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Biomedical subjects

V J Webster

Publications and source records attributed to V J Webster.

13 recordsLinked to original sources
PubMed2005

The use of iloprost in early pregnancy in patients with pulmonary arterial hypertension.

In patients with pulmonary hypertension, pregnancy is associated with a high risk of maternal death. Such patients are counselled to avoid pregnancy, or if it occurs, are offered early interruption. Some patients, however, decide to continue with their pregnancy and others may present with symptoms for the first time whilst pregnant. Pulmonary vasodilator therapy provides a treatment option for these high-risk patients. The present study describes three patients with pulmonary arterial hypertension of various aetiologies who were treated with the prostacyclin analogue iloprost during pregnancy, and the post-partum period. Nebulised iloprost commenced as early as 8 weeks of gestation and patients were admitted to hospital between 24-36 weeks of gestation. All pregnancies were completed with a duration of between 25-36 weeks and all deliveries were by caesarean section under local anaesthetic. All patients delivered children free from congenital abnormalities, and there was no post-partum maternal or infant mortality. In conclusion, although pregnancy is strongly advised against in those with pulmonary hypertension, the current authors have achieved a successful outcome for mother and foetus with a multidisciplinary approach and targeted pulmonary vascular therapy.

Administration, Inhalation↗
PubMed2004

Epidural analgesia for acute symphysis pubis dysfunction in the second trimester.

We report a case of severe symphysis pubis dysfunction in a parturient during her second trimester of a twin pregnancy. Symphysis pubis dysfunction produces pain, instability and limitation of mobility and function, of the symphysis pubis during pregnancy and labour. It is often under-treated. We provided lumbar epidural analgesia with intermittent top-ups of bupivacaine 0.1% with fentanyl 2 micrograms/mL for 72 h. This provided initial analgesia, breaking a vicious cycle of pain and muscle spasm. The benefits extended into the remainder of her pregnancy. Subsequently, simple analgesics and physiotherapy allowed control of pain until vaginal delivery 15 weeks later.

Adult↗
PubMed2003

Spinal anaesthesia for caesarean section in a patient with Cockayne syndrome.

Cockayne syndrome is a rare inherited disorder with photosensitivity, dysmorphism, short stature and neurological deficits. Sufferers with this condition rarely survive into reproductive life. We report the successful delivery of a woman in her second pregnancy with Cockayne syndrome, her first pregnancy having resulted premature labour, caesarean section under spinal anaesthesia with considerable hypotension, and neonatal death. On this occasion she was hospitalised at 19 weeks' gestation and delivered by elective caesarean section at 34 weeks. She had a Mallampatti score of 3, so spinal anaesthesia using 1.8 mL of hyperbaric bupivacaine was given with good effect and mother and baby did well. The aetiology and clinical symptoms of this rare congenital syndrome, together with the anaesthetic implications and management, are described and discussed.

Journal Article↗
PubMed2001

Royal College of Anaesthetists Tutors. A survey of their duties and resources.

Royal College of Anaesthetists Tutors have a key role in the delivery of postgraduate anaesthetic training in the UK. We report the results of a postal questionnaire sent to all College Tutors in April 2000. An 89% response rate (253 of 283 Tutors) was received. Respondents were responsible for a median 11 trainees. Forty-nine Tutors with responsibility for larger numbers of trainees had the assistance of a deputy. The duties of a College Tutor comprised the organisation and delivery of training, appraisal and assessment, and 73% of respondents undertook all of these. In addition, a proportion had other administrative duties. The average time spent on College Tutor duties was 1.6 notional half days. Almost two-thirds of Tutors received some resources (time or remuneration) for their duties.

Adult↗
PubMed1985

Determination of serum methotrexate and 7-hydroxymethotrexate concentrations. Method evaluation showing advantages of high-performance liquid chromatography.

The use of large doses of methotrexate (MTX), greater than 3 g/m2, for the treatment of some malignant disorders requires careful monitoring of serum concentrations. A simple and sensitive method for the separation of MTX and 7-hydroxymethotrexate (7-OH-MTX) by reversed-phase high-performance liquid chromatography (HPLC) is described. The method involves deproteinizing the serum sample on a Sep-Pak C18 cartridge, followed by separation on a C18 column and detection at 313 nm. The extraction efficiency of free MTX from serum is 70% and the maximum sensitivity is 2.2 X 10(-8) M. A high degree of correlation was obtained between the HPLC method of serum MTX determination and an enzyme multiplied immunoassay technique. The HPLC method separates MTX from its analogues, or drugs which may be administered concomitantly with MTX. Concentrations of MTX and 7-OH-MTX achieved over a 24-h period during high-dose therapy, (500-1000 mg/m2), and over 48 h for very-high-dose methotrexate therapy (8-12 g/m2) are described. A significant observation is the presence of 7-OH-MTX in sera of patients 6 h after commencement of infusion. This method was also utilized for monitoring cerebrospinal fluid MTX concentrations.

Chromatography, High Pressure Liquid↗
PubMed1985

Abdominal trauma: pre-operative assessment and postoperative problems in intensive care.

Although penetrating abdominal trauma is on the increase in Australia, blunt trauma continues to account for the majority of cases and usually presents a more challenging problem than the former. Diagnosis has been greatly facilitated by the widespread use of peritoneal lavage and computerised tomography. Conservative management of solid organ ruptures, especially of the spleen, is being increasingly utilised in selected cases. If haemorrhage continues following initial resuscitation, urgent laparotomy is required. Heroic attempts at achieving normo-volaemia in the presence of major haemorrhage must not be allowed to delay laparotomy. Postoperative problems such as intra-abdominal sepsis or visceral infarction usually have few if any localising features; more typically multiple organ failure insidiously develops. When no clear extra-abdominal cause exists, laparotomy must not be delayed.

Abdominal Injuries↗
PubMed1980

Necrotizing gastritis and phlegmonous gastritis--are they separate entities?

Phlegmonous gastritis, although a rare condition, is a submucosal bacterial infection strictly confined to the stomach with characteristic macroscopic and histological findings. A case of necrotizing gastritis with perforation is presented, and another similar case is reviewed, in which the gross and microscopic features are considerably different from those ascribed to classical phlegmonous gastritis. There was no evidence of an infectious aetiology in either case, and the predominant feature was necrosis. It is proposed that this variant may represent a separate disease entity of unknown aetiology. A combination of early radical gastric resection and vigorous antibiotic therapy appears to be the treatment of choice in both classical phlegmonous gastritis and necrotizing gastritis.

Adult↗