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Biomedical subjects

G Mathew

Publications and source records attributed to G Mathew.

At least 19 recordsLinked to original sources
PubMed2006

A missing denture's misadventure!

We report a late onset, benign, tracheoesophageal fistula in a 51-year-old man, due to an accidentally swallowed denture. In view of the extensive peri-esophageal sepsis and fibrosis, he was managed by a subtotal esophagectomy and a cervical esophagogastric anastomosis. The tracheal defect was closed with the help of an intercostal muscle flap. This report also highlights the difficulty in identifying swallowed prosthetic dental material radiologically, when no metallic component is present. This fact was also responsible for the delay in diagnosis, eventually leading to the rare complication of a tracheoesophageal fistula.

Anastomosis, Surgical↗
PubMed2006

Prevention of parastomal hernia using preperitoneal mesh: a prospective observational study.

OBJECTIVE: Parastomal hernia is a common complication after stoma formation. The objective of the study was to see whether placing prophylactic preperitoneal mesh could reduce the incidence of parastomal hernia. METHOD: Patients having elective bowel surgery requiring permanent stoma were included in this study. The time required for mesh insertion, day of stoma function, and early complications were recorded. Follow up was at 6 weeks, 3-monthly for the first year and at 6-monthly intervals thereafter. RESULTS: Eighteen patients fulfilled the inclusion criteria and were followed up for 6-28 months (mean 16.05). The time taken for mesh placement was 12-22 min (mean 14). One patient had to have revision surgery on day 1 for stomal necrosis - the mesh was left in situ in that instance. This patient developed superficial laparotomy wound infection. During the follow up, no patients developed parastomal hernia, stomal prolapse, stenosis, retraction, fistula or obstruction. CONCLUSION: The early results, in this group of patients, show that prophylactic polypropylene mesh insertion at the time of permanent stoma formation is encouraging and long-term results are awaited.

Aged↗
PubMed2004

Postoperative mortality following oesophagectomy and problems in reporting its rate.

BACKGROUND: There have been three previous reviews of the world literature describing postoperative mortality rate following oesophagectomy. The first documented rates in the first half of the last century, the second the period 1960-1979 and the third the interval 1980-1988. The aim of this review was to document the rate for the period 1990-2000. METHODS: Reports were sourced through PubMed and/or Medline listings. RESULTS: The number of papers included in the review was 312, involving 70,756 patients. The overall mortality rate was 6.7 per cent. The 30-day mortality rate was 4.9 per cent and the in-hospital mortality rate 8.8 per cent. Survival rates, where reported, were 62.7 per cent at 1 year and 27.9 per cent at 5 years. CONCLUSION: Operative mortality rates following oesophagectomy have continued to fall. However, the true rate is almost certainly higher than that reported here, for a variety of reasons. The 1-year survival of patients was only reported in about a quarter of the papers. It may be a more meaningful figure than postoperative mortality rate.

Esophageal Neoplasms↗
PubMed2003

Relapse of coccidioidomycosis despite immune reconstitution after fluconazole secondary prophylaxis in a patient with AIDS.

We report a case of relapse of coccidioidomycosis in an HIV-infected person who discontinued maintenance azole therapy following a response to antiretroviral therapy. This experience raises concern about the safety of withholding secondary prophylaxis for coccidioidomycosis in persons with HIV infection who have achieved immunological responses to antiretroviral therapy.

AIDS-Related Opportunistic Infections↗
PubMed2003

Post-cholecystectomy benign biliary stricture with portal hypertension: is a portosystemic shunt before hepaticojejunostomy necessary?

