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Biomedical subjects

A L Polglase

Publications and source records attributed to A L Polglase.

At least 19 recordsLinked to original sources
PubMed1995

The longer term results of internal anal sphincterotomy for anal fissure.

This study details the results of a retrospective analysis of 98 patients who underwent lateral subcutaneous internal sphincterotomy for the treatment of fissure in ano. Data with particular emphasis on patient satisfaction and anorectal control were collected by postal questionnaire. Minimum follow up was 15 months with an average of 41 months. Ninety-seven per cent of patients indicated that they were moderately or very satisfied with the outcome of the procedure and 90% claimed symptomatic improvement with this being sustained in 69%. Eighteen per cent of patients noted ongoing new problems with minor impairment of anorectal control. Despite these symptoms, 90% of this group were also moderately or very pleased with the outcome and 72% had resolution of their symptoms which was sustained in more than two-thirds of cases. It is concluded that lateral subcutaneous internal sphincterotomy is well tolerated and the majority of patients are more than moderately pleased with the outcome. There was however a significant incidence of minor impairment in anorectal control but this did not detract from the perceived success of the procedure.

Adolescent↗
PubMed1992

Perineal proctectomy for rectal prolapse in elderly and debilitated patients.

This paper details the indications, operative technique and results of perineal proctectomy in the management of complete rectal prolapse in a high risk, elderly and debilitated group of patients. Eighteen procedures were performed by one surgeon (A.L.P.) on 16 consecutive patients over a 5 year period. Data collection was via: (i) retrospective analysis of hospital and office records; and (ii) response to a postal questionnaire by the patient, a relative or attending nursing staff. There were 14 females and two males with a mean age of 81 years. All patients had significant associated medical conditions. The interval from the time of a surgical procedure until review varied from 3 to 37 months with a mean follow-up period of 16 months. Total hospital stay varied between 6 and 20 days with a mean of 7 days. Eleven procedures were performed under general anaesthesia and seven under spinal anaesthesia. There was no postoperative mortality. One patient suffered an anastomotic haemorrhage that required operative intervention and another patient suffered a rectal stricture that necessitated dilatation. Two patients were re-operated for recurrent symptomatic prolapses at 34 and 36 months after the initial procedure. Continence improved in seven patients, worsened in one and was unchanged in the remaining patients. Fifteen of 16 patients were considered to have had a successful result from the operation with satisfactory control of the symptom of rectal prolapse. Perineal proctectomy is a low risk operative procedure for the elderly and debilitated group of patients in controlling complete rectal prolapse. If the condition recurs, the procedure can be repeated with equally low morbidity.

Aged↗
PubMed1991

Inguinal surgery for debilitating chronic groin pain in athletes.

OBJECTIVES: To identify and surgically treat correctable inguinal injuries in athletes with chronic groin pain and to assess the results of surgical treatment. DESIGN: Sixty-four athletes presented between March 1987 and January 1990 for treatment of chronic groin pain in which surgical exploration of the inguinal canal was considered necessary. Follow-up was performed by questionnaire. MAIN OUTCOME MEASURE: Patient self-assessment of the success of the operation, including postoperative pain, ability to return to active sport and any further treatment required. RESULTS: Sixty-four athletes were treated, Australian Rules footballers predominated (46/64, 72%). Eight athletes had bilateral groin pain. Fifty-nine (92%) reported an incipient onset of pain. The most common operative finding was of a substantially deranged posterior wall of the inguinal canal which was evident in 61/72 instances (85%). Apparent splitting of the conjoint tendon was found in 19 instances (26%) and previously occult indirect inguinal hernias were discovered in six (8%). Repair of the posterior wall of the inguinal canal was by the standard Bassini repair and Tanner slide or by plication of the transversalis fascia followed by a nylon darn. Follow-up by questionnaire of the 64 athletes revealed that 40 athletes (62.5%) considered themselves cured and had returned to competitive sport. Twenty athletes (31.3%) were partially satisfied with the results of their operation, and also able to return to active sport. Three athletes (4.7%) were dissatisfied with the operative result. One patient was lost to follow-up. CONCLUSION: The most common finding in athletes with chronic groin pain was a deficiency of the posterior wall of the inguinal canal. Surgical exploration and repair of the posterior wall of the inguinal canal in athletes with chronic debilitating groin pain achieved excellent or good relief of pain in 93.8% of athletes and improved physical performance.

Adolescent↗
PubMed1991

Aberrant expression of intestinal mucin antigens associated with colorectal carcinoma defined by a panel of monoclonal antibodies.

