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Biomedical subjects

A Munro

Publications and source records attributed to A Munro.

At least 37 records · Page 2Linked to original sources
PubMed1997

The impact of the development of restorative proctocolectomy on the management of inflammatory bowel disease in the north of Scotland.

In the North of Scotland, 40 out of 196 patients who had surgery for colitis between 1986 and 1992 underwent restorative proctocolectomy. The problems of the development of experience in a new technique were reduced by cooperation between two consultant surgeons from centres 100 miles apart who performed the first 30 operations together. Over 7 years, the standard operative technique evolved from perimuscular dissection of the rectum with formation of an S pouch and hand sutured endo-anal anastomosis to perimesenteric rectal dissection with a stapled J pouch and double stapled anastomosis. There was no mortality and no pelvic sepsis requiring urgent re-operation. One pouch has been removed subsequently because of Crohn's disease. One patient required revisional surgery for severe stricture of the ileo-anal anastomosis. At 1 year post-operatively, 35 out of 40 patients were highly satisfied with the result of surgery. The proportion of patients undergoing restorative proctocolectomy rather than panproctocolectomy for ulcerative colitis has risen from 15 to 52%. The number of total colectomies performed as initial procedures for colitis has increased. The age of patients who have restorative proctocolectomy has widened to include teenagers as well as a few patients over 50 years of age.

Adolescent↗
PubMed1997

Training for minor surgery in general practice: is it adequate?

To assess training and operative practice in minor surgery a postal questionnaire was sent to all general practitioners practising in the Scottish Highlands and Western Isles in 1992. Information was requested regarding the type and adequacy of surgical training, operations performed, the desire for surgical skills training and possible methods of assessment. Seventy per cent (144/205) of general practitioners (GPs) replied to the questionnaire. Teaching in minor surgery had been received by 74% of GPs (107/144), yet 43% (62) considered their training inadequate. Although confident to suture simple wounds or excise skin lesions from the trunk, significantly fewer were confident to excise such lesions from the face (P < 0.001, 1 df, Chi square test). From 86% of GPs (124/144) who wished to attend a training course on minor surgery, 62% (77) would prefer to be taught on patients and 36% (45) on a realistic skin simulator. Assessment of technical competence by a hospital consultant was considered desirable by 56% (80/144) either on patients 40% (57), or using a skin simulator 38% (54). While most GPs receive some training in minor surgery, there is a perceived need for improved training. The use of a skin simulator may allow both the teaching and assessment of surgical competence for GPs who undertake minor surgery.

Adult↗
PubMed1997

Helicobacter pylori and gastric cancer.

BACKGROUND: Considerable progress has been made over the past two decades in understanding gastric carcinogenesis. Genetic and environmental factors have been shown to play a part. Infection with Helicobacter pylori leads to chronic gastritis and evidence is accumulating to link this disease with the subsequent development of gastric cancer. METHOD: A literature review was undertaken using Medline (National Library of Medicine, Washington DC, USA) searches of the headings gastrointestinal neoplasms and H. pylori for the years 1993-1997; further relevant references were examined. RESULTS: H. pylori is implicated in gastric carcinogenesis. Proposed mechanisms centre on the inflammatory response of the gastric mucosa to the bacterium. CONCLUSION: Investigation is still required to elucidate the exact role of H. pylori in the development of gastric carcinoma. Eradication of the organism in high-risk groups might lead to a reduction in the incidence of gastric cancer.

Gastritis↗
PubMed1995

Optimum method for urinary drainage in major abdominal surgery: a prospective randomized trial of suprapubic versus urethral catheterization.

The outcome of suprapubic and urethral catheterization in abdominal surgery was compared in a prospective randomized trial. Twenty-eight patients received a suprapubic and 29 a urethral catheter. The groups were similar in terms of age, sex, operation performed and postoperative analgesia. There was no difference in the duration of catheterization (suprapubic: median 5 (range 4-10) days; urethral: median 4 (range 2-11) days). Urinary sepsis occurred in three patients in each group. Urethral catheters caused pain in significantly more patients (urethral 13; suprapubic two; chi 2 = 8.6, 1 d.f. P < 0.01), on more days (suprapubic: 6 of 142 catheter days; urethral: 37 of 126 catheter days; chi 2 = 29.5, 1 d.f. P < 0.001). Two men with urethral catheters and one with a suprapubic catheter failed to void urethrally when required to do so. Suprapubic catheterization is the method of choice for urinary drainage when this is required in abdominal surgery.

Abdomen↗
PubMed1995

Colectomy for acute colitis: is it safe to close the rectal stump?

We report 62 operations for acute colonic inflammatory bowel disease in which the rectal stump was closed. Operative findings were of severe colitis in 46, toxic megacolon in 8 and faecal peritonitis in 8 patients. Histology showed ulcerative colitis in 48, Crohn's disease in 9 and indeterminate colitis in 5 patients. Clinical evidence of stump leakage occurred in only one of 53 patients with a long rectal stump in contrast to 3 of 9 patients who had a short rectal stump. Leaving a very short stump also led to difficulty at subsequent proctectomy in 3 patients and at restorative proctocolectomy in 1 patient. This suggests that careful closure of the rectum above the peritoneal reflection can be a safe means of dealing with the rectal stump after total colectomy and ileostomy for acute colitis.

