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Biomedical subjects

J V Robbs

Publications and source records attributed to J V Robbs.

At least 109 records · Page 6Linked to original sources
PubMed1982

Peri-operative antibiotic cover in amputations using an amoxycillin-clavulanic acid combination.

In a series of 64 patients requiring amputation for lower limb sepsis, the performance of a new antibiotic combination with beta-lactamase-inhibiting properties, amoxycillin plus clavulanic acid (A-CA) (Augmentin; Beecham) in the prophylaxis of postoperative wound sepsis, was compared with that of a combination of amoxycillin and ampicillin (A-A) (Suprapen; Bencard) and a control group. The sepsis rate following A-CA prophylaxis (12,9%) was significantly less than in the control group (x 2 = 18, 49; P less than 0,001). Although not attaining statistical significance (x 2 = 2, 12),, A-CA compared favourably with A-A (sepsis rate 35.3%) in the prevention of post-amputation wound sepsis. There was no statistically significant difference in the development of sepsis between wounds closed primarily and those left unsatured while under A-CA cover. It is concluded that peri-operative antibiotic cover for amputations in septic lower limb lesions is advisable and that A-CA is a valuable antibiotic in this situation.

Adult↗
PubMed1982

A clinical re-evaluation of intravenous aortography for aortic aneurysms.

The value of intravenous aortography in the preoperative assessment of patients with abdominal aortic aneurysms is discussed. Fifteen patients with abdominal aortic aneurysms were investigated by ultrasonography followed by intravenous aortography, and the diagnostic accuracy of pre-operative clinical assessment was compared with these investigations. Particular attention was paid to the relationship of the renal arteries to the level of origin of the aneurysm, as this determines the operative approach. In 6 patients the operative approach was altered when intravenous aortography indicated erroneous clinical or ultrasonic diagnoses. We have found this a safe and useful part of the routine pre-operative investigation of patients with aortic aneurysms.

Aorta, Abdominal↗
PubMed1982

Surgery for aneurysms involving the thoraco-abdominal aorta. Report on 2 patients.

The surgical management of 2 patients presenting with symptomatic thoraco-abdominal aneurysms is reported. In the first patient a technique which utilized multiple side-arm grafts to the visceral arteries is described. In the second patient we used the simpler and more expeditious technique of anastomosing the visceral artery orifices to "windows" in the aortic replacement graft from within the opened aneurysm. The merits and demerits of the different techniques and their hazards are discussed. It would seem that few aneurysms can be regarded as inoperable.

Adult↗
PubMed1981

A clinical trial of a combination of amoxycillin and flucloxacillin in amputations for septic ischaemic lower limb lesions.

The incidence of sepsis after amputation with or without a proximal arterial reconstructive procedure in 24 patients presenting with septic ischaemic lower limb lesions and who received a parenteral combination of amoxycillin and flucloxacillin (Suprapen; Bencard) is compared with that in a similar control group of 22 patients who received antibiotics only if postoperative sepsis developed. There was no significant difference in the incidence of sepsis in the arterial reconstruction wounds. Amputation stump sepsis occurred in 33.3% of patients receiving prophylactic antibiotics compared with 72.7% of the control group. The difference is statistically significant. A similar significant difference was found among 32 patients submitted to primary amputation without an arterial reconstructive procedure. Bacteriological data are discussed.

Adult↗
PubMed1981

Cervicomediastinal arterial injuries. A surgical challenge.

The initial clinical observations and methods and results of treatment in 104 patients with subclavian (48), vertebral (four), and carotid (52) artery injuries are reported. Delayed hemorrhage ten days after misdiagnosed subclavian artery injuries resulted in false aneurysms causing compressive brachial plexus palsies. A conservative approach to penetrating cervicomediastinal wounds was adopted with selective use of arch aortography when arterial injury was suspected by defined criteria. This proved safe, accurate, and invaluable for planning operative approach. Partial median sternotomy without entering the pleura proved optimal for superior mediastinal access; simple clavicle transection provided adequate distal subclavian exposure. External carotid and vertebral arteries were ligated. No shunts were employed for common and internal carotid repair. None of the 14 patients revascularized in the presence of a neurologic deficit died and none was made worse by carotid reconstruction.

Adolescent↗
PubMed1981

Factors contributing to recurrent lower limb ischemia following bypass surgery for aortoiliac occlusive disease, and their management.

