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Biomedical subjects

C Wastell

Publications and source records attributed to C Wastell.

At least 37 records · Page 2Linked to original sources
PubMed1992

The right approach to carcinoma of the cardia: preliminary results.

Surgical treatment of carcinoma of the lower oesophagus and cardia can be compromised by technical difficulties associated with inadequate exposure of the operative field. This may lead to anastomotic failure or local recurrence. A simultaneous right abdominothoracic approach to the oesophagogastric junction without division of either the costal margin or diaphragm facilitates access, allowing radical resection and the performance of a safe anastomosis without the necessity of redraping the patient part way through the procedure. Maintaining the costal margin and diaphragm reduces the pulmonary problems associated with a conventional abdominothoracic incision. Thirty two consecutive patients who have been operated upon between 1983 and 1990 using the synchronous right abdominothoracic approach and who have had a stapled anastomosis have been reviewed. The post-operative complication rate was low and the 5 year survival figure is 17%.

Adenocarcinoma↗
PubMed1991

Emergency laparotomy in patients with AIDS.

The presentation, operative management and final diagnosis were reviewed in 28 patients with AIDS (27 men and one woman) who underwent emergency laparotomy. On clinical and radiological examination, six patients showed features of toxic megacolon, five patients had small bowel obstruction, six patients had localized peritonitis and three had perforated viscus with generalized peritonitis. The most common disease processes were acute colitis in seven patients (associated with cytomegalovirus (CMV) infection in six), intra-abdominal lymphoma in five patients, acute appendicitis in five patients (associated with CMV infection in two), and atypical mycobacterial (MAI) infection in four patients. Two perioperative deaths occurred; one in a patient with acute pancreatitis and a second with generalized peritonitis. Later deaths were due to progression of AIDS, and patient survival at 1 month, 3 months and 6 months was 89 per cent, 64 per cent and 48 per cent, respectively. Lower operative mortality than in previously reported series may be due to earlier intervention in CMV toxic megacolon. Surgery, however, conferred less benefit in patients with acute abdominal pain from MAI infection or lymphoma. With careful patient selection, emergency laparotomy may achieve worthwhile palliation in patients with AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Persistent ulceration of the anal margin in homosexuals with HIV infection.

A study of the outcome of surgical treatment of ulceration of the anal margin occurring in male homosexuals with HIV infection was undertaken. Ten patients with acquired immunodeficiency syndrome and three patients with symptomatic HIV infection were referred to the Department of Surgery with painful anal ulceration which had not responded to medical treatment. The medical treatments given prior to surgical referral included high dose oral acyclovir, intravenous foscarnet and broad spectrum antibiotics. Excision biopsy was performed in 12 patients and in 11 cases was followed by healing of the ulcers within 10 weeks. One patient died 2 weeks postoperatively from Pneumocystis carinii pneumonia without healing. The response to excision biopsy was unexpected but suggests that surgical excision may be beneficial for lesions which have failed to respond to aggressive medical treatment.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Psychological Profile and Outcome in Patients Undergoing Gastroplasty for Morbid Obesity.

Eighteen out of 22 consecutive patients undergoing vertical banded gastroplasty were reviewed with regard to preoperative psychological assessment and postoperative outcome. Each patient was initially evaluated by a consultant liaison psychiatrist with regard to previous or ongoing psychological disturbance, and suitability for bariatric surgery. Patients could be grouped into three broad categories: Group A (seven patients) those with no psychiatric abnormality; Group B (six patients) those with minor psychiatric disorders such as sociopathic teenage behavior, outpatient treatment for depression; and Group C (five patients) those with a history of major psychiatric disturbance such as depressive psychosis and drug dependency. Psychiatric morbidity had no adverse effect in terms of postoperative outcome or weight loss. Mean weight loss of 26%, 30% and 33% was recorded in groups A, B and C respectively after a mean follow-up period of 33 months following gastroplasty. The occurrence of postoperative psychiatric problems correlated closely with none of seven patients in group A but in four of the five patients in Group C requiring psychiatric management. Our findings indicate that psychiatric illness is not associated with poor outcome following surgery for morbid obesity and such patients should not be excluded if psychiatric support is available before and after surgery.

Journal Article↗
PubMed1990

HIV and surgeons.

Explore the source record for details and available documents.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Surgical management of anorectal disease in HIV-positive homosexuals.

