ABSTRACT
The aim of this paper is to evaluate some aspects of the life of William Hunter (1718-1783), and to argue that he deserves a better place in history as he was one of the most outstanding figures in British medicine of the 18th century. A Scotsman, Presbyterian, from a family without means or connections, he underwent a classic education at the University of Glasgow, completed with apprenticeships with William Cullen and Alexander Monro first in Scotland, and then in London, with William Smellie, James Douglas and James Wilkie, in anatomy, obstetrics and surgery, respectively. Despite initial disadvantages, he was highly successful as an anatomist, educator, surgeon, man-midwife, artist, gentleman and collector. He moved and had influences in the highest medical, cultural and social circles of his time, was named Physician Extraordinary to Queen Charlotte, and was a member of many scientific, medical and cultural societies in Great Britain and in France, such as the Royal Society, the Royal College of Physicians and the Societé Royale de Médicine of Paris. His museum was notable in its magnitude and its diversity, including anatomical preparations, coins, shells, plants, birds, insects, fossils, and minerals. He donated his great museum to the University of Glasgow. His figure has been relegated mainly due to the absence of heirs, individuals or institutional, that could have cared for, maintained, and increased his legacy as happened with his brother John.
Subject(s)
History, 18th Century , Anatomy/history , Obstetrics/history , Education, Medical/history , United Kingdom , Medicine in the Arts/historyABSTRACT
Este artículo, tercero de una serie sobre el desarrollo de la anestesia local, describe los acontecimientos que siguieron al descubrimiento hecho por Carl Koller en 1884 del uso anestésico de la cocaína hasta la introducción de la procaína por Einhorn. En un lapso de veinte años, varias investigaciones culminaron con la introducción de muchas de las técnicas de anestesia local y regional usadas contemporáneamente: troncular, por infiltración, raquídea y peridural caudal. El escrito toca aspectos tales como la juventud de los innovadores, en su mayoría cirujanos, la toxicidad y el terrible poder de adicción de la cocaína que alcanzó a algunos de ellos, las disputas por la precedencia y la tradición de autoexperimentación.
This paper, third of a series dedicated to the development of local anesthesia, describes the events that followed the discovery made by Carl Koller in 1884 of the local anesthetic use of cocaine up until the discovery of procaine by Einhorn. Over the span of twenty years, several investigations led to the introduction of many of the local and regional anesthesia techniques used today: troncular, by infiltration, spinal and peridural by caudal route. It touches aspects such as the youth of the innovators, mostly surgeons, the toxicity and terrible addictive power of cocaine that affected some of them, priority disputes and the autoexperimentation tradition.
Subject(s)
Humans , Anesthesia, Caudal , Anesthesia, Epidural , Anesthesia, Local , Anesthesia, Spinal , Cocaine , Procaine , Medical Staff, HospitalSubject(s)
Humans , History, Ancient , History, 18th Century , Cocaine/history , Cocaine/therapeutic useABSTRACT
Background: Vasoactive drugs used in the reanimation of septic patients, can modify splanchnic perfusion. Aim: To compare the effects of dobutamine and amrinone on gastric intramucosal pH (pHi), lactate levels and hemodynamics in surgical patients with compensated septic shock. Patients and methods: Fourteen postoperative patients with abdominal sepsis and compensated septic shock (pHi <7.32 or lactate >2.5 mmol/l) were studied in a prospective, randomized, unblinded study. Patients were randomized to receive (Group 1, n=7) dobutamine at 5 µg/Kg/min or (Group 2, n=7) amrinone at 5 µg/Kg/min. Hemodynamic data, arterial lactate and pHi were measured before and 30, 60 and 120 minutes after starting drug infusion. Results: Both drugs were associated with a decrease in lactate levels. Dobutamine infusion, but not amrinone, increased gastric pHi, as well as cardiac index and oxygen delivery. Conclusions: An improvement in gastric pHi associated with an increase in oxygen delivery, was observed with dobutamine. Amrinone showed no effect at the fixed, low dose used in the study
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Amrinone/pharmacology , Dobutamine/pharmacology , Shock, Septic/drug therapy , Postoperative Complications/drug therapy , Abdomen, Acute/surgery , Lactates/metabolism , Lactates/blood , Splanchnic Circulation , Hydrogen-Ion Concentration , Shock, Septic/etiologyABSTRACT
