Search PubMed⌕ Search

Biomedical subjects

B R Parry

Publications and source records attributed to B R Parry.

At least 37 records · Page 2Linked to original sources
PubMed1996

Surgery for inflammatory bowel disease in Singapore.

Inflammatory bowel disease is uncommon in Asians and reports of surgery in these populations are rare. Eighty-two patients with inflammatory bowel disease were seen in the Department of Colorectal Surgery over a five-year period (1989-1994). Twenty-three patients underwent surgery for their disease. There were 12 males and 11 females with 16 Chinese, 4 Indians and 3 Malays. Twelve had Crohn's disease and 11, ulcerative colitis. The majority of patients with Crohn's disease had emergency surgery for bleeding, perforation, abdominal masses and intestinal fistulae. Fifty percent of these had the diagnosis made intraoperatively or post-operatively. Surgery for ulcerative colitis was indicated because of multiple relapses, non-response to medical treatment, side effects of therapy or malignant change. The median age at surgery of patients with Crohn's disease and ulcerative colitis was 39 years (range 24-84) and 40 (range 18-60) respectively. The median follow-up was 22.4 months (range 9-50). The results of surgical therapy in these patients show that surgery when indicated can be done with minimum morbidity and mortality.

Adult↗
PubMed1995

Solitary rectal ulcer syndrome: the clinical entity and anorectal physiological findings in Singapore.

The clinical pattern and physiological abnormalities in solitary rectal ulcer syndrome (SRUS) occurring in Singapore, were investigated. Since April 1989, 25 patients have presented with histologically proven SRUS. There were 13 males and 12 females (20 Chinese, 4 Malay and 1 Indian) with a mean age of 47.5 (+/- 3.1) years. Ninety-six per cent presented with rectal bleeding, 92% strained at stools, 40% had mucus discharge, 40% felt incomplete defecation and 32% digitated to defecate. Four had previous haemorrhoidectomies that did not cure their symptoms. The lesions were at a mean 6.8 (+/- 0.5) cm above the anal verge, usually anteriorly (64%) but one was circumferential. Anorectal physiology performed on 14 patients was compared with 13 age and gender matched normal controls. The measured mean resting perineum level in SRUS (1.4 +/- 0.3 cm) was significantly lower than in normals (P < 0.01). The mean anal electrosensory threshold (2.5 +/- 0.52 mV) was also significantly higher than in the controls (P < 0.05). Fifteen patients were successfully treated with a high fibre diet and avoidance of straining. Three patients required surgery and the most recent seven patients have responded well to biofeedback treatment. Awareness of this uncommon anorectal condition is necessary for early diagnosis and appropriate management. The physiological findings support a pelvic straining pathophysiology resulting in perineal descent, with less sensitive rectal mucosa prolapsing into, and raising, the anal canal electrosensory threshold. Treatment strategies aimed at correcting the straining have usually been successful.

Anal Canal↗
PubMed1995

A 23-year-old man with pain and swelling in his left thumb.

The following case is presented to illustrate the roentgenographic and clinical findings of a condition of interest to the orthopedic surgeon. Initial history, physical findings, and roentgenographic examinations are found on the first page. The final clinical and roentgenographic differential diagnoses are presented on the following pages.

Adult↗
PubMed1995

Colorectal cancer in the young adult.

Out of 964 patients presenting with primary colorectal cancer (CRC) to the Department of Colorectal Surgery, Singapore General Hospital between April 1989 until December 1992, there were 57 (5.9%) aged 40 years or less. These younger patients were significantly more likely to have a family history of cancer, particularly CRC; a tumour situated more proximally; and tumours displaying certain characteristics histopathologic features. There were no adverse findings for clinicopathologic staging at presentation, curative resection rate, and systemic recurrence rate within the early follow up period. With proper management, the young adult with CRC enjoys the same outlook as his older counterpart. But, in view of the likely operation of inherited genetic factors, follow up surveillance of the patient and the provision of advice and screening are vital elements in optimising outcome. Furthermore, advice and screening should be available for first degree relatives as well.

Adult↗
PubMed1994

Rectal carcinoma during pregnancy.

