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Biomedical subjects

A R Talbot

Publications and source records attributed to A R Talbot.

18 recordsLinked to original sources
PubMed1999

Esophageal tuberculosis: a rare presentation with massive hematemesis.

A 43-year-old female presented with massive hematemesis. Esophagoscopy showed an ulcer 22 to 25 cm from the incisor with active bleeding. A thoracotomy and primary closure of the ulcer was performed. Massive hematemesis recurred 8 days later, resulting in hypovolemic shock. The thoracic esophagus was resected and histological examination showed granuloma with central caseous necrosis. Combined chemotherapy was given for 10 months. At 6 months after the subtotal esophagectomy, the esophagus was reconstructed using the right-side colon.

Adult↗
PubMed1997

Mucociliary clearance and buffered hypertonic saline solution.

Nasal irrigations have been used for centuries without any scientific data to determine efficacy. For 10 years, the senior author has used buffered hypertonic saline nasal irrigation for patients with acute/chronic sinusitis and for those having undergone sinus surgery. A simple study was undertaken using volunteers without any significant sinonasal disease. Patients served as their own control using a saccharin clearance test before any nasal irrigation was used. Patients then used one of two solutions to irrigate their nose-buffered normal saline or buffered hypertonic saline-and were then retested. On a separate day, the control test was repeated, followed by irrigation with the alternate solution and a second saccharin clearance test. The outcome showed buffered hypertonic saline nasal irrigation to improve mucociliary transit times of saccharin, while buffered normal saline had no such effect.

Adult↗
PubMed1996

Frontal sinus surgery in children.

Surgery for frontal sinusitis in children is unusual. When required, surgery for ostiomeatal disease or, in certain circumstances, frontal sinus trephination is usually all that is required. Nevertheless, for a few children, surgery of the nasofrontal recess and frontal sinus is required and can be very beneficial. A variety of surgical approaches to the frontal sinus are discussed. Functional endoscopic surgery based upon physiologic principles and the concept of reversible disease is emphasized.

Acute Disease↗
PubMed1996

The missed ostium sequence and the surgical approach to revision functional endoscopic sinus surgery.

Maxillary sinus disease often is exacerbated by a laterally displaced uncinate process that functionally obstructs the infundibulum and the natural ostium. The drainage pathway may be adequate during periods of wellness but with the introduction of nasal edema, the ostium/infundibulum interface is inadequate, thus preventing acceptable ventilation and drainage. Incomplete removal of the most anterior uncinate can keep the surgeon from identifying the natural ostium. Failure to relieve any obstruction from this important opening, with simultaneous creation of an MMA that does not include the natural ostium of the maxillary sinus, leads to the missed ostium sequence and continued sinus disease.

Child↗
PubMed1991

Acute poisoning with a glyphosate-surfactant herbicide ('Roundup'): a review of 93 cases.

Between 1 January 1980, and 30 September 1989, 93 cases of exposure to herbicides containing glyphosphate and surfactant ('Roundup') were treated at Changhua Christian Hospital. The average amount of the 41% solution of glyphosate herbicide ingested by non-survivors was 184 +/- 70 ml (range 85-200 ml), but much larger amounts (500 ml) were reported to have been ingested by some patients and only resulted in mild to moderate symptomatology. Accidental exposure was asymptomatic after dermal contact with spray (six cases), while mild oral discomfort occurred after accidental ingestion (13 cases). Intentional ingestion (80 cases) resulted in erosion of the gastrointestinal tract (66%), seen as sore throat (43%), dysphagia (31%), and gastrointestinal haemorrhage (8%). Other organs were affected less often (non-specific leucocytosis 65%, lung 23%, liver 19%, cardiovascular 18%, kidney 14%, and CNS 12%). There were seven deaths, all of which occurred within hours of ingestion, two before the patient arrived at the hospital. Deaths following ingestion of 'Roundup' alone were due to a syndrome that involved hypotension, unresponsive to intravenous fluids or vasopressor drugs, and sometimes pulmonary oedema, in the presence of normal central venous pressure.

Adolescent↗
PubMed1990

Laryngeal amyloidosis.

Laryngeal amyloidosis is a rare disease. Surgery has been the mainstay of treatment either endoscopically or by an external neck approach. In more recent years, surgery with the carbon dioxide laser has been advocated for this condition. Four cases of laryngeal amyloidosis are presented. The application and the advantages of the carbon dioxide laser for the treatment of laryngeal amyloidosis are discussed.

Aged↗
PubMed1990

Paraganglioma of the maxillary sinus.

Non-chromaffin paragangliomas are unusual tumours arising in specialized tissue, probably of neural crest origin. A primary non-chromaffin paraganglioma of the paranasal sinuses is a very rare tumour with only a handful of such cases documented in the literature. The presence of such a tumour raises interesting questions as to the origin of such specialized tissue within the nose and paranasal sinuses.

Adolescent↗
PubMed1989

Clinical use of differential lung ventilation in the treatment of asymmetric lung injury: report of a case.

