropolitan Sydney or NSW. Eight per cent of the LGA population are Vietnamese but this study identified 16% of victims as being Vietnamese. CONCLUSIONS: This study found no significant increase in penetrating trauma or violent crime predisposing to penetrating injury in south-western Sydney.

Adolescent↗
PubMed1995

Prospective study of intra-abdominal hypertension and renal function after laparotomy.

The value of postoperative monitoring of intra-abdominal pressure (IAP) in surgical patients has not been established. This study prospectively evaluated the occurrence of increased IAP and its association with renal impairment and outcome in surgical patients admitted to an intensive care unit. One hundred consecutive patients after laparotomy were studied, 88 of whom had complete IAP measurements. IAP was measured using an intravesical catheter and was considered increased when equal to 20 mmHg or above. Renal impairment was defined as a postoperative serum creatinine concentration of greater than 130 mumol/l, or an increase in serum creatinine of greater than 100 mumol/l within 72 h of surgery. The median (range) APACHE (Acute Physiology And Chronic Health Evaluation) II score of the patients was 13.5 (4-43). The incidence of raised IAP was 29 of 88 (33 per cent). Renal impairment was present in 29 of 88 (33 per cent), of whom 20 of 29 (69 per cent) had raised IAP (P < 0.01). The odds ratios (95 per cent confidence interval) for the development of renal impairment and death in patients with increased IAP were 12.4 (3.8-41.7) and 11.2 (2.8-47.9) respectively. There is a clinically significant association between increased IAP and renal impairment in patients admitted to an intensive care unit after laparotomy.

Abdomen↗
PubMed1995

Characterization of placenta accreta using transvaginal sonography and color Doppler imaging.

The safe use of transvaginal sonography in patients with placenta previa has been confirmed, and has revolutionized precise placental localization. The aim of our study was to evaluate the efficacy of transvaginal sonography and color-coded blood flow in the prediction of placenta accreta. Twenty-one patients with persistent placenta previa were scanned using transvaginal sonography and color-coded flow. Suspicion for placenta accreta consisted of total placenta previa at term with several placental lacunae exhibiting marked or turbulent blood flow, as seen with color Doppler transvaginal sonography from within the placenta, extending into the surrounding tissues. Five of the patients exhibited sonographic placental patterns suspicious for placenta accreta and one patient exhibited placental and cervical blood flow described as lacunar. Five Cesarean hysterectomies were performed for placenta accreta. Every placenta accreta was correctly diagnosed sonographically by the use of color flow studies. One patient with suspicion of placenta accreta delivered at another institution, a Cesarean hysterectomy was performed, and the pathology was confirmed. The one placenta previa exhibiting turbulent lacunar flow in the cervical area only was not confirmed to be an accreta at Cesarean section, although hemostasis was difficult at the placental bed. The remaining 15 patients with placenta previa and who on sonography were not suspicious for placenta accreta underwent uncomplicated Cesarean section. Transvaginal sonography and color Doppler imaging improve the diagnostic accuracy in the prediction of placenta accreta in patients with persistent placenta previa. A pattern of turbulent blood flow extending from the placenta into the surrounding tissues should alert the physician to the possibility of placenta accreta.

Blood Flow Velocity↗
PubMed1995

A prospective study of the performance of the trauma team leader.

This study assessed the performance of the trauma team leader in 50 consecutive trauma resuscitations at Liverpool Hospital over a two-month period. The trauma team consists of intensive care (ICU), emergency, and surgical registrars, three nurses, a wardsman, a radiographer, and a social worker. The team leader position alternates between the ICU and emergency registrar on a fortnightly roster. A panel of specialists experienced in trauma management evaluated 38 aspects of the initial resuscitation. Individual variables received different weightings. The maximum possible score for team leader performance was 80. The mean team leader score was 70.4 +/- 8 (SD). The main deficiencies in the team leader's performances were in their interpersonal communications and in the adequacy of documentation of the history of the injury. In 20% of resuscitations there were failures to completely expose the patient. Medical skills were uniformly well performed. Poor communication with other team members were the main pitfall of the team leader in this study. The team leader score may prove a useful tool in improving the quality of the trauma team.

Clinical Competence↗
PubMed1995

A modified combination technique for performing diagnostic peritoneal lavage.

Existing open diagnostic peritoneal lavage techniques (DPL) use small bore catheters, through a small lower midline incision or infra-umbilical incision. This study evaluated a modified DPL technique using a 10 mm umbilical incision, with open insertion of a 20 French peritoneal lavage catheter. The catheter has 27 radial side holes in the terminal distal 13 cm, and a female Leur lock connector. Warmed saline is infused via a cystoscopy infusion set. The time required to perform a new technique was studied in 10 patients. The median time to catheter insertion was 2.4 +/- 3.8 min, infusion time 0.75 +/- 0.3 min, effusion time 0.3 +/- 1.7 min, and a median total time of 7.6 +/- 4.2 min (median +/- s.d.). There was no complications. This technique of DPL is cosmetically attractive, much quicker than existing techniques and we have found its initial use encouraging.

