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Biomedical subjects

A W Lambert

Publications and source records attributed to A W Lambert.

At least 19 recordsLinked to original sources
PubMed2004

Damage control laparotomy.

BACKGROUND: Damage Control Surgery (DCS) is well established in the management of trauma. This study assessed the results of DCS in the management of critically ill patients who had not had trauma. METHODS: This was a prospective series of patients treated by DCS. The Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) and Portsmouth predictor equation (P-POSSUM) were used to predict the risk of death, which was compared with the observed mortality rate. RESULTS: Fourteen patients were studied. Nine had sepsis from gastrointestinal perforation. Eight of these underwent bowel resection without anastomosis or stoma formation at the initial laparotomy. Six patients later underwent bowel anastomosis and two had an end stoma formed at second laparotomy. A further three patients had a ruptured aortic aneurysm, one had a reactionary haemorrhage after elective aortic surgery, and one had a retroperitoneal bleed; all required haemostatic packing that was removed at second laparotomy. Mortality rates predicted by POSSUM and P-POSSUM scoring were 64.5 and 49.6 per cent respectively. One patient (7.1 per cent) died after operation, giving an observed mortality rate significantly lower than predicted (P = 0.002 and P = 0.038 versus values predicted by POSSUM and P-POSSUM, respectively). CONCLUSION: The use of DCS in the treatment of critically ill patients resulted in a lower mortality rate than that predicted by POSSUM or P-POSSUM. DCS should not be restricted to trauma.

Adult↗
PubMed2004

Improving risk disclosure during the consent process.

OBJECTIVES: To provide guidance about the risks which should be disclosed to patients and documented during the consent process. METHODS: The Delphi Consensus Technique was used to decide what constitutes mandatory risk disclosure for three index procedures. Documentation of risk on consent forms was audited and compared to these locally agreed standards. A four stage strategy for change was undertaken following which practice was reviewed. RESULTS: Mean mandatory risk documentation rose from 61.2% (95% CI: 58.1-64.4) pre-intervention, to 78.1% (95% CI: 72.6-83.6) post-intervention (ccc2; P < 0.001). CONCLUSIONS: Although we demonstrated some benefit from this simple approach, the need for pragmatic means of achieving and sustaining complete discussion and documentation of risks across all surgical interventions based on universally accepted standards remains.

Humans↗
PubMed2003

A randomised trial of knife versus diathermy in pilonidal disease.

BACKGROUND: Pilonidal disease is a common debilitating condition. This prospective randomised study compared excision of pilonidal disease with a scalpel or diathermy with respect to operation time, postoperative pain, functional recovery and wound healing. PATIENTS AND METHODS: Patients undergoing surgery for pilonidal disease were randomised to excision by scalpel (group 1) or diathermy (group 2). Patients received regular peri-operative oral analgesia and a standardised general anaesthetic technique. Duration of operation was recorded. Following surgery, pain, analgesic requirements, sedation, nausea and vomiting scores and time to mobilise and time to complete healing were compared. RESULTS: Statistical significance between groups was obtained for five outcomes after 32 patients had been recruited; of these, 81% were admitted as emergencies with an abscess. The duration of surgery in group 2 was significantly less, postoperative pain scores and morphine requirements were lower and mobility was regained sooner. CONCLUSIONS: We advocate the use of diathermy needle rather than scalpel blade when undertaking excision of pilonidal disease in both acute and chronic patients.

Adolescent↗
PubMed2001

Mesh hiatal reinforcement in Nissen fundoplication.

Persistent or recurrent gastro-oesophageal reflux (GOR) following Nissen fundoplication occurs in up to one in five cases, especially if the child is neurologically impaired. We advocate the use of mesh hiatal reinforcement for patients undergoing reoperation for GOR or if the diaphragmatic crura are thought to require reinforcement at the time of the original surgery.

Child, Preschool↗
PubMed2001

Randomized clinical trial of intravenous fluid replacement during bowel preparation for surgery.

BACKGROUND: Bowel preparation using purgatives has previously been shown significantly to increase haemoglobin concentration and decrease weight. This prospective randomized study assessed the effects of administering intravenous fluid during bowel preparation. METHODS: Patients having bowel preparation with Picolax for colonic procedures were randomized prospectively to receive no intravenous fluid (group 1) or calculated intravenous crystalloid based on body-weight (group 2) during preparation. Physiological, haematological and biochemical variables were measured before and after bowel preparation. RESULTS: Forty-one patients were recruited with a median age of 69 (range 29-86) years, 22 in group 1 and 19 in group 2. There was no difference between groups in any of the variables measured before bowel preparation. On completion, there was a significant difference between groups in mean weight loss (P = 0.01), postural change in systolic pressure (P = 0.015) and serum creatinine concentration (P = 0.008). In addition there was a significant fall in erect blood pressure after bowel preparation in group 1 (P = 0.02). The mean urine output in group 1 was 982 ml and in group 2 was 1808 ml (P = 0.004). The faeces weight between groups was not significantly different. CONCLUSION: Picolax bowel preparation has a significant dehydrating effect, which can be minimized by administering a simultaneous volume of intravenous fluid (mean 2 litres in this study).

