PubMed Health⌕ Search

Biomedical subjects

D J Adam

Publications and source records attributed to D J Adam.

47 records · Page 3Linked to original sources
PubMed1997

Subfascial endoscopic perforator surgery is associated with significantly less morbidity and shorter hospital stay than open operation (Linton's procedure)

BACKGROUND: Subfascial endoscopic perforator surgery (SEPS) is the minimally invasive alternative to the open (Linton's) procedure. This new technique may allow perforating vein interruption with fewer complications and a shorter postoperative hospital stay. METHODS: This study was a case note review of 67 procedures: 30 SEPS and 37 Linton's. RESULTS: There were no significant differences between the two groups in age, sex and indication for surgery. SEPS was associated with a significantly reduced postoperative stay in hospital (median 2 (range 1-49) days) compared with the Linton's procedure (median 9 (range 3-36) days) (P < 0.01). Nine patients who had Linton's procedure suffered a calf wound complication compared with none who had SEPS. The presence of an open ulcer at the time of surgery did not prolong the duration of stay in either group, nor did it increase the incidence of calf wound complications. CONCLUSION: In patients undergoing calf perforator interruption for chronic venous insufficiency, SEPS is associated with significantly less morbidity and a shorter hospital stay than Linton's procedure. SEPS can be performed safely at the same time as skin grafting and in the presence of an open ulcer without any increase in wound complications.

Adult↗
PubMed1997

Twelve-year experience of the management of ruptured abdominal aortic aneurysm.

BACKGROUND: The operative mortality rate for elective repair of asymptomatic abdominal aortic aneurysm (AAA) is falling but the fate of patients with ruptured AAA may have changed little over the past decade. METHODS: This study was an analysis of a prospectively gathered computerized database. RESULTS: In the 12 years to 31 December 1994, 1144 patients underwent (attempted) repair of AAA. In 514 patients (44.9 per cent) who had an operation for ruptured AAA there was no significant change in the mean age, male:female ratio (418:96), or operative mortality rate (35.0 per cent) over the interval of the study. Forty-seven patients died before reaching the operating theatre, giving an 'intention to operate' mortality rate of 40.5 per cent. A further 68 patients (10.8 per cent of all patients who presented with a ruptured AAA) were not offered operation because of poor medical condition (n = 34) or extreme age (n = 34); three patients refused operation. A greater proportion of patients had surgery between 1989 and 1994 (276 of 323, 85.4 per cent) than between 1983 and 1988 (238 of 309, 77.0 per cent) (P < 0.01, chi2 test). CONCLUSION: The proportion of aneurysms operated on for rupture in this unit remains high (almost 50 per cent). The results of surgery for ruptured AAA have not improved in the past 12 years.

Aged↗
PubMed1996

Oesophagogastrectomy for iatrogenic perforation of oesophageal and cardia carcinoma.

A casenote review identified 18 patients with carcinoma of the oesophagus and gastric cardia who underwent transthoracic oesophagectomy after instrumental perforation. Oesophagectomy was performed within 48 h in ten patients (early surgery group) and after a median delay of 22 (range 5-48) days in eight patients (delayed surgery group). All patients underwent resection via left thoracolaparotomy with immediate intrathoracic anastomosis using the stomach in 17 of 18 patients. There were no anastomotic leaks. Significant postoperative complications occurred in five of ten of the early group with two in-hospital deaths and a mean survival of 551 days. Six of eight patients in the delayed group developed postoperative complications with two in-hospital deaths and a mean survival of 297 days. Transthoracic resection with immediate intrathoracic anastomosis can be performed without anastomotic leakage but there is high associated respiratory morbidity. The timing of oesophagectomy has little effect on hospital morbidity or mortality rates but early surgery is associated with better long-term survival.

Adenocarcinoma↗
PubMed1996

Esophagectomy for carcinoma in the octogenarian.

BACKGROUND: Esophageal carcinoma is predominantly a disease of the elderly, a group often only considered for palliative therapies. METHODS: A case note review identified 31 octogenarians undergoing resection for carcinoma of the esophagus or gastric cardia over a 12-year period ending December 1994. RESULTS: Nineteen patients made either an uncomplicated postoperative recovery (n = 12) or suffered minor complications (n = 7). Of the 12 patients who suffered moderate or severe complications, 5 died (in-hospital mortality, 16%). The deaths included 2 of 3 patients who underwent emergency operation for esophageal perforation and 3 of 28 patients who underwent elective esophagectomy (elective mortality rate, 10.7%). Nineteen of the 26 survivors (73%) experienced no further dysphagia. The 5-year survival rate was 17%. CONCLUSIONS: Elective esophageal resection can be performed safety in selected octogenarians who have no or few coexisting medical problems and present with a localized carcinoma that is technically easy to resect. Patients undergoing emergency operations or in whom moderate or severe postoperative complications develop often have poor physiologic reserve and are therefore at risk of early postoperative death.

Adenocarcinoma↗
PubMed1996

Pyoderma gangrenosum severely affecting both hands.

We report a case of pyoderma gangrenosum affecting both hands simultaneously. Pyoderma gangrenosum affecting the hands is an extremely rare condition which may result in considerable tissue destruction. Management includes immunosuppressant therapy, treatment of associated medical conditions and minimal surgical intervention. Despite a high maintenance dose of corticosteroid and adequate control of coexisting ulcerative colitis and rheumatoid arthritis, tissue destruction in the hands spread rapidly in our patient. The key to the patient's dramatic improvement was the tissue biopsy suggesting pyoderma gangrenosum and the subsequent treatment with the cytotoxic immunosuppressant, azathioprine.

Amputation, Surgical↗
PubMed1996

Oesophagogastrectomy for carcinoma in patients under 50 years of age.

Oesophagogastrectomy for carcinoma of the oesophagus or gastric cardia has been reported as being associated with a poorer outcome in young adults than in older patients in an Oriental population. A retrospective analysis of 597 patients who underwent oesophagogastrectomy for carcinoma was undertaken to ascertain if resection in younger Scottish patients was associated with the same poorer outcome. Forty-seven patients aged less than 50 years were compared with 323 patients aged 50-69 years and 227 patients aged 70 years and older. Young patients had a higher incidence of distal third oesophageal tumours than older patients, who tended to have carcinomas of the gastric cardia. There were no differences with regard to tumour pathology, stage, extent of resection, hospital mortality or survival. In Scotland, carcinoma of the oesophagus or gastric cardia in young adults behaves similarly to that in older patients, and survival following resection is independent of age.

Adult↗
PubMed1995

Presentation of endometriosis to general surgeons: a 10-year experience.

The presentation and management of 24 patients with endometriosis (median age 34 (range 21-68)years) presenting to general surgeons over a period of 10 years (1985-1994) was reviewed. Patients presented with an abdominal wall swelling related to a previous Pfannenstiel incision (seven patients), umbilical swelling (four), inguinal canal swelling (two), incidentally following appendicectomy (five), terminal ileal obstruction (two), rectal bleeding (two) and urinary symptoms (two). Endometriosis was not suspected in most patients but was confirmed by surgical excision or resection with minimal morbidity. No recurrence occurred during a median follow-up of 53 (range 9-113) months. Endometriosis is a disease rarely seen by general surgeons and is often diagnosed incidentally or on histological examination. Cyclical symptoms associated with menstruation are present in 50 per cent of patients and should suggest the diagnosis in those presenting with scar-related and/or subcutaneous swellings. Simple excision or resection of the presenting lesion provides adequate treatment but, since pelvic endometriosis may be present, referral to a gynaecologist is recommended in every case.

Abdominal Muscles↗