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Biomedical subjects

H J Scott

Publications and source records attributed to H J Scott.

At least 37 records · Page 2Linked to original sources
PubMed1995

Colectomy: the role of laparoscopy.

Laparoscopically assisted colonic surgery was performed in 23 patients in the last 12 months. In all cases, after an initial diagnostic laparoscopy, the colon was mobilized laparoscopically. The mesenteric and bowel division was performed extracorporeally, as was the anastomosis. No deaths occurred. There was a 13% complication rate; one patient suffered a late (10 days) anastomotic dehiscence at home, and two patients had postoperative upper respiratory chest infections. The mean number of lymph nodes excised for malignant cases was 12, and the total mean postoperative hospital stay was 7 days. The laparoscopic dissection required 40% of the operating time. Although this is our initial experience, we conclude that laparoscopically assisted bowel surgery replaces one operation with two, is more costly, requires a longer-lasting anaesthetic, and in our hands appears to offer little additional benefit to the patient compared with conventional surgery.

Adult↗
PubMed1994

Adenocarcinoma of the duodenum with a duodeno-colic fistula occurring after childhood Wilms' cancer.

A case of a 44 year old man with a duodeno-colic fistula secondary to an adenocarcinoma of the second part of the duodenum is described. An asymptomatic leiomyoma of the second part of the duodenum was also present. The patient had been treated successfully for a right Wilms' cancer in childhood with surgery and radiotherapy. There are no previous reports of a duodenal carcinoma arising following a Wilms' tumour and cases of gastrointestinal adenocarcinoma arising as second malignancies following Wilms' tumours are reviewed. The aetiology of duodeno-colic fistulas is reviewed. Duodenal carcinoma is a unusual cause of duodeno-colic fistulas and this case may be unique in that respect.

Adenocarcinoma↗
PubMed1993

Characterization of pulsed-dye laser-mediated vasodilatation in a rabbit femoral artery model of vasoconstriction.

Vasoconstriction is a clinical problem associated with invasive vascular procedures, microvascular reconstruction and subarachnoid hemorrhage. We sought to characterize the ability of pulsed-dye laser irradiation to reverse and prevent vasoconstriction in an anesthetized rabbit model of surgically and pharmacologically induced vasoconstriction. Five groups of experiments were performed to study the effect of pulsed-dye laser irradiation delivered through a 320 microns core ball-tip fiber into the femoral artery. The studies demonstrated that pulsed-dye irradiation can reproducibly cause vascular dilatation. The zone of vasodilatation propagated equally proximal and distal to the site of irradiation within the vessel. When saline was infused into the vessel to replace flowing blood during delivery of laser irradiation, no significant vasodilatation occurred. After laser irradiation reversed surgical and pharmacologic vasoconstriction, the vessel was resistant to further pharmacologic vasoconstriction. This resistance to pharmacologic vasoconstriction did not occur if the vessel was pharmacologically predilated before delivery of laser irradiation. Pathologic analysis of the vessels revealed endothelial damage and mild to moderate medial necrosis, most significant at the site of energy delivery. These studies provide characterization of pulsed-dye laser-mediated vasodilatation in an in vivo model. Delivery of pulsed-dye laser energy has potential clinical application and warrants further investigation.

Absorption↗
PubMed1993

The influence of diagnostic and therapeutic laparoscopy on patients presenting with an acute abdomen.

The role of laparoscopy in the management of patients presenting to one surgical firm with an acute abdomen is discussed. Sixty-seven laparoscopies have been performed over an 18 month period and it has altered the diagnosis in 19.4% of cases and the management in 13.4% of cases. At laparoscopy the diagnosis of appendicitis was made in 37 patients (81% had attempted laparoscopic appendicectomies); pelvic inflammatory disease in 15 patients; torted fimbrial cyst in two patients; and free pus in the right lower peritoneum as a result of a perforated appendix was seen in two patients. Normal laparoscopy was performed in five patients and four patients who presented with a perforated duodenal ulcer had the diagnosis confirmed at laparoscopy, in three cases the perforation was oversewn laparoscopically. Two laparoscopies were performed on trauma patients; one stabbing and one blunt trauma to the right hypochondrium. It has been demonstrated that diagnostic laparoscopy is a useful adjunct to the general surgeon's armamentarium. It is suggested that the skill of laparoscopy is passed on to junior trainee surgeons who can use this technique to help attain a diagnosis in patients presenting with an acute abdomen.

Abdomen, Acute↗
PubMed1992

Attitudes and experiences of human immunodeficiency virus-positive patients to surgery and surgeons.

The issues regarding screening and identification of patients at risk for human immunodeficiency virus (HIV) infection before surgery continue to be discussed, and there is a need for information regarding attitudes of both surgeons and patients to this issue. A population of HIV-positive patients attending a genitourinary medicine clinic were given an anonymous questionnaire to review their experiences of attending for operation. Of 174 patients who replied, 52 had undergone a total of 65 procedures. In all but three of the operations, the HIV status was made known to the surgeon.

Adult↗
PubMed1992

Ruptured abdominal aortic aneurysm presenting with acute urinary retention.

