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Biomedical subjects

C J O'Brien

Publications and source records attributed to C J O'Brien.

124 records · Page 7Linked to original sources
PubMed1984

One millimetre polytetrafluoroethylene (Gore-Tex) as a microvascular prosthesis: technique and early patency.

We have described a technique for grafting 1 mm internal diameter polytetrafluoroethylene (Gore-Tex) to the rat femoral artery. By spatulating the ends of the recipient artery and completing the proximal anastomosis before commencing the distal one, gentle and accurate suture placement is assured. At a mean of 40 days postoperatively (range 35-42 days) 16 of 20 Gore-Tex grafts (80%) were patent compared with 17 of 20 autogenous femoral vein grafts (85%). Examination of the prosthetic grafts by light microscopy and scanning electron microscopy showed incomplete development of a cellular lining and some areas of neo-intimal hyperplasia. One millimetre Gore-Tex provides excellent early patency as a microvascular graft in this experimental setting but long term patency is still undetermined.

Animals↗
PubMed1983

Massive retroperitoneal lymphadenopathy as a terminal event in hairy cell leukaemia.

A case of hairy cell leukaemia complicated as a terminal event by massive retroperitoneal lymphadenopathy is described. The patient had recently been treated with lithium carbonate and had previously been demonstrated to suffer from a systemic vasculitis, either or both of which may have contributed to the development of this rare complication.

Adult↗
PubMed1983

Proximal aortic cross clamping during non-aortic surgery.

Temporary control of the aorta at the level of the diaphragm above the origins of the major visceral arteries is of proven value in the management of complex aortic disease including ruptured aneurysm, 're-do' aortic surgery and for aortic trauma. The value of the technique in elective non-aortic surgery is less well known. Two patients, one with a massive leiomyosarcoma of the stomach and the other with blood loss complicating a distal splenorenal shunt, are described in which proximal aortic control was of use.

Adult↗
PubMed1983

Coeliac disease, adenocarcinoma of jejunum and in situ squamous carcinoma of oesophagus.

The development of both adenocarcinoma of the jejunum and in situ squamous carcinoma of the oesophagus in an adult coeliac patient is described. Good evidence that adenocarcinoma of jejunum occurs more frequently in patients with coeliac disease has recently become available though this association has been suggested for some time. While oesophageal carcinoma has long been associated with coeliac disease, in situ carcinoma of oesophagus has not been previously described in these circumstances. We feel that the risk of this complication, as calculated from published series, warrants a screening programme for oesophageal malignancy in adult coeliacs.

Adenocarcinoma↗
PubMedDate not supplied

Videofluoroscopy of the pharyngoesophageal segment during tracheoesophageal and esophageal speech.

The purpose of this preliminary investigation was to identify the location and length of the pharyngoesophageal (PE) segment during esophageal and tracheoesophageal (TE) speech among laryngectomees who were proficient in both methods of vocalization. Four patients who had undergone total laryngectomy and tracheoesophageal puncture served as subjects. Voice recordings were obtained and played to listeners of varying experience with laryngectomees. Videofluoroscopy was performed while the patients sustained "ah" in both modes of speech. Results of these analyses revealed that TE speech was rated as more effective than esophageal speech in all 4 subjects. However, only minimal differences were found in the length and the location of the PE segment during TE and esophageal speech when within subject comparisons were made. This study is the first to compare the physical characteristics of the PE segment during esophageal speech and TE speech as produced by the same speaker.

Aged↗
PubMedDate not supplied

Surgical management of chronic parotitis.

A series of 17 consecutive parotidectomies for chronic sialoadenitis is presented. This comprises 10% of all parotidectomies performed by one surgeon over the 5-year period between 1987 and 1991. In 16 patients, symptoms were relieved by surgery. The extent of surgery was guided by the clinical findings. In this series, near total and superficial parotidectomy were equally efficacious and no patient suffered permanent facial nerve dysfunction. Surgery is a safe and effective treatment for parotitis.

Adult↗
PubMedDate not supplied

Radical, modified, and selective neck dissection for cutaneous malignant melanoma.

BACKGROUND: The roles of modified and selective neck dissections in treating patients with clinical metastatic melanoma and the place of adjuvant radiotherapy are unclear. In the elective setting, the efficacy of various selective dissections also requires clarification. METHODS: The prospectively documented experience of the senior author (COB) was analyzed. A total of 175 patients had 183 neck dissections and 92 parotidectomies in 6 years. There were 75 therapeutic and 108 elective operations. Modified or selective neck dissections were performed in 58% of patients with clinical neck metastases. Ali but two elective operations were modified or selective dissections. Postoperative radiotherapy was given to 27 dissected necks. Minimum follow-up was 12 months, and 86% of patients were followed up for 2 years or to neck recurrence. RESULTS: Nodes were histologically positive in 80 dissections. The cumulative rate of control of metastatic melanoma in the neck was 86% at 5 years. Neck recurrence developed in 14% of radical dissections, 0% of modified, and 23% of selective dissections performed for clinical disease. Neck recurrence occurred after 5% of elective dissections. Recurrence was 7% among irradiated necks compared to 23% in nonirradiated (p-value not significant). The 5-year survival rate was 50%, and this was significantly worsened by increasing node involvement. CONCLUSIONS: Modified radical neck dissection is highly effective in controlling metastatic melanoma in selected patients. Selective dissections are less effective and need further study. Adjuvant radiotherapy appears to decrease the risk of neck recurrence. In the elective setting, recurrence is uncommon following the selective neck dissections described.

