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Biomedical subjects

J W Fielding

Publications and source records attributed to J W Fielding.

At least 55 records · Page 3Linked to original sources
PubMed1989

Occipitoatlantoaxial fusion utilizing a rectangular rod.

Atlantoaxial subluxation has been treated conventionally by Gallie posterior fusion. This technique, however, has disadvantages such as the frequent occurrence of pseudarthrosis, a high probability of relapse, and the necessity of long-standing strict external fixation until bone fusion. To overcome these problems, posterior occipitoatlantoaxial fusion was performed using a rectangular rod that assures strong internal fixation in 16 patients with atlantoaxial subluxation. The condition was complicated by superior migration of the dens in five patients. Clinical and roentgenographic examinations before and after the operation showed improvements in neurological symptoms and in pain in the neck and occipital region in all patients. Bone fusion was observed in all patients and reduction, performed to the extent possible during the operation, was retained adequately. The present method, which provides strong internal fixation, allows bone fusion and early initiation of rehabilitation with a simple external support of the neck. It also facilitates laminectomy of C1 in patients with associated myelopathy. This procedure, therefore, is particularly effective in patients with marked instability or with rheumatoid arthritis and makes postoperative application of a halo vest or skull traction unnecessary.

Adolescent↗
PubMed1989

Traumatic spondylolisthesis of the axis.

Hanging, a common method of execution, began in antiquity and continues to this date. Unfortunately, the exact cause of a victim's demise was not always obvious, and many victims died as the result of asphyxiation from the hangman's noose. In the latter part of the 19th century, scientific curiosity led to autopsy studies of the cervical spine; Paterson in 1890 first described the lethal lesion. Experimental work in 1913 demonstrated that when the hangman's knot was placed beneath the chin, death rapidly occurred because of a traumatic spondylolisthesis of the second cervical vertebra. This knot placement then became standard as the most efficient method of execution. It was not until the mid-20th century that the similarity between judicial and civilian injury was recognized. The reports were infrequent, and most of the pars interarticularis fractures resulted from automobile accidents in which the victim was thrown forward and struck his or her face against the windshield which caused sudden violent hyperextension. The similarity between civilian and vehicular injuries was recognized in 1965 by Schneider who, together with his associates, reported eight cases; it was this group who introduced the term "hangman's fracture". Garber presented his thoughts on this subject, noting that there was a difference between the forces generated by judicial hanging and those caused by motor vehicle accidents and other similar civilian injuries. The former results in axial loading and hyperextension, and, rarely, in flexion or axial loading. Since the lesion occurs at the pars interarticularis of C2, Garber suggested that a more appropriate term might be traumatic spondylolisthesis of the axis.

Axis, Cervical Vertebra↗
PubMed1988

Palliative surgery for gastric cancer.

Most patients with gastric carcinoma have a disease that is too advanced for radical surgery. A Review was made of 13,175 cases of gastric carcinoma registered at the Birmingham Cancer Registry during the period of 1960-1969. Of the patients, 79.6% had disease that was not radically resected, and few of these patients survived to 2 years. Those who had a palliative resection or bypass had the lowest 30-day mortality rate when compared to all other palliative measures (P less than 0.001). Furthermore, palliative resection gave the best survival in the presence of both locally advanced and metastatic disease (P less than 0.001). This suggests that the best palliative procedure for those with a disease unsuitable for radical surgery is a resection.

Adenocarcinoma↗
PubMed1988

Survival following intestinal obstruction in ovarian cancer.

A retrospective survey of 38 ovarian cancer patients who developed radiologically confirmed intestinal obstruction was performed. Twenty-six patients underwent surgery. In the surgical treatment group, obstruction was not due to recurrent disease in six cases. The median survival for the group as a whole was 56 days. Patients in the operative group survived significantly longer than those in the non-operative group. There was an operative mortality of 15% and major postoperative morbidity was seen in 42%. Neither the site of the obstruction nor the type of operation influenced survival. No postoperative chemotherapy responses were seen in previously treated patients.

Adult↗
PubMed1988

Effect of C1-C2 rotation on canal size.

