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Biomedical subjects

G A Coupland

Publications and source records attributed to G A Coupland.

At least 19 recordsLinked to original sources
PubMed1985

Inflammatory aneurysms of the abdominal aorta.

Over a 5 year period 268 abdominal aortic aneurysms were operated on, 15 of these (5.6%) showed the characteristic features of inflammatory aneurysms. Rupture of the aneurysm was an unusual method for presentation (one patient), and back and abdominal pain were present in 13 patients. The ESR may be of value in the pre-operative diagnosis. Ultrasound and CT scanning can, by the detection of a peri-aortic mass lead to confusion in the diagnosis. Two patients were initially diagnosed as having lymphoma. Strict adherence to the surgical principles outlined resulted in no mortality or significant morbidity in these 15 patients.

Aged↗
PubMed1985

Vein, Gore-tex or a composite graft for femoropopliteal bypass.

Experience with a variety of graft materials has suggested that the nature of the material significantly affects long term graft patency. In 126 femoropopliteal bypass grafts performed during a 54 month period, the over-all patency rate for RSV (68.0 per cent at three years) was significantly superior to either Gore-tex alone (34.1 per cent at three years) or a composite graft of RSV below the knee anastomosed to Gore-tex above the knee (49.3 per cent at three years). The composite graft performed significantly better than Gore-tex alone, however, in patients with poor runoff or when a distal anastomosis was performed below the knee. The reason for the superior performance of RSV or the composite over Gore-tex alone probably relates to compliance mismatch at the site of the distal anastomosis. While RSV remains the graft material of choice for femoropopliteal bypass grafting, a extensive role exists for the use of a composite graft rather than Gore-tex graft alone especially in patients with poor runoff with an anastomosis below the knee.

Aged↗
PubMed1983

Surgery in patients with advanced germ cell malignancy following a clinical partial response to chemotherapy.

Twenty-one patients with metastatic germ cell tumors achieved only partial clinical tumor regression following chemotherapy, and underwent surgical biopsy or resection of the residual tumor deposits. Sixteen (76%) are at present clinically disease-free after a median 30 + months (range 17-50 months) from the time of surgery, and five (24%) died after 9-29 months. Adverse prognostic signs were the finding of persistent cancer at histopathological examination of the resected tumor masses, and the presence of elevated serum tumor markers at the time of surgery. Postchemotherapy surgery in this setting provides tissue for the prognostically important histopathological examination on which a decision regarding further chemotherapy may be based. In addition, it provides tumor bulk reduction in the cases of differentiated teratoma and persistent cancer.

Adolescent↗
PubMed1982

Operative ultrasonic features of insulinomas.

The technique of operative pancreaticosonography is described as a method of localizing occult insulinomas. The specific ultrasonic features of two small but palpable insulinomas are compared with those of other small lesions in the pancreas. Insulinomas are ultrasonically hypoechoeic and well-defined, with smooth borders, they deform but do not infiltrate surrounding structures, and they cause some dilatation of the secondary pancreatic ducts. Real-time, high resolution, intraoperative ultrasonic pancreatography is suggested as an adjunct to assist in the localization of insulinomas at surgery.

Adenoma, Islet Cell↗
PubMed1982

Ultrasonic indications to explore the common bile duct.

A prospective comparison between operative cholangiography and operative choledochosonography has been made in 100 patients with cholelithiasis and potential choledocholithiasis. Thirty-one common bile ducts were explored, and 25 of them contained stones. Operative cholangiography was attempted in every case, but technical difficulties prevented examination of 12 common bile ducts, two of which contained stones. Both of these stones were detected by operative ultrasonography. Of the remaining 88 ducts, the sensitivity of the operative cholangiogram was 96% and the specificity 96%. Operative ultrasonography was performed for all 100 patients, with a sensitivity of 96% and a specificity of 93%. The ultrasonic findings of a sonically dense particle, shadowing, dilatation of the duct, and the persistence and meniscus signs are described with their relative incidence in the 100 patients. The time required for choledochosonography (3 to 5 minutes) compared favorably with the time needed for operative cholangiography (10 to 15 minutes). Operative bile duct scanning is a rapid, reliable technique for detecting the presence of choledocholithiasis at the time of routine cholecystectomy.