BACKGROUND: Portal hypertension develops in 15-20% of patients with benign bile duct stricture. Hepaticojejunostomy in such patients is associated with considerable morbidity and mortality. Preliminary portosystemic shunting has been suggested to reduce intra-operative bleeding. We present our experience without preliminary shunting in such patients. PATIENTS AND METHODS: Fourteen consecutive cases of biliary stricture with portal hypertension over a 13-year period (1989-2001) were retrospectively analysed. RESULTS: Thirteen patients were operated upon. One patient had a preliminary portosystemic shunt. In another patient, shunt was attempted. One stage hepaticojejunostomy was possible in 11 patients. There were no intra-operative deaths. Nine of the 13 survived and were available for follow-up. One patient had cholangitis. Another had jaundice related both to chronic liver disease and a strictured hepaticojejunostomy. The remaining 7 patients are asymptomatic and anicteric although alkaline phosphatase levels remain elevated in 5 of them. CONCLUSIONS: Hepaticojejunostomy without preliminary portosystemic shunting is possible in patients with portal hypertension and benign biliary stricture with acceptable morbidity and mortality rates.

Adolescent↗
PubMed2002

Metallothionein in human oesophagus, Barrett's epithelium and adenocarcinoma.

The potential of the metal-binding protein, metallothionein, in assessing the progression of normal oesophagus through Barrett's to adenocarcinoma was investigated. Metallothionein was quantitatively determined in resected tissues from patients undergoing oesophagectomy for high grade dysplasia/adenocarcinoma and in biopsies from patients with Barrett's syndrome. In 10 cancer patients, metallothionein concentrations in adenocarcinoma were not significantly different from normal oesophagus, although six had elevated metallothionein concentrations in the metaplastic tissue bordering the adenocarcinoma. In 17 out of 20 non-cancer patients with Barrett's epithelium, metallothionein was significantly increased by 108% (P<0.004). There was no association between the metallothionein levels in Barrett's epithelium and the presence of inflammatory cells, metaplasia or dysplasia. Metallothionein is a marker of progression from normal to Barrett's epithelium but is not increased in oesophageal adenocarcinoma.

Adenocarcinoma↗
PubMed2000

Influence of gases on intraperitoneal immunity during laparoscopy in tumor-bearing rats.

Laparoscopy has been associated with metastases to abdominal wall wounds. In addition, many recent experimental studies suggest that laparoscopy is associated with increased tumor dissemination. It is possible that immune or metabolic disturbances due to the use of a pneumoperitoneum could contribute to this problem. To investigate this possibility, we studied the effect of two insufflation gases and gasless laparoscopy on in vivo peritoneal macrophage function and intraperitoneal pH in an experimental model. A carcinoma was implanted into the flank of 32 experimental rats that underwent laparoscopic surgery in one of four treatment groups: anesthesia alone, gasless laparoscopy, helium insufflation, and CO2 insufflation. Intraperitoneal pH was monitored during surgery, and peritoneal macrophage function was determined 3 days after surgery by harvesting peritoneal macrophages and then examining their ability to produce tumour necrosis factor-alpha (TNF-alpha). CO2 insufflation was associated with a consistent fall in intraperitoneal pH and a significant reduction in TNFalpha production. These findings did not occur in the other study groups. The results of this study demonstrate that CO2 insufflation results in depressed intraperitoneal macrophage activity. It is possible that it is mediated by pH changes. In addition, it could be a contributing factor to the development of port-site metastases. Further studies are needed to determine whether the factors identified act during clinical surgery.

Animals↗
PubMed2000

Risk factor analysis of post-operative mortality in oesophagectomy.

Oesophagectomy for cancer is associated with a significant incidence of post-operative complications and death, and so this study sought to determine objective criteria which could better predict operative risk. Clinical risk factors for oesophagectomy and the results of objective investigations were assessed prospectively by independent surgical and intensive care specialists and a multivariate analysis was used to develop a scoring system for predicting operative risk. From September 1994 to June 1997, 32 patients from an overall experience of 70 oesophagectomy procedures for cancer at the Royal Adelaide Hospital were entered into this study. Hypertension, a history of previous cigarette smoking and FEV1/FVC were identified as independent predictors of the post-operative outcome. Age and FEV1/FVC were also significantly associated with the occurrence of cardiovascular and pulmonary complications respectively. The average risk score was 4.8 +/- 4.5 (mean +/- SD) for patients who died, 2.9 +/- 2.9 for patients who developed post-operative complications and 2.6 +/- 2.1 for patients who had an uncomplicated recovery. The likelihood of post-operative mortality and morbidity was highest in patients with a score of 5 or more. Mortality rates of different patient groups undergoing oesophagectomy by the same surgeons during the same time period were also compared, showing greatly different mortality rates. Important risk factors can be identified preoperatively, and a scoring system can be used to provide objective criteria which can be used to identify patients at an increased risk of post-operative complications and death. A prospective study of this scoring system is now needed to determine whether it proves useful in rejecting patients for surgery who would otherwise have undergone oesophagectomy.

