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Biomedical subjects

C J O'Brien

Publications and source records attributed to C J O'Brien.

At least 109 records · Page 6Linked to original sources
PubMed1986

Surgical treatment of bullous emphysema.

Between 1974 and 1981, 20 patients had surgical treatment for bullous emphysema. There were 15 males and five females with a mean age of 40 years. The majority of patients had symptomatic respiratory disease, were smokers and had a past history of lung disease. In all cases bullae were visible on chest X-ray, the primary diagnostic investigation, and simple spirometry was used to assess lung function pre- and postoperatively. Cyst resection was performed in 14 cases (two bi-laterally) and pleurodesis was added in six of these cases. Lobectomy was performed in four patients and in two a pedunculated cyst was simply ligated and excised. There were no deaths and morbidity was acceptably low. Vital capacity (VC), Forced expiratory volume in 1 s (FEV1) and FEV1:VC ratio were all significantly improved with surgery though the correlation of subjective and objective results was variable. Surgery is appropriate for symptomatic patients with bullae visible on chest X-ray and asymptomatic patients with rapidly enlarging bullae occupying more than 30% of a hemithorax.

Adolescent↗
PubMed1986

Prognostic implications of perineural spread in squamous carcinomas of the head and neck.

The occurrence and prognostic implications of perineural spread were examined in 239 patients with mucosal squamous carcinomas of the head and neck. Perineural spread was demonstrated in resections from 64 patients (27%), the majority having primary tumors at one of three sites: buccal cavity, larynx, and pharynx. Perineural spread near nodal metastases was uncommon. There was no evidence that perineural involvement was more commonly associated with large tumors or less differentiated ones. No association was established between perineural spread and coexistent lymph node deposits in the surgical resections. Perineural spread was, however, shown to be a statistically significant prognostic factor for an increased incidence of subsequent locoregional recurrence and for decreased survival.

Adult↗
PubMed1985

Transcapsular spread of metastatic squamous cell carcinoma from cervical lymph nodes.

The incidence, extent, and selected clinicopathologic correlations of transcapsular spread from metastatic tumor in the cervical lymph nodes have been investigated in 210 specimens obtained by radical neck dissection from 203 patients with squamous cell carcinomas of the head and neck. Transcapsular spread was detected in 137 of 159 (86 percent) positive specimens, and classified as macroscopic in 74 (54 percent) and microscopic in 63 (46 percent). Macroscopic transcapsular spread was seen most frequently in association with large nodal masses more than 3 cm in diameter (48 of 70 specimens, 69 percent), but also occurred in some specimens with smaller lymph nodes less than 3 cm in diameter (26 of 67 specimens, 39 percent). Anatomic structures most commonly invaded in areas of neck dissection with macroscopic spread from nodal metastases were skeletal muscle (39 dissections) and the adventitial coat of the internal jugular vein (27 dissections). Macroscopic transcapsular infiltration was associated with a high incidence (44 percent) of recurrent tumor in the ipsilateral neck, particularly within 12 months of surgery. Microscopic transcapsular growth was associated with a lower incidence (25 percent) of recurrent tumor in the ipsilateral neck but the difference did not reach statistical significance. Similar recurrence figures (32 percent) were found in the minority of patients whose nodal disease was intracapsular at the time of neck dissection. More precise definition of the morphologic extent of transcapsular spread could be important in clarifying its clinicopathologic correlations.

Adult↗
PubMed1985

Long-term follow up of experimental microvascular grafts using Doppler ultrasound.

Non-directional Doppler ultrasound was used to determine patency in prosthetic microvascular grafts in 30 rats over 24 weeks. Examinations were carried out every two weeks and exploration and arteriography were used at intervals during the study to confirm the Doppler findings. Two rats died and were excluded from the study. Twenty-six grafts were patent at the time of examination and these were correctly assessed by the Doppler technique. However, only one of two occluded grafts was correctly identified. Our results suggest that while this technique is sensitive, its specificity is low, and graft exploration may still be required to confirm patency. Doppler ultrasound may prove a useful non-invasive tool for long-term follow-up of experimental microvascular grafts if the false positive rate can be reduced by improved technique and further experience.

Animals↗
PubMed1985

Experimental microvascular polytetrafluoroethylene grafts: 6-month patency.

The efficacy of 1-mm internal-diameter polytetrafluoroethylene as a microvascular prosthesis is unclear. In this study, 8-mm-long segments of this material were implanted into the femoral arteries of 30 rats. Animals were examined every 2 weeks up to 6 months by Doppler ultrasound. Cumulative patency by the life-table method was 86.7 percent at 6 months. There were 26 patent grafts, 2 occlusions, and 2 deaths. Intimal hyperplasia adjacent to the anastomoses was seen in the native arteries. The pseudointima lining the grafts was cellular near the anastomoses but usually acellular in midgraft regions. It is concluded that if early failure does not occur, then good long-term patency is possible with 1-mm polytetrafluoroethylene in this setting and that patency is not dependent on development of a cellular pseudointima. Longer graft segments should be evaluated in future studies.

