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Biomedical subjects

J B Rainey

Publications and source records attributed to J B Rainey.

31 records · Page 2Linked to original sources
PubMed1985

Distal transposition of rat caecum does not render it susceptible to carcinogenesis.

As the relative resistance of rat caecum to chemical carcinogens could reflect its luminal environment, caecal mucosa was exposed to the distal faecal stream in male Sprague-Dawley rats (n = 50) previously treated with azoxymethane (total dose 90 mg/kg sc). After colonic transection at the pelvic brim, the caecum was inserted isoperistaltically between colocaecal and caecorectal anastomoses (n = 30); an ileocolic anastomosis restored intestinal continuity. Controls (n = 20) had transection and reanastomosis at equivalent points of the bowel, plus caecotomy and resuture. Caecal crypt cell production rate, as determined stathmokinetically at 28 weeks, was not consistently affected by transposition. No tumors developed in either transposed or orthotopic caecum, apart from three suture-line tumours found at the caecotomy site in controls. The colonic tumour yield in controls (1.4 +/- 0.3 per rat : mean +/- SEM) matched that after transposition (1.5 +/- 0.2), but anastomotic tumours were twice as common after transposition (p less than 0.05) and rectal tumours were increased four-fold (p less than 0.05). The caecum remains resistant to carcinogenesis despite transposition to a distal colonic environment. Local epithelial defence mechanisms are more important than luminal contents in maintaining this resistance.

Animals↗
PubMed1984

Relative effects of ileal resection and bypass on intestinal adaptation and carcinogenesis.

Since ileal resection and ileal bypass are commonly performed in man and might stimulate colonic hyperplasia, their co-carcinogenic potential was explored in male Sprague-Dawley rats (n = 135). One week after 33 per cent distal small-bowel resection, 33 per cent distal small-bowel bypass or distal ileal transection (control), animals started a 6-week course of azoxymethane injections (total dose 90 mg/kg ip). Findings in rats killed at 20 and 25 weeks were similar: bypass produced a higher yield of colorectal tumours (4.0 +/- 0.6 per rat: mean +/- s.e.) than controls (2.4 +/- 0.4; P less than 0.05), but resection caused maximal enhancement (5.2 +/- 0.5: P less than 0.01). In rats killed at 30 weeks, however, tumour yields were almost identical. Overall, resection increased colonic tumour yield by 55 per cent (P less than 0.02) and bypass by 32 per cent. Stathmokinetic measurements of crypt cell production rate (CCPR) at 20 weeks showed similar increases after resection and bypass both in residual functioning small bowel (109-200 per cent: P less than 0.01) and in colorectum (63-100 per cent: P less than 0.05). At 30 weeks these adaptive effects persisted, despite an overall increase in CCPR with age. Loss of functioning ileum enhances experimental colorectal carcinogenesis principally by reducing the latent period for tumour development. Resection has a greater effect than bypass probably by producing earlier hyperplasia, though later adaptive effects are similar.

Adaptation, Physiological↗
PubMed1984

Survival of 727 patients with single carcinomas of the large bowel.

The outcome of 727 patients presenting with solitary colorectal carcinoma over a seven-year period is reviewed. Of the patients, 52 per cent were females 45 per cent were over 70 years and 31 per cent had an emergency admission. Of the tumors, 43 per cent occurred in the rectum and 40 per cent were stage D (not treated curatively). Predisposing causes included inflammatory bowel disease (n = 12) and abdominal irradiation (n = 6); associated adenomatous polyps were present in 22 per cent of resection specimens. Hospital mortality rates (20 per cent overall) were adversely affected by emergency admission (36 per cent), age greater than 70 years (29 per cent) and advanced, stage D disease (31 per cent). Corrected overall five-year survival rate was 32 per cent and, after curative resection, 59 per cent. Of patients in whom curative resection included contiguous organs, 47 per cent survived five years. Survival was reduced in patients over 70 years (26 per cent), in emergency admissions (24 per cent), in poorly differentiated tumors (18 per cent), and if tumor fixity was present (14 per cent). Factors contributing to a favorable outlook included a long history (greater than one year) and a tumor situated in the left colon. Recurrence developed in 47 per cent of patients surviving curative resection and was seldom diagnosed at a curable stage.