One thousand and ninety human immunodeficiency virus (HIV)-positive homosexual or bisexual males were seen in one hospital for management of HIV disease over a 9-year period. One hundred and fifty-five patients were referred by acquired immunodeficiency syndrome (AIDS) physicians for general surgical management. The most frequent reason for surgical referral (64 patients) was anorectal disease which occurred in 5.9 per cent of all HIV-positive patients. One or more diagnoses were reached in 61 of the 64 patients referred with anorectal disease: warts (38 per cent of diagnoses), anorectal ulceration (26 per cent), perianal sepsis (15 per cent), neoplasia (14 per cent) and haemorrhoidal disease (8 per cent). Anorectal symptoms were relieved in 68 per cent of patients and the median survival of those treated was 17.5 months from the time of surgical referral. Both warts and perianal sepsis were associated with in situ neoplasia, but no case of progression from in situ to invasive anal squamous carcinoma was detected. The aetiology of anorectal ulcers was not clear, but surgical excision of anal ulcers and skin tags can produce healing. Palliation of anorectal symptoms in HIV-positive homosexual patients is possible but some conditions are unusual and surgeons should be familiar with their presentation and management.

Abscess↗
PubMed1990

Quantitative relation between gastric acid secretion and changes in urinary acid excretion.

This study was designed to investigate the relations between gastric acid secretion and alkalinisation of the urine. Normal subjects underwent standard pentagastrin (6 micrograms/kg) (n = 5) and sham feeding (n = 6) tests, with additional collection of urine samples before and two and three hours after the start of the test for measurement of titratable urine acidity. Nine subjects provided urine before and two hours after a test meal. Sham feeding (n = 5) and meal (n = 6) tests were carried out in patients who had had a successful vagotomy for duodenal ulcer. There was a significant correlation of gastric acid response in the standard tests with simultaneous changes in urine acidity (r = -0.79, p less than 0.001) and also with urine acid output after the test meal, on another day (r = -0.73; p less than 0.02). The correlation was insufficient to predict gastric function from changes in urinary acidity, but there was clear separation of the results in normal subjects and patients with vagotomy. Changes in urine acidity after a standardised meal may prove to be useful as a screening test after vagotomy to select patients who are likely to have a persisting high gastric acid response to vagal stimulants.

Acids↗
PubMed1990

Cell renewal in non-specific duodenitis, ulcer-related duodenitis and duodenal ulcer. Experiments in Mastomys (Praomys natalensis).

Cell renewal in the duodenal mucosa of Mastomys was studied by autoradiography 1 and 24 h after intraperitoneal injection of tritiated thymidine. Non-specific duodenitis and duodenal ulceration were produced with a continuous infusion of histamine. Mucosal renewal in the duodenum of 30 control Mastomys was compared with 30 which received histamine dihydrochloride for 5 days. No abnormality developed in the controls, but 11 of the experimental group developed non-specific duodenitis and 12 duodenal ulcers. The size of the proliferative zone was increased in the Mastomys sacrificed 1 h after injection of tritiated thymidine which received histamine, compared with controls (p = 0.004). The number of labelled nuclei (p = 0.0003) and the size of the columns of labelled nuclei (p = 0.001) were increased in the Mastomys receiving histamine and sacrificed 24 h after injection of tritiated thymidine, compared with controls. The number of labelled nuclei (p = 0.004) and the size of the columns of labelled nuclei (p = 0.01) were increased in the Mastomys with ulcers compared with the other Mastomys which had received histamine. Cimetidine prevented duodenitis and ulceration, normalising the pattern of cell renewal. There was correlation between the severity of non-specific and ulcer-related duodenitis as judged by Lance's system and the number of labelled nuclei (Spearman rank correlation coefficient 0.771, p less than 0.002). Cell renewal increased as duodenitis became more severe and duodenal ulcers were found in duodenal mucosa where cell renewal was fastest.

Animals↗
PubMed1990

Surgical procedures in patients at risk of human immunodeficiency virus infection.

We have studied the outcome of 140 general surgical procedures in 112 patients known or suspected to be infected with human immunodeficiency virus (HIV) or hepatitis B virus. Forty patients had antibodies to HIV. A wide range of surgical procedures was performed, with an overall complication rate of 5.7%. Wound infection, wound haematoma and one unexplained pyrexia were the only complications seen. Some anorectal wounds in patients with HIV antibodies were noted to heal extremely slowly, but the aggressive anorectal sepsis reported by others was not seen. The postoperative course after general surgical procedures was unremarkable in patients with HIV antibodies, and in those suspected of HIV infection, but because anorectal wounds were found to heal slowly, we recommend that anorectal surgery be conservative in patients with HIV antibodies.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Attitudes of operating theatre staff to inoculation-risk cases.

