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Biomedical subjects

A E Brannigan

Publications and source records attributed to A E Brannigan.

15 recordsLinked to original sources
PubMed2007

Routine mobilization of the splenic flexure is not necessary during anterior resection for rectal cancer.

PURPOSE: Splenic flexure mobilization is widely considered to be an essential component of anterior resection for rectal cancer. It was our hypothesis that selective splenic flexure mobilization would reduce operative times without increasing morbidity or affecting cure. METHODS: A total of 100 consecutive patients with rectal cancer (mean 8 (range, 4-15) cm from anal verge) who underwent anterior resection for cure between 1996 and 2002 had splenic flexure mobilization only as required to achieve a tension-free anastomosis. Operative time, postoperative morbidity, pathologic findings, and recurrence rates were recorded. RESULTS: There were no clinicopathologic differences between those who had splenic flexure mobilization (n = 26) and those who did not (n = 74). Mean operative time in the splenic flexure mobilization group was longer, 167 (range, 130-200) minutes vs. 120 (range, 95-180) minutes in the nonmobilized group (P = 0.023). Mean length of specimen resected was longer in the splenic flexure mobilization group: 36 vs. 18 cm (P = 0.008). Anastomotic complications (4 percent), local recurrence (7 percent, median follow-up, 38 months), perioperative morbidity (32 percent) and mortality (2 percent), and survival did not differ between the two groups. CONCLUSIONS: Routine splenic flexure mobilization is not required for safe anterior resection in patients with rectal cancer. Avoiding splenic flexure mobilization results in shorter operative times and does not increase postoperative morbidity, anastomotic leakage, or local recurrence.

Adult↗
PubMed2006

Intracorporeal rectal stapling following laparoscopic total mesorectal excision: overcoming a challenge.

BACKGROUND: Division of the rectum following total mesorectal excision (TME) using intracorporeal stapling devices is technically difficult due to their width and limited roticulation. More than one cartridge is often required and resultant wedging of the stump may be associated with an appreciable leak rate. METHODS: Three-dimensional reconstruction was performed of CT and MRI images from the lower abdomen of six patients undergoing laparoscopic TME using the Amira software environment. The stapling device was virtually reconstructed by in-house developed software, superimposed over the point of division of the rectum and the site of skin entry identified. RESULTS: The 45 degrees angulation of available roticulating stapling devices precludes perpendicular division of the rectum following laparoscopic TME. The optimal angulation for transverse rectal stapling varied between 62 degrees and 68 degrees . CONCLUSION: A roticulating stapler with minimum angulation of 65 degrees would achieve transverse division of the rectum following laparoscopic TME.

Aged↗
PubMed2005

Hyaluronidase assisted reduction of intestinal intussusception; a novel application.

Failed manual reduction of entero-enteric intussusception in adults leads to intestinal resection for benign disease. The case of a twenty-year old male with an eight inch jejuno-jejunal intussusception is presented. The authors resected a hamartomatous polyp from the apex of the intussusceptum and a subsequent attempt at manual reduction was unsuccessful. Hyaluronidase was injected into the neck of the intussusception and dissipation of tissue oedema facilitated reduction within two minutes. To our knowledge, this is the first reported case of this application of Hyaluronidase.

Adult↗
PubMed2001

Differential regulation of calcitonin secretion in normal and neoplastic pulmonary neuroendocrine cells in vitro.

Within the mammalian lung, cells with a neuroendocrine phenotype are few in number and are sparsely distributed. In contrast, neuroendocrine neoplasms represent a major group of lung cancers. The aim of this study was to develop a model of mammalian PNECs and to compare glucocorticoid regulation of calcitonin secretion in normal and neoplastic cells with neuroendocrine differentiation. Cell cultures of PNECs were initiated after the disaggregation of neonatal hamster lungs with 0.1% collagenase and fractionation of the resultant cell suspension on a gradient of iodixanol (1.320 g/mL). Cell fractions enriched in PNECs were identified by positive staining for 5-hydroxytryptamine and the presence of calcitonin. Calcitonin secretion was investigated after exposure to hydrocortisone (0 to 1,000 nM). A dose-dependant inhibition of calcitonin secretion was seen after 7 days between 10 nM (55% of control), and 1,000 nM (29%) hydrocortisone. Cell cultures grown in the presence of hydrocortisone also contained significantly fewer PNECs between 10 nM (90% of control), and 1,000 nM (45%). Human bronchial carcinoid cells (NCIH727) cultured under identical conditions showed a similar inhibition of calcitonin secretion between 10 nM (53%) and 1,000 nM (52%), although at these concentrations, no reduction in cell number was seen. In contrast, 2 human small cell lung cancer cell lines (DMS-79 and COR-L24 cells) showed no dose-dependent inhibition of calcitonin secretion and no effect on cell proliferation in response to hydrocortisone. These results show that enriched cultures of mammalian PNECs can be used to investigate functional aspects of their biology, including peptide secretion in response to potential regulators. Furthermore, calcitonin secretion is inhibited in normal PNECs and bronchial carcinoid cells at physiological concentrations of glucocorticoids, but this feature appears not to be present in the 2 more invasive neuroendocrine neoplasms (small cell lung cancer cells) investigated in this study.

