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1.  Surgical treatment of para-oesophageal hiatal hernia. 
The development of laparoscopic antireflux surgery has stimulated interest in laparoscopic para-oesophageal hiatal hernia repair. This review of our practice over 10 years using a standard transthoracic technique was undertaken to establish the safety and effectiveness of the open technique to allow comparison. Sixty patients with para-oesophageal hiatal hernia were operated on between 1989 and 1999. There were 38 women and 22 men with a median age of 69.5 years. There were 47 elective and 13 emergency presentations. Operation consisted of a left thoracotomy, hernia reduction and crural repair. An antireflux procedure was added in selected patients. There were no deaths among the elective cases and one among the emergency cases. Median follow-up time was 19 months. There was one recurrence (1.5%). Seven patients (12%) required a single oesophagoscopy and dilatation up to 2 years postoperatively but have been asymptomatic since. Two patients (3%) developed symptomatic reflux which has been well controlled on proton-pump inhibitors. Transthoracic para-oesophageal hernia repair can be safely performed with minimal recurrence.
PMCID: PMC2503683  PMID: 11777134
3.  Cancer of the oesophagus. 
BMJ : British Medical Journal  1990;300(6725):679.
PMCID: PMC1662434  PMID: 2322710
5.  A suggested site for the implantation of myocardial pacemakers in infants and young children. 
Thorax  1976;31(3):346-349.
A new site for burying an implantable pacemaker in infants and young children is described. The Medtronic sutureless screw electrode is applied to the diaphragmatic surface of the heart through a transxiphoid approach. The unit is inserted in the abdominal wall between the transversalis fascia and the transversus muscle. The method is simple, taking approximately 30 minutes to complete. It avoids thoracotomy. The unit is well concealed and protected. The coils of the lead are relatively free from adhesions and allow for growth in the child.
PMCID: PMC470437  PMID: 133473
6.  Silent lower aortic obstruction 
Thorax  1972;27(5):586-590.
Three cases of lower aortic obstruction are described in which the diagnosis was made at operation.
Profound hypothermia with circulatory arrest was used for replacement of the mitral valve by a Starr Edwards prosthesis. Femoral perfusion was used and the diagnosis was made in the first case only because the rectal temperature fell precipitously during cooling, while the temperature in the upper part of the body was slow to fall. In this case disobliteration was not carried out, but in two further cases this was done through a bilateral femoral arteriotomy using Fogarty catheters.
All cases were seen during a period of 18 months among 35 mitral valve replacements.
Silent lower aortic obstruction may not therefore be a rare condition and might be responsible for hypotension during normothermic cardiopulmonary bypass when the femoral artery is used for cannulation. If the aortic root is used, the condition will not be discovered.
If exercise tolerance is greatly improved after successful operation symptoms of the obstruction may become manifest, and if further thrombosis occurs and symptoms are more acute they may be wrongly attributed to embolization from the valve replacement. Routine abdominal aortography during left heart studies should disclose a clinically silent obstruction.
PMCID: PMC470558  PMID: 5083727
7.  Differential role of vasoactive prostanoids in porcine and human isolated pulmonary arteries in response to endothelium-dependent relaxants 
British Journal of Pharmacology  1998;125(6):1128-1137.
The pig is increasingly being used in medical research, both as a model of the human cardiovascular system, and as a possible source of organs for xenotransplantation. However, little is known about the comparative functions of the vascular endothelium between porcine and human arteries. We have therefore compared the effects of two endothelium-dependent vasorelaxants, acetylcholine (ACh) and the Ca2+-ATPase inhibitor, cyclopiazonic acid (CPA) on the porcine and human isolated pulmonary artery using isometric tension recording.ACh and CPA produced endothelium-dependent relaxations of both the human and porcine pulmonary arteries.In the porcine pulmonary artery, the cyclo-oxygenase inhibitor, flurbiprofen had no effect on relaxations to ACh (Emax: control 67.8±8.8% versus 72.4±9.5% (n=11)) or CPA (Emax: control 79.6±5.0% versus 94.0±10.6% (n=7)). The nitric oxide synthase inhibitor, L-NAME converted relaxations to both ACh and CPA into contractile responses (maximum response: ACh 30.0±11.1% (n=10); CPA 80.4±26.2% (n=8) of U46619-induced tone). These contractile responses in the presence of L-NAME were abolished by flurbiprofen.In the human pulmonary artery, L-NAME and flurbiprofen partly attenuated relaxations to ACh (Emax: control: 45.1±12.1%; flurbiprofen: 33.4±13.5%; L-NAME: 10.1±7.2%) and CPA (Emax: control: 78.1±5.5%; flurbiprofen: 69.6±7.2%; L-NAME 37.9±10.7% of U46619-induced tone). These responses were abolished by the combination of both inhibitors.We have demonstrated that while the release of nitric oxide is important in responses to endothelium-dependent vasorelaxants in both human and porcine pulmonary arteries, in the human arteries, there is an important role for vasorelaxant prostanoids whilst in the porcine arteries, vasoconstrictor prostanoids are released.
