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Biomedical subjects

J M Searles

Publications and source records attributed to J M Searles.

9 recordsLinked to original sources
PubMed2004

Home-dilatation of the urethral meatus in boys.

OBJECTIVES: To evaluate the efficacy of dilatation of the stenotic urethral meatus in boys at home. PATIENTS AND METHODS: Eighteen boys aged 3-15 years, or their parents, were taught to dilate the urethral meatus at home. The cause of the stricture was balanitis xerotica obliterans (BXO) in five and consequent upon hypospadias surgery in 12, of whom two were complicated by BXO, and one after circumcision for cultural reasons. One boy was re-referred after an interval of 3 years because of apparent deterioration of the stream of urine. Meatal dilatation was taught in the home by one of the authors (J.M.S.). RESULTS: Nine patients were cured by the first course of dilatation, four relapsed early after initial success but responded to further treatment, and three proceeded to meatoplasty because they had no response. Two relapsed late and one responded to further dilatation but the other required surgery. CONCLUSION: Dilatation of the urethral meatus can be taught successfully to boys or their families at home, thus avoiding repeated hospital attendance and often general anaesthesia.

Adolescent↗
PubMed1995

Mitrofanoff stoma--an iceberg of problems?

The advent of a self-catheterisable continent abdominal wall urinary stoma has provided an enormous improvement in the quality of life for many patients. Successful results of surgery have been presented from many centres. However, these reports concentrate on the technical aspect of patient care. In this paper we review the work of the outreach nursing sister in supporting thirty patients operated upon during a four-year period, and their families.

Adaptation, Psychological↗
PubMed1991

Foot reconstruction in diabetes mellitus and peripheral vascular insufficiency.

The great majority of diabetic patients have diabetic foot symptoms. Significant recent advances in reconstructive surgery, as well as improvements in the management of both diabetes mellitus and peripheral vascular disease, make these patients eligible for plastic and reconstructive surgery. Many diabetic patients who would previously have had below-the-knee amputations are now having their complex foot wounds reconstructed. In addition to the metabolic consequences of the disease and the increased susceptibility to infection and wound healing complications, infrapopliteal arterial occlusive disease, peripheral neuropathy, and hemorrheologic changes are addressed in this article.

Diabetic Angiopathies↗
PubMed1989

Jejunal free autograft: analysis of complications and their resolution.

Review of 101 patients who underwent 111 free jejunal autografts has demonstrated an absolute procedural failure rate of 13.5 percent. Salvage reconstruction with a second jejunum was successful in six of nine patients and one third-time jejunum was successful, giving an overall salvage rate of 70 percent. There were 33 patients experiencing pharyngocutaneous fistulas, 20 of whom had been previously irradiated. Of these patients, 15 experienced spontaneous closure and 9 others had successful surgical correction. The mortality rate was 5 percent. Eighty-three percent of patients were restored to adequate per oral alimentation. The jejunum, despite its relatively high complication rate, is an excellent method for pharyngoesophageal reconstruction, expeditiously providing return to function for patients with late-stage disease.

Adolescent↗
PubMed1987

Ten years experience with the free jejunal autograft.

Retrospective analysis by chart review, personal interview, and physical examination identified 88 patients who received 96 jejunal free flaps over a 10 year period. Seventy-nine of these patients had cancer. There were 13 operative failures (13.5 percent) in 10 patients. Failures were attributed to arterial thrombosis in four instances, venous anastomotic problems in four instances, fistula and infection in the neck in one instance, carotid blowout in one instance, psychosis with avulsion in one instance, and an unknown cause in two instances. Seven second attempts at salvage of jejunal flaps were performed with five successes. There were five deaths in the perioperative period (6 percent). Of these, one was directly attributed to graft failure. The following eight abdominal complications required operation: wound dehiscence (four instances), small bowel obstruction (one instance), Mallory-Weiss tear (one instance), gastrostomy tube leak (one instance), and acute gastric dilatation (one instance). Complications in the neck included infection (six instances), infection requiring operation (three instances), hematoma (three instances), and suture line dehiscence (one instance). Fistulas developed in 28 patients (32 percent), 12 of whom required operative closure (43 percent). Significant stenosis developed in six patients, two of whom required operative revision. Of 79 patients treated for cancer, 34 died from progression of disease which recurred an average of 9.7 months postoperatively. Death ensued an average of 16.7 months postoperatively. Ten patients died with no evidence of disease. At last follow-up, 28 patients were alive without apparent disease. Twenty-six of these patients have good swallowing function. Significant palliation and a high rate of restoration of function are possible with the free jejunal autograft. Careful patient selection should markedly decrease operative morbidity and mortality.

Adult↗
PubMed1978

Oxygen cost of breathing in dogs.

The O2 cost of breathing has been calculated in awake and anesthetized dogs breathing spontaneously. Respiratory variables were measured in tracheostomized dogs in the standing position, while supported in a canvas sling, at room temperatures between 20 and 23 degrees C. Minute ventilation ranged between 3 and 53 liters/min while VO2 ranged from 61 to 686 ml/min. VE, VO2 and f varied considerably from measurement to measurement even though body temperatures and experimental conditions changed very little. VO2 increased with VE: VO2 = 10.2 VE + 58.4 r = 0.94. A cubic polynomial equation was also calculated for these data: VO2 = 11.6 + 19.0 VE-0.42 (VE)2 + 0.0057 (VE)3. Awake dogs showed panting and considerable hyperventilation (PACO2 = 22.5 +/- SD of 4.5 mm Hg). Anesthetized dogs had lower average values of f, VE and VO2; while average PACO2 was 29.1 +/- 4.5 mm Hg. VO2 and VE measured when the dogs were anesthetized, paralyzed and artifically ventilated were related by this equation: VO2 = 5.9 VE + 87.5, r = 0.88. The O2 cost of breathing, calculated by subtracting the regression equation obtained while the dogs were under artificial respiration, from the cubic polynomial equation, increased with increasing VE in a curvilinear fashion. The values for O2 cost of breathing at high levels of ventilation were high because dogs' lungs are small. After correcting for lung size, values for O2 cost of breathing were similar to those in humans.

Anesthesia↗
PubMed1978

Effects of added airway dead space on VO2 in dogs.

In dogs breathing spontaneously with added dead space, 198, 298 and 548 ml, the O2 consumption is a function of minute ventilation. This relationship (VO2 = 9.3 VE + 81.6; r = 0.95) was the same as that found in dogs breathing spontaneously with normal dead space. With added dead space, average tidal volumes increased but not enough to compensate for the added volume and, thus, dogs achieved alveolar ventilation mainly by using the fatest molecules of gas in the airway, because of the conical shape of the velocity profile of gas molecules. When the values for VO2 and f were grouped according to different VTS, VO2 was found to be a linear function of f. Also, for a given f, VO2 increased progressively with VT; however, the higher the f, the more taxing a given increase in VT was. Over a certain range of respiratory frequencies, dogs could reduce f and increase VT without significantly affecting VO2.

Animals↗