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Biomedical subjects

A R Berry

Publications and source records attributed to A R Berry.

At least 19 recordsLinked to original sources
PubMed2002

Restorative proctocolectomy: one surgeon's experience of a now routine procedure in a district general hospital.

Restorative proctocolectomy is now the operation of choice for the definitive management of ulcerative colitis and familial adenomatous polyposis coli. The aim of this review is to evaluate clinical and functional results of the first fifty patients treated with restorative proctocolectomy over a period of seven years. A total of 50 patients (28 males, 22 females) underwent restorative proctocolectomy over a period of seven years in our district general hospital. A retrospective analysis of hospital notes was undertaken and supplemented with a patient questionnaire. Forty-three patients had ulcerative colitis and seven had familial adenomatous polyposis coli. Two pouch designs were used, a four limbed "pear pouch" (94%) and a two limb "J" pouch (6%). The majority (98%) of patients had a stapled ileal pouch-anal anastomosis and a similar number had a defunctioning ileostomy. There was no mortality. Early complications (within 30 days of operation) occurred in 18(36%) patients. Late complications were seen in 22 (44%) patients. The median number of daily bowel movements was four (range 1-10). Pouchitis was seen in ten patients (20%). Restorative proctocolectomy is a safe procedure for patients with ulcerative colitis and familial adenomatous polyposis coli. Although total morbidity is appreciable, functional results are generally good and patient satisfaction is high.

Adenomatous Polyposis Coli↗
PubMed1996

Colorectal cancer surgery in a district general hospital.

The purpose of our study was to audit colorectal cancer surgery in a large district hospital, compare our results with other series and highlight any areas in patient management where improvements could be made. A comprehensive audit was undertaken of all patients undergoing surgery for colorectal adenocarcinoma over a 2-year period (December 1989 to November 1991). Two hundred and twenty-two patients were studied. General practitioner referrals were seen within 8 weeks in 140 (96%) of 149 cases. Delay to diagnosis was associated with barium enema examination. A consultant or senior registrar was present at 187 (84.2%) of operations, and only two (0.9%) were undertaken between 24.00 and 08.00 hours. For rectal tumours the ratio of anterior resection to abdomino-perineal excision was 2:1. Eight of nine anastomotic leaks followed low anterior resection. All required re-operation and three died. The overall in-hospital mortality was 17 (7.7%). Although our results compare favourably with other published series, several areas for potential improvement in management have been identified.

Adenocarcinoma↗
PubMed1994

Management of advanced rectal cancer.

If possible, palliative resection should be undertaken for advanced rectal cancer as it provides good relief of local symptoms; there is, however, little evidence that it prolongs survival. If palliative excision is not possible, endoscopic transanal resection may be used for obstructing lesions at or below the peritoneal reflection. Laser therapy is an alternative in the frail. Both procedures allow quick and effective relief of symptoms. These methods and other options for treating advanced rectal cancer are described in this review.

Combined Modality Therapy↗
PubMed1994

The management of splenic injuries in a District General Hospital.

Between January 1987 and March 1992, 52 patients with splenic injuries were treated at Northampton General Hospital. Thirty-nine were men, 13 women with a mean age of 30 years (range 5-80 years). Splenic injuries were graded in severity from one to five using the organ injury scaling. Fifteen percent were Grade one injuries, 33% Grade two, 25% Grade three, 21% Grade four and only 6% Grade five. Forty (76%) of injured spleens required splenectomy, 6 (12%) had splenorrhaphy performed and 6 (12%) were conservatively treated. In 50% of Grade 1 injuries, 29% Grade 2 injuries and 23% of Grade 3 injuries the spleen was preserved either by nonoperative treatment or by splenorrhaphy. All of Grade 4 and 5 injuries required splenectomy. Methods for improving the rate of splenic conservation are discussed.

Adolescent↗
PubMed1992

Acute colonic pseudo-obstruction.

The syndrome of acute colonic pseudo-obstruction is well delineated but its aetiology remains poorly understood and patients are still treated inappropriately. This article reviews the pathogenesis and surgical management of this condition. Early diagnosis is stressed as a pivotal factor in reducing morbidity and mortality.

Acute Disease↗
PubMed1992

Management variability in surgery for colorectal emergencies.

