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Biomedical subjects

R W Strong

Publications and source records attributed to R W Strong.

At least 73 records · Page 4Linked to original sources
PubMed1992

Undifferentiated (embryonal) sarcoma of the liver. Pathologic findings and long-term survival after complete surgical resection.

Undifferentiated (embryonal) sarcoma of liver is a rare tumor with a reputed poor prognosis. Four patients with this tumor are reported, of whom three were alive without recurrence 1.5, 2.5, and 12 years after initial complete surgical resection, and two of whom received no adjuvant therapy. The fourth patient, in whom complete surgical resection of tumor was not achieved, died with recurrent tumor at 13 months. The latter tumor differed histologically and consisted mainly of closely packed smaller undifferentiated cells with a higher mitotic and apoptotic rate. Eosinophilic globules, characteristic of embryonal sarcoma, were found in some cases to contain condensed nuclear chromatin, evidence of origin from tumor cells dying by apoptosis. One tumor mainly contained large cysts lined by biliary-type epithelium; this suggested an origin from a multipotent precursor cell able to differentiate along both stromal and epithelial lines.

Adolescent↗
PubMed1992

Glomerular abnormalities in children undergoing orthotopic liver transplantation.

A prospective study of renal function was undertaken on an unselected group of 8 children with chronic progressive liver disease on whom a renal biopsy was performed subsequently at the time of orthotopic liver transplantation. Two patients had abnormal urinalyses and 2 elevated urinary albumin/creatinine ratios. The remainder had no clinical evidence of renal dysfunction. All had normal serum creatinine concentrations. Glomerular abnormalities were present in all renal biopsies and were of two types: hepatic glomerulosclerosis (n = 5) and minor glomerular abnormalities (n = 3). IgM immunofluorescence was present in all biopsies and IgA in 6. Elevated serum immunoglobulin levels were observed in all patients, with IgM elevation in 6, IgA in 4 and IgG in 6. C3 and/or C4 were reduced in 5 patients and increased circulating immune complexes containing IgM were noted in 4. The clinical significance of these cirrhosis-associated glomerular abnormalities can only be established by long-term follow-up studies after orthotopic liver transplantation.

Albuminuria↗
PubMed1992

Universal occurrence of glomerular abnormalities in patients receiving liver transplants.

We conducted a prospective study of renal histology and function in 18 consecutive nonalcoholic patients who underwent orthotopic liver transplantation (OLT). Despite well-preserved renal function, all patients had abnormal renal biopsies. Four patterns of glomerular injury were identified: minor glomerular abnormalities (eight patients), hepatic glomerulosclerosis (seven), membranoproliferative glomerulonephritis (one), and IgA nephropathy (one). In one patient there was insufficient tissue to allow classification. There was a trend toward lower plasma bilirubin and higher plasma albumin in patients with minor glomerular abnormalities than in the group of patients with more severe forms of glomerular injury (29 v 82 mumol/L, 35.5 v 30 g/L; P = 0.1, 0.1 greater than P greater than 0.05, respectively). Glomerular changes persisted in the three patients who died within 7 weeks post-OLT. IgM immunofluorescence was present in all biopsies and IgA in 11. IgM-containing circulating immune complexes occurred in five patients, suggesting a pathogenic role for IgM immune complex deposition. The significance of cirrhosis-associated glomerular abnormalities is not yet known. They may contribute to the hepatorenal syndrome and the renal dysfunction that occurs in up to 94% of patients post-OLT.

Adolescent↗
PubMed1992

Primary adenocarcinoma in a colonic 'oesophageal' segment.

A case of primary adenocarcinoma of the colon in a segment used to reconstruct after an oesophageal resection is reported. The original lesion was a relatively advanced adenocarcinoma of the gastro-oesophageal junction. An ACPS 'C' colon carcinoma was diagnosed 12 years later. A curative resection was achieved. The literature is reviewed in regard to late complications in colonic interpositions, including primary carcinomas.

Adenocarcinoma↗
PubMed1991

Primary adenocarcinoma in a colonic oesophageal segment.

A case of primary adenocarcinoma of the colon in a segment used to reconstruct after an oesophageal resection is described. The original lesion was a relatively advanced adenocarcinoma of the gastro-oesophageal junction. An ACPS 'C' colon carcinoma was diagnosed 12 years later. A curative resection was achieved. The literature is reviewed with respect to late complications in colonic interpositions, including primary carcinomas.

Adenocarcinoma↗
PubMed1991

Diagnosis of ruptured diaphragm following blunt trauma: results from 85 cases.

