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Biomedical subjects

R C Russell

Publications and source records attributed to R C Russell.

At least 145 records · Page 8Linked to original sources
PubMed1988

Obstructive pancreatitis: unusual causes of chronic pancreatitis.

Fifty-eight consecutive surgical pancreatic resections for chronic pancreatitis were examined. Eight cases were identified with obstructive pancreatopathy; all underwent pancreato-duodenectomy. Histological examination revealed that obstruction in three cases was due to duodenal wall cysts, and in two patients it was associated with pancreas divisum (the accessory papilla was obstructed by a neuroendocrine tumour in one case and by ectopic pancreatic tissue in the other). One case each was due to obstruction of an anomalous duct by vegetable matter, to segmental pancreatitis, and to an intraductal carcinoma. Obstructive pancreatitis has many causes and diligent pre-operative assessment is required as surgical resection may be beneficial. Special efforts should be made to identify ductal anomalies, duodenal cysts, ectopic pancreatic tissue, and small ampullary tumours of exocrine and endocrine origin in order to define the aetiology of pancreatitis.

Adult↗
PubMed1988

Conservative excision of penile melanoma.

Penile melanoma is a rare disease, especially in younger men. Most authorities advocate aggressive surgical management by partial or radical phallectomy and in some cases inguinal lymph node dissection. A 27-year old man with a clinical stage I, Clark's level II, microinvasive (less than 0.76 mm) superficial spreading penile melanoma underwent conservative resection and skin grafting without inguinal node dissection. He has normal penile function and is disease free 5 years following surgery. We believe that in clinical stage I, microinvasive penile melanoma, local excision without inguinal node dissection should be the treatment of choice.

Adult↗
PubMed1988

Experimental evaluation of the antibiotic carrying capacity of a muscle flap into a fibrotic cavity.

A study was undertaken to determine the antibiotic carrying capacity of a transferred muscle flap into a fibrotic cavity using a tissue cage model in rabbits. Blood and chamber fluid antibiotic levels were determined after intramuscular hindlimb gentamicin injection up to 56 days following muscle transfer. This study suggests that muscle flaps increase the concentration of antibiotics that can be achieved within a fibrotic cavity. The measurable peak level decreases with time, probably due to increased scarring around the muscle. This model should enable the study of many different classes of antibiotics with different protein binding and other administration schedules using multiple timed doses or a combination of agents.

Animals↗
PubMed1988

Inflammatory pseudotumour of the liver.

A case of inflammatory pseudotumour of the liver is described, the twelfth such case reported. Although these lesions are benign and self-limiting, they may encroach upon the biliary tree or portal vein and may be confused with true hepatic neoplasia. In the presence of single or multiple hepatic deposits seen on radiologic examination, a history of fever (or other systemic symptoms) and a negative fine needle aspiration biopsy should raise the possibility of inflammatory pseudotumour and prompt formal biopsy to guide further treatment.

Adult↗
PubMed1988

Total pancreatectomy for chronic pancreatitis.

The operation of total pancreatectomy is performed rarely. Its role in the management of patients with chronic pancreatitis remains to be elucidated. We have reviewed our series of 29 total pancreatectomies for benign disease [14 women median age 39 years; 15 men median age 34 years]. Twelve underwent standard total pancreatectomy, in 17 duodenum preserving total pancreatectomy (DPTP) was performed. There was one death (mortality 3.4%). In no patient was the total pancreatectomy the first operative procedure. The patients were compared with age and sex matched diabetic control subjects selected on a best fit basis from the diabetic clinic database. The aetiology of the pancreatitis was idiopathic nine, pancreas divisum nine, alcohol eight and other causes three. The indication for surgery was pain 27, acute pancreatitis one and cholangitis with pancreatitis one. The complications of the procedures were mainly caused by infection [wound three, chest six and central line sepsis four] and in two there was a leak from the duodenum; no patient required re-operation. The postoperative stay [standard total, median 21 days (range 13-98) DPTP median 31 days (range 17-49)] has lengthened over the period due to greater attention to analgesic, diabetic and enzyme deficiency control before discharge. In standard total pancreatectomy there were five major hypoglycaemic episodes with only two in 17 DPTP patients. The per cent ideal body weight, the insulin requirement and the HbAl compared less well in standard total pancreatectomy group compared with controls than did DPTP. With both groups large doses of enzyme replacement were required, and this proved of importance in diabetic control. Our experience with total pancreatectomy suggests that pain will be improved in over 80% of patients and that the results of surgery will improve with prolonged follow up provided attention is given to analgesic abuse, enzyme deficiency and diabetes.

