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Biomedical subjects

A Mannell

Publications and source records attributed to A Mannell.

At least 37 records · Page 2Linked to original sources
PubMed1989

Giant submandibular calculus. A case report.

A case of giant mandibular calculus, 6.5 X 5.5 cm, is presented. The management of this condition is reviewed and an explanation offered for the occurrence of these calculi.

Adult↗
PubMed1989

Parotid tumours in black patients. The Baragwanath Hospital experience, 1981-1986.

Parotid tumours are rare, but their diagnosis and management continue to be a surgical challenge. In a retrospective review of 60 patients over a 6-year period, the value of clinical features in distinguishing malignant from benign parotid tumours was examined. The sex of patients, the consistency, size and site of tumour, smoking, length of history and rate of growth were not helpful in differentiation. However, the association of pain, facial nerve paralysis, skin infiltration and enlarged ipsilateral cervical nodes with a final diagnosis of cancer was significant (P less than 0.005). Fixity of tumour and old age were also significant indicators of malignancy (P less than 0.05). When these symptoms and signs suggestive of malignant disease are associated with a parotid tumour, the patient should be prepared for the possibility of a radical operation. The surgeon should make extra efforts to obtain a histological diagnosis before proceeding to definitive surgery.

Adolescent↗
PubMed1989

Respiratory obstruction after thyroidectomy. A report of 2 cases.

Respiratory obstruction is the principal danger in thyroid surgery and is almost always caused by laryngeal oedema. Two patients who suffered from this complication are presented, and the factors which increase the risk of laryngeal oedema are identified. Prophylactic measures to prevent respiratory obstruction after thyroidectomy are discussed.

Airway Obstruction↗
PubMed1988

Bypass surgery for unresectable oesophageal cancer: early and late results in 124 cases.

The early and late results of bypass surgery in 124 patients with unresectable oesophageal cancer are reported. Patients were grouped according to the extent of disease: group A, tumour localized to the oesophagus where severe pulmonary disease contra-indicated oesophagectomy (n = 9); group B, tumour less than or equal to 10 cm in length with mediastinal invasion (n = 81); group C, tumour greater than 10 cm in length with mediastinal invasion and/or fixed malignant lymph nodes (n = 33). Extent of disease was not recorded in one patient. The operative mortality was 4 per cent but 9 other patients died in hospital (hospital mortality, 11 per cent). Mortality was increased in patients undergoing colon bypass and in those with a large tumour load but these differences failed to reach statistical significance. The most frequent complication was neck sepsis, secondary to leakage from the proximal end of the excluded oesophagus. Eighty-nine per cent of the survivors could eat a normal, unrestricted diet on discharge and eighty-two per cent of survivors had complete and lasting relief from dysphagia. Median survival after bypass was 5 months but survival was significantly improved by radiotherapy to the tumour (P less than 0.001). Gastric bypass with radiotherapy is indicated in patients with extra-oesophageal spread of malignancy and in patients with tumours localized to the oesophagus who are unfit for resection. Bypass surgery may be contra-indicated in patients with a primary tumour greater than 10 cm in length and/or fixed lymph node metastases because mortality is increased and survival after operation is short.

Adult↗
PubMed1988

Surgical management of chronic pancreatitis: long-term results in 141 patients.

The management of pancreatic pain is a controversial subject and the treatment recommended varies from one extreme to the other. Some authorities advise simply waiting for chronic pancreatitis to 'burn out', while others practise removal of the entire gland. In this paper we present 141 patients who underwent surgery for chronic pancreatitis at the Mayo Clinic. The main indication for operation was pancreatic pain and the choice of operation was based on anatomical abnormalities in the gland. The long-term results of the policy are reviewed (mean follow-up 8.5 years). Length of history, aetiology of disease, pancreatic dysfunction and pathology, time after operation and continued alcohol abuse were computer analysed for a statistically significant influence on pain relief, ability to work, pancreatic function and survival. There was one operative death (mortality rate 0.7 per cent). Continued drinking was not shown to affect postoperative pain relief but 10-year survival was significantly less in alcoholics than in those with non-alcoholic pancreatitis (P less than 0.02). Dilated ducts and duct calculi were associated with good results for pain relief although this association did not achieve statistical significance. Parenchymal calcification and time after operation did not influence the results of surgery. When the operation failed to relieve pain, spontaneous remission occurred in a few cases only. Seventy-seven per cent of patients had lasting relief of pain and operations selected on the basis of gross pathology were equally effective in relieving pain. Longitudinal pancreaticojejunostomy in those with dilated ducts and a Whipple operation for disease of the pancreatic head gave good results.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1987

Pancreaticoduodenectomy for pancreatic trauma. A case report.

