I gave a talk yesterday on congenital diaphragmatic hernia to an audience in the Royal Alexandra Hospital in Brighton. The meeting was to discuss the possibilities of restarting a paediatric surgical service for neonates with this problem, as paediatric surgical and neonatal services have recently both started operating on the same site.

I wrote a little while ago about the UK Medical Careers Research Group survey of 1999 medical school graduates, and how I had answered (most of) the questions. I also mentioned that I'd been taking part in it for the past however many years - well, we've been surveyed a number of times. Now - revelation! - I was tidying up just the other day and came across the form from 2004-05. So I guess I didn't send it in. Is it now too late? Anyway, some of it I'd filled in, other bits are obvious, so I've included it below...

Introduction

I received this survey in the mail today - "Calling all 1999 Graduates" - it said. I've taken part (kind of: I can't remember returning all the forms) in the past surveys, and this is the most recent one to come out. I guess in part that I have always been ambiguous about the responses: it's very hard to know how to reply to a single-response questionnaire, when really you (one) wants to put several choices, and justify them.... Anyway, am filling in the current one and, as usual, there's not enough space, so thought I'd put additional comments on here.

Found a good site whilst looking on the web for echo resources - it's based at Yale University in the states and has an atlas of different images, along with explanations:

Yale Echo library

This is a copy of a talk that I gave on oxygen delivery on ECMO to some of the nurses and junior doctors at the hospital where I am working. As ever, it was designed using Open Office although I've also provided some micro$oft powerpoint versions. These, as before, are likely to have some problems with formatting, although content is the same. For the "commercial break," I played some videos that I found on a site called ... ahh, well I can't remember the site at the moment.

Paediatric heart transplantation is an evolving science. Currently, I've been working at one of the two cardiac transplant centres in the UK and we have not infrequently debated the resource implications of mechanical support to transplantation, the availability of paediatric heart donors and the needs of the recipients. The ethical questions are often huge with the timely availability of organs not matching the presentation times of our patients. Various interventions can be used to "buy time" from relatively conservative, non-invasive treatments such as elective ventilation, paralysis and cooling (to reduce the metabolic needs of the body) through the use of extra-corporeal membrane oxygenation (ECMO) to the use of ventricular support devices such as the Excor Paediatric system developed by the Berlin Heart Group.

Protein C is involved in the regulation of the clotting cascade. Normally, it inactivates factor Va and factor VIIIa, causing them to be degraded.

Protein C deficiency occurs in 0.2% of the population, with one in a thousand havign a thrombotic effect each year.

more info: http://www.med.uiuc.edu/hematology/PtProtC.htm

Methicillin Resistant Staphylococcus Aureus (MRSA) is a bug that is resistant to many antibiotics and has been the star of many headlines within the British press, becoming known as a "super bug." Within the UK, MRSA has predominantly been a hospital-acquired infection, although with increasing frequency over the past 10-15 years. By contrast, in North America, I have heard anecdotally of a number of cases of community-acquired MRSA infections - these are usually more severe and have a poorer outcome.

Our local experience with MRSA infection in patients on ECMO was the basis for this poster that was prepared for the ECMO conference in Colorado earlier this year. It sparked a number of interesting discussions between attendants; perhaps, to me, the most interesting revelation being the differing epidemiology between continents. I was also struck by the importance of microbiological consultation with the ICU - we have an extremely involved team who round daily and provide a 24-hour specialist service for our children. Combined with strict protocols for nursing and interventions, we have experienced an extremely low rate of MRSA infection.

I posted up some information from a previous website: http://travelsoforion.net/medicalnotes/FOAD2003/contents.html

Paediatric hypertension is probably under-recognised due to the fact that it is primarily considered as being an illness of the elderly and a risk factor for strokes. The same is true for children - and, often, the consequences can be even more devestating with a one off catastrophic event leaving permanent disability which lasts many, many years (as opposed to stroke in the elderly which is frequently part of an ongoing illness and usually occurs near the end of life).

Thus, it is important to know what the "normal" values are for paediatric blood pressure.

http://www.emedicine.com/ped/topic1097.htm