Fifty-eight patients have been treated for recurrent lower limb ischemia following bypass surgery for aortoiliac occlusive disease over a three-year period. Based on clinical case notes, angiograms, operative notes and histologic examination of endarterectomy specimens, 32 patients (55.2%) were found to have progressive atherosclerotic occlusion involving the inflow (seven patients) or outflow (25 patients) tracts. Seven patients (12.0%) had problems related to graft angulation or mural thrombus fragmentation and, in four patients, anastomotic fibroplasia was demonstrated. Fifteen patients (25.9%) had not had their disease bypassed by the primary operation and required reoperation within one year. It is suggested that the use of juxtarenal end-to-end proximal anastomosis, extending to the groins distally in most cases, and good graft to host size match may be important considerations. Management entailed major aortic reconstructions in 28 patients, and local groin procedures or crossover grafts in 30 patients. There was one postoperative death (1.7%). Two patients had amputations (3.4%) although all grafts were functioning at the time the patients were discharged from the hospital. Major complications were more frequent following aortic reconstruction, and operations of this magnitude may, possibly, be confined to patients with aortic inflow obstruction, infection involving the graft body or redundancy of the graft body causing sufficient angulation to cause obstruction.

Adult↗
PubMed1981

Eight-year experience with 3392 endoscopically proven duodenal ulcers in Durban, 1972-79. Rise and fall of duodenal ulcers and a theory of changing dietary and social factors.

From 1972 to 1979, a total of 3392 patients with endoscopically proven ulcers were seen, in six ethnic groups. The distribution was as follows: Africans 456 males, 182 females; Muslim Gujerati Indians 206 males, 60 females; Hindu Hindi 433 males; total North Indians 639 males, 195 females; Hindu Tamils 593 males, 184 females; Hindu Telegu 179 males, 46 females; total South Indians 872 males, 230 females, and Whites 465 males, 303 females. In the continent of India, it is predominantly the South Indians who suffer from duodenal ulcer. In Durban, the number of North Indians with duodenal ulcers approximates that of those from the South (North: South ratio 0.83). The first question raised by this study is that the protective factors in North Indians in India are not genetic, and are lost when they emigrate to Natal. This may be due to changes in diet. A seasonal analysis indicates that, for females, there is a striking Autumn and Winter predominance in all Indian groups, reaching 80% in Muslims and Telegus but not in African females (52.7%). The second question raised by this study is that protective factors must be sought which operate in Indian females in the Spring and Summer months. The third question emanating from this study is that duodenal ulcers (and ischaemic heart disease) appear to increase in times of dietary and social change. This occurred in the West from 1890 to 1960, and is still occurring in the Third World. The restoration of dietary fibre and unsaturated fat, and the possible adjustment to stress in the West since 1960, has been accompanied by a fall in the incidence of these diseases. A 'changing factors' theory of duodenal ulcers and ischaemic heart disease is proposed. These conditions fall when a 'plateau situation' is reached.

Adult↗
PubMed1980

Prospective evaluation of selection for operation for duodenal ulcer based on acid secretory studies: Interim report after 1-5-year follow-up.

The interim results of elective vagotomy for duodenal ulcer in 102 patients in whom the pre-operative pentagastrin-stimulated maximal acid output (MAO) was used to select patients for operation have been propectively evaluated 1-5 years after operation. Sixty-seven patients had an MAO of less than 25 mmol/h and were submitted to truncal vagotomy with a drainage procedure; 35 had an MAO in excess of this and underwent antrectomy in addition to truncal vagotomy. There have been no deaths and no proven recurrences of duodenal ulcer. Two patients in the truncal vagotomy and drainage group have developed gastric ulcers, probably due to gastric stasis, and are the only patients in the series who can be classified as surgical failures (Visick grade 4). The preliminary results indicate that the selective policy is justified.

Drainage↗
PubMed1980

Penetrating injuries of the neck: a prospective study of 108 patients.

One hundred and eight patients were admitted to King Edward VIII Hospital, Durban, with a penetrating wound of the neck and were managed by a conservative policy. Intervention was undertaken if, and only if, there was an indication of damage to deep structures. Data were collected prospectively. Significant sequelae were seen in only 50 patients (46 per cent) and 26 underwent surgery. Three patients died from their neck injuries (2.8 per cent). 2 after operative intervention and 1 after conservative management. Morbidity was higher after surgery, though local sepsis in wound haematomas was more common in those treated conservatively. A selective policy for surgical intervention is safe and justifiable. A minimum mortality and morbidity can be obtained by adequate preoperative evaluation which includes the use of contrast radiography and angiography.

Adolescent↗
PubMed1980

Septic erosion of the internal carotid artery. A case report.

A case of pseudo-aneurysm of the internal carotid artery with arterio-venous fistula formation, involvement of the vagus and sympathetic nerves and proptosis is described. The diagnostic features are stressed, namely: recurrent minor haemorrhages from the nose and throat, a Horner's Syndrome, a swelling resembling a quinsy and involvement of the last four cranial nerves. Early diagnosis and immediate ligation are essential in these cases.

Adult↗