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Biomedical subjects

J R Monson

Publications and source records attributed to J R Monson.

At least 73 records · Page 4Linked to original sources
PubMed1996

Randomized trial of blunt-tipped versus cutting needles to reduce glove puncture during mass closure of the abdomen.

Eighty-five consecutive patients were randomized to undergo mass closure of the abdomen with no. 1 polydioxanone mounted on either a blunt-tipped (n = 46) or cutting (n = 39) needle. Gloves were changed before closure and tested for perforation afterwards using standard air or water techniques. Fourteen pairs of gloves were punctured when using a cutting needle, and three pairs when a blunt-tipped needle was used. The majority of punctures were to the non-dominant glove. The surgeon was aware of the puncture in eight of the 14 instances involving a sharp needle and in one of the three involving a blunt-tipped needle. Blunt-tipped needles, while not eliminating the risk, significantly reduced the incidence of surgical glove puncture (P < 0.001, Fisher's exact test). The use of cutting needles for abdominal closure should be abandoned.

Abdomen↗
PubMed1996

Brush cytology for the diagnosis of rectal carcinoma.

The use of brush cytology as an aid in the preoperative diagnosis of rectal cancer was prospectively assessed at 328 examinations in 289 consecutive patients with rectal lesions suspicious of carcinoma. Forty-five patients were reported as having benign polyps. There was 97 per cent agreement between conventional biopsy and cytology brushings for this group. Some 249 patients underwent a subsequent resection allowing comparison with formal histology. Forceps biopsy produced a true-positive diagnosis of cancer in 218 patients (89.7 per cent) and cytology in 222 (91 per cent). The sensitivity for forceps biopsy and cytology was 81 and 83 per cent respectively, with a combined sensitivity of 98 per cent. It is concluded that the addition of cytology to forceps biopsy increases the diagnostic yield in a single examination, and may be a complementary method of establishing the diagnosis of rectal lesions.

Biopsy↗
PubMed1996

Vaginography--investigation of choice for clinically suspected vaginal fistulas.

PURPOSE: Vaginal fistulas are rare but can cause extremely distressing symptoms for patients and prove difficult to define anatomically. Barium studies have been reported as having a maximum sensitivity of only 34 percent for detection of vaginal fistulas. Vaginography is an alternative method for diagnosis and evaluation of suspected vaginal fistulas, which has been reported to have a sensitivity of 100 percent. We reviewed our total experience of vaginography to fully assess its capabilities. METHODS: Twenty-seven patients with clinically suspected vaginal fistulas were investigated with vaginography during a six-year period. Results of vaginograms were compared with final operative or clinical diagnosis and with results of other radiologic investigations. RESULTS: Vaginography successfully identified 19 of 24 fistulas, giving a sensitivity of 79 percent. In our series, barium enema was only able to identify 9 percent of fistulas arising from the colon. CONCLUSIONS: In this, the largest series of vaginograms, apparent reduction in sensitivity from the 100 percent quoted in earlier series to 79 percent probably represents a more accurate assessment of vaginography as a diagnostic investigation. Even allowing for this reduction, vaginography is still the most sensitive, economic, and informative investigation for identification and delineation of vaginal fistulas. We recommend that vaginography be the initial investigation of choice in patients with clinically suspected vaginal fistulas.

Adult↗
PubMed1996

Suprapubic versus transurethral catheterisation of males undergoing pelvic colorectal surgery.

A prospective, randomised double-blind trial of suprapubic (SPC) versus transurethral (TUC) catheterisation was undertaken in fifty consecutive male patients of median age 66 (range 32-81) years undergoing pelvic colorectal surgery. Twenty-four patients were randomised to SPC. Catheter removal times were comparable between the two groups: SPC = mean 7.2 (3-14) days; TUC = man 7.5 (2-13) days; P > 0.5. Acute urinary retention was recorded in 5 patients with SPC and 6 in the TUC group. Chronic retention with overflow was recorded in one TUC patient. Frequent voiding after catheter removal occurred in two SPC, and in eleven TUC patients (P < 0.05). Re-catheterization was required in two SPC, and seven TUC patients. One culture positive urinary tract infection occurred in the SPC, and three in the TUC groups. It is concluded that suprapubic catheterisation allows comparable controlled return of normal voiding with fewer bladder and urethral symptoms when compared with transurethral catheterisation.

