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Biomedical subjects

J V Robbs

Publications and source records attributed to J V Robbs.

At least 127 records · Page 7Linked to original sources
PubMed1980

Blunt abdominal trauma with jejunal injury: a review.

Jejunal perforation is relatively common following focal blunt abdominal trauma. The mortality rate remains in the region of 30%. Significant factors affecting mortality are therapeutic delay of 24 hours or more, and multiple injuries. The commonest clinical features are abdominal pain, tenderness, and guarding, diminished or absent bowel sounds and signs of hypovolemia. Diagnostic difficulty is presented by the patient with an impaired level of consciousness and/or associated remote injuries which may distract the clinician from the abdomen. Delayed rupture may also occur, and observation should continue for at least 48 to 72 hours with a warning to return immediately if pain recurs. Straight abdominal and chest radiography are of limited diagnostic value, but nevertheless may prove helpful in 50% of cases. All patients with multiple injuries, particularly in the presence of a head injury with an impaired level of consciousness should be submitted to diagnostic abdominal paracentesis. A negative result should prompt diagnostic peritoneal lavage. Early diagnosis and aggressive therapy are essential if the mortality is to be reduced. To this end careful, frequent abdominal assessment should be practiced, with immediate laparotomy if clinical parameters deteriorate, or do not improve over a 12 to 18-hour period.

Abdominal Injuries↗
PubMed1979

Duodenal ulceration in Indians and Blacks in Durban.

Duodenal ulceration among Black and Indian patients admitted to King Edward VIII Hospital, Durban, over a 26-year period (1950-1976) was studied. Analysis was made over a series of time intervals within this period, and expressed as the number of admissions for duodenal ulcer per 1,000 total admissions (excluding obstetric and gynaecological patients). Admissions for duodenal ulceration increased 2,4-fold among the Indians and 11,9-fold among the Blacks from 1950 to 1976. The disease appears to have become commoner among women in both race groups. The peak age for Indian men is the 3rd decade, but for Indian women the peak age incidence has changed from the 4th to the 6th decade. There is now a peak in the 3rd decade for Black men, compared with the 4th decade, as reported 20 years ago. The pattern is similar in Black women. The clinical presentation is similar in the two groups, although it is significant that haemorrhage occurs more frequently among the Black patients.

Adolescent↗
PubMed1979

Late revascularization of the lower limb following acute arterial occlusion.

Thirty-four patients presenting with signs of grave ischaemia of the lower limb following acute arterial occlusion had revascularization procedures performed. Fifteen of the incidents followed embolism or thrombosis and 19 were due to a traumatic cause. Limb salvage was achieved in 67 per cent of the nontraumatic group and in 56 per cent of the traumatic group. Severe complications such as crush syndrome and disseminated intravascular coagulation occurred but there were no deaths. No significant adverse factors with regard to limb prognosis could be defined. We feel that late revascularization in the absence of major gangrene is worth while provided that facilities for critical postoperative care exist.

Adolescent↗
PubMed1978

The alternative to colostomy for the injured colon.

In 34 patients with penetrating colon wounds which were considered to be liable to dehiscence, the sutured wounds were exteriorized. There were several 'high-risk' factors, i.e. operative delay of more than 6 hours after injury, faecal contamination of the peritoneal cavity, marked contusion of the bowel wall, and severe associated visceral haematoma which is deemed liable to infection. Additional considerations were thoraco-abdominal penetration and combined colonic and renal injuries. The operative technique is described in detail, and the morbidity of the procedure, which is low, is analysed. Comparison is made with a similar group of patients in whom colostomy was performed with subsequent closure. Exteriorization and closure of the penetrating colon wound appear significantly superior to colostomy in terms of mortality, septic complications and period of hospitalization.

Adult↗
PubMed1978

Major arterial trauma: review of experience with 267 injuries.

Experience with 267 arterial injuries treated over a 3--4-year period is reported. Vessels in the lower limb were involved most commonly (43 per cent), but there was also a relatively high incidence of carotid (13 per cent) and subclavian (9 per cent) injuries in this series. Penetrating wounds (stab and gunshot) were most commonly responsible. We found that serious distal ischaemia is uncommon in upper limb injuries, but expanding haematoma at the root of the limb is a cause of mortality and serious morbidity. Selective use of preoperative angiography is recommended. Successful results follow liberal use of interposition grafts after wide excision of doubtful vessel, rigorous wound excision, delayed primary closure and fixation of associated fractures. Repair of concomitant venous injuries should always be attempted but is more important in the lower than the upper limb. Late revascularization in the presence of critical ischaemia yields a 50 per cent limb salvage rate, but great care must be taken to avoid renal insufficiency and, if it occurs, energetic treatment is necessary for survival.

Adult↗
PubMed1978

Arterial trauma involving the lower limb.

