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Biomedical subjects

D M Lloyd

Publications and source records attributed to D M Lloyd.

At least 37 records · Page 2Linked to original sources
PubMed1996

No obvious advantages for thoracoscopic two-stage oesophagectomy.

Thoracoscopically assisted Ivor-Lewis oesophagectomy potentially combines the pulmonary advantages of transhiatal oesophageal dissection, with the visibility and control permitted by thoracotomy. This study reviewed 17 patients who underwent this procedure with an intrathoracic anastomosis. Five patients required conversion to thoracotomy, four because of technical difficulties with the anastomosis. After operation 13 patients had radiological evidence of atelectasis, six developed a left pleural effusion and five had clinically significant pneumonia. Three patients developed an anastomotic leak, two of whom died giving an in-hospital mortality rate of 12 per cent. Median postoperative hospital stay was 12 days. Four patients developed benign anastomotic strictures requiring dilatation. The 1- and 2-year survival rates were 73 per cent (11 of 15 patients) and 63 per cent (five of eight) respectively. The use of minimal access techniques in this context does not appear to reduce the postoperative incidence of either pulmonary or anastomotic complications.

Adenocarcinoma↗
PubMed1996

Hormonal and physiological effects of a 15 hour road journey in sheep: comparison with the responses to loading, handling and penning in the absence of transport.

A controlled study was carried out to investigate the physiological effects of road transport on sheep. Animals (n = 10; body weight 38.9 +/- 1.3 kg), previously with catheters in their jugular veins, were rounded up and loaded onto a vehicle where they were held in a communal pen with eight other lambs. Blood samples were taken at 30 min intervals during the next 15 h while the vehicle remained stationary or was driven a distance of 548 miles (876 km). Measurements were made of plasma concentrations of cortisol, prolactin, creatine phosphokinase and lactase dehydrogenase isozymes and also of plasma osmolality, haematocrit and body weight; heart rate was also recorded in one animal. Loading and the start of driving produced large increases in cortisol and prolactin concentrations. Heart rate also increased whereas osmolality and haematocrit decreased. The major changes in hormone release occurred in the first 3 h period while, during the remaining 12 h, the stimulatory effect of transport was present but small. Body weight loss was similar under both stationary and driven conditions.

Animal Welfare↗
PubMed1995

Laparoscopic Heller's cardiomyotomy without an antireflux procedure.

The treatment of achalasia by laparoscopic Heller's cardiomyotomy may combine the minimally invasive advantages of pneumatic dilatation with the success rate and low risk of perforation of conventional surgery. The requirement for an antireflux procedure remains a contentious issue, as in conventional surgery. Nine patients underwent laparoscopic cardiomyotomy; excellent symptomatic relief was obtained in eight at follow-up between 12 and 21 months after operation. Four of these patients agreed to 24-h pH monitoring and showed no evidence of acid reflux. One patient, however, developed recurrent symptoms associated with significant acidity on monitoring. Laparoscopic Heller's cardiomyotomy without an antireflux procedure produced effective symptomatic relief in this small group of patients.

Adult↗
PubMed1995

Laparoscopic Nissen fundoplication in children.

Laparoscopic surgery for the definitive treatment of gastroesophageal reflux (GOR) has become an accepted alternative to conventional techniques in adults. Although relatively rare, GOR in children represents an important clinical entity with symptoms including failure to thrive, nocturnal dyspnea, and vomiting. This paper details our experience in eight children who have undergone a laparoscopic Nissen fundoplication for failed medical treatment of severe GOR. Particular attention is paid to technical aspects of the procedure and the differences between adult and pediatric techniques are emphasized. The preliminary results suggest that a laparoscopic Nissen fundoplication is a safe procedure which significantly improves reflux symptoms in children and that these results are comparable to those obtained with conventional surgery.

Child↗
PubMed1995

Cyclo-oxygenase mediation of endotoxin-induced fever, anterior and posterior pituitary hormone release, and hypothalamic c-Fos expression in the prepubertal pig.

