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Biomedical subjects

R J Fairfull-Smith

Publications and source records attributed to R J Fairfull-Smith.

7 recordsLinked to original sources
PubMed2000

Management of adult splenic injuries in Ontario: a population-based study.

OBJECTIVES: To determine the population-based incidence of splenic injuries in the Province of Ontario, the proportion of splenic injuries treated by observation, splenectomy and splenorrhaphy, changes in management over time and the variation in management of splenic injuries among Ontario hospitals. DESIGN: A retrospective cohort study. PATIENTS: All adults (older than 16 years) admitted with a diagnosis of splenic injury (clinical modification of the International Classification of Diseases, 9th revision) to acute care hospitals in Ontario between 1991 and 1994, identified from the Ontario Trauma Registry. RESULTS: The incidence of splenic injury was 1.7 cases per 1000 trauma admissions per year. Patients with splenic injury were young (median age 32 years) and male (71%), and the death rate was 8%. Observation was the commonest method of treatment (69%), followed by splenectomy (28%) and splenorrhaphy (4%). The use of observation increased over the study period from 59% to 75% (p < 0.001). There was significant variation in the use of observation among hospitals (range 11% to 100%, p < 0.0001). CONCLUSIONS: The majority of splenic injuries are managed by observation with an acceptable hospital death rate. The use of observation has increased over time, confirming the growing adoption of this management approach by most hospitals in the province when feasible. Splenorrhaphy was infrequently performed despite reports to the contrary from many centres in the United States. There was significant variation in splenic injury management, suggesting the need for further refinement and dissemination of practical guidelines for splenic salvage.

Abdominal Injuries↗
PubMed1997

Management of choledocholithiasis in the time of laparoscopic cholecystectomy.

BACKGROUND: The best way to detect and manage common duct stones in conjunction with laparoscopic cholecystectomy is not agreed upon at the present time. PATIENTS AND METHODS: Our experience with choledocholithiasis in a consecutive series of 1,123 cholecystectomies (94% by laparoscopy) has been reviewed. Suspected duct stones were investigated preoperatively or postoperatively by endoscopic retrograde cholangiography (ERC), and if necessary, duct clearance was attempted by endoscopic sphincterotomy (ES). No attempt was made to identify choledocholithiasis intraoperatively. RESULTS: Endoscopic retrograde cholangiography was performed in 11% of patients, and 32% of these required ES. The complication rate of ERC and ES was 8%, without mortality. Two patients required a second operation for missed choledocholithiasis, for a reoperation rate of 0.2%. CONCLUSION: We believe that primary or secondary open surgery is only occasionally necessary for the management of choledocholithiasis. Preoperative ERC and ES for suspected duct stones, with the same strategy employed as a salvage for stones presenting after cholecystectomy, was safe and efficient.

Aged↗
PubMed1995

Intraoperative cholangiography is not essential to avoid duct injuries during laparoscopic cholecystectomy.

BACKGROUND: Whether or not to perform intraoperative cholangiography (IOC) with laparoscopic cholecystectomy is controversial. The decision to perform IOC should depend on the individual surgeon's preference for the management of choledocholithiasis. PATIENTS AND METHODS: An initial experience of 525 patients undergoing laparoscopic cholecystectomy done without IOC is reviewed. RESULTS: Suspected or proven choledocholithiasis was managed by endoscopic retrograde cholangiography with sphincterotomy if necessary. There were no bile duct injuries or bile leaks, and 9% (47) of patients underwent endoscopic investigation or treatment. There have been no secondary operations for duct stones. CONCLUSION: We think that the use of IOC to avoid bile duct injuries is not essential, and that the key to avoiding such injuries is meticulous demonstration of anatomic detail at operation. We have been satisfied with selective use of endoscopic cholangiography and sphincterotomy for the management of choledocholithiasis.

Adolescent↗
PubMed1982

Use of glycerol in peripheral parenteral nutrition.

Peripheral parenteral nutrition avoids the use of central lines and is a useful means of nutritional support for selected patients. Amino acids alone have been used for peripheral parenteral nutrition and have been shown to give near nitrogen equilibrium. The addition of small amounts of dextrose to amino acids further improves nitrogen balance, but at the expense of making the solutions unsterilizable and unstable by standard techniques. Glycerol is a nonprotein calorie source that can be autoclaved with amino acids and stored. Fasting patients about to undergo major abdominal surgery were randomly allocated to receive 3% amino acids with or without 3% glycerol. The solution was infused by peripheral vein for 5 days, starting the morning following surgery. Routine monitoring, blood tests, and nitrogen balance tests were performed during this time. No adverse reactions to either solution were encountered. Liver function tests, electrolytes, and hematologic values were similar in both groups. The cumulative nitrogen balance was better in the amino acid plus glycerol group (+5 +/- 3.3 gm) than in the amino acid group (-9.7 +/- 3 gm) (P less than 0.02). Serum insulin levels were higher and serum free fatty acids lower in the amino acid plus glycerol group. Glycerol levels rose and plateaued by the third day in the amino acid plus glycerol patients. Amino acids plus glycerol is safe solution to administer by peripheral vein. The addition of glycerol improves nitrogen balance as compared to amino acids alone.

Amino Acids↗
PubMed1981

Feeding jejunostomy under local anesthesia.

A feeding jejunostomy may be performed with ease and safety under local anesthesia. The authors describe their technique. The tube is easy to maintain and replace and avoids some of the problems of feeding gastrostomies. In patients with major nutritional problems and a functioning intestinal tract the need for parenteral nutrition may be eliminated.

Anesthesia, Local↗