Biomedical subjects
Publications and source records attributed to M G Wyatt.
A case of primary squamous cell carcinoma of the caecum arising in a tubulo-villous adenoma is described. This rare lesion develops following genomic derangement of the multipotential colonic stem cells. The literature is reviewed and factors contributing towards squamous cell differentiation discussed.
Explore the source record for details and available documents.
The delay involved in operating on emergency general surgical patients is often excessive. This problem has been examined prospectively in a district general hospital with a catchment population of 450,000. Over a 16-week period, the details of 204 consecutive general surgical emergency operations were recorded and analysed. Following essential resuscitation, the median delay in operating on emergency general surgical patients was 3 h. Eighty-eight patients had to wait in excess of 1 h, with 15% experiencing a delay of over 6 h. In only 10% of cases was a theatre required after midnight, yet 26% of all emergency general surgical operating was performed between midnight and 8 am. The majority of delays were due to a combination of factors; theatre delay was mentioned in 47% of cases, anesthetic delay in 30% and the overrunning of routine lists in 14% of cases. Our results suggest that unnecessary theatre delay results in an unacceptable number of emergency general surgical operations occurring after midnight. It is important that routine afternoon lists do not overrun, as this contributes directly to evening theatre delay. If both theatre and anaesthetic availability could be ensured in the afternoon and early evening, the after midnight workload could be cut from 26% to 10%, and staff sleep deprivation reduced.
Thirty-four patients admitted to the Bristol Royal Infirmary during the 20-year period 1966-85 and diagnosed as suffering from high grade parotid carcinoma were studied. The male:female ratio was 2.4:1, with a mean age at presentation of 68 years. Facial swelling was present in all patients with a mean duration of 9.9 months before treatment. Pain, deep fixation, facial nerve involvement, ulceration and distal metastases were all associated with a poor prognosis. Diagnosis was made either at operation or by fine needle biopsy. All 34 patients received radiotherapy. Fourteen patients (41 per cent) underwent a definitive surgical procedure. The local recurrence rates for the non-surgical and surgically treated groups were 30 per cent (six patients) and 36 per cent (five patients) respectively; twelve patients (60 per cent) in the non-surgical group developed distant metastases as opposed to six patients (43 per cent) in the surgical group. Both local and distant recurrent disease are indicators of poor prognosis, with only one patient alive at 104 months. Seven patients (21 per cent) remain recurrence free. Definitive surgery, combined with radiotherapy, improved survival in those with amenable localized disease.
With an ageing population the demand for prostatectomy in the over 80-year-olds is increasing. This study assesses the place of prostatectomy in this age group. All patients over the age of 80 who underwent prostatectomy in a 2-year period were studied retrospectively; 90 such patients underwent 94 operations, 90 of which were TURPs. Serious concomitant disease was found in 64 patients (71%) and 11 (12%) had had a previous prostatectomy at least 1 year before. The mean weight of tissue removed was 24.8 g. In 18 men histology showed malignant change. Two men died from cardiovascular disease immediately after surgery (2.1%); a further 5 patients (7.8%) died within 6 months. Post-operative morbidity was high, with 64 patients (71%) developing complications. These were related to pre-operative urinary tract infections and uraemia. Nevertheless, at 6 weeks 72 patients (80%) were considered to have had a satisfactory result. Prostatectomy in the over 80-year-old has a good long-term outcome. Although the morbidity rate is high, these patients should be considered for operation provided they undergo careful pre-operative assessment.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Six patients developed colorectal carcinoma in association with Crohn's disease. The cancer was diagnosed at a mean age of 46 years and a mean 19 years after the onset of Crohn's disease. Five carcinomas arose in the chronically inflamed segment of bowel, while a sixth arose in caecum previously bypassed for Crohn's ileitis. Four carcinomas were mucinous, four presented with fistula and four were treated by complete removal of the large intestine. Three patients have died of residual or recurrent cancer. The data support an aetiological link between Crohn's proctocolitis and carcinoma.
The mechanism of gastrointestinal villous damage following ionizing irradiation is complex. Various compartments within the gastrointestinal tract have in turn been considered important for the maintenance of normal villous structure. To date, however, evidence for a single overriding regulator of epithelial well-being is lacking. In this study, the role of the gastro-intestinal (enteroendocrine) cells is explored and comparison made between endocrine cell number and villous structure. Experiments were organised using both control and irradiated groups of mice. Two time points (1 and 3 days) and three radiation doses (6, 10 and 18Gy) were employed. A simple method for endocrine cell identification and subsequent quantification is described. Endocrine cell number was then compared with villous surface detail, as seen with a scanning electron microscope (SEM). Results indicated a decrease in the endocrine cell number at all three radiation doses. Whereas at low doses endocrine cell recovery occurred between 1 and 3 days, at medium and high doses further decline was noticed. A similar pattern was seen when considering villous surface structure. It is suggested that both scanning electron microscopy and endocrine cell number provide a more sensitive indicator of gastrointestinal radiation damage than do current crypt counting techniques. In addition, a link between endocrine cell number and villous structure is proposed.
Explore the source record for details and available documents.
A 71-year-old patient with high-output cardiac failure was found to have an aneurysmal distal aorta with evidence of an arteriocaval fistula on ultrasound scanning. CT demonstrated an aneurysm of the distal aorta and right common iliac artery and an intraarterial digital subtraction angiogram confirmed an arteriocaval fistula. In view of the patient's cardiac failure and general condition an endovascular stent was considered. The right internal iliac artery was occluded with Tungsten coils prior to the insertion of a bifurcated stent-graft. This resulted in total occlusion of the aneurysm and obliteration of the arteriocaval fistula. To our knowledge such a case has not been previously reported.
Femoro-distal vein grafts for limb salvage have a 30% failure rate at 6 months. Graft surveillance may enable the "at risk" grafts to be recognised and corrected, but there remains the need for a simple test to identify these patients. The ankle pressure response to exercise and reactive hyperaemia has been investigated prospectively in 40 "at risk" femoro-distal non-reversed grafts (median age 73 years, range 51-87 years, M/F = 33:7), defined as those with a resting ankle brachial index less than 0.9 or a drop of greater than 0.2 following a stress test. Four different stress tests have been assessed; active ankle plantar-dorsiflexion for 2 minutes (I), occlusive calf cuff 50 mmHg above systolic pressure for 2 minutes (II), treadmill exercise test for 1 minute, slope = 10%, at 3 km/hr (III) and 4 km/hr (IV). Ankle brachial indices (ABI's) were recorded before and immediately following each test and expressed as mean % drop +/- standard error of mean. Test I was only tolerated by 45% of patients whereas 55% and 50% could complete tests III and IV respectively. By contrast, 85% of patients could tolerate occlusive cuff hyperaemia (test II). Test I produced a significantly lower mean percentage drop in ABI when compared with each of the others (p less than 0.02, Mann U Whitney). There was an excellent correlation between test II and both the 3 km/hr (r = 0.77, p less than 0.001) and 4 km/hr (r = 0.84, p less than 0.001) exercise tests.(ABSTRACT TRUNCATED AT 250 WORDS)