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Biomedical subjects

J F Thompson

Publications and source records attributed to J F Thompson.

At least 145 records · Page 8Linked to original sources
PubMed1996

Retrieval of organs for transplantation: experience of the Australian National Liver Transplantation Unit.

The Australian National Liver Transplantation Unit carried out 251 multiple organ-retrieval procedures between January 1986 and December 1994: 53% were in the Sydney metropolitan area, 22% in country New South Wales and the Australian Capital Territory, 21% interstate and 4% in New Zealand; mean total procurement times were, respectively, 4 hours 57 minutes, 6 hours 58 minutes, 9 hours 20 minutes and 12 hours 20 minutes. Donor operation times steadily decreased over the nine years. One-year patient and graft survival rates were 77.1% and 70.3%, respectively; primary non-function occurred in only one case. The importance of coordination of donor organ procurement and efficient organ retrieval to the success of transplantation programs is discussed.

Adolescent↗
PubMed1996

The role of whole-body positron emission tomography with [18F]fluorodeoxyglucose in identifying operable colorectal cancer metastases to the liver.

OBJECTIVE: To compare the accuracy of whole-body position emission tomography (PET)using [18F]fluorodeoxyglucose (FDG) with conventional radiological imaging techniques in identifying operable colorectal cancer metastases to the liver. DESIGN: A double-blind comparative study of FDG-PET as the criterion standard vs conventional radiological imaging methods as the criterion standard, in staging of recurrent colorectal cancer. SETTING: Institutional practice in a tertiary referral center. PATIENTS: Thirty-four consecutive patients with suspected colorectal cancer metastases recruited for the study between May 1993 and October 1994. INTERVENTIONS: Conventional radiological methods of cancer staging included abdominal computed tomography (CT) (n = 34), chest x-rays (n = 15), and chest CT (n = 19) to evaluate extrahepatic disease. Twenty-seven patients were subsequently considered to have apparently isolated cancer metastases to the liver. Anatomical resectability was assessed by magnetic resonance imaging (n = 24) or CT angiography (n = 3) in all study patients. The FDG-PET studies (n = 34) were performed within 8 weeks of conventional radiological imaging. MAIN OUTCOME MEASURES: Malignancy of suspected lesions detected by means of FDG-PET and conventional radiological imaging was confirmed by histopathologic examination of resected specimens and percutaneous biopsy specimens and by serial CT scans demonstrating progression of disease. RESULTS: Unsuspected extrahepatic malignant disease that was missed by conventional radiological imaging was detected by FDG-PET in 11 patients (32%). The PET-detected extrahepatic malignant disease included retroperitoneal nodal metastases (n = 6), pulmonary metastases (n = 3), and locoregional cancer recurrences (n = 2). The additional information afforded by PET consequently had an influence on the clinical management in 10 patients (29%). CONCLUSIONS: The FDG-PET method enabled selection of patients with apparently curable colorectal cancer metastases to the liver for hepatic resection.

Colorectal Neoplasms↗
PubMed1996

Intraoperative heparinisation, blood loss and myocardial infarction during aortic aneurysm surgery: a Joint Vascular Research Group study.

OBJECTIVES: The primary aim of this prospective multi-centre study involving patients undergoing elective abdominal aortic aneurysm (AAA) surgery was to investigate the relationship between intraoperative intravenous heparinisation, blood loss during surgery and thrombotic complications. METHODS: Two hundred and eighty-four patients were randomised to receive intravenous heparin (n = 145) or no heparin (n = 139). Groups were evenly matched for age, sex, weight, aneurysm size, haemoglobin concentration, platelet counts and distal occlusive disease measured by ankle/brachial systolic pressure. RESULTS: There were no statistically significant differences in blood loss (median 1400 ml vs. 1500 ml; z = 0.02, p = 0.98, 95% C.I. = -200 to 200), blood transfused (4.0 units vs. 4.0 units; z = 1.09, p = 0.28, 95% C.I. = -1 to 0) or distal thrombosis between the two groups. However, analysis of the clinical outcome revealed that 5.7% of the non-heparin group but only 1.4% of the heparinised patients suffered a fatal perioperative myocardial infarction (MI); p < 0.05. All MI, including non fatal events, affected 8.5% and 2% respectively (p = 0.02). CONCLUSIONS: Heparin does not increase blood loss or the need for blood transfusion during surgery. Heparin is not necessary to prevent distal thrombosis when the aorta is cross clamped. The results of the study are consistent with the known mechanisms leading to intraoperative MI and strategies for its prevention. Intravenous heparin, given before aortic cross clamping, is an important prophylaxic against perioperative MI in relation to AAA surgery.

Anticoagulants↗
PubMed1996

Direct lymphatic drainage from the skin of the forearm to a supraclavicular node.

