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Biomedical subjects

R A Greatorex

Publications and source records attributed to R A Greatorex.

At least 19 recordsLinked to original sources
PubMed2001

Use of the laryngeal mask airway in thyroid and parathyroid surgery as an aid to the identification and preservation of the recurrent laryngeal nerves.

A prospective study was carried out in patients undergoing thyroid and parathyroid surgery using a laryngeal mask airway (LMA) and electrical nerve stimulation to identify the recurrent laryngeal nerves. A total of 150 consecutive patients undergoing thyroid and parathyroid surgery by a single surgeon were assessed for suitability of anaesthesia via the LMA. Peroperatively, a fibre-optic laryngoscope was passed through the LMA to enable the anaesthetist to visualise the vocal cords while adduction of the cords was elicited by applying a nerve stimulator in the operative field. In all, 144 patients were selected for anaesthesia via the LMA. Fibre-optic laryngoscopy and nerve stimulation were performed in 64 patients (42.7%). The trachea was deviated in 51 (34.0%) and narrowed in 33 (22.0%). The recurrent laryngeal nerves were identified in all patients. There were no cases of vocal cord dysfunction resulting from surgery. The LMA can be safely used for thyroid and parathyroid surgery even in the presence of a deviated or narrowed trachea. It can assist in identification and preservation of the recurrent laryngeal nerve and is, therefore, of benefit to both patient and surgeon.

Adult↗
PubMed2000

Laryngeal mask airway and fibre-optic tracheal inspection in thyroid surgery: a method for timely identification of tracheomalacia requiring tracheostomy.

Use of the laryngeal mask airway combined with fibre-optic laryngoscopy in thyroid surgery was first described in 1991. In this unit, it has been successfully used in over 130 cases. The advantages in identification and preservation of the recurrent laryngeal nerves using this technique have been demonstrated. However, to date, no report exists of a further advantage, namely the management of tracheomalacia.

Fiber Optic Technology↗
PubMed1992

Torsion of a malignant undescended testis mimicking appendicitis.

Testicular maldescent is known to be associated with later development of malignancy. The maldescended testis is prone to other complications--in particular, torsion. We report an unusual coincidence of both malignancy and torsion of an intra-abdominal testis which closely simulated a ruptured appendix abscess. This case demonstrates that an intra-abdominal testis can develop acute life-threatening complications which should be considered in any patient with acute abdominal symptoms who has an 'absent' testis.

Adult↗
PubMed1989

Total hip replacement in the renal transplant recipient.

Osteonecrosis of the femoral head is a severely disabling complication of steroid immunosuppression in renal transplant patients. We report 31 total hip arthroplasties in 21 renal transplant recipients with an average follow-up of six years. There were no problems with wound healing or infection despite full immunosuppression. Four hips developed symptomatic loosening but the other results were excellent, comparing well with other methods of treatment for osteonecrosis. Ten patients died during the follow-up period. Total hip replacement is a safe and effective treatment for transplant recipients and, in view of their limited life expectancy, should be considered at an early stage in their treatment.

Aged↗
PubMed1987

Three years after Colles' fracture. A prospective review.

A prospective study was made over a three-year period of 900 consecutive unilateral Colles' fractures. The radiographic features at the time of fracture, after reduction and one week later were measured and correlated with grip strength and range of movement at three years. The most significant radiographic feature to influence the outcome was the presence of shortening of the radius one week after reduction of the fracture. Persistent dorsal tilt, radiocarpal joint involvement and ulnar styloid fracture were each associated with reduced range of movement, but had no effect on grip strength. Extension of the fracture into the distal radio-ulnar joint was associated with reduced grip strength but had no effect on range of movement. Radial tilt of the radial fragment did not correlate with any aspect of the result after three years.

Aged↗
PubMed1987

The value and significance of the limited barium enema examination following restorative resection for carcinoma of the rectum.

The results of limited barium enema examinations from a consecutive series of 143 patients who underwent restorative resections for carcinoma of the rectum were studied. An assessment was made of the value of the investigation both in terms of clinical management decisions and also to see whether radiologically detected anastomotic leakage was associated with a higher incidence of tumour recurrence. A study was also made of the incidence of leakage with respect to tumour size, length of the distal resection margin, Dukes' grading and histological differentiation. Results showed that there was a greater incidence of tumour recurrence following anastomoses which leaked, although due to small numbers the figures did not reach statistical significance. There was no relationship between tumour size, grade, differentiation, or length of the distal resection margin, and radiological leakage. We consider that the limited ten day barium enema examination does not contribute significantly to surgical management of these patients, except to define the extent of a leak and in the assessment of new anastomotic techniques. However, we suggest that a larger series may demonstrate a statistically significant increase in pelvic recurrence in patients who developed leakage from the anastomosis. This could dramatically alter the application of the postoperative limited barium enema.

Barium Sulfate↗
PubMed1985

Delayed acute rejection episodes in cyclosporine-treated renal transplant recipients.

Of 109 cyclosporine-treated cadaveric renal allograft recipients, 45 were free of acute rejection in the first 4 weeks after transplantation. Eleven of 45 (24%) subsequently had delayed, biopsy-proven first rejection episodes 34-61 days after grafting, often after discharge from the hospital. Delayed rejectors had significantly higher plasma creatinine levels at all times during the first posttransplant month than 34 nonrejectors. Trough serum cyclosporine levels were similar in the two groups, although by the 4th week oral cyclosporine dose was significantly lower in the delayed rejection group. Two-thirds of those patients who had serum creatinine levels greater than or equal to 260 mumol/l at 2 weeks and greater than or equal to 225 mumol/l at 3 weeks had a delayed acute rejection episode. Renal transplant recipients treated with cyclosporine who have serum creatinine levels at or above these levels should be aggressively worked up and closely followed for the development of delayed acute rejection.

Cyclosporins↗