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Biomedical subjects

J B Bourke

Publications and source records attributed to J B Bourke.

At least 19 recordsLinked to original sources
PubMed1997

A comparison outcome of male breast cancer with female breast cancer.

BACKGROUND: It is unclear whether breast cancer has a similar prognosis in males and females. METHODS: A 20-year retrospective study of all male breast cancer patients in our region was undertaken. We compared this series with a group of females matched for the major prognostic factors and an unmatched series of female patients treated over the same period. RESULTS: Forty-one patients with invasive cancer and 2 with ductal carcinoma in situ were identified. One invasive cancer was treated with radiotherapy, 40 had surgery. Local recurrence occurred in 23% and axillary recurrence in 40% of cases. Male and female patients (n = 123) matched for the major prognostic factors showed a similar outcome for disease-free interval (P = 0.90) and survival (P = 0.27). However, both the above groups had a significantly worse outcome than the unmatched series of female patients with breast cancer. CONCLUSIONS: When prognostic factors are allowed for, male and female breast cancer patients have a similar outcome. This suggests that such features should be taken into account when determining management for males with breast cancer just as they are in females.

Adult↗
PubMed1994

Taurolidine peritoneal lavage as prophylaxis against infection after elective colorectal surgery.

A total of 300 patients undergoing elective colorectal surgery over a 3-year period were randomly assigned to receive intraoperative peritoneal lavage with either taurolidine or saline. Culture swabs were taken from the region of surgery before and after lavage and the development of postoperative infection monitored. Of the positive culture swabs before lavage, a significantly higher proportion were negative after lavage with taurolidine than after that with saline. However, there was no difference in the incidence of postoperative infection between groups, suggesting that taurolidine intraoperative peritoneal lavage confers no clinical benefit over that with saline.

Anti-Infective Agents, Local↗
PubMed1990

Adenocarcinoma of the stomach following radical radiotherapy for testicular cancer.

Two male patients who underwent curative surgery and adjuvant radiotherapy (with further chemotherapy in one) for testicular cancer developed adenocarcinoma of the stomach 5 and 19 years after treatment. The stomach is included in the field of radiotherapy used to treat the para-aortic lymph nodes and this may lead to dysplastic changes in the stomach mucosa which can lead to frank malignancy. Early endoscopy should be offered to patients with dyspeptic symptoms after adjuvant radiotherapy for testicular cancer.

Adenocarcinoma↗
PubMed1990

[Incidence and geographical distribution of acute pancreatitis in Nottingham 1969 to 1983].

During the fifteen year period 1969-1983, 493 patients with primary acute pancreatitis were admitted to Nottingham hospitals. The incidence of this disease increased from 75.1 per million per year for 1969-1976 admissions to 116.9 per million per year for 1977-1983 admissions. For both cohorts there were large statistically significant variations in the distribution of pancreatitis within the study area. The spatial distribution for both cohorts revealed that the highest incidence rates clustered in an area east of the city centre which is supplied by particularly "hard" water. The chemical composition of the domestic water supply may play a role in the manifestation of acute pancreatitis.

Acute Disease↗
PubMed1988

The epidemiology of primary acute pancreatitis in Greater Nottingham: 1969-1983.

In most countries primary acute pancreatitis is a rare disease. However, its incidence has been increasing for several decades and many patients do not survive their first attack. During the 15 years (1969-83) 493 patients with the disease were admitted to Nottingham's two District General Hospitals. The geographical distribution of the disease within the study area was determined using 62 electoral wards and two patient cohorts namely 214 1969-76 admissions (1971 census base) and 279 1977-83 admissions (1981 census base). The incidence of the disease increased from 27 per annum to 40 per annum in the two cohorts. Most of the alcohol associated patients (18 first cohort: 38 second cohort) were young or middle aged males. For gallstone and 'non-gallstone' associated groups the incidence rose sharply with increasing age for both sexes. For both cohorts there were large statistically significant variations in the distribution of pancreatitis within the study area. Moreover, the spatial distribution was very similar for both cohorts with most of the highest rate wards clustering in a U-shaped area east of the city centre. Investigation of environmental factors suggested that this high-rate area coincides with the region served by the Burton Joyce domestic drinking water supply. Examination of the residential histories of the 493 patients showed that 25.6% had moved home less than five years prior to their first attack. Analysis of these moves confirmed that many patients had moved to suburban areas from two major inner city housing renewal schemes located within the high-rate Burton Joyce water supply area. Re-calculation of incidence rates of pancreatitis by former address for the six water supply areas established that only the Burton Joyce area had significantly high numbers of cases for both cohorts.

Acute Disease↗
PubMed1988

Cefotaxime plus metronidazole appears more effective than piperacillin in the prevention of postappendicectomy wound sepsis. Preliminary results of a comparative trial.