Adult↗
PubMed2001

A case of fatal tumor embolus following trauma in a patient with undiagnosed Wilms' tumor.

Involvement of the inferior vena cava with tumor thrombus has been reported in 5 to 10% of patients with Wilms' tumor. Preoperative imaging usually alerts the surgeon to the extent of the intravascular extension. We present a case report of trauma to a previously undiagnosed Wilms' tumor that resulted in a fatal intraoperative pulmonary tumor embolus.

Accidental Falls↗
PubMed2001

Correlation between psychometric test scores and learning tying of surgical reef knots.

We have investigated the correlation between the scores attained on a computerised psychometric test, measuring psychomotor aptitude and learning tying of a surgical reef knot. Fifteen surgical trainees performed a test of psychomotor aptitude (ADTRACK 2) from the MICROPAT testing system. They then performed a simple test of their ability to tie a surgical reef knot and were assessed by a panel of experts prior to embarking on a standardised course of instruction and practice session. The knot-tying test was repeated at the end of the day and the differences in average scores recorded. There was a significant correlation between the means of the differences in knot tying scores and ADTRACK 2 scores (r = -0.533, P < 0.05). Psychomotor abilities appear to be determinants of trainees' initial proficiency in learning to tie a surgical reef knot.

Adult↗
PubMed2000

Vagus nerve stimulation: quality control in thyroid and parathyroid surgery.

This paper describes the use of the Neurosign 100 Nerve Monitor and vagus nerve stimulation in the identification and assessment of the integrity of the recurrent laryngeal nerve (RLN) during thyroid and parathyroid surgery. Vocal fold function was assessed pre- and post-operatively in all patients undergoing thyroid and parathyroid surgery. The nerve monitor, used in association with endotracheal electrodes, was used to confirm correct RLN identification and demonstrate its integrity at the completion of surgery. There were 21 unilateral and 19 bilateral neck explorations. In these 40 patients, 57 of 59 RLNs were identified. The nerve monitor demonstrated RLN continuity in all but one case (equipment failure: electrode misplacement) after initial identification. Vagus nerve stimulation was performed in 21 patients without adverse sequelae. Damage to the RLN was identified in one of these patients, in whom direct RLN stimulation close to the larynx had failed to indicate discontinuity. Post-operatively this patient had a transient unilateral vocal fold palsy. The use of the Neurosign 100 Nerve Monitor is no substitute for meticulous surgery. Stimulation of the vagus nerve may be a more sensitive means of assessing RLN integrity during thyroid and parathyroid surgery than stimulation of the RLN itself. Confirmation of RLN integrity allows the surgeon to proceed with confidence to the contralateral side of the neck during hazardous bilateral explorations.

Adolescent↗
PubMed2000

Analgesic requirements for appendicectomy: the differences between adults and children.

AIM: The analgesia provided for children is often less than for adults with the same underlying pathology. This paper attempts to quantify the postoperative analgesic requirements of patients undergoing appendicectomy. METHODS: Patients between 6 and 30 years of age who underwent an unscheduled appendicectomy were prospectively recruited. Regular non-opiate analgesia, calculated according to weight, was administered. Hourly visual analogue pain scores and morphine patient controlled analgesia (mPCA) usage were recorded for 24 h following surgery. RESULTS: 19 children (6-16 years) and 23 adults (17-30 years) were recruited. There was no significant difference in the pain scores following appendicectomy between the two groups. Significantly more mPCA was demanded (t = 2.02, P < 0.02) and morphine received (t = 2.02, P < 0.005) by adults than children following appendicectomy. CONCLUSION: Children appear to require and do demand less analgesia than adults following appendicectomy to maintain similar postoperative pain scores. Acceptable pain scores may be achieved by the administration of regular analgesia to these patients.

Adolescent↗
PubMed1999

Experience with heparin-bonded collagen-coated grafts for infrainguinal bypass.

The perfect conduit for infrainguinal reconstructive surgery does not exist. When autologous vein is not available, then a prosthetic graft must be used. The use of a heparin-bonded graft has the theoretical advantage of reducing smooth muscle cell proliferation and thrombus formation, thereby reducing occlusion rates. The application of a collagen layer to the external surface of the graft serves to reduce transfabric haemorrhage. Forty-six patients underwent 47 infrainguinal reconstructions using heparin-bonded collagen-coated Dacron grafts over a 4-year period. Twenty grafts were for disabling claudication and 27 for critical ischaemia. Twenty-two grafts were to the above knee popliteal artery (47%), 10 to the below knee popliteal (21%) and 15 to one of the crural vessels (32%). There was a cumulative patency at 4 years of 69% for the above knee grafts, and 30-month patency of 58% and 45% for the below knee and crural grafts, respectively. There were three deaths over the study period and eight patients required major amputations.

Aged↗