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Biomedical subjects

J V Robbs

Publications and source records attributed to J V Robbs.

At least 91 records · Page 5Linked to original sources
PubMed1985

Intra-arterial diazepam. A report of 2 cases.

Two patients are described who suffered severe complications after inadvertent intra-arterial administration of diazepam. The effects of intra-arterial diazepam are discussed and the prevention of this disaster is emphasized.

Adult↗
PubMed1985

Abdominal aortic aneurysm resection--operative risk and long-term results.

The aim of the study was to assess the early results of abdominal aortic aneurysm resection in relation to cardiac and other operative risk factors, assess the magnitude of the procedure, and evaluate longer-term postoperative rehabilitation; 176 patients (mean age 67,1 years) were assessed, of whom 160 (90,9%) had operations. Using the multifactorial index of cardiac risk in non-cardiac surgical procedures (Goldman) the majority fell into the low-risk category (groups I and II). Other risk factors evaluated were respiratory disease, renal insufficiency, hypertension and diabetes. The majority of these patients had creatinine clearance rates of less than 50% of the theoretical normal rate for age. Of 7 postoperative deaths (operative mortality rate 4,4%) 4 followed myocardial infarction, and all the latter patients fell into cardiac risk grade III. The other risk factors did not significantly influence the mortality or complication rates. The highest complication rate occurred in patients who underwent aortic bifurcation graft placement and the lowest in patients who underwent simple infrarenal tube grafting. Of 153 survivors, 10 have been lost to follow-up and 141 have returned to full activity. In conclusion, the cardiac risk index used is a valuable predictor of operative risk. If the patient survives surgery, excellent longer-term rehabilitation can be expected.

Adult↗
PubMed1985

Atherosclerotic peripheral arterial disease in blacks--an established problem.

Records of black (predominantly Zulu), Indian and white patients admitted to hospital for elective evaluation of chronic peripheral arterial disease over a 2-year interval were examined. The commonest lesion encountered in all three groups was atherosclerosis, although arteritis occurred more frequently in blacks. While atherosclerotic occlusive disease of the lower extremities showed minor differences in distribution in the three groups, aneurysmal disease of the aorta was more frequent in the white than Indian and black groups. Cerebrovascular occlusive disease was also less prevalent among blacks. Age and sex distribution was similar. In a subset of patients, matched for age, with aorto-iliac occlusive disease blacks had a statistically significantly lower incidence of ischaemic heart disease, cerebrovascular disease and hypertension than whites or Indians; and smoked less. Diabetes had a significantly higher incidence in Indians. Within the same group of patients, blacks tended to present at a more advanced stage in the natural history of the disease. However, early and medium-term results of aortobifemoral bypass are not significantly different from those in whites or Indians. Atherosclerosis, contrary to popular belief, is a well-established clinical problem in the black population in Natal.

Black or African American↗
PubMed1985

Management of retroperitoneal haematoma following penetrating trauma.

Experience with the management of 106 consecutive patients found to have a retroperitoneal haematoma (RH) at laparotomy for penetrating trauma over a 2-year period is reviewed. Three types of retroperitoneal haematoma are recognized: Type I (central), Type II (flank) and Type III (pelvic). Type I RH was present in 22 patients as a result of injuries to the inferior vena cava (9), the aorta (5), the pancreas and duodenum (5), the portal vein (2), and to both aorta and inferior vena cava (1). Fourteen patients died (63.8 per cent) representing 70 per cent of all deaths in the series. Type II RH was seen in 73 patients. Thirty-two were stable and the perinephric fascia was not opened with no morbidity or mortality. Forty-one were explored: 15 on pre-operative evidence of renal injury which was confirmed at laparotomy. In the remaining 26 a stable haematoma was explored and no significant lesion found. It is considered that in 45 of 73 Type II RH (61.0 per cent) exploration was unnecessary. Five patients died (6.8 per cent). Type III RH was found in 11 patients and was due to iliac vessel injuries. Two patients died. In conclusion Type I and III RH should be routinely explored. Stable Type II RH discovered at laparotomy should be explored selectively based on pre-operative clinical and radiological assessment of renal injury.

Abdominal Injuries↗
PubMed1984

Bypass versus primary major amputation in patients with femoropopliteal distal disease and a threatened limb.

Over a 36-month period 201 patients came to the Vascular Service, King Edward VIII Hospital, with atherosclerotic occlusive disease involving the femoropopliteal or femoro-infrapopliteal segments. On the basis of angiographic and clinical assessment 113 patients underwent bypass procedures and in 88 amputation was performed. The two groups were well matched as regards age and clinical condition. In-hospital mortality was 3,5% and 2,3% in the bypass and amputation groups respectively and the time spent in hospital was 5-6 weeks. In the longer term the desired achievement was limb salvage or ambulation on a prosthesis. Cumulative life-table analysis showed that more patients in the limb-salvage group than amputees were ambulant over any given time interval, although at 36 months after operation there was only an 8-10% difference. The results suggest that it is worth while attempting limb salvage in these cases, certainly as far as the first 3 years after operation are concerned.

Amputation, Surgical↗
PubMed1984

Prevention of septic complications in massive pelvic-perineal injuries. Case reports.

If they do not immediately lead to death, severe injuries of the pelvis and perineum are frequently complicated by serious invasive infection. This results in a considerable number of late deaths. Adherence to a strict treatment protocol aimed at the prevention of septic complications has undoubtedly reduced the mortality rate related to these injuries. The different aspects of our treatment protocol are outlined, and comprise: (i) antibiotic prophylaxis; (ii) assessment under general anaesthesia; (iii) radical surgical debridement; (iv) diversion of the faecal stream; (v) conservative management of urethral injuries; and (vi)frequent revision of the wounds at 24 - 48-hour intervals. Eight consecutive patients in whom septic complications were successfully prevented are reported on.