In a 12-month period, 177 patients at risk of infection with human immunodeficiency virus (HIV) or hepatitis B were operated on. Sixty-nine had HIV antibodies. The procedures used to identify these patients and minimize the risk of infection of hospital staff in the operating department are described. All staff working in the operating department were surveyed to determine their caseload, feelings of anxiety, and the incidence of high-risk exposure to infection. Anxiety was not related to workload, but was more common in those who had high-risk exposure. All members of staff who sustained a needlestick injury were tested for HIV antibodies at intervals after injury; 33 also volunteered to be tested in a screening session 3 months after the study period. None had HIV antibodies, suggesting that the risk of acquiring HIV infection in the operating department is low.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Non-steroidal anti-inflammatory drug ingestion: retrospective study of 272 bleeding or perforated peptic ulcers.

The ingestion of non-steroidal anti-inflammatory drugs (NSAID) in 272 patients with bleeding or perforated peptic ulcer was compared with 272 age/sex matched controls. A significantly higher proportion of patients with gastric ulcers had received NSAID than those with duodenal ulcers. Twelve of 90 (13%) patients admitted with bleeding duodenal ulcers had received NSAID compared with 11 of 26 (42%) patients with bleeding gastric ulcers (P = 0.003). Sixteen of 132 (12%) patients with perforated duodenal ulcer were taking NSAID compared with 8 of 24 (33%) patients with perforated gastric ulcer. Thirty eight percent of patients with both bleeding and perforated gastric ulcers had received NSAID compared with 13% bleeding and perforated duodenal ulcers (P less than 0.002). This study confirms the association of NSAID and complicated peptic ulcer in patients of over 65 years and highlights the particular susceptibility of the gastric mucosa to their injurious effect.

Adult↗
PubMed1988

Transcutaneous electrical nerve stimulation for pain relief following inguinal hernia repair: a controlled trial.

The efficacy of transcutaneous electrical nerve stimulation (TENS) in relieving postoperative pain has been assessed by means of a prospective randomized controlled trial in 62 male patients undergoing unilateral inguinal herniorrhaphy. Thirty-four patients received TENS and 28 patients received sham TENS for 48 h after the operation. Pain was assessed by means of linear analogue pain scales, analgesic requirements and peak expiratory flow readings. We were unable to detect any significant differences in these variables when the two groups were compared. These results do not support the use of TENS.

Adult↗
PubMed1988

Cimetidine and mucosal cell renewal in the duodenum.

Cimetidine may protect gastric and duodenal mucosa by increasing cell turnover. Mucosal cell turnover in the duodenum of 7 control rats receiving intraperitoneal injections of normal saline for 6 days was compared with 8 rats receiving cimetidine for 6 days (500 mg/kg/24 h). Cell proliferation was assessed by autoradiography after injection of tritiated thymidine. The 'leading edge' was defined as the highest tritium-labelled nucleus in the crypt-villus (D/V) column expressed as a percentage of the complete C/V column. Ten C/V columns were measured in each rat. The number of tritium-labelled nuclei in 10 complete C/V columns was also counted in each rat. In the controls the median leading edge was 74.8% (25% quartile 70.6%, 75% quartile 76.2%) and in the rats receiving cimetidine 73.4% (25% quartile 72.1%, 75% quartile 75.9%). The median labelled cell counts were 2,052 (25% quartile 2,008, 75% quartile 2,173) and 1,999 (25% quartile 1,822, 75% quartile 2,041), respectively. These differences were not significant (p greater than 0.1; Mann-Whitney U test). Duodenal mucosal proliferation was assessed in 19 rats 48 h after two subcutaneous injections of 20 mg cysteamine and in another 9 after the same dose of cysteamine plus cimetidine (500 mg/kg/24 h). The median leading edge was 90.1% (25% quartile 84.4%, 75% quartile 92.8%) in cysteamine-treated rats and 76.7% (25% quartile 71%, 75% quartile 79.9%) in rats receiving cysteamine plus cimetidine.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