Acute Disease↗
PubMed1995

An overview of treatment in paranoia/delusional disorder.

OBJECTIVE: To examine delusional disorder (formerly paranoia) which has re-emerged as an important diagnosis in psychiatry and familiarize present-generation psychiatrists with this disorder and its treatment. To benefit other researchers, a bibliography is appended. METHOD: Approximately 1,000 articles on paranoia/delusional disorder were analyzed in detail. These articles date from 1961 with the greater majority dating from 1980 onward. Case descriptions were often vague and only cases identifiable by DSM-IV diagnostic criteria were accepted. Eventually 257 cases were accumulated, but it was only possible to report on treatment aspects of 209 of these, due to lack of detail. RESULTS: Because the data are so disparate, and the literature is confusing in therapeutics aspects, only the broadest conclusions can be drawn. However, it does appear that when adequately treated, delusional disorder is an illness with a reasonably good prognosis. Cases respond equally well to treatment, whatever the specific delusional content, and pimozide currently appears to be the neuroleptic which produces the best results. CONCLUSIONS: There is an urgent need to raise standards in the study of delusional disorder and its treatment.

Antipsychotic Agents↗
PubMed1995

Total colonic mobilization and exteriorization facilitates intra-operative colonic irrigation.

Intraoperative colonic irrigation has become an accepted procedure in the management of left-sided bowel obstruction, making it possible to perform a safe primary anastomosis after resection. However, many surgeons raise objections to the technique because it is a complex procedure to perform on an acutely ill patient and, furthermore, the procedure is time consuming. A modification of the technique initially described by Dudley and his colleagues has already been reported from our hospital and utilizes an irrigation needle and a one-piece disposal sack. During irrigation, the colon requires to be manipulated to encourage the onward flow of faecal contents. Difficulty may be experienced because of the sharp angulation and fixity of the colon at both the hepatic and splenic flexures. Mobilization and exteriorization of the whole colon eliminates this problem.

Colon↗
PubMed1995

The classification of delusional disorders.

Recognition of a delusion in a psychiatric illness places that illness in the broad category of psychotic disorders. The form and content of the delusion are, in themselves, however, insufficient to make a detailed diagnosis, and it is the context of the delusion within a particular disorder that is more pathognomonic. Among the large number of illnesses whose symptoms include delusions, there is a discrete group known as the delusional disorders. After many years of neglect, these are becoming of considerable interest to psychiatrists, and research to define their characteristics is on the rise. This article attempts to describe these illnesses, to indicate where possible their relationships to other psychiatric disorders, and to suggest promising areas of investigation.

Delusions↗
PubMed1994

Effect of preoperative skin infiltration with 0.5% bupivacaine on postoperative pain following cesarean section under spinal anesthesia.

Recent work suggests that preoperative skin infiltration with local anesthetic may lead to reduced postoperative pain. We have studied this in a randomised, prospective, double-blind trial of 40 women having cesarean section under spinal anesthesia. After establishment of the spinal block, the incision line was infiltrated in 20 women with 30 ml 0.5% bupivacaine and in 20 with 30 ml normal saline. There was no difference in pain scores between the 2 groups on any of the 3 postoperative days, perhaps due to the high quality analgesia provided by supplemental subarachnoid morphine.

Journal Article↗
PubMed1994

Delusional disorders are a naturally occurring 'experimental psychosis'.

A delusion can only be 'explained' if it can be correlated with a demonstrable brain event, and this is only beginning to be possible. The misidentification syndromes are leading the way in demonstrating a close relationship between quite specific brain abnormalities and highly characteristic delusional symptoms. Although delusional disorder (DSM-IV 297.10) and its treatment are well described, virtually no investigations have been carried out on the neuropathological substrate. This article suggests that delusional disorder is a naturally occurring 'model psychosis' which would reward experimental study.

Brain↗
PubMed1994

Skin simulation for minor surgical procedures.

A simulated skin preparation is described which is made by bonding siliconized rubber to a latex foam base. This composite material, which simulates both the dermis/epidermis and subcutaneous fat, provides a realistic model which can be used to teach excision of skin lesions and a variety of suturing methods. We believe that this simulator is of value not only for surgeons in-training but also will allow general practitioners to improve their technical skills in performing minor surgical procedures.

Dermatologic Surgical Procedures↗
PubMed1993

Needlestick injuries: the shock and reality.

It has been a typically busy Saturday night in the emergency department. Then, near midnight, a trauma casualty was admitted and an incident occurred that would occupy Suzanne Smith's thoughts for months to come. When starting an intravenous line on this patient, Suzanne spiked herself with a needle. Later the patient was taken to the intensive care unit and placed on a ventilator. Suzanne was overcome with fear that she might have contracted AIDS. Her fears intensified when she learned that the patient, Mr. Norman, was a heroin addict.

Fear↗