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Biomedical subjects

D R Donaldson

Publications and source records attributed to D R Donaldson.

At least 19 recordsLinked to original sources
PubMed2006

Jass staging is a predictor of outcome following "curative" resection of Dukes' B colorectal carcinoma.

BACKGROUND AND AIMS: We have sought to determine if the addition of the Jass pathological classification to Dukes' staging would provide improved prognostic information for patients undergoing curative surgery for Dukes' B colorectal carcinoma. PATIENTS AND METHODS: One hundred and eighty three patients who underwent curative surgery for Dukes' B colorectal cancers between December 1988 and January 1998 were identified. An assessment of Jass scoring was made at the time of initial histological staging. All patients entered a comprehensive follow-up system. RESULTS: Jass grouping was found to correlate significantly with cancer specific mortality rates; group III having a worse prognosis than groups I and II (p<0.005). There was no significant difference between either local recurrence or systemic recurrence and the Jass group. CONCLUSION: The Jass classification provides additional prognostic information in patients following curative resection of Dukes' B colorectal carcinoma and may therefore facilitate the selection of patients who will benefit most from adjuvant treatment

Adult↗
PubMed2005

Multiple, large, benign peritoneal cysts--a case report.

This case report describes a unique case of large (up to 17 cm!) peritoneal cysts of uncertain aetiology. It illustrates the diagnostic and management difficulties encountered with such a rare problem. Although subsequently proven to be benign, they were thought to represent an extreme form of endosalpingiosis after a literature review.

Cysts↗
PubMed2004

Acute ulcerative colitis in a Meckel's diverticulum.

This report describes the case of a patient with acute ulcerative colitis who underwent an emergency colectomy and removal of an incidental Meckel's diverticulum which appeared inflamed. Histology showed acute inflammation of colonic epithelium within the Meckel's diverticulum, justifying its removal and confirming that this was indeed a 'skip lesion'.

Adult↗
PubMed2004

A study on the routes of referral for patients with colorectal cancer and its affect on the time to surgery and pathological stage.

OBJECTIVE: Firstly, to determine the proportion of colorectal cancer (CRC) patients seen within an established two week rule (TWR) system and to observe other routes of referral for CRC patients. Secondly to determine if referral route affects the interval to, and cancer stage at, definitive treatment. PATIENTS AND METHODS: GP referrals of patients with CRC were divided into direct surgical outpatient referrals (group 1) and indirect referrals to accident and emergency and medical outpatients (group 2). Data were recorded on the time to definitive treatment and the location and stage of tumour. RESULTS: There were 78 patients in group 1. Thirty (20%) patients were referred by their GP under the TWR, 31 (21%) as urgent and 17 (12%) as nonurgent referrals, to surgical outpatients. There were 69 patients in group 2. Forty-two (29%) were referred initially to the accident and emergency department and 27 (18%) to general medical outpatients. Group 1 patients were treated within a median of 70.5 days and group 2 patients within 14 days of referral (P < 0.0005). Group 2 contained tumours of a significantly more advanced pathological stage (P = 0.015) and more proximal colonic cancers (P < 0.005). CONCLUSION: Fifty-three percent of patients with CRC were referred directly to surgical outpatients, 20% under the TWR guidelines. Despite having this system in place direct referrals were slower to treatment but the tumours were still of a less advanced pathological stage. Compliance with the TWR should not be used as a means of assessing a colorectal unit's treatment of CRC.

Adult↗
PubMed2002

Diagnostic lessons learnt from a series of enterovesical fistulae.

