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Biomedical subjects

G T Royle

Publications and source records attributed to G T Royle.

At least 73 records · Page 4Linked to original sources
PubMed1988

Bilateral inguinal hernias: simultaneous or sequential repair?

Two hundred and forty four patients underwent either simultaneous bilateral inguinal hernia repair (n = 122) or unilateral inguinal hernia (n = 122) repair at a general hospital between January 1971 and December 1981. The two groups of patients were matched for age and sex. Both groups had a similar overall incidence of post-operative complications and in both groups the duration of post-operative stay and duration of operating time were similar. Chest infections developed in 12 patients after bilateral repair and in 3 patients after unilateral repair (P less than 0.02). All patients were assessed prospectively from 4 to 15 years after operation, when no significant difference in the number of recurrent hernias was found. Our results suggest that simultaneous bilateral inguinal herniorrhaphy is economical in terms of both operating time and duration of hospital stay, and that this economy is not bought at a cost of increased short term morbidity or long-term recurrence rate.

Adult↗
PubMed1988

Wide excision of primary breast cancer: the incidence of residual carcinoma at the site of excision.

Fifty-one consecutive women with early breast cancer underwent wide excision and axillary clearance. After wide excision five biopsies were taken from the walls of the cavity. On histological examination tumour was present in the cavity biopsies in 13 cases (25%). The presence of ductal carcinoma in situ in the primary tumour was not associated with an increased number of positive cavity biopsies. In nine cases incomplete excision was due to separate foci of invasive or in situ carcinoma, in two cases tumour was contiguous with the primary carcinoma and in two, separate foci and contiguous disease both occurred. The high incidence of residual local tumour after wide excision of breast cancer demands the need for postoperative irradiation to the breast and frequent review.

Adult↗
PubMed1988

The practical management of Fournier's gangrene.

Effective early treatment of this serious condition is necessary to prevent death. Urgent exploration by the most experienced surgeon available should include wide excision of all necrotic or dubious tissue, and adequate drainage of deep fascial planes. Deep and apparently healthy tissues must be exposed and the surgeon must be prepared to proceed to laparotomy, and even diverting colostomy and/or suprapubic cystotomy when necessary. Cross matched blood must be available, and we have found hydrogen peroxide irrigation useful. Pus, tissues, and blood samples for bacteriological culture and sensitivity should always be sent, but broad spectrum antibiotics should be started without delay to prevent systemic complications. In addition to the urgent initial surgery, repeated daily examination of all wounds is necessary, usually under general anaesthesia to allow full inspection, further débridement, irrigation and change of dressings, until the infective process is halted. This is a serious condition with a high mortality which we believe may be reduced by early diagnosis and appropriate aggressive surgery.

Aged↗
PubMed1987

Choice of surgery for early breast cancer: pre- and postoperative levels of clinical anxiety and depression in patients and their husbands.

Two groups of patients with early breast cancer were studied prospectively to assess whether being offered a choice of surgery (simple mastectomy or wide excision plus radiotherapy) influenced levels of anxiety and depression pre- and postoperatively. A significantly higher percentage of the patients not offered a choice of surgery experienced high levels of anxiety and depression pre-operatively and up to 2 months postoperatively compared with patients offered a choice; the results were also similar for the husbands of these patients. At 4 months, differences between the two groups were not statistically significant, although the trend remained the same with more patients not offered a choice of treatment showing high levels of anxiety and depression. Patients offered a choice of surgery had similar pre- and postoperative levels of anxiety and depression to patients with benign breast disease and patients undergoing surgery for non-cancerous conditions.

Adult↗
PubMed1987

X-ray and ultrasound localization of non-palpable breast lesions and difficulties in management.

Seventy-four patients who have had biopsy of a non-palpable breast lesion are reviewed. A double-dye localization technique was used in 88% while in 12% localization of the lesion was best achieved by ultrasound mammography. Biopsy was successful in 70 patients (95%) at the first attempt. The overall incidence of malignancy was 20%, being greater in asymptomatic patients (32%) than in patients with mastalagia (16%). Re-excision of the biopsy site in these patients showed residual cancer in 33%. It is suggested that both careful examination of the operative specimen and postoperative mammography may be necessary to ensure that the original lesion has been removed. Re-excision of the biopsy site appears to be necessary when the histology is malignant.

Adult↗
PubMed1986

Depression and social stress among patients with benign breast disease.

One hundred and forty women referred to the Southampton breast clinic had a psychiatric interview at home, before their first clinic attendance. The 107 subsequently diagnosed as having benign breast disease had a high rate of depressive symptomatology in comparison with women in published surveys of the general population. In the year before referral, 25 (23 per cent) had had definite depression and 19 (18 per cent) had had borderline depression: at the time of interview 9 (8 per cent) had major depression and 22 (21 per cent) had minor depression. Depression in these patients was associated with recent life events and social difficulties. Mood disturbance and psychosocial stress may lead to medical consultation about benign breast disease, or even contribute to its development. Severe depression was less common in the 33 patients who turned out to have breast cancer, though more of them had minor depression, and they reported fewer recent life events.