Ruptured abdominal aortic aneurysm classically presents with abdominal pain radiating to the back, a pulsatile abdominal mass and circulatory collapse. However, other symptoms may be the only presenting complaint. We report the case of a patient who presented with a history of acute retention of urine relieved by catheterisation, but who then developed clinical features more typical of abdominal aortic aneurysm rupture.

Aged↗
PubMed1991

Histological study of white blood cells and their association with lipodermatosclerosis and venous ulceration.

The number of white blood cells per mm2 has been determined in serial histological slides taken from punch biopsies of skin from the goiter region in patients with varicose veins. In eight patients the varicose veins were complicated by lipodermatosclerosis of the skin, and in a further six there was a history of ulceration. In uncomplicated varicose veins there was a median of 6 white blood cells per mm2, in patients with lipodermatosclerosis there were 45 white blood cells per mm2, and where there was a history of ulceration, 217 white blood cells per mm2. No change in white blood cell content was observed after the venous pressure was raised for 30 min by sitting the patient with the lower limb dependent. White blood cell infiltration of the skin is associated with lipodermatosclerotic changes caused by venous insufficiency.

Humans↗
PubMed1990

Reappraisal of the oxygenation of blood in varicose veins.

Raised oxygen tension in the blood of varicose veins has led to arteriovenous communications being implicated in the pathogenesis of varicose veins. The aim of this study was to compare the oxygen tension of blood from varicose veins with that from normal legs, and to observe the effect of posture on these measurements. Twenty-six subjects (13 normal controls and 13 with uncomplicated varicose veins) had blood sampled from the long saphenous vein or a varicose vein near the ankle. Samples were taken after 30 min in the supine position and repeated after 30 min standing. Samples were also taken simultaneously from the arm. Transcutaneous oxygen measurements of the gaiter skin were performed continuously throughout the experiment. In the supine position, blood from varicose veins had a significantly higher oxygen tension (median = 6.09 kPa) than that from normal veins (median = 4.54 kPa) (P = 0.022). In all subjects, there was a higher oxygen tension in leg vein blood when lying (varicose vein median value = 6.09 kPa, control median value = 4.54 kPa) than while standing (varicose vein median value = 3.93 kPa, control median value = 3.74 kPa) (P less than 0.002, varicose vein group; P = 0.005, normal group). Changes in transcutaneous oxygen tension correlate poorly with changes in venous blood. It is concluded that the theory of arteriovenous anastomoses is only one among a number of possible explanations for the pathogenesis of varicose veins.

Humans↗
PubMed1990

Venous disease: investigation and treatment, fact or fiction?

This review looks at some clinical and experimental methods and treatments used in venous disease, and attempts to dispel some myths which have been associated with it. Over the last century numerous techniques have been introduced to aid the understanding of the physiology of normal legs and the pathophysiology of those with venous disease. Tourniquet testing along with clinical examination remains the only method of venous assessment in most hospitals. Venous ulceration in the past has been associated with deep vein incompetence, but the newer, non-invasive techniques of Doppler ultrasound and duplex examination are now identifying patients with leg ulceration who have superficial venous insufficiency and therefore a surgically correctable condition. Perforating veins and their possible role in the aetiology of venous ulceration along with invasive and non-invasive methods for their detection is reviewed. Some of the conservative compression treatments and dressings available for the treatment of venous ulceration are discussed. It is concluded that adherence to sound surgical principles remains the mainstay of the successful management of patients with venous disease.

Bandages↗
PubMed1988

An evaluation of Dacron prostheses in the relief of jaundice due to malignant obstruction.

In 26 patients, relief of obstructive jaundice due to malignancy has been effected by inserting a Dacron biliary-enteric prosthesis. All cases were considered unsuitable for conventional biliary bypass procedures. The hospital mortality was 27% and mean survival of those patients discharged was 8 months. Insertion of a Dacron prosthesis may prove an alternative to percutaneous biliary stenting in selected patients with neoplastic biliary obstruction.

Adenocarcinoma↗
PubMed1986

Strategy for lymph node biopsy in homosexual men suspected of having LAV/HTLV-III related disease.

Since January 1985 we have changed our policy regarding lymph node biopsy in male homosexuals presenting with lymphadenopathy. Before that date all such patients underwent biopsy if there was no apparent cause. We no longer perform biopsy in male homosexuals presenting with uncomplicated persistent generalized lymphadenopathy (enlargement to more than 1 cm of lymph nodes in more than one extra-inguinal site for more than 3 months with no apparent cause) provided that the patient is positive for the antibody to lymphadenopathy associated virus/human T-lymphotropic virus type III. Such a policy should reduce the need for open biopsy procedures in this group of patients.

Adult↗
PubMed1986

Colonic haemorrhage: a technique for rapid intra-operative bowel preparation and colonoscopy.

We describe a new technique of operative orthograde colonic washout followed by colonoscopy for use in patients with severe colonic haemorrhage. We report its use in four patients in whom the exact source of bleeding was localized and treated. In two of these cases a policy of 'blind' hemicolectomy would have been incorrect. The technique is simple and safe, and we advocate its use during laparotomy for major colonic haemorrhage.

Aged↗