Adult↗
PubMed2000

Management of congenital pseudarthrosis of the tibia by excision of the pseudarthrosis, onlay grafting, and intramedullary nailing.

Fourteen skeletally immature children with congenital pseudarthrosis of the tibia were treated by excision of the pseudarthrosis, double onlay autogenous cortical bone grafting, and intramedullary nailing. Union was achieved in 12 patients, and no refractures occurred at the site of the original pseudarthrosis. In three patients, a fresh pseudarthrosis developed at a different site; these united after repeat onlay grafting. Five skeletally mature patients were treated by excision of the pseudarthrosis, compression at the site, and limb lengthening by callotasis. Union was achieved in three. Gain in tibial length ranged from 6 to 13 cm, with no significant complications during lengthening. The authors conclude that union can be achieved and refractures prevented in a significant proportion of skeletally immature children with congenital pseudarthrosis of the tibia by excision of the pseudarthrosis, dual onlay bone grafting, and intramedullary nailing. Any residual shortening of the limb can be treated at skeletal maturity.

Adolescent↗
PubMed1999

The role of peritoneal immunity and the tumour-bearing state on the development of wound and peritoneal metastases after laparoscopy.

BACKGROUND: The effect of the tumour-bearing state and alterations in peritoneal immune function on the incidence of port-site and peritoneal metastases was investigated after laparoscopy with and without CO2 pneumoperitoneum. METHODS: A suspension of viable adenocarcinoma cells was introduced into the left upper quadrant of the peritoneal cavity of syngeneic tumour-bearing rats at laparotomy, laparoscopy with CO2, and gasless laparoscopy. Control rats did not have pre-existing tumours. A group of non-tumour-bearing rats were also injected intraperitoneally with endotoxin 4 h before intraperitoneal tumour cell injection. Six days later the peritoneal cavity and surgical wounds were examined for macroscopic evidence of implanted tumour. Peritoneal macrophages were obtained from tumour-bearing rats subjected to different laparoscopic procedures and the activation state measured following exposure to lipopolysaccharide in vitro. RESULTS: In the control rats, tumour implantation in the surgical wounds and peritoneum was significantly greater in the rats that had undergone laparoscopy with CO2. The presence of a pre-existing tumour was associated with increased tumour spread in all treatment groups and at most sites. Injection of endotoxin also resulted in increased tumour spread. Peritoneal macrophages from control and tumour-bearing rats who underwent laparoscopy with CO2 produced significantly less TNF-alpha in vitro, compared to gasless laparoscopy or laparotomy. CONCLUSIONS: Carbon dioxide insufflation enhances tumour spread and implantation. The underlying immune or metabolic status of the host, as influenced by the tumour-bearing state or modification of the peritoneal environment, also has a marked independent effect on tumour spread and implantation. The immune and metabolic status of the peritoneum including the extent of macrophage activation is implicated in this effect.

Adenocarcinoma↗
PubMed1999

Motility across esophageal anastomoses after esophagectomy or gastrectomy.

The esophageal motility of 23 patients who underwent esophagectomy or gastrectomy for carcinoma of the esophagus or gastroesophageal junction was recorded daily during the immediate post-operative period for high-pressure transients or other motility disturbances. Patients were divided into three subgroups according to the level of the esophageal anastomosis: group 1, neck (n = 4); group 2, thoracic (n = 14); group 3, diaphragmatic hiatus (n = 5). Peristalsis was absent in all patients studied during ventilation and sedation in the intensive care unit (five patients). Early post-operative esophageal motility after esophageal anastomosis varied somewhat with the length of residual esophagus. With short lengths of residual esophagus, no consistent motility pattern emerged. With longer lengths, early peristaltic activity was evident, but diminished over the first few post-operative days. Esophageal resection and anastomosis is associated with loss of peristalsis in the initial post-operative period, consistent with the concept of an esophageal ileus.

