PubMed Health⌕ Search

Biomedical subjects

R J Fitzgibbons

Publications and source records attributed to R J Fitzgibbons.

68 records · Page 4Linked to original sources
PubMed1987

Reliability of implantable central venous access devices in patients with cancer.

We reviewed complications requiring removal of Hickman catheters (HCs) and implantable central venous access devices (ICVADs) in patients with cancer over a 30-month period. The study was unique in the sense that patients chose which system would be inserted, unless continuous infusion was anticipated. A total of 115 systems were inserted in 102 patients. Forty-four HCs were inserted in 34 patients (total system days, 8533 [mean, 194 days]); 71 ICVADs were inserted in 68 patients (total system days, 18,681 [mean, 263 days]). Complications required removal in 38.6% of HCs and 18.3% of ICVADs. Complication rates were one in 501 days in the HC group and one in 1450 days in the ICVAD group. Although 15 systems were removed for suspected infection, closer analysis revealed that bacteremia ultimately found to be unrelated to the catheter resulted in premature removal in many cases. The catheter tip was located high in the superior vena cava or in the subclavian vein in all systems removed due to thrombosis. Miscellaneous complications in HCs included dislodgment and catheter embolism. The increased longevity, lower complication rate, and decreased maintenance requirements in the use of ICVADs support their superiority over HCs in the treatment of patients with cancer.

Adolescent↗
PubMed1987

Recognition and treatment of patients with hereditary nonpolyposis colon cancer (Lynch syndromes I and II).

Primary genetic factors are etiologic in at least 5-10% of patients with colon cancer. The polyposis syndromes (FPC) are easily identified examples because of the spectacular number of polyps. The hereditary nonpolyposis syndromes (HNPCC), although five times more common than FPC, are usually not recognized because they do not have such a distinctive clinical, premonitory genetic marker. Colorectal cancer expression was surveyed in 10 extended, thoroughly documented HNPCC kindreds. One hundred sixteen patients were found to have 183 colorectal cancers. Despite the striking family history, less than 5% were correctly treated by subtotal colectomy. This provided a unique opportunity to study the natural history. Five findings differed significantly (p less than 0.05) from patients with sporadic colon cancer: (1) mean age of initial colon cancer diagnosed was 45.6 years; (2) 69.1% of first colon cancers were located proximal to the splenic flexure of the colon; (3) 18.1% had synchronous colon cancer; (4) 24.2% had metachronous colon cancer develop with life table analysis showing the risk for a metachronous lesion at 10 years to be 40%; and (5) only 23.3% of cancers were located in the sigmoid colon or rectum. Based on this data, it is recommended that the family history of all patients with a newly diagnosed colon cancer be evaluated for evidence of this syndrome. If an autosomal dominant inheritance pattern emerges, an in-depth genetic investigation is indicated. When HNPCC is confirmed, the following recommendations apply: a subtotal abdominal colectomy is indicated at the time of the initial colon cancer because of the risk of synchronous and metachronous lesions. The rectum should be spared in favor of careful lifetime surveillance because of the proclivity for proximal colon cancer involvement. As yet unaffected members of a newly diagnosed HNPCC kindred who are in the "direct genetic line" should be cautioned that they are at 50% risk and must begin an intensive surveillance program beginning in the third decade with careful attention to the right colon. Patients from newly diagnosed HNPCC families who have had a previous conventional colectomy for colon cancer should, at the very least, enter an intensive surveillance program; a prophylactic completion subtotal colectomy should be considered for patients who are less than totally compliant.

Adolescent↗
PubMed1987

A simple technique for constructing a loop enterostomy which allows immediate placement of an ostomy appliance.

A technique for constructing a loop enterostomy using a red Robinson catheter as a stabilizing "rod" is described. The catheter is placed subcutaneously and exits through skin stab wounds placed far enough from the stoma to allow immediate placement of a standard ostomy appliance. By eliminating the skin level rod common to most descriptions of loop enterostomy construction techniques, difficulty with good fixation of skin appliances is eliminated.

Catheterization↗
PubMed1984

Hepatic artery infusion: surgical approach.

Hepatic artery infusion chemotherapy for the treatment of nonresectable liver cancer is gaining popularity among the medical community. A lack of knowledge of the variants in the anatomy of the arterial blood supply to the liver may lead to inadequate hepatic perfusion, or inadvertent perfusion of extrahepatic organs. A review of 70 hepatic artery angiograms on patients referred to the liver program at the Creighton Cancer Center was performed to integrate angiographic findings, surgical techniques, and clinical decision making.

Angiography↗
PubMed1980

Unusual thoracoabdominal duplication associated with pancreaticopleural fistula.

The clinical case is presented of a 16-yr-old patient with thoracoabdominal duplication that communicated with the main pancreatic duct and the right pleural cavity and resulted in pancreaticopleural fistula. Although abdominal duplications communicating with the pancreas have been described before, to our knowledge, such an anomaly with intrathoracic extension has never been reported. Pleural effusions of high amylase content and surgical management of thoracoabdominal duplications are discussed.

Adolescent↗
PubMed1977

Review of abdominoperineal resections for cancer.

