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Biomedical subjects

J R Telfer

Publications and source records attributed to J R Telfer.

6 recordsLinked to original sources
PubMed1998

An investigation into the role of waterproofing in a two-stage hypospadias repair.

In our unit a two-stage procedure, using a full thickness preputial graft, has been adopted as the method of choice for the repair of hypospadias proximal to the coronal sulcus. In 1993 an audit was undertaken to establish our complication rate for this procedure. Twenty-two consecutive patients who completed a two-stage repair between January 1988 and December 1993 were studied. An unacceptably high fistula rate was identified (63%, 14/22 cases). Consequently our technique was modified by transposing a vascularised flap of preputial areolar tissue over the urethral suture line, at the time of urethroplasty. A second group of 22 consecutive patients, operated upon between January 1994 and July 1997, were subsequently investigated and a dramatic improvement in the fistula rate was demonstrated (4.5%, 1/22 cases). These cases represent a subgroup of almost 200 cases, which the senior author has managed over the last 10 years. The senior author undertook or supervised the surgery in all 44 cases, which were the focus of this study, and the introduction of a waterproofing layer represents the only change in technique.

Child, Preschool↗
PubMed1996

Metastatic colonic adenocarcinoma in a pedicled omental flap used for sternal reconstruction: a case report.

Dehiscence of a median sternotomy wound is a fortunately rare but potentially lethal complication of cardiac surgery. If conservative management, including irrigation and secondary closure, fails then osteomyelitis with or without necrosis of the sternum, costochondritis and anterior mediastinitis may result. In the face of such sequelae, radical debidement of the sternum and flap coverage is required. A variety of flaps may be used to cover the defect following debridement of the sternum, in particular pectoralis major or rectus abdominis muscle flaps and the omentum. We report the case of a 65-year-old man, who required an omental flap for sternal dehiscence after coronary artery bypass grafting and who subsequently presented with a metastatic colonic adenocarcinoma within the flap.

Adenocarcinoma↗
PubMed1996

Rotation-angulation osteotomy in the hand.

The use of a single osteotomy combining both rotation and angulation is described, with a means of achieving the correct angle and direction of the osteotomy. Patients who have been treated by this method are presented.

Adolescent↗
PubMed1994

Avascular necrosis of the hamate.

Avascular necrosis of the hamate is a rare condition, only one case having been reported in the literature (Van Demark and Parke, 1992). This reflects the relative rarity of fractures of the body of the hamate and the arrangement of the intraosseous vascular anatomy. A case is presented, which was diagnosed by MR Imaging and treated surgically.

Adolescent↗
PubMed1993

Comparative study of abdominal incision techniques.

The characteristics of surgical incisions made with an electrosurgical technique were compared with those made using conventional methods in a prospective randomized trial. In particular, the claim that the method of incision may influence postoperative pain was investigated. A total of 101 consecutive patients receiving full-length midline laparotomy incisions for gastrointestinal resection were studied. A record was kept of the time required to make the incision and blood loss as well as postoperative pain (using a linear analogue scale), ventilatory function and requirement for analgesia. There were 50 patients in group 1 (scalpel; 15 men, 35 women) and 51 in group 2 (electrocautery; 26 men, 25 women). The groups were similar in age, body-weight, diagnosis and the type of surgical procedures being performed. Incision time was similar in the two groups but median blood loss during incision was significantly less in group 2 patients than in group 1 (10 versus 25 ml, P < 0.0001). Linear analogue pain scores were not significantly different between the groups at any stage after operation. The same was true of postoperative ventilatory function and requirement for analgesia. A total value for morphine use during the entire postoperative period was derived for each group and the median was 1.55 mg/kg for group 1 compared with 1.49 mg/kg for group 2. The electrosurgical method is associated with less blood loss during incision, although this study has failed to confirm any reduction in postoperative pain or requirement for analgesia in these patients.

Abdominal Muscles↗