PubMed Health⌕ Search

Biomedical subjects

R Fitzgibbons

Publications and source records attributed to R Fitzgibbons.

14 recordsLinked to original sources
PubMed1996

An assessment of pain and return to normal activity. Laparoscopic herniorrhaphy vs open tension-free Lichtenstein repair.

BACKGROUND: Laparoscopic herniorrhaphy is controversial and deserves critical evaluation. METHODS: In a randomized prospective study transabdominal preperitoneal laparoscopic herniorrhaphy (n = 24) was compared in patients to the tension-free Lichtenstein repair (n = 29) utilizing validated and reliable pain and activity assessment tools. The Sickness Impact Profile (SIP) was used to compare preoperative normal activity to postoperative activity. A Pain-O-Meter (visual analogue scale plus affective and sensory pain descriptors) assessed intensity of pain. The total pain assessment score and SIP were compared across time (postoperative day 1-42). Analgesic medication was used as a covariate. RESULTS: The total pain score was less for laparoscopic herniorrhaphy but this did not reach statistical significance. Similarly, the SIP showed modest improvement for laparoscopic herniorrhaphy. No differences between groups were noted for morphine equivalents of administered analgesics or length of hospitalization. CONCLUSION: Further investigation of laparoscopic herniorrhaphy is warranted.

Adult↗
PubMed1996

Surgery, desmoid tumors, and familial adenomatous polyposis: case report and literature review.

OBJECTIVES: To demonstrate the role of surgical trauma in desmoid tumor formation in Gardner's syndrome. METHODS: Literature review indicates that desmoid tumors are exceedingly common in familial adenomatous polyposis (FAP) where the comparative risk is 852 times that of the general population. Prior abdominal surgery has been found in as many as 68% of FAP patients with abdominal desmoids. Fifty-five percent develop these lesions within 5 yr of their surgery. We describe a patient with Gardner's syndrome complicated by a desmoid tumor. RESULTS: This patient underwent a prophylactic colectomy at age 14, and 3 yr later developed intra-abdominal desmoid tumors unresponsive to radiation therapy, surgical excision, Sulindac, and tamoxifen therapy. The desmoids became massive and were inoperable. However, they showed an apparent complete response to a chemotherapeutic regimen of doxorubicin (90 mg/m2) and dacarbazine (900 mg/m2) in divided doses over 4 days of continuous infusion every 28 days. Because CT scans could not confirm this complete response, laparoscopy was performed. However, within a matter of only several months, desmoid tumors began developing in each of the three trocar sites, became massive and inoperable, and led to the death of this patient. CONCLUSION: These findings provide convincing evidence of the association between surgical trauma and the occurrence of desmoid tumors in patients with Gardner's syndrome.

Adenomatous Polyposis Coli↗
PubMed1995

Reasons for early recurrence following laparoscopic hernioplasty.

The incidence and reasons for early recurrences following laparoscopic hernioplasty have not been studied. Because the incidence is small and the follow up is short, a multi-institutional study was performed among the pioneers in the field. The incidence figures were obtained by survey of surgeons who had significant experience (over 100 cases) and kept concurrent records. Fifty-four recurrences (1.7%) occurred after 3229 laparoscopic hernia repairs. There were 1944 transabdominal preperitoneal (TAPP) repairs with 19 recurrences (1%) and 578 preperitoneal repairs with no recurrences. There were 345 onlay mesh (IPOM) repairs with seven recurrences (2%), and 286 plug and patch repairs with 26 recurrences (9%). Simple closures were performed 76 times with two recurrences (2.6%). Fifty-seven patients (three cases were referred to the author without incidence data but complete records for analysis) had 60 recurrent hernias. Recurrences were noted, on average, 5.1 months postoperatively (range 0-30 months). The most common reason for recurrence was that the mesh was too small - 36 (60%). The mesh was never stapled in 19 instances (32%), and the hernia was never repaired in three cases (20%). The clips pulled through the tissue in six cases (8%), and in 10 cases (15%) the repair has not yet been undertaken because the etiology was unclear. There was more than one reason in 19 patients. Technical factors were responsible for nearly all recurrences.

