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Biomedical subjects

B D Hancock

Publications and source records attributed to B D Hancock.

At least 19 recordsLinked to original sources
PubMed1999

Clinically benign parotid tumours: local dissection as an alternative to superficial parotidectomy in selected cases.

In a personal series of 162 tumours, 101 were pleomorphic adenomas 28 of which were removed by elective local extra capsular dissection and 73 by a conventional nerve dissection. There were no recurrences in either group after a mean follow-up 10.3 years, range 3-21 years for local dissection and 8.3 years, range 3-22 years for nerve dissection. Frey's syndrome did not occur after local dissection but was present in 25% of patients after a nerve dissection. Of the 162 parotid lumps, 17 proved to be a carcinoma but only one was deemed suitable for a local removal, a low grade muco epidermoid carcinoma of the accessory lobe and no recurrence has occurred after 8 years. In benign disease, local dissection gives similar results to conventional nerve dissection with less morbidity and confirms that tumour recurrence cannot be ascribed to any properties of the tumour but lies in the hands of the surgeon and depends on the care with which the tumour is removed.

Adenoma, Pleomorphic↗
PubMed1996

Clinical significance of the tumour capsule in the treatment of parotid pleomorphic adenomas.

The propensity of pleomorphic adenomas to recur is generally attributed to the biological nature of the tumour, and surgery close to the capsule is perceived as undesirable. At the Christie Hospital, Manchester, between 1947 and 1992, 475 tumours arising within the superficial portion of the parotid gland were treated by two surgical techniques: extracapsular dissection (380 patients) and superficial parotidectomy (95). Recurrence rates were 2 per cent in each group (median follow-up 12.5 years). Contact of the tumour with the facial nerve was recorded in 51 per cent of patients. There was no difference between the treatment groups in the incidence of permanent facial nerve injury (2 versus 1 per cent respectively). This study demonstrates that dissection in close proximity to the tumour is possible without inducing recurrence and that in practice the microinvasion of the capsule by tumour buds has limited clinical significance.

Adenoma, Pleomorphic↗
PubMed1996

Long-term follow-up of over 1000 patients with salivary gland tumours treated in a single centre.

Between 1947 and 1992, 1403 patients with 1432 salivary gland tumours were treated at the Christie Hospital, Manchester. There were 1194 epithelial neoplasms: parotid, 1082 (91 per cent); submandibular, 47 (4 per cent); minor glands, 65 (5 per cent). The commonest histological diagnoses were pleomorphic adenoma (n = 776) and adenolymphoma (n = 159). A total of 244 carcinomas were seen (adenoid cystic carcinoma, n = 75). Treatment was primarily surgical, conservative where possible, and determined by tumour extent and not histology. Adjuvant radiation therapy was used in over half the definitively treated malignancies. The recurrence rate following the treatment of 551 new parotid pleomorphic adenomas was 1.6 per cent at median follow-up 12.5 (range 1-34) years, increasing to 15 per cent in the secondarily referred group (n = 170). For patients with definitively treated primary salivary carcinomas (n = 148), the disease-free survival rate at 5, 10 and 15 years was 58, 47 and 45 per cent respectively. Using multivariate analysis, clinical stage was the most important predictor of survival; the 10-year survival rate for stages I-IV was 96, 70, 47 and 19 per cent respectively.

Adenolymphoma↗
PubMed1990

Audit of major colorectal and biliary surgery to reduce rates of wound infection.