Adult↗
PubMed1988

Peripheral neuropathy complicating pancreatitis and major pancreatic surgery.

Four cases of a polyneuropathy associated with pancreatitis and pancreatic pseudocyst formation are reported. Electrophysiological investigation showed the peripheral neuropathy to be predominantly axonal in type. These patients were all seriously ill and many factors may have been involved in the pathogenesis of their neuropathy. They had all received parenteral nutrition and multiple drug therapy including metronidazole, and all had severe sepsis. There was evidence that insufficient vitamin replacement had been given during total parenteral nutrition. It was not possible to decide whether the polyneuropathy resulted from the summation of these factors, is similar to what has been called the polyneuropathy of the critically ill, or is a new association with pancreatic disease.

Acute Disease↗
PubMed1988

Experimental pretransfer expansion of free-flap donor sites: II. Physiology, histology, and clinical correlation.

There is a statistically significant increase in blood flow into expanded cutaneous and myocutaneous flaps in a pig model over controls. The vascular trees within flaps enlarge following expansion, and pronounced neovascularization is seen in the papillary dermis and capsular layers. Experimentally, there is differential thinning of all tissue layers except the epidermis. A successful clinical application of this technique, by free-tissue transfer of an expanded fasciocutaneous scapular flap, is described. The technique is applicable when altered flap size or contour is desired.

Adipose Tissue↗
PubMed1988

Experimental pretransfer expansion of free-flap donor sites: I. Flap viability and expansion characteristics.

Expansion of cutaneous and myocutaneous free-flap donor sites prior to elevation is possible in the pig model. There is no significant difference in survival between control and expanded cutaneous buttock and myocutaneous latissimus dorsi flaps after elevation solely on their axial pedicles. Axial-pattern flap expansion appears to augment capillary blood flow. The maximum amount of expansion occurs directly over the center of the expander and decreases toward the periphery. There is virtually no expansion of skin adjacent to the expander.

Animals↗
PubMed1988

The dumping syndrome after pancreatoduodenectomy.

Some patients have postoperative nutritional problems after a pancreatoduodenectomy. These problems have been attributed without objective evidence to the partial gastrectomy that is performed at the time of the pancreatoduodenectomy. The dumping syndrome has been implicated, and the results of this study determine, for the first time, the role of the dumping syndrome in pancreatic surgical procedures. Sixty-four dumping provocation tests have been performed upon patients with pancreatic disease or after pancreatic surgical treatment. Three patients had the dumping syndrome, and in eight, the result of the test was equivocal. Results of the present study demonstrate an incidence of dumping syndrome after pancreatoduodenectomy of 10 per cent; however, in none of these patients, was the dumping syndrome a significant problem. There was no instance of the dumping syndrome after pylorus-preserving or duodenum-preserving pancreatectomy. It is concluded that, contrary to previous assumptions, the dumping syndrome does not contribute to long term postoperative problems after pancreatic surgical procedures.

Diagnosis, Differential↗
PubMed1987

Randomised trial of endoscopic versus percutaneous stent insertion in malignant obstructive jaundice.

Patients with biliary obstruction due to malignant disease, and judged unfit for open operation, were randomised to have a biliary stent inserted either endoscopically via the papilla of Vater or percutaneously. Analysis after 75 patients had been entered showed that the endoscopic method had a significantly higher success rate for relief of jaundice (81% versus 61%, p = 0.017) and a significantly lower 30-day mortality (15% versus 33%, p = 0.016). The higher mortality after percutaneous stents was due to complications associated with liver puncture (haemorrhage and bile leaks). When stenting is indicated in elderly and frail patients the endoscopic method should be tried first.

Aged↗
PubMed1987

Duodenum-preserving total pancreatectomy for end stage chronic pancreatitis.