Metronidazole suppositories have previously been shown to be superior to povidone iodine intraoperative wound spray in reducing postappendicectomy wound sepsis. In subsequent studies metronidazole suppositories and cefotaxime injections reduced the sepsis rate to 9.3%, while the same combination produced a wound sepsis rate of 7.6% compared with 17.2% for cefotaxime alone. In an ongoing study, metronidazole and cefotaxime are now being compared with piperacillin in a single-blind trial. Adult patients undergoing emergency appendicectomy in Nottingham have been included in this study, which has ethical committee approval. When the decision to perform emergency appendicectomy was made, the patient was randomly allocated a numbered pack. This contained either 3 x 1g injections of cefotaxime and 6 x 1g metronidazole suppositories or 3 x 2g injections of piperacillin and 6 placebos. 40 minutes before operation the patient received the first suppository and the remainder every 8 hours. The patient received the first injection of antibiotic by intravenous or intramuscular injection and the remaining doses 8 and 16 hours later. A wound was regarded as infected if pus discharged either spontaneously or on incision. 175 patients have been studied to date. The treatment groups were well matched for age and sex. Seven of the 77 patients in the cefotaxime/metronidazole group (9.1%) compared with 12 of the 76 in the piperacillin group (15.8%) have developed wound infections. This study confirms that the combination of cefotaxime and metronidazole seems to be more effective than piperacillin alone in the reduction of postappendicectomy wound sepsis. Currently cefotaxime plus metronidazole is the therapy of choice.

Administration, Rectal↗
PubMed1984

Skeletal muscle metastasis from prostatic carcinoma.

We report a case of prostatic adenocarcinoma with bone metastases, and a cavitating metastasis in the skeletal muscle and soft tissue of the upper limb, resulting in amputation. Carcinoma of the prostate commonly gives rise to metastases in the lymph nodes and bone. Less frequent sites of metastases include the lung, liver and suprarenal gland, although other organs and the skin may be involved rarely.

Adenocarcinoma↗
PubMed1984

Surgical emergencies and manpower.

The emergency surgical admissions to one firm during the year 1979 have been reviewed. Emergency cases constituted half the workload of this and other units in the hospital. Male and female admissions were equal. The under twenty year old was the largest age group admitted. The commonest diagnosis, non specific abdominal pain, was made in 22.9% of all the patients and acute appendicitis accounted for 11.1%, whilst the remainder fell into a large number of diagnostic categories with only a few patients in each. Only 30.2% of all the patients had an operation within 48 of admission. These figures suggest that surgical trainees may no longer gain the experience in managing acute admissions which was once possible and that any future training programmes must ensure wider exposure to surgical emergencies.

Abdomen, Acute↗
PubMed1983

Profile of recovery after general anaesthesia.

The duration of impairment of mental functioning after anaesthesia was studied in 55 patients undergoing hernia repair who were divided into three groups in which the method of induction of anaesthesia (intravenous or inhalational) and ventilation (spontaneous or controlled) was varied. Performance in a five minute serial reaction time test and subjective estimates of coordination were assessed four times a day for two complete postoperative days and were compared with those in a control group of orthopaedic patients in hospital. After considerable impairment initially, reaction times in all groups gradually returned towards control values, but in patients breathing spontaneously during anaesthesia impairment recurred during the second postoperative day. These results suggest that such patients should be advised not to undertake hazardous tasks such as driving a car for at least 48 hours after a general anaesthetic. Discrepancies between subjective and objective assessments of impairment also suggest that patients should not rely on their own assessments of fitness to drive.

Anesthesia, General↗
PubMed1981

Effect of early return to work after elective repair of inguinal hernia: Clinical and financial consequences at one year and three years.

Since January, 1976, male patients undergoing elective unilateral inguinal herniorrhaphy have been included in a trial to see whether early return to normal activity is associated with an increased recurrence rate and to investigate economic consequences. By June, 1981, 500 patients had been reviewed at one year. 2 patients had defaulted. The first 200 patients had been examined at one year and three years. Recurrence was assessed independently, and recurrences were found of which the patient was unaware. The acceptable definition of recurrence was need for reoperation or a truss. The overall recurrence rate at one year was 3.9%. At three years no further recurrences were detected in the first 200 patients. There was no difference in the recurrence rate for those in the "early" group with 8 recurrences in a total of 246 patients and 10 recurrences in 245 patients in the control group. the median inactivity period in the "early" group was 48 days, compared with 65 days in the control. This differences of 17 days is significant (p=0.001). The self-employed "early" group returned to work in a median of 31 days. One-third of workers were losing a median of pounds 31 per week (range pounds 3- pounds 200). Patients can return to normal activity sooner after inguinal herniorrhaphy than has been advised without increasing the recurrence rate at one year and three years and with considerable monetary benefit to one-third of workers.

Clinical Trials as Topic↗
PubMed1981

Clinical and economic consequences of wound sepsis after appendicectomy and their modification by metronidazole or povidone iodine.

The effects of intrarectal metronidazole and intraincisional povidone iodine on sepsis after emergency appendicectomy were compared in a double-blind randomised controlled trial in 496 patients. Wound sepsis occurred in 12.3% of metronidazole-treated patients compared with 24% in the povidone-iodine group and 23.5% in an untreated control group. The metronidazole-treated patients left hospital approximately 2 days earlier than patients in the other two groups. They returned to work sooner and receiver fewer visits from the district nursing service. A short six-dose course of metronidazole significantly reduces the wound-infection rate in patients over the age of 12 undergoing emergency appendicectomy. If the clinical and economic benefits of metronidazole shown by this study are confirmed, the drug should be considered for routine use in emergency appendicectomy.

Appendectomy↗