Experience with 105 lower limb arterial injuries in 103 patients in a general hospital is described. The pathology is discussed: it is noted that spasm per se could not be incriminated as a cause of ischemia. Management of the injuries and associated fractures is outlined. A plea is made for use of external fixation in compound injuries. An aggressive approach to the degloved limb, open three-compartment fasiotomy for severe vascular injury with signs of ischemia, and delayed primary closure for wounds with septic complications are recommended. Associated soft-tissue injury requires arterial reconstruction even in the presence of muscle rigor and anesthesia.

Adolescent↗
PubMed1977

Tests for completeness of vagotomy.

A battery of tests was applied to 60 patients at periods varying from 2 to 24 months after they had undergone truncal vagotomy (42 with pyloroplasty, 18 with gastro-enterostomy). The major comparison was between those with endoscopic evidence of recurrent duodenal ulcers, and those in whom endoscopy showed no abnormality. Tests which differentiated between the two groups to a statistically significant extent were those for increased acid concentration in the first hour after insulin and serum gastrin, which was lower in this group. Useful, but statistically not significant tests, in patients with no endoscopic evidence of recurrent ulcers, were a postoperative decrease in basal acid output and maximal acid output after pentagastrin or insulin. Symptoms, the combined pentagastrin-insulin test, the volume of acid secreted after insulin, and the acid concentration in the second hour after insulin stimulation were poor indicators for differentiating between patients with recurrent ulcers and those without ulcers. Almost as much information was obtained by the postoperative basal acid output alone as by the pentagastrin and insulin stimulatory tests.

Duodenal Ulcer↗
PubMed1977

Subclavian and axillary artery injuries.

Experience with 36 Black patients with disruption of the subclavian or axillary arteries is reported. The clinical presentation and operative approaches are described. The average time interval between injury and diagnosis of arterial injury was 10 days. Two case reports which illustrate the adverse consequences of delayed treatment are presented. Careful clinical assessment of penetrating injuries in the neck and shoulder region is necessary to exclude major arterial injury. Arch aortography is indicated if arterial injury is suspected.

Adolescent↗
PubMed1977

An experimental study of suture of colonic wounds in the rabbit.

It would seem that, during the early phase of healing of a sutured colonic wound in the rabbit when a single layer continuous suture is used, silk results in a significantly stronger wound when compared with polypropylene, polyglactin 910 and chromic catgut of the same gauge, 000. Although at 14 days after operation, no significant differences in wound strength are apparent there appears to be some weakening at 21 days after operation. This is most marked with absorbable sutures, especially polyglactin 910. The mechanism of this is uncertain but may well be at a biochemical level related to collagen maturation. The strength of the suture line bears no correlation whatever to the degree of acute inflammatory reaction or fibrosis excited by the suture material upon histologic examination.

Animals↗
PubMed1976

Tuberculous renal artery aneurysm: a case report.

Tuberculous renal artery aneurysm in a 36-year-old Black man is reported. This is thought to be the first case reported in the English language medical literature. The literature is reviewed with regard to presentation and management of renal artery aneurysm in general, with specific reference to tuberculous arterial infection.

Adult↗
PubMed1976

Aorto-oesophageal fistula complicating tuberculous aortitis. A case report.

A case of massive upper gastro-intestinal haemorrhage in a Black woman owing to tuberculous aorto-oesophageal fistula is reported. The literature is reviewed and the clinical presentation discussed. This possibly represents only the second case of aorto-oesophageal fistula complicating postprimary tuberculosis to appear in medical literature.

Aorta, Thoracic↗
PubMed1975

The management of colon injuries.

Surgical management of colon injuries was assessed in 97 patients. Injuries comprised stab wounds (88 cases), blunt trauma (5 cases), and gunshot wounds (4 cases). Injury involved the right colon in 52,6% and the left colon in 47,4% of patients. Fifty-eight per cent had associated major visceral injury. Patients were divided into two categories; those in whom proximal colostomy or exteriorisation of the perforation was performed constituted the one group, and those who had primary closure, the other. Analysis of results were made with regard to the incidence of wound infection, intra-abdominal abscess formation, peritonitis, and other postoperative complications. Seventeen patients had exteriorisation of the colon performed. Colostomy and colostomy closure had a significant morbidity rate, with a mean total period of hospitalisation of 58,5 days. Eighty patients were treated by primary closure. Septic complications occurred in 36,7% of cases. An analysis of the factors influencing mortality and morbidity was made, with reference to the side of the colon involved, the time interval between injury and surgery, faecal contamination of the peritoneal cavity, associated visceral injury and the presence of more than one colonic perforation. Increased morbidity was noted when the operative delay exceeded 6 hours and when faecal contamination of the peritoneal cavity was marked. Primary closure of a lacerated colon is safe provided that careful consideration is given to the above factors.

Abscess↗