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author:("lumbley, J")
2.  A surgical approach to coexistent coronary and carotid artery disease. 
Heart  1997;77(2):164-167.
OBJECTIVE: To assess the early results of combined coronary artery bypass graft surgery and carotid endarterectomy. DESIGN: Retrospective and ongoing analysis of patients who underwent combined coronary artery bypass graft surgery and carotid endarterectomy. SETTING: Cardiothoracic unit in a London teaching hospital. PATIENTS: From June 1987 to March 1995, 64 patients were identified. They were patients who were scheduled to have coronary artery bypass graft surgery or required urgent coronary revascularisation and who were found to have significant coexistent carotid disease. (Unilateral carotid stenosis > 70%, bilateral carotid stenosis > 50%, or unilateral carotid stenosis > 50% with contralateral occlusion.) INTERVENTIONS: Both procedures were performed during one anaesthesia: the carotid endarterectomy was performed first without cardiopulmonary bypass. After completion of carotid endarterectomy, coronary artery bypass graft surgery was performed. MAIN OUTCOME MEASURES: The incidence of stroke, transient ischaemic attack, and myocardial infarction in the early postoperative period was analysed. RESULTS: Myocardial revascularisation was successful in all 64 patients. There were no perioperative infarcts. In three patients (4.7%) a new neurological deficit developed postoperatively: two recovered fully before hospital discharge. CONCLUSIONS: Combined coronary artery bypass graft surgery and carotid endarterectomy were performed safely and with good results.
PMCID: PMC484667  PMID: 9068401
3.  The role of the general practitioner in postnatal care: a survey from Australian general practice. 
The British Journal of General Practice  1998;48(434):1570-1574.
BACKGROUND: Despite the practice of routine postnatal check-ups, many women experience problems in the months after childbirth. General practitioners (GPs) are involved in routine postnatal care, yet little research has been undertaken to explore this role. AIM: To report the views of Australian GPs as to what physical examination and discussion should take place at the routine six week postnatal check-up and to determine the influence of gender on the approach to the check-up. METHOD: Postal survey of 1104 Australian GPs, yielding an eligible sample of 1022. RESULTS: A total of 715/1022 (70%) usable surveys returned. Over 65% of GPs recommend routine examination of the abdomen, blood pressure, perineum, vagina, pelvic floor, and breasts at the six week check-up. Fewer than a half the sample believed that physical problems (urine and bowel symptoms, back problems), sexual issues, relationship and parenting issues should be routinely discussed. After controlling for age, practice location, obstetric practice, and qualifications, the sex of the GP remains an important factor influencing the GP's approach to postnatal care. Female GPs are three times more likely to believe that maternal feelings should be discussed routinely and about twice as likely to believe that infant sleeping/behaviour, maternal sleeping/diet/tiredness, coping with other children, relationship with partner, and household work should form part of the routine discussion with all recent mothers. CONCLUSIONS: Sex of practitioner and older age (60 years or more) are the two most important influences on a GP's approach to postnatal care. This study indicates a need for GPs to shift their focus from routine examination to indicated examination to allow more time to discuss common postnatal problems.
PMCID: PMC1313219  PMID: 9830181
5.  Glossopharyngeal schwannoma presenting as gagging dysphagia. 
Postgraduate Medical Journal  1994;70(821):207-209.
A case of cervical glossopharyngeal schwannoma presenting with gagging dysphagia is presented. Treatment was by total excision of the schwannoma following which the patient made a good recovery. To our knowledge, this is the first report of gagging dysphagia associated with a glossopharyngeal schwannoma.
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PMCID: PMC2397855  PMID: 8183755
6.  Value of routine ultrasound scanning. 
BMJ : British Medical Journal  1992;305(6853):584.