OBJECTIVE: To reduce the rates of wound infection for major colorectal and biliary surgery. DESIGN: Prospective audit of antibiotic prophylaxis by keeping copies of typed notes of operations and annotating them at discharge and at first follow up visit and annual review of prophylactic regimen according to yearly rate of wound infection and modification if necessary. SETTING: The work of one consultant surgeon working in a district general hospital. PATIENTS: All patients having major colorectal resection during 1976-89 (400) and cholecystectomy during 1981-9 (500). MAIN OUTCOME MEASURES: Wound infection, defined as any discharge from the wound as detected by observation during inpatient stay and by specific questioning at the first follow up visit six weeks later. RESULTS: Serial changes in prophylaxis for colorectal surgery resulted in a progressive reduction in the rate of wound infection from 43% in 1976, with no prophylaxis, to 1% during 1986-9 with single intravenous doses of metronidazole and cefuroxime intraoperatively and with lavage of the peritoneal cavity and wound with 0.1% tetracycline. During 1981-7, with no prophylaxis, the rate of infection in biliary surgery was 12% whereas in 1988-9, after the introduction of lavage with tetracycline alone, the rate was reduced to 2%. IMPLICATIONS AND ACTION: Simple prospective audit identified the need for changes in antibiotic prophylaxis; successive rounds of audit resulted in improved rates of wound infection, and lavage with 0.1% tetracycline seemed to be a major factor in achieving this.

Anti-Bacterial Agents↗
PubMed1987

Pleomorphic adenomas of the parotid: removal without rupture.

A personal series of 64 new pleomorphic adenomas of the parotid were removed with a very low rate of capsular rupture (1.6%) using a flexible approach. The aim was to remove the tumour with a covering of normal parotid where possible after exposing the trunk and appropriate branches of the facial nerve. Exposure of the capsule, however, was unavoidable in some situations, as in deep tumours, those in contact with the nerve and in very superficial tumours. Great care must be taken to avoid capsular rupture and, provided this is done, long term recurrence rates of less than 2% can be expected.

Adenoma↗
PubMed1986

Management of the septic complications of diverticular disease.

One hundred and five patients underwent surgical treatment of septic complications of diverticular disease. In nine cases, operation was carried out for acute large bowel obstruction and in the remainder for peritonitis. An inflammatory mass and/or localized abscess was found in 23 cases. Free pus without evidence of 'communicating' perforation was found in a further 33 and 'communicating' perforation in 40. Treatment by primary resection or by transverse colostomy and drainage were both associated with significantly lower mortality from sepsis than treatment by drainage alone. In cases without 'communicating' perforation, there was no difference in mortality between primary resection and transverse colostomy with drainage. Although the advantage of primary resection was most apparent in cases with 'communicating' perforation, it did not reach statistical significance. In three cases treated primarily without resection the pathology was subsequently found to be that of carcinoma. In 'favourable' circumstances, i.e. without 'communicating' perforation, defunctioning colostomy with drainage has an acceptably low mortality rate and may be undertaken by a less experienced surgeon to avoid a difficult resection. Ideally these problems should be dealt with by an experienced surgeon; we prefer to treat the septic complications of diverticular disease by primary resection.

Abscess↗
PubMed1984

Management of pelvic sepsis after Ivalon rectopexy.

The consequences of pelvic sepsis after Ivalon rectopexy are described in four patients. Despite clear evidence of pelvic infection, reoperation was delayed by ineffective conservative measures and morbidity thereby prolonged. In three, the causative organism was Staphylococcus aureus and it is suggested that prophylactic antimicrobial regimens for intestinal organisms alone may be inadequate.

Abscess↗
PubMed1982

How do surgeons treat haemorrhoids? A study with special reference to Lord's procedure.

Forty-eight patients treated for haemorrhoids by Lord's procedure have been followed up for 5 years. Preoperative anal pressure and motility studies suggest that the best long-term results occur in patients with an active internal sphincter. Anal pressure was reduced by dilatation and remained static over the next 5 years. It was not possible to predict which patients would have later recurrence of symptoms from anal pressures measured one year after dilatation. Excellent clinical results were obtained in patients with first- and second-degree haemorrhoids, but in those with third-degree haemorrhoids a completely satisfactory outcome occurred in just under half the patients. Members of the Manchester Regional Association of Surgeons completed a questionnaire concerning their methods of treating haemorrhoids. Lord's procedure was the method used most frequently, but only 11% of surgeons used it regularly for patients with third-degree haemorrhoids. One-third of the surgeons still used haemorrhoidectomy for 25% of more of all their patients. Outpatient cryosurgery and rubber-band ligation were not popular, but treatment by dietary advice alone was common.