Abdominal Injuries↗
PubMed1994

Experience with lower urinary tract disruptions associated with pelvic fractures: implications for emergency room management.

A retrospective review of prospectively gathered data from 249 trauma patients was undertaken to study the association of lower urinary tract disruptions with pelvic fractures and to confirm guidelines for the initial investigation and management of such patients in the emergency room. Of 249 patients with pelvic fractures, 124 (50%) had haematuria and 17 (7%) had lower urinary tract disruptions (7 urethral ruptures, 9 bladder ruptures and 1 patient with both bladder and urethral ruptures). Gross haematuria or blood at the urethral meatus was noted in 16 of 17 patients with urological injuries. Twenty-five per cent of patients with unstable pelvic fractures had lower urinary tract disruption compared to 6% of patients with stable fractures (P < 0.05). Retrograde urethrography followed by cystography is indicated in all cases of pelvic fractures with blood at the urethral meatus, macroscopic haematuria or associated signs such as inability to void and perineal haematoma. Urinary diversion alone was used in partial urethral ruptures while surgical exploration and repair were performed in complete urethral ruptures and in most cases of bladder ruptures.

Adolescent↗
PubMed1989

Trauma during pregnancy--a review of management.

The assessment and management of 22 pregnant patients who were admitted after trauma to Westmead Hospital between July, 1987 and October, 1988 was reviewed. Thirteen of the 22 patients were victims of motor vehicle accidents. Despite the fact that an injury research unit, responsible for the clerking and review of all trauma patients, is well established at our institution, only 6 patients in this series had been assessed in this fashion. Although a number of important obstetric investigations (albeit uncommon in the accident and emergency room situation) are well described in the literature, these were not performed in a number of patients. A protocol for the management of such patients is recommended so that more standardized and appropriate care might be given to the injured pregnant patient.

Accidents, Home↗
PubMed1987

Gunshot wounds and stabbings: experience with 124 cases.

A retrospective study was undertaken of 124 patients admitted with gunshot and stab wounds between January 1980 and the end of June 1985. The present series found an almost equal number of gunshot wounds (65) and stabbings (59), with an increasing incidence. The patients fell heavily into the categories of being male (88.7%), in their twenties (42%) and having consumed alcohol (52% when documented). There were 77 cases of assault, with 50 of these being caused by persons known to the victim, whilst violent crimes and prison riots accounted for the rest. The majority of injuries occurred outside normal working hours, with 62% arriving at the hospital between 8 pm and 8 am. There were 14 deaths (11.3%), usually within the first 4 h, with all but one occurring in the first 24 h. Gunshot wounds resulted in a higher mortality rate (16.9% cf. 5%) and longer hospital stay.

Adolescent↗
PubMed1986

Intrahepatic biliary-intestinal bypass in malignant jaundice.

There is still dispute as to the best treatment for obstructive jaundice of malignant origin when the bile ducts are blocked high in the porta hepatis. Intrahepatic duct-to-jejunal anastomoses provide a surgical solution which frees the patient from the need to wear external appliances. A series of eight patients having such anastomoses have been studied to determine the adequacy of bilirubin clearance, the durability of relief from jaundice, the length of hospital stay, the operative mortality and survival from the time of surgery. Intrahepatic bypasses were shown to allow bilirubin clearance in the lower range of normal. Freedom from jaundice persisted until death at a median time of 5 months from operation. Cholangitis was not a problem in any patient postoperatively. There was only one operative death. The major disadvantage of the technique arose from the hospital stay, a median of 30 days. It is suggested that all these factors should be considered in studies to compare surgical bypass with endoscopic or percutaneous methods for the relief of malignant jaundice.

Aged↗
PubMedDate not supplied

Trauma outcomes: a death analysis study.

Survival and mortality outcomes for trauma patients admitted to Liverpool Hospital, Sydney were analysed to determine the adequacy of trauma care. TRISS and ASCOT survival probabilities and peer review were utilised to determine if deaths were avoidable. Evaluation methods were compared for assessment of care. During the study period 2205 trauma patients were admitted, 518 of which fulfilled the study entry criteria. There were 38 deaths. The age and Injury Severity Score (ISS) of survivors was 34 +/- 18 years, 9.8 +/- 9 (mean +/- sd) compared to age and ISS for nonsurvivors 37 +/- 22 years and 45 +/- 22*, *p < 0.001. Peer review suggested that 32 deaths were non avoidable, 4 potentially avoidable and 2 were probably avoidable. TRISS and ASCOT survival probabilities were > 0.5 in 16 and 18 patients respectively. TRISS and ASCOT had low positive predictive value (25%) in identifying avoidable deaths. The Z Score was 1.79. The standardised mortality ratio (SMR) was 1.16. The Effectiveness (E) value for outcome was 0.91. Poor communication within the Area Trauma System was the greatest contributor to avoidable deaths. All trauma deaths need peer review rather than solely relying upon ASCOT and TRISS probabilities to identify "unexpected" deaths for detailed review.

Adolescent↗