Search PubMed⌕ Search

Biomedical subjects

J C Graham

Publications and source records attributed to J C Graham.

At least 55 records · Page 3Linked to original sources
PubMed1988

Primary iliac-appendiceal fistula.

Primary aorto-appendiceal fistula has been reported only once previously. A further case is presented in which bleeding, per rectum, occurred in association with rupture of an aorto-iliac aneurysm adherent to an acutely inflamed appendix. Postoperatively the patient had several complications including permanent asymmetrical L1 paraplegia and delayed presentation of an intramedullary abscess of the femur which grew Bacteroides fragilis organisms. These complications highlight the high morbidity associated with aortocolic fistulae.

Abscess↗
PubMed1988

Systemic crisis intervention as a response to adolescent crises: an outcome study.

The present study demonstrates the safety and effectiveness of an outpatient program designed to respond to adolescent-precipitated crises by mobilizing and restructuring the family's kinship system. Families of 75 adolescents at risk for hospitalization were followed up to 24 months after treatment with Systemic Crisis Intervention. Measures of offspring and family functioning, suicidal behavior, institutional use, and treatment costs are presented. Results clearly demonstrate the safety, effectiveness, and economic viability of Systemic Crisis Intervention.

Adolescent↗
PubMed1988

Liver graft revascularization by donor portal vein arterialization following "no touch" donor hepatectomy.

Unsatisfactory immediate function of the transplanted liver together with technical complications contribute to a persisting early mortality for hepatic transplantation in the 20% range. We report our initial clinical experience with methods, one not previously used clinically, that resulted in uniformly well-functioning liver grafts in 11 patients and contributed to a satisfactory success rate for the procedure. Donors were heart-beating. During the donor operation all manipulations of the liver were avoided until after cold preservation, achieved by external cooling at the same time as circulatory interruption, donor exsanguination and perfusion of the liver with cold oxygenated fluid of "extracellular" type. The organs were then gently dissected. At transplantation the livers were revascularized with arterial blood shunted from the recipient iliac artery to the graft portal vein after completion of the suprahepatic IVC anastomosis. The infrahepatic IVCs and hepatic arteries were then joined, the iliac artery shunts discontinued and the portal veins joined. Total ischaemic intervals for the allografts were 3 1/2-8 (average 5). Anhepatic intervals were 1-2 1/4 (average 2). The arterio-portal shunts were operating for 18-85 (mean 46) min. Blood loss and haemodynamic, acid-base and electrolyte abnormalities at revascularization were minimal. All grafts secreted bile immediately and all parameters reflected continuing improvement of liver function thereafter. Nine patients (82%) are alive between 4 and 18 (mean 11) months after transplantation. We conclude that these methods offer effective avoidance of serious organ damage during donor hepatectomy and preservation, reduced allograft ischaemic interval and reduced recipient anhepatic time. They result in avoidance of blood loss at the time of revascularization, together with minimal haemodynamic, acid-base or biochemical changes. In addition, they allow the surgeon to perform and test all anastomoses without time constraints, provide the capability to deal with unexpected complications, and assure good early graft function.

Adolescent↗
PubMed1987

Initial report of the Australian National Pilot Liver Transplantation Programme.

Our group began a National Pilot Liver Transplantation Programme in January, 1986, for which this report documents the results of the first 15 months' work. Seventy potential recipients (55 adults, 15 children) were referred for consideration for liver transplantation either directly or by state selection committees that had been established in most Australian states. The most common conditions for referral of adults were chronic active hepatitis, primary sclerosing cholangitis and primary biliary cirrhosis; 11 patients had fulminant hepatic failure. In children, the most common condition for referral was biliary atresia. Twenty-nine (41%) patients were considered unsuitable candidates for liver transplantation, 25 patients (21 adults and four children) were accepted for transplantation at a later time, and 16 patients (11 adults and five children) were selected for immediate transplantation. Of these 16 patients, three patients died before a donor could be found. Of the 13 patients to receive transplants (one patient received two transplants), 10 patients (seven of nine adults; three of four children) are alive and well; nine patients have good liver function and one patient has impaired liver function. The additional costs of the Programme to the hospitals were estimated at approximately $2 million a year. It is concluded that for those persons who require liver transplantation in Australia, worthwhile survival after this procedure can be obtained.

Adolescent↗
PubMed1985

Renal autotransplantation for severe loin-pain/haematuria syndrome.

Most forms of therapy for the loin-pain/haematuria syndrome are unsuccessful, though nerve-block procedures and renal denervation sometimes provide temporary relief. Three young patients, with pain so severe that they were dependent on narcotics, were treated for this syndrome. All three had been repeatedly admitted to hospital. Loin pain was unilateral in two patients and predominantly so in the third. Renal function, excretion urography, and angiography were normal, but renal biopsy specimens showed deposition of the third component of complement in the renal arterioles. All were treated with renal autotransplantation; the kidney causing pain (or the one causing the most pain) was completely excised and reimplanted in the iliac fossa. Two patients had complete relief of pain and the third almost complete relief, despite recurrence of haematuria in all three. It is too early to determine whether this major procedure is justified in the treatment of the loin-pain/haematuria syndrome, but the early results are encouraging.

Adolescent↗
PubMed1983

Axillofemoral and femorofemoral grafts: a 6-year experience with emphasis on the relationship of peroperative flow measurement to graft survival.

Over a 6-year period 64 axillofemoral bypass and femorofemoral crossover grafts have been performed in 58 patients, most of whom were considered unfit for intra-abdominal surgery. Indications were peripheral ischaemia in 78 per cent and disabling claudication in 22 per cent. The limb salvage rate at 3 years was 75 per cent. No claudicants lost limbs, but only one-third of patients presenting with forefoot gangrene or ulceration avoided amputation. Most patients presenting with ischaemic symptoms at rest had associated femoropopliteal and distal disease, confirmed by the ankle pressure index measurements, and this influenced graft patency. Although the cumulative patency at 3 years for all grafts combined was 57 per cent with similar patencies for both the axillofemoral and femorofemoral grafts, early occlusion was more common in axillofemoral grafts and this may be reduced in bifemoral grafts by the increased flow rate in the vertical limbs. Peroperative electromagnetic flowmeter measurements were made after reconstruction on 55 femoral arteries in 46 of the patients and graft flow velocities were derived from these measurements. Comparison between velocities from those grafts remaining patent and those subsequently occluding showed a high incidence of occlusion in grafts with a maximal velocity after distal vasodilatation of less than 8 cm/s. Graft occlusion after the first postoperative month was more commonly associated with other factors such as continued smoking, severity of distal disease and perigraft infection.

Aged↗
PubMed1983

On-line analysis of the femoral artery flow velocity waveform and its application in the diagnosis of arterial disease.

Analysis of the instantaneous peak velocity waveform obtained from the common femoral artery can be used to provide an objective assessment of arterial disease in the leg. The calculation of waveform indices pulsatility index and rise time together with principal component analysis has been found to be the ideal method by which to assess the flow data on-line.

Blood Flow Velocity↗
PubMed1983

Per-operative haemodynamic assessment of lower limb arterial surgery. Part 1: Hydraulic impedance measurement.

Hydraulic impedance measurements have been made during surgery on 32 patients undergoing reconstructive arterial surgery. The reconstructive procedures included aorto-iliac, femoro-popliteal and axillo-femoral bypass, and extended deep femoral angioplasty. It was found that in aorto-iliac reconstruction the phase curves provide the means of assessing success, but that in other cases the impedance measurements though showing a similar trend are unable unequivocally to differentiate between success or failure.

Arteries↗