Hernia↗
PubMed1994

Use of doxorubicin and dacarbazine for the management of unresectable intra-abdominal desmoid tumors in Gardner's syndrome.

PURPOSE: The aim of this study was to describe the natural history and management of surgically unresectable intra-abdominal desmoid tumors in two patients with Gardner's syndrome from two unrelated families, where each had failed on conventional therapy. METHODS: Two patients with Gardner's syndrome were placed on a chemotherapy regimen which included doxorubicin (90 mg/m2) and dacarbazine (900 mg/m2) in divided doses over four days of continuous infusion. Their progress on chemotherapy was assessed by abdominal computerized tomography and laparoscopy. RESULTS: The computerized abdominal tomography scans proved difficult to interpret because of adhesions and matted small bowel resulting from the patients original colectomies. These findings made it difficult to differentiate postoperative changes from residual desmoid tumor. Second-look laparotomy in such patients was contraindicated as this may predispose to further desmoid production. Laparoscopy disclosed a complete response to this chemotherapy. Nevertheless, we had an iatrogenic small bowel perforation in one of these patients. Each patient showed a complete response to chemotherapy. CONCLUSION: Surgical resection remains the first-line treatment of intraabdominal desmoid tumors. However, doxorubicin/dacarbazine chemotherapy on a clinical trial basis may be indicated in patients whose intra-abdominal desmoid is unresectable, or who have failed to respond to treatment with hormones (tamoxifen, Toremifene), steroids (prednisone), and nonsteroidal anti-inflammatory agents (Clinoril; Merck & Co., Inc., West Point, PA).

Adult↗
PubMed1991

The prevention of cholelithiasis with infused sodium chenodeoxycholate in the prairie dog (Cynomys ludovicianus).

1. This study examines the efficacy of infused sodium chenodeoxycholate to prevent cholesterol gallstone formation in the prairie dog when fed a high cholesterol diet. 2. Three experimental groups were designed to examine this. The first group (N = 5) was fed a normal rat chow diet, the second group (N = 5) was fed a high cholesterol diet (0.4% cholesterol by weight), and the third group (N = 5) was fed a high cholesterol diet plus given a daily injection of intravenous sodium chenodeoxycholate (15 mg/kg). 3. All of the animals in the second group had cholesterol crystals and cholesterol gallstones. In the third group, none of the animals had gallstones, and all but one lacked cholesterol crystals. 4. Statistical analysis showed that the first and third groups were statistically identical in their lithogenic indices and biliary lipid composition. 5. We concluded that infused sodium chenodeoxycholate is effective in preventing cholesterol gallstone formation in the prairie dog when fed a high cholesterol diet.

Analysis of Variance↗
PubMed1990

The quantitative and qualitative analysis for biliary lipids in the prairie dog Cynomys ludovicianus.

1. The quantitative analysis of biliary lipids has been well characterized, however, there is little data related to the qualitative and quantitative analysis of phospholipids and conjugated bile salts for the prairie dog. 2. Gallbladder and hepatic bile were collected and the bile salts in each sample were analyzed by first fractionating them into unconjugated, glycoconjugated, and tauroconjugated bile salts. These fractions were further resolved by using HPLC techniques. 3. The data has shown that cholate exists predominately as the tauroconjugate and is the major bile salt, whereas chenodeoxycholate is rarely conjugated. 4. The qualitative analysis of biliary phospholipids by thin layer chromatography has shown a remarkable similarity to that of humans. Phosphatidylcholine was found to be the major phospholipid followed by phosphatidylethanolamine with trace amounts of lysophosphatidylcholine and phosphatidylserine.

