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Biomedical subjects

H Ellis

Publications and source records attributed to H Ellis.

At least 91 records · Page 5Linked to original sources
PubMed1990

The hazards of surgical glove dusting powders.

Surgical contaminants of many kinds, including glove powder, constitute a source of formation of granulomas. This is particularly well-documented in the peritoneal cavity ("starch peritonitis"), but has been documented in most anatomic sites. The production of starch-free gloves should remove this hazard, but the surgeon should remain aware that most particulate substances introduced into the body inevitably set up an inflammatory response.

Gloves, Surgical↗
PubMed1990

Preliminary results for the repair of difficult recurrent inguinal hernias using expanded PTFE patch.

The repair of recurrent inguinal hernias can be a complex problem. This study examines the results of 52 difficult recurrent inguinal hernias repaired with an expanded PTFE patch. Patients were selected because the hernia had either multiple defects, a single large defect that could only be repaired with excessive tension, or the surrounding tissues were unable to support a sutured repair. The number of previous hernia repairs ranged from 1 to 7 with a mean of 2.5 repairs. Hernias recurred in 5 patients (10%) after a mean follow up of almost 2 years. Three of these recurrences were inguinal, around the patch, and 2 were through the femoral canal. There was no association between postoperative wound complications and hernia recurrence.

Adult↗
PubMed1990

Intestinal obstruction from adhesions--how big is the problem?

Apart from one post-mortem study, the incidence of adhesions following laparotomy has not been well documented. 1. In a prospective analysis of 210 patients undergoing a laparotomy, who had previously had one or more abdominal operations, we found that 93% had intra-abdominal adhesions that were a result of their previous surgery. This compared with 115 first-time laparotomies in which 10.4% had adhesions. 2. Over a 25-year period, 261 of 28 297 adult general surgical admissions were for intestinal obstruction from adhesions (0.9%). Of 4502 laparotomies, 148 were for adhesive obstruction (3.3%). 3. Over a 13-year period all laparotomies were followed up for an average of 14.5 months (range 0-91 months). From these 2708 laparotomies, 26 developed intestinal obstruction due to postoperative adhesions within 1 year of surgery (1%). Fourteen did so within 1 month of surgery (0.5%). 4. The majority of the operations producing intestinal obstruction were lower abdominal, principally involving the colon. The volume of general surgical work from adhesions is large and the incidence of early intestinal obstruction is high.

Abdomen↗
PubMed1990

Drainage or suture of the cavity after breast biopsy.

An initial series of 105 women who underwent excision biopsy of the breast were entered into a controlled randomised trial to determine the effect on postoperative morbidity of drainage of the cavity with a soft rubber Penrose drain. The use of this drain had no effect on the incidence of postoperative wound complications (drain 11 of 40 (28%), no drain 10 of 58 (17%]. A second series of 202 women were entered into a randomised controlled trial to determine the effect of closed suction drainage and suture of the cavity after breast biopsy. The use of this drain significantly reduced the incidence of postoperative wound complications (drain 9 of 93 (10%), no drain 22 of 105 (21%], but although suture of the cavity halved the number of wound complications (suture 11 of 97 (11%), no suture 20 of 101 (20%], this did not reach statistical significance. Wound complications were more frequent with large wounds (28%) than with smaller ones (15%), and with less experienced operators (registrar 21%, senior registrar/consultant 10%). We conclude that a closed suction drain will reduce the incidence of wound haematomas after breast biopsy but that a Penrose drain is ineffective in the prevention of wound complications.

Biopsy↗
PubMed1989

Uncontrolled local recurrence after treatment of breast cancer with breast conservation.

Three hundred fifty-six patients with early (Stage I and II) breast cancer and 55 with advanced (Stage III and IV) breast cancer were treated between 1979 and 1985 with a consistent policy of breast conservation irrespective of tumor site, size, or histologic features. Only three patients underwent primary mastectomy (Stage III), and the remainder were treated either by wide local excision and postoperative radiotherapy (357 cases) or by needle biopsy and primary irradiation (51 cases). A total of seven of 356 (2%) Stage I and II patients have developed uncontrolled local or nodal recurrence at a median follow-up of 5 years, and nine of 55 (16%) of Stage III and IV patients. Of the 62 Stage I and II patients who have died, seven (11%) have died with uncontrolled locoregional disease. Of the 22 Stage III and IV patients who have died, eight (36%) have died with uncontrolled locoregional disease. Although the majority of local recurrences within the conserved breast could be salvaged by secondary surgery (37/38 Stage I and II patients), the development of chest wall or nodal recurrence was usually associated with the appearance of distant metastases and a poor prognosis. Data on uncontrolled local recurrence should be given in all studies of breast cancer treatment, since it represents an important end-point of therapy and a difficult clinical problem.

Breast Neoplasms↗
PubMed1989

How does sepsis promote thrombosis in microvascular anastomoses?

This study on 100 rats, divided into five equal groups, has shown that chronic distant sepsis promotes occlusion of microvascular anastomoses to a significantly greater extent than aseptic inflammation, transient bacteraemia and even local infection. This may be related to the significant increase in the number of platelets in the group with distant sepsis.

Abscess↗
PubMed1989

Revised model for the study of colonic anastomotic healing in protein malnourished rats.

