Search PubMed⌕ Search

Biomedical subjects

J V Robbs

Publications and source records attributed to J V Robbs.

At least 73 records · Page 4Linked to original sources
PubMed1989

Systemic complications after elective abdominal aortic surgery. A retrospective analysis.

While the range of systemic complications causing death after aortic surgery is well documented, the incidence is not. A study was undertaken to determine the incidence of systemic postoperative complications and the operative mortality of patients undergoing elective aortic surgery in a hospital that caters to a homogeneous population group. Records of 557 patients who had undergone aortic bypass or aneurysm replacement surgery over an 8-year period were studied at Addington Hospital, Durban. All had placement of a prosthetic fabric graft, 188 (33%) for aortic aneurysm replacement. Men made up 56% of the patients and the average age was 66 years. Standard selection criteria and peri-operative management were employed in all cases. All patients were classified according to the Goldman scoring system. There were significant systemic complications in 48 patients (8.6%), with 23 (4%) deaths. Respiratory complications were the most frequent (2.9%) followed by gastro-intestinal complications. (2.9%) followed by gastro-intestinal complications. The most frequent causes of death were cardiac arrest (20%) and gastro-intestinal malfunction, mainly bowel infarction. Only 3 patients developed acute renal failure in isolation but all died. When age was analysed as a factor in the causation of morbidity, there was an appreciably lower complication rate in patients under 50 years, but this reached a plateau in the 6th decade. The overall mortality and morbidity rates were acceptable. It would appear that age is weighted too heavily in the Goldman scoring system, although these criteria have reduced the incidence of cardiac complications.

Adult↗
PubMed1988

Nonpenetrating subclavian artery trauma.

Nonpenetrating injury to the subclavian vessels is uncommon. During a 6-year period we have treated 167 patients with injuries to the subclavian and superior mediastinal arteries. Fifteen of these injuries (9%) occurred after blunt trauma. In 10 patients the proximal segment (first and second parts) of the artery was involved. No patient had an isolated injury; the most frequent associated injuries were rib fractures (n = 11), with the first rib being involved in four of these. Total brachial plexus disruption was found in nine patients. All patients with distal artery involvement had a clavicular fracture. All had an absent radial pulse and eight had critical ischemia of the hand. Four patients were treated nonoperatively and the remainder were treated along standard lines. Brachial plexus reconstruction was not feasible in any patient. Within 2 weeks of operation, one patient died as a result of head injuries and one required amputation because of sepsis. During a 12-month period, five regained full function, one additional patient requested above-elbow amputation after 6 months, and seven had a flail anesthetic limb. Twelve of these patients were involved in automobile accidents, eight of whom were wearing lap-shoulder harness seat belts with a loose-fitting shoulder strap component that created a characteristic abrasion pattern on the torso and chest. We conclude that the torsionshearing motion allowed by this situation contributed significantly to the pattern of injury and a plea is made for correctly fitted restraining devices.

Adult↗
PubMed1988

Antibiotic prophylaxis in aortic and peripheral arterial surgery in the presence of infected extremity lesions. Results of a prospective evaluation.

Over a 6-month period 124 patients submitted to aortic or infra-inguinal arterial reconstruction were alternately allocated to receive cloxacillin plus gentamicin (CX/GM) for 48 hours or cefotaxime (CTX) for 24 hours perioperatively. Evaluations during during the first month were performed by a blinded independent observer and patients were followed for between 6 and 20 months. 63 patients received CX/GM and 61 CTX; the groups were matched for sepsis risk factors. Sepsis rates were: groin and abdominal wounds, CX/GM 5.4% (7 of 129), CTX 6.2% (8 of 127); graft, CX/GM 1.5% (1 of 63), CTX 3.3% (2 of 61). The differences were not statistically significant (p greater than 0.05). Virtually all wound infections were superficial (class I) and no late infections have emerged. 56 patients had infected extremity lesions and 68 had no lesion. There was no significant difference in wound or graft sepsis rates between the 2 groups. Positive cultures of groin lymph nodes and/or aortic clot or atheroma did not predispose patients to postoperative sepsis. The organisms cultured from the extremity lesions were not found in infected wounds of abdominal surgery patients. However, species type and antibiotic susceptibility patterns suggest that the same pathogens were present in wound infections as were isolated from the extremity lesions of patients who underwent infra-inguinal surgery. Thus direct, rather than lymphatic, contamination may be the major aetiological factor. Most infecting organisms were susceptible to the antibiotic used.

Adult↗
PubMed1987

Management options for penetrating injuries to the great veins of the neck and superior mediastinum.

Between January 1984 and January 1986, 74 patients were treated for stab or gunshot injury to the great veins in the neck and superior mediastinum. Veins involved in the neck were the subclavian and internal jugular and in the mediastinum, the brachiocephalic and subclavian vein and the superior vena cava. Most patients presented in a state of shock. Twenty-nine were bleeding too rapidly to resuscitate adequately and required emergency operation while in a moribund state. Twenty-five had arteriovenous fistulas and were hemodynamically stable. Direct venous repair was attempted if simple lateral suture or end to end anastomosis could be rapidly done. If complex repairs were required, ligation was performed. Fifty-five veins were ligated on this basis, including 14 brachiocephalic trunks, nine proximal subclavian veins and one superior vena cava cephalad to the azygos. Nineteen were repaired. Two patients died after ligation and one patient after repair, all as a result of the effects of massive hypovolemia. Edema of the upper limb developed in two patients in each treatment group in whom the distal part of the subclavian vein had been involved. The edema resolved within five to seven days. Chronic venous stasis problems did not develop in any patient during the two to 26 month follow-up period.