An anthropometric study of the atlas and axis was undertaken to determine spinal canal diameters, the degree of narrowing with rotation, and odontoid tilt. The mean sagittal diameter of the atlas was 30.1 mm and the mean coronal diameter was 28.8 mm. The mean sagittal diameter of the axis was 19.0 mm and the mean coronal diameter was 22.8 mm. Approximately 64 degrees of rotation occurred at the atlantoaxial complex before sufficient narrowing caused spinal cord compression in the average specimen. An average of 63 degrees of rotation was required to cause facet dislocation. Most specimens examined had a posterior odontoid tilt up to 45 degrees and a facet angle between 1 degree and 29 degrees. Bilateral facet dislocation occurred at 63 degrees. Spinal canal narrowing to 1 cm occurred at 64 degrees. This narrowing would probably not damage the cord, which averages 1 cm in diameter; however, if the rotary motion of C1 and C2 progressed, cord damage could occur. Facet angles and posterior odontoid tilts that are not within the normal range indicate pathological changes.

Anthropometry↗
PubMed1987

Primary gastric lymphoma.

This is a population-based review of 153 cases of primary gastric lymphoma. Sixty-seven (43 per cent) were histologically reviewed using the Kiel classification. There were no significant differences between reviewed and unreviewed cases. Ninety-seven per cent of all cases were of the non-Hodgkin's type. The annual incidence was constant at 1.2 per cent of gastric malignancies. The mean age was 60 years and the male to female ratio 1:8. Presenting symptoms were similar to those of gastric cancer. Twenty-one per cent had a palpable mass but one-third of these were amenable to a potentially curative resection. Some 66 per cent were resectable and 58 per cent had a macroscopic clearance of tumour. TNM stage and absolute tumour size were significant prognostic factors (P less than 0.005 and P less than 0.05 respectively) but the Kiel classification was not. The overall 5 year survival was 24 per cent. Apart from 10 patients whose only anti-tumour treatment was radiotherapy (5 year survival 36.9 per cent) no patient who did not have curative surgery survived 5 years. The 5 year survival for curative resection was 34 per cent and for curative resection plus radiotherapy was 43.5 per cent (45 and 73.4 per cent for the node negative cases respectively). A laparotomy is essential; 'curative' surgery possibly with adjuvant radiotherapy offers the best hope for cure.

Adolescent↗
PubMed1987

Radiotherapy for pain relief in locally recurrent colorectal cancer.

Eighteen patients with local recurrence of colorectal cancer have been treated by external beam radiotherapy for pain relief. Seven received a fractionated course of 4500cGy and the remainder received single fractions of 1000cGy, a number being treated more than once. The median survival for all patients once recurrence had produced pain was 7 months. Treatment benefit was recorded in 71% treated by fractionated courses and in 66% by single fractions. The duration of pain relief was 3 months for each method. The repeatability of single fraction treatment indicates that this is a worthwhile alternative technique, particularly for those in poor general condition.

Colonic Neoplasms↗
PubMed1987

Rectal carcinoma: a new technique to allow safer postoperative irradiation of the pelvis.

Local recurrence after abdomino-perineal excision of the rectum for Dukes C carcinoma is common. The influence of postoperative radiotherapy in reducing this is currently under investigation, and one of the potential complications is radiation damage to the small bowel. This paper describes a simple and quick method of excluding the small bowel from the pelvis which, combined with more sophisticated radiation field planning, could dramatically reduce the incidence of enteric effects.

Adenocarcinoma↗
PubMed1987

Defunctioning colostomy for perianal sepsis in acute leukaemia.

Perianal sepsis in patients with acute leukaemia is a life threatening complication which carries an extremely poor prognosis. The usual approach to this problem is simple incision and parenteral antibiotics but we have recently treated two patients with wide excision combined with a defunctioning colostomy which resulted in rapid and complete eradication of sepsis.

Abscess↗
PubMed1987

Evaluation of immunolocalization in gastrointestinal cancer.

Tumor localization by a 131I-labeled monoclonal antibody to CEA has been evaluated in a series of 50 patients with clinically suspected primary or recurrent gastrointestinal cancer. Eighty-five percent of the primary tumors were correctly detected, as were 43% of associated nodal metastases. Localization was compared with computerized tomography in the detection of recurrent disease. Each technique correctly identified 61% of the sites but missed 39%. In addition, labeled antibody localization produced a significant number of false-positive images. Radioactivity accumulated by tumors, both primary and secondary, was significantly higher than that in surrounding normal tissue (P less than .01). However, less than 0.8% of the injected radioactivity and 0.01% of the injected antibody were detectable in the tumors. Radiolabeled antibody was rapidly cleared from the circulation, and this may reflect a recipient reaction to the foreign protein.

Antibodies, Monoclonal↗