Adolescent↗
PubMedDate not supplied

Invasion of the mandible by squamous carcinomas of the oral cavity and oropharynx.

The radiologic and histologic features of mandibular invasion, and its clinical implications, are considered in a retrospective series of 111 patients with squamous carcinomas of the oral cavity and oropharynx treated by composite resection. Eighty percent of the entire group had either recurrent or advanced (T3, T4) local disease, and 33 patients (30%) had histologic evidence of mandibular invasion by tumor. Preoperative radiologic assessment was unreliable in cases in which infiltrating tumor was confined to the periosteum and superficial cortex-44% false negatives. The extent of bone invasion was found to correlate with the size of the tumor, but not with its histologic grade. The mandibular periosteum was not seen as a morphologically discrete "barrier" and infiltration occurred at various points along the mandibular body, mainly related to the course of the inferior dental canal. The gross and microscopic patterns of bone invasion appeared to be similar in irradiated and nonirradiated resections. The incidence and pattern of recurrent disease following composite resection was the same in the groups with and without mandibular invasion: in each group half the patients were dead from disease and one third alive and free of disease at 2 years. Mandibular invasion alone did not appear to influence prognosis in this series.

Adult↗
PubMedDate not supplied

Surgical treatment of early-stage carcinoma of the oral tongue--wound adjuvant treatment be beneficial?

A group of 97 patients with clinical stage I and stage II squamous carcinoma of the oral tongue, treated by partial glossectomy alone, has been reviewed to define prognostic indicators. Sixty-seven patients were staged T1N0 and 30 were T2N0. Disease recurred in 28 patients (27%) and the most common site of failure was the ipsilateral neck (21%). The incidence of initial recurrence did not vary significantly with patient age, sex, T-stage, or when tumor size was examined in other subdivisions. The presence of perineural invasion significantly increased recurrence rate (P = 0.003) and decreased survival (P = 0.002). Disease-free survival at 5 yr was 73% for patients with T1 tumors, and 62% for T2 tumors. This difference was not significant. In this low-risk patient population with early stage carcinoma of the oral tongue, partial glossectomy is adequate treatment in most cases. However, we recommend postoperative radiation therapy to the primary site and ipsilateral neck for patients with perineural invasion. No evidence could be found to support adjuvant local therapy or elective neck treatment in the remaining patients.

Adult↗
PubMedDate not supplied

Malignant salivary tumors--analysis of prognostic factors and survival.

A group of 113 patients with malignant salivary gland tumors was retrospectively reviewed to analyze the association of clinical and histologic factors with survival. These factors were patient sex and age, tumor site, clinical stage, histologic diagnosis, tumor grade, and whether or not final surgical margins were clear. There were 57 parotid, 40 minor salivary, and 16 submandibular gland cancers. The histologic groups were mucoepidermoid carcinoma (49 patients), adenoid cystic carcinoma (31), adenocarcinoma not otherwise specified (18), acinic cell carcinoma (7), malignant mixed tumor (5), squamous cell carcinoma (2), and undifferentiated carcinoma (1). Univariate analysis of clinical factors showed that age and clinical stage significantly influenced survival. At 10 yr the predicted cumulative survival rates for Stage I, II, III, and IV tumors were 74%, 56%, 32%, and 10%, respectively. Tumor grade was the only significant histologic factor. This was most obviously reflected among patients with mucoepidermoid carcinomas. Cumulative survival at 5 yr was 94% for those with low-grade tumors and 26% for high-grade tumors. By multivariate analysis, clinical stage, age, and tumor grade remained highly significant. Analysis of patients with only Stage I and II disease demonstrated that the significant factors were patient age, tumor site, tumor grade, and whether or not surgical clearance was achieved. These results suggest that clinical stage should not be the exclusive determinant of the extent of surgery and that the selection of patients, for adjuvant therapy may be improved by an awareness of these prognostic factors.

Adolescent↗
PubMedDate not supplied

Pharyngoesophageal diverticulum complicated by squamous cell carcinoma.

Pharyngoesophageal (Zenker's) diverticulum is a relatively common acquired condition that may cause dysphagia and regurgitation of food. Squamous carcinoma may develop in such a diverticulum, but this complication is exceedingly rare and may not be suspected preoperatively. This report describes a case in which the diagnosis of squamous carcinoma was made after regurgitation of malignant tissue from a radiographically proven pharyngoesophageal diverticulum. The patient was treated by simple diverticulectomy and postoperative radiation therapy.

Carcinoma, Squamous Cell↗
PubMedDate not supplied

T lymphocyte sensitization to HBcAg and T cell-mediated unresponsiveness to HBsAg in hepatitis B virus-related chronic liver disease.

