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Biomedical subjects

C V Mann

Publications and source records attributed to C V Mann.

At least 37 records · Page 2Linked to original sources
PubMed1985

Re-routing of the track for the treatment of high anal and anorectal fistulae.

A transposition technique for the management of high anal and anorectal fistulae is described. The method involves re-routing the extrasphincteric portion of the track into an intersphincteric position with immediate repair of the external sphincter. The newly positioned intersphincteric fistula is then dealt with at a later date when the external sphincter is soundly healed. In this way the number of operations needed to deal with such a fistula may be reduced, a colostomy is not necessary, healing is more rapid and continence is preserved. Details of the first five cases dealt with in this way and their successful outcome are reported.

Adult↗
PubMed1985

The results of surgical treatment of cancer of the rectum by radical resection and extended abdomino-iliac lymphadenectomy.

At St Mark's Hospital survival after radical surgery for cancer of the rectum has not changed significantly over the past 30 years. The technique of extended abdomino-iliac lymphadenectomy was developed in an attempt to improve prognosis in patients considered to have particularly unfavourable tumours. Between 1960 and 1981 the technique was used in 75 patients with a single adenocarcinoma of the rectum. Two patients died postoperatively and 52 patients developed complications; a mortality and morbidity similar to those seen after conventional surgery at this hospital. Five-year survival rate showed no improvement over that achieved by conventional techniques; disappointingly this was also the case for patients with Dukes' C1 tumours. The results of this study suggest that an improvement in survival in patients with cancer of the rectum is unlikely to be achieved by any extension of conventional radical surgery.

Abdomen↗
PubMed1984

Smooth muscle neoplasms of the rectum and anal canal.

Forty-eight patients who presented to St. Mark's Hospital, London between 1948 and 1979 with smooth muscle neoplasms of the rectum or anal canal have been reviewed. Twenty-six tumours arose from the muscularis mucosae of the rectum. These lesions were small, asymptomatic and did not recur after local removal. Eighteen tumours arose from the muscularis externa of the rectum. Local excision of these resulted in a high local recurrence rate regardless of the degree of differentiation of the tumour but long-term survival figures were similar whether the tumours were treated by local or radical techniques. However, the prognosis did relate to the degree of tumour differentiation, being worst in the poorly differentiated group. In four cases the smooth muscle tumour arose from the internal sphincter of the anal canal.

Adult↗
PubMed1980

Drainage after cholecystectomy.

Sixty-one patients undergoing simple cholecystectomy and 12 undergoing cholecystectomy and exploration of the common bile duct were studied. The volumes produced from the abdominal drains were measured and the postoperative course observed and compared in all cases. The mean total drainage after simple cholecystectomy was 135 ml in 5 days and after cholecystectomy and exploration of the common bile duct 94 ml in 5 days. With such low volumes drained the majority of patients undergoing simple elective cholecystectomy do not need to be drained. In the small number of patients studied our results would also appear to indicate that a policy of non-drainage may be safe after cholecystectomy with exploration of the common bile duct or after cholecystectomy combined with other operative procedures--for example, vagotomy and pyloroplasty. If the surgeon decides to use a drain it would seem that the RediVac system is as efficient as other systems commonly used and is associated with less pain and fewer complications.

Adult↗
PubMed1975

How should the common bile duct be explored?

An attempt has been made to find which of 3 operations currently in use for exploring the bile ducts gave the best clinical results. For this purpose 3 series of consecutive patients treated at The London Hospital over a 12-year period have been studied retrospectively. The operations used were as follows: (1) conventional supraduodenal choledochotomy; (2) transduodenal biliary sphincterotomy; and (3) a combined approach. The mortality in the supraduodenal series was 4 (4%) of 101 patients and in the transduodenal series 2 (2.4%) of 82 patients. Both routes were used in 26 patients, of whom 2 (7.7%) died. Early complications were commoner after choledochotomy than after biliary sphincterotomy, but when both procedures were combined the incidence was higher still. Late complications were also more frequent after both the supraduodenal and the combined approach, residual or recurrent stones and cholangitis being 6 times more common than after sphincterotomy alone. Postexploratory cholangiography, however, was not used routinly in the supraduodenal series and might conceivably have reduced this factor further, but not below 3. Stenosis occurred in one patient after choledochotomy and in one patient after the combined operation but not after sphincterotomy alone. In this study, therefore, transduodenal biliary sphincterotomy gave the lowest mortality and morbidity. With the combined procedure, however, the mortality and morbidity were much higher than after either method alone.

Adult↗
PubMed1970

Effects of neostigmine and atropine on motor activity of ileum, colon, and rectum of anaesthetized subjects.

In unanaesthetized patients atropine and neostigmine in doses normally used by anaesthetists to reverse muscle relaxants produced a pronounced increase in bowel activity. This response occurred whether atropine was given before or simultaneously with neostigmine.The response still occurred in 38% of patients anaesthetized without halothane, and possibly this increase in motility might endanger a recently constructed anastomosis. The ileum appeared particularly prone to neostigmine stimulation, and anastomoses involving ileum would seem especially at risk. When halothane was used during anaesthesia the response was completely inhibited during the period studied.

Anesthesia, General↗
PubMed1970

Physical factors in the stimulation of colonic peristalsis.

The effect of colonic distension and changes in intraluminal pH and osmolality have been investigated in patients with well established colostomies. Small volumes of acidic buffer (pH4) and hypertonic saline (4%) were found to be only a very weak peristaltic stimulus. Strong hypertonic solutions (glycerine BP) induced a poorly sustained peristaltic response in the majority of cases. Distension of the inactive colon did not stimulate peristalsis. Distension of a colon previously stimulated to peristaltic activity caused fresh waves of contraction. This study appears to show that by themselves physical factors play an unimportant role in initiating peristaltic activity in the colon.

Buffers↗