Cholangiography↗
PubMed1981

Accurate localization and extraperitoneal drainage of pancreatic abscess.

Localization of a pancreatic abscess can be difficult. CT scanning can confirm the presence of an intraabdominal collection and define its extent. Five consecutive patients with pancreatic abscess have been investigated by CT scanning and the site and extent of the abscess defined. Extraperitoneal dissection with drainage was undertaken in all five patients. In four patients the abscess resolved completely, and in one laparotomy with further drainage was necessary. No complications occurred as a result of the procedure.

Abscess↗
PubMed1981

Peritoneoscopy--use in assessment of intra-abdominal malignancy.

Peritoneoscopy was performed on 236 patients between 1971 and 1980 to assess intraabdominal malignancy or to determine its presence when doubt existed. The diagnostic rate was 86%. The main causes of failure to reach a diagnosis were adhesions arising from previous surgery and tumor adhesions. It was a useful means of obtaining a tissue diagnosis, and the complication rate was low--4.5%. Peritoneoscopy demonstrated the cause of hepatomegaly in 90.9% of patients, the pathology of abdominal masses in 82.5%, and of ascites in 80.5%. It was also useful in assessing abdominal ultrasound and isotope liver scan abnormalities. The procedure is safe, cheap, and allows adequate assessment of intra-abdominal malignancy in a high proportion of patients.

Abdominal Neoplasms↗
PubMed1980

Nutritional status and postoperative complications in an Australian hospital.

A simple nutritional assessment was performed in 92 consecutive patients undergoing abdominal surgery, excluding appendicitis. The patients were given a nutritional score, and on the basis of that score were described as malnourished or normal. There was a statistically significant increase in postoperative complications in the malnourished group. This increase was observed in both the major and the minor complication groups, and also when septic and non-septic, and wound and non-wound, complications were considered.

Abdomen↗
PubMed1980

Ruptured abdominal aortic aneurysm: long-term survival after operation.

The long-term follow-up of 65 patients surviving surgery for ruptured abdominal aortic aneurysms is presented. Fifty-six per cent of these patients were alive at the time of review, having survived for a mean period of 36 months. The majority were enjoying a quality of life similar to that experienced before operation. Preexisting ischaemic heart disease did not alter the long-term prognosis. Cumulative survival curves for this group of survivors approximated both the survival curve for the average matched Australian population and similar curves constructed for patients operated upon electively for abdominal aortic aneurysms.

Adult↗
PubMed1978

Angiodysplasia of the small bowel: a method of intraoperative identification.

Two cases of recurrent bleeding from the gastro-intestinal tract are described. The initial diagnosis and the identification of the lesions at laparotomy were difficult problems. In both cases the bleeding was due to a vascular lesion of the small bowel, referred to as angiodysplasia. The lesions were detected before operation by selective angiography and identified at laparotomy by a preoperative and an intraoperative injection of a vital stain through the catheter into the feeding vessels.

Aged↗
PubMed1978

Surgery for recurrent peptic ulceration.

Sixty-six patients having surgery for recurrent peptic ulcers over a 10-year period are reviewed. The majority of the patients were male and developed their initial ulcers at an early age. Bleeding was the most common presenting symptom. Seventy-one percent of the recurrences occurred within three years. Barium meal X-ray examination plus endoscopy gave the correct diagnosis in 96% of cases. The causes of the recurrent peptic ulcers were: (1) incomplete vagotomy; (2) inadequate gastric resection; (3) inappropriate surgery; (4) Zollinger-Ellison syndrome; (5) gastric outflow obstruction; and (6) bile reflux. Other factors such as alcohol, analgesic abuse and psychiatric disorders were found to be common associations. Resection plus vagotomy was the summation of primary and secondary surgery in 85%. The operative mortality was 3%. Eighty-five percent of patients had a Visick grading of I or II. Only one patient had a further recurrent ulcer and this healed on medical treatment.

Adolescent↗
PubMed1977

Selective vagotomy for duodenal ulcer: a five-year follow-up.

