British medical bulletin
-
British medical bulletin · Jan 1999
ReviewCerebral protection in severe brain injury: physiological determinants of outcome and their optimisation.
The primary role of intensive care in acute head injury lies in the prevention, detection and reversal of secondary neuronal injury. The maintenance of optimal systemic and cerebrovascular physiology can substantially contribute to these aims. There is, however, a role for novel neuroprotective interventions, many of which are currently under investigation.
-
British medical bulletin · Jan 1999
ReviewNon-ventilatory treatment of acute hypoxic respiratory failure.
Severe acute hypoxic respiratory failure is uncommon but often fatal. Standard treatment involves high inspired oxygen concentrations, mechanical ventilation and positive end-expiratory pressure. Many other interventions have been used in parallel with conventional treatment or as rescue therapy when it fails, including extracorporeal gas exchange, prone positioning, inhaled vasodilators, exogenous surfactants and drugs which modify the inflammatory process. ⋯ Randomised controlled trials are, therefore, needed to assess the effects of these treatments on mortality. In such trials, extracorporeal oxygenation and extracorporeal carbon dioxide elimination, surfactant, early methylprednisolone, and prostaglandin E1 offer no survival advantage over conventional therapy. Prophylactic ketoconazole and pentoxifylline appear to improve mortality in small studies in surgical and oncology patients respectively, and methylprednisolone improves mortality and morbidity in unresolving disease.
-
British medical bulletin · Jan 1999
ReviewThe role of micronutrients in psychomotor and cognitive development.
The literature on the effects of micronutrients on cognitive, motor and behavioural development is reviewed focusing mainly on children. Iron, zinc, iodine and vitamins are discussed. The review is selective and concentrates on the more recent work and areas of controversy. There are well established associations with poor development and iron and iodine deficiency but the deficiencies usually occur in disadvantaged circumstances and establishing causal relationships is difficult.
-
British medical bulletin · Jan 1999
ReviewFolic acid deficiency and cancer: mechanisms of DNA instability.
Folic acid deficiency in humans has been linked with megaloblastic anaemia, neural tube defects in the neonate, and heart disease. Folate has also been implicated in the development of cancer, especially cancer of the colorectum. There appear to be two principal mechanisms through which low folate status may increase the risk of malignancy. ⋯ Folate deficiency may cause an imbalance in DNA precursors, uracil misincorporation into DNA, and chromosome breakage. This chapter briefly describes the epidemiological data supporting the involvement of folic acid in the aetiology of cancer. It also assesses the evidence from cellular, animal and human studies that folic acid can modulate DNA by such mechanisms.
-
Sedation is a process of soothing. The concept of the ideal level of sedation is controversial and has changed over the last decade. ⋯ This change in attitude has been brought about by sophisticated modes of ventilation allowing the ventilator to synchronize with the patient's own breathing pattern. In addition, the increasingly recognised adverse effects of over-sedation have contributed to the reduction in the depth of sedation.