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Biomedical subjects

M S Robertson

Publications and source records attributed to M S Robertson.

At least 19 recordsLinked to original sources

Helicobacter pylori infection in the Australian community: current prevalence and lack of association with ABO blood groups.

AIMS: To assess the current prevalence of Helicobacter pylori infection in an Australian urban population sample and to relate this to age, gender and ABO and Rhesus blood groups. METHODS: We performed a prospective epidemiological survey of H. pylori serological status in 500 consecutive voluntary blood donors who presented for the purpose of blood donation at the central -Melbourne branch of the Australian Red Cross Blood Service, Victoria, Australia, and gave a Melbourne suburban home address. RESULTS: The overall prevalence of specific anti-H. pylori IgG antibodies in this cohort was 32% (95% confidence interval = 28-36%) and H. pylori sero-positivity increased with age. The rate of H. pylori infection was not significantly different in men and women, with anti-H. pylori IgG anti-bodies detected in 35% (97/277) of men compared with 28% (63/233) of women (P = 0.12). Similarly, H. pylori serological status was not significantly different between subjects of different ABO (P = 0.18) or Rhesus blood groups (P = 0.55). CONCLUSION: This study showed that, contrary to expectation, the updated prevalence of H. pylori seropositivity (32%) in this Melbourne sample is at least as high as that found in previous Australian studies over the past 19 years. Seropositivity increased with age, and was not related to gender, confirming the infection pattern seen in other developed nations. Despite epidemiological evidence of increased peptic ulcer disease in ABO blood group O subjects, and recent evidence that H. pylori adhesion to gastric epithelial cells is mediated by blood group epitopes, no significant association between blood groups and H. pylori serological status was detected.

ABO Blood-Group System↗

Helicobacter pylori infection in intensive care: increased prevalence and a new nosocomial infection.

OBJECTIVE: The pathogenesis of acute gastric stress ulceration in the seriously ill is uncertain, and any role of Helicobacter pylori infection is unknown. We aimed to assess the relationship between H. pylori serological status and stress ulceration in seriously ill patients, as well as H. pylori serological status in intensive care nurses as a marker for nosocomial infection. DESIGN: Prospective epidemiologic survey. SETTING: Adult intensive care unit in a university teaching hospital. PATIENTS: One hundred patients, 100 nurses, and 500 blood donors as community controls. INTERVENTIONS: H. pylori serological status was measured in patients, staff, and controls using a rapid whole blood test. Upper gastrointestinal bleeding and risk factors for acute stress ulceration were recorded. MEASUREMENTS AND MAIN RESULTS: In seriously ill patients, H. pylori seropositivity (67%) was significantly higher than in the control group (39%) (p < .001). In patients, seropositivity was not related to age, country of birth, diagnostic category, severity of illness, or risk score for stress ulceration. There was a trend toward increased macroscopic gastric bleeding in seropositive patients. In intensive care nurses, H. pylori seropositivity (40%) was significantly higher than in age-matched controls (19%) (p < .001). Only duration of intensive care nursing was significantly associated with seropositivity (p = .02). CONCLUSIONS: The unexpectedly high H. pylori seropositivity rate in this seriously ill cohort raises the possibility that under intensive care conditions, H. pylori infection may modulate responses to illness and injury, with consequent clinical implications. Furthermore, the elevated seropositivity rate in intensive care nurses suggests that H. pylori can be nosocomially transmitted.

Adult↗

Limited CT scanning techniques of the paranasal sinuses.

Computerized tomographic (CT) imaging provides detailed information on the paranasal sinuses and is now well established as an alternative to standard radiographs. The planning and safety of surgery to the paranasal sinuses is greatly improved by CT imaging. We describe a new CT protocol comprising a limited coronal and axial scan series, based on our experience with the previously described 'CT-Mini-series'.

Humans↗

Aspiration cytology in the diagnosis of head and neck masses: the early Christchurch experience.

Fine needle aspiration cytology has been performed on patients presenting with head and neck masses in Christchurch since mid-1985. The results of an initial 120 aspirations were reviewed. Histology was available to compare with the cytology result in 58% of cases. Clinical review was used to assess the accuracy of the cytology result in the remaining cases. The majority of the masses aspirated were of benign origin (72%). The cytological diagnosis was accurate in 79% of cases. Of the remaining aspirates, 13% were inaccurate and 8% nondiagnostic. The sensitivity for malignant lesions was 100%, with 86% specificity (for benign lesions). Particular diagnostic difficulty was found in the differentiation between some salivary gland tumours, and the assessment of aspirates from neck masses after combined therapy (radiotherapy and surgery). Fine needle aspiration cytology is of considerable value in the management of head and neck masses.

Adolescent↗

A technique of tongue reconstruction following near-total glossectomy.

Total glossectomy is the most crippling of all oral cavity resections. Speech problems are unavoidable and post-operative aspiration is often severe. Two patients are presented who have had tongue reconstructions following near-total glossectomies. In each case a quilted, split-skin grafted pectoralis major muscle flap was used. The speech and swallowing results of these two patients are compared with two patients who underwent a hemiglossectomy and total glossectomy respectively without tongue reconstruction. Only if the suprahyoid and extrinsic tongue muscles are preserved can an active oral phase of swallowing and usable speech be regained by tongue reconstruction.