The effect of a low-protein diet on the healing of colonic anastomoses in the rat was studied. The low-protein diet given for 2 weeks caused a weight loss of 11.9%. The healing of colonic anastomoses was assessed by bursting pressure measurement performance sequentially in the postoperative period. Compared to control animals, rats on a low-protein diet had significantly lower bursting pressures from the 4th to the 7th postoperative day. There was no difference in the hydroxyproline concentration at the anastomoses of the two groups of rats. These results suggest that the 5th postoperative day is the most appropriate time to investigate the effects of protein malnutrition on colonic healing in the rat.

Anastomosis, Surgical↗
PubMed1989

Intra-abdominal adhesions and their prevention by topical tissue plasminogen activator.

Recent work shows that a common pathway in adhesion production is a reduction in local plasminogen activator activity (PAA). This deficit permits deposited surface fibrin to become organized to fibrous adhesions. A rabbit model for adhesion formation was used to assess the effect of replacing the deficit with recombinant tissue plasminogen activator (rt-PA). Adhesions were produced by stripping peritoneum from corresponding parietal and visceral areas. One week later the adhesions were divided. Either rt-PA or placebo was applied to the divided adhesion. After a further week the animal was killed and the adhesions assessed. Sixty strips were performed. Fifty-five adhesions were produced (92%). Placebo gel was applied to 28 sides and rt-PA applied to 27. Twenty-two of the placebo group recurred (79%). Two of the rt-PA group reformed (7%, chi 2 = 20.883, P less than 0.001). Recombinant tissue plasminogen activator is an effective inhibitor of adhesion formation in the experimental animal.

Administration, Topical↗
PubMed1989

Paget's disease of the nipple occurring after wide local excision and radiotherapy for carcinoma of the breast.

Between 1979 and 1985, 356 cases of Stage I or II breast carcinomas have been treated at Westminster Hospital with breast conservation. Of these patients, 338 underwent local excision and radiotherapy and there have been 38 local recurrences. Three of these have been as Paget's disease of the nipple occurring 16, 8 and 5 months following radiotherapy. In each case the nipple appearances were attributed to postradiotherapy changes; the true diagnosis was not made for an average of 19 months. The increasing use of conservative breast management for early breast tumours permits the appearance of Paget's disease as a significant proportion of local recurrences. Previously this has been considered to be a rare event. We recommend that Paget's disease of the nipple should be suspected early following radiotherapy in the presence of any nipple changes.

Aged↗
PubMed1989

The primary management of breast cancer: is breast conservation feasible for all patients?

A consecutive series of 411 patients with primary breast cancer treated by a consistent policy of breast conservation, regardless of tumour size, location, clinical stage or histological subtype, is reported. Actuarial 5-year survival was 84% for UICC Stage I, 73% for Stage II and 47% for Stage III/IV. The incidence of local recurrence at 5 years was 13% for Stage I, 12% for Stage II, and 26% for Stage III/IV. The probability of salvage mastectomy at 5 years was 5% for Stage I, 8% for Stage II, and 15% for Stage III/IV. Of local recurrences, 40% were managed with further breast conservation. Primary treatment with breast conservation results in satisfactory local control rates, 5-year survival and cosmesis, but the prevention, diagnosis and treatment of local recurrence within the conserved breast requires further evaluation.

Breast Neoplasms↗
PubMed1989

Histologic features predictive of an increased risk of early local recurrence after treatment of breast cancer by local tumor excision and radical radiotherapy.

A histopathologic review was undertaken of 293 patients with breast cancer treated by local tumor excision and radical radiotherapy. In a 6-year period, there were 37 local treatment failures with 16 deaths, and an additional 20 patients died without local recurrence. Pathologic data were available for 272 patients. Multivariate analysis indicated that the pathologic features in an invasive tumor most predictive for local recurrence were the combination of a high proportion of intraduct carcinoma with extensive necrosis (comedocarcinoma). Of 18 patients with these features, nine have had early local recurrence (a risk of 50% with these features vs 10% in those without), and four have died (a risk of 22% against 12%). Despite the short follow-up, the results already appear significant, and the study is ongoing. The importance of comedonecrosis in the intraduct component as a prognostic indicator in invasive carcinoma of the breast is not widely recognized and might constitute a relative contraindication to conservative treatment of the breast.

Actuarial Analysis↗
PubMed1989

Transthoracic sympathectomy for palmar hyperhidrosis in children under 16 years of age.

Palmar hyperhidrosis can be a disabling condition in children. We report the results of transthoracic sympathectomy in 18 children aged 16 years or under. Follow-up, 1 to 11 years after surgery, revealed a high incidence of late sequelae, but these were not significant when compared to the primary condition. Transthoracic sympathectomy is recommended for children with severe palmar hyperhidrosis.

Adolescent↗
PubMed1988

Incisional hernia in re-opened abdominal incisions: an overlooked risk factor.

Many patients undergoing laparotomy will have had a previous incision in the abdominal wall which offers a convenient and logical route for reexploration. This study aims to examine the risk of subsequent incisional herniation in incisions made through previous scar tissue compared with incisions made through fresh tissues. Out of a total of 1022 laparotomies performed in a 5-year period on one surgical unit, the incisional hernia rates were available for assessment in 699 freshly made incisions, 142 reincisions and 36 incisional hernias. The incidence of incisional hernia was 6 per cent after freshly made incisions and this incidence was increased after both re-incision (12 per cent, P less than 0.05) and incisional hernia repair (44 per cent, P less than 0.01). With the exception of jaundice, none of the other commonly accepted risk factors for incisional herniation were significantly increased in those patients with re-incised wounds who subsequently developed a hernia, when compared with patients who did not develop a hernia. An increased risk of incisional herniation is present when laparotomy is performed through a previous abdominal incision.

Adult↗