Using a newly developed indirect T lymphocyte migration inhibition test, cell-mediated immunity to HBsAg and HBcAg was directly and simultaneously examined in a total of 21 patients with HBsAg-positive chronic liver disease (CLD), and in seven subjects whose sera contained anti-HBs (2 previous acute hepatitis B; 4 hepatitis B vaccine recipients and 1 chronic active hepatitis). T cell sensitization to HBcAg was invariably detected in the HBsAg-positive CLD patients tested (12/12), whereas T cell sensitization to HBsAg was not present in any of the patients (0/21). In contrast, T cell sensitization to HBsAg was present in all anti-HBs-positive subjects. These results support the hypothesis that the cellular immune response to HBcAg, rather than to HBsAg, is implicated in the pathogenesis of HBsAg-positive CLD. Moreover, the observation that the addition of T cells from patients with HBsAg-positive CLD to T cells from anti-HBs positive subjects in a ratio of 1 to 9 reversed their sensitization to HBsAg, suggests that a hyperactivity of HBsAg-specific suppressor T cell population may be responsible for persistent HBs antigenemia.

Adult↗
PubMedDate not supplied

Prognosis in low grade non-Hodgkin's lymphoma: relevance of the number of sites involved, absolute lymphocyte count and serum immunoglobulin level.

Eighty-eight patients with low grade non-Hodgkin's lymphoma were followed for a median period of 63 months. Sixty-eight per cent of the group were centrocytic/centroblastic B cell lymphomas by the updated Kiel classification. Fifty-one (58 per cent) of the patients were stage IV by the Ann Arbor classification. In 18 of these patients the bone marrow was the only site of extranodal involvement. Univariate survival analysis showed that the sum of involved sites was more discriminatory than Ann Arbor stage. Analysis by site of involvement showed that the liver and other intraabdominal sites were associated with worse survival than involvement of peripheral lymph nodes. Bone marrow and spleen involvement were not significantly associated with short survival. Increasing age at presentation was strongly associated with shorter survival and was also inversely correlated with serum albumin. Both low absolute lymphocyte count (< 1.0 x 10(9)/l), low serum IgG level (< 10 g/l) and low total immunoglobulins on presentation were significantly associated with short survival. Multivariate analysis showed that age, serum albumin and number of involved sites gave the best survival prediction. The sum of involved sites, immunoglobulin level and absolute lymphocyte count may be useful objective markers of prognosis in low-grade non-Hodgkin's lymphoma.

Adolescent↗
PubMedDate not supplied

Neck dissection for cutaneous malignant melanoma.

This retrospective study examines the experience of the Sydney Melanoma Unit in the management of cervical lymph nodes among patients with cutaneous melanoma of the head and neck. From 1960 to 1990, 397 patients had neck dissections for cutaneous malignant melanoma of the head and neck. This number represents 40% of all patients treated for head and neck melanoma at the Sydney Melanoma Unit during this period. Neck dissections were therapeutic in 152 patients, elective in 234 patients and for an unknown indication in 11 patients. Lymph nodes were histologically positive in 39% of operations overall and in 7% of elective neck dissections. The incidence of recurrence in the neck after dissection was 24% overall, 28% when nodes were histologically positive and 13% when nodes were histologically negative. Patients who developed recurrent neck disease after neck dissection had a worse prognosis than those with positive nodes who did not recur, but the difference in survival was not statistically significant. Patients with histologically positive nodes had a significantly worse survival than those with negative nodes, 34% vs 67% respectively at 10 years (p less than 0.001). Elective neck dissection was associated with a significant improvement in survival for patients with melanomas 1.5-3.9 mm thick, using univariate analysis. This apparent benefit was lost when multivariate analysis was carried out. Patients having elective neck dissection currently have selective modified radical dissections depending upon the anatomic site of the primary melanoma. Postoperative radiotherapy is used for multiple positive nodes or extracapsular spread.

Female↗
PubMedDate not supplied

Trends in ophthalmic surgery in Ireland.

AIMS: This study was designed to document the changing trends in ophthalmic surgery in acute public hospitals in the Republic of Ireland over the years 1994 to 2001. METHOD: We obtained Hospital In-Patient Enquiry (HIPE) data returned from the major acute public hospitals to the Economic and Social Research Institute. We searched for cataracts, glaucoma, retinal detachment, strabismus, corneal transplant and repair of perforating injuries of the globe. RESULTS: There was a 24% increase in the total number of the searched operations occurring during the study period, from 8,857 procedures in 1994 to 11,005 in 2001. In 2001, cataract surgery alone counted for 82% of all procedures performed. There was a large increase in cataract (49%) and vitreo-retinal procedures (41%) reported between 1994 and 2001. Conversely, a large fall in trabeculectomy (67%), strabismus (63%) and corneal transplant (52%) procedures occurred during the study period. CONCLUSION: These data suggest that surgical numbers in ophthalmology in Ireland are increasing and the relative proportions are changing.

Hospitals, Public↗