Prepubertal pigs (n = 8) treated with bacterial endotoxin (20 micrograms lipopolysaccharide; LPS) exhibited a sustained (4 h) hyperthermia, increased plasma concentrations of cortisol, prolactin, growth hormone and vasopressin, but no change in adrenaline or noradrenaline levels was observed. All these effects were prevented or attenuated when the animals were pretreated intravenously with the cyclo-oxygenase inhibitor indomethacin (IND; 2 mg/kg). Similarly, in pigs (n = 3 per treatment) given IND, LPS or IND + LPS, parallel changes in the neuronal expression of c-Fos were observed in hypothalamic regions concerned with thermoregulation, neurohypophysial secretion, and the control of pituitary-adrenocortical function. The stimulatory action of LPS in the median preoptic, supraoptic and paraventricular nuclei was prevented by IND, whereas IND given alone was without effect. These findings suggest that inducible cyclo-oxygenase pathways are responsible for the febrile and neuroendocrine effects of endotoxin in this species.

Animals↗
PubMed1995

Factors predicting outcome after selective ERCP in the laparoscopic era.

This study assessed the outcome of 342 patients with in situ gallbladders undergoing ERCP for suspected choledocholithiasis. The result of ERCP was found to play a significant role (P < 0.0001) in determining whether patients were subsequently managed conservatively (n = 152) or underwent either laparoscopic (n = 110) or open (n = 80) surgery. Those undergoing laparoscopic surgery were noted to be younger (P = 0.0001) and were less likely to be jaundiced (P = 0.0015) or have CBD stones at ERCP (P = 0.0295). In 28 patients with CBD stones remaining after ERCP, pre- rather than postoperative timing of ERCP prevented a potential second operation. The current success rate of 85% in clearing CBD stones at ERCP cannot support a routine policy of intraoperative cholangiography followed by postoperative ERCP.

Adolescent↗
PubMed1994

Thoracoscopic oesophago-gastrectomy--a new technique for intra-thoracic stapling.

A new technique for performing a standard Ivor Lewis oesophagectomy avoiding the need for a conventional right thoracotomy is described. The intrathoracic dissection and the intrathoracic anastomosis, using a conventional EEA circular staple-gun, is done thoracoscopically. Eight patients with carcinoma of the gastric cardia or distal oesophagus were prepared for a palliative Ivor Lewis two-stage oesophago-gastrectomy. The details of the technique for placing the anvil of a circular staple gun in the upper oesophagus and performing the intrathoracic stapled anastomosis are described. Intrathoracic stapling under thoracoscopic video control was successful in five of the eight patients. The three other patients received 10 cm mini-thoracotomies. All patients were transferred from the intensive care unit within 24 hours and were discharged from hospital within 14 days. There were no complications and no deaths. We believe that this procedure offers many patients better palliation with reduced morbidity because the standard right thoracotomy is avoided.

Adenocarcinoma↗
PubMed1993

Injuries of the portal vein in patients with blunt abdominal trauma.

Between January 1987 and September 1991, 68 severely traumatized patients underwent emergency laparotomy because of blunt abdominal trauma. Intraoperatively, 54.4% of the patients had a major injury to one organ, 23.5% had injuries to two organs, 16.2% had injuries to three organs and 5.9% to four or more organs. Additionally, in 11.8% of these cases (n = 8) a major vascular injury (portal vein n = 5, vena cava n = 2, mesenteric root n = 1) was found. Injuries to the portal vein were always associated with complete rupture of the pancreas, requiring distal pancreatic resection in four cases and a duodenum preserving resection of the head of the pancreas in one. In two of these patients the portal vein had to be reconstructed with a Goretex prosthetic graft. Mortality was 14.7% for the whole group (n = 68) and 0% for patients with additional portal venous injuries.

Abdominal Injuries↗
PubMed1993

Successful surgical treatment of liver and kidney metastases 25 years after a primary lacrimal gland tumor.

Among primary lacrimal gland tumors the adenoid-cystic carcinoma is the most common malignant epithelial lesion. We present a unique case of hepatic and renal metastases surgically treated 25 years after excision of a primary adenoid-cystic carcinoma of the lacrimal gland and after resection of intracranial and pulmonary metastases. The clinical and pathological features of this malignant tumor are discussed. To our knowledge this is the longest reported survival of a patient with such a tumor.

Brain Neoplasms↗
PubMed1993

[Right-sided hemihepatectomy in echinococcosis of the liver in pregnancy].

The treatment of symptomatic echinococcal disease of the liver during pregnancy is a rare, but difficult problem. A 42 year old, pregnant woman with obstructive jaundice and acute cholangitis due to extensive echinococcus cysticus infection of the right hepatic lobe is presented. A formal, right hemihepatectomy was successfully performed.