The results for the first 101 consecutive patients who had selective vagotomy and a drainage procedure performed for duodenal ulceration between 1967 and 1971 are presented. Seventy-four patients were followed up for five to nine years, 13 patients were lost to follow-up for part of the five-year period, and 14 patients died during follow-up. Six patients developed recurrent ulcers. Five of these recurrent ulcers were observed in patients in whom the vagotomy was not tested for completeness during the operation; this represents a recurrence rate of 10%. One patient, in whom testing was used at operation, developed a recurrent ulcer; this represents a recurrence rate of 2%. There was a statistically significant difference in the rate of recurrence between the group tested during operation and that not tested.

Adult↗
PubMed1977

Treatment of chronic gastric ulcer a study of the treatment recived by 135 gastric ulcer patients in a western community.

A study was made of the treatment received by 135 gastric ulcer patients within one month and within six months of diagnosis. The treatment was divided into three types. Effective measures included surgery and those measures that have been shown favourably to influence the initial healing rate of chronic gastric ulcer (i.e. hospital admission and carbenoxolone sodium). Ineffective measures included those that have been shown convincingly not to accelerate ulcer healing--diet, antacids, sedatives and no treatmen at all. Anticholinergic drugs were included in the third group where the evidence is conflicting. The patient's therapeutic status was assessed one month and six months after diagnosis. Within six months of diagnosis only 32% of patients received treatment that clinical trials have shown favourably to influence the course of gastric ulcer and approximately half received treatment that has never been shown favourably to influence the course of gastric ulcer. The social class of the patients and whether they were seen by a consultant physicians or family doctor made no difference to the form of therapy received.

Australia↗
PubMed1976

Sequential multidrug chemotherapy and radiotherapy with possible surgery for locally advanced cancer.

A preliminary report describes the use of both a single and a combined chemotherapeutic drug regime before radiotherapy for locally advanced and radioresistant cancers. Some tumours have been rendered operable with safety by this sequence. This method is suggested to replace the current practice of following surgery with radiotherapy and finally chemotherapy. In our experience, chemotherapy before radiotherapy is assisting in the effective control of locally advanced and hitherto radioresistant cancers of many types, and in converting inoperable cancers into cancers that can be resected sometimes with safety. Also, when chemotherapeutic drugs are given before radiotherapy, damage to normal adjacent tissue is less than that seen after radiotherapy alone.

Aged↗
PubMed1976

Haematemesis and Melaena: surgical management.

A prospective study of the surgical management of 100 consecutive patients with benign, non-variceal upper gastrointestinal bleeding is presented. The manner of presentation, precipitating factors, investigations and associated medical problems are discussed. Chronic duodenal ulceration was the most common cause of haemorrhage. Vagotomy and drainage with oversewing or excision of the bleeding ulcer was the surgical procedure performed in 71 of the patients in the series. The incidence of recurrent bleeding was 7%; no patient in this category required further operation. The mortality rate was 6%, and there were no deaths recorded in the patients who underwent vagotomy and drainage. The reasons for the relatively low surgical mortality are discussed.

Adolescent↗
PubMed1975

Parietal cell vagotomy.

In a series of 100 consecutive patients who had parietal cell vagotomy performed, no drainage procedure was performed in 56 while 44 were drained. Dumping was significantly less in those who were not drained. All patients were tested for adequacy of vagotomy and for function of the nerve of Latarget at operation. Four patients have had further operations, two for proven recurrent ulcers. Parietal cell vagotomy has given excellent clinical results in this group of patients.

Adult↗
PubMed1975

Factors relevant to the prognosis of chronic gastric ulcer.

The factors that determine the recurrence rate of chronic gastric ulcer were studied in 105 patients. It was found that complete healing of the ulcer significantly reduced the recurrence rate and subsequent need for hospital admission because of ulcer symptoms when this group was compared with those who left hospital with their ulcers unhealed. Those admitted with large ulcers also had a higher recurrence rate. The age and sex of the patient, ingestion of analgesics and cigarette smoking did not influence recurrence. The initial healing rate of the ulcer also had no effect on the subsequent course of the patient.

Age Factors↗