Adult↗
PubMed1996

Anterior resection syndrome is secondary to sympathetic denervation.

The mechanism of faecal incontinence following low anterior resection (LAR) has been speculative and the role of disordered neorectal dynamics difficult to quantify. Using a new methodology which quantifies rectal response to rapid and ramp inflation, in combination with anal physiology, we have evaluated 25 LAR-7 with major incontinence and 5 with minor incontinence. The three groups had comparable age, duration post surgery and anastomotic distance from the puborectalis. The resting anal canal pressure (RAP) did not related to the anastomotic distance (R2 = 0.09). With the anastomosis at and below 3 cms from the puborectalis, the rectoanal inhibitory reflex (RAIR) was a sustained drop in the mid anal canal pressure, in contrast to the normal pattern of recovery above this level. Major incontinence was characterised by a subnormal anal defence, hypersensitive neorectal dynamics and high amplitude contractile wave while minor incontinence was characterised by a hypernormal anal defence and a lesser degree of neorectal hypersensitivity. The mathematical viscoelastic rectal model, defined an increasing longitudinal smooth muscle tone and a decreasing functional collagen with increasing severity of incontinence as well as a high and low circular smooth muscle (CSM) tone with major and minor incontinence respectively. This correlated with previous in vitro studies on myenteric plexus denervation and localised damage to the inferior mesenteric plexus respectively. Based on the findings in this study, we conclude that major incontinence is secondary to neurotenesis of the inferior mesenteric ganglia and the hypogastric plexus, whereas minor incontinence represents a localised neurotenesis/neuropraxia of the inferior mesenteric plexus.

Adult↗
PubMed1995

Laparoscopic colonic surgery.

Laparoscopic surgical techniques have recently entered the field of colorectal surgery. Because the laparoscopic approach has revolutionized biliary surgery, it is hoped that similar advances will be possible in the more elderly population with colorectal disease. Early experience suggests that such advances have not been achieved and there is concern about developing minimal access surgical techniques in the face of potentially curable cancer. This article reviews the current state of knowledge based on published series; however, the current lack of controlled data in patients with extended follow-up makes this area highly controversial. Suggestions regarding the future of laparoscopic surgery are made and include the establishment of a national register and the development of controlled randomized trials.

Colon↗
PubMed1995

Laparoscopic abdominoperineal excision of the rectum.

In laparoscopic abdominoperineal resection of the rectum (LAP-AP) an abdominal incision is completely avoided as the tumor is delivered through the perineal incision. It is our belief that the view provided in the pelvis by laparoscopy is significantly better than at laparotomy and allows excellent anatomical definition and meticulous dissection. In this study we compared the adequacy of excision of the first 12 patients undergoing LAP-AP to the last 16 patients undergoing open abdominoperineal resection (OP-AP). In all patients the procedure was carried with curative intent for adenocarcinoma and the Dukes staging and Jass score's were similar in both groups. [table: see text] The data demonstrate similar nodal harvest in both groups as well as extent of radial excision. However, two patients in the open group had microscopic radial margin involvement despite being microscopically clear at surgery. We conclude that although long-term follow-up is required to address the issue of local cancer recurrence, laparoscopic rectal dissection appears as good as open surgery and may allow a more precise assessment of excision margins.

Adult↗
PubMed1995

Stapled laparoscopic rectopexy for rectal prolapse.

The widespread success of laparoscopic cholecystectomy has led to the development of a wide range of laparoscopic surgical procedures. Procedures for treating rectal prolapse (Procidentia) may constitute some of the best applications for colorectal laparoscopic techniques. A technique of laparoscopic rectopexy performed using the endo-stapler is described. Twenty-nine consecutive patients have undergone laparoscopic rectopexy. The median age was 71 years (52-89), and male:female ratio was 27:2. One procedure had to be converted to open due to ventilatory difficulties. The mean operative time was 95 minutes (50-190). The mean hospital stay was 5 days (4-15). There was no mortality in this series. Morbidity included incisional hernia through a port hole (n = 1), extraperitoneal haematoma (n = 1), and urinary tract infection with retention (n = 1). In conclusion, laparoscopic abdominal rectopexy is a safe and effective technique in the management of rectal prolapse.