PMCID: PMC1883266  PMID: 1393049
7.  A comparative study between Michel and Proximate clips for the closure of neck incisions. 
A prospective study comparing two types of surgical clip, the Proximate II (Ethicon) staple and the Michel clip, was performed on 30 thyroidectomy (horizontal) and 50 carotid endarterectomy (vertical) incisions with reference to their ease of handling, patient comfort, complication rate, cosmetic result and cost. In each patient half of the wound was approximated with one type of clip and half with the other. The Proximate II staple was more comfortable for the patient in the vertical wounds (P less than 0.02), easier to remove as judged by the nurse in both horizontal (P less than 0.001) and vertical (P less than 0.02) wounds, and by the patient in the horizontal wounds (P less than 0.02) only. The incidence of inflammation was significantly higher with the Michel clip (P less than 0.001). In both the horizontal (P less than 0.05) and the vertical (P less than 0.001) wounds, when the scar was assessed at the time of discharge from hospital, the Proximate II staple achieved a significantly better result. However, assessment of the wounds by patient and researcher 6 weeks postoperatively, revealed no significant difference between the wounds with regard to cosmetic outcome. The Proximate II design, however, costs between seven and ten times more than the Michel clip depending on the size of the dispenser used, and since the late cosmetic result offers no advantage over the latter design, we feel these financial variables deserve consideration.
PMCID: PMC2499424  PMID: 1863039
8.  Review of the teaching of medical ethics in London medical schools. 
Journal of Medical Ethics  1990;16(4):206-209.
The study examined the influence of the Pond Report on the teaching of medical ethics in the London medical schools. A questionnaire was given to both medical students and college officers. All medical colleges reported that ethics was included in the curriculum. However, from students' replies, it seems that attendance of optional courses is low and that not all current final year medical students have had any formal teaching in medical ethics. Stronger guidelines are necessary to ensure appropriate ethical training in London medical schools.
PMCID: PMC1375913  PMID: 2287017
9.  Pharmacocavernometry in the assessment of erectile impotence. 
Thirty-three impotent men underwent pharmacocavernometry and cavernography. Ten patients had a good clinical response to 60 mg papaverine, nine had a moderate clinical response and in 14, the response was judged to be a poor one. Twelve patients had evidence of abnormal venous leakage from the corpora. Subsequent investigation with isotope phallography showed six patients to have arterial insufficiency and in three of these patients this was amenable to reconstructive vascular surgery. We conclude that pharmacocavernometry provides a useful, cheap and reliable method for the investigation of impotent men which may be performed on an outpatient basis.
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PMCID: PMC1292459  PMID: 2304050
10.  Propofol infusion for sedation in the intensive care unit: preliminary report. 
Propofol (2,6,di-isopropylphenol) was given by continuous intravenous infusion to provide sedation after cardiac surgery in 30 patients and its effects compared with those of midazolam given to a further 30 patients. Propofol infusion allowed rapid and accurate control of the level of sedation, which was satisfactory for longer than with midazolam. Patients given propofol recovered significantly more rapidly from their sedation once they had fulfilled the criteria for weaning from artificial ventilation and as a result spent a significantly shorter time attached to a ventilator. There were no serious complications in either group. Both medical and nursing staff considered the propofol infusion to be superior to midazolam in these patients. These findings suggest that propofol is a suitable replacement for etomidate and alphaxalone-alphadolone for sedating patients receiving intensive care.
PMCID: PMC1245409  PMID: 3101895
11.  Brain revascularisation in hypertension. 
Archives of Disease in Childhood  1985;60(12):1177-1179.
Neurological symptoms in hypertensive subjects may be a reflection of intracranial vascular disease and not just a consequence of hypertension. Two hypertensive children with renovascular disease, neurological symptoms, and severe cerebral arterial disease were treated by extracranial-intracranial arterial bypass surgery with improvement of symptoms and easier control of blood pressure. Where revascularisation surgery is appropriate, this should be undertaken before neurological complications arise.
