Biomedical subjects
Publications and source records attributed to M E Foster.
Groin injuries are a common and often difficult diagnostic problem. This paper reviews six patients presenting with symptoms highly suggestive of the syndrome 'Gilmore's groin', but in whom the pathophysiology of the groin disruption and its surgical management differed from Gilmore's description.
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A retrospective study of 110 patients, out of a total of 743 open cholecystectomies, who have undergone common bile duct (CBD) exploration for stones between 1985 and 1990. CBD exploration was performed in the presence of abnormal peroperative cholangiogram in 86 (78%) patients. The remaining 24 patients were known to have either an abnormal preoperative ERCP or palpable ductal stones at the time of surgery. Post exploratory choledochoscopy was performed as an additional completion procedure in 58 (53%) patients and it identified further stones in 28 (48.3%) of these patients. There were three patients in whom no stones were identified on exploration of the CBD. Documented evidence of peroperative antibiotic prophylaxis was obtained in 78 (71%) patients. A total of 27 (24.5%) patients developed complications including seven (6.4%) patients with retained stones. In four of these patients with retained stones, flexible choledochoscopy was undertaken as an additional completion procedure to ensure ductal clearance. Cardiorespiratory and septic complications were the next most common problems occurring in 6.5% and 5.4% respectively, of patients reviewed. In conclusion, the retained stone rate has fallen from 14% in 1987 to 6.4% in this study. The choledochoscope has influenced this as it identified further residual stones following conventional exploration. The sepsis rate has also fallen from 19.5% to 4.5% in this study. We believe this is due to the use of antibiotic prophylaxis.
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A study was undertaken to compare open cholecystectomy with laparoscopic in terms of patient related variables. This was not a randomized study but compared two groups of patients treated at different times. A number of variables were assessed. The study showed that each method was equally effective in treating symptomatic gall stone disease. Very few significant differences, in terms of the patients' perceptions of the procedures, were found, although the trend appeared to favour the laparoscopic procedure.
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Since January 1989 a policy of day-case surgery has been adopted for suitable paediatric procedures by one firm (MEF) at East Glamorgan Hospital. There have been 184 children treated to date, with an age range of 4 weeks to 13 years. There were 58 circumcisions, 48 hernias, 35 orchidopexies, 18 hydrocoeles and 25 miscellaneous procedures performed with no significant complications. All children were given a general anaesthetic, 42 procedures (22%) were performed using endotracheal intubation, the remainder with a facemask. Postoperative analgesia was provided in most cases by local wound infiltration with bupivacaine 0.25%. The average length of stay before January 1989 was 3 days and 2 nights for similar cases. Cost analysis shows significant potential financial savings of 105 pounds per patient treated. The implications for future planning are discussed.
The results of treatment in 22 patients with anal carcinoma are reviewed. The overall results are disappointing with only five (28%) surviving more than 5 years. The commonest form of treatment during the study period was an abdomino-perineal excision of rectum (APER). For patients with tumours less than 2 cm in diameter local excision is an acceptable alternative. The majority (76%) of tumours were diagnosed as common benign conditions by the referring practitioners leading to a delay in initiating definitive treatment. Most tumours (81%) were greater than 2 cm in diameter and therefore unsuitable for local excision. There was a high recurrence rate (76%) amongst the group treated by APER. This along with the poor overall survival is probably due to late presentation.
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Xenograft tumours from an oestrogen-dependent human breast cancer cell line MCF-7 have been established and characterised in thymectomised, irradiated female CBA strain mice. There was evidence for selection in xenografts of a subpopulation of MCF-7 cells with an altered pattern of gene expression as measured by mRNA levels compared with the original cells in vitro. Tumorigenicity increased significantly on repeated animal passage but oestrogen dependence was retained. Following injection of the mice with oestrogen, mitosis was induced in the tumour cells with associated increases in thymidine uptake and percentage of cells in S-phase. In accord with these changes, c-myc and p53 expression were increased and TGF-beta was suppressed. Thereafter the expression of the c-myc and p53 genes fell whilst that of the TGF-beta gene was induced as the oestrogenic-stimulus declined. The oestrogen-regulated mRNA pS2 showed a biphasic response to oestrogen and levels declined as the serum oestrogen fell to undetectable levels. This xenograft system demonstrates that changes in transcription of oncogenes, growth factor and oestrogen-regulated genes can be detected in vivo in response to oestrogen. It thus provides an in vivo model for studies of the biochemical and molecular basis for therapeutic manipulation of hormone-sensitive human breast cancer.
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The importance of bowel preparation in elective colorectal surgery has often been stressed. We have surveyed the current practice of bowel preparation and chemoprophylaxis amongst surgeons in Wales and the south-west of England. From this we identified one surgeon who used no preoperative preparation and his results are reported in detail. One hundred consecutive colorectal cases were studied from one surgeon (J.M.P-T.). There was a 7% incidence of wound infection and one anastomosis leaked. None of these patients had mechanical bowel preparation but all had antibiotic chemoprophylaxis. Mechanical bowel preparation is usual in the UK. These results demonstrate that its importance as a factor in wound infection and anastomotic dehiscence may be overstated.
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