Anal Canal↗
PubMed1981

Lord's procedure for haemorrhoids: a prospective anal pressure study.

Forty-eight patients treated by Lord's procedure were studied prospectively with preoperative and several postoperative anal pressure recordings over at least 5 years. Excellent long term results were obtained in the patients with first and second-degree haemorrhoids but only just under half of those with third-degree haemorrhoids were symptom-free. There was some evidence that patients with the most active internal sphincter had the best clinical results. Pressure was significantly reduced by dilatation and pressure remained static over the next 5 years. Five patients developed recurrent symptoms between 1 and 5 years after dilatation. It was not possible to predict relapse from serial anal pressure measurements.

Adult↗
PubMed1978

Internal sphincter and haemorrhoids: a pathological study.

Histological examination of the lower margin of the internal sphincter has demonstrated an increased amount of fibrous tissue in patients with haemorrhoids compared with controls. This finding may be of relevance to the treatment of haemorrhoids by maximal anal dilatation.

Anal Canal↗
PubMed1978

Lord's procedure.

Explore the source record for details and available documents.

Anal Canal↗
PubMed1977

The internal sphincter and anal fissure.

The activity of the internal anal sphincter in patients with fissure has been studied by measuring anal pressure and motility with a small balloon probe. The mean maximum anal pressure in 12 patients with fissure (116-8 +/- 21-8, s.d., cm H2O) was significantly higher than that in 40 control subjects (85-0 +/- 20-5 cm H2O; P less than 0-01). Ultra-slow pressure waves were present in 80 per cent of the patients and in 5 per cent of the controls. Both the high pressure of ultra-slow waves were due to abnormal activity of the internal sphincter. This could be corrected equally well by either dilatation or lateral subcutaneous sphincterotomy.

Anal Canal↗
PubMed1977

Internal sphincter and the nature of haemorrhoids.

Internal anal sphincter activity has been studied in 84 patients with haemorrhoids and 40 asymptomatic subjects. Activity was estimated by measuring maximum resting anal pressure with a water filled anal balloon probe 7 mm in diameter connected to a strain gauge pressure transducer. There was greater activity of the internal sphincter in patients with haemorrhoids than in controls, but there was no significant relationship between sphincter activity and duration of symptoms, predominant symptom (bleeding or prolapse), severity of symptoms, history of pain, history of straining at stool, or size of haemorrhoids. Straining at stool occurred significantly more often in patients whose main complaint was prolapse than in those whose main complaint was bleeding. Anal dilatation reduced sphincter activity and the best clinical results were obtained in those with the most active sphincter. An internal sphincter abnormality may be an aetiological factor in some patients but there must be other factors as well. Straining at stool may determine whether bleeding or prolapse is the predominant symptom.

Adult↗
PubMed1976

Measurement of anal pressure and motility.

A fine open perfused system and a closed balloon system for the measurement of anal pressure and motility have been compared. Measurements were made in 40 normal subjects and 84 patients with haemorrhoids. The rate of perfusion had a marked effect on the recorded pressure and motility details. The motility pattern was seen most clearly with the balloon probe and the pressure recorded was reproducible and easy to measure, making this a convenient method for recording activity of the internal anal sphincter. Anal motility in normal subjects was characterised by slow pressure waves (10-20/min). The frequency was fastest in the distal anal canal and this frequency gradient may represent a normal mechanism to keep the anal canal empty. Ultra slow pressure waves (0-6-1-9/min) were seen in 42% of patients with haemorrhoids and 5% of normal subjects and arose from a synchronous contraction of the whole internal sphincter.

Anal Canal↗