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Biomedical subjects

J M Edwards

Publications and source records attributed to J M Edwards.

At least 91 records · Page 5Linked to original sources
PubMed1989

Squamous carcinoma of the oesophagus: histological criteria and their prognostic significance.

One hundred resected cases of squamous cell carcinomas of the oesophagus were reviewed and a series of histological criteria related to the survival time. Two histological features were important in the assessment of survival. Good prognostic factors were a marked lymphocytic response to the tumour and a lack of intravenous tumour infiltration. Presence of tumour in the middle third of the oesophagus, infiltration through the muscularis propria, severe tumour necrosis, glandular or small cell tumour differentiation, lymphatic invasion and lack of peritumoural fibrosis were all factors which tended to worsen prognosis. None of these factors reached statistical significance. The degree of squamous differentiation had no effect on survival.

Adult↗
PubMed1989

Asymmetries in intermanual transfer of training and motor overflow in adults with Down's syndrome and nonhandicapped children.

A sequential finger-lifting task was used to examine asymmetries in intermanual transfer of training and motor overflow in Down's syndrome adults and young, nonhandicapped children. Both groups exhibited more interlimb transfer of training from the left hand to the right hand than the reverse. This finding provides evidence for left-hemisphere specialization for the organization and control of sequential movement. While the motor overflow results were less compelling, they provide some evidence for left-hemisphere dominance for movement control in Down's syndrome persons. It is suggested that perhaps the same neural mechanisms are responsible for motor overflow and transfer of training asymmetries.

Adult↗
PubMed1989

Drug use by prostitutes in Sydney.

We report a comparative study of drug consumption by 277 female prostitutes and 95 women who had never worked as prostitutes, attending the Sydney STD Centre in 1985 and 1987. Marijuana was the drug most often used by prostitutes and non-prostitutes, followed by sleeping pills, amphetamines, cocaine and heroin. About 12% in both groups used intravenous drugs but prostitutes were significantly more likely to share needles and syringes. Prostitutes were also more likely to smoke cigarettes than non-prostitutes, and young prostitutes smoked significantly more heavily than other women in the study. Although fewer prostitutes than non-prostitutes drank alcohol, those who did drink were more likely to do so at a harmful level. We conclude that where differences in drug consumption exist between prostitutes and non-prostitutes, they are mainly work related.

Adult↗
PubMed1988

Limb salvage in end-stage renal disease (ESRD). Comparison of modern results in patients with and without ESRD.

We reviewed our experience with femoral-popliteal-tibial reversed vein bypasses performed for limb salvage in 226 patients without and 19 patients with end-stage renal disease (ESRD). While 18-month primary patency rates were comparable (85% and 89%), limb salvage was significantly lower (76% vs 95%) in patients with ESRD. Five amputations in the ESRD group were required for nonhealing, large foot ulcers in diabetic patients despite patent arterial bypass while only five of 13 amputations in patients without ESRD were required in the presence of patent grafts. The need for major amputation despite patent bypass in diabetic patients with ESRD who have extensive foot gangrene or ischemic ulceration occurs sufficiently often that we recommend primary amputation be considered in these patients without regard to possible vascular reconstruction.

Aged↗
PubMed1988

Is analysis of vaginal secretions for volatile organic acids to detect bacterial vaginosis of any diagnostic value?

A study was undertaken to determine which fermentation products in vaginal secretions serve as the best markers for bacterial vaginosis. Three categories of markers had been previously identified, but due to cost considerations it was necessary to accurately determine if analysis for all three were necessary. With the use of vaginal secretions from well-defined patient populations, we applied gas-liquid chromatography to test for both volatile and nonvolatile acid fermentation products. It was found that only the detection of nonvolatile acids was necessary, because no additional patients with bacterial vaginosis were identified by subsequent analysis of volatile acids. Routine analysis of volatile acids to identify patients with bacterial vaginosis is labor intensive and costly and had no clinical diagnostic value.

Acids↗
PubMed1988

Vascular laboratory prediction of pedal pressure following femoropopliteal bypass.

This study examines the hypothesis that postoperative ankle-brachial pressure index (postop ABI) can be accurately predicted using noninvasive preoperative segmental leg pressure measurements. Seventy-three patients who underwent successful reverse autogenous vein femoropopliteal bypass and who had pre- and postoperative segmental leg pressure measurements were examined. Predicted postop ABI was estimated using the following formula: Postop ABI = 1 + (Preop ABI) - (Preop BKI). (BKI = below-knee brachial pressure index). Using this formula, 56 out of 73 (81%) patients had a measured postop ABI +/- 20% of predicted postop ABI. Five out of 73 (7%) patients had postop ABI less than 80% predicted, while 12 out of 73 (16%) patients had postop ABI greater than 120% of predicted. All patients with postop ABI greater than 120% of predicted had apparent tibial artery occlusive disease as indicated by preoperative gradients (BKI-ABI) greater than 0.15.