Animals↗
PubMed1988

Age-of-onset heterogeneity in hereditary breast cancer: minimal clues for diagnosis.

Knowledge of the family history of cancer may significantly influence diagnosis and surgical management. Hereditary breast cancer (HBC) is common and accounts for approximately 9% of the total breast cancer burden. The pattern of HBC's natural history, including age of onset, increased incidence of bilaterality, integral tumor combinations in certain kindreds, and vertical transmission consonant with an autosomal dominantly inherited factor, when observed in context with the family history, enables pattern recognition so that the diagnosis might be facilitated. We describe seven families from our Hereditary Cancer Consultation Center (HCCC) and the Creighton Oncology Clinic which are noteworthy for extraordinarily early age of onset. This appears to be an additional example of heterogeneity in HBC and may represent the first account of this remarkable subset. The manner in which age of onset can be incorporated with other aspects of natural history for expediting diagnosis is discussed.

Age Factors↗
PubMed1985

Colorectal cancer in a nuclear family. Familial or hereditary?

Because of the high incidence of colorectal cancer, familial aggregations of this disease are common. Differentiation between etiologies contributing to familial clustering (which may have resulted either from common environmental exposure or from mere chance) and primary genetic factors may prove vexing to the physician. This report deals with the myriad problems encountered when attempting to make such etiologic distinctions in order to provide appropriate surveillance and management, based upon tumor spectrum and natural history, for patients at increased cancer risk.

Aged↗
PubMedDate not supplied

Hereditary breast cancer and family cancer syndromes.

Hereditary breast cancer (HBC) shows extant clinical and genetic heterogeneity. Clinically one finds the onset of breast cancer at an early age, an excess of bilaterality, and patterns of multiple primary cancer such as combinations of breast and ovarian carcinoma in the hereditary breast-ovarian cancer (HBOC) syndrome. In addition to HBOC, one sees a variety of putative breast cancer-prone genotypes inclusive of hereditary site-specific breast cancer, and the Li-Fraumeni (SBLA) syndrome that is characterized by cancers involving all three germinal layers including sarcomas, brain tumors, leukemia, lymphoma, and adrenal cortical carcinoma in addition to often markedly early-onset breast cancer. Breast cancer is also associated with autosomal dominantly inherited Cowden's disease and autosomal recessively inherited ataxia-telangiectasia. Examples of pedigrees depicting clinical examples of these several HBC syndromes are presented in order to describe HBC's heterogeneity. The recent identification of the BRCA1 gene in early-onset hereditary site-specific breast cancer and the HBOC syndrome has led to new challenges for the genetic counselor. We review genetic counseling, which embraces surveillance and management recommendations that are responsive to the natural history of HBC and address the concept for future development of centers of expertise for HBC in the interest of improving cancer control.

Age of Onset↗
PubMedDate not supplied

Update on the differential diagnosis, surveillance and management of hereditary non-polyposis colorectal cancer.

Hereditary non-polyposis colorectal cancer (HNPCC) is the most common hereditary form of colorectal cancer (CRC), accounting for approximately 10% of the total CRC burden. HNPCC lacks premonitory physical stigmata, thereby making the family history crucial for diagnosis. Advances in molecular genetics during the past 2 years have led to the cloning of four HNPCC genes (MHS2, MLH1, PMS1 and PMS2). It is now possible to provide presymptomatic DNA testing followed by genetic counselling for gene carriers. Some studies have shown that adenomas in HNPCC are larger, more villous, and have more high grade dysplasia than sporadic cases, suggesting an accelerated adenoma-carcinoma sequence. Given the early age of onset and proximal predominance of CRC, we initiate colonoscopy at age 20-25 years and we recommend that it be performed every 1-2 years. The wealth of clinical and molecular genetic knowledge currently available to physicians about HNPCC can be used effectively for cancer control.

Colorectal Neoplasms, Hereditary Nonpolyposis↗