Fifteen elective patients (6 M, 9 F, 51+-8 years old) scheduled for laparotomy (n=8) or laparoscopy (n=7) were studied. Ventilatory parameters and pulse oximetry were measured pre and postoperatively. Patients were randomly assigned to receive oxygen by nasal cannula either during the first or the second postoperative night. PONH (Sat2 85) developed in seven patients (47 per cent)of which four had undergone laparoscopic surgery. PONH was more frequent in mildly obese patients and those presenting preoperative hypoxemia (p=0.03). Peak flow was lower in patients presenting PONH (p=0.04). In five patients, PONH was associated with significant tachycardia. Oxygen administration was associated with a higher SatO2 and prevented PONH in 6/7 patients. PONH is a common event in patients older than 40 years scheduled for open or laparascopic abdominal surgery, and develops more frequently in those with preoperative nocturnal hypoxemia and greater ventilatory impairment. PONH can be prevented, most of the time, with oxygen administration
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Surgical Procedures, Operative/adverse effects , Laparoscopy/adverse effects , Hypoxia/therapy , Postoperative Complications/therapy , Risk Factors , Hypoxia/complications , Oxygen Inhalation Therapy/methodsABSTRACT
Adult respiratory distress syndrome is highly prevalent in intensive care units and has a high mortality. Lately, nitric oxide has been used as adjuvant therapy. To study the effects of nitric oxide inhalation in patients with adult respiratory distress syndrome, 12 patients were subjected to nitric oxide inhalation at a concentration of 10 parts per million, during 30 minutes. At the end of the nitric oxide inhalation period, there was an improvement of PaO2/FIOa ratio from 89ñ32 to 111ñ43 mm Hg and 16 percent reduction of lung shunting (Qs/Qt). Nitric oxide inhalation at a concentration of 10 parts per million improved arterial oxygenation and reduced pulmonary shunting in patients with adult respiratory distress syndrome
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Nitric Oxide/pharmacokinetics , Respiratory Distress Syndrome/therapy , Respiratory Therapy , Pulmonary Gas Exchange/physiology , Hemodynamics , Respiratory Distress Syndrome/physiopathologyABSTRACT
To assess the acute effects of methylene blue infusion, an inhibitor of nitric oxyde synthesis, on hemodynamic parameters in patients with refractory septic shock. Fourteen patients admitted to intensive care units with septic shock of diverse etiologies and unable to maintain median arterial pressures over 60 mm Hg with the use of at least 2 vasoactive drugs, were studied. All received a 1 mg/kg bolus of methylene blue. Hemodinamic parameters were measured before and 30, 60, 120 and 180 min after the bolus. Systolic and diastolic blood pressure and systemic vascular resistance increased in all patients. There were no significant changes in cardiac output, oxygen consumption or extraction. Methylene blue has an acute pressor effect in patients with septic shock
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Guanylate Cyclase/antagonists & inhibitors , Methylene Blue/pharmacology , Nitric Oxide/antagonists & inhibitors , Systemic Inflammatory Response Syndrome/drug therapy , Vascular Resistance/drug effects , Vasoconstrictor Agents/pharmacology , Hemodynamics , Blood Pressure , Central Venous Pressure , Clinical ProtocolsABSTRACT
Changes in health care delivery in Chile over the lact years include rising costs and the relative increase of prepaid private insurance programs. It is expected that there will be increasing pressures on helath providers to disease cost while maintaining or improving quality. A series of common clinical problems are reviewed (herni repair, appendicitis, gallstone disease, trauma, preoperative evaluation) to demonstrate that using a scientific method-continuous quality improvement and considering tha local socioeconomic reality, this challenge can be met. Emphasis is made on the need for physicians to participate in such a process and on the teaching of these concepts. Medical societies and schools should consider these health care developments and adapt to this changes
Subject(s)
Humans , Total Quality Management/organization & administration , Health Plan Implementation/trends , Quality Control , Cost Efficiency Analysis , Quality of Health Care/organization & administrationABSTRACT
Inhalation therapy with nitric oxide has been suggested as beneficial in the adult respiratory distress syndrome, however there are few reports of its prolonged use. We report a patient with a chronic lymphocytic leukemia that developed an adult respiratory distress syndrome with severe hypoxemia, refractory to conventional therapeutic measures, during the course of a septic shock. The patient received nitric oxide (19 ppm) improving arterial oxygen saturation and allowing the reduction of FiO2 to 40 percent. The patient died 5 days later due to a multiple organ failure