Anastomosis, Surgical↗
PubMed1988

The anaesthetic management of patients undergoing free flap reconstructive surgery following resection of head and neck neoplasms--a review of 64 patients.

A retrospective study was made of 64 patients who underwent free flap reconstructive surgery following resection of neoplasms, mainly in the head and neck region, over a period of approximately 4 years, from 1983 to 1987, in the Royal Marsden Hospital, London. A brief history of free flap surgery is presented, followed by a description of the anaesthetic technique used, and the results of the study. The various ways in which anaesthetic management may influence the results of surgery are discussed.

Adolescent↗
PubMed1987

Autogenous reversed vein bypass for lower extremity ischemia in patients with absent or inadequate greater saphenous vein.

This report has presented the results of 329 reversed vein bypasses performed for lower extremity ischemia over a 6 3/4 year period. One hundred eighty-nine bypasses were formed from intact ipsilateral greater saphenous veins of adequate size and length. One hundred forty bypasses were formed in patients in whom the ipsilateral greater saphenous vein was absent or of inadequate size or length to complete the bypass. The grafts in these patients were accomplished using a variety of techniques including distal graft origin, use of arm veins and lesser saphenous veins, and use of vein splicing. The patency rates of these grafts were equivalent to those achieved using adequate intact ipsilateral greater saphenous vein. In view of these results, we conclude that the absence of a greater saphenous vein does not preclude successful autogenous lower extremity vein bypass and that prosthetic bypass is rarely justified.

Femoral Artery↗
PubMed1987

Reversed vein bypass to infrapopliteal arteries. Modern results are superior to or equivalent to in-situ bypass for patency and for vein utilization.

In recent years many reports have attributed improved patency and improved vein utilization with lower extremity arterial bypass to infrapopliteal arteries to the use of the in-situ vein graft technique (ISVB). This report describes 110 reversed vein bypasses (RVB) to infrapopliteal arteries performed from 1980-1986. Thirty-three per cent of these patients did not have an intact ipsilateral greater saphenous vein. One hundred per cent of patients had autogenous RVB performed using a variety of techniques, including vein splicing, use of arm veins, lesser saphenous veins, branch veins, and use of graft origins distal to the common femoral artery. The life table patency figures for these grafts are 90%, 85%, and 85% at 1 year, 3 years, and 5 years, respectively. The life table limb salvage at 5 years is 93%. These figures for patency, vein utilization, and limb salvage for modern RVB to infrapopliteal arteries are clearly equal to or superior to any reported figures for ISVB. Results for RVB are greatly improved when compared with historic controls, as are results for ISVB. There is no evidence to date demonstrating superiority of one technique versus another.

Adult↗
PubMed1987

Digital ischemia as a manifestation of malignancy.

The association of malignancy with thrombotic disorders of the arterial and venous systems is well described. To date, however, there are only 23 published case reports of digital gangrene associated with malignancy. During a prospective evaluation of over 700 patients with finger ischemia, there were five patients with finger gangrene associated with malignancy. Detailed clinical and laboratory evaluation, including detailed immunologic survey and hand angiography, allowed establishment of the precise mechanisms responsible for vascular occlusions in each patient. Three mechanisms were identified: arteritis, hyperviscosity, and hypercoagulability. Digital gangrene associated with malignancy is a rare condition, the mechanism for which can be deduced by careful diagnostic evaluation.

Adult↗
PubMed1987

Management of difficult intracranial aneurysms by deep hypothermia and elective cardiac arrest using cardiopulmonary bypass.

Giant anterior circulation aneurysms and some basilar aneurysms can cause problems due to their size, the presence of clot in the aneurysm and the difficulty of applying a clip without kinking the perforating vessels. By utilising cardiopulmonary bypass via the femoro-femoral perforating vessels. By utilising cardiopulmonary bypass via the femoro-femoral route the patient can be cooled to below 20 degrees C allowing the circulation to be stopped for up to 3/4 hour. This will enable the neurosurgeon to unhurriedly dissect out the aneurysm without fear of rupture and where necessary open the aneurysm to remove clot and clip the aneurysm. By draining the circulating volume into the venous reservoir of the pump, a large aneurysm may collapse thus enabling it to be clipped more easily. It is, therefore, a useful technique for difficult aneurysms. We present here a series of 11 patients who underwent this procedure with excellent results in 7. All patients had aneurysms which would otherwise have been either inoperable or very risky to tackle.

Adult↗
PubMed1987

Cerebral specialization in young adults with Down syndrome.