Rectal carcinoma presenting during pregnancy is rare with a reported incidence of 0.002%. Management of such an emotionally charged condition can be difficult, especially when the twin goals of curing the disease and preserving the pregnancy are divergent. Four cases of rectal carcinoma presenting during pregnancy are reported. In the first or second trimester of pregnancy, it is possible to resect the tumour with preservation of pregnancy, and in the third trimester, it is best to bring the pregnancy to term before removing the tumour. Unfortunately, the prognosis for such rectal cancer is poor.

Abortion, Spontaneous↗
PubMed1994

Small bowel causes of per rectum haemorrhage.

The majority of cases of per rectal haemorrhage (PRH) are due to colorectal causes within the diagnostic reach of the colonoscope. However a few cases are from the small bowel which may pose difficulty and delay in diagnosis. We reviewed 1489 patients with PRH from 1989 to 1993 and identified 10 cases of bleeding originating from the small bowel (0.7%). These were diagnosed when both the colonoscopy and upper gastrointestinal endoscopy were negative or by observing blood coming through the ileo-caecal valve. The causes were Meckel's diverticulum (4), leiomyoma (1), intussusception (1), lymphoma (1), carcinoma (1), Crohn's disease (1) and vasculitis (1). Six cases presented with active bleeding and haemodynamic instability; 4 had chronic bleeding associated with anaemia. Bleeding from Meckel's diverticulum could be differentiated by age, mid-20s or younger compared with mid-40s or older of non-Meckel's cases. Small bowel causes need to be considered in PR bleeding unexplained on colonoscopy and oesophagogastroduodenoscopy findings. A 99mtechnetium isotope scan is most likely to be of help in the young adult but from mid-life onwards, however, other techniques such as small bowel barium studies are required.

Adolescent↗
PubMed1993

Increased expression of the mRNA for hormone-sensitive lipase in adipose tissue of cancer patients.

The expression of genes coding for regulatory enzymes involved in the uptake, synthesis and mobilisation of lipid was measured in adipose tissue of cancer patients. Total RNA was isolated from subcutaneous adipose tissue of control and cancer patients and the various mRNAs measured by Northern blot analysis. The total lipoprotein lipase enzymic activity and the relative levels of the mRNAs for lipoprotein lipase and for fatty acid synthase were not significantly different between cancer patients and control patients. However, there was a significant two-fold increase in the relative level of mRNA for hormone-sensitive lipase (HSL) in adipose tissue of cancer patients compared with control patients. The cancer patients also exhibited a two-fold elevation in serum triacylglycerol levels and serum free fatty acid levels. There was a significant correlation between the serum free fatty acid level and expression of HSL mRNA in the adipose tissue. The serum levels of insulin and tumour necrosis factor-alpha were not different between cancer and control patients. The results suggest that at least one of the mechanisms for depletion of lipid from adipose tissue in cancer patients operates at the level of increased expression of mRNA of the lipolytic regulatory enzyme, hormone-sensitive lipase.

Adipose Tissue↗
PubMed1993

Quality control in colonoscopy: a Singapore perspective.

For quality control purposes, a computer based auditing system for colonoscopy has been developed in the Department of Colorectal Surgery, Singapore General Hospital, Singapore. The first year's experience was reviewed to determine both workload patterns and the individual operators' performances. Colonoscopic completion rates, both as raw data and cusum transformations, were used as indices of quality control. The mean colonoscopic completion rate for the Unit was 97.0% and, when temporal trends were analysed by cusum, all operators consistently met or exceeded the minimum target completion rate of 90%.

Colonoscopy↗
PubMed1992

Serum tumour necrosis factor alpha and insulin resistance in gastrointestinal cancer.

Cancer cachexia may be mediated by endogenous peptides such as tumour necrosis factor alpha (TNF-alpha). Insulin resistance occurs in these patients, and is also seen experimentally with TNF-alpha administration. In this study, insulin sensitivity and energy metabolism were measured in 11 patients with gastrointestinal cancer and ten controls, using the euglycaemic glucose clamp and indirect calorimetry. Patients with cancer were significantly more insulin resistant than controls (P < 0.01) and in such patients insulin resistance correlated with serum TNF-alpha level (rs = 0.74, P < 0.01). Fasting insulin levels also correlated inversely with insulin sensitivity (rs = -0.62, P = 0.003). These results suggest a possible association between endogenous TNF-alpha production and insulin resistance in patients with gastrointestinal cancer.