Aged↗
PubMed1995

Inflammatory markers following laparoscopic and open hernia repair.

Laparoscopic surgery may reduce the inflammatory response to surgery by the avoidance of a skin incision which is frequently the site of maximum tissue trauma. We hypothesized that the inflammatory response is less with minimally invasive procedures. The aim of this study was to evaluate the response of inflammatory mediators following laparoscopic and open hernia repair. Thirty-four patients undergoing unilateral primary inguinal hernia repair were prospectively assigned to either laparoscopic mesh hernia repair (n = 14), open mesh hernia repair (n = 11), or a Bassini repair (n = 9). Serum samples withdrawn prior to surgery, 6 h after surgery, and then again at 24 h after surgery were assayed for interleukin-6 and C-reactive protein content. Interleukin-6 levels at 24 h in the laparoscopic (13.1 +/- 3.1 pg/ml), open mesh (15.5 +/- 2.5 pg/ml), or Bassini group) (15.4 +/- 2.0 pg/ml) did not differ significantly. Neither did C-reactive protein levels at 24 h in the laparoscopic (12.4 +/- 2.7 pg/ml), open mesh (23.0 +/- 7.8 pg/ml), or Bassini group 18.6 +/- 6.6 pg/ml) differ significantly. The response of inflammatory mediators to hernia repair is not modified by undertaking the procedure laparoscopically.

C-Reactive Protein↗
PubMed1995

Surgery and the release of a neutrophil Fc gamma receptor.

BACKGROUND: The fact that the incidence and mortality from postsurgical sepsis have remained unchanged over the past 15 years raises the possibility that some patients possess an idiosyncratic predisposition to the development of a postoperative sepsis response. Genetic polymorphisms of the neutrophil receptor for immunoglobulin G, CD16, are known, and their inheritance is associated with functional differences in neutrophil phagocytosis. The present studies were designed to provide preliminary data on the effects of surgery on the level of expression of CD16 and its metabolism preparatory to detailed examination of the relationship of these polymorphisms to sepsis responses. PATIENTS AND METHODS: Neutrophil CD16 expression was measured by flow cytometry before and after operation in patients undergoing major resectional surgery of the digestive tract. Assays were performed on whole blood preparations as well as on isolated and activated neutrophil preparations from these patients. RESULTS: Neutrophil CD16 expression was constitutively higher both before and after surgery in patients who developed a postoperative sepsis response than in those who did not. Surgery had no effect on the level of surface neutrophil CD16 expression in either group. Surgery depleted intracellular CD16 stores despite the maintenance of a constant level of CD16 on the neutrophil surface, membrane-bound CD16 being more readily cleaved by physiological neutrophil activators after surgery than before surgery. CONCLUSIONS: The intrinsic level of expression and postsurgical metabolism of neutrophil CD16 may be an important component of the predisposition of some patients to develop infection or sepsis after injury. Further studies of the distribution of CD16 allotypes and neutrophil function among surgical patients are warranted.

Adult↗
PubMed1995

Advanced colorectal cancer treated with combined 5-fluorouracil and folinic acid: the experience within a surgical department.

Thirty-seven patients with advanced colorectal cancer were treated with fluorouracil (5-FU) and folinic acid (FA) (Jan 1990-Dec 1992). Clinical assessment and administration of chemotherapy was incorporated as part of the daily work load of a busy general surgical unit. Records were available for all 37 patients and showed that 13 patients (Treatment failures, Group B) failed to receive more than 3 monthly cycles of treatment, while the remaining 24 received 6 or greater cycles (Treatment completed, Group A). There was no survival advantage demonstrated for the complete study cohort (n = 37) when compared to an historical group (n = 1038) of untreated patients. Median survival in Group A (14.2 months) was significantly greater (chi-squared, P < 0.0001) than survival in Group B (6.7 months). Toxicity was common with 43% experiencing mouth ulcers or stomatitis (13% severe). Three per cent had dose-limiting diarrhoea and myelotoxicity was minimal. There were six partial responses and 16 patients had no change in their disease status while on treatment. Current regimen of 5-FU/FA are well-tolerated with low toxicity but show no survival advantage for advanced colorectal cancer. However, these regimens may be administered within the confines of general surgical practice.