Animals↗
PubMed2000

Neutrophil apoptosis is delayed in patients with inflammatory bowel disease.

Delayed neutrophil apoptosis is a feature of persistent acute inflammation. Neutrophil-mediated damage has been shown to be associated with the development of inflammatory bowel disease (IBD). Persistence of these cells both at the colonic site and circulation may further contribute to IBD. The aims of this study were to determine whether neutrophils isolated from IBD patients delay apoptosis and to investigate possible mechanisms involved in this delay. We studied 20 patients with IBD, 13 with Crohn's disease, and 7 with ulcerative colitis, all of whom were undergoing intestinal resection for symptomatic disease. Seventeen patients undergoing elective resection of colon cancer acted as operative controls. Systemic, mesenteric arterial, and mesenteric venous blood was harvested. Neutrophils isolated from patients with IBD showed decreased spontaneous apoptosis compared to cancer patients. Mesenteric venous serum of IBD patients contributed to this delay, which contained higher concentrations of interleukin-8 (IL-8). Pro-caspase 3 expression was also reduced in IBD neutrophils, which may contribute to decreased spontaneous and Fas antibody-induced apoptosis. Neutrophil apoptosis may be altered in Crohn's disease and ulcerative colitis through release of anti-apoptotic cytokines and altered caspase expression. The alterations in cell death mechanisms may lead to persistence of the inflammatory response associated with IBD.

Adolescent↗
PubMed2000

Gilmore's groin repair in athletes.

Incapacitating groin pain is a frequent problem among athletes and its etiology may be multifactorial. A specific clinical syndrome relating to injury to the lower abdominal wall has been described and successfully treated by O. J. Gilmore. This paper presents our results of 100 consecutive groin repairs in 85 young athletes using a diagnostic and therapeutic strategy similar to Gilmore's. Ninety-six percent of our patients returned to competitive sport within 15 weeks; we suggest that this is an appropriate therapeutic intervention for athletes who develop chronic incapacitating groin pain.

Adolescent↗
PubMed1999

Regulation of Fas antibody induced neutrophil apoptosis is both caspase and mitochondrial dependent.

Resolution of neutrophil mediated inflammation is achieved, in part, through induction of neutrophil apoptosis. This constitutively expressed programme can be delayed by inflammatory mediators and induced by ligation of the Fas receptor. However, functional activation of the neutrophil results in resistance to Fas signalled death. We evaluated the effects of Fas antibody engagement on caspase activation and mitochondrial permeability, and the impact of co-stimulation by lipopolysaccharide (LPS) or granulocyte macrophage-colony stimulating factor (GM-CSF) on these events. Fas engagement by an agonistic anti-Fas antibody resulted in enhanced caspase 3 and 8 activity and increased mitochondrial permeability. Studies with pharmacological inhibitors of caspase activity showed that activation of caspase 8 occurred before, and activation of caspase 3 occurred after mitochondrial disruption. The mitochondrial stabilising agent bongkrekic acid also inhibited caspase activation and apoptosis. LPS, GM-CSF and increased glutathione stabilised the mitochondria and inhibited caspase 3. Caspase 8 activity was also inhibited by co-stimulation through a mechanism independent of mitochondrial stabilisation. Glutathione directly inhibited caspase 3 and 8 activity. We conclude inhibition of Fas antibody induced apoptosis by inflammatory proteins is associated with augmented mitochondrial stability and reduced caspase 3 activity that may be glutathione mediated.

Acetylcysteine↗
PubMedDate not supplied

Timing of laparoscopic cholecystectomy in acute cholecystitis.

