Search PubMed⌕ Search

Biomedical subjects

J Boey

Publications and source records attributed to J Boey.

At least 37 records · Page 2Linked to original sources
PubMed1984

Mesenteric hammock for retaining the small intestine after radical pelvic surgery.

The small bowel often partakes in complications seen after major colorectal and other pelvic operations. Trapped loops of small intestine within the pelvic basin may produce benign adhesive obstruction and are also exposed to recurrent malignancy. These problems may be compounded by the effects of radiotherapy. To reduce some of these complications, many methods have been devised to reconstruct the pelvic floor and thereby retain the small intestine within the abdominal cavity. Autogenous material such as omentum and peritoneal flaps have been employed as a substitute for the excised peritoneal pelvic lining. However, these methods may not be feasible in some reoperated patients, especially if prior irradiation has induced extensive peritoneal fibrosis, or if the omentum is absent or attenuated. We describe a technique in which the small-bowel mesentery is used as a hammock across the pelvic brim in order to support the small intestine out of the pelvic cavity. It has been used successfully in patients with complications after abdominoperineal resection for carcinoma of the rectum: one enterovaginal fistula associated with radiation injury and cancer, and three enteroperineal fistulas.

Humans↗
PubMed1983

Gastric acid secretion and its predictive value after vagotomy for perforated duodenal ulcer.

In a prospective randomized clinical trial, gastric acid secretion was compared in patients after simple closure, proximal gastric vagotomy with closure, or truncal vagotomy with pyloroplasty performed for perforated duodenal ulcer. The basal and pentagastrin- and insulin-stimulated acid outputs were similar after either proximal gastric or truncal vagotomy; they were also comparable with the postoperative acid values after corresponding procedures performed electively for chronic duodenal ulcer. Conversely, the basal and maximum acid outputs after simple closure of perforation were no different from the preoperative acid outputs of a group of duodenal ulcer patients matched for age and sex. The efficacy of acid reduction by emergency proximal gastric and truncal vagotomy was shown by the respective ulcer recurrence rate of 3% (1/34) and 6% (2/32) compared with 43% (15/35) after simple closure (p less than 0.01). Acid secretory data and serum gastrin levels did not predict ulcer relapse in patients after simple closure of perforation.

Adult↗
PubMed1982

Bacteria and septic complications in patients with perforated duodenal ulcers.

To evaluate the clinical significance of bacterial contamination in perforated duodenal ulcers, we prospectively studied septic complications in 184 consecutive patients. All patients received parenteral antibiotics (over 90 percent preoperatively) for at least 7 days. Thirteen infections developed in eight patients (4.3 percent). Peritoneal cultures, performed in 143 unselected patients, were positive in 33.6 percent of cases. Bacterial growth occurred more often and in heavier amounts in patients who underwent exploration late (after 48 hours) and those who had gross peritoneal soilage. Candida and gram-negative organisms predominated, but there was no correlation with pathogens that produced abscesses or wound infections. Old age and late exploration significantly increased the risk of infection. Neither peritoneal soiling nor a positive culture was likely to be clinically important when explorations was performed within 2 days of perforation. We treated perforated ulcers as clean-contaminated cases, and recommend that three doses of prophylactic antibiotics be begun preoperatively in all patients.

Adult↗
PubMed1982

A prospective study of operative risk factors in perforated duodenal ulcers.

Operative risk factors for patients with perforated duodenal ulcers were examined prospectively in 213 operated patients. Nine hospital deaths (4.2%) resulted from respiratory failure, sepsis, and bleeding. Forty-five complications developed in 27 patients (12.7%). Concurrent medical illness, preoperative shock, and longstanding perforations (more than 48 hours) were significant features that increased mortality. Old age, gross peritoneal soiling, and the length of the ulcer history did not affect mortality in the absence of risk factors. No death attributable to either sepsis or abscess formation occurred when surgery was performed within two days of perforation. Bacterial contamination may not signify clinical peritonitis during this period. We conclude that simple closure of perforated ulcers is a more prudent choice when any risk factor is present, but that definitive surgery in good-risk patients merits further evaluations.

Bacterial Infections↗
PubMed1982

Pelvic exenteration for locally advanced colorectal carcinoma.

Pelvic exenteration provided worthwhile palliation and achieved a cumulative five-year survival rate of 38.8% in 49 patients who had carcinoma of the lower colon or rectum infiltrating adjoining pelvic viscera. Survival and the disease-free period were not significantly different after total or posterior exenteration. The stage of disease was the major determinant of outcome: five-year survival rates averaged 51.8% and 28.8% for Stages II and III, respectively. Hospital mortality (26.9%) after total exenteration was chiefly due to technical mishaps, and the inclusion of many high-risk but symptomatic elderly patients. Complete clearance of locally advanced colorectal cancer by pelvic exenteration is indicated in fit patients, especially those with Stage II disease.

Adenocarcinoma↗
PubMed1982

Immediate definitive surgery for perforated duodenal ulcers: a prospective controlled trial.

