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Biomedical subjects

T F Gorey

Publications and source records attributed to T F Gorey.

At least 73 records · Page 4Linked to original sources
PubMed1984

Highly selective vagotomy in duodenal ulceration and its complications. A 12-year review.

Highly selective vagotomy (HSV) was performed in 509 patients over 12 years for the surgical management of duodenal ulceration; 103 HSVs were carried out during the treatment of complications. The overall rate of ulcer recurrence was 7%, ranging from 10% in the first 4 years to 4% in the 6 years between 1975 and 1980. Highly selective vagotomy was performed in addition to closure of a perforated ulcer in 16 patients, with no recurrent ulcers or re-perforations. After the control of their bleeding duodenal ulcers, 25 patients had HSV with no rebleeding, although two patients had recurrent ulceration. Highly selective vagotomy was performed in 62 patients with stenosis in addition to dilatation (44) or duodenoplasty (18). There was a high incidence of recurrent ulceration (7) and stenosis (9) with digital dilatation while duodenoplasty gave better results with one recurrent stenosis and no recurrent ulceration. The authors conclude that HSV is justified by its late results as a definitive operation in chronic duodenal ulceration that allows preservation of the pylorus during surgery for complications.

Adolescent↗
PubMed1980

The recovery of intestine after ischaemic injury.

A reproducible model of reversible segmental ischaemia was used to evaluate methods of predicting intestinal viability after the release of strangulation. Visual assessment in the immediate period after reperfusion and at "second-look' 24 hours later was inaccurate in identifying recoverable bowel. A Doppler probe used to detect the return of pulsatile blood flow was overpredictive of necrosis. The pattern of surface fluorescence after injection of the supravital dye fluorescein increased the accuracy of predicting intestinal recovery. A series of silicone rubber injections was carried out to investigate whether the patency of the microvessels influenced the outcome. It was shown that as the ischaemic period increased there was progressive failure of the microcirculation. It was concluded that the fluorescein injection test correctly identifies recoverable bowel and that the outcome after ischaemic injury is related to microvascular patency.

Animals↗
PubMed1980

Prediction of intestinal recovery after ischaemic injury due to arterial, venous and mixed arterial and venous occlusions.

Methods to predict intestinal viability after release of vascular occlusion were evaluated in a rat model of reversible segmental strangulation. Visual criteria of colour, pulsation and peristalsis in the ischaemic intestine were applied both in the immmediate period after restoration of the circulation and at `second-look' 24 hours later. In addition two simple tests using a Doppler probe and surface fluorescence were evaluated. As a test in identifying nonviable intestine the fluorescent method had an overall sensitivity of 96% with a specificity of 95% for all types of vascular occlusion, which compared favourably with the other methods tested.

Animals↗
PubMed1979

Iliac artery ligation: the relative paucity of ischemic sequelae in renal transplant patients.

In order to assess the effect of iliac artery ligation on the distal extremity, the ten year experience of the Johns Hopkins renal transplantation program was reviewed. Among 467 transplant procedures in 390 patients there were six cases in which the common and/or external iliac artery had been ligated for control of untoward hemorrhage from an infected arteriotomy site. These six cases were studied in detail with particular attention to ischemic sequelae in the involved leg. There were no immediate or causally-related deaths. No patient lost a leg or required an immediate reconstructive procedure for limb salvage. Four of the six recovered ambulatory status, and only two of these required a later, elective reconstruction for claudication. The combination of these six with eight other similar patients previously reported provides a total of 14 cases of iliac artery ligation in renal transplant patients. No patient suffered actual limb loss, and only three underwent subsequent elective reconstruction for claudication. It is concluded that common and/or external iliac artery ligation without immediate revascularization may be performed for control of hemorrhage with little danger of limb loss in renal transplant patients.

Adult↗
PubMedDate not supplied

Modelling medical devices: the application of bioengineering in surgery.

Medical device technology has an increasingly important role in surgical procedures. In this article, five case studies of bioengineering in surgery are described as follows: computer-aided design of vascular grafts; middle-ear prostheses; hip prosthesis stems for optimal cement pressurisation; prototype development of a device for measurement of abdominal sounds for monitoring digestive tract activity and a hand-access device for laparoscopic surgery. In each case, new bioengineering design methodologies are demonstrated. The general principles underlying the application of bioengineering in surgery are discussed.

Arthroplasty, Replacement, Hip↗
PubMedDate not supplied

Case report: combined hand access with laparoscopic pneumoperitoneum in intraperitoneal adhesiolysis.

Previous abdominal surgery is one of the relative contraindications to safe induction of pneumoperitoneum with a Veress needle. Similarly visual inspection with a telescope may be limited and instrumental manipulation difficult. The manual ability to distract bowel loops and finger dissect greatly facilitates adhesiolysis and this is lost with conventional laparoscopy. A novel hand-access port is described which combines manual tactile ability with minimally invasive laparoscopic adhesiolysis.

Aged↗
PubMedDate not supplied

The role of surgery and laser ablation in oesophageal carcinoma.

Between January 1990 and December 1994 oesophagectomy was carried out in 42 patients and comparison made with 38 who had palliative laser therapy. Apart from six patients referred after being unresectable at surgical exploration there were no agreed selection criteria, although the laser patients were in general older (mean 64 V 73 year) with a higher proportion of cardiorespiratory co-morbidity (14 per cent V 18 per cent). Lateral margins were involved in 14 per cent of known palliative resections with 50 per cent having positive nodes. The mean operating time was three hours and two chest drains inserted electively were removed after 3.6 days with mean drainage of 817 ml. The mean ICU stay was 5.4 days and 3 had radiological leaks; all but one settled conservatively. The 90 day mortality was 11.9 per cent for surgery and 34 per cent for laser patients. Twenty-three patients (61 per cent) required further courses of laser-therapy for benign anastomotic stenosis. Including the initial treatment of both groups 6.0 procedures per patient year were required in the laser groups compared with 1.1 for surgery. The 1, 2 and 3 year survival was 60 per cent, 31 per cent, 39 per cent for surgery compared with 24 per cent, 8 per cent, 3 per cent for laser--12 surgical patients are still alive and well at mean of 29 months (range 16-68). Surgery where possible with acceptable morbidity and mortality offers good palliation and long-term survival is possible; selection criteria for palliation only need to be defined.

Adult↗