Adults with and without Down syndrome performed a rapid unimanual finger-tapping task alone and while sound-shadowing high frequency words. For male subjects, the concurrent speech disrupted right-hand, but not left-hand performance. Females suffered finger-tapping decrements in both hands in the dual-task situation. These results provide no evidence for reverse (right hemisphere) lateralization of speech in individuals with Down syndrome.

Adolescent↗
PubMed1987

Alpha 2-adrenergic receptor levels in obstructive and spastic Raynaud's syndrome.

The present study examines the hypothesis that alterations in the activity of alpha 2-adrenergic receptors (A2R) may underlie the clinical vasospasm seen in patients with Raynaud's syndrome. Platelets were isolated from 13 normal subjects, from 50 patients with vasospastic Raynaud's syndrome, and from 20 patients with obstructive Raynaud's syndrome and A2R levels measured. Binding capacity as determined in femtomoles per milligram of protein (fmol/mg of protein) and affinity were measured by Scatchard plot analysis. In a separate experiment normal human platelets were incubated with either buffer, normal serum, or serum from patients with spastic Raynaud's syndrome and A2R levels were measured. A2R levels in normal subjects averaged 112 +/- 18 fmol/mg; in the patients with spastic Raynaud's syndrome, 191 +/- 14 fmol/mg, p less than 0.01; and in the patients with obstructive Raynaud's syndrome, 164 +/- 31 fmol/mg, p greater than 0.05 (ns). Of the patients with spastic Raynaud's syndrome, 26% had values that were less than the mean value of the normal subjects (69 +/- 7 fmol/mg, p less than 0.05). The A2R levels decreased after incubation with serum from patients who had spastic Raynaud's syndrome by 17.4 +/- 3.1 fmol/mg (p less than 0.05). These results indicate that most patients with vasospastic Raynaud's syndrome have increased platelet A2R levels, which may constitute a primary pathophysiologic abnormality underlying this condition. The presence of subnormal A2R levels in a portion of the patients and the finding of a decrease in measurable A2R levels after incubation in serum from patients with spastic Raynaud's syndrome suggests the possibility of receptor modulation as a mechanism for increased cellular receptor synthesis.

Blood Platelets↗
PubMed1986

Extraperitoneal iliac endarterectomy in the treatment of multilevel lower extremity arterial occlusive disease.

The traditional approach to the surgical correction of lower extremity ischemia resulting from combined aortoiliac and femoropopliteal disease has consisted of aortofemoral bypass as the initial step. This operation is of considerable magnitude, mandates the use of prosthetic material, and may not adequately relieve distal ischemia. Extraperitoneal iliac endarterectomy is an operation of lesser magnitude and does not require the use of prosthetic material. When applied to selected patients with multilevel disease, it can be conveniently and expeditiously combined with distal bypass and deep femoral repair, femorofemoral bypass, or both for the simultaneous and complete correction of multilevel disease. In the past 10 years, 65 patients underwent simultaneous extraperitoneal iliac endarterectomy in combination with an outflow procedure for the correction of multilevel lower extremity arterial occlusive disease. Using a two-team approach, operative time averaged 3 hours. Operative mortality was 5 percent. The procedure was combined with femoral endarterectomy in 60 patients, with femoropopliteal-to-tibial bypass in 30 patients, and with femorofemoral bypass in 10 patients. The life table patency for iliac endarterectomy was 100 percent at 6 years, whereas patency for the associated outflow procedures was 87 percent at 6 years. These results indicate that extraperitoneal iliac endarterectomy is uniquely suited for combination with distal procedures to permit the simultaneous repair of combined aortoiliac and femoropopliteal disease in a single operation of reasonable magnitude.

Adult↗
PubMed1986

Association of the human Lewis blood group Le(a-b-c-d-) with the failure of expression of alpha-3-L fucosyltransferase.

Two unrelated individuals are reported who lack alpha-3-L-fucosyltransferase activity in their serum and saliva. Both were blacks, one from the United States and the other from South Africa. No other of the tested members of their families lacked this enzyme. A survey of more than 2000 serum samples from both black and white South African blood donors, black United States donors and white United Kingdom donors failed to disclose another example of a serum deficient in alpha-3-L-fucosyltransferase activity. The two individuals lacking in alpha-3-L-fucosyltransferase activity both had the Lewis blood group phenotype Le(a-b-c-d-). No other persons with this phenotype have been reported. The absence of Lec activity in the two individuals who are deficient in alpha-3-L-fucosyltransferase is consistent with the interpretation that alpha-3-linked L-fucose is an essential part of the antigenic determinant recognised by the anti-Lec reagent used in this investigation.

Black People↗