PMCID: PMC1777670  PMID: 4091584
12.  The MCQ in the primary FRCS(Eng). 
Analysis of the primary fellowship results showed that on average candidates were scoring a significantly higher mark in the MCQ than in the essay or viva. The level of MCQ marking has therefore been reset to the standards of the other parts of the examination. The need for continually monitoring the results of all examinations is emphasised.
PMCID: PMC2494451  PMID: 6508170
13.  Cerebral function before and after extra-intracranial carotid bypass. 
Thirty-eight patients had their cerebral function measured before and after extra-intracranial carotid bypass surgery using the Halstead-Reitan neuropsychology test battery. Two composite indices of cerebral function for each patient showed them to be impaired before operation. There was no improvement in the composite measures after operation to match that previously demonstrated after carotid endarterectomy. This may reflect the greater pre-operative cerebral impairment of the extra-intracranial group.
PMCID: PMC1028012  PMID: 6481373
14.  Microsurgery: renewed sensation. 
PMCID: PMC1439240  PMID: 7288779
15.  Cerebral revascularisation in stroke prophylaxis 
Over 700 cerebral vascular operations have been undertaken on the Surgical Unit of St Bartholomew's Hospital, London, for stroke prophylaxis, the majority being carotid endarterectomies. One of the unique features of the latter procedure is the marked instability of postoperative blood pressure. The relation of this change to interference with carotid baroreceptor function was studied by per-operative carotid sinus nerve recording. It was possible to relate nerve activity to the postend-arterectomy changes in the mechanical properties of the vessel wall in the region of the carotid sinus. Postoperative hypotensive episodes could be reversed by the injection of local anaesthetic alongside the carotid sinus nerve through a cannula left in situ at operation.
The complications of 425 carotid endarterectomies were analysed by computer and specific risk factors were found to be hypertension, the presence of contralateral internal carotid artery disease, and the presence of lower limb vascular disease. The carotid angiograms of 200 patients were studied with respect to the extent of the disease at the origin of the internal carotid arteries. The operative complication rate was found to be closely related to the severity of this disease, all severe complications occurring in patients with severe bilateral internal carotid artery stenosis or occlusion. This finding has led to the introduction of the term the `reperfusion syndrome', and the mechanism of the complication is still under study.
Seventy-nine extraintracranial revascularising procedures have been undertaken and this operation has been shown to carry a very low morbidity. The postoperative incidence of recurrent transitory ischaemic attacks (TIAs) and strokes is low, but the longest follow-up period is still only 4 years. The value of the procedure for TIAs and strokes is under study, as is its place in the treatment of patients with dementia.
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PMCID: PMC2493745  PMID: 7436290
STROKE SURGERY; CAROTID ENDARTERECTOMY; COMPLICATIONS; AORTIC ARCH AND CAROTID BIFURCATION DISEASE; SUPERFICIAL TEMPORAL—MIDDLE CEREBRAL ARTERY BYPASS
16.  The prepregnancy clinic. 
British Medical Journal  1980;281(6240):619.
PMCID: PMC1713912  PMID: 7427398
17.  Stress and premature labour. 
British Medical Journal  1979;2(6199):1222.
PMCID: PMC1597243  PMID: 519376
18.  Some observations on blood microfilters. 
Under laboratory conditions 3 types of filter designed to prevent the passage of microemboli into the circulation during the transfusion of stored blood were compared with the standard Baxter BR10 filter, designed only to hold back macroemboli, in respect of resistance to blood flow and damage to the cellular elements of the blood. In both respects the Pall Ultipor microfilter proved more efficient than the Swank IL200 microfilter and the Bentley Polyfilter (PF-127) and, except with 3-week-old blood, was comparable to the Baxter filter.
PMCID: PMC2388627  PMID: 1200574
20.  Infiltrating glomus tumour of lower limb. 
British Medical Journal  1972;1(5798):484-485.
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PMCID: PMC1787503  PMID: 4332599
21.  A stomal clamp. 
British Medical Journal  1971;1(5749):604.
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PMCID: PMC1795232  PMID: 5548303

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