A prospective study was made of 92 patients who underwent emergency colorectal surgery during a 1-year period. A dedicated emergency theatre allowed half of the patients to be operated on between 09.00 and 17.00 hours with greater seniority of operating surgeons. The overall mortality rate was 14 per cent and the primary resection rate was 79 per cent. The mortality rate was 12 per cent for right-sided resection with anastomosis and 24 per cent for left-sided resection without anastomosis, including those undergoing Hartmann's procedure which had a 35 per cent mortality rate. Immediate left-sided anastomosis was performed safely in all 14 patients in whom it was attempted. Firms headed by consultants with and without a special interest in colorectal disease made differing use of primary resection and immediate anastomosis (67 versus 41 per cent, P less than 0.05) and Hartmann's (7 versus 25 per cent, P less than 0.05) and non-resectional (15 versus 29 per cent, P not significant) procedures. Retrospective surveys of perioperative deaths examine inadequate management and subsequent mortality rates, but do not reveal the significant morbidity rate that occurs in survivors. This audit revealed significant differences in the management of patients with colorectal emergencies between firms headed by specialist and non-specialist consultants. In order to minimize these differences we believe that recent advances in colorectal practice should be included in the training of all surgeons.

Adult↗
PubMed1992

Management of perianal sepsis in a district general hospital.

Perianal sepsis remains a common surgical problem. A total of 121 patients undergoing surgery for perianal abscess and/or fistulae over a 2-year period was studied. Of these, 50 patients (41.3%) had suffered from previous perianal sepsis (not necessarily resulting in hospital attendance). Ninety-one patients underwent incision and drainage of abscesses (ischiorectal and perianal) for the first time, whereas eight patients underwent drainage of recurrent abscesses. Fistulae were identified when the abscess was drained in 14 of 91 patients, and a further ten patients subsequently developed fistulae. Twenty-two patients presented with a discharging fistula. A high yield of bowel organisms was present in patients with coexisting fistulae (88%), recurrent abscesses (75%) and in those who subsequently developed fistulae (83%). We confirm that such a growth can be used to identify patients who will benefit from further examinations.

Adolescent↗
PubMed1990

Endoscopic transanal resection of rectal tumours--a preliminary report of its use.

Endoscopic transanal resection (ETAR) of rectal tumours is a simple and inexpensive procedure, well tolerated in elderly patients or those undergoing palliation. We have performed 137 ETARs in 81 patients with a 30-day mortality rate of 11.1 per cent and a postoperative complication rate of 15.3 per cent. Thirty-one patients (38 per cent) had ETAR for palliation: in this group rectal bleeding was abolished or improved in 66 per cent of patients, altered bowel habit (diarrhoea) corrected in 77 per cent of patients, faecal incontinence improved in 50 per cent of patients and rectal pain (including tenesmus) improved in 50 per cent of patients. Twenty-three patients (28 per cent) were treated for large benign rectal polyps: in this group symptoms were universally abolished. The technique is particularly suited to the management of these patients. Twenty-seven elderly patients with theoretically 'curable' rectal cancer underwent ETAR with a 78 per cent crude survival rate at 1 year. While long-term results remain to be assessed, ETAR appears a useful technique for treating selected patients with rectal tumours.

Aged↗
PubMed1990

Endoscopic sphincterotomy for the palliation of ampullary carcinoma.

Palliative endoscopic sphincterotomy was performed on 17 patients with adenocarcinoma of the ampulla of Vater. An endoprosthesis was inserted immediately after the sphincterotomy in four of the patients. Fourteen patients made uncomplicated recoveries from the procedure and their jaundice resolved completely. Early complications developed in three patients. One patient died from haemorrhage. Two patients, both of whom had an endoprosthesis, developed cholangitis. The endoprosthesis was removed and another inserted in one patient and the other underwent surgery. Both thereafter made uncomplicated recoveries. Jaundice subsequently recurred in eight patients and further endoscopic treatment was successful in five of these patients. Eleven patients died between 4 days and 23 months after the sphincterotomy with a median survival of 12 months. Four patients remain alive between 3 and 17 months after treatment. The results indicate that reasonable palliation can be achieved safely by endoscopic sphincterotomy.

Adenocarcinoma↗
PubMed1989

Emergency surgery for complicated diverticular disease. A five-year experience.

Ninety-three patients who underwent surgery were studied retrospectively over a five-year period for complications of diverticular disease, including free perforation in 32 patients (with fecal peritonitis in 8), inflammation or peritonitis in 22 patients, an abscess in 11 patients, and intestinal obstruction in 14 patients. Sixty-eight patients (73 percent) had systemic symptoms and signs consistent with serious sepsis. There has been a growing popularity of the Hartmann procedure throughout the study period. The overall 30-day mortality rate was 10.8 percent. Because of a high proportion of poor-risk patients, the Hartmann group fared particularly badly compared with those who had other operations, with a 28 percent mortality rate, 69 percent incidence of major complications, and one third of the survivors having a permanent colostomy. Other operative procedures are discussed, but until prospective data become available, it is unlikely that the widespread popularity of the Hartmann procedure will decline. Therefore, the importance of meticulous attention to technical detail is stressed if results are to improve.

Aged↗
PubMed1989

Endoscopic sphincterotomy for bile duct stones: an institutional review of 272 patients.