Aged↗
PubMed1992

Methylxanthines in surgery: a bright future?

Methylxanthines have been used in clinical practice for over 100 years, and although understanding of their mechanisms of action is growing their effects are not fully understood. Nevertheless the knowledge to date has brought about a general upsurge of interest in methylxanthines and the development of novel derivatives. Methylxanthines are poised to escape the confines of their traditional role as these agents are applied in novel ways to surgical illnesses such as septic shock, the adult respiratory distress syndrome, cancer cachexia and functional neutrophil disorders. Methylxanthines, alone or in combination with other compounds, may well become part of the surgeon's future stock-in-trade.

Humans↗
PubMed1992

Validation of subjective measures of fatigue after elective operations.

OBJECTIVE: To find out if it was possible to evaluate postoperative fatigue by questionnaire. DESIGN: Open study. SETTING: University hospital. SUBJECTS: 23 patients about to undergo elective general surgical operations. INTERVENTIONS: A questionnaire was filled in before, and 2-46 days after, operation. MAIN OUTCOME MEASURES: Six measures of fatigue were derived from the questionnaire and validated objectively with changes in body weight, exercise tolerance (n = 10), or grip strength (n = 21). RESULTS: The six measures all showed a significant increase after operation. The changes in fatigue correlated well, but there were differences in sensitivity to changes in perceived weakness compared with perceived tiredness. Each measure correlated significantly with either body weight, exercise tolerance or grip strength. CONCLUSION: Questionnaires can provide reliable results in the assessment of postoperative fatigue.

Adult↗
PubMed1992

Peritoneal fine structure of inguinal hernia: a transmission electron microscope study.

Fine structure of normal human parietal peritoneum served as control data for recording changes in the fine structure of the peritoneum of hernial sacs. In these sacs, mesothelial cells retracted, rounded up and some of them eventually separated altogether to give rise to wide open intercellular spaces thus creating unhindered passageways (stomata) between the subserosal connective tissue and the cavity of the sacs. There was a considerable collagen build-up in the subserosal fibrous tissue of hernial sacs. Occurrence of this fibrosis is at variance with an accepted surgical concept which suggests a defect in collagen synthesis as the cause of herniation. In some sacs mesothelial nodules and/or peritoneal adhesions were present. Certain cytological changes in the mesothelial cells of hernial sacs showed features in common with cells of malignant tumours in general, and features mimicking malignant mesotheliomas in particular. This is in spite of the fact that thorough gross and light microscopic examination of operative specimens and cytological evaluation of peritoneal effusion failed to reveal any evidence of malignancy. Pathologists should be aware of the consummate ability of mesothelial cells to mimic carcinomas in order to avoid possible diagnostic errors. In this report, an electron micrograph of peritoneal adhesion is being published for the first time in the literature. A syncytium-like firm bond between adjoining mesothelial cells constituted the adhesion which is obviously an irreversible process.

Epithelial Cells↗
PubMed1991

Tumour necrosis factor-alpha immunodetection in blood monocytes and serum: preliminary findings in weight-losing cancer patients.

The peptide tumour necrosis factor-alpha (TNF-alpha) is a central mediator of the host response. Identifying where and when TNF-alpha is produced may give insights into its potential role in various pathophysiological states. This paper describes a quantitative analysis of TNF-alpha expression in peripheral blood monocytes (PBM) at the single cell level. A pilot study has been undertaken, using this method to assess TNF-alpha expression in PBM from healthy volunteers and cancer patients. We also report mildly elevated serum TNF-alpha levels in the cancer patients, using an immunoradiometric assay (IRMA) sensitive to 1 pg/mL of recombinant TNF-alpha. The results of this preliminary investigation suggest that TNF-alpha production may be altered in cancer patients.

Humans↗