Actuarial Analysis↗
PubMed1985

Concurrent T-cell lymphocytic lymphoma and malignant histiocytosis.

A case in which both malignant histiocytosis and T-cell lymphocytic lymphoma occurred together is presented. Examples of malignant histiocytosis-like syndromes associated with lymphoreticular malignancies have been previously reported. Many of these represent reactive haemophagocytic syndromes, probably virally induced. The considerable degree of cytological atypia and frequent mitotic figures seen in the histiocytes in this case were indicative of a true malignant histiocytosis.

Adult↗
PubMed1985

Should polytetrafluoroethylene grafts be used in preference to saphenous vein for femoropopliteal arterial bypass?

Some surgeons have advocated using polytetrafluoroethylene (PTFE) as the graft material of choice for femoropopliteal arterial bypass so that the saphenous vein could be preserved for future cardiovascular surgery. We have examined our results to see if this approach could be justified in our patient population. PTFE was used for 101 femoropopliteal reconstructions in 96 patients (56 male and 40 female). Thirty-eight (40%) complained of debilitating claudication and 58 (60%) had limb-threatening ischaemia. There were 83 primary PTFE femoropopliteal reconstructions and 18 repetitive procedures after failure of an earlier ipsilateral bypass. Twenty-nine of the 101 PTFE grafts were anastomosed distally to the popliteal artery above knee and the remaining 72 below knee. At 5 years, the cumulative patency for all grafts was only 11%. The 4 year cumulative patency was better for claudicants (40%) than for those with threatened limb loss (11%) but two of the 38 claudicants required amputation when their grafts failed. Patency rates were not significantly affected by the site of the distal anastomosis or by a previous failed ipsilateral femoropopliteal bypass. Worthwhile limb salvage was achieved only by frequent re-operation. Our results with PTFE are not good enough to use it in preference to an adequate saphenous vein for femoropopliteal bypass.

Aged↗
PubMed1984

Shoulder girdle resection for giant basal cell carcinoma.

Forequarter amputation may seem the only surgical option when a tumour of the scapula or its overlying soft tissues invades the bones of the shoulder joint. As illustrated in this case of giant basal cell carcinoma, shoulder girdle (Tikhor-Linberg) resection is occasionally, possible, thus preserving a functional arm.

Bone Neoplasms↗
PubMed1984

Doppler ultrasound in the evaluation of experimental microvascular grafts.

A study was made to evaluate the accuracy of Doppler ultrasound in assessing patency in experimental microvascular grafts in rats. In 20 animals, pre-operative assessment produced a phasic wave form and audio signal consistent with arterial flow when the Doppler probe was placed over the groin crease. Ten animals then had a sham operation exposing the femoral vessels through a groin crease incision. The remaining 10 had a 10 mm segment of femoral artery excised to simulate an occluded graft. These animals were re-assessed 18 to 20 days later and the wave form and audio signal of arterial flow were detectable in the sham operated animals with the probe placed below the groin incision. No signal was elicited at this site in the animals whose femoral arteries had been excised. When these principles were applied to 20 rats with microvenous grafts and 20 with 1 mm PTFE grafts in the femoral artery we predicted graft patency with 100% accuracy. This non-invasive technique is inexpensive and highly accurate.

Animals↗
PubMed1984

One millimetre polytetrafluoroethylene (Gore-Tex) as a microvascular prosthesis: technique and early patency.

We have described a technique for grafting 1 mm internal diameter polytetrafluoroethylene (Gore-Tex) to the rat femoral artery. By spatulating the ends of the recipient artery and completing the proximal anastomosis before commencing the distal one, gentle and accurate suture placement is assured. At a mean of 40 days postoperatively (range 35-42 days) 16 of 20 Gore-Tex grafts (80%) were patent compared with 17 of 20 autogenous femoral vein grafts (85%). Examination of the prosthetic grafts by light microscopy and scanning electron microscopy showed incomplete development of a cellular lining and some areas of neo-intimal hyperplasia. One millimetre Gore-Tex provides excellent early patency as a microvascular graft in this experimental setting but long term patency is still undetermined.

Animals↗
PubMed1983

Massive retroperitoneal lymphadenopathy as a terminal event in hairy cell leukaemia.

A case of hairy cell leukaemia complicated as a terminal event by massive retroperitoneal lymphadenopathy is described. The patient had recently been treated with lithium carbonate and had previously been demonstrated to suffer from a systemic vasculitis, either or both of which may have contributed to the development of this rare complication.

Adult↗
PubMed1983

Proximal aortic cross clamping during non-aortic surgery.

Temporary control of the aorta at the level of the diaphragm above the origins of the major visceral arteries is of proven value in the management of complex aortic disease including ruptured aneurysm, 're-do' aortic surgery and for aortic trauma. The value of the technique in elective non-aortic surgery is less well known. Two patients, one with a massive leiomyosarcoma of the stomach and the other with blood loss complicating a distal splenorenal shunt, are described in which proximal aortic control was of use.

