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R C Russell

Publications and source records attributed to R C Russell.

At least 55 records · Page 3Linked to original sources
PubMed1997

Management of nonmelanoma skin tumors of the hand.

A wide variety of tumors can afflict the hand. Nonmelanoma skin tumors are common and usually benign. The most common malignant tumor of the hand is a SCC. Whether benign or malignant, these need neoplasms and are often initially symptomatic, presenting as an area of discoloration or excoriation. The tumor mass may become disfiguring or impair function. It behooves all hand surgeons to be aware of these nonmelanoma skin tumors and to secure prompt recognition and early treatment, thereby optimizing long-term results.

Basal Cell Carcinoma↗
PubMed1997

Low mortality following resection for pancreatic and periampullary tumours in 1026 patients: UK survey of specialist pancreatic units. UK Pancreatic Cancer Group.

BACKGROUND: Recent studies have suggested that the mortality rate from pancreatic resection for cancer is high in the UK compared with that in published series. A survey of specialist units was conducted to determine whether the results differed from those in general units. METHODS: The postoperative outcome following resection of pancreatic and periampullary tumours was analysed from specialist units in the UK and compared with that of other multi-institutional and large single institutional studies published recently (1900-1996). RESULTS: A total of 1026 resections was reported from 21 units (33 surgeons). Postoperative complications necessitated reoperation in 57 patients (6 per cent) and there were 58 deaths (6 per cent) in hospital. Pylorus-preserving resections were performed in 102 (41 per cent) of 250 patients with ampullary adenocarcinoma undergoing a major right-sided resection and in 123 (32 per cent) of 381 patients with ductal adenocarcinoma of the head of the pancreas undergoing right-sided resection (chi 2 = 4.01, 1 d.f., 2P = 0.04). The mean number of resections for pancreatic ductal adenocarcinoma was 3.41 (range 1.0-7.1) per institution per year. Combining these data with those from the nine published series from specialist units, there was a lower mortality rate compared with the results of five published general surveys (median 4.9 per cent (95 per cent confidence interval (c.i.) 3.1-8.0 per cent) versus 9.8 (2.5-23.2 per cent), 2P < 0.01) and specialist units had a higher volume caseload (median 5.5 (95 per cent c.i. 4.2-8.1) versus 0.5 (-0.2-2.0) cases per institution per year, 2P < 0.001). Postoperative mortality was related to caseload both for the UK (chi 2 = 7.17, 1 d.f., P < 0.01) and for all the data combined (chi 2 = 40.4, 1 d.f., P < 0.0001). CONCLUSION: The results from specialist units in the UK compare favourably with those from specialist units outside the UK and are superior to those from non-specialist units. The mortality rate is generally lower in units with a higher caseload.

Hospital Mortality↗
PubMed1996

Surgical research.

Explore the source record for details and available documents.

General Surgery↗
PubMed1996

Phase II study of gemcitabine in patients with advanced pancreatic cancer.

The efficacy and safety of gemcitabine at a starting dose of 800 mg m2 administered once a week for 3 weeks with 1 week's rest was investigated in chemonaive patients with advanced and/or metastatic pancreatic cancer. Of 34 patients, 32 were evaluable for efficacy, 20 patients had metastatic stage IV disease, 25 had a performance status of 1 and 26 (76%) patients has significant pain on presentation. All responses were independently validated by an external oncology review board: two patients achieved a partial response that lasted 5.8 and 5.2 months (6.3%) and six patients were stable for at least 4 weeks. The median duration of survival for evaluable patients was 6.3 months (range 1.6-19.2 months). The tumour markers, CEA, CA 19-9 and CA 195 were serially measured in 16 patients. There was a good correlation with tumour response when all three markers were significantly decreased. In 4 of 16 patients, tumour marker levels decreased by > or = 60%, including the two responders, one patient who survived for 12 months and one patient who showed objective tumour shrinkage but was deemed ineligible for response evaluation because the disease was considered not to be bidimensionally measurable. Symptomatic benefits included improvement in performance status (17.2%), analgesic requirement (7.4%), pain score (28.6%) and nausea (27.3%). The mean number of cycles administered was 2.5 and the mean dosage received was 890 mg m2 per injection. Seventy-four per cent of dose administrations were given on schedule. Toxicity, particularly haematological toxicity, reported as the maximum WHO grade experienced by patients was mild. Infective episodes were rare and limited to WHO grade 2 (6.7%). Nausea and vomiting was generally modest (WHO grade 3, 26.7%). Other side-effects included mild transient flu-like symptoms (seven patients) and peripheral oedema (three patients), which was not associated with abnormal cardiac hepatic or renal function. Gemcitabine has modest activity in pancreatic cancer, a limited positive improvement on a range of patient benefit parameters and has a mild toxicity profile. For these reasons and because of its novel mode of action, gemcitabine warrants further investigation in combination studies in pancreatic cancer.

