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Biomedical subjects

F B Keane

Publications and source records attributed to F B Keane.

68 records · Page 4Linked to original sources
PubMed1979

Primary nonfunctioning carcinoma of adrenal cortex.

Two cases of nonfunctioning adrenocortical carcinomas are presented. The clinical features, operative findings, and histopathologic appearances are discussed. It is believed that these tumors are difficult to diagnose because of their vague presentation. Intravenous urography with nephrotomography is the most valuable method of detecting these tumors, and surgery remains the best treatment.

Adrenal Cortex↗
PubMed1977

Phenol lumbar sympathectomy for severe arterial occlusive disease in the elderly.

Phenol chemical lumbar sympathectomy is an additional aid in the management of ischaemic rest pain and incipient gangrene. This technique was used in 132 elderly patients in Bath between September 1972 and March 1975 and the results are presented here. The patients were unfit for reconstructive arterial surgery. In this series an image intensifier was used in order to make the procedure safer. One hundred and twenty-six patients were available for review, their average age being 71.5 years. The average period of follow-up was 16.3 months. Of the 126 patients, 111 were not diabetic, and of these 45 (41 per cent) had satisfactory results while 17 (15.4 per cent) had persistent symptoms but had avoided amputation. Thirty (27 per cent) patients required amputation and 12 of these died as a direct result of this procedure. A further 19 patients in the non-diabetic group died during the period of follow-up. However, of the 15 diabetic patients, only 3 (20 per cent) improved whilst one patient with persistent symptoms avoided amputation. The remainder either died (8) or had an amputation (5) during the period of follow-up. Two died after amputation.

Aged↗
PubMedDate not supplied

A comparison of circular stapling devices for rectal anastomoses. A study in dogs.

Mechanical circular stapling devices offer several advantages in the formation of low rectal anastomoses. The authors aim was to compare the quality of rectal anastomoses created in dogs using the two commonly available staple suture guns, the EEA and SPTU. Thirty dogs, 15 with each gun, had rectal division and anastomosis. The first 20 dogs (ten EEA and ten SPTU) were sacrificed at eight days. Anastomotic integrity was assessed using plain x-ray, barium enema, and postmortem examination and pressure studies. The remaining ten dogs, five in each group, were sacrificed at 48 hours, and the anastomoses were inspected and examined histologically. Eleven of 15 anastomoses in the EEA group showed evidence of breakdown compared with only three of 15 in the SPTU group (P less than 0.02). It is concluded that the SPTU gun created a more satisfactory anastomosis and that this was probably due to its staples having an adjustable closure.

Animals↗
PubMedDate not supplied

Symptoms of oesophageal reflux are more common following laparoscopic cholecystectomy than in a control population.

Previous studies have shown that up to 40 per cent of patients have symptoms after cholecystectomy or laparoscopic cholecystectomy (LC). There are concerns, however, that these symptoms reflect those of the general population and are not a specific post-operative phenomenon. Abdominal symptoms of 212 patients following LC were compared to a healthy acalculous control population (n = 62). Patients and controls were assessed by questionnaire. Age and sex profiles were similar in both groups. There was no significant difference in the incidence of abdominal pain, bloating or nausea between the 2 groups. Frequent heartburn was a symptom in 19.3 per cent of patients following LC as compared to 3.2 per cent of control patients (p = 0.004, chi-squared 9.39, 1 d.f.). Furthermore 11.3 per cent of post-operative patients complained of dysphagia versus 6.4 per cent of the control group (p = 0.08, chi-squared 1.245, 1 d.f.). One hundred and twenty (57.1 per cent) patients judged their operation to be a complete success, while 9 (4.3 per cent) were dissatisfied. Five of the latter group cited frequent heartburn as the cause of their dissatisfaction. We conclude that abdominal pain, bloating and nausea occur as frequently in the general population as in patients following LC. Patients are more likely to suffer from heartburn and dysphagia following LC than a normal population supporting a link between cholecystectomy and lower oesophageal dysfunction.

Adult↗
PubMedDate not supplied

Helicobacter pylori does not play a role in the aetiology of acute appendicitis.

The aetiology of acute appendicitis remains uncertain. H. pylori is viable outside the gastroduodenum, however its pathological role outside this area has not been fully investigated. Ten consecutive patients with a histological diagnosis of acute appendicitis were investigated for H. pylori status by serology, and by culture, histology, and polymerase chain reaction (PCR) analysis of the appendiceal specimens. One patient had positive serology for H. pylori, however PCR analysis was negative. Culture failed to reveal H. pylori colonies. Histology in 5 cases did reveal organisms with a morphological appearance of H. pylori, but PCR analysis confirmed that H. pylori was not present. Using a variety of methods, with PCR acting as the 'gold standard', we have shown that H. pylori is not associated with acute appendicitis.

Acute Disease↗
PubMedDate not supplied

An audit of surgery for seventy-one primary parotid tumours.

Seventy-one consecutive patients who presented with lumps in the parotid gland over an eight year period (1981-1989) were analysed. Two-thirds of the patients presented with a history of swelling for over one year, while a quarter (24%) had a parotid mass for over five years at initial referral. The pathology of these masses was diverse, with pleomorphic adenoma being the commonest (64%). Superficial parotidectomy was the commonest procedure employed (50/71) with local excision being performed only in the initial part of our series (15/71). There were five cases of permanent facial palsy, four following radical resection for malignancy. Tumour recurrence rate was 2/15 (13%) in cases treated by local excision while none of the 50 patients treated by superficial parotidectomy had tumour recurrence at a mean follow-up of five years. Only three patients developed Frey's Syndrome. It is recommended that increased community awareness of early referral of a parotid mass is necessary, as surgical treatment in the form of superficial parotidectomy, which is the ideal procedure for such lumps, carries minimal morbidity when performed by a surgeon with a special interest in parotid surgery.

Adolescent↗
PubMedDate not supplied

Inflammatory aortic aneurysm: report of a case suggesting athero-ischaemic aetiology.

A case of inflammatory aortic aneurysm is presented in which histology revealed athero-emboli in the aortic vasa vasorum. It is suggested that ischaemic injury to the media, caused by lesions such as these and by other features of atherosclerosis, may be the initiating factor in some cases of idiopathic chronic periaortitis.

Aged↗
PubMedDate not supplied

Staged resection or primary anastomosis for obstructing lesions to the left colon.

The management of obstructing left-sided colonic and rectal lesions has traditionally been by a staged procedure. The introduction of 'on-table lavage', has made primary resection and anastomosis of the large bowel feasible for patients presenting as emergencies. We have studied the perioperative course of 28 patients who presented with left colonic obstruction to determine whether primary anastomosis conferred additional morbidity. The patients ranged in age from 29 to 89 years (mean 66 years) at presentation. The ASA status of patients was comparable in both groups (Table 1). Fourteen patients underwent resection, on-table lavage, and primary anastomosis (PA) and 14 a Hartmann's procedure (HP). The mean operative time for the PA procedure was 200 minutes compared to 110 minutes for the HP group. There was no significant difference in the postoperative complication rate nor mean hospital stay rate for the primary procedures between the two groups. There was no clinical anastomotic leak in patients undergoing primary anastomosis. However secondary surgery for patients undergoing colorectal reconnection conferred added morbidity for patients who had a HP. We conclude that resection, on-table lavage, and primary anastomosis is safe in the management of left-sided colonic obstruction and in most cases is the treatment of choice.

Aged↗