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Biomedical subjects

M C Winslet

Publications and source records attributed to M C Winslet.

At least 55 records · Page 3Linked to original sources
PubMed1993

On-table pneumoperitoneum in the management of complicated incisional hernias.

'On-table' pneumoperitoneum before repair of 'complicated' incisional hernias has been used in eight patients considered to be at high risk of recurrence. In four patients the procedure revealed the presence of occult defects. The procedure was uncomplicated and a primary repair without the need for a prosthetic implant was possible in all cases. Six patients remain well with no sign of recurrence at a median follow-up of 96 months (range 22-120 months). Two patients died from conditions unrelated to the method of repair; acute necrotising pancreatitis on the 10th postoperative day and lobar pneumonia 2 months postoperatively. Peroperative pneumoperitoneum is a simple procedure which obviates the need for a prosthetic implant in selected patients. It is therefore particularly useful in the management of incisional hernias associated with sepsis, stomas or in patients requiring synchronous bowel resection.

Aged↗
PubMed1992

Reduction of mucosal crypt cell proliferation in patients with colorectal adenomatous polyps by dietary calcium supplementation.

The crypt cell production rate was measured in 14 patients with adenomatous colorectal polyps, 17 patients with colorectal cancer and 12 control subjects. The median (interquartile range) rate (cells per crypt per hour) was found to be significantly higher (P less than 0.001) in the polyp (2.45 (1.94-3.20)) and cancer (3.01 (2.35-3.68)) groups compared with controls (1.25 (0.70-1.85)). A double-blind cross-over study was performed in patients with adenomatous polyps consisting of 2 months' treatment, 2 weeks' washout, followed by 2 months' treatment with dietary calcium supplementation (1.25 g day-1) versus placebo. A significant reduction in the crypt cell production rate occurred with calcium treatment compared with the placebo (1.25 (0.6-2.25) versus 2.15 (1.58-3.08) cells per crypt per hour, P = 0.035). This study demonstrates a significant reduction in mucosal cell proliferation by dietary calcium supplementation in patients with adenomatous polyps. Such treatment may be worthy of further investigation in patients at high risk of developing colorectal polyps.

Aged↗
PubMed1991

Assessment of the defunctioning efficiency of the loop ileostomy.

The defunctioning efficiency of the loop ileostomy has been assessed using a radioisotope and dye technique. The median defunctioning capacity in patients without episodes of fecal discharge per rectum (n = 18) was 99.99 percent and was not affected by body position or the formation of a dependent stoma. In patients (n = 4) who passed fecal material per rectum but who had no stomal retraction, the median defunctioning efficiency was 99.99 percent, and continued fecal discharge was considered to be due to mucopurulent secretion from active distal disease. In patients who passed fecal material per rectum and also had a retracted stoma (n = 4), the defunctioning efficiency was significantly reduced (median = 84.70 [31.2-99.10 percent; P less than 0.01]), owing to the overspill into the distal limb. Two patients underwent stomal revision, with an improvement in defunctioning efficiency to 99.99 percent.

Adolescent↗
PubMed1991

Loop ileostomy after ileal pouch-anal anastomosis--is it necessary?

Construction of a loop ileostomy is usually advised in patients having an ileal pouch-anal anastomosis to minimize the complication of chronic pelvic sepsis. Formation and closure of a loop ileostomy was associated with a 41 percent and 30 percent complication rate, respectively, in a prospective series of 34 patients. This morbidity must now be assessed in relation to the benefits of avoiding temporary fecal diversion in restorative proctocolectomy.

Adolescent↗
PubMed1991

Biliary acute pancreatitis.

Severe biliary acute pancreatitis is frequently associated with persisting bile duct stones, which has important implications with regard to management. In mild cases, cholecystectomy with operative cholangiography during the same admission is the treatment of choice. In patients with a severe attack, however, management remains controversial. There is increasing evidence to suggest that early biliary decompression with endoscopic sphincterotomy is associated with a lower morbidity and mortality than a conservative regime. In certain situations endoscopic sphincterotomy may also obviate the need to explore the common bile duct, and in high-risk patients may allow surgery to be avoided altogether.

Acute Disease↗
PubMed1990

Conservative proctocolectomy with low transection of the anorectum is a poor alternative to conventional proctocolectomy in inflammatory bowel disease.