Adenocarcinoma↗
PubMed1995

Results of a prospective randomized trial using DTIC and interferon as adjuvant therapy for stage I malignant melanoma.

This prospective randomized trial evaluated the effect of DTIC and interferon as adjuvant therapy for high risk stage 1 malignant melanoma in 26 patients. Both groups were well matched for depth of disease, site of melanoma and other prognostic criteria. Like other studies the findings of 2.6 times increased relative risk of mortality in the treatment arm do not support a rationale for adjuvant immuno-chemotherapy even in patients at high risk of recurrence.

Adult↗
PubMed1995

Inflammatory breast carcinoma.

Inflammatory breast cancer (IBC) is a rare subtype of breast cancer traditionally associated with an extremely poor prognosis. The appearance of the effected breast can be misleading, with the incorrect diagnosis of an infective process, rather than a malignant disease, further delaying treatment. Compared with the results achieved by monotherapy with either surgery, radiotherapy or chemotherapy; multimodality treatments have achieved significant improvements in both disease-free and overall survival. The purpose of this article is to provide a comprehensive review of the current literature and highlight those areas where potential advances in the overall management of IBC have been made.

Adenocarcinoma↗
PubMed1995

Interleukin 1 and tumour necrosis factor alpha may be responsible for the lytic mechanism during anti-tumour antibody-dependent cell-mediated cytotoxicity.

Antibodies are thought to bring about tumour cell lysis by antibody-dependent cell-mediated cytotoxicity (ADCC), but the exact mechanism is not well elucidated. Monocytes are known to be important mediators of anti-tumour ADCC and are also known to secrete the cytokines tumour necrosis factor alpha (TNF-alpha) and interleukin 1 beta (IL-1 beta), both of which have been shown to bring about tumour cell lysis. We examined the release of these cytokines during ADCC and attempted to elucidate which components of the ADCC reaction were necessary for cytokine production. We measured TNF-alpha and IL-1 beta in supernatants collected from a standard ADCC assay using each of the anti-colorectal antibodies m17-1A, c17-1A and cSF25. We found that there was significant TNF-alpha and IL-1 beta release during ADCC mediated by each of these three antibodies and that the magnitude of cytokine release seemed to reflect the degree of tumour cell lysis produced by each antibody. Furthermore, we found that effector cells, target cells and a specific anti-tumour antibody were necessary for this to occur. The presence of only some of the components of the reaction or of an irrelevant antibody produced little or no TNF-alpha or IL-1 beta. We conclude that TNF-alpha and IL-1 beta are released when an effector and tumour target cell are united by a specific tumour antibody and that these cytokines may be important in bringing about tumour cell lysis during the ADCC reaction.

Adenocarcinoma↗
PubMed1994

Effects of minimally invasive surgery on hypochlorous acid production by neutrophils.

The production of chlorinated oxidants such as hypochlorous acid is a central antimicrobial and immunoregulatory function of neutrophils. Neutrophil hypochlorous acid production was compared in patients undergoing uncomplicated laparoscopic surgery (group 1) and those submitted to conventional open surgery (group 2). Preoperative peak hypochlorous acid production was similar in the two groups (mean(s.e.m.) 0.60(0.05) versus 0.69(0.06) nmol/min respectively). In group 2, mean(s.e.m.) neutrophil hypochlorous acid production fell significantly on day 1 after surgery (0.36(0.05) nmol/min; P < 0.01) but this did not occur in group 1 (0.63(0.07) nmol/min). By day 6 hypochlorous acid kinetics had returned to preoperative levels in both groups. Minimally invasive surgery is less disruptive of neutrophil function than conventional open procedures.

Abdomen↗