OBJECTIVE: An enterovesical fistula (EVF) is an uncommon condition requiring careful and sometimes extensive preoperative investigation. Our experience over a 10-year period has been reviewed with emphasis on the diagnostic investigations performed. PATIENTS AND METHOD: Forty-two patients (30 male) have been studied. Presenting symptoms, diagnostic investigations, and subsequent treatment have been reviewed. RESULTS: The site of the fistulae were; 37 colonic, 2 rectal, and 3 ileal. The commonest presenting symptoms were; pneumaturia 75%, faecaluria 63% and urinary tract infections 57%. The positivity rate of the investigations performed were; cystoscopy 89%, urine cytology 86%, barium enema 65%, computerized tomography (CT) scanning 55%, IVP 35%, and cystography 27.5%. The causes of the fistula were; diverticular disease 71%, carcinoma 20%, Crohn's disease 7%, and radiotherapy 2%. CONCLUSIONS: We recommend cystoscopy and urine cytology for faecal material as the first-line investigations in all patients with a suspected enterovesical fistulae. CT scanning and barium enema should not be first line investigations but may be performed subsequently to help determine the aetiology and planning of surgery.

Journal Article↗
PubMed2000

Chest radiographs after dilatational percutaneous tracheotomy: are they necessary?

BACKGROUND: The efficacy of routinely obtaining chest radiographs after standard open tracheotomy has been questioned. Recent literature would suggest that after a routine, uncomplicated tracheotomy, chest radiography is a low-yield procedure that incurs unnecessary expense. Percutaneous dilatational tracheotomy (PDT) is rapidly replacing open tracheotomy as the intensive care unit procedure of choice for airway management. Complication rates are equivalent between the two procedures. OBJECTIVE: We examined the value and cost-effectiveness of routine postoperative chest radiographs in patients undergoing PDT. STUDY DESIGN AND SETTING: The study was a prospective analysis of 54 consecutive PDTs performed at a tertiary care academic institution. RESULTS: Eighteen (33%) patients had chest radiographs obtained within 1 hour of PDT (6 at the request of the otolaryngology service); 35 (66%) underwent radiography more than 2 hours later at the request of the intensive care unit for reasons other than PDT. There were no incidents of pneumothorax, pneumomediastinum, or tracheotomy tube malposition in any patient. Patients undergoing chest radiography within 1 hour of the PDT also had chest radiographs within 12 hours at the request of ICU staff for their underlying disease. CONCLUSIONS: Routine chest radiography after PDT is of low yield. Because most of these patients require chest radiographs for their underlying disease within 12 hours, a cost savings of approximately $13,500 would be realized in this patient population. SIGNIFICANCE: Routine chest radiography after PDT is unwarranted in most cases.

Cost Savings↗
PubMed2000

Endoscopically monitored percutaneous dilational tracheotomy in a residency program.

OBJECTIVES/HYPOTHESIS: Endoscopically guided percutaneous dilational tracheotomy (PDT) has become a well-established alternative to the more traditional open tracheotomy, yet its use by otolaryngologists is limited. As airway management specialists, otolaryngologists should be familiar with a wide range of definitive procedures, including PDT. Few otolaryngology programs teach the technique. The objective of the present study was to determine the complication rate and outcome of PDT after its introduction in a residency teaching program. We also wished to evaluate whether the time savings reported by experienced surgeons could be repeated in our setting. SETTING: Tertiary referral teaching hospital. METHODS: We prospectively reviewed our first 54 consecutive PDTs and compared them to 29 consecutive standard open tracheotomies, which were reviewed retrospectively. RESULTS: Complications (13% vs. 33%, P = .030), operative time (12 vs. 24 min, P < .0001) and total procedure time (37 vs. 80 min, P < .001) were significantly reduced in the PDT group as compared with standard tracheotomy. Initial outcome data were equal in both groups. CONCLUSIONS: We found that PDT can be safely and effectively taught as part of an otolaryngology residency training program.

Aged↗
PubMed1999

Treatment of persistent pruritus ani in a combined colorectal and dermatological clinic.