Adenocarcinoma↗
PubMed1984

Congenital epulis of the newborn.

A case history of congenital epulis of the newborn is described and two unusual features are noted. First, two lesions were present, and second, following excision, the patient continued to have minor feeding difficulties due to associated partial nasal obstruction.

Female↗
PubMed1984

The cocarcinogenic effect of intrarectal deoxycholate in rats is reduced by oral metronidazole.

Bile acids enhance colorectal carcinogenesis in animals and man, perhaps after degradation by faecal anaerobes. The promotional effect of sodium deoxycholate (SDC) and its relationship to bacteria was examined in male Sprague-Dawley rats (n = 115) which had received a 6-week course of azoxymethane (total dose 90 mg kg-1 s.c.) Two groups received 3 X weekly intrarectal (i.r.) instillations of N saline or 0.12 M SDC for 18 weeks. Another group received SDC i.r. plus metronidazole (22.5 mg kg-1) daily in the drinking water. Controls had no instillations or metronidazole alone. By 28 weeks SDC had increased mean colonic crypt depth by 9% (P less than 0.001), and had almost trebled colorectal tumour yields from 2.4 +/- 0.4 per rat (mean +/- s.e.) in controls to 6.4 +/- 0.5 (P less than 0.001). Tumour yields after SDC + metronidazole (4.2 +/- 0.5) remained 75% higher than in controls (P less than 0.01) but were 33% less than after SDC alone (P less than 0.01), and the increase in crypt depth was maintained at 7% (P less than 0.001). Neither metronidazole alone nor saline i.r. had any effect on tumour yield, but metronidazole alone reduced crypt depth by 9% (P less than 0.001). Deoxycholate is a potent cocarcinogen and also stimulates mucosal hyperplasia. Metronidazole reduces its tumour-promoting effect, suggesting that faecal anaerobes are important in bile acid cocarcinogenesis.

Animals↗
PubMed1984

The relationship between intestinal hyperplasia and carcinogenesis.

Conditions that potentiate colorectal carcinogenesis have in common the ability to increase cell proliferation in colonic crypts. Since compensatory hyperplasia of the shortened gut involves large bowel as well as small bowel, postoperative adaptation might promote the development of bowel cancer. This hypothesis was tested in Sprague-Dawley or Fischer rats given parenteral azoxymethane (50-160 mg/kg). Resection and bypass of a third or more of the small intestine consistently enhance colorectal carcinogenesis; so does pancreatobiliary diversion to mid small bowel. Partial colectomy has little effect on adaptation or carcinogenesis, but colonic defunction reduces mucosal mass and tumour yields. Bile acids are cocarcinogenic when instilled per rectum but not in colon sequestered as a Thiry-Vella fistula. Most intestinal anastomoses and stomas are favoured sites for tumour development. Postoperative hyperplasia plays a cocarcinogenic role in this experimental model. Patients with operations such as ileal resection and jejunoileal bypass should be screened for evidence of hyperplasia or dysplasia in the large intestine.

Animals↗
PubMed1983

The use of a resuscitation room: a review of current trends.

One hundred consecutive patients treated in the resuscitation room of the Accident and Emergency Department at the Royal Infirmary of Edinburgh were studied and the results were compared with earlier surveys. Half the cases were medical emergencies, which suggests that this should be reflected in the training for specialists in accident and emergency medicine.

Adult↗
PubMed1983

Adaptation and carcinogenesis in defunctioned rat colon: divergent effects of faeces and bile acids.