Small intestine mucin antigen (SIMA) is an oncofoetal antigen for the colon and is distinct from the normal large intestinal mucin antigen (LIMA). In the present study, a panel of anti-SIMA and anti-LIMA monoclonal antibodies (MAb) was used to charaterise altered mucin expression in colorectal adenocarcinomas, by immunohistochemistry and quantitative immunoassays of tissue extracts. These results are compared with CEA expression and correlated with various clinicopathological indices. All mucin MAb reacted with a high proportion of the 100 colon cancers of every stage, histological type (including non-mucinous cancers), differentiation, site, or size. Inappropriate SIMA production was detected by either anti-SIMA MAb 4D3 or 4A1, even in 85% of early stage cancers. MAb 4D3 reacted with a higher proportion of cancers of smaller size and better differentiation. At the subcellular level, both anti-SIMA MAb showed reactivity typical of normal mucin, i.e., goblet cell and extracellular mucin. The normal colonic antigen, LIMA, was also detectable in the majority of cases, but quantitatively overproduced in some cases and reduced in others. However, in contrast to SIMA, LIMA was detected in predominantly undifferentiated cancer cells but not in goblet cells. Heterogeneity of MAb reactivity between cases and complementarity within each cancer was frequently observed. Mucin reactive with at least one of the MAb was detected in all of the CEA-negative cancers. A high rate of inappropriate SIMA expression was also detected in the perineoplastic transitional mucosa (88%, c.f. CEA, 35%) and adjacent, morphologically normal mucosa (80% c.f. CEA, 24%), indicating biochemical changes similar to the cancer. This panel of anti-mucin MAb demonstrated altered mucin glycoprotein metabolism associated with the development and progression of most colorectal cancers, which emphasises their utility as indicators of neoplastic change in the colon, and their superiority to CEA.

Aged↗
PubMed1988

Giant inguinal hernia.

Giant inguinal herniae present a major challenge in management. This case details clinical features of an enormous inguinoscrotal hernia associated with septic gangrene and elephantiasis of the scrotum. Two initial operations were required for control of sepsis, followed by a two-staged hernial repair, involving a total colectomy and a subsequent neoscrotal repair. The problems of loss of domain within the abdominal cavity and the special features presented by this case are discussed.

Colectomy↗
PubMed1986

Changing survival prospects in rectal carcinoma. A series of 1,306 patients managed by one surgeon.

Cancer-specific survival prospects for rectal carcinoma in a series of 1306 patients managed from 1950 to 1979 by one surgeon worsened from 1970 to 1979. The prognosis was worse for all patients treated operatively from 1970 to 1979 compared with 1960 to 1969 (P less than 0.03). After potentially curative resection, survival was worse from 1970 to 1979 compared with 1950 to 1959 (P less than 0.02) and 1960 to 1969 (P less than 0.01), respectively; the corresponding five-year survivals were 72.5 percent, 72.3 percent, and 61.5 percent. The curative resection rate for the three decades was similar (66 to 70 percent). An increase in the incidence of Dukes' Stage C tumors from 23.3 percent to 32.3 percent (P less than 0.01) explains, at least partly, the decreased survival. The worsened survival prospects were not accounted for by changes in referral pattern, tumor site, or in the proportion of sphincter-saving resections performed. The worsening was paradoxically paralleled by earlier symptomatic presentation (P less than 0.001). Analyses of other Australian data are required to test the hypothesis that the worsened survival prospects are consequent to altered tumor biologic aggressiveness, possibly related to differences in the causal factors operating over the 30-year study period.

Adult↗
PubMed1985

Total and subtotal colectomy for colonic obstruction.

Colectomy (total or subtotal) is not the operation of choice for elective colonic cancer unless the patient is under 50 years of age, is undergoing curative resection, and has associated adenomatous polyps. Routine colectomy is not supported when a partial obstruction prevents preparation of the colon and interferes with proximal colonic examination. Colectomy (especially subtotal) is acceptable for the acutely obstructed colon but it is technically demanding and requires experience in patient selection.

Adult↗
PubMed1985

Post-proctectomy perineal hernia: case report and discussion.

Perineal hernia is a rare complication of pelvic surgery. Women are more commonly affected, and development of the condition is usually gradual. Although the true incidence of this problem is unknown, few cases are severe enough to require operative repair. We report the experience of one of the authors (E.S.R.H.) in post-proctectomy perineal hernia. One case required surgical repair and is presented, with a discussion of the operative management.

Abdomen↗
PubMed1984

Gastric cancer and survival.

The survival of patients with cancer of the stomach in a Melbourne series showed no improvement over a 20-year period. Of 246 patients, 8.1% survived for a period of five years, and 4.8% survived for 10 years after presentation. A further plea is made to establish a "100%" register of cancer.

Australia↗
PubMed1984

A pitfall with the EEA stapler in vertical banded gastroplasty.

This report details an intraoperative complication with the anvil of the EEA stapler in the course of a Mason vertical banded gastroplasty for morbid obesity. It was unrecognized by the operating team, and resulted in prolongation of the procedure, excessive manipulation of the stomach, and the use of a second EEA stapling instrument.

Adult↗
PubMed1984

Ulcerative colitis and Crohn's disease. What your patient wants to know.

The chronic nature of non specific inflammatory bowel disease causes anxiety for the patients who confront the doctor with concern about their future outlook. This paper addresses the questions a doctor is most likely to be asked and provides answers based on the most recent information.

Colitis, Ulcerative↗
PubMed1983

The leaking anus.

Explore the source record for details and available documents.

Anal Canal↗