Lymphoscintigraphy with Tc-99m antimony sulfur colloid was performed on a patient with cutaneous melanoma of the left forearm to define the sentinel nodes before surgery. The patient was found to have direct lymphatic drainage from the left forearm through a clearly seen lymph channel to a sentinel lymph node in the left supraclavicular fossa, and drainage through a separate channel to two sentinel nodes in the left axilla. Surprising patterns of lymphatic drainage can be seen from the forearm, as well as other parts of the skin, and lymphoscintigraphy will enable such patients to be identified before sentinel node biopsy.

Axilla↗
PubMed1996

Determinants of acute regional toxicity following isolated limb perfusion for melanoma.

Hyperthermic isolated limb perfusion (ILP) with melphalan is well established as an effective form of treatment for recurrent melanoma confined to an extremity. High drug concentrations in the limb are readily achieved, without systemic side-effects. However, regional toxicity can lead to considerable morbidity and functional disturbance. This study was undertaken to evaluate factors which might contribute to acute regional toxicity following ILP. Melphalan concentrations in limb blood samples taken at regular intervals during 135 ILPs were measured by HPLC, allowing peak melphalan concentration and area under the curve (AUC) for each procedure to be determined. Acute regional toxicity associated with ILP was found to be significantly correlated with limb tissue temperatures > 40 degrees C, peak melphalan concentration and melphalan AUC, in decreasing order, but was not correlated with tourniquet time. Further studies are required to directly assess melphalan uptake by tumour tissue, and to relate this to both limb toxicity and tumour response.

Antineoplastic Agents, Alkylating↗
PubMed1996

Positron emission tomography in the detection and management of metastatic melanoma.

Initial reports suggest that positron emission tomography with [18F]fluorodeoxyglucose (FDG-PET) may offer greater diagnostic accuracy and versatility than conventional radiology in staging patients with metastatic melanoma. We reviewed the first 100 melanoma patients to have PET imaging at our institution. PET findings were correlated with all other available results, including plain X-ray, computed tomography (CT), magnetic resonance (MR) imaging, bone scintigraphy, clinical findings and histopathology. A total of 415 metastatic lesions were evaluated, 388 (93%) of which were detected by PET. In 20 patients, PET detected 24 metastases up to 6 months earlier than conventional imaging or physical examination. Selection of surgical or medical management was specifically influenced by PET findings in 22 patients, and PET was used to clarify another 12 cases where CT was inconclusive. In nine patients undergoing chemotherapy, PET was used to assess response to treatment. We conclude that FDG-PET can accurately detect metastatic melanoma with a single non-invasive scan, and can demonstrate some metastases months before conventional imaging techniques. PET can improve the selection of patients for surgery, has potential for monitoring response to treatment and may prove a cost-effective means of staging melanoma patients.

Adult↗
PubMed1996

Melanoma of the lip.

Melanoma of the lip is a very rare condition that tends to behave in an aggressive manner. Surgery remains the mainstay of treatment. Five patients with melanoma of the lip are reported, illustrating some of the difficulties that may be encountered in its management. Radical local treatment is necessary to minimize the risk of local recurrence, and flap reconstruction will usually be required to achieve acceptable aesthetic and functional results.

Adult↗
PubMed1996

A lamb-meat-based formula for infants allergic to casein hydrolysate formulas.

Ten infants with colitis due to milk protein allergy, presenting as hematochezia, whose symptoms did not resolve with the use of hydrolyzed cow-milk-based formulas, were treated with a modular lamb-meat-based formula (LOP). The patients were followed up for 3 months to 5 years. Prompt resolution of symptoms was achieved. In three patients, increased levels of creatinine and blood urea nitrogen and mild metabolic acidosis were noted, all returning to normal after the protein intake was lowered. All patients had normal growth. Seven patients were able to tolerate cow milk protein or soy at age 9-15 months. The LOP formula is well tolerated and is a safe alternative formula for infants allergic to cow milk hydrolysate formula.

Animals↗
PubMed1996

Anaesthetic experience with isolated limb perfusion with melphalan for melanoma.

Hyperthermic isolated limb perfusion (ILP) with melphalan is an accepted method of treatment for advanced or recurrent melanoma on a limb. In a review of 124 patients who underwent 130 ILPs at the Sydney Melanoma Unit, the anaesthetic considerations are summarized. All patients received general anaesthesia. The level of monitoring is discussed and monitoring of the limb venous pressure is important to minimize major fluid shifts between the systemic vasculature and the vascular compartment of the isolated limb and extracorporeal circuit.

Adult↗
PubMed1996

Lymphatic drainage to triangular intermuscular space lymph nodes in melanoma on the back.