Carcinoma, Squamous Cell↗

Pectoralis major muscle flap in head and neck reconstruction.

Pectoralis major muscle flaps have rarely been used on their own for head and neck reconstruction. Some of the problems experienced with myocutaneous flaps can be avoided by the judicious use of muscle flaps. These include suture line separation, excessive bulk, hair growth from the flap, and alteration of breast position. In contrast to the pectoralis major myocutaneous flap, the pectoralis major muscle flap is light and pliable. When it is employed for reconstruction in the oral cavity, oropharynx, or hypopharynx, it can be covered by a "quilted" skin graft or used on its own. We believe that pectoralis major muscle flaps provide a valuable alternative to the more bulky myocutaneous flaps in head and neck reconstruction.

Aged↗

The pectoralis major muscle in head and neck reconstruction.

From June 1980 to June 1985 51 pectoralis major muscle flaps have been used for one-stage reconstruction of extensive defects in the head and neck following cancer surgery. The pectoralis major muscle was used as a myocutaneous flap on 28 occasions, as a muscle covered with split thickness skin on 17 occasions, and as a muscle-only flap six times. The muscle, in its various forms, was used for reconstruction of the pharyngooesophageal segment, the tongue, floor of the mouth and oropharynx, to replace the skin of the face and neck, and to provide a well vascularized recipient bed for a split-rib graft, used to replace a defect of the anterior arch of the mandible. Many of the problems associated with the use of a pectoralis major myocutaneous flap can be avoided by the judicious use of a muscle flap on its own or covered by a split thickness skin graft.

Aged↗

A cure for snoring.

Conservative measures are rarely effective in treating the habitual snorer. A new operation called a uvulopalatopharyngoplasty has been successful in curing snoring in seven patients.

Adolescent↗

Pharyngoesophageal reconstruction. Is a skin-lined pharynx necessary?

Current methods of pharyngoesophageal reconstruction have in common the creation of an epithelial lined pharynx. We performed eight cases of pharyngoesophageal reconstruction with a pectoralis major muscle flap. In the first six cases, split-thickness skin was quilted onto the muscle. In the last two cases, pectoralis major muscle alone was used, allowing epithelialization to occur from adjacent mucosa. The results with this simplified technique have been as good as when a skin-grafted muscle flap was used. We prefer a pectoralis major muscle flap, with or without split-thickness skin, to a pectoralis myocutaneous flap. There is no hair growth, it is easy to tube, and a thin-walled pharynx is produced. This is an advantage for the development of an esophageal voice, and tracheoesophageal puncture can be easily performed if no voice is achieved. All of our patients received full-dose, preoperative radiotherapy. One patient developed a fistula that closed spontaneously. There have been no strictures at the pharyngoesophageal junction. All patients quickly established a good oral intake.

Aged↗

The management of preauricular sinus.

Preauricular sinus is a common congenital condition which does not always cause symptoms. It is often misdiagnosed, can be difficult to treat surgically, and recurrences are common. The results of treatment in twelve Christchurch patients are discussed and a surgical technique is described.

Adolescent↗

Immediate pharyngoesophageal reconstruction. Use of a quilted skin-grafted pectoralis major muscle flap.

Pharyngoesophageal reconstruction continues to be a problem in the management of cancer involving the hypopharynx. In our experience, the use of deltopectoral and pectoralis major myocutaneous flaps for total reconstruction has been disappointing. We report four cases of immediate near-total reconstruction using a quilted , skin-grafted pectoralis major muscle flap. All cases had received full dosage preoperative irradiation. A thin-walled pharynx was created that has allowed early development of a good esophageal voice. There has been no stricture formation. All patients have experienced no difficulty in establishing a good oral intake.

Aged↗

Chondrosarcoma arising in the nasal septum.

A case is presented of a chondrosarcoma arising in the nasal septum and extending into the maxillary sinuses. This tumour is unusual in the head and neck and rarely arises in the nasal septum. Diagnostic difficulties are discussed. The treatment was radical surgery with removal of a major portion of the upper jaw, necessitating reconstruction with a maxillo-facial prothesis.

Aged↗

The presenting symptoms of head and neck cancer.

The late presentation of head and neck malignancies is often attributable to failure by the patient and the doctors to appreciate the significance of early symptoms. The presenting features of 522 cases are summarised. They emphasize that the following clinical features are significant, especially in a patient who smokes or drinks: local pain, pain referred to the ear, hoarseness, dysphagia, dyspnoea and stridor, persistent sore throat, nasal obstruction, bleeding, problems fitting dentures and a neck lump. An adequate history and ability to examine the head and neck region are prerequisites to early diagnosis. A knowledge of the presenting features of head and neck malignancies could be stressed more adequately by public health authorities.

Adult↗

Glue ear.

Explore the source record for details and available documents.

Child↗

The malignant gland in the neck as a presenting sign in head and neck cancer.

A retrospective study of 262 patients with malignancy in the head and neck was undertaken. 15.6 percent of these patients presented with a metastatic gland in the neck as the only symptom. Forty-four percent of the nasopharyngeal tumours presented solely with a metastatic cervical node; as did 26 percent of hypopharyngeal tumours and 24 percent of tumours of the oropharynx. The problem of a patient presenting with a suspected malignant cervical gland as the only symptom is one which demands careful evaluation.

Carcinoma, Squamous Cell↗