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Port Glasgow, United Kingdom

Brydon C.,Gartnavel General Hospital
Anaesthesia and Intensive Care Medicine | Year: 2013

The Jehovah's Witness society is a Christian movement established 140 years ago. It has around 7 million members worldwide who believe that the Bible prohibits the transfusion of blood and its primary components. Some minor components of plasma and clotting factors may be acceptable to some members of the faith. Similarly some will accept intraoperative cell salvage where their own blood from the surgical site can be aspirated and returned to them provided the blood remains within a closed circuit and is never stored. A competent adult may refuse or accept any treatment without giving a reason. These wishes must be respected and followed even if the patient's life is at risk. Senior medical staff must be involved in the care of Jehovah's Witnesses from the outset. They must employ any techniques which will optimize the patient's haemoglobin and minimize blood loss. This ranges from iron and erythropoietin pre- and postoperatively to careful patient positioning and choice of anaesthetic technique to meticulous haemostasis by surgeons. Alternatives to red blood cells remain elusive despite years of research. When faced with life-threatening haemorrhage these patients are likely to require intensive care to ensure adequate oxygenation, possibly for a prolonged period. Source

Robertson I.,Gartnavel General Hospital
The Cochrane database of systematic reviews | Year: 2013

Peripheral arterial thrombolysis is used in the management of peripheral arterial ischaemia. Streptokinase was originally used but safety concerns led to a search for other agents. Urokinase and recombinant tissue plasminogen activator (rt-PA) have increasingly become established as first line agents for peripheral arterial thrombolysis. Potential advantages of these agents include improved safety, greater efficacy and a more rapid response. Recently drugs such as pro-urokinase, recombinant staphylokinase and alfimperase have been introduced. This is an update of a review first published in 2010. To determine which fibrinolytic agents are most effective in peripheral arterial ischaemia. For this update the Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator (TSC) searched the Specialised Register (last searched March 2013) and CENTRAL (2013, Issue 3) for randomised controlled trials (RCTs) comparing fibrinolytic agents to treat peripheral arterial ischaemia. RCTs comparing fibrinolytic agents to treat peripheral arterial occlusion. Data were analysed for the outcomes vessel patency, time to lysis, limb salvage, amputation, death, complications including major haemorrhage, stroke, and distal embolization. Five RCTs involving a total of 687 participants with a range of clinical indications were included. No new studies were included in this update. In one three-pronged study, vessel patency was greater with intra-arterial recombinant tissue plasminogen activator (rt-PA) than with intra-arterial streptokinase (P < 0.04) or intravenous rt-PA (P < 0.01). In participants with peripheral arterial occlusion there was no statistically significant difference in limb salvage at 30 days with either urokinase or rt-PA, though this may reflect the small numbers in the studies. Incidences of haemorrhagic complications varied with fibrinolytic regime but there was no statistically significant difference between intra-arterial urokinase and intra-arterial rt-PA. In the three-pronged study intravenous rt-PA and intra-arterial streptokinase were associated with a significantly higher risk of haemorrhagic complications than with intra-arterial rt-PA (P < 0.05). There is some evidence to suggest that intra-arterial rt-PA is more effective than intra-arterial streptokinase or intravenous rt-PA in improving vessel patency in people with peripheral arterial occlusion. There was no evidence that rt-PA was more effective than urokinase for patients with peripheral arterial occlusion and some evidence that initial lysis may be more rapid with rt-PA, depending on the regime. Incidences of haemorrhagic complications were not statistically significantly greater with rt-PA than with other regimes. However, all of the findings come from small studies and a general paucity of results means that it is not possible to draw clear conclusions. Source

McKay P.,Gartnavel General Hospital
Journal of the Royal College of Physicians of Edinburgh | Year: 2010

Bleomycin is an anti-neoplastic antibiotic used in chemotherapeutic regimens for Hodgkin lymphoma, testicular tumour and Kaposi's sarcoma and to induce chemical pleurodesis in malignant effusions. Bleomycin toxicity predominantly affects the skin and lungs. Skin toxicity classically presents as flagellate erythema, a rare drug rash, where the patient appears to have been whipped. Bleomycininduced pneumonitis is more commonly recognised and can occasionally prove fatal. Although both these conditions are well documented in the literature, in clinical practice they are uncommon. Indeed, in our institution (a teaching hospital with a large lymphoma practice) we cannot recall a previous case of flagellate erythema. Both skin and lung toxicities induced by bleomycin usually respond to discontinuation of the drug and steroid therapy. We present two case studies of patients with bleomycin-related toxicity and a short synopsis of current literature. © 2010 Royal College of Physicians of Edinburgh. Source

Hamaekers A.E.,Maastricht University | Henderson J.J.,Gartnavel General Hospital
Anaesthesia | Year: 2011

The inability to maintain oxygenation by non-invasive means is one of the most pressing emergencies in anaesthesia and emergency care. To prevent hypoxic brain damage and death in a 'cannot intubate, cannot oxygenate' situation, emergency percutaneous airway access must be performed immediately. Even though this emergency is rare, every anaesthetist should be capable of performing an emergency percutaneous airway as the situation may arise unexpectedly. Clear knowledge of the anatomy and the insertion technique, and repeated skill training are essential to ensure completion of this procedure rapidly and successfully. Various techniques have been described for emergency oxygenation and several commercial emergency cricothyroidotomy sets are available. There is, however, no consensus on the best technique or device. As each has its limitations, it is recommended that all anaesthetists are skilled in more than one technique of emergency percutaneous airway. Avoiding delay in initiating rescue techniques is at least as important as choice of device in determining outcome. © 2011 The Association of Anaesthetists of Great Britain and Ireland. Source

Shams F.,Gartnavel General Hospital
Ophthalmic Plastic and Reconstructive Surgery | Year: 2016

Sporadic inclusion body myositis is the most commonly acquired type of idiopathic inflammatory myopathy in people aged 50 and above. There is early weakness and atrophy of forearms and quadriceps and a third of patients also have mild facial weakness. Extraocular muscles are not affected and ptosis is rarely seen. The authors describe a unique case in which inclusion body myositis presented with early mid face weakness and atrophy resulting in unilateral lagophthalmus, and ptosis, which have not been documented before. This case is not only unique in its presentation but also emphasizes the importance of considering differential diagnoses and conservative measures before contemplating surgery. © 2016 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved. Source

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