METHODS: Lymphoscintigraphy with 99mTc-antimony sulphide colloid was performed on patients with cutaneous melanoma of the back to define draining node fields and sentinel nodes before surgery. RESULTS: One patient was found to have drainage from the back to sentinel lymph nodes in the triangular intermuscular spaces bilaterally, above and lateral to the scapula. Subsequently, drainage to this node field has been found in 26% of 42 consecutive patients who have had lymphoscintigraphy performed for melanoma on the back. CONCLUSION: When performing lymphoscintigraphy to locate draining node fields and sentinel nodes in patients with melanoma on the back, it is important to look for drainage to the triangular intermuscular space node field by obtaining posterior and lateral scans. Any sentinel lymph nodes found in this field should be marked prior to surgery in the same way as nodes in other node fields are delineated so that they may be removed at surgery.

Adult↗
PubMed1996

Providing an acute vascular service: two years experience in a district general hospital.

Provision of acute vascular services is a topical subject for debate, but little has been documented on the total numbers of patients referred urgently to vascular surgeons. With the appointment in Exeter of a second consultant surgeon with a vascular interest, a thorough prospective audit was started of all vascular referrals seen outside the normal outpatient booking system. Between 1 February 1993 and 31 January 1995 a total of 877 such referrals were seen (446 in 1993-94 and 431 in 1994-95). The majority were inpatient referrals (38 percent) and patients seen urgently on the vascular surgical ward at the request of general practitioners (37 percent). The commonest presenting problems were limb ischaemia (42 percent), aortic aneurysms (11 percent) and diabetic foot complications (9 percent). The majority of patients were managed non-operatively. The commonest surgical procedure was amputation (in 8 percent), while 6 percent had grafts for aortic aneurysm, 4 percent grafts for ischaemia, 3 percent embolectomy, and 2 percent graft thrombectomy or revision. The two vascular surgeons were involved in out-of-hours operating substantially more than all but one of their general surgical colleagues, despite their reduced commitment to general surgical 'takes'. These figures document the substantial numbers of urgent referrals seen by vascular surgeons, many of which might well remain unrecorded in workload figures, because of the circumstances in which they are seen. We present the details of our arrangements for urgent vascular cover, and discuss the possible alternatives.

Acute Disease↗
PubMed1996

The place of duplex scanning for varicose veins and common venous problems.

Duplex scanning has become the 'gold standard' for confirming reflux and demonstrating anatomy in cases of lower limb venous disease. However, the large numbers of patients presenting with varicose veins (or with skin changes and ulcers) mean that routine use of duplex is impractical, and this investigation has still not become well established in many hospitals. In order to determine the proportion of patients likely to require duplex scanning (and other special tests-photoplethysmography and ascending venography) we reviewed a consecutive series of 201 patients referred to the vascular clinic of a district general hospital with 283 symptomatic limbs affected by varicose veins and/or skin changes and ulcers. Patients were examined clinically and with hand-held Doppler. Duplex scanning was then requested to check for reflux in the popliteal fossa and to examine the groin and residual long saphenous vein in some cases of recurrent varicose veins. Duplex scanning was required in 51 (18%) limbs, venography in 8 (3%), and photoplethysmography in only one limb. In total, special tests were needed in 60 (21%) limbs. Subsequently, 198 (70%) limbs were referred for surgery. We would now (in 1996) duplex scan every case with popliteal fossa reflux and most recurrences. Had all these been scanned, then 79 (28%) would have had special tests. This knowledge should help in planning the implications of a duplex scanning service for varicose veins, skin changes and ulcers.

Adolescent↗
PubMed1996

Cutaneous melanomas that defy conventional prognostic indicators.

Tumor thickness is usually an accurate prognostic indicator for the patient with melanoma. However, very thin primary melanomas occasionally recur locally or metastasize, whereas some patients with very thick primary melanomas survive far longer than expected. There is also a group of patients with primary melanomas of various thicknesses who relapse after a very long disease-free interval. The large database of the Sydney Melanoma Unit which now contains comprehensive long-term follow-up on more than 13,000 patients treated over a 45-year period, has provided a unique opportunity to study melanomas that defy conventional prognostic indicators. Recurrence developed in 2.8% of melanoma patients classified as stage I (pTNM staging system) and with very thin lesions (< 0.50 mm). These recurrences developed more frequently in women than men and histologically were found to be associated with ulceration, high mitotic activity, and invasion to Clark's level IV, but not with regression. Concurrent lymph node metastases (stage III) were present in 3.1% of patients with very thin lesions (< 0.50 mm). In this group, most patients were men, and every lesion displayed regression. Total survival exceeded 15 years in 15.7% of stage II and III patients with very thick lesions (> 5.5 mm). In 1.7% of patients with lesions of any thickness, the disease-free interval before relapse was > 15 years. Neither in patients with very thick lesions surviving for > 15 years, nor in those with a disease-free interval of > 15 years was it consistently possible to show the presence or absence of any of the histological features usually considered to be of prognostic significance.

Adult↗