Adult↗
PubMed1996

The influence of microfilarial density of dog heartworm Dirofilaria immitis on infection rate and survival of Aedes notoscriptus and Culex annulirostris from Australia.

The mosquitoes Aedes notoscriptus and Culex annulirostris, previously shown to be competent vectors of Dirofilaria immitis, were allowed to feed on dogs with densities of microfilariae ranging from 2665 to 33,055 microfilariae/ml. Filaria developed in both species at a similar rate independent of the initial microfilarial density. Cx annulirostris ingested more microfilariae although the number of developing larvae was consistently greater in Ae.notoscriptus; one female Ae.notoscriptus carried sixty-two third-stage larvae 10 days after feeding, although no more than twelve were found in Cx annulirostris. The mortality rate of Ae.notoscriptus in the first 3 days of filarial development was related to increasing microfilarial density, and was greater than that of Cx annulirostris, which quickly reduced its worm load and survived with fewer third-stage larvae but for longer than Ae.notoscriptus. The vector efficiency index was higher at all microfilarial densities for Ae.notoscriptus, but its survival was much reduced, and therefore Cx annulirostris may be the more effective vector in localities where dogs have very high parasitaemias.

Aedes↗
PubMed1995

Management of bile leaks after laparoscopic cholecystectomy.

The success of laparoscopic cholecystectomy has been tarnished by the increased risk of bile duct damage associated with the operation. Many of these injuries can be managed by endoscopic techniques. Experience of such injuries between 1991 and 1994 was reviewed. Twenty-four patients were referred: 11 with injuries to the cystic duct alone, five with complete hepatic duct obstruction and eight with high bile duct leaks. All patients with leaks from the cystic duct were managed successfully endoscopically (sphincterotomy, four; stent, seven) without recourse to further surgery. Patients with complete obstruction were aided in their recovery by endoscopic and percutaneous techniques, either for postoperative problems (two patients) or in preparation for surgery (three). The eight patients with high bile duct leaks were managed endoscopically by stenting (seven patients) or sphincterotomy (one). Stenting appeared to encourage leaks to heal better than sphincterotomy alone; stents should probably be left in situ for 2 months before removal. There were no deaths and all but one patient had normal biliary function at follow-up. It is suggested that all suspected injuries after biliary surgery require management by a combination of interventional radiology and endoscopic interventional techniques. Surgery may be required only if there is complete obstruction of the biliary tree.

Adult↗
PubMed1995

A model for recording the microcirculatory changes associated with standardized electrical injury of skeletal muscle.

The rate of major limb amputation following high voltage electrical injury remains high despite a decrease in mortality rate. Several theories about the pathophysiology of electrical injury have been discussed in the literature and different clinical regimens have been attempted to decrease the high amputation rate. However, to date, the overall tissue response after electrical injury remains incompletely understood with nothing new to offer these unfortunate patients. We have developed a rat gracilis muscle intravital microscopy preparation in order to better understand the mechanisms of this injury. A standardized 40-V stimulation of 10-sec duration was applied to the anterior belly of the gracilis muscle which translated into a current load of 30 mA. The current density was 750 mA/cm2. Sequential intravital assessment of microcirculatory changes before injury, as well as 5, 15, 30, 60, 120, 180 and 240 min after injury was performed. Consistent findings included initial cessation of blood flow in many capillary beds, focal flow reversal, venous and arterial vascular spasm. Restitution of microvascular flow varied from several minutes to 1 hr and was preceded by vasodilation at 5-15 min following the injury (+16.9 microns from baseline at 15 min). Starting at 30 min progressive vasoconstriction was noted (-0.8 micron from baseline at 30 min, -31.3 microns from baseline at 4 hr). High resolution observation of neutrophil behavior showed an increase in the number of these cells adherent to venular endothelium in areas exhibiting circulatory disturbances (+11.4 cells at 5 min, +15 cells at 4 hr). The standardization of this model allows a quantitative method of evaluating the microcirculatory changes associated with electrical injury and of studying ways to prevent tissue damage. The microcirculatory changes induced by electrical injury were similar to those reported in ischemia-reperfusion injury of skeletal muscle.