Abdominal Pain↗
PubMed1992

Audit of general practitioner referrals to an acute surgical unit.

One hundred and ninety referrals from general practitioners (GPs) to an acute surgical unit were audited prospectively over a 6-month period. A total of 78 admissions were considered inappropriate of whom 23 patients were thought to have needed neither surgical admission nor opinion. The estimated expenditure resulting from admissions deemed inappropriate was 25,000 pounds. The daytime commitments of more senior staff on routine emergency duty days meant they were not easily available to deal with calls concerning acute GP referrals. These admissions reduce the efficiency of the service; this may be improved by a senior member of the team accepting and screening GP calls.

Acute Disease↗
PubMed1992

Role of sequential leucocyte counts and C-reactive protein measurements in acute appendicitis.

The accurate clinical diagnosis of acute appendicitis is difficult, and many techniques have been suggested to improve diagnostic accuracy such as laparoscopy, ultrasonography and barium enema examination. In this study serial total leucocyte counts and serial C-reactive protein (CRP) concentrations in acute appendicitis were measured. The sensitivity and specificity of serial leucocyte counts in acute appendicitis were 92 and 100 per cent, and for CRP concentrations 69 and 75 per cent, respectively. The sensitivity and specificity of serial total leucocyte counts fulfilled the criteria for a diagnostic test. It is suggested that in patients with equivocal clinical findings, clinical observation combined with serial leucocyte counts may improve decision making.

Acute Disease↗
PubMed1991

Passive smoking and the risk of heart attack or coronary death.

OBJECTIVES: To estimate the prevalence of passive smoking in an Australian population, the magnitude of risk of myocardial infarction or coronary death associated with passive smoking and the extent to which fibrinogen concentrations might be affected by passive smoking. DESIGN: A population-based case-control study of myocardial infarction or coronary death and passive smoking, and measurement of fibrinogen in a random sample from the same population. SETTING AND PARTICIPANTS: Residents of the Lower Hunter Region of New South Wales aged 35-69 years in 1988-1989. Case subjects were all those who suffered myocardial infarction or coronary death. Control subjects were participants in a risk factor prevalence survey. OUTCOME MEASURES: Myocardial infarction or coronary death, defined by criteria of the WHO MONICA Project, and fibrinogen concentration (measured in controls only). RESULTS: Prevalence of passive smoking at home was 20% for male case subjects, 13% for male control subjects, 29% for female case subjects and 19% for female control subjects. The corresponding prevalence rates for passive smoking at work were 40%, 44%, 41% and 37%. Odds ratios of myocardial infarction or coronary death for active smokers compared with non-smokers were 4.70 (95% confidence interval [CI], 3.35-6.58) in women and 2.71 (95% CI, 2.07-3.53) in men. For women the odds ratios of myocardial infarction or coronary death for those exposed to passive smoking at home were 2.46 (95% CI, 1.47-4.13) among non-smokers and 1.48 (95% CI, 0.67-3.30) among ex-smokers. For men the odds ratios for passive smoking at home were 0.97 (95% CI, 0.50-1.86) for non-smokers and 1.78 (95% CI, 1.13-2.79) for ex-smokers. The odds ratios for passive smoking at work did not suggest increased risk. Fibrinogen concentrations were generally higher among people exposed to passive smoking at home or work compared with those not exposed but were not as high as concentrations in active smokers. CONCLUSIONS: Passive smoking increases the risk of coronary heart disease and increased fibrinogen concentration provides a marker of its effect.

Adult↗
PubMed1991

How soon after quitting smoking does risk of heart attack decline?

A population-based case-control study (involving 1282 cases and 2068 controls) was conducted to examine the risk of myocardial infarction or coronary death after cigarette smokers quit smoking. The odds ratios for current smokers were significantly elevated compared to non-smokers (OR = 2.7 for men and OR = 4.7 for women). For ex-smokers odds ratios declined rapidly after quitting and after about 3 years they were not significantly different from unity. Fibrinogen concentrations measured in the controls only were higher in current smokers and ex-smokers up to 2 years after quitting than in non-smokers and after that time were similar to levels in non-smokers; however, most of the differences among categories of smokers were not statistically significant. These results support the hypothesis that risk of a coronary event in ex-smokers declines rapidly after quitting and within 2-3 years is similar to the risk for non-smokers.

Adult↗