Adolescent↗
PubMed1984

Vascular injury with associated bone and joint trauma.

The clinical presentation and management of 102 vascular injuries associated with bone and joint trauma, in 100 patients over a 6-year period, is reviewed. Eighty-three injuries involved the lower limbs. Amputation became necessary in 16 patients. In 12 this was directly attributable to delay in revascularization or the extent of the soft tissue injury with consequent sepsis. Early graft occlusion in an otherwise salvageable limb occurred in four patients (3.9 per cent). Successful therapy involves close co-operation between vascular and orthopaedic surgeons with the vascular injury taking priority. The orthopaedic injury should be treated on its merits. In contaminated or comminuted fractures skeletal traction (or in suitable cases exoskeletal fixation) can be employed without adversely affecting the vascular repair. A plea is made for early diagnosis of concomitant vascular injury in patients with bone and joint injuries; this depends on clinical awareness and careful and repeated examination.

Adolescent↗
PubMed1984

Serum and tissue concentrations of intravenous cefotaxime during aortic surgery.

Ten patients submitted to prosthetic aortic replacement received repeated intravenous bolus doses of cefotaxime (1 g) during induction of anaesthesia and at 2 hourly intervals during the operation. Hourly blood samples were taken and serum cefotaxime concentrations measured using high performance liquid chromatography. Subcutaneous fat, aortic and peripheral arterial wall samples were taken at various intervals intra-operatively, and tissue antibiotic levels were determined by bio-assay using an agar well diffusion method. Mean serum levels were consistently in excess of 50 mg/l which exceeds the MIC90 of virtually all aerobic and anaerobic pathogens. Tissue levels obtained exceeded the MIC90 of most pathogens. Cefotaxime would appear to provide adequate perioperative prophylactic cover in the dosage regimen used.

Aged↗
PubMed1984

Nerve compression injuries due to traumatic false aneurysm.

Experience with 17 patients with delayed onset of compression neuropraxia due to hemorrhage following nonoperative treatment of penetrating arterial injuries is presented. Fifteen cases involved the arteries of the neck shoulder girdle and upper extremity and two the gluteal vessels. This resulted in dysfunction of components of the brachial plexus, median ulnar, and sciatic nerves. Follow-up extended from 3 to 18 months. Of 10 brachial plexus lesions two recovered fully, five partially, and three not at all. Of seven peripheral nerve injuries, full recovery occurred in two patients and none in five. Adverse prognostic factors for neurological recovery are sepsis, involvement of intrinsic hand innervation and the sciatic nerve. An improved prognosis may be expected for upper trunk lesions of the brachial plexus and radial nerve lesions. The complication is essentially avoidable and a careful appraisal of the circulatory status must be made in all patients with penetrating trauma in the neck and shoulder girdle and buttock.

Adolescent↗
PubMed1983

Paraplegia following abdominal aortic surgery. Case reports.

Well-known complications of abdominal aortic aneurysm surgery include haemorrhage, arterial occlusion, infection and aortoduodenal fistula. Less well known is the occurrence of paraplegia. At present there is no estimate of its incidence, and only isolated cases have been reported. We report 2 cases of paraplegia following elective aortic surgery and 2 others following acute occlusion of the abdominal aorta.

Aged↗
PubMed1983

Prevention of wound sepsis in amputations by peri-operative antibiotic cover with an amoxycillin-clavulanic acid combination.

In a series of 44 patients with lower limb ischaemia requiring amputation for major limb sepsis, the performance of a new antibiotic combination with beta-lactamase-inhibiting properties, amoxycillin plus clavulanic acid (A-CA) (Augmentin; Beecham), was compared with that of penicillin in the prevention of wound infection. The sepsis rate of 12,9% in the group of patients receiving peri-operative A-CA was significantly lower than the 76,9% in the penicillin control group (x2 = 14,48; P less than 0,001). It is concluded that there is a need for peri-operative antibiotic cover in this situation and that A-CA appears to be highly effective. No statistical difference was found as regards development of sepsis in wounds closed primarily or left open while under A-CA cover.

Adult↗
PubMed1983

Neurological deficit and injuries involving the neck arteries.

The management of 85 patients with penetrating injuries involving the external (n = 19), internal (n = 6) and common carotid (n = 46), vertebral (n = 10) and brachiocephalic (n = 4) arteries over a 5-year period in one hospital is reviewed. Sixty-three patients had no peroperative neurological deficit; 22 presented with localizing neurological signs. Where there was no deficit, the external carotid (n = 19) and vertebral (n = 10) arteries were ligated without adverse sequelae. Arterial reconstruction was performed of the internal carotid (n = 2) which resulted in a temporary neurological deficit in 7 patients and death in 3. Among the 22 patients with a preoperative neurological deficit, arterial reconstruction was performed in 18, which involved the common carotid in 17 patients and the internal, carotid in 1 patient. There was complete neurological recovery in 11 patients and 2 patients died. Four comatose patients had cerebral revascularization performed without fatality and with complete recovery in 3 of them. CT head scanning was not routinely employed for logistic reasons but has proved of limited value. No intraluminal arterial shunts were used in this series. It would seem that arterial reconstruction is not harmful and may well be beneficial to the young patient with extracranial cerebral arterial injury associated with a neurological deficit. Shunts are probably unnecessary for routine use.

Adolescent↗