Animals↗
PubMed1995

Electrical injuries--morbidity, outcome and treatment rationale.

Electrical injuries are unique with respect to low mortality rates, but very high rates of short- and long-term morbidity, and overall outcome. Controversy still exists regarding the advantages of one-stage debridement versus early serial debridement of necrotic tissue. The purpose of this study was a retrospective evaluation of treatment, morbidity and outcome in a group of patients with electrical injuries. Over a 13-year period 1992 patients were admitted with acute burns to our burn centre. Electrical injuries occurred in 129 (6.5 per cent) of these patients. There were 38 high-tension injuries and 91 low-tension injuries. The average age was 33.7 years (5 months to 63 years), with burn wounds ranging from 1 to 57 per cent total body surface area (mean 9.5 per cent). Ninety-four (72.9 per cent) of these injuries were work related, and most occurred in males (85 per cent). A total of 323 surgical procedures were performed on those 129 patients. An average of 0.48, surgical debridements per patient was necessary in the low-tension injury group and only three partial finger or toe amputations were necessary. In the high-tension group, 27 major limb amputations were performed after 2.3 debridements per patient, resulting in an overall major limb amputation rate of 35 per cent. The average length of stay was 22 days, and the cost of hospitalization ranged from $900 to $120 000 (mean !4,901). Significant long-term neurological deficits persisted in 73 per cent of patients at long-term follow-up (mean 4.5 years). Only 5.3 per cent of patients after high-voltage electrical injury were able to return to their premorbid job.

Adolescent↗
PubMed1995

Effect of motion on digital nerve repair in a fresh cadaver model.

Information in the literature regarding the postoperative management of digital nerve lacerations is vague, and postoperative immobilization for up to 3 weeks is frequently recommended. In order to define more precisely what, if any, postoperative restrictions are necessary, a fresh cadaver model was designed for digital nerve division, resection, repair, and passive motion. Ten digital nerves were divided at the proximal interphalangeal joint and then repaired, mobilized, and inspected. Intact nerve repairs were serially resected in order to determine the limits of resection that would allow motion without repair disruption. All repairs were resistant to disruption even with hyperextension up to a resection length of 2.5 mm, and all repairs were resistant to disruption if splinted in neutral up to a resection length of 5 mm. There was not 100 percent disruption of repairs until a resection length of 1 cm and range of motion including hyperextension. These results give valuable objective data that can be used to guide early motion and splinting protocols after various degrees of digital nerve injury and repair.

Cadaver↗
PubMed1995

The expanded scapular flap.

The scapular fasciocutaneous flap is a very reliable free tissue transfer, but its size and/or thickness may limit its use in some patients. Scapular fasciocutaneous flaps were expanded for 6 to 12 weeks prior to transfer in 14 patients. The flaps ranged in size from 96 to 1885 cm2 and were used to cover chronic soft-tissue defects. Twelve were transferred as free flaps to distant sites, while two were transferred as pedicled flaps to the ipsilateral extremity. The pedicled flaps were designed across the entire back to incorporate both scapular territories but were rotated on a single vascular pedicle. All flaps survived, but three had marginal distal necrosis not related to the microvascular anastomoses. Two flaps transferred by microsurgical technique developed arterial thromboses requiring revision of the anastomoses. Three patients developed partial donor wound dehiscence after transfer of large flaps that healed by secondary intention in two cases and required a split-thickness skin graft for donor-site closure in the third. Flap expansion produces a delay phenomenon that augments blood supply and increases the area of skin that can survive on a single vascular pedicle. This technique may be useful in selected patients in whom a large, thin fasciocutaneous flap is required and there is sufficient time to allow flap expansion prior to transfer.

