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Biomedical subjects

J D Stamatakis

Publications and source records attributed to J D Stamatakis.

34 records · Page 2Linked to original sources
PubMed1984

Management of esophageal varices in children by injection sclerotherapy.

Esophageal varices in 57 consecutive children were treated by injection sclerotherapy using 5% ethanolamine oleate injection via a fiberoptic endoscope (Olympus P2). Variceal obliteration was achieved with 4.7 and 5.7 injections in the extra- and intrahepatic disease groups. Complications of injections included hemorrhage, esophageal ulceration, and stricture. Thirty two cases were followed from 6 to 60 months after treatment and only five further bleeds were observed (extrahepatic 1: intrahepatic 4). The early results suggest that sclerotherapy is an effective method for the control of esophageal varices in children.

Adolescent↗
PubMed1982

Injection sclerotherapy for oesophageal varices in children.

Oesophageal varices in 21 children with portal hypertension (intrahepatic 13, extrahepatic 8) were treated with sclerotherapy using ethanolamine oleate injected via a fibreoptic endoscope. Repeat endoscopy confirmed variceal obliteration in 18 children with a mean of 3.5 (range 1-8) injections. No patient has bled since obliteration of varices. Complications were oesophageal stricture (2 patients), oesophageal ulcer (5 patients) and haemorrhage within 3 days of injection (5 patients). The early results suggest that this is a satisfactory method for the treatment of oesophageal varices in children.

Adolescent↗
PubMed1979

Prophylaxis for postoperative deep-vein thrombosis. Synergistic effect of heparin and dihydroergotamine.

Randomized clinical trials in 300 patients undergoing major abdominal surgery or hip replacement arthroplasty were performed to investigate the efficacy of dihydroergotamine mesylate, heparin calcium, or a combination of dihydroergotamine with heparin in preventing postoperative deep-vein thrombosis (DVT). The diagnosis of DVT was established by an uptake test using fibrinogen labeled with iodine 125; in patients undergoing hip replacement, phlebography was also employed to confirm or refute the presence of isotopic thrombi. The data indicate that the combination of dihydroergotamine and heparin is more effective than heparin or dihydroergotamine alone in preventing DVT.

Abdomen↗
PubMed1979

Benign inflammatory tumour of the common bile duct.

A rare cause of obstructive jaundice in childhood is presented. Ultrasound and subsequent percutaneous cholangiography demonstrated the site of obstruction. Histological examination of the resected tumour showed features consistent with a diagnosis of benign inflammatory tumour of the common bile duct.

Adolescent↗
PubMed1978

The origin of thrombi in the deep veins of the lower limb: a venographic study.

A series of 952 patients was examined by ascending venography; 812 with clinically diagnosed deep vein thrombosis (DVT) (group 1) and 140 with clinical features suggestive of pulmonary embolism (group 2). Thrombus was demonstrated in 401 (49.4 per cent) of group 1 and in 74 (53 per cent) of group 2 patients. A total of 535 limbs contained thrombus. In 493 (92 per cent) thrombus was present in the calf with either no further clot, or clot in continuity with that in more proximal veins. In the remaining 42 legs (8 per cent) thrombus either originated from multiple discontinuous sites in the legs and pelvis, or in proximal major veins without concomitant calf involvement. The clinical implications of these findings are discussed.

Femoral Vein↗
PubMed1977

Femoral vein thrombosis and total hip replacement.

Of 160 patients who underwent total hip replacement, 81 developed venographic evidence of thrombi in the operated leg. In 46 cases (57%) the thrombus originated from the femoral vein, and in 43 of these the exact site of origin was defined by venography. In 34 cases (74%) the thrombus arose from the wall of the femoral vein at the level of the lesser trochanter. This region was studied by intraoperative venography in eight patients undergoing total hip replacement, and in every case severe distortion of the common femoral vein was observed, producing almost total occlusion. We suggest that intraoperative damage to the femoral vein results from manipulation of the leg, and that this is one reason why the operation is followed by a high incidence of deep vein thrombosis in the upper femoral region.

Femoral Vein↗
PubMed1977

Surgery, venous thrombosis and anti-Xa.

Deep venous thrombosis is a common and unpredictable complication of surgery. In this study it is proposed that patients who develop this complication may be predicted by a low preoperative level of a naturally occurring inhibitor of coagulation, anti-Xa. Two groups of patients were investigated. Women taking the oral contraceptive pill had lower preoperative anti-Xa levels than their non-pill controls (P less than 0.01) and in addition had a significantly higher incidence of deep venous thrombosis (DVT) following emergency surgery (P less than 0.05). In 90 patients undergoing total hip replacement, the mean preoperative anti-Xa level of those patients who developed DVT was significantly lower than those who did not (P less than 0.001). Ninety-four per cent of patients with a preoperative anti-Xa level of less than 80 per cent developed DVT. The effect of low dose heparin on anti-Xa was studied. The results suggest a mechanism for the cause of postoperative thrombosis which also permits selection of individual patients who will develop this complication.

