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Biomedical subjects

J R Isaac

Publications and source records attributed to J R Isaac.

9 recordsLinked to original sources
PubMed1995

Combination therapy using adrenaline and heater probe to reduce rebleeding in patients with peptic ulcer haemorrhage: a prospective randomized trial.

A prospective randomized trial was performed to assess the efficacy of the combined therapy of endoscopic injection of adrenaline and heater probe application in the management of patients with major peptic ulcer haemorrhage. Some 153 consecutive patients were randomized to receive either local injection of adrenaline (1:10,000) followed by heater probe thermocoagulation (74 patients) or no endoscopic treatment (79 patients). The two groups were well matched with regard to age, haemoglobin concentration on admission, non-steroidal anti-inflammatory drug usage and endoscopic findings. More patients in the treatment group were in shock on admission (21 versus 13). Initial haemostasis was achieved in all patients randomized to endoscopic therapy. Rebleeding occurred in fewer treated than control patients (five versus 16, P = 0.01). The treated group also had fewer deaths (zero versus two) and requirement for operation (two versus six). The results show that the combination of sclerotherapy with adrenaline and subsequent thermocoagulation reduces the rate of rebleeding in peptic ulcer haemorrhage.

Adult↗
PubMed1994

Laparoscopic cholecystectomy for acute cholecystitis.

The safety and efficacy of laparoscopic cholecystectomy for acute cholecystitis were evaluated in a 2-year retrospective review. Results of laparoscopic cholecystectomy in 66 patients with acute inflammation of the gallbladder were compared with those of the standard open procedure for this condition (43 patients) and routine laparoscopic cholecystectomy (227 patients). The laparoscopic procedure for acute cholecystitis was successful in 46 of 66 patients. There was no difference in mean operating time when the inflamed gallbladder was removed laparoscopically or at open surgery (82 versus 84 min); however, each procedure took longer than did routine laparoscopic cholecystectomy (mean 69 min; P < 0.01). There was no difference in analgesic requirement between patients who underwent laparoscopic removal of an acutely inflamed gallbladder and those in the other two groups. Postoperative recovery was significantly faster than that after open surgery (P < 0.01), but took longer than that following routine laparoscopic cholecystectomy (P < 0.01). Inability to identify the cystic duct was the most common reason for conversion to open operation, which occurred in 20 cases of acute cholecystitis. Bile duct injury occurred in one of 66 patients with acute cholecystitis treated laparoscopically, two of 227 cases of routine laparoscopic cholecystectomy but in no patient who underwent open cholecystectomy. In conclusion, laparoscopic cholecystectomy is technically achievable in the majority of patients with acute cholecystitis. The conversion rate is high but, if the procedure is completed successfully, postoperative recovery is more rapid than that after open surgery. However, the method carries a higher incidence of complications and should be attempted only by experienced surgeons.

Acute Disease↗
PubMed1993

Randomized controlled trial comparing laparoscopic and open appendicectomy.

A study was carried out of 137 patients with a diagnosis of acute appendicitis who were randomized to either laparoscopic or open appendicectomy. Patients found to have perforated or normal appendices at histological examination were excluded. Fifty-two patients undergoing laparoscopic appendicectomy and those receiving 57 open procedures were analysed. Laparoscopic appendicectomy took no longer than the open procedure (mean 43 versus 40 min). The number of doses of pethidine (1 mg per kg body-weight) required in the immediate postoperative period did not differ between the two groups but the mean number of doses of oral analgesic (naproxen sodium 550 mg twice daily) required was less in patients undergoing laparoscopic appendicectomy (2.8 versus 5.0, P < 0.05). There was no significant difference between time to resumption of fluid and diet intake and length of hospital stay. There were five (9 per cent) wound infections after open appendicectomy compared with none after the laparoscopic operation (P < 0.01). Patients who underwent laparoscopy returned to full home (17 versus 30 days, P < 0.01) and social (19 versus 32 days, P < 0.05) activities earlier than those who underwent open operation. Laparoscopic appendicectomy may allow reduction in the number of wound infections and earlier return to normal activities.

Adolescent↗
PubMed1991

Safe and rapid palliation of dysphagia for carcinoma of the esophagus.

Patients with carcinoma of the esophagus continue to present late when their tumors are inoperable. This makes palliation of their dysphagia the main therapeutic aim. The Nd-YAG laser has been used in our department to treat dysphagia resulting from cancer of the esophagus since 1986. Our rapid, one-stage cannulation technique using the Nd-YAG laser in both contact and noncontact modes was applied to 35 cases of carcinoma of the esophagus with the aim of achieving rapid and safe palliation of dysphagia. During the treatment we aimed not to coagulate the tumor and await sloughing, but to vaporize the tumor and ablate as much as possible in a single session. In this way there was less need for repeat sessions to create an adequate lumen. In a small number of patients (9) who had tight strictures with no visible lumen, a pre-laser dilation was required to allow visualization of the lumen and tumor vaporization. For nondilated patients (26) we achieved a 15-mm lumen in an average of 1.6 sessions, and in the dilated patients (9) this was achieved in one session in all patients. Functional improvement occurred in 28 patients (80%). There were four minor complications and no mortality associated with the procedure.

Aged↗
PubMed1990

Percutaneous endoscopic gastrostomy in the adult patient--a local case report.

Patients who require a gastrostomy tube placement have traditionally been subjected to various open surgical methods requiring laparotomy. Since it was first described Percutaneous Endoscopic Gastrostomy (PEG) has rapidly become the preferred method for gastrostomy tube placement. We present a case report to illustrate the simplicity and elegance of the technique in a patient with bulbar palsy.

Adult↗