Search PubMed⌕ Search

Biomedical subjects

R W Strong

Publications and source records attributed to R W Strong.

86 records · Page 5Linked to original sources
PubMed1984

Dieulafoy's disease--a distinct clinical entity.

Dieulafoy's disease is a condition characterized by massive gastric haemorrhage from an abnormal submucosal artery in the upper third of the stomach. The site of rupture is marked by a small mucosal erosion over the point of rupture. Identification of the lesion is made by endoscopy, angiography or operation. However, the diagnosis is not always easy, especially as the bleeding is intermittent. Once diagnosed, treatment by operation is simple. The disease is possibly not rare, but rarely recognized.

Adult↗
PubMed1981

Long-term experience of Thomas shunts on the iliac vessels.

Thomas shunts have been utilized 24 times in 20 patients to provide secondary vascular access in an often poor-risk group of patients, including children. Twenty of the shunts were on the iliac vessels. Five shunts are in current use, the longest having been in situ for 83 months. Another 13 shunts provided access until renal transplantation or death of the patient. Six shunts developed deep infection which usually extended to the Dacron-arterial anastomosis; the management of these infected iliac shunts was difficult and hazardous. No definite advantage for the iliac placement of shunts has been established, and its use at this site cannot be recommended. Although the Thomas shunt can provide good long-term access, our experience suggests that its use should be limited to that of a "shunt of last resort".

Adolescent↗
PubMed1981

Colorectal injuries.

Forty-two cases of colorectal injury occurring over a five-year period at the Princess Alexandra Hospital are described. The ratio of penetrating trauma to blunt trauma was approximately 2:1. There are a number of alternative methods of survival management available. The indications and problems associated with each are discussed. Surgeons should match the appropriate treatment to the individual problem, with the emphasis on conservatism.

Adolescent↗
PubMed1980

Gunshot wounds of adolescents.

A study of gunshot wounds sustained by adolescents revealed 55 cases which required admission to hospital over a five-year period. The most serious injuries occurred in patients who attempted suicide. Two-thirds of the cases resulted from accidental firing of the weapon in a variety of circumstances. The law relating to the possession and use of firearms by adolescents is outlined.

Accidents↗
PubMed1980

Skin cancer in Caucasian renal allograft recipients living in a subtropical climate.

Between September, 1969, and December, 1978, 290 patients received 325 cadaveric renal allografts; 11 others transplanted elsewhere were also observed. Cancers developed in 28 patients (9.3%); 26 of these (93%) had skin cancers. The incidence of skin cancer increased by 5% annually after the first year of graft function, to a cumulative 44% in those surviving 9 years with functioning grafts. This represents an incidence of 4,356/100,000 person years of post-transplant risk--20.6 times the annual incidence of skin cancer in the general population of Southern Queensland. Half of the patients had multiple tumors when the first skin cancer was diagnosed, after a mean latent interval of 34 months. A total of 138 skin cancers occurred in 26 patients (average, 5.3 per patient), with a maximum of 19 in one individual. The ratio of basal to squamous cell carcinoma was reversed from 4:1, in the general population, to 1:1.7. Conventional surgical excision gave satisfactory results, with the one local recurrence being controlled by reexcision. Two patients (7%) died of melanoma and metastatic squamous cell carcinoma, respectively, whereas two of the other four patients who died from cancer had coincidental skin cancer. The two skin cancer deaths represent only 2% of all deaths in allograft recipients. These results suggest that the problem of skin cancer in these patients can be controlled and thus is not a significant contraindication to the continued clinical use of cadaveric renal transplantation.

Adolescent↗
PubMed1979

Gastrointestinal complications following renal transplantation.

Gastrointestinal complications occurred in 19 of 290 recipients (6.6%) of the 325 cadaveric renal allografts undertaken between September 1969 and December 1978. The mortality was 42.1%. Upper gastrointestinal complications, principally haemorrhage, occurred in 12 patients (4.1%), 11 of whom were males, usually within four months of transplantation, and often associated with acute rejection and its treatment. Surgery was required in five patients. The overall mortality was 16.7%. Colonic complications occurred in five patients (1.7%), four of whom died, the absence of specific signs having led to a significant delay in diagnosis. One patient died from abdominal vascular disease, and one from carcinoma of the gallbladder. To decrease the high morbidity and mortality, both medical and appropriate surgical prophylaxis for peptic ulceration and diverticular disease are necessary, as is an awareness of the transplant recipient's propensity to develop a gastrointestinal complication at any time, up to years after transplantation. Early recognition and treatment of such complications are essential.

Cholestasis, Extrahepatic↗
PubMed1979

Further experience with an external ureterovesical anastomosis in renal transplantation.

Review of the results of the use of an external ureterovesical anastomosis in 266 renal transplantations showed that urinary fistulae occurred in 34 patients (12.8%), and ureteric obstruction in six (2.3%). The fistulae were due to technical failure of the anastomosis in 13 patients, to distal ureteric necrosis in 13, to total ureteric necrosis in six, and to other causes in two. Fistula management was successful in 26 cases (76.5%), but multiple operations were often necessary and wound complications frequent (41.2%). The continuing high incidence of urological complications following ureterovesical anastomosis has resulted in increasing use of ureteroneocystostomy as the primary form of urinary reconstruction after transplantation in this unit.

