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Biomedical subjects

R J Cuschieri

Publications and source records attributed to R J Cuschieri.

At least 19 recordsLinked to original sources
PubMed2003

Non-vascular claudication: a clinical conundrum.

This is a prospective study of patients referred to our department with symptoms of claudication unlikely to be of vascular origin. After clinical assessment these patients were referred to an orthopaedic physician. Of 1070 patients referred, 33 patients were diagnosed with a non-vascular problem. Of these, 21 were cases of spinal stenosis with or without nerve root irritation, seven had a combination of spinal pathology and peripheral vascular disease, and five were diagnosed with intervertebral disc prolapse (n=3), diabetic neuropathy (n=1) and chronic fatigue syndrome (n=1). The prognosis for patients with non-vascular claudication in respect of the development of premature vascular events is likely to be different from vascular claudicants and they should be counselled appropriately. Furthermore, the potentially less favourable outcome following reconstruction must be clearly explained to patients with a non-vascular contribution to their symptoms before any therapeutic vascular intervention. Failure to do this is likely to have significant medicolegal implications.

Adult↗
PubMed1997

Emergency abdominal surgery in the elderly.

A retrospective survey of 152 patients undergoing emergency abdominal surgery was carried out to examine factors which may have affected the outcome of surgery. The operative diagnosis and procedure carried out, pre-operative health of the patient, duration of surgery and grade of surgeon were studied to assess whether these factors had any bearing on the eventual outcome. A large variety of surgical emergencies were treated but none of the factors under study were related to the eventual morbidity or mortality recorded. The overall mortality among these patients was 25% which concurs with other studies. The presence of an obstructing cancer of the left colon or upper gastro-intestinal haemorrhage had a particularly poor outcome. Most patients were discharged to their own homes within 3 weeks of admission and they did not comprise an undue burden on the surgical service.

Abdomen↗
PubMed1996

Myofibroblastoma: an unusual breast lump.

A case of myofibroblastoma of the breast is reported. The clinical significance of this entity lies primarily in its recognition as a distinctive benign neoplasm.

Aged↗
PubMed1992

Outcome after thymectomy for myasthenia gravis: a retrospective review.

This is a retrospective study of 54 patients, who in the period November 1977 to November 1986 underwent thymectomy as treatment for myasthenia gravis. Patients in whom difficulty attempting complete excision of the gland was anticipated were selected for a transthoracic procedure. All others underwent an initial transcervical approach, proceeding to an upper sternal splitting incision if further access was required to remove adequately a large gland. The sample was split almost equally between the two surgical procedures. Patients in the transthoracic group were significantly older and experienced significantly greater peri-operative morbidity or mortality. There was no significant difference in outcome between the two groups, 52% achieving a good result (defined as remission or clinically significant improvement of symptoms) that was sustained over the five year follow-up period. In our opinion, complete removal of the thymus should be the goal of surgical treatment for myasthenia gravis.

Adult↗
PubMed1991

Early experience with intra-arterial thrombolytic therapy for peripheral arterial occlusion.

The authors present their early experience with local intra-arterial thrombolytic therapy for peripheral arterial occlusions causing limb threatening ischaemia, using streptokinase or urokinase. Ten patients were treated in a period of one year. Five patients had successful recanalisation, two patients had partial success and three patients required major amputation. The indications, contraindications and results of this treatment are reviewed.

Adult↗
PubMed1990

Management of congenital arteriovenous malformations.

Over a 6-year period, 12 patients with 14 congenital arteriovenous malformations were considered for a staged approach to include afferent vessel ligation (AVL) and/or intra-arterial embolization (IAE) and surgical excision where possible. Patients were followed for a period ranging from 3 to 60 months. Two patients had localized lesions which were completely excised. Five patients were treated by IAE followed by excision with a successful outcome in four. One patient had a transmetatarsal amputation for failed IAE. Two patients had both IAE and AVL before excision of the lesion. In one patient AVL alone was followed by a recurrence. Two patients with multiple lesions were kept under observation. It would appear that IAE and excision of an arteriovenous malformation can achieve cure or excellent palliation in most patients.

Adolescent↗
PubMed1989

Penetrating abdominal stab wounds: a plea for a more conservative policy.

This is a retrospective study of 107 penetrating abdominal stab wounds which have been reviewed on the basis of the clinical indications for surgery. Eighty-four patients underwent laparotomy. The unnecessary laparotomy rate was 35 per cent and the mortality 2.4 per cent. Important complications developed in 44 per cent of those undergoing surgery. Evaluation of clinical variables is presented and it is suggested that in the absence of shock, generalized peritonitis or evisceration, careful initial assessment, monitoring and regular re-examination would be a satisfactory method of treatment for many cases. This would result in a decrease in unnecessary laparotomies and associated excess morbidity.

Abdominal Injuries↗
PubMed1989

Monoclonal antibody immunoassay in the study of thrombogenicity of preclotted and gelatin-impregnated aortic prostheses.

The Dimertest Enzyme Immunoassay has been used to compare the degree of thrombogenicity of the standard knitted Dacron prosthesis (n = 10) and the gelatin-impregnated Dacron prosthesis (n = 10) after infrarenal aortic reconstruction. After surgery there was a similar rise in cross-linked fibrin degradation products with both types of prostheses. Although on the third day the D-Dimer level in the gelatin-impregnated prosthesis was lower, there was no significant difference in the D-Dimer level at six weeks. This suggests that the potential risk of thrombogenicity in the gelatin-impregnated prosthesis is similar to the standard preclotted type.

Aged↗
PubMed1989

Vascular injury after arterial catheterization.

Twenty-three cases of arterial injury after 8,208 arterial catheterizations for diagnostic or therapeutic indications at Glasgow Royal Infirmary are reviewed. Clinical presentation included haematoma formation, development of an acutely ischaemic limb or a false aneurysm. Patients with valvular heart disease are identified as a high risk group. Nine cases were managed by simple suture of the puncture site whereas thrombectomy and vein patch closure was required in 12 patients. The incidence of late complications requiring vascular reconstruction was 9%. The early recognition of complications after arterial catheterization and prompt referral to a specialized vascular unit is essential if morbidity is to be avoided.

Aged↗
PubMed1989

Effect of intravenous naftidrofuryl on transcutaneous oxygen pressure in severe peripheral vascular disease.

Intravenous naftidrofuryl has been shown to improve transcutaneous oxygen pressure values in patients with severe ischemia of the lower limbs who were considered unsuitable for reconstructive surgery. Although it did not alter the outcome in patients with rest pain, the clinical impression is that it afforded symptomatic relief for a period of time. Clinical implications of these findings require further long-term studies.

Aged↗