Adolescent↗
PubMed1995

Soft-tissue calcifications: differential diagnosis and therapeutic approaches.

Calcification of soft tissue may be an unspecific local response or present as only a symptom of a complex underlying disease. Patient approach and treatment vary greatly depending on the cause of soft-tissue calcifications. The review of literature reveals multiple causes but also confusing nomenclature for similar clinical entities. Dystrophic and metastatic soft-tissue calcifications are discerned, but there is also contribution of both types of soft-tissue calcification to some syndromes. Six previously unpublished cases of soft-tissue calcification including Thibièrge-Weissenbach syndrome, scleroderma (progressive systemic sclerosis), calcifying cavernous hemangioma (2 patients), and heterotopic calcifications after burn injury (2 patients) are presented to discuss the differential diagnosis. The correct diagnosis is crucial for successful treatment. Resections of the lateral heads of the gastrocnemius muscles in 2 patients resulted in cure of the problem. The patient suffering from Thibièrge-Weissenbach syndrome had no recurrence during a 30-month postoperative follow-up period. Surgical treatment of scleroderma or soft-tissue calcification after burn injury is aimed toward relief of symptoms. A proposal for patient assessment and indications for surgical correction with regard to soft-tissue calcifications is presented and discussed.

Adolescent↗
PubMed1995

Skin allograft rejection and hyperbaric oxygen treatment in immune-histoincompatible mice.

The effect of hyperbaric oxygen (HBO) as an immunosuppressive agent was evaluated by using a highly immunogenic skin allograft mouse model. Immune-histoincompatible female C57BL/6 and BALB/c mice (N = 30) were randomly assigned to three groups receiving no treatment (control group), low dose HBO treatment (two treatments once a week), and intermediate HBO treatment (two treatments 3 times/wk) 1 wk before and 2 wk after transplantation of a 1.5 x 2 cm full thickness skin allograft from the back. Rejection was observed a Day 7 and was completed 14 days after surgery in controls. Low dose and intermediate HBO treatment delayed skin allograft rejection, which was histologically confirmed.

Animals↗
PubMed1994

Randomised trial of endoscopic stenting versus surgical bypass in malignant low bileduct obstruction.

The development of non-surgical techniques for the relief of malignant low bileduct obstruction has cast doubt on the best way of relieving jaundice, particularly in patients fit for surgery whose life expectancy is more than a few weeks. We did a randomised prospective controlled trial comparing endoscopic stent insertion and surgical biliary bypass in patients with malignant low bileduct obstruction. 204 patients were randomised (surgery 103, stent 101); 3 subsequently proved to have benign disease and were excluded, leaving 101 surgical and 100 stented patients for assessment. Technical success was achieved in 94 surgical and 95 stented patients, with functional biliary decompression obtained in 92 patients in both groups. In stented patients, there was a lower procedure-related mortality (3% vs 14%, p = 0.01), major complication rate (11% vs 29%, p = 0.02), and median total hospital stay (20 vs 26 days, p = 0.001). Recurrent jaundice occurred in 36 stented patients and 2 surgical patients. Late gastric outlet obstruction occurred in 17% of stented patients and 7% of the surgical group. Despite the early benefits of stenting there was no significant difference in overall survival between the two groups (median survival: surgical 26 weeks; stented 21 weeks; p = 0.065). Endoscopic stenting and surgery are effective palliative treatments with the former having fewer early treatment-related complications and the latter fewer late complications.

Adult↗
PubMed1994

Management of bile duct stones in the era of laparoscopic cholecystectomy.

The introduction of laparoscopic cholecystectomy has resulted in increased options for the management of bile duct stones and has stimulated a fundamental reappraisal of the situation before the laparoscopic era. This article reviews the natural history of bile duct stones and details the different ways in which they may now be treated. New areas of controversy are highlighted and the need for further studies is emphasized.

Aged↗