Between 1975 and 1990, 85 patients with diaphragmatic rupture following blunt trauma were treated at the Royal Brisbane and Princess Alexandra Hospitals, Brisbane. There were 65 on the left, 17 on the right and three were bilateral. Road trauma was the cause in 88% of cases. In the first 48 h the diagnosis was made by chest X-ray in 51 patients, laparotomy in 22, autopsy in two, emergency room thoracotomy, ultrasound and pneumoperitoneum each in a single patient. Seven patients (8%) had delay in diagnosis greater than 48 h ranging from 6 days to 6 months. Diagnosis was subsequently made by pneumoperitoneum (3), chest X-ray (1) and exploratory thoracotomy (1). Two patients presented with a strangulated diaphragmatic hernia 3 and 6 months following an acute admission with blunt chest trauma and urological trauma respectively. During the study period a further five patients presented with an obstructing diaphragmatic hernia. Sixteen patients died (19%), fifteen from associated injuries and one related to the diaphragmatic repair. Ruptured diaphragm should be suspected in patients with severe chest trauma, particularly those requiring positive pressure ventilation, patients with intra-abdominal injuries and those with pelvic fractures. Early recognition and repair results in low morbidity and mortality. Measures that confirmed the diagnosis in patients with delay included repeated chest X-rays and pneumoperitoneum.

Diaphragm↗
PubMed1987

Surgical resection for cholangiocarcinoma involving the confluence of the major hepatic ducts.

In the 5-year period, ending October 1986, 15 patients underwent resection for cholangiocarcinoma involving the confluence of the right and left hepatic ducts. The operative mortality was 13%. Accurate pre-operative assessment is dependent on adequate cholangiography. Intra-operative use of frozen section is important to be certain of histological clearance above and below the tumour. Hepatic resection was necessary to adequately resect the malignancy. To date, the mean survival is 20 months, with two patients alive 5 years after resection. The length and quality of survival following this major surgical approach is such that patients whose age and condition would allow resection, should be considered for exploration and potentially curative surgery.

Adenoma, Bile Duct↗
PubMed1987

Management of familial aortic dissection.

Aortic dissection uncommonly occurs in multiple family members, and this association is most commonly seen in kindreds with Marfan's syndrome. There is increasing evidence that such connective tissue disturbances may not always appear in their complete phenotypic pattern. This report describes two siblings with aortic dissection. It is proposed that this suggests underlying connective tissue disease and warrants investigation of close relatives.

Adult↗
PubMed1986

Algal peritonitis complicating continuous ambulatory peritoneal dialysis.

A 41-year-old woman on continuous ambulatory peritoneal dialysis (CAPD) presented with algal peritonitis. Prototheca wickerhamii was isolated from multiple dialysate effluent cultures. Despite treatment with amphotericin B, catheter removal was required. An attempt to reinsert a Tenckhoff catheter 3 months later was unsuccessful because of dense intraperitoneal adhesions. Prototheca sp are a rare cause of human disease, this being the first reported case of algal peritonitis complicating CAPD.

Adult↗
PubMed1986

Splenorrhaphy in the management of splenic injury.

A retrospective study of 301 adult splenic injuries presenting to the Princess Alexandra Hospital during a 15 year period, from 1970 to 1984, was conducted. Particular attention was paid to the last 5 years during which 25% of the ruptured spleens were preserved. The details of the preserved spleens are discussed. Respiratory infections were the only complications in this same selected group of patients; the complication rate being higher in the splenectomy group (15.8%) than the splenorrhaphy group (6.25%). None of the cases of splenorrhaphy required re-operation for continued haemorrhage. Twenty-five per cent of all cases of splenic injury had associated intra-abdominal injury which, of its own nature, would require laparotomy. A policy of operative management for splenic injury in adults with major trauma is therefore proposed because of the rate of associated intra-abdominal injuries. When laparotomy is performed, splenorrhaphy should be considered because of the now widely acknowledged risks of diminished immunological competence and overwhelming sepsis in asplenic individuals.

Adolescent↗
PubMed1986

Abdominal hernias complicating continuous ambulatory peritoneal dialysis.

Twenty-five percent of all CAPD patients reviewed in this study developed abdominal hernias. Eleven hernias (32.4%) occurred at the catheter insertion site, 17.6% were inguinal, 26.5% were epigastric and umbilical and 23.5% occurred at the site of previous abdominal incisions. The risk of developing a hernia was significantly greater in patients over 40 years of age, women of parity greater than 3, patients who had had undergone more than 3 laparotomies and those with a previous hernia repair. Three hernias became incarcerated, one with intestinal strangulation. Early surgical repair is advisable to avoid these complications.

Abdomen↗