BACKGROUND: Laparoscopic cholecystectomy is associated with an increased conversion rate in acute cholecystitis. AIM: To review the operative management of symptomatic cholelithiasis with particular reference to conversion rates and morbidity for laparoscopic cholecystectomy for acute cholecystitis. METHODS: Patients undergoing cholecystectomy between January 1994 and December 1998 were recruited. Demographic details, diagnosis, duration of symptoms, treatment, outcome, post-operative stay and complications were recorded. RESULTS: Complete data were available on 482 patients (84%). Laparoscopic cholecystectomy was attempted in 120 of 132 patients (91%) with acute cholecystitis and 329 of 350 patients (94%) with non-acute gallbladder disease. Conversion rates were 27% (33/120) and 6.7% (22/329) for acute and non-acute gallbladder disease, respectively (p < 0.001 chi2 test). Relating the interval from onset of symptoms to surgery, conversion rates for acute cholecystitis were: < 3 days, 5/17 (29%); 4 to 42 days, 14/59 (23%) and > 42 days, 14/44 (31%). There were three bile duct injuries, two in the delayed (> 45 days) acute group and one in the non-acute group. CONCLUSION: Early laparoscopic cholecystectomy is the treatment of choice for acute cholecystitis, but is associated with a high conversion rate independent of the timing of surgery.

Cholecystectomy, Laparoscopic↗
PubMedDate not supplied

Are elective surgical operations cancelled due to increasing medical admissions?

BACKGROUND: Cancellation of operations increases theatre costs and decreases efficiency. We examined the causes of theatre cancellations in general surgery. METHODS: The Beaumont hospital database (ORSUS system) and theatre records were examined retrospectively between April 1997 and March 2002. The number and causes of theatre cancellations, the number of emergency admissions and their length of hospital stay were studied. RESULTS: The number of elective operations cancelled between April 1997-March 1998 and April 2001-March 2002 were 368 and 427 respectively. 'No bed' was the reason for theatre cancellation in 114 (31.0%) cases between April 1997-March 1998 and this increased to 267 (62.5%) cases between April 2001-March 2002. Between April 1997-March 1998 and April 2001-March 2002, general surgical emergency admissions decreased by 6.74% (3,116 to 2,906), and emergency surgical admissions across the specialties decreased by 2.02% (4,002 to 3,921). In the same time interval, general medical emergency admissions rose from 4,195 to 5,386 (a 28.39% increase), and emergency medical admissions across the specialties rose from 5,401 to 6,689 (a 23.84% increase). General surgical bed days for emergency admissions fell between April 1997-March 1998 and April 2001-March 2002 from 28,839 to 26,698 (7.4% decrease). There was a similar decrease from 38,188 to 36,004 (5.7% decrease) for all surgical specialties. Total bed days necessitated by general medical emergency admissions increased from 53,226 to 61,623 (15.8%). Across the medical specialties, an increase from 71,590 to 82,180 bed days (14.79%) was seen. CONCLUSIONS: Elective surgery cancellation is a significant problem with far-reaching consequences. While multifactorial in aetiology, increased bed usage by medical specialties is one important factor. This study has implications for doctors, training, administrators and patients.

Appointments and Schedules↗
PubMedDate not supplied

Popliteal-to-distal artery bypass for diabetic limb salvage.

BACKGROUND: Poor long-term survival and significant co-morbidity among diabetic patients with limb ischaemia makes the shortest, simplest revascularisation procedure desirable. AIM: Evaluate limb salvage, primary graft patency and peri-operative morbidity rates in diabetic patients undergoing popliteal-to-distal artery bypass for limb salvage. METHODS: Patients undergoing popliteal-to-distal artery bypass for critical limb ischaemia over a seven-year period were retrospectively identified. Patients operative and follow-up data were entered into a database and limb salvage and patient survival determined using Kaplan Meier survival analysis. RESULTS: During the study period 21 popliteal-to-distal artery bypasses were performed on 19 diabetic patients. Mortality rate after one year was 11%. Primary graft patency rates among surviving patients was 81%, 67% and 48% at 1, 2 and 6 years respectively. Amputation was required in three patients. CONCLUSION: Popliteal-to-distal artery bypass produces favourable results in high-risk diabetic patients with critical limb ischaemia.

Aged↗
PubMedDate not supplied

Day case laparoscopic cholecystectomy is feasible.

