Search PubMed⌕ Search

Biomedical subjects

J R Gibbons

Publications and source records attributed to J R Gibbons.

At least 37 records · Page 2Linked to original sources
PubMed1992

The role of rigid oesophagoscopy in oesophageal carcinoma.

The efficacy and safety of rigid oesophagoscopy in diagnostic and therapeutic settings in a consecutive series of 404 patients with oesophageal carcinoma were studied and compared to that for flexible oesophagoscopy in the same group. In addition, we examined the same parameters in a smaller group who had undergone radiotherapy with subsequent malignant stricturing. We performed 328 rigid procedures and 118 flexible procedures in a single regional surgical referral unit over a 7 year period. The combined perforation rate was 1.3%, with an overall mortality of 1% from 446 procedures. We conclude that rigid oesophagoscopy in the presence of carcinoma retains an important diagnostic and therapeutic role which can be achieved with low incidence of perforation in high-risk patients.

Dilatation↗
PubMed1992

Prophylactic digitalisation in pulmonary surgery.

BACKGROUND: Prophylactic digoxin is widely used in patients undergoing pulmonary surgery to prevent or control cardiac arrhythmias, but whether it is helpful or not is uncertain. METHODS: An open, controlled randomised prospective clinical study of 111 patients was undertaken to compare the incidence of cardiac arrhythmias in the 58 patients who received preoperative digoxin and the 53 who did not. RESULTS: Cardiac arrhythmia occurred in half (29/58) of those given prophylactic digoxin and in 36% (19/53) of those who were not. The overall incidence of arrhythmia was 43%, with no statistically significant difference between the groups. CONCLUSION: Cardiac arrhythmias remain an important complication of pulmonary surgery and the incidence is not reduced by prophylactic digoxin.

Aged↗
PubMed1992

Randomised clinical trial of chest drainage systems.

BACKGROUND: Problems in the management of thoracic trauma have stimulated the search for an alternative to underwater seals for drainage of the pleural cavity. A chest drainage bag incorporating a one way flutter valve has been compared with underwater seal drains in a randomised clinical trial. METHODS: During June-December 1989 119 patients undergoing elective thoracotomy were randomised to receive postoperative chest drainage by drainage bags (56 patients, 87 drains) or by underwater seal drains (63 patients, 98 drains). Daily drainage volumes, the requirement for pleural suction, mobility, and complications were recorded prospectively. RESULTS: There was no significant difference between the two groups in the mean volume drained, the requirements for pleural suction, or the occurrence of complications. Patients with drainage bags were fully mobile 23 hours (95% confidence interval 0-47 hours) earlier than the others. CONCLUSIONS: When used after elective thoracotomy drainage bags are safe and effective and permit earlier mobility than underwater seal drains.

Adolescent↗
PubMed1990

Gastrin-releasing peptide in normal and neoplastic human lung: measurement and biochemical characterization.

Levels of gastrin-releasing peptide (GRP) were determined by radioimmunoassay in human normal main and lobar bronchus and parenchymal lung tissue extracts. It was found that the level of GRP differed significantly between all 3 areas. The concentration of GRP was statistically higher in main bronchus (median 6.74 ng/g) compared to both lobar bronchus (median 4.79 ng/g) and parenchymal lung (median 1.73 ng/g), and also statistically higher in lobar bronchus compared to parenchymal lung. Chromatographically, GRP-immunoreactivity in both main and lobar bronchial extracts corresponded to GRP1-27 and GRP18-27, while in lung tissue only one major species was identified which corresponded in retention time to GRP18-27. No significant difference was detected when the levels of GRP in normal lobar bronchus and normal lung tissue were compared to the levels in lobar bronchus and lung taken from patients with lung carcinoma, at a site adjacent to the carcinoma. However, a significant difference was observed between the GRP content of normal main bronchus compared to main bronchus from patients with carcinoma. GRP was measured in 26/56 lung carcinomas examined. The levels ranged from 42,000 ng/g in a carcinoid tumour to 0.18 ng/g in a squamous-cell carcinoma, though only in 6 tumours were the levels outside the range determined for normal pulmonary tissue. Chromatography of selected tumour extracts of different histopathologies showed that there were differences in the GRP products present.

Adenocarcinoma↗
PubMed1990

Prophylactic digitalization for thoracotomy: a reassessment.