A prospective, randomized, double-blind trial was conducted in 101 patients to evaluate the safety and benefits of immediate definitive surgery for perforated duodenal ulcers. These patients, who were judged by predefined criteria to be medically fit and to have perforations in chronic ulcers, were randomized to undergo simple closure (35 patients), truncal vagotomy and drainage (VD) (32 patients), or proximal gastric vagotomy with closure (PGV) (34 patients). Patients were followed with endoscopic assessment for up to 39 months. There was no mortality and only a few minor postoperative complications. At 39 months follow-up, the cumulative rates of recurrence were 63.3%, 11.8% and 3.8% after closure, VD, and PGV, respectively (p less than 0.001). With the exception of the one recurrence after PGV, all relapses were symptomatic, and eight of these 18 required reoperation. Relapse rates and Visick scores between VD and PGV were significantly different. Both safe as well as effective, immediate, nonresective, definitive operation is indicated for good-risk patients who have perforations in chronic duodenal ulcers.

Adult↗
PubMed1982

Epidermoid carcinoma of the anus.

Twenty five patients with epidermoid carcinoma of the anus, representing 1.5% of all large bowel malignancies, were seen over a 33 year period. Most patients presented with an advanced lesion which gave rise to a fungating mass, bleeding or pain. Nearly all patients who received either palliative irradiation or refused treatment died within a year of diagnosis. Abdominoperineal resection in 12 patients yielded an encouraging five year survival rate of 68.5%. Therapeutic groin node dissection performed on six occasions led to only one late recurrence. The surgical literature on sphincter saving local excision and therapeutic radiotherapy is reviewed. Currently, radical resection remains the most appropriate treatment for the majority of patients with epidermoid anal cancer.

Anus Neoplasms↗
PubMed1982

Fine-needle aspiration versus drill-needle biopsy of thyroid nodules: a controlled clinical trial.

Percutaneous needle biopsy by two different methods was evaluated in a prospective controlled study of 167 consecutive patients with dominant thyroid nodules. Fine-needle aspiration was superior to high-speed drill-needle biopsy because of its higher diagnostic yield (93.9%). When a sample sufficient for diagnosis was obtained, the accuracy rate for both methods was comparable. Diagnostic errors were due to inadequate samples, difficulties in interpreting hypercellular adenomas, and geographic sampling problems. In the detection of thyroid cancer, neither technique alone appears completely adequate because of occasional false negative errors. The selection of patients for operation should depend on clinical parameters as well as the findings on fine-needle aspiration of thyroid nodules.

Adenocarcinoma↗
PubMed1982

Perforations in acute duodenal ulcers.

To determine the clinical characteristics and outcome of perforated acute ulcers of the duodenum, we prospectively studied 60 patients, 28.3 per cent of all perforations, after closure only. Patients with acute ulcers were significantly older and had a higher hospital mortality than did those with perforated chronic ulcers. Within the first three years following closure, chronic ulcers recurred significantly more often than did acute ulcers. Nevertheless, relapses in patients with acute ulcers were usually symptomatic and, on occasion, necessitated reoperation for complications. Among the acute ulcer group, individuals who had perforated ulcers by the age of 30 years had a significantly increased risk of early recurrence. Due to the higher risk, we suggest that an immediate, definitive operation be evaluated in younger patients with a perforated acute ulcer of the duodenum.

Acute Disease↗
PubMed1981

The surgical management of anorectal malignant melanoma.

The biological vagaries of anal malignant melanoma are illustrated by four cases in Chinese patients. All four died within five years. Their poor prognosis emphasizes the value of preoperative studies to detect clinically occult metastases and obviate futile radical surgery. Many patients already have disseminated disease at the time of diagnosis, and local excision of the tumour provides acceptable palliation. For localized disease, abdominoperineal resection prevents local recurrence and removes the mesenteric nodes which are frequently involved. Palpable inguinal nodes necessitate therapeutic groin dissection, but we perform elective resection only when affected nodes are found at laparotomy. Pelvic lymphadenectomy should be performed in conjunction with abdominoperineal resection. The efficacy of chemotherapy for anorectal melanoma remains uncertain.

Adult↗
PubMed1981

Carcinoma of the colon and rectum with liver involvement.

The records of 126 patients with adenocarcinoma of the colon and rectum who presented with liver involvement were reviewed. Prognosis was determined by the amount of metastases to the liver, which was usually extensive of ascites or a raised alkaline phosphatase level was present. The longest survival period was achieved with resection of the primary tumor along with hepatic lesions confined to a single lobe, especially those due to direct tumor infiltration. If liver deposits were found bilaterally, palliative resection of the primary lesion relieved intestinal symptoms. This may also prolong the survival time, because a fixed primary tumor appeared to diminish the outlook among patients with comparable liver disease. Palliative resection in the presence of ascites resulted in a high mortality, and the survival rate was no better than that after diversion procedures. We recommend resection without anastomosis for carcinoma of the rectosigmoid in patients with ascites and unresectable secondary lesions of the liver.

Adenocarcinoma↗
PubMed1975

Appendicitis. A critical review of diagnosis and treatment in 1,000 cases.

One thousand cases of appendicitis seen from 1963 to 1973 were reviewed. The overall negative appendectomy rate was 20%, but in women between ages 20 and 40 it exceeded 40%. Two thirds of the negative appendectomies were due to nonsurgical lesions. Mesenteric adenitis, gastroenteritis, and abdominal pain of unknown cause accounted for one third of the errors in females and two thirds in males. These diseases were best distinguished from appendicitis on the basis of temperature and white blood cell count. The remainder of the errors in females were due to pelvic inflammatory disease or other gynecologic diagnosis and were best distinguished from appendicitis on the basis of history and physical findings. The rate of perforation was 21% overall. The incidence of wound infection was 8.5%. Use of systemic antibiotics did not affect the wound infection rate.

Adolescent↗