The results of the first 283 endoscopic sphincterotomies (ES) attempted in Oxford for bile duct stones are described. Endoscopic sphincterotomy was achieved in 272 patients (96%) and complete duct clearance was achieved in 88% of these patients; an overall success rate of 85%. Complications occurred in 26 patients (10%), five of whom required an emergency laparotomy. Eight patients died within 30 days of ES but only two deaths were attributed directly to the procedure. Although the sphincterotomies were performed by several endoscopists in varying stages of training, the results are similar to those from other large reports. In the last year of the study (1987), 58 patients were referred from within the Oxfordshire District which suggests an annual demand for ES for bile duct stones of 11 patients per 100,000 of population.

Adult↗
PubMed1989

Comparison of the value of emergency mesenteric angiography and intraoperative colonoscopy with antegrade colonic irrigation in massive rectal haemorrhage.

The investigation of massive rectal haemorrhage has routinely included emergency mesenteric angiography to identify the site of bleeding in preparation for surgery. Nine cases over 18 months were identified from the angiography register and reviewed retrospectively. Angiography demonstrated the bleeding point in only one case, rendering colonoscopy unnecessary. However, that patient became shocked, requiring six units of blood during angiography. A second patient suffered cardiac arrest during angiography. The mean time taken was 1 1/2 h constituting a considerable delay before proceeding to surgery. On-table colonoscopy with antegrade lavage showed the bleeding site in seven out of nine cases and the mean time for operation was 3 h. One patient stopped bleeding spontaneously and there was one postoperative death from an unrelated cause. We conclude that there is no place for emergency mesenteric angiography in massive acute large bowel haemorrhage and that early surgery with antegrade colonic lavage and on-table colonoscopy is the treatment of choice.

Acute Disease↗
PubMed1988

Epidermal growth factor (EGF) and hormones stimulate phosphoinositide hydrolysis and increase EGF receptor protein synthesis and mRNA levels in rat liver epithelial cells. Evidence for protein kinase C-dependent and -independent pathways.

Epidermal growth factor (EGF) stimulated the rapid accumulation of inositol trisphosphate in WB cells, a continuous line of rat hepatic epithelial cells. Since we previously had shown that EGF stimulates EGF receptor synthesis in these cells, we tested whether hormones that stimulate PtdIns(4,5)P2 hydrolysis would increase EGF receptor protein synthesis and mRNA levels. Epinephrine, angiotensin II, and [Arg8]vasopressin activate phospholipase C in WB cells as evidenced by the accumulation of the inositol phosphates, inositol monophosphate, inositol bisphosphate, and inositol trisphosphate. A 3-4-h treatment with each hormone also increased the rate of EGF receptor protein synthesis by 3-6-fold as assessed by immunoprecipitation of EGF receptor from [35S]methionine-labeled cells. Northern blot analyses of WB cell EGF receptor mRNA levels revealed that agents linked to the phosphoinositide signaling system increased receptor mRNA content within 1-2 h. A maximal increase of 3-7-fold was observed after a 3-h exposure to EGF and hormones. The phorbol ester, 12-O-tetradecanoylphorbol 13-acetate (TPA), which activates protein kinase C also stimulated EGF receptor synthesis. Pretreatment of WB cells for 18 h with high concentrations of TPA "down-regulated" protein kinase C and blocked TPA-directed EGF receptor mRNA synthesis. In contrast, the effect of EGF on EGF receptor mRNA levels was not significantly decreased by TPA pretreatment. Epinephrine-induced increases in EGF receptor mRNA were reduced from 4- to 2-fold. Similarly, 18 h TPA pretreatment abolished the effect of TPA on EGF receptor protein synthesis but did not affect EGF-dependent EGF receptor protein synthesis. The 18-h TPA pretreatment diminished by 30-50% the induction of receptor protein synthesis by epinephrine or angiotensin II. We conclude that in WB cells EGF receptor synthesis can be regulated by EGF and other hormones that stimulate PtdIns(4,5)P2 hydrolysis. In these cells, EGF receptor synthesis appears to be regulated by several mechanism: one pathway is dependent upon EGF receptor activation and can operate independently of protein kinase C activation; another pathway is correlated with PtdIns(4,5)P2 hydrolysis and is dependent, at least in part, upon protein kinase C activation.

Angiotensin II↗
PubMed1988

Management of major colonic haemorrhage.

Major colonic haemorrhage remains a difficult diagnostic and therapeutic problem. We propose that those patients who continue to bleed after resuscitation are best served by immediate laparotomy. High flow antegrade irrigation and intra-operative colonoscopy can then be used to localize the site of bleeding and allow appropriate excisional surgery rather than blind colonic resection.

Algorithms↗