PMCID: PMC1565684  PMID: 9863638
Acetylcholine; cyclopiazonic acid; pulmonary artery; endothelium; nitric oxide; prostanoids; man; pig
8.  Antireflux surgery. 
BMJ : British Medical Journal  1990;301(6746):292-293.
PMCID: PMC1663485  PMID: 2390627
10.  Airway fire during tracheostomy: prevention strategies for surgeons and anaesthetists. 
Airway fires are an uncommon but real and devastating complication of tracheostomy. One such fire in a 31-year-old man is described. Surgical fires are discussed, and 15 reported cases of tracheostomy fire are reviewed. A tracheostomy protocol, adopted by our department and designed to avoid this life-threatening complication, is described. Surgeons and anaesthetists involved in tracheostomy must understand the fire hazard and how to avoid it.
PMCID: PMC2503679  PMID: 11777128
11.  Primary oat cell carcinoma of the oesophagus. 
Thorax  1986;41(4):318-321.
Three cases of oat cell carcinoma of the oesophagus are presented and published reports reviewed. This is mainly a disease of older age with a 3:2 predominance of men. Of all published cases, 43 (47.3%) occurred in the middle third, 41 (45.1%) in the lower third, and four (4.4%) in the upper third. In one case it was multifocal and in two the location was not stated. Dysphagia was the most common symptom and was found in 82.5% of cases. Overall survival was 4.7 months. The longest survival in a patient treated by resection was 24 months and in a patient treated by chemotherapy 11 months. All but one of the patients had widely disseminated metastatic disease at death. It is concluded that surgery, possibly with adjuvant chemotherapy, holds out the best prospect for such patients.
PMCID: PMC460317  PMID: 3016939
12.  Oesophageal intramural pseudodiverticulosis. 
Thorax  1985;40(11):849-857.
Twelve cases of oesophageal intramural pseudodiverticulosis are described and the findings in 85 previously reported cases are reviewed. The condition occurs in all age groups, predominantly in the sixth and seventh decades, with a slight predilection for males. The characteristic radiographic appearance is of multiple flask shaped outpouchings of 1-4 mm with narrow necks communicating with the oesophageal lumen. The source of the pseudodiverticula has been shown to be pathologically dilated excretory ducts of the submucous glands due to chronic submucosal inflammation. The distribution was segmental in 57 cases (59%) and diffuse in 40 (41%). Dysphagia is the main symptom and was found in 85 cases (88%); 88 cases out of 97 had radiological narrowing of the oesophagus; of these, 39 (44%) were in the upper oesophagus, 20 (23%) in the middle oesophagus, and 29 (33%) in the lower oesophagus. Treatment is directed towards management of the associated disorder, as the diverticula themselves rarely cause problems.
PMCID: PMC1020564  PMID: 3934782
13.  Aneurysmal bone cyst of the rib. 
Thorax  1984;39(2):125-130.
Aneurysmal bone cysts are uncommon lesions, especially in the ribs. Four patients with aneurysmal bone cysts of the rib are presented and previously reported cases reviewed. A brief discussion of the clinical manifestations, pathology, aetiology, and current treatment of aneurysmal bone cyst is also included.
PMCID: PMC459738  PMID: 6701823

Results 1-13 (13)