Because the composition of faeces modulates colorectal carcinogenesis, promotional effects of the secondary bile salt sodium deoxycholate (SDC) were compared with those of dilute homogenised faeces (12.5% w/v) or saline alone in rat colon isolated from the faecal stream as a Thiry-Vella fistula (TVF). Each fluid was used to irrigate a group of TVFs 3 times per week for 12 weeks. Other rats had TVF without irrigation or colonic transection and reanastomosis (sham TVF). Operations followed a 6-week course of azoxymethane injections. At sacrifice 15 weeks postoperatively crypt depth and tumour yield were reduced to the same extent in both the non-irrigated TVFs and the SDC-irrigated TVFs, when compared to shams. Irrigation with faeces and saline completely restored crypt depth and partly restored tumour yields to the levels in shams. Tumours were smaller in the SDC group than in the other 4 groups. While tumours developed mainly in the left colon of shams, there was significantly more even distribution in the TVFs. Exclusion of the colon from the faecal stream leads to mucosal hypoplasia and impaired carcinogenesis. Irrigation with faeces or saline partly reverses these changes. Deoxycholate has no such effect and clearly is not co-carcinogenic in this model.

Animals↗
PubMed1982

Sequential grafts for limb salvage in the presence of widespread occlusive vascular disease. A review of twenty patients.

Twenty patients with widespread occlusive vascular disease received sequential bypass grafts for lower-limb salvage. In 16 patients an isolated common femoral or profunda segment was perfused by a proximal graft and run-off was augmented by femoropopliteal bypass. In 4 a femoropopliteal bypass constituted the proximal component perfusing an isolated popliteal segment, run-off being increased by a popliteal-to-tibial graft. Dacron, expanded polytetrafluoroethylene (PTFE) (Gore-Tex), and autogenous vein grafts were used. The mean period of follow-up was 10.6 +/- 7 months and 70% of the limbs were salvaged. Thirteen graft systems remain currently patent, 4 have thrombosed, 2 patients died with patent grafts, and 1 required amputation despite graft patency.

Aged↗
PubMed1981

Treatment for partial tears of the lateral ligament of the ankle: a prospective trial.

There is debate about the most appropriate form of treatment for partial tears of the lateral ligament of the ankle, which are common after inversion injuries. A prospective trial of four forms of treatment was carried out. The forms of treatment used were: no treatment with only a minimal bandage, Tubigrip support, immobilisation in plaster-of-Paris, and physiotherapy. The end point was taken when the patient returned to work or had a low score on an objective clinical scale. Early mobilisation, with or without physiotherapy, was found to offer the most rapid return to functional activity. Patients who had had their ankle immobilised in plaster-of-Paris required more days off work and longer attendance at a follow-up clinic. Inversion injuries are common and cause absence from work and discomfort for the patient. These findings suggest that mobilisation with physiotherapy, although not practical for all patients, is the most satisfactory course of treatment.

Adolescent↗
PubMed1981

Inversion injuries of the ankle: clinical assessment and radiographic review.

Inversion injuries of the ankle are a common cause of referral and presentation to accident units. They impose a load on radiographic services. A prospective trial was carried out to determine the accuracy of clinical examination. All patients were assessed clinically then examined radiographically, the clinical assessment missed 5% of the fractures. These, however, were all minor avulsion fractures or crush fractures and Tubigrip support was sufficient. Clinical examinations is, therefore, accurate and the need for most x-ray examination is questionable. X-ray examination should be reserved for patients with continuing pain or those who clinically have a fracture requiring immobilisation. This would produce a large saving in NHS resources.

Adolescent↗
PubMed1979

Work of a day-bed unit 1972-8.

From 1972 to 1978 inclusive 32 311 patients were managed in a 24-bedded day-bed unit in a district general hospital. The principal specialties using this were urology, gastroenterology, general surgery, gynaecology, haematology, orthopaedics, and radiology. Patient selection, a high standard of secretarial work, and good liaison with general practitioners, the community nursing service, and the ambulance service are most important. Day care forms a large, important, and increasing part of the work of the hospital, and without it many of the specialties would be unable to cope with the demand, and their waiting lists would lengthen continuously.

Ambulatory Surgical Procedures↗