Biomedical subjects
Publications and source records attributed to B J Britton.
A 47 year old woman presented with melaena and haemodynamic instability. Preliminary investigations failed to locate the source of bleeding. At laparotomy an arteriovenous malformation was identified in the distal ileum. Histology revealed this to be of the Dieulafoy type. This is the first published case of a histologically proved ileal Dieulafoy lesion in an adult.
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Haemoperitoneum is an extremely rare presentation of hepatocellular carcinoma in the industrialised world. We present the first reported case in the UK. In contrast, up to 10% of hepatocellular carcinomas in Africa present in this way, the median time between presentation and death being just six weeks. Hepatitis B infection at birth and during childhood is the major cause of hepatocellular carcinoma in the developing world. The World Health Organisation, UNICEF and the World Bank have all advocated routine hepatitis B vaccination of children. This can reduce the burden of disease in these communities, among people in their productive years of life.
BACKGROUND AND STUDY AIMS: The aim of this study was to assess whether the use of laser ablation could palliate or potentially cure ampullary carcinoma. PATIENTS AND METHODS: This study involved patients with confirmed ampullary carcinomas who were deemed fit for repeated endoscopic treatment but who were unfit for more radical treatment, and included six patients in Oxford and six in Gloucester. Repeated laser therapy was used after endoscopic stenting, following investigation as described. RESULTS: Good periods of survival were seen with good palliation and no complications of treatment. The longest survival was 36 months (range 4-36, median 21). Duodenal obstruction was successfully relieved in one patient. CONCLUSION: The treatment shows promise in selected patients, but conclusions are limited by the small numbers and lack of controls in this study.
BACKGROUND: A study of the incidence of polycystic liver in a transplant population and an assessment of the impact of this disease on the group was undertaken. Clinical presentation, investigation and treatment of hepatic polycystic disease are explored. METHODS: The study examined the morbidity incurred by polycystic liver disease in patients, patient and graft survival, incidence of hepatic cysts and presentation, investigation and management of morbid hepatic cystic disease. One hundred and eleven patients were studied. RESULTS: It was found that hepatic cysts occurred in the majority of patients that underwent transplants for renal failure because of polycystic kidney disease at this institution. Symptomatic hepatic cystic disease was found to be primarily responsible for three deaths and affected between 15 and 20% of the group. Gall bladder disease was found to be associated with highly symptomatic hepatic cystic disease. CONCLUSION: Hepatic cystic disease is common in patients that have had kidney transplants because of polycystic kidney disease. Morbidity is likely to increase as patients survive for longer periods. Cholecystectomy should be considered in patients with significant hepatic cystic disease.
Seven patients who had functioning or non-functioning endocrine pancreatic tumours were investigated by magnetic resonance imaging. Combinations of fat suppressed T1 weighted spin echo and gradient recalled echo (n = 7), T2 weighted spin echo (n = 3) and gadolinium diethylamine triamine pentaacetic acid (Gd-DTPA) enhanced fat suppressed T1 images were acquired. Magnetic resonance imaging detected five of seven tumours prospectively (three of which were smaller than 10 mm) and a further 10 mm tumour retrospectively. Tumours were low signal on T1 weighted images and showed enhancement after Gd-DTPA. On T2 weighted images one tumour was hyperintense, and two were isointense with normal pancreas. Computed tomography, transabdominal ultrasound and angiography were performed in six patients but detected only one tumour each. Intraoperative palpation and ultrasound detected all tumours. If pre-operative imaging is required magnetic resonance imaging is the technique of choice to detect small endocrine pancreatic tumours.
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.
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Two fold variations in the age and sex standardised post mortem prevalence of gallstones have been demonstrated between nine British towns by Barker and his colleagues. We have examined the rates of cholecystectomy in the Districts serving seven of these towns to discover whether the incidence of operation bears any relation to this variation in morbidity. The opportunity to compare independent measurements of morbidity with the supply of health services and their use is rare, and in this example a plausible association is demonstrated. Variations in cholecystectomy rates between countries is, however, more difficult to explain by variations in relevant morbidity.
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Accidental anorectal injuries are becoming less common. This case, where impalement of the anorectal region by the shaft of a stool occurred to a junior surgeon at work, illustrates a previously unrecognized menace.
Recurrence rates after local anesthetic hernia repair are as good as those after repair under general anesthesia. Early mobility and return to work within a month reduces the complications without increasing the rate of recurrence.
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A consecutive series of 227 inguinal hernias were repaired under local anaesthetic between 1976 and 1978 in the Oxford hospitals. A total of 187 of these operations was performed on a day-case basis. Data were available for analysis from 183 cases in whom there were 13 recurrences. The factor most strongly influencing the recurrence rate was the experience of a particular surgeon with the local anaesthetic technique. It was found that once 6 hernias had been repaired under local anaesthetic the chance of recurrence fell to a level of 2.5 per cent (which projects to 7.5 per cent at the end of 25 years). The recurrence rate for beginners (those who have repaired less than 6 hernias under local anaesthetic) was unacceptably high at 9.4 per cent (which projects to 28 per cent at the end of 25 years). Our recurrence rate was high in patients with a direct hernia in whom there were associated risk factors known to predispose to recurrence.