Biomedical subjects
Publications and source records attributed to P N Roberts.
Popliteal artery entrapment syndrome (PAES) is a rare but potentially limb threatening anatomical anomaly occurring predominantly in young adults. We report a case of a 14 year old boy who presented with limb threatening ischaemia requiring urgent surgery. The pathology, presentation, and management are discussed.
Metastatic melanoma of the small bowel is a pathological entity that is not frequently reported but may present with features of unexplained anaemia. We report a case of a 51-year-old man with occult intestinal bleeding due to metastatic melanoma of the small bowel. Although the diagnosis was somewhat delayed, the patient was managed successfully by small bowel resection. Careful investigation of melanoma patients with gastrointestinal symptoms is important as surgical intervention often results in improved quality of life and survival.
OBJECTIVES: To assess the efficacy of the patellar tendon bearing orthosis (PTBO) as adjunctive treatment of patients with significant lower-limb ischaemia and tissue loss complicated by neuropathy. DESIGN, MATERIALS AND METHODS: Twelve consecutive patients (14 legs) with a variety of underlying conditions causing extensive lower limb tissue loss are described. Seven patients were diabetic. Six patients (seven legs) underwent vascular reconstruction procedures. CHIEF OUTCOME MEASURES: Wound healing and amputation rate. RESULTS: Eight patients had ulcer healing within 5 months, one at 18 months (patient with alcoholic neuropathy who was poorly compliant with treatment), one stopped using the PTBO at 3 months and was converted to protective footwear with healing, one died of a myocardial infarct 1 month after the PTBO was fitted (the ulcer was showing signs of healing), and one has just had surgery and been fitted with a PTBO. CONCLUSIONS: Early results from this anecdotal series are encouraging and a prospective study to determine the application of the PTBO in patients with neuropathic and neuropathic/ischaemic tissue loss is planned.
Intraoperative manometry can provide an objective means of determining the correct length of myotomy in patients with esophageal motility disorders. Of the patients in this series who underwent primary repair, 94 percent were relieved of pain and dysphagia. One patient required repeat myotomy for vigorous achalasia. After a mean follow-up period of 33 months, gastroesophageal reflux had not developed in any patient, indicating that myotomy with intraoperative manometry eliminates the need for an antireflux procedure. Such a procedure in these patients with poor esophageal motility can lead to dysphagia and obstruction, which is a very difficult problem to correct. We recommend intraoperative manometric be used routinely with myotomy for esophageal motility disorders.
Forty patients selected for transurethral prostatic resection (TUR) were randomly allocated to one of 2 groups. Irrigating fluid used in the first group of 20 patients was cooled to a constant 8 degrees C; in the second group fluid at ambient temperature was used. Measurements were made of the volume of irrigating fluid used and haemoglobin loss during and after operation; the weight of resected tissue and its histological appearance were also studied. The core temperature of each patient was monitored throughout the operation. Significantly less irrigating fluid was used in the group receiving cooled fluid. Although per-operative and post-operative haemoglobin loss was also markedly reduced in this group, the difference failed to achieve statistical significance. The clarity of the operative field was considerably improved by the use of cooled fluid.
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