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Biomedical subjects

B M Smithers

Publications and source records attributed to B M Smithers.

47 records · Page 3Linked to original sources
PubMed1990

Desmoplastic, neural transforming and neurotropic melanoma: a review of 45 cases.

An analysis of the clinicopathological features of 45 cases of desmoplastic, neural transforming and neurotropic melanoma assessed by a single pathologist are reported. The age range of 27 males and 18 females was 17-88 years. Twenty primary lesions (44%) were on the head and neck and fourteen (31%) were on the trunk. Thirty lesions (67%) were amelanotic. The initial clinical diagnosis was incorrect for 16 patients. Mean thickness was 4.5 mm. Recurrence occurred in 17 patients (38%). Local recurrence has occurred in 12 patients. This was related to a primary where: pathological diagnosis was incorrect; excision was less than 1 cm; the site was on the head and neck; Clarke level was V; and Breslow thickness was greater than 4 mm. Four patients had cranial nerve neuropathies due to recurrent neurotropic melanoma. Four patients are alive with inoperable disease and five have died from disseminated melanoma. These tumours can be difficult to recognize clinically and pathologically, with poor results if not adequately treated primarily. Therefore, the need for surgeons to be aware of this tumour and its clinicopathological features is important. Close follow-up is essential.

Adolescent↗
PubMed1989

Intercostal blockade and pulmonary function after cholecystectomy.

Sixty-six patients undergoing cholecystectomy were randomly allocated to receive either intercostal blockade with bupivacaine supplemented with papaveretum or papaveretum alone for postoperative analgesia. Both groups were similar regarding distribution of sex, age, and weight. These two groups were compared. Patients who did not have intercostal blockade required postoperative analgesia sooner. There was no significant difference, however, in the total consumption of papaveretum. Both groups experienced similar degrees of pain, and there were no differences in postoperative pulmonary function. We conclude that although single intercostal blockade is an effective analgesic, it does not improve pain relief and does not improve pulmonary function after cholecystectomy when compared with a regimen of on-demand, intramuscularly administered papaveretum.

Analgesia↗
PubMed1987

Multiple enteroliths in a chronically obstructed duodenal loop after Roux-en-Y biliary diversion.

A case of chronic mechanical obstruction of the duodenal loop due to stricturing of the enteroenterostomy after diversion following a Polya gastrectomy for bile reflux gastritis is reported. The dilated loop contained several hundred enteroliths. The clinical and chemical evidence strongly supports the view that the enteroliths were formed in the intestinal loop. This complication of Roux-en-Y reconstruction has not previously been recognized.

Anastomosis, Roux-en-Y↗
PubMed1986

Emergency right hemicolectomy in colon carcinoma: a prospective study.

The morbidity and mortality in right hemicolectomy for carcinoma of the colon is examined, with particular attention to the influence of emergency surgery and advanced disease. Of the 244 patients who had surgery, 57 required emergency surgery and 187 elective surgery. The overall mortality was 5.7% with no difference statistically between the elective and emergency groups. Anastomotic complications were significantly greater in the groups undergoing emergency resection and elective palliative surgery when compared with elective curative surgery. All patients with advanced disease had a higher morbidity and mortality, both in elective and emergency surgery. The factors most important in relation to mortality and morbidity were thus advanced disease, advanced age and cardiorespiratory complications. This being the case, it is felt that the present management of emergency right hemicolectomy with anastomosis should continue to be the treatment of choice for obstructing or perforated carcinomas of the right colon.

Age Factors↗
PubMed1983

Actinomycosis of the gall bladder.

This report describes the sixth case of actinomycosis of the gall bladder and discusses the salient features of the diagnosis and management of this rare disease.

Actinomycosis↗
PubMedDate not supplied

Radiation therapy for nodal disease in malignant melanoma.

Radiation therapy has been widely used for palliative management of inoperable metastatic malignant melanoma. For patients with nodal disease, response rates of approximately 70% have been reported. There are limited data concerning the role of adjuvant irradiation following therapeutic lymph node dissection. In this review, 57 patients with isolated resectable and nonresectable nodal disease have been treated with radiation. The overall response rate is 84% for bulky disease. Large fractions are beneficial. The median disease-free survivals were 11 months after adjuvant treatment and 7 months for those with inoperable disease. The median overall survivals were 20 months and 18 months, respectively. Local control in long-term survivors was excellent. Sixty-five percent of patients developed distant metastases. There is a need for additional studies with the use of adjuvant radiation therapy following lymph node dissection.

Adolescent↗
PubMedDate not supplied

Desmoplastic melanoma: patterns of recurrence.

Desmoplastic melanoma is a rare type of malignant melanoma, recognized since 1971. Other variants of desmoplastic melanoma include neural transforming melanoma and neurotropic melanoma. The pathology and clinical features of 58 patients whose tumor had the features of desmoplastic melanoma, neural transforming melanoma, and neurotropic melanoma, either separately or in combination, were examined to assess patterns of recurrent disease. The tumor was situated on the head and neck in 41% of patients and was amelanotic in 71% of patients. There was an associated superficial melanoma in 48% of patients. There was a combination of the 3 histologic patterns, commonly found in the 1 melanoma. Local recurrence occurred in 29% of patients and malignant cranial neuropathies were documented in 4 patients. Nineteen percent of patients have died from disseminated disease. Neurotropic melanomas had a lower incidence of visceral recurrence. Desmoplastic and neural transforming melanomas had similar rates of local and visceral recurrence. When this specific variant of melanoma is compared with larger series of malignant melanoma in general, they appear to be more advanced locally, with a higher incidence of local recurrence. When considered in relation to the thicker nondesmoplastic melanomas, the survival is no worse and may be more favorable. Surgeons should excise the primary tumor and local recurrences with wide margins and adopt close follow-up. On the head and neck, symptoms and signs relating to trigeminal or facial nerve innervation may herald a developing malignant cranial neuropathy.

Adolescent↗