Pancreatic trauma is uncommon and severe, combined pancreaticoduodenal injuries are rare. Different surgical techniques for the management of these injuries have been used. In this article a case of severe pancreaticoduodenal injury which required pancreaticoduodenectomy is reported. This case is unusual because there was no history of trauma, the serum amylase level and abdominal radiograph were normal and the abdominal findings on admission to hospital were minimal. A system of grading pancreatic trauma in terms of severity is advocated and the management of pancreaticoduodenal injuries is discussed.

Adult↗
PubMed1986

Axillary intercostal drain in traumatic haemopneumothorax.

During an 8-month period, 242 patients with thoracic injuries were admitted to one of the general surgical units at Baragwanath Hospital. Of these, 7.4% required surgical exploration, while 92.6% had pneumothorax treated conservatively by insertion of a single drain at the mid-axillary line in the 5th intercostal space. Of patients managed conservatively 76 had pneumothorax and 148 haemopneumothorax. There were no deaths in this series. All patients explored recovered well from the operation and were discharged after a mean period of 6 days. Of those with a pneumothorax managed conservatively full expansion of the lung was obtained in 98.7%. In 80% of the patients with haemopneumothorax, axillary intercostal drainage proved adequate treatment and resulted in prompt re-expansion of the lung. However, 6.8% of the patients in this group required further needle aspiration of the pleural cavity and in 2.7% a second drain was inserted for evacuation of residual blood. Eight (5.4%) patients were discharged with a small and insignificant residual haemothorax.

Adult↗
PubMed1986

Factors influencing survival after resection for ductal adenocarcinoma of the pancreas.

Twenty-three patients with pancreatic cancer who survived greater than or equal to 3 years after surgical treatment and 56 who survived less than 12 months were studied. The association of steatorrhea with long survival was significant (p less than 0.05), and the association of back pain with short survival showed a trend toward significance (p = 0.06). Other presenting symptoms, as well as the age, sex, or past medical history of the patients; the gross morphology of the tumor and regional lymph nodes; the operations performed; and the use of postoperative adjuvant therapy had no significant influence on survival. Certain histopathologic characteristics of the resected specimens were significantly associated (p less than 0.05) with a poor prognosis: malignant infiltration of the pancreatic capsule, proximity of the tumor to lymphatic and blood vessels, a round-cell infiltrate at the tumor margin, and epithelial atypia in the uninvolved pancreatic ducts. The association of Broders' grades 3 and 4 in the primary tumor and metastases to lymph nodes showed a trend toward significance with short survival. Multivariate analysis confirmed that the associations of Broders' grades 3 and 4 in the primary tumor, a round-cell infiltrate at the tumor margin, and atypia of the pancreatic ductal epithelium with short survival were statistically significant.

Aged↗
PubMed1986

Oesophagectomy: the lessons learnt from 128 cases.

The mortality and morbidity of oesophagectomy are examined in this retrospective review of 128 patients with benign and malignant oesophageal disease. There were 11 deaths in hospital. The operative mortality was not influenced by age, sex, or the approach to oesophagectomy, but was significantly greater in patients given chemoradiation therapy before surgery. Complications were frequent in the early postoperative period and some were due to avoidable errors in technique or selection of operative approach. Follow-up was complete in over 90% of survivors. Late complications included aspiration pneumonia secondary to gastric stasis following total oesophagectomy and anastomotic recurrence after the one-stage procedure of gastro-oesophagectomy. When the whole stomach is used to replace the oesophagus a pyloroplasty is advised. The one-stage operation is not recommended for squamous cancer of the distal oesophagus and adenocarcinoma of the cardia.

Adult↗
PubMed1985

Kaposi's sarcoma of the oral cavity. A case report.

A case of Kaposi's sarcoma of the oral cavity in a 54-year-old black man is reported. The possible association with acquired immune deficiency syndrome is emphasized and the diagnosis, treatment and prognosis of oral Kaposi's sarcoma are discussed.

Cheek↗