Successful treatment of a 26-year-old male with asymmetric lung injury following a traffic accident is described. The patient was admitted with head injuries, right lung contusion, right pneumothorax, and multiple rib fractures (right 1-9). He developed a left pneumohemothorax and complete atelectasis of the lower lobe of the left lung two days later. Conventional mechanical ventilation with and without positive end-expiratory pressure (PEEP), supplemented by repeated therapeutic bronchoscopy, failed to reexpand the left lung. After 16 days of atelectasis, synchronized differential lung ventilation using a double lumen endobronchial tube connected to two ventilators (Siemens 900C) was instituted. Measurement of the tidal volume and static compliance of each lung showed marked inequality and 9 cm H2O of PEEP was applied selectively to the left lung (zero PEEP to the right) in an attempt to equalize tidal volumes. Evident improvement in blood gases and chest radiograph was obtained within 30 min but weaning back to a single lumen tube required 6 days, and was complicated by further episodes of atelectasis. Complete pulmonary and neurological recovery was obtained, and a normal chest radiograph was documented 3 months later. Differential ventilation proved simple to use, and highly effective in the management of this combination of lung problems.

Adult↗
PubMed1989

A comparison of hemoperfusion columns for paraquat.

The efficiency of charcoal hemoperfusion (HP) columns during the treatment of paraquat poisoning by continuous hemoperfusion is poorly documented, and fears of saturation of the charcoal by paraquat have led to replacement of the column in as little as 2-4 hr. Four commercially availably HP devices were compared in a prospective study of 54 patients who had ingested paraquat deliberately. The charcoal columns studied were Hemosorba CH-350 (Asahi Medical, Tokyo, Japan), DHP-1 (Kuraray, Osaka, Japan), Adsorba 300 (Gambro Dialysatoren KG, Hechingen, West Germany) and Hemokart-Adult (National Medical Care, Rockleigh, NJ, USA). Plasma paraquat levels were measured at the inlet and outlet 15 min after the commencement of HP, and hourly during the next 12 hr or until HP was ceased (if less than 12 hr). Platelet levels were measured before HP and every 4 hr thereafter. All 4 types showed almost 100% removal at 15 min and maintained this efficiency throughout the period studied. Both DHP-1 and Hemokart-Adult caused minimal thrombocytopenia (mean always greater than 100,000/mm3). Adsorba 300 and Hemosorba CH-350 caused marked thrombocytopenia, and the levels with Adsorba 300 were significantly lower than for DHP-1 and Hemokart-Adult (P less than 0.05). The thrombocytopenia induced by Adsorba 300 often required platelet transfusions or cessation of HP. Commercially available HP columns are not saturated by the paraquat levels met clinically, so longer use of each column should be considered.

Adolescent↗
PubMed1988

Radiotherapy for the treatment of pulmonary complications of paraquat poisoning.

The effect of radiotherapy on the pulmonary damage caused by paraquat (24% solution of 1,1'-dimethyl-4,4'-bipyridylium dichloride) was investigated in a preliminary series of nine patients. Paraquat intoxication was diagnosed by quantitative analysis of urine and plasma using colorimetry after extraction of a cation exchange column. The irradiation was given as a planned procedure from day 2 in cases 1 to 7, and after changes in chest X-ray were recognized in cases 8 and 9. A cobalt-60 unit with opposed anterior and posterior portals was used to give a total dose of 12.50 Gy (uncorrected) over 10 fractions, sparing the pericardium and mediastinum as much as possible. Each fraction consisted of 1.25 Gy (125 rad) given once a day, alternating between the left and right lungs. Radiological diagnosis consisted of clear chest X-rays (cases 2 to 4), pulmonary oedema (cases 7 and 9) and interstitial infiltrates (cases 1, 5, 6 and 8). Cases 1, 5 and 8 survived. Case 8 had residual interstitial infiltrates three months after ingestion but these had cleared one month later, suggesting that the diagnosis of irreversible fibrosis should only be made after a follow-up period of at least one year. The results have failed to show a definite benefit, but do support the fact that radiotherapy should be assessed carefully in a randomized trial which is now in progress.

Adolescent↗
PubMed1988

Paraquat intoxication during pregnancy: a report of 9 cases.

The details of nine patients who deliberately ingested paraquat (24% solution) while pregnant are presented. Two patients refused treatment. Paraquat levels in maternal, fetal and cord blood in 1 case shows that paraquat crosses the placenta and is concentrated to levels 4-6 times greater than the maternal blood. Amnioscopy in another case showed paraquat levels in amniotic fluid nearly twice that of maternal blood. All fetuses died, whether or not emergency cesarean operation was performed. The condition of the fetus worsened at delivery, or in utero if the gestational age was greater than 30 weeks. One of the 2 survivors has had a normal pregnancy since, with no evidence of teratogenicity from the earlier paraquat intoxication. This patient has shown a gradual return to normal spirometry values from the marked reduction that occurred at the time of paraquat intoxication.

Adolescent↗