BACKGROUND: Pruritus ani is a common and socially embarrassing condition which is often poorly managed. It is often classified as idiopathic where the symptoms are usually transitory or secondary when a more persistent itch is experienced. The aim of this study was to establish the cause of pruritus ani in a group of patients referred to a combined colorectal and dermatological clinic, and to determine the most appropriate treatment. METHODS: Forty consecutive patients with pruritus ani were referred over a 6-month period from either the general practitioner or another hospital consultant to a combined colorectal and dermatological clinic. They were assessed by history, completion of a general health questionnaire, full examination of the skin, digital rectal examination, proctoscopy, sigmoidoscopy and patch testing. Patients were treated according to clinical findings at assessment. RESULTS: Thirty-four patients had a recognizable dermatosis, three had superficial perianal fissuring and three had a normal perineum; two required surgical intervention. Eighteen patients had a positive reaction when patch tested. All patients have shown an improvement or complete resolution of symptoms with treatment. CONCLUSION: This series has shown that the majority of patients presenting with pruritus ani have a dermatosis as the underlying cause of their symptoms and that many of them have developed contact sensitivities to the various topical medications used. These findings suggest that referral to a dermatologist in the first instance may be more appropriate.

Adolescent↗
PubMed1998

Closure of transverse loop colostomy and loop ileostomy.

The aim of a defunctioning stoma is to protect patients from the consequences of faecal leakage and pelvic sepsis, should it occur. A retrospective audit of 77 patients who had undergone closure of a loop stoma between 1988 and 1996 was performed. Sixty patients had either transverse loop colostomy (52) or loop ileostomy (8) to defunction distal colorectal/anal anastomoses or pathology, and 17 patients had a loop ileostomy to defunction an ileoanal pouch. Those who had restorative proctocolectomy experienced a much higher (24%) complication rate than the loop colostomy group (5%), despite similar perioperative care and surgery performed by surgeons of equivalent seniority. The complication rate of ileostomy closure in pouch patients is similar to other published series. As a result of these findings, a selective approach to the use of loop ileostomy to protect pouches has been introduced. The absence of wound infections in our series would suggest that primary closure of the stomal wound without drainage can be achieved.

Adult↗
PubMed1998

Maximum surgical blood ordering schedule in a district general hospital saves money and resources.

A 6-month prospective audit was carried out in three surgical departments of a district general hospital. Over that period, 2720 units of red cells were electively cross-matched, 957 being transfused. The overall cross-match-to-transfusion ratio (CTR) was 2.8, but this varied from over 40 for some gynaecological procedures to 1.5 for major surgical procedures. The average CTR for general surgery was 2.2, orthopaedics 2.3, and obstetrics and gynaecology 5.7. A maximum surgical blood ordering system (MSBOS) was introduced and a second 6-month audit carried out. The number of units cross-matched had fallen by 36% to 1746, with a CTR of 1.8. The change in activity had led to a saving conservatively estimated at 11,616.00 Pounds per annum. Local audit and the introduction of a MSBOS in a district general hospital is an exercise which can demonstrate inefficiencies in blood ordering practices and can lead to large financial savings without detracting from standards of patient care.

Blood Grouping and Crossmatching↗
PubMed1997

Perforated diverticulitis following extra-abdominal surgery.

The peritonitis of perforated diverticular disease is a life-threatening condition. We report three cases where it occurred following unrelated extra-abdominal surgery and where surgical intervention proved to be the correct course of management. All cases were treated with a Hartmann's procedure; this is probably the safest option for purulent peritonitis in patients who are a high operative risk and have recently undergone major surgery.

Aged↗
PubMed1995

'To bead or not to bead?'.

In subcuticular wound closure, the use of anchorage beads or knots to maintain opposition of wound edges is a common practice, but can lead to complications. One hundred and one abdominal subcuticular wound closures (44 vertical and 57 transverse) were prospectively studied and assessment of wound swelling was made by measuring the length of exposed suture at both ends of the wound, on successive days postoperatively. Results showed progressive reduction in the exposed suture length. We would suggest that if anchorage beads are used with subcuticular sutures then they should not be pulled tight as postoperative wound swelling will cause the beads to be drawn into the wound often resulting in a troublesome ulcer(s) at the end(s) of the wound.

Abdominal Muscles↗
PubMed1993

Is the hot appendix really hot?

The skin temperature in the right and left iliac fossae was recorded in 100 patients who were referred with a provisional diagnosis of acute appendicitis. This was not found to be a reliable aid in diagnosis of acute appendicitis nor an indicator to the need for surgery in patients with right iliac fossa pain.

Acute Disease↗