Adult↗
PubMed1983

Coeliac disease, adenocarcinoma of jejunum and in situ squamous carcinoma of oesophagus.

The development of both adenocarcinoma of the jejunum and in situ squamous carcinoma of the oesophagus in an adult coeliac patient is described. Good evidence that adenocarcinoma of jejunum occurs more frequently in patients with coeliac disease has recently become available though this association has been suggested for some time. While oesophageal carcinoma has long been associated with coeliac disease, in situ carcinoma of oesophagus has not been previously described in these circumstances. We feel that the risk of this complication, as calculated from published series, warrants a screening programme for oesophageal malignancy in adult coeliacs.

Adenocarcinoma↗
PubMedDate not supplied

Videofluoroscopy of the pharyngoesophageal segment during tracheoesophageal and esophageal speech.

The purpose of this preliminary investigation was to identify the location and length of the pharyngoesophageal (PE) segment during esophageal and tracheoesophageal (TE) speech among laryngectomees who were proficient in both methods of vocalization. Four patients who had undergone total laryngectomy and tracheoesophageal puncture served as subjects. Voice recordings were obtained and played to listeners of varying experience with laryngectomees. Videofluoroscopy was performed while the patients sustained "ah" in both modes of speech. Results of these analyses revealed that TE speech was rated as more effective than esophageal speech in all 4 subjects. However, only minimal differences were found in the length and the location of the PE segment during TE and esophageal speech when within subject comparisons were made. This study is the first to compare the physical characteristics of the PE segment during esophageal speech and TE speech as produced by the same speaker.

Aged↗
PubMedDate not supplied

Surgical management of chronic parotitis.

A series of 17 consecutive parotidectomies for chronic sialoadenitis is presented. This comprises 10% of all parotidectomies performed by one surgeon over the 5-year period between 1987 and 1991. In 16 patients, symptoms were relieved by surgery. The extent of surgery was guided by the clinical findings. In this series, near total and superficial parotidectomy were equally efficacious and no patient suffered permanent facial nerve dysfunction. Surgery is a safe and effective treatment for parotitis.

Adult↗
PubMedDate not supplied

Radical, modified, and selective neck dissection for cutaneous malignant melanoma.

BACKGROUND: The roles of modified and selective neck dissections in treating patients with clinical metastatic melanoma and the place of adjuvant radiotherapy are unclear. In the elective setting, the efficacy of various selective dissections also requires clarification. METHODS: The prospectively documented experience of the senior author (COB) was analyzed. A total of 175 patients had 183 neck dissections and 92 parotidectomies in 6 years. There were 75 therapeutic and 108 elective operations. Modified or selective neck dissections were performed in 58% of patients with clinical neck metastases. Ali but two elective operations were modified or selective dissections. Postoperative radiotherapy was given to 27 dissected necks. Minimum follow-up was 12 months, and 86% of patients were followed up for 2 years or to neck recurrence. RESULTS: Nodes were histologically positive in 80 dissections. The cumulative rate of control of metastatic melanoma in the neck was 86% at 5 years. Neck recurrence developed in 14% of radical dissections, 0% of modified, and 23% of selective dissections performed for clinical disease. Neck recurrence occurred after 5% of elective dissections. Recurrence was 7% among irradiated necks compared to 23% in nonirradiated (p-value not significant). The 5-year survival rate was 50%, and this was significantly worsened by increasing node involvement. CONCLUSIONS: Modified radical neck dissection is highly effective in controlling metastatic melanoma in selected patients. Selective dissections are less effective and need further study. Adjuvant radiotherapy appears to decrease the risk of neck recurrence. In the elective setting, recurrence is uncommon following the selective neck dissections described.

Adolescent↗
PubMedDate not supplied

Invasion of the mandible by squamous carcinomas of the oral cavity and oropharynx.

The radiologic and histologic features of mandibular invasion, and its clinical implications, are considered in a retrospective series of 111 patients with squamous carcinomas of the oral cavity and oropharynx treated by composite resection. Eighty percent of the entire group had either recurrent or advanced (T3, T4) local disease, and 33 patients (30%) had histologic evidence of mandibular invasion by tumor. Preoperative radiologic assessment was unreliable in cases in which infiltrating tumor was confined to the periosteum and superficial cortex-44% false negatives. The extent of bone invasion was found to correlate with the size of the tumor, but not with its histologic grade. The mandibular periosteum was not seen as a morphologically discrete "barrier" and infiltration occurred at various points along the mandibular body, mainly related to the course of the inferior dental canal. The gross and microscopic patterns of bone invasion appeared to be similar in irradiated and nonirradiated resections. The incidence and pattern of recurrent disease following composite resection was the same in the groups with and without mandibular invasion: in each group half the patients were dead from disease and one third alive and free of disease at 2 years. Mandibular invasion alone did not appear to influence prognosis in this series.

Adult↗