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Biomedical subjects

O H Beahrs

Publications and source records attributed to O H Beahrs.

At least 19 recordsLinked to original sources
PubMed1989

Quality of life after Brooke ileostomy and ileal pouch-anal anastomosis. Comparison of performance status.

Although the clinical results of Brooke ileostomy are good, patients are permanently incontinent of stool and gas. Alternative operations designed to restore enteric continence, such as ileal pouch-anal anastomosis, must not only be as safe and effective as Brooke ileostomy, but should provide an improved quality of life in order to establish long-term acceptability. Ileal pouch-anal anastomosis has been performed safely and good functional results have been reported. The quality of life after ileal pouch-anal anastomosis, however, has not been documented. Two hundred ninety-eight ileal pouch patients and 406 Brooke ileostomy patients who had the operations performed for chronic ulcerative colitis or familial adenomatous polyposis formed the basis of the study. After adjusting for age, diagnosis, and reoperation rate, logistic regression analysis of performance scores in seven different categories was used to discriminate between operations. Median follow-up was longer in Brooke ileostomy patients than in ileal pouch patients (104 months vs. 47 months, respectively), and Brooke ileostomy patients were slightly older (38 years vs. 32 years). A great majority of patients in each group were satisfied (93% Brooke ileostomy; 95% ileal pouch-anal anastomosis). Thirty-nine per cent of Brooke ileostomy patients, however, desired a change in the type of ileostomy they had. At 47 months, ileal pouch patients had a median of 5 stools per day and 1 at night, 77% did not experience any daytime incontinence, while 22% reported occasional spotting. In each performance category, the performance score discriminated between operations, with the probability of having had an ileal pouch-anal anastomosis operation increasing with improvement in performance scores (p less than 0.05). We concluded that after ileal pouch-anal anastomosis, patients experienced significant advantages in performing daily activities compared to patients with Brooke ileostomy and thus may experience a better quality of life. These results help further to establish ileal pouch-anal anastomosis as a safe, attractive, and valid alternative to Brooke ileostomy.

Activities of Daily Living↗
PubMed1988

Modified and complete neck dissection in the treatment of squamous cell carcinoma of the head and neck.

The relative merits and indications for complete or modified dissection of the neck are straightforward. Which operation is selected centers on the perception of the value of the preservation or the risk with the loss of one or more of three structures: the spinal accessory nerve, the internal jugular vein and the sternocleidomastoid muscle. If these were the only issues, the choice of operation would be easy. Unfortunately, some of the most contentious issues in treatment of metastasis to the neck have been linked with the concept of the modified neck dissection. Such issues as combined multimodality therapy, preoperative and postoperative radiation therapy or surgical treatment alone, prophylactic dissection and bilateral simultaneous dissection of the neck are rightly or wrongly tied in with the type of dissection of the neck. More information, such as the certainty of the real risk factors in the neck with metastatic disease, the real value, if any, of adjunctive combined therapy and basic information about the role of the nodes in the neck, is necessary before the debate on the modified versus the radical dissection of the neck will end.

Carcinoma, Squamous Cell↗
PubMed1986

Continent ileostomy and ileoanal procedures.

It is fortunate today that several alternatives are available for reconstruction of the intestinal tract when proctocolectomy is required in the management of inflammatory diseases of the colon or multiple neoplastic diseases. The Brooke ileostomy proves to be very satisfactory and is acceptable to the majority of patients but does require the continual wearing of an appliance. For patients with chronic ulcerative colitis and a poorly functioning anal sphincter or one that is diseased, a continent ileostomy is the preferred procedure. However, in patients with a normally functioning anal sphincter, an ileoanal anastomosis, most often with a "J" pouch, is the first alternative procedure to be considered because evacuation following this operation is through the normal route and requires no equipment. For patients with granulomatous colitis (Crohn's disease), it seems best to consider only the Brooke type of ileostomy because of the risk of recurrent inflammatory disease involving the ileum. However, for colonic ulcerative colitis and familial polyposis, either the continent ileostomy or the ileoanal anastomosis is the preferred procedure to be considered. Dozois has reviewed in detail the technical aspects of the various surgical procedures, the indications for their use, the results that can be expected, and the comments of many of the contributors to the advances in the management of patients requiring proctocolectomy and one method or another of re-establishing a means for bowel evacuation. With the various alternatives that are available today and the excellent results that can be expected when patients are properly selected, more patients with diseases of the colon and rectum requiring proctocolectomy can be offered the benefits of surgical treatment, returning them to society and improving their quality of life.

Anal Canal↗
PubMed1986

Gross anatomy in medical education.

The present state of human gross anatomy in medical education can generally be characterized as the presentation of a large bolus of information that is swallowed and only partly digested during the first year of medical school. The subject is often taught in a depth beyond that which would be relevant to all physicians irrespective of their future professional careers. This condition has resulted from adaptive adjustments to the escalating discrepancy between a rapidly expanding knowledge base in science and technology and the relatively fixed time period for education of a physician. Initially, traditional courses retained their comprehensive character, and new information was simply piled on top of existing departmental offerings. It soon became obvious that there would have to be a reduction in time devoted to established courses and a reciprocal expansion of time to accommodate newly developing sciences. Such adjustments were painful and often led to conflicts about what comprises essential knowledge in medical education. Thus, the curriculum time devoted to human gross anatomy has been significantly reduced to accommodate new knowledge in cellular and sub-cellular structures and other disciplines. That common foundation of knowledge, skills, values, and attitudes essential to all physicians regardless of specialty is ever-changing and often debated by medical school faculty members. However, two facts are generally agreed upon: that today's medical student with a broad but perhaps thin base in science and limited direct clinical experience is not competent upon graduation to assume patient care responsibilities without supervision and that as a result, the formal education of a physician has expanded into the graduate domain.(ABSTRACT TRUNCATED AT 250 WORDS)

Anatomy↗
PubMed1985

Neck dissection and combined therapy. Study of effectiveness.

Data on 1,385 neck dissections in 1,192 patients were studied to evaluate the effectiveness of treatment with operation alone and with various forms of combined therapy in controlling cervical metastasis. Of the 1,192 patients, 837 were treated by operation (neck dissection) alone, and the remainder had preoperative or postoperative radiation to the primary site and to the entire side of the neck that was dissected. In no stage of neck disease was either form of combined therapy superior to operation alone in decreasing the rates of recurrence. In an attempt to simulate a randomized, prospective study in a clinical situation for which the end results were already known, we used a separate statistical analysis--a case-control technique to specifically address the issue of the effectiveness of postoperative radiation in decreasing the frequency of recurrences after dissection in the various stages of disease. No evidence of a relationship between recurrence and the administration of planned postoperative radiation was found.

Carcinoma, Squamous Cell↗
PubMed1984

Staging of cancer of the breast as a guide to therapy.

Staging of a cancer of the breast reflects the anatomic extent of the tumor either at the time of diagnosis prior to treatment based on clinical, diagnostic, and biopsy information or at the time of postsurgical resection when all pathologic information obtained or studied of the resected specimen is used. In the future, chemical or biological markers may add another dimension to staging. There have been several schemes suggested for staging breast cancer, but the current recommendation of the American Joint Committee on Cancer (AJCC) jointly with the TNM Committee of the International Union against Cancer (UICC) should be universally used. More complete definitions of staging of the primary tumor (T), nodes (N), and distant spread (M), are discussed in this report. It is stressed that, obviously, the smaller a cancer and the earlier it is diagnosed has a greater influence on therapy.

Breast↗