Adult↗
PubMed1986

Extracranial arterial reconstruction for chronic cerebral ischaemia. An audit of experience in the Durban Teaching Hospitals.

Experience with 147 operations for extracranial cerebral arterial reconstruction in 122 patients over a 36-month period is presented. The commonest condition in white, black and indian patients was atherosclerosis, although 8 of the 23 black patients had nonspecific aorto-arteritis (Takayasu's disease). Operations within the mediastinum included bypass from the ascending aorta to major arterial branches (14), brachiocephalic endarterectomy (1), and replacement grafts of carotid (1) and subclavian (1) arteries. Cervical procedures included carotid endarterectomy or reconstruction (115), carotid-subclavian artery bypass (13) and axillary-to-axillary artery crossover (2). Both early and longer-term results are comparable with those reported in the surgical literature.

Adult↗
PubMed1986

Staged below-knee amputations for septic peripheral lesions due to ischaemia.

Preservation of the knee joint is of paramount importance in lower limb amputation for ischaemia. Clinical predictors of healing are unreliable in patients with septic peripheral lesions due to ischaemia. Seventy-three patients in whom a below-knee amputation was considered likely to heal, based on the temperature and appearance of the skin and bleeding from skin and muscle flaps, were divided into two groups. Twenty-nine (Group A) had a primary below-knee (BK) amputation at the site of election with delayed primary skin closure, while 44 patients (Group B) initially had a guillotine BK amputation below the site of election, with elective amputation at the appropriate level once infection had been eradicated (4-5 days later). The groups were similarly matched with regard to level of occlusive arterial disease, nature of ischaemic lesions and operative risk factors. There was no significant difference in the overall operative mortality in Group A (6.7 per cent) compared with Group B (11.4 per cent) (P greater than 0.05). There was a significantly higher above-knee revision rate in Group A survivors (33.3 per cent) compared with Group B (7.7 per cent) (P less than 0.01) due to non-viability and uncontrolled sepsis of the BK amputation site. The presence or absence of a palpable femoral or popliteal pulse had no significant influence on healing in either group.

Amputation, Surgical↗
PubMed1986

Abdominal aneurysms in a black population: clinicopathological study.

With exclusion of vascular trauma 2182 patients (1302 black and 880 white) have been treated in our Vascular Service over a period of 3 years. Sixty black patients (4.6 per cent) and 260 white patients (29.5 per cent) presented with aneurysms of the aorta and its abdominal branches. The aneurysms in the black group were distributed as follows: 50 aortic (9 suprarenal, 41 infrarenal), 6 common iliac artery, 2 superior mesenteric and 2 renal artery aneurysms. None of the 260 aneurysms seen in white patients involved arteries other than the aorta (16 suprarenal, 244 infrarenal). In the black group there was an almost equal distribution among sexes, whereas in the white group there was a male to female ratio of 2:1. The mean age was 49.4 years among the black patients, and 67.1 years among the white patients. Surgery was performed on 47 black patients and 245 white patients. Among the black patients 16 aneurysms were atherosclerotic (34 per cent), 22 were of non-atherosclerotic origin (47 per cent) and 9 were of uncertain nature (19 per cent). Of the 22 non-atherosclerotic aneurysms 14 were due to non-specific aorto-arteritis, 4 were due to tuberculous arteritis, 2 were due to intimomedial mucoid degeneration, 1 was due to syphilitic aortitis and 1 was a mycotic aneurysm. In the white group 243 aneurysms were atherosclerotic and 2 had changes of intimomedial mucoid degeneration. All aneurysms were treated along standard surgical lines, antituberculous treatment was initiated when appropriate. It was concluded that abdominal aneurysm is an uncommon disease in black patients. When it occurs a more heterogeneous pathology can be expected with an unusually high prevalence of aorto-arteritis compared with the white population.

Adolescent↗
PubMed1986

Operative treatment of nonspecific aortoarteritis (Takayasu's arteritis).

Operative treatment of nonspecific aortoarteritis remains controversial and little information is available on the results of reconstruction of extracranial cerebral vasculature in this disease. Our experience with 25 patients with histologically proven symptomatic disease treated during a 4-year period is presented. The aortic arch and its branches were involved in 12 patients and 13 had disease affecting the descending aorta and its tributaries. Patients with cerebrovascular disease had aneurysms, minor stroke, or intermittent neurologic dysfunction. Descending aortic involvement resulted either in symptomatic or ruptured aneurysm and renovascular hypertension. Operative treatment of cerebrovascular disease comprised aortic arch (three patients), carotid (three patients), or subclavian artery reconstruction (six patients). Descending aortic reconstruction comprised thoracoabdominal (four patients) or infrarenal (five patients) aneurysmorrhaphy, abdominal aortic replacement with bilateral renal artery reconstruction (two patients), and nephrectomy (two patients). One early postoperative death occurred because of stroke. Twenty-four survivors have been observed between 3 and 42 months. No deaths or further neurologic episodes have occurred during this period and three of five hypertensive patients were cured. We conclude that symptomatic aortoarteritis, including cerebrovascular disease, may be treated by standard operative techniques with rewarding results.

Adolescent↗