Adolescent↗
PubMed1978

Abdominal apoplexy.

Seven patients with abdominal apoplexy have been treated between 1975 and 1977 and their clinical features and management are reviewed. Accurate preoperative diagnosis is difficult but the condition should be considered in patients with abdominal pain and vomiting or diarrhoea who have signs of shock, peritonism or a falling haemoglobin level. Urgent laparotomy to identify and ligate the bleeding artery offers the best chance of survival.

Abdomen↗
PubMedDate not supplied

Transplantation for liver and biliary cancer.

The early survival of patients transplanted for liver and biliary cancer is excellent, but the overall mid- to long-term survival is poor. In an era of severe donor organ shortage, it is not justified to allocate donor liver to patients with a suboptimal outcome. Patients with non-resectable hepatocellular carcinoma in a non-cirrhotic liver should not be assigned to liver transplantation. Although patients with the fibrolamellar variant have a somewhat better outlook, they are still likely to recur, and the young age of many of these patients is likely to overwhelm any rational approach. The results of transplantation for early-stage hepatocellular carcinoma in a cirrhotic liver are similar to those achieved with benign disease. The inclusion of such cases as a group is justified, but attempts should be made to resect tumors whenever possible and to not assign the entire group to transplantation as the first and only option. The value of pre- and postoperative adjuvant therapy for this group is still under debate, but the present waiting period is so long that some form of therapy to slow growth and prevent dissemination of tumor cells is probably required. The results following transplantation for cholangiocarcinoma can only be regarded as dismal, and the diagnosis of cholangiocarcinoma is a contraindication for the procedure. Liver transplantation has a definite place in the treatment of epithelioid hemangioendothelioma and unresectable chemo-responsive hepatoblastoma when confined to the liver, and in a limited number of metastatic neuroendocrine tumors.

Antineoplastic Combined Chemotherapy Protocols↗
PubMedDate not supplied

Necrotizing pancreatitis: operating for life.

Infected necrotizing pancreatitis is the most fulminant variety of this disease. Colonic involvement and retroperitoneal fasciitis are particularly lethal. The reported mortality is up to 50%. The purpose of this study is to review our combined experience at the Princess Alexandra Hospital and the Royal Brisbane Hospital, Brisbane, to determine whether patient survival was related to a particular etiology, treatment, or complication. All patients treated since 1986 with infected pancreatitis who required surgical necrosectomy and then ventilation in the intensive care unit (ICU) were studied. There were 48 patients so managed. The median age of survivors was 52 years, and for those who died it was 64 years (p = 0.001). The etiology was gallstones in 22 and alcoholism in 12. Of the alcoholics, 11 survived and 1 died. Of the patients with gallstones, 13 survived and 9 died. There was an overall mortality of 31%. Survivors were in hospital for a median of 73 days, whereas deaths occurred after a median of 35 days (p = 0.04). Seven patients underwent hemofiltration; five survived, and two died. N-Acetylcysteine has been used in four patients, of whom three survived and one died. The abdomen was left open in 38 patients and kept closed in 10. Although Ranson's criteria at admission to the ICU did not predict survival, it was found that the median APACHE II score in survivors was significantly lower than in those who died (p = 0.025).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Surgical complications and long-term outcome in pediatric liver transplantation.

BACKGROUND/AIMS: Liver transplantation has been widely accepted for the treatment of children with end-stage liver disease over the last 10 years particularly with the advent of reduced-size liver transplant technique. This study reviewed the perioperative and long-term results in the pediatric program of the Queensland Liver Transplant Service, Brisbane, Australia. METHODOLOGY: Retrospective analysis was performed in 153 children who received 176 liver grafts between 1985 and 1995, including 109 (62%) reduced-size and 67 (38%) whole liver grafts. Median follow-up period was 5.3 years. RESULTS: One-, 5-, and 10-year patient and graft survival rates were 82% and 74%, 75% and 63%, and 70% and 60%, respectively. Normal physical and intellectual development was observed in 98% of survivors. There were no significant differences in patient or graft survival rates between transplants using reduced-size and whole liver grafts. Portal vein thrombosis was the most common vascular complication, occurring in 8%. Hepatic artery thrombosis occurred in 7%, including 11% of children less than 1 year old and 8% of those under 10 kg. Biliary complication was found in 16% and posttransplant gastrointestinal perforation in 19%. CONCLUSIONS: Liver transplantation has the potential to cure and allow development in children with end-stage liver disease.

Adolescent↗
PubMedDate not supplied

Selection and management of the brain dead donor for liver and kidney transplantation.

The passing of brain death legislation by the Indian Parliament in June 1994 has paved the way for the commencement of cadaveric organ transplant programmes in India. The medical profession must develop a code of practice that is legally, medically and ethically acceptable. Once established, adherence to the policy and procedures is mandatory or transplantation in India will fall into disrepute at home and abroad. Donor selection and management is an integral part of the transplant process. The final result of transplantation can only be as good as the quality of the organ transplanted. The key elements of the selection criteria and management of the donor after the determination of brain death are outlined in this article.

Brain Death↗