Adolescent↗
PubMed1976

Endotoxaemia and renal failure in cirrhosis and obstructive jaundice.

An investigation into the possible role of endotoxins in the pathogenesis of renal failure in cirrhosis and obstructive jaundice showed the two to be closely related. None of the patients with cirrhosis who had endotoxaemia had other evidence of Gram-negative infection at the time of the study, and the endotoxaemia was therefore probably due to impaired hepatic clearance of toxins normally absorbed from the gastrointestinal tract. In contrast, bacteriological evidence of Gram-negative infection was found in most of the patients with obstructive jaundice and endotoxaemia.

Adult↗
PubMed1976

Efficacy of low-dose heparin in prevention of extensive deep-vein thrombosis in patients undergoing total-hip replacement.

In a prospective trial, the prophylactic efficacy of low-dose heparin was investigated in 84 consecutive patients undergoing total-hip replacement. 52 of these were randomly allocated to receive heparin or a combination of heparin and dihydroergotamine (D.H.E.); the remaining 32 patients, who were operated on by one orthopaedic team and did not receive prophylaxis, acted as a control group. The frequency of deep-vein thrombosis (D.V.T.), determined by the 125I-fibrinogen test and venography, was 69% in the control group, 32% in the patients receiving heparin alone, and 16% in those receiving heparin and D.H.E. The difference between the control group and each group receiving prophylaxis was statistically significant. The frequency of femoral-vein thrombi, demonstrated by venography, was analysed separately because of its frequent association with major pulmonary embolism. Femoral-vein thrombi developed in 17 (53%) in the control group, while they developed in only 4 patients (8%) in the prophylaxis group (P less than 0.01). 1 patient in the control group died due to massive pulmonary embolism; in another patient, again in the control group, clinical features suggestive of major non-fatal pulmonary embolism developed. This complication was not observed in patients receiving prophylaxis. There was no difference in the amount of operative or postoperative blood-loss in the three groups. In 3 patients in the entire series wound haematomata developed; all 3 were controls and haematomata developed after the administration of streptokinase or large doses of heparin for the treatment of extensive femoral-vein thrombi. By use of a sensitive assay, heparin could be detected in the plasma in 67% of samples in patients in whom D.V.T. did not develop. In contrast, in those patients in whom D.V.T. developed, heparin could be detected in only 21% of blood-samples (P less than 0.01). It is concluded that in patients undergoing total-hip replacement, low-dose heparin prophylaxis is effective in reducing the frequency of life-threatening extensive thrombi in the femoral vein. Prophylaxis using a combination of heparin and D.H.E. requires further evaluation.

Clinical Trials as Topic↗
PubMed1976

Oral contraceptives, antithrombin- III activity, and postoperative deep-vein thrombosis.

Deep-vein thrombosis (D.V.T.) was detected by the fibrinogen-uptake test in six out of a total of thirty-one young women undergoing emergency abdominal surgery who gave a history of recent oral contraceptive intake. In contrast, no D.V.T. developed in nineteen similar patients who were not on oral contraceptives (P less than 0-01). Plasma-antithrombin-III activity was significantly lower preoperatively in patients taking oral contraceptives; postoperative D.V.T. subsequently developed in three out of five patients with preoperative antithrombin-III activity below 50%. In seventy-eight dental patients undergoing molar extraction, antithrombin-III activity was measured before, during, and after operation. Activity fell in all patients during operation, but the fall was significantly greater in women taking oral contraceptives (P less than 0-01). The intra-operative fall in antithrombin-III activity was prevented by a small preoperative dose of subcutaneous heparin.

Adolescent↗
PubMedDate not supplied

Ideal pain relief following laparoscopic cholecystectomy.

In a previous report the effectiveness of intraperitoneal bupivacaine in reducing pain following laparoscopic cholecystectomy was demonstrated. Other methods of pain relief are commonly used but none has been compared following laparoscopic cholecystectomy. In two further studies we have compared the analgesic effect of intraperitoneal bupivacaine against wound infiltration with bupivacaine, and against intraperitoneal bupivacaine with the addition of a non-steroidal anti-inflammatory drug (NSAID) in patients undergoing laparoscopic cholecystectomy. Two consecutive studies were performed. In the first, patients in group 1 were given 20 ml of 0.25% bupivacaine into the peritoneal cavity; patients in group 2 were given 20 ml of 0.25% bupivacaine injected into the trocar wounds. In the second study, patients in group 1 were given 20 ml of 0.25% bupivacaine into the peritoneal cavity; patients in group 2 were given 20 ml of 0.25% bupivacaine into the peritoneal cavity and a diclofenac suppository (100 mg) one hour before surgery. Postoperative pain was assessed with a visual analogue pain scale. There was no difference in pain scores in the two groups in either study. Intraperitoneal bupivacaine is as effective as wound infiltration. The addition of an NSAID makes no difference in the reduction of postoperative pain following laparoscopic cholecystectomy.

Adult↗