One hundred eighty-six consecutive abdominoperineal resections for primary carcinoma of the anus, rectum, or sigmoid colon performed at Charity Hospital of Louisiana at New Orleans between January 1, 1963 and December 31, 1974 were reviewed. The operative mortality was 16 per cent. Complications during the same hospitalization occurred in 70 percent of the patients. Although most of the complications were minor, 22 percent did require some form of surgical intervention. Twenty-nine percent of the patients who were discharged developed late mechanical or cancer-caused complications which required surgical correction. A history of congestive heart failure or a significant weight loss were the most consistent preoperative findings in the operative mortality group. The overall five year survival rate was 25 percent. White females with no history of weight loss had the best long-term prognosis. Better survival in white patients can be accounted for by the less advanced lesions in these patients. No such difference between male and female patients could be demonstrated. Better selection of surgical candidates with alternate forms of therapy for poor risk patients have probably been the most significant factors in decreasing the operative mortality from 21 percent in the first six years of the study to 9 percent in the last six years. Primary closure of the perineal wound would appear to be of value in decreasing operative morbidity.

Abdomen↗
PubMedDate not supplied

Complications of laparoscopic herniorrhaphy.

Anterior inguinal hernia repair is the second-most-commonly performed abdominal operation and has been associated with low morbidity and mortality rates. The principle of laparoscopy has been applied to this surgical problem in a series of 762 patients with 841 inguinal hernias. Four types of laparoscopic repairs were conducted: (1) high ligation of the indirect inguinal hernia sac and closure of the internal ring (87 patients with 89 hernias); (2) plug and patch of the internal ring (74 patients with 87 hernias); (3) transperitoneal suture repair of the transversalis fascia to the iliopubic tract or Cooper's ligament (28 patients with 30 hernias); and (4) placement of a large prosthesis over the myopectoneal orifice (563 patients with 635 hernias). These early results indicate that the overall complication rates were low, especially when a large prosthesis was used to reinforce the myopectoneal orifice. It is concluded that laparoscopic inguinal herniorrhaphy is a safe and effective procedure with which to manage this surgical problem.

Hernia, Inguinal↗
PubMedDate not supplied

IV chenodeoxycholate prevents calcium bilirubinate gallstones during total parenteral nutrition in the prairie dog.

BACKGROUND: The purpose of this study was to determine whether IV chenodeoxycholate (CDC) could prevent total parenteral nutrition (TPN)-associated pigmented gallstones in the prairie dog. METHODS: Twelve prairie dogs were divided into two equal groups, each receiving an identical TPN regimen. Each animal received 92 kcal/d with 61% of the calories from carbohydrate. The total volume of infusate delivered to each animal was 59 mL/d. Animals in one group, termed the TPN + CDC group, received a daily bolus injection of CDC at a dose of 15 mg/kg. Prairie dogs in the second group, termed the TPN group, received water (vehicle carrier) 1 mL/kg/d. The TPN and TPN + CDC groups received TPN for 40.3 +/- 1.3 and 42.5 +/- 0.6 days, respectively. RESULTS: There was no statistical difference in the initial and final weights between the two groups. None of the TPN + CDC-treated animals had gallstones or calcium bilirubinate crystals. In contrast, all of the TPN-treated animals had calcium bilirubinate crystals (p = .002), and five of six had macroscopic black pigmented gallstones (p = .015). Cholesterol crystals were not observed in either group of animals. The amount of biliary bilirubin and ionized calcium was significantly greater in the TPN group (both p < .001); however, both groups had a similar total biliary calcium concentration. CONCLUSION: IV CDC is effective in preventing TPN-associated gallstones in the prairie dog.

Animals↗
PubMedDate not supplied

Laparoscopic inguinal herniorrhaphy: transabdominal techniques.

Laparoscopic inguinal herniorrhaphy is an investigational procedure and the best technique and the exact indications are presently unclear. Preliminary results suggest that further investigation is indicated. A multi-center trial involving institutions from Europe and North America has recently been completed comparing various laparoscopic herniorrhaphy techniques. The rate of complications and recurrence was low despite the relative inexperience of the surgeon investigators. Laparoscopy affords an excellent exposure of the preperitoneal space which can be quite useful in repairing many inguinal hernias, especially those which are recurrent or otherwise complicated. It seems that laparoscopy will certainly have a place in the armamentarium of general surgeons caring for inguinal hernias. It is unlikely though that every inguinal hernia will best be repaired laparoscopically.

Abdomen↗
PubMedDate not supplied

Spontaneous erosion of a lost intra-abdominal gallstone through the back eight months following laparoscopic cholecystectomy.

BACKGROUND AND OBJECTIVES: Gallbladder perforation during laparoscopic cholecystectomy with spillage of bile and gallstones occurs in up to 40% of patients. Several reports have recently been published describing complications related to these lost gallstones. The purpose of this study was to determine the incidence of this complication in our patients. METHODS: A prospectively maintained database of 856 laparoscopic cholecystectomies performed between 1989 and 1996 by a single surgeon was analyzed. RESULTS: The number of perforations resulting in loss of stones in the abdominal cavity was 16% (165 patients). Of these 165 patients, only a single patient could be identified as having a long-term complication. CONCLUSIONS: Intra-abdominal lost gallstones can produce complications secondary to migration and erosion. It is prudent to make a concerted effort to remove spilled gallstones by every possible means but conversion to laparotomy is not justifiable.

Abdominal Abscess↗