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Biomedical subjects

J W Serpell

Publications and source records attributed to J W Serpell.

28 records · Page 2Linked to original sources
PubMed1991

Stercoral perforation of the colon proximal to an end colostomy.

Stercoral perforation of the colon is rare, and has not previously been reported as a postoperative complication, proximal to an end colostomy. Two such cases are reported; in addition in one the stercoral perforation was recurrent, emphasizing the multifocal nature of the disease. Both cases demonstrate the failure of standard techniques to deal with scybala in the loaded proximal colon. It is, therefore, suggested that intra-operative orthograde colonic lavage is indicated to protect a terminal colostomy from the risk of stercoral perforation in such cases.

Adult↗
PubMed1991

Misinterpretation of the upper parathyroid adenoma on thallium-201/technetium-99m subtraction scintigraphy.

Pre-operative thallium-technetium subtraction scintigraphy of 50 patients with primary hyperparathyroidism, which was subsequently proven on histology to be due to an adenoma, was compared with operative findings. Six scans were negative and seven uninterpretable. Of the remaining 37 patients, 34 had correct scan prediction of the anatomical locations of the adenomas. On examination of the origins of the adenomas, all six scintigraphic predictions of upper adenomas corresponded to tumours arising from the upper gland found at operation. Of the 25 lower predictions, there was one false positive and 16 were correct, i.e. of lower gland origin, but eight were found to originate from the upper gland. This misinterpretation is though to be due to the prolapse of an adenoma arising from the upper gland towards the lower pole of the thyroid, thereby mimicking a lower lesion on the scan.

Adenoma↗
PubMed1991

Significance of 'Langer's axillary arch' in axillary dissection.

The axillary arch is reported to occur in 7% of the population, but in our experience has only been observed in 0.25%. The anatomical features are described and its importance in axillary dissection is indicated. In addition, its relevance to the prevention of lymphoedema and to the construction of latissimus dorsi flaps is discussed. The axillary arch should be considered in the differential diagnosis of axillary swellings.

Axilla↗
PubMed1990

Stercoral perforation of the colon.

Stercoral perforation of the colon is rare. The 64 reported cases are reviewed to define the syndrome of stercoral perforation, and to facilitate accurate diagnosis and treatment. Features of localized or generalized peritonitis were universal; however, only 11 per cent were correctly diagnosed before operation. Recognition that the disease involves a segment of colon rather than only the focal point of perforation is essential to adequate surgical treatment. It is postulated that this is the reason for the higher postoperative mortality following closure of the perforation and proximal colostomy (57 per cent) or exteriorization alone (43 per cent), compared with resection of the diseased segment and exteriorization (32 per cent). Resection and exteriorization is therefore the treatment of choice is most situations.

Adolescent↗
PubMed1990

A prospective study of bilateral inguinal hernia repair.

A prospective study of outcome after inguinal hernia repair in patients undergoing simultaneous repair of bilateral hernias (n = 31), sequential repair of bilateral hernias (n = 5), and unilateral hernia repair (n = 75) is reported. There were no differences in wound complications, post-operative respiratory complications, or other adverse effects in the three groups. Operating time was similar in the unilateral and bilateral simultaneous repairs (median 55 min), but was longer (100 min) for the combination of two sequential repairs. Hospital stay was shortest for patients undergoing unilateral repair (2 days) but was less with bilateral simultaneous repair (4 days) than after two sequential repairs (total of 6 days). There were 12 (11%) wound complications of which five (5%) were infections. There was no difference in complication rate between unilateral and bilateral hernia repair. Postoperative recovery was assessed prospectively and was recorded at 1 month. There was no difference between unilateral and bilateral simultaneous repairs in the number of days before the patient was able to climb stairs easily, drive a car or return to work. The duration of the requirement for analgesia was similar in each group. We conclude that bilateral simultaneous hernia repair can be carried out with no greater morbidity than a unilateral repair, and the return to normal activity is as rapid. Bilateral hernias should be repaired simultaneously rather than sequentially.

Adolescent↗
PubMed1989

Obstructing carcinomas of the colon.

A series of 908 cases of colonic carcinoma has been analysed to elucidate reasons for the poor prognosis in obstructing colonic cancer. Complete obstruction was present in 148 cases (16.3 per cent), 280 cases (30.8 per cent) had partial obstruction and 480 (52.8 per cent) presented without obstruction. There were fewer Dukes' A tumours in those with complete obstruction (P less than 0.005) and greater numbers of advanced tumours (P less than 0.0005) compared with those without obstruction. This is reflected in a lower curative resection rate of 50.7 per cent in those with obstruction compared with 70.6 per cent in those without obstruction (P less than 0.001). However, after curative resection there was no significant difference in the distribution of tumour stage. Patients with complete obstruction showed a higher incidence of recurrence (P less than 0.01) after curative resection, consequent to an increased incidence of local recurrence (P less than 0.02). Five-year cancer-specific survival for the total series was decreased from 59.1 per cent in patients without obstruction to 31.8 per cent in those with complete obstruction (P less than 0.001). After curative resection there was also a significant reduction in survival (P less than 0.001). It is concluded that completely obstructing colonic cancers are more aggressive than other colonic cancers.

Adult↗
PubMed1988

Giant inguinal hernia.

Giant inguinal herniae present a major challenge in management. This case details clinical features of an enormous inguinoscrotal hernia associated with septic gangrene and elephantiasis of the scrotum. Two initial operations were required for control of sepsis, followed by a two-staged hernial repair, involving a total colectomy and a subsequent neoscrotal repair. The problems of loss of domain within the abdominal cavity and the special features presented by this case are discussed.

Colectomy↗