BACKGROUND: Laparoscopic cholecystectomy is the operation of choice for cholelithiasis. AIMS: The aims of our study were to assess the feasibility of day case laparoscopic cholecystectomy (DCLC) in selected patients. METHODS: DCLC was introduced in this unit in July 1999. The first 50 patients were prospectively evaluated up to February 2001. RESULTS: All patients were under 55 years of age with an ASA grade of I (n = 48) or II (n = 2). The mean age was 41.1 years (range 20-55 years) and the male:female ratio was 1:6. All patients had a standard anaesthetic protocol. Patients were discharged 10 to 12 hours postoperatively with a pro forma, which was reviewed at one week in the clinic. The conversion rate was 2%. Three required overnight admission due to excessive nausea, hypertension and for an unforeseen psychosocial problem. Ninety per cent of patients were suitable for same day discharge. No patient required subsequent readmission. CONCLUSION: DCLC is feasible and safe in carefully selected patients and has the advantages of convenience and cost-effectiveness.

Adolescent↗
PubMedDate not supplied

Defining small bowel strictures.

BACKGROUND: Strictures of the intestine can be difficult to detect despite current radiological techniques. AIM: To review our experience with a new Foley catheter technique. METHOD: Three cases are reviewed in which a Foley catheter was used to identify a fibrous stricture. RESULTS: A Foley catheter with an inflated 10ml balloon inserted through an enterotomy successfully identified the site of stricture in three cases of fibrous stricture obstruction. CONCLUSION: A Foley catheter inserted through an enterotomy is a useful method of identifying fibrous strictures.

Aged↗
PubMedDate not supplied

Critical appraisal of the application of carotid duplex scanning.

AIMS: To evaluate the indications for carotid arterial imaging in an open access vascular laboratory. To identify those symptoms predictive of > 50% stenosis of the carotid artery in order to reduce unnecessary imaging. To test the hypothesis that duplex scanning would not be of significant benefit in the management of those patients with ill defined symptoms. METHODS: We compared the outcome of carotid duplex scanning performed on 816 consecutive patients referred for a variety of clinical indications. The medical records of 816 patients were retrospectively analysed to identify the clinical indication for carotid duplex imaging over a three-year period (1997-9). RESULTS: The indications for duplex imaging were divided into two groups: definite carotid symptoms, n=350 (transient ischaemic attack n=205, cerebrovascular accident n=66, amaurosis fugax n=49, dysphasia n=30); and non-carotid symptoms, n=466 (dizziness n=63, syncope n=63, confusion n=20, vertigo n=10 and others n=310). Less than 5% of those with definite carotid symptoms and 2% of those with ill-defined symptoms had a stenosis > 80%. CONCLUSION: Regardless of symptoms, 14% and 2.9% of patients referred for carotid duplex imaging have a stenosis of > or = 50% and > or = 80%, respectively. Patients without definite carotid symptoms are of low priority for duplex imaging.

Aged↗
PubMedDate not supplied

Sigmoid volvulus: a 10-year-audit.

BACKGROUND: Chronic constipation in elderly, institutionalised patients is the leading cause of sigmoid volvulus in the developed world. Endoscopic deflation is associated with a 90% recurrence rate and a 35% mortality rate. AIMS: To review a 10-year experience of sigmoid volvulus and encourage more aggressive primary treatment. METHODS: A retrospective study was performed on 16 patients with sigmoid volvulus from 1992 to 1999. Patients were identified using the hospital inpatient enquiry (HIPE) data system. Demographics, clinical course, intervention, complications and outcome were recorded. RESULTS: The male:female ratio was 5:3 and mean age was 78 years (range 39-92). Fifty per cent had at least one risk factor: Parkinson's disease (n=3); multiple sclerosis (n=1); Alzheimer's disease (n=1); and hypokalaemia (n=3). Thirty-seven per cent were managed conservatively and 63% required surgical intervention. Mean time to surgery was 2.4 days. Operations performed were sigmoid colectomy (45%), Hartmann's procedure (33%) and total colectomy (22%). There was one post-operative death from myocardial ischaemia. Mean duration of admission was 21 days. CONCLUSIONS: Endoscopic deflation of a sigmoid volvulus facilitates optimisation of cardiopulmonary co-morbidity in a high-risk group of patients. It converts an emergent to an elective procedure and minimises operative morbidity as a result.

Aged↗