A prospective, controlled, randomized clinical study of 140 patients undergoing elective thoracic operations over a period of 1 year in a regional referral unit was performed in which one group received digoxin and the other did not. The incidence of cardiac arrhythmia was compared in each group. Overall mortality was 5.7%. There was no significant difference in incidence of cardiac arrhythmia in each group, and we conclude that the prophylactic use of digoxin in elective thoracic operations should be revised.

Age Factors↗
PubMed1990

Sutures, staplers, leaks and strictures. A review of anastomoses in oesophageal resection at Royal Victoria Hospital, Belfast 1977-1986.

Leakage from an oesophagogastric anastomosis has a high morbidity and mortality. Recent evidence suggests that mechanical tissue stapling devices can decrease the rate of anastomotic breakdown but at the expense of an increase in the occurrence of fibrotic strictures at the anastomosis site. This study examines the rate of leakage and stricture in hand sutured and stapled anastomoses. A retrospective study was made of 221 oesophagogastric anastomoses following resection for carcinoma between 1977 and 1986. There were 122 sutured and 99 stapled anastomoses. Leak occurred in 21 sutured (17.2%) and 7 stapled (7.1%), P less than 0.05. If the stapled anastomosis was completely satisfactory and required no reinforcing sutures, the breakdown rate was in fact only 3% (2/69), P less than 0.01. A stapled anastomosis which required reinforcement had a similar chance of breakdown as a sutured anastomosis (16.7%). There was little difference in the performance of registrars in training and consultants at hand-sewn anastomoses with leakage rates of 13.7% and 18%, respectively; P greater than 0.05. The registrars, however, did not improve with the use of the stapler with a leakage rate of 14.3% compared to the consultants' rate of 1.75%, P less than 0.05. Involvement of the limits of resection with tumour slightly favoured breakdown--15.5% compared to 11.6% if the limits were free from tumour, P greater than 0.05. The incidence of malignant strictures was similar in both groups but benign stricture was more common in the stapled group--13% (13/99) compared to 1.6% (2/122), P less than 0.01. The mechanical stapler brings uniformity to the anastomosis but cannot compensate for deficiencies in surgical technique.

Anastomosis, Surgical↗
PubMed1990

Placement of an apical chest tube by a posterior intercostal approach.

Apical pneumothorax due to incomplete expansion of the lung is not uncommon following thoracotomy and also occurs in some patients with recurring spontaneous pneumothorax. Standard methods of intercostal drainage may be unsatisfactory because of difficulty in placing an intercostal tube safely and accurately within the apical air space.

Chest Tubes↗
PubMed1990

Post-operative sputum retention treated by minitracheostomy--a ward procedure?

Cricothyroidotomy, using the percutaneous 'minitracheotomy' technique, was performed in 67 patients (55 for sputum retention, two for endobronchial rupture of an empyema, 10 prophylactically). In two patients the cricothyroid membrane was penetrated with considerable difficulty, and in one further patient insertion was not possible due to calcification of the cricothyroid membrane. One patient required exploration of the insertion site because of bleeding. Two patients inhaled the 'Mark 1 Minitrach' device and required urgent bronchoscopic removal. In those patients undergoing successful cricothyroidotomy, there was a dramatic improvement in respiratory distress. There were no deaths related to the insertion of the minitracheotomy device in this series.

Adolescent↗
PubMed1989

Treatment of missile injuries of the chest: Belfast experience.

Four hundred and thirty patients with major missile-induced injuries of the chest have been treated in one surgical unit. Over 30% of cases had multiple injuries. The immediate first-aid treatment and hospital management are described. As a result of our experiences, an aggressive surgical approach has developed and our indications for thoracotomy are described. The overall mortality was 6%.

Firearms↗
PubMed1988

Oesophago-pericardial fistula and cardiac tamponade after oesophagoscopy.

A case of oesophago-pericardial fistula following oesophagoscopy and dilatation is reported. This is a rare and usually fatal complication of oesophageal instrumentation. This case is of further interest as cardiac tamponade following a Niopam swallow subsequently occurred, and the patient survived emergency surgery.

Aged↗
PubMed1988

Pericardial hemangiopericytoma as a cause of dysphagia.

A 68-year-old woman was seen with recent-onset dysphagia. Investigations suggested a large retrocardiac tumor. At thoracotomy, a highly vascular tumor was found, involving the posterior and left aspect of the pericardium with attachment to the heart. The lesion was partially removed, and histopathological analysis revealed a malignant hemangiopericytoma. To our knowledge, this tumor site and its presentation have not been reported before.

Aged↗