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Biomedical subjects

M Killingback

Publications and source records attributed to M Killingback.

10 recordsLinked to original sources
PubMed1989

Rectal bleeding. Do other symptoms aid in diagnosis?

It has been shown previously that it is difficult for a general practitioner to predict anal vs. colorectal sources of bleeding in patients presenting with rectal bleeding. The aim of the present study was to determine whether there are any aspects of such a patient's history or clinical features that strongly indicate bleeding from a colorectal cancer or polyp. One hundred forty-five consecutive patients, aged 40 years and older, who had complained of rectal bleeding to a general practitioner, were referred to a specialist for full colonic investigation. Among 15 symptoms and clinical features examined, few had any statistically significant association with the source of bleeding. There was an elevated probability of colorectal cancer (21 percent) in patients who had seen blood mixed with feces. Most bowel symptoms and clinical features are not helpful in deciding whether to proceed with full colorectal assessment in patients aged 40 and older who have rectal bleeding of recent onset.

Adult↗
PubMed1979

Fibreoptic colonoscopy. Indications, results and complications.

Fibreoptic colonoscopy was commenced in the Edward Wilson Colon and Rectum Unit at Sydney Hospital in June, 1973. The experience of the first five years of its use is reported. Six hundred and twenty-six examinations have been performed in 568 patients. Fibreoptic colonoscopy has been of particular value in the diagnosis and treatment of colonic polyps. A total of 318 polyps were removed from 184 patients. Their distribution, size and histological features are recorded. Eight complications occurred in the 628 examinations (1.6%). There were six colonic perforations (1.2%) with one death, and two significant haemorrhages (0.4%). This incidence of complications is acceptably low, especially in view of the great benefits obtained by the patient from fibreoptic colonoscopy. The newer instruments, especially the medium length Olympus MB3 colonoscope, have greatly facilitated the examination and, combined with increasing experience, may significantly lower the incidence of complications in the future.

Adolescent↗
PubMed1979

Low anterior resection.

A personal series of 93 patients treated by low anterior resection for carcinoma (87) and benign disease (6) is reviewed to highlight the technical problems and complications of the operation. The series comprises two groups for comparison of (i) technique of anstomosis; (ii) the use of protective stoma; and (iii) methods of drainage.

Adult↗
PubMed1979

Elective resection for diverticular disease.

A series of 119 patients undergoing elective resection for diverticular disease has been reviewed. The indications for resection were classified into two major groups--those with severe infections ("complicated" diverticulitis), comprising 58 patients, and those with minimal infections, comprising 61 patients. The majority of the resections were limited to the sigmoid colon (101 patients). Fifteen patients underwent left hemicolectomy, whilst three had total colectomy. Thirty-six patients (30%) had a proximal defunctioning stoma--18 prior to resection and 19 at the time of resection. Anastomotic defects were noted in 15 patients (12.6%), but these were of clinical significance only in eight (6.7%). There were two deaths (1.7%) and 17 wound infections (14.3%). The group classified as "complicated" diverticulitis included the great majority of the patients requiring colostomy (32 out of 37), almost all those with anastomotic defects (14 out of 15), and most of the patients who had postoperative complications.

Acute Disease↗
PubMed1979

Rectal prolapse.

One hundred and twenty-seven patients with complete rectal prolapse have been reviewed. The condition occurred more commonly in females than males (105 to 22), and at an older age in females (mean age 55 years compared with 40 years for males). Although the diagnosis is usually obvious, the importance of recognizing occult prolapse is stressed, especially in association with benign rectal ulcer, localized proctitis and colitis cystica profunda. Examination of the patient in the squatting position may assit in showing occult prolapse. Associated incontinence occurred in 33 patients (26%). Since 1971 the policy of this Unit has been to perform a Ripstein repair for complete rectal prolapse wherever possible. One hundred and two Ripstein repairs have not been performed. A minimum follow-up period of two years is available for 53 patients, of whom 50 (94%) have had their prolapse cured. Control of prolapse usually improves continence; however, seven (13%) remained incontinent despite surgery. The Ripstein repair is strongly advocated as the most effective operation for cure of complete rectal prolapse.

Adolescent↗
PubMed1979

Ileostomy reconstruction.

A study of 47 patients undergoing ileostomy reconstruction is presented. The most common indications were recession (15 patients) and a desire for a continent type of ileostomy (12 patients). Less frequent indications were stenosis (6 patients), parastomal ulceration (6 patients), prolapse (4 patients), unsatisfactory siting (3 patients), and parastomal hernia (1 patient). Refashioning of the ileostomy at the same site was possible in 17 patients, whilst repositioning at a new site was required in 30 cases. In 28 of these laparotomy was carried out to enable repositioning, but in two cases resiting was performed without laparotomy. After the original operation, reconstruction may become necessary at any time from a few months to over 20 years.

Adolescent↗
PubMed1979

The surgical treatment of anal incontinence.

This study is review of 31 patients undergoing surgery for anal incontinence. Three groups of patients are defined--those with incontinence due to trauma (nine patients), to a combination of trauma and degeneration (five patients), and to degeneration alone (17 patients). Two surgical techniques were used--either a direct repair of the anal sphincter or a postanal repair of the levator ani muscles and external sphincter (Parks operation). In the trauma group and the combined group the more common method used was a direct repair (ten patients)--five underwent a Parks operation. In the degeneration group all but one patient underwent a Parks operation. A defunctioning proximal colostomy was carried out in only four patients--all with incontinence due to trauma. Satisfactory continence was restored in 80% of these patients. Although this is a small series, the results are considered worthwhile and greater awareness and use of the above technique is recommended.

Adult↗
PubMed1979

Colostomy closure: technique and morbidity.

A personal retrospective series of 100 consecutive colostomy closures performed between 1968 and 1978 is reviewed. Serious intraabdominal complications occurred in three patients. The total complication rate in this series was 29%. There were no deaths and no faecal fistulae. However, wound infection occurred in 22 patients.

Adolescent↗
PubMedDate not supplied

Local excision of carcinoma of the rectum: indications.

To discuss indications for local excision of adenocarcinoma of the low rectum, two different series of patients were analysed. Series I consisted of 60 patients treated by local excision from 1969 to 1985 in whom local recurrence developed. Series II consisted of 59 patients who underwent resection for non high grade tumors less than or equal to 3.5 cm from 1980 to 1990 in whom lymph node spread was studied. A distinction is made between tumors which are obvious cancers and malignant polyps, and the discussion of indications for local excision is orientated to the former. The results of local excision have been disappointing but a number of compromise selections for local excision have been necessary. Endorectal ultrasound has emerged as the most important method of assessing the depth of invasion of the tumor. Stratifying the depth of the tumor is at present the most important prognostic indicator for lymph node metastasis and local recurrence in non high grade tumors. If the muscle layer is invaded by tumor, local metastasis will occur in 17% of patients. It is likely that only tumors involving superficial layers of muscle are suitable for local excision, but this needs further study. Mucinous carcinomas and the presence of lymphatic invasion are contra-indications to local excision. The shape and size of tumors are not independent prognostic indicators. The techniques available for local excision alter the indications. Salvage operations for recurrence after local excision have proved disappointing.

Adenocarcinoma↗