Biomedical subjects
Publications and source records attributed to A P Ross.
Neurologic degenerative disorders pose challenges to patients, their families, and health care professionals who care for them. In recent years there have been many advances in the diagnosis and management of neurologic degenerative diseases. Multiple sclerosis, myasthenia gravis, Parkinson's disease, and amyotrophic lateral sclerosis are discussed.
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The client receiving immunosuppressive therapy for demyelinating disorders faces many challenges. The nurse should be involved in the constant assessment of the client for potential complications of the therapy as well as changes in the underlying disease process. Many of the nursing interventions focus on comfort and symptom management as well as providing information for the client and family to use in understanding the therapy and minimizing the effects of immunosuppression. Involving the family in client management will only strengthen the overall plan and outcomes for client care.
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A total of 52 jaundiced elderly patients who had malignant obstruction of the distal common bile duct and who required palliative biliary decompression were randomized to receive either an endoscopically placed biliary endoprosthesis (10 French gauge) or conventional surgical bypass. Patients within the two treatment groups were well matched and 51 were followed until their death. Patients treated with endoprosthesis had a significantly shorter initial hospital stay than those treated surgically. In the long term, overall survival in the two groups was similar and jaundice was relieved in over 90 per cent of patients. Despite more re-admissions to hospital for those patients treated endoscopically, the total time spent in hospital still remained significantly shorter in this treatment group compared with those subjected to surgery. The endoscopically placed biliary endoprosthesis is a valuable alternative to conventional surgical bypass in the palliation of extrahepatic biliary obstruction.
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After a two-year history of recurrent abdominal pain, an 84-year-old man presented with acute pancreatitis and obstructive jaundice. An endoscopic retrograde cholangiogram demonstrated two filling defects approximately 1.0 cm in diameter, in a dilated common bile duct. Endoscopic papillotomy was performed which resulted in a polypoid tumour delivering itself into the wound followed by a free flow of bile. In addition, a single 1.0 cm gallstone was removed from the common bile duct, above the tumour, using a Dormia basket. The patient recovered completely. Histological examination of biopsies of the tumour taken on three subsequent occasions showed it to consist only of inflammatory tissue (an inflammatory polyp) and later, regenerating bile duct mucosa. After six months this tumour had completely regressed.
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The traditional methods of follow-up of patients after curative surgery for large-bowel carcinoma have been shown to be time-consuming but largely ineffectual. A new approach is proposed which utilises laboratory investigations. A plea is made for controlled trials of cytotoxic regimens in patients with proven recurrent disease.
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A survey of 260 adult male patients who had undergone inguinal hernia repair was carried out to see how long they stayed off work after operation. There was no evidence that a prolonged convalescent period reduced the subsequent hernia recurrence rate. Evidence from the North American literature suggests that patients can resume their usual physical activity without ill effect much sooner after operation than is the current practice in the United Kingdom. General practitioners should be informed of the advice that has been given to their patients about the resumption of physical activities after operation.
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In a review of 103 patients with carcinoma of the proximal bile ducts, eight patients were noted to have had ulcerative colitis also. This finding is strongly suggestive of a specific association between the two diseases. In three of the patients, carcinoma developed several years after proctocolectomy. Seven of the eight patients were significantly younger than the median age of the group as a whole, but no other apparent difference was noted between those with ulcerative colitis and the remainder of the group.
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