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Biomedical subjects

W F Kerr

Publications and source records attributed to W F Kerr.

4 recordsLinked to original sources
PubMed1987

Role of cryoanalgesia in the control of pain after thoracotomy.

Thoracotomy causes severe postoperative pain, which is difficult to manage since the use of systemic analgesics often causes respiratory depression. Cryoanalgesia of the intercostal nerves has been advocated as an effective means of local analgesia without serious side effects. A prospective randomised blind trial to investigate the efficacy of the technique was carried out. A total of 53 patients undergoing thoracotomy were allocated to either the trial or a control group. At thoracotomy the surgeon was informed of the patient's trial allocation. The trial group received one minute of direct cryotherapy to at least five intercostal nerves related to the incision. All patients received methadone via the lumbar epidural route in a dose calculated according to their weight. A linear analogue assessment of postoperative pain was made by the patients as soon as they were sufficiently awake. An independent record of all postoperative analgesia was kept. After discharge from hospital further assessments were made at least six weeks after operation. Statistical analysis of the scores of postoperative pain and analgesic consumption showed that there was no significant difference between the trial and the control group. There was, however, a suggestion of an increase in the long term morbidity, although these figures were not amenable to statistical analysis. Thus is has not been possible to demonstrate a role for cryoanalgesia in the control of post thoracotomy pain.

Adult↗
PubMed1980

Spontaneous intramural rupture and intramural haematoma of the oesophagus.

Spontaneous intramural rupture or intramural haematoma of the oesophagus is a rare cause of acute pain in the chest and upper abdomen. Much less ominous than spontaneous complete rupture from which it must be distinguished, it seldom if ever necessitates operation. Five new cases are described and reviewed together with 15 collected from published reports. The dominant symptom of every case was severe and constant retrosternal or epigastric pain; concomitant dysphagia was mentioned in 11 cases. In seven the pain was preceded by or coincided with vomiting. The condition was related to other stresses in three and appeared to be truly spontaneous in 10. In approximately one-third of cases it started suddenly but more often it began as discomfort worsening rapidly. Fourteen patients vomited blood after experiencing pain but only four were given transfusions. In contradistinction to complete rupture, none had surgical emphysema and plain chest radiographs were unremarkable. All had abnormal gastrografin or barium swallows. Intramural haematomas with or without mucosal tears were seen in the 11 cases in which oesophagoscopy was performed. Fifteen patients made rapid and complete recoveries on conservative management. Of the four who did not respond satisfactorily, one had the oesophagus repaired, two had drainage of the mediastinum after failure to find the false lumen at thoracotomy, and one had only an abdominal exploration. The only death in the whole series occurred after a disastrous emergency exploration and subsequent total oesophagectomy.

Aged↗
PubMed1977

Late-onset post-pneumonectomy empyema.

Nine cases of empyema developing more than three months after pneumonectomy are presented. Diagnosis is difficult; with one exception, all the patients had been ill for at least three weeks and some for several months before the cause was discovered. In four, the radiological demonstration of gas in a previously opaque hemithorax led to the diagnosis. One of these had a bronchial fistula, two had oesophageal fistulae, and one had both. The remaining patients had no fistulae and the diagnoses were not made until empyema necessitatis had developed. Two from this group yielded pure cultures of pneumococci and one a pure culture of Streptococcus viridans. Except for one patient admitted moribund, all were treated in the first instance by rib resection and open drainage without tubes and all survived. Four of the five without fistulae subsequently had their drainage sinuses successfully closed after the infection of the chest wall had cleared. The belief that a pneumonectomy space normally becomes obliterated is challenged. The history and mode of onset of some of these cases suggested that infection of the residual fluid was bloodborne.

Adult↗