The classical Whipple procedure for chronic pancreatitis has been associated with significant long term postoperative morbidity. The pylorus-preserving procedure of Longmire has reduced but not eliminated the long-term morbidity. Preservation of the whole duodenum with total pancreatectomy has been introduced for the treatment of patients with end-stage chronic pancreatitis after favourable experience with this procedure in infants for nesidioblastosis. Fourteen patients with chronic pancreatitis have had a total pancreatectomy with preservation of the duodenum and the bile duct. All patients are still alive (median follow-up 9.5 months) and none suffered major complications in the perioperative period. One patient developed a biliary stricture at 3 months, requiring biliary reconstruction. Six of the patients have returned to full-time work; nine require no analgesia. All patients require pancreatic enzyme replacement, and all patients have gained weight postoperatively. Diabetic control is satisfactory with a twice daily insulin regime. Duodenum-preserving total pancreatectomy is feasible in the adult without mortality or high morbidity; early experience suggests that preserving the duodenum improves gastrointestinal function with easier control of the diabetes.

Adult↗
PubMed1987

Surgical technique.

Explore the source record for details and available documents.

Postoperative Complications↗
PubMed1987

Total pancreatectomy for chronic pancreatitis.

A survey of six British centres collected data on 83 patients undergoing total pancreatectomy (TP) for chronic pancreatitis between 1977 and 1986. There were 57 men and 26 women with a median age of 38 years (range 19-61 years). Half were alcoholics and half had had previous acute pancreatitis. Besides jaundice (14 per cent) severe pain was the indication for the operation; regular opiates had been needed in 82 per cent of patients and 37 per cent were addicted to these drugs. All but 12 had had previous pancreatic or biliary surgery, with a median of two operations and a maximum of six. TP was a one-stage procedure in 32 patients, 42 had had distal resections and 9 proximal resections in the past; the pylorus was preserved in 30. Median operation time was 4 h (range 2-18 h) and median blood loss was 3 units (1-21 units). Intraoperative complications in 11 patients included haemorrhage in 9. Four deaths occurred within 30 days from bleeding (2), respiratory failure (1) and Roux-loop infarction (1). All but one of the 79 survivors required full pancreatic supplementation and 38 per cent had difficulties in endocrine control. At a median follow-up of 1.5 years (range 0.25-10 years), 57 patients (72 per cent) were pain-free and 9 (11 per cent) needed only occasional analgesia. Though 13 (17 per cent) still took regular analgesics, all were symptomatically improved. There have been 10 late deaths (13 per cent), all but one of which are attributable to the operation.

Adult↗
PubMed1987

Glutaraldehyde-treated autogenous skin as a substitute for elastic cartilage: an experimental study.

In an experimental study in rats, a piece of dorsal skin was removed, molded, and tanned in glutaraldehyde. After rinsing in saline, the piece of skin was tested for extensibility and implanted under the dorsal skin of the same rat. It was removed after 1 to 12 weeks and its extensibility was again measured. Specimens were examined under the light and electron microscopes. None of the 63 implants extruded and at 12 weeks a thin, densely adherent fibrous capsule had formed. Light and electron microscopy revealed early inflammatory changes that later subsided. The implant maintained or increased its stiffness. The weight of the implant remained constant.

Animals↗
PubMed1987

Effect of arteriovenous flow reversal on blood flow and metabolism in a skin flap.

Twelve pig buttock island flaps (10 X 10 cm) were studied for 6 hours after arteriovenous flow reversal at the level of the pedicle. Follow-up was 48 hours. Blood pressure, Po2, pH, and lactate were measured in flap arteries and veins. Oxygen consumption was calculated. Data indicated true flow reversal. Blood pressure and Po2 in flap veins increased to systemic arterial levels. Outflow was provided by the arterial system, demonstrating venous pressure and Po2 values. Lactate increased significantly (1.8 +/- 0.5 to 4.0 +/- 2.3 mmol/liter), while pH dropped from 7.43 +/- 0.03 to 7.11 +/- 0.02. Oxygen consumption remained below baseline. In four flaps thrombosis occurred within 6 hours; no flap survived 48 hours. The results of this study do not encourage clinical application of the concept of flow reversal.

Animals↗