Adult↗
PubMed1986

The accuracy of ultrasound in the diagnosis of breast disease.

The accuracy of breast ultrasound using all purpose static beta-scanning equipment has been compared with mammography. Ultrasound was found to be both more sensitive (93%:82%) and specific (95%:89%) in a large retrospective series of 1000 patients undergoing investigation for symptomatic breast disease. In a smaller prospective and consecutive series of 142 patients undergoing surgery where histological proof was obtained ultrasound was also found to be more sensitive (91%:81%) and specific (81%:69%). In both studies, the greater accuracy of ultrasound was attributed to its ability to diagnose lesions hidden in X-ray dense breasts and where mammography had revealed featureless asymmetical densities of uncertain nature. In these instances ultrasound may have a significant role to play as an adjunct to mammography in the preoperative assessment of breast lesions.

Breast Diseases↗
PubMed1985

Vitamin K requirements in patients receiving total parenteral nutrition.

The vitamin K requirements of 47 adult patients on total parenteral nutrition (TPN) were investigated by randomly allocating them to receive either 0.15 mg vitamin K1 (1 ampoule of 'Vitlipid') per week or 20.15 mg vitamin K1 (1 ampoule of 'Vitlipid' plus 10 mg vitamin K X 2) per week. Vitamin K1 in a dose of 0.15 mg was as effective as a dose of 20.15 mg per week in maintaining a normal BCR (British Corrected Ratio) in most TPN patients. Seven patients in each group developed a BCR greater than 1.3; this was significantly associated with the use of cephalosporin antibiotics and responded to 10 mg vitamin K1 per day. Most patients receiving parenteral feeding require no more vitamin K than that provided by 1 ampoule of 'Vitlipid' per week. Regular monitoring of the BCR, especially in patients on antibiotics, will reveal those who need more. Such patients need 10 mg vitamin K1 per day.

Adolescent↗
PubMed1984

The effect of pre-operative glucose loading on postoperative nitrogen metabolism.

The nitrogen sparing effect of glucose loading at either 1 mg kg-1 min-1 or 5 mg kg-1 min-1 from the evening before surgery was compared with similar glucose infusions commenced after elective surgery. Thirty-two patients undergoing abdominal surgery of moderate severity were studied. Glucose at 5 mg kg-1 min-1 reduced urea excretion compared with glucose at 1 mg kg-1 min-1. The timing of the carbohydrate infusion was not critical in altering the overall extent of the protein sparing at either rate. High dose glucose infusions markedly reduced overall urea and 3-methylhistidine excretion. This implies a reduction in protein breakdown. A pre-operative high dose infusion of glucose may in particular improve protein synthesis for the first 24 h after surgery.

Abdomen↗
PubMed1984

What do patients eat in hospital?

A study was made of the food chosen and eaten by patients on a surgical, a medical, an accident service and an elective orthopaedic ward. Patients were studied over 5 consecutive days. Daily energy intake was less than the predicted basal metabolic rate in 13 (24 per cent) of the 55 patients studied. Daily protein intake was less than 0.8 g/kg ideal body weight in nine (16 per cent) patients. Many of the patients had daily intakes of iron and of vitamins less than those recommended for healthy adults. There were no differences in food intake between the patients on the different wards. This study indicates the neglect of nutrient intake of many hospital patients.

Adult↗
PubMed1984

Disposable drains.

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Disposable Equipment↗
PubMed1983

The measurement of glucose turnover and oxidation using radioactive and stable isotopes.

Isotopes have become the best means for investigating glucose kinetics in vivo. With the recent greater availability of stable isotopes there has developed a need to understand how data may be obtained from the use of both radioactive and stable glucose tracers. Described for the nonexpert is the calculation of glucose appearance and disappearance, clearance and oxidation using both stable and radioactive glucose isotopes, administered both by bolus and primed constant infusion and under both steady and nonsteady state conditions. Other substrates may be studied using similar methodology. The use of stable substrate isotopes will be an expanding field of metabolic research in man.

Glucose↗
PubMed1982

Reduced catheter sepsis and prolonged catheter life using a tunnelled silicone rubber catheter for total parenteral nutrition.

One hundred and five patients were given total parenteral nutrition (TPN) for an average of 15 days via centrally placed venous catheters. Thirty-seven polyvinyl chloride (PVC) and 80 silicone rubber catheters were used. All the silicone rubber and 8 of the PVC catheters were buried in a subcutaneous tunnel. When silicone rubber catheters were used, there was significantly less catheter sepsis (P much less than 0.01), catheter life was prolonged by 50 per cent and fewer catheter insertions per patient were necessary.

Catheterization↗