Adult↗
PubMed1998

Concurrent fluoroscopy and manometry reveal differences in laparoscopic Nissen and anterior fundoplication.

A prospective double-blind randomized trial was initiated to examine two types of laparoscopic fundoplication (Nissen and anterior). Thirty-two patients with proven gastroesophageal reflux disease presenting for primary laparoscopic antireflux surgery were randomized to undergo either Nissen fundoplication (N = 13) or anterior hemifundoplication (N = 19). Postoperative fluoroscopic and manometric examination was carried out concomitantly. Nissen fundoplication resulted in significantly greater elevation of resting (33.5 vs 23 mm Hg) and residual lower esophageal sphincter pressures (17 vs 6.5 mm Hg) and lower esophageal ramp pressure (26 vs 20.5 mm Hg) than the anterior partial fundoplication. A smaller radiologically measured sphincter opening diameter was seen following Nissen fundoplication (9 mm) compared with anterior fundoplication (12 mm). Lower esophageal ramp pressure correlated weakly (r = 0.37, P = 0.04) with postoperative dysphagia. It is concluded that the type of fundoplication performed significantly influences postoperative manometric and video barium radiology outcomes. The clinical relevance of this requires further investigation.

Barium Sulfate↗
PubMed1998

Efficacy of anterior, posterior and total fundoplication in an experimental model.

BACKGROUND: This study examined the effect of different types of laparoscopic fundoplication on an incompetent lower oesophageal sphincter to test their effectiveness at preventing gastro-oesophageal reflux in the early postoperative period. METHODS: An experimental porcine model was used. Initial oesophageal myotomy ensured an incompetent lower oesophageal sphincter with free reflux of 'intragastric fluid'. Anterior, posterior or total fundoplication was then performed laparoscopically in 15 laboratory pigs (five in each group). Fundoplication competence and efficacy were determined 2 weeks after laparoscopic antireflux surgery by inflating the stomach with liquid through a gastrostomy cannula. Some animals were also studied at 4 and 6 weeks. Lower oesophageal sphincter pressure was determined using a water-perfused oesophageal manometry catheter incorporating a Dent sleeve. RESULTS: All three types of fundoplication produced similar increases in postoperative resting lower oesophageal sphincter pressure and restored adequate competence to the gastro-oesophageal junction. CONCLUSION: All three variants of laparoscopic fundoplication restore gastro-oesophageal competence in the early postoperative period.

Animals↗
PubMed1998

A five-year follow-up study of older long-stay clients with intellectual disability using the Disability Assessment Schedule.

The emphasis on community care means closure of the long-stay institutions for people with intellectual disability. Studies have indicated that older people with intellectual disability in particular may not be adequately cared for because of poor monitoring of their changing needs and inadequate provision of services. The use of rating instruments to monitor changes, and to predict outcome or needs in this population may help to improve care by assisting with planning and projection of service requirements. In 1991, all residents of a long-stay hospital for people with intellectual disability were assessed using the Disability Assessment Schedule (DAS). Five years later, the 1991 scores of the older residents (aged > 50 years) were reviewed and compared under three outcome groups: in-patients, discharged and deceased. Furthermore, all older people resident in the hospital in 1996 were reassessed using the DAS. Out of the 144 older clients resident in 1991, five years later, 78 were still in-patients, 38 had been discharged into the community and 28 were deceased. In 1991, the decreased group had the greatest problems with continence and symbolic behaviour, while the discharged group had the greatest problems with self-help, vision, hearing, communication, social interaction, echolalia and repetitive speech. In comparison with 1991, the 1996 DAS scores of older residents showed that there were increasing problems with vision, hearing, communication, behaviour and symbolic activities. The present study suggested that the DAS is a useful instrument for monitoring change and predicting outcome in older people with intellectual disability.

Activities of Daily Living↗