The perineal wound is a frequent source of morbidity following proctocolectomy for inflammatory bowel disease. In 8 patients low transection of the anorectum or conservative proctocolectomy has been performed as an alternative to proctocolectomy in order to avoid a perineal wound. All patients passed copious mucoid discharge per anum post-operatively. Five patients required a proctectomy, 2 remain symptomatic and 1 patient has undergone a restorative proctocolectomy. This small series suggests conservative proctocolectomy does not seem to offer any advantage over conventional proctocolectomy in the surgical management of inflammatory bowel disease.

Adult↗
PubMed1990

Diffuse increase in renal uptake of technetium 99m methylene diphosphonate in association with disseminated cholangiocarcinoma.

A 48-year-old woman presented with disseminated cholangiocarcinoma and diffuse joint pain. A technetium 99m methylene diphosphonate bone scan revealed no bony abnormality, but intense bilateral renal uptake was seen. There was temporary renal impairment following imaging, but the cause of this is uncertain. An association between cholangiocarcinoma and 'hot kidneys' on bone imaging scanning has not been previously reported.

Adenoma, Bile Duct↗
PubMed1990

Short-term chemoprophylaxis with ceftizoxime vs. five-day aminoglycoside with metronidazole in 'contaminated' lower gastrointestinal surgery.

In a prospective, open, randomized controlled trial, 173 patients requiring surgery for potentially "contaminated" lower gastrointestinal surgery were allocated to receive either two doses of ceftizoxime (2 gm) with one dose of metronidazole (1.5 gm) or gentamicin 3 mg/kg/day for five days with one dose of metronidazole (1.5 gm). Eighty-nine patients received ceftizoxime and 84 patients received gentamicin. The groups were comparable with respect to diagnosis, procedure, type of anastomosis, and wound closure. The incidence of withdrawal due to failure to respond to the study drug (11.5 percent) was equivalent in the two groups. There was no difference in the overall incidence of postsurgical infection between the ceftizoxime and metronidazole group (22.2 percent) and the gentamicin and metronidazole group (25.7 percent). The incidence of wound infection (ceftizoxime and metronidazole, 6.9 percent; gentamicin and metronidazole, 10 percent) and deep sepsis (ceftizoxime and metronidazole, 15.3 percent; gentamicin and metronidazole, 15.7 percent) was similar.

Aminoglycosides↗
PubMed1990

Wernicke's encephalopathy in association with complicated acute pancreatitis and morbid obesity.

A young obese female with acute pancreatitis complicated by pseudocyst formation and intermittent gastric outlet obstruction, who had been maintained on high-calorie enteral feeds, developed a sudden onset of confusion and ophthalmoplegia associated with papilloedema and retinal haemorrhages. A possible diagnosis of Wernicke's encephalopathy (WE) was made, and the patient was treated with parenteral thiamine. Clinical resolution was complete. Any patient with suspicious or unusual neurological symptoms and signs associated with possible malnutrition, hyperemesis or malabsorption should be given intravenous thiamine without delay to avoid the potential morbidity and mortality associated with undiagnosed WE.

Acute Disease↗
PubMed1989

Multivariate analysis of factors influencing the results of restorative proctocolectomy.

Univariate and multivariate analyses have been used to assess the influence of 14 variables on the results of 65 consecutive ileoanal pouch procedures over 5 years. There were nine failures requiring intubation, ileostomy or pouch excision. There was a significant association between failure and pelvic sepsis (P less than 0.05, n = 8), endoanal mucosectomy (P less than 0.05, n = 7), preservation of a long rectal cuff (P less than 0.05, n = 5) and lack of experience with the operation (P less than 0.05, n = 8). Of 49 patients with preoperative evidence of ulcerative colitis, three are now known to have Crohn's disease. Functional outcome was significantly impaired in patients who developed pelvic sepsis (P less than 0.01) or a postoperative fistula (P less than 0.05), and who had an endoanal mucosectomy (P less than 0.05). Success with ileoanal pouch reconstruction increases with experience. Avoidance of sepsis is associated with a lower failure rate, improved functional results and reduced hospital stay. Preliminary colectomy is also advised to exclude Crohn's disease if the diagnosis is in question.

Adult↗