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Biomedical subjects

R B Stephens

Publications and source records attributed to R B Stephens.

At least 19 recordsLinked to original sources
PubMed1995

Pilonidal sinus: management objectives.

In spite of a number of ingenious operative and non-operative techniques in the management of pilonidal sinus no single technique can be relied upon to prevent recurrence of this benign yet troublesome condition. Once thought to be a congenital condition it is now appreciated that pilonidal sinus most often an acquired condition due to accumulation of tough, bristly hair penetrating the skin, or local hair growing into a skin crevice, pit or abnormal follicle. The most common site is the upper natal cleft but the condition may occur in other sites especially where there is a crevice or irregularity of skin surface with pressure or suction applied to that region. Most surgical procedures have been designed to eradicate the existing sinus and the crevice in which hair tends to accumulate. However, without the presence of hair there can be no pilonidal sinus and, in the past, little attention has been given to preventing the re-accumulation of hair in the troublesome site; hence the risk of recurrence. Management objectives should be directed not only at eradicating the obvious lesion present but also to preventing recurrence of aetiological factors; especially the re-accumulation or re-growth of hair.

Hair↗
PubMed1994

Adhesions after laparoscopic inguinal hernia repair. A comparison of extra versus intra peritoneal placement of a polypropylene mesh in an animal model.

Prosthetic mesh for laparoscopic inguinal hernia repair has become popular but the method of its placement is controversial. Mesh placed within the peritoneum may cause adhesion formation and further complications. The aim of this study was to examine the laparoscopic placement of a mesh, comparing intraperitoneal vs extraperitoneal insertion. In a porcine model (n = 15) a polypropylene mesh was placed laparoscopically over the anterior abdominal wall. On the left side the mesh was stapled on the parietal peritoneum. On the right side the peritoneum was incised, an extraperitoneal space was dissected, the mesh was inserted, and the peritoneum was closed over it. The animals were maintained for 2 weeks. At postmortem there were adhesions in two of those placed extraperitoneally and five of those placed intraperitoneally (P = 0.19, Fisher's exact test). The adhesions comprised fibrous peritoneal bands to loops of small intestine. Both methods of laparoscopic mesh placement were associated with a small but significant incidence of adhesion formation.

Animals↗
PubMed1994

Cyclosporin treatment of atopic dermatitis: five case studies and literature review.

This study reports on five adult patients with severe atopic dermatitis who were treated in our department with a three month course of cyclosporin. All patients demonstrated significant clinical improvement with minimal side effects. We conclude that provided safety guidelines are observed, cyclosporin can be used with good effect in those patients where conventional treatment is unsatisfactory. This paper also reviews the use of cyclosporin in atopic dermatitis and includes a brief discussion of how it may alter pathophysiologic mechanisms.

Adolescent↗
PubMed1992

A prospective randomized trial of laparoscopic versus open appendectomy.

BACKGROUND: Laparoscopic appendectomy is feasible, but whether it confers any advantage to patients with acute appendicitis is not known. We performed a randomized controlled trial to compare results of laparoscopic and open appendectomy in patients with signs and symptoms suggesting acute appendicitis who were seen by one surgical team. METHODS: Sixty-two consecutive patients were randomized, 30 to laparoscopy and 32 to a classical open appendectomy. Postoperative recovery, complications, and return to normal activities were compared in the two groups. RESULTS: The laparoscopy group were discharged earlier (2.5 vs 3.8 days, p less than 0.01). Postoperative complications were more frequent after open appendectomy. Follow-up showed less pain, shorter bed stay at home, and faster return to work and sport after laparoscopic appendectomy. CONCLUSIONS: This prospective randomized study shows that laparoscopic appendectomy is superior to open appendectomy in terms of hospital stay, postoperative complications, and return to normal activities and is recommended as the approach of choice in the management of acute appendicitis.

Adult↗
PubMed1992

A prospective comparison of laparoscopic versus open cholecystectomy.

In one surgical unit, 115 patients undergoing cholecystectomy were studied to compare patient recovery, subjective and objective pain experienced and complications after laparoscopic and open cholecystectomy. The data were collected prospectively where allocation to open or laparoscopic cholecystectomy was by consecutive attendance. Laparoscopic cholecystectomy was feasible in 90% of patients presenting with symptomatic gallstones. Compared with the open operation, laparoscopic cholecystectomy was safe with less peroperative and postoperative morbidity, was more cost-effective and was associated with faster patient recovery as documented by less postoperative pain, earlier return to diet, earlier full mobilisation and discharge home. Laparoscopic cholecystectomy is superior to open cholecystectomy and should be available to all patients requiring elective cholecystectomy.

Adult↗
PubMed1991

Laparoscopy appendicectomy is feasible and safe in acute appendicitis.

Our initial experience of using laparoscopy to perform appendicectomy for appendicitis has shown that the operation is feasible, safe and as effective as open surgery in early appendicitis. The precise role of laparoscopic appendicectomy will need to be defined by a prospective randomised trial.

Acute Disease↗
PubMed1990

Ingrowing toenails: improving treatment.

Sixty-six patients with ingrowing toenails were randomly assigned to one of two treatment groups and followed up for 16 to 30 months after surgery. In group A 39 nail edges in 32 patients were treated by excision of the nail edge and chemical ablation of germinal matrix edge with 70% aqueous phenol. There were 34 patients in group B, in whom 46 nail edges and germinal matrix edges were surgically excised. In group A recurring symptoms developed in four (10%) nail edges, necessitating further surgery, and asymptomatic spicules developed in seven (18%) nail edges. Two (4%) nails in group B required reoperation and spicules developed in 10 (22%). Both procedures were performed as outpatient surgery, relieved pain and infection, and were acceptable to patients. At an average 2-year follow-up, both procedures yielded comparable results that were superior to those of simple avulsion.

Adult↗
PubMed1988

Diagnosis of significant abdominal trauma after road traffic accidents: preliminary results of a multicentre clinical trial comparing minilaparoscopy with peritoneal lavage.

A prospective multicentre study comparing the value of the recently introduced minilaparoscopy with peritoneal lavage in patients with abdominal trauma is in progress. To date 55 patients with blunt abdominal trauma have been entered into the study. Following initial resuscitation, 26 were randomised to peritoneal lavage and 29 to minilaparoscopy performed under intravenous sedation and local anaesthesia. The two groups were comparable with respect to age, sex, incidence of multiple injuries and mortality (2 patients in the lavage group and 1 in the minilaparoscopy group). A negative test was obtained in 15 patients subjected to lavage and 12 patients who underwent minilaparoscopy. A further four patients in the minilaparoscopy group were found to have a minimal static haemoperitoneum. All these patients were treated conservatively and none required surgical intervention on the abdomen. Thus neither investigation carried a false negative rate. A positive test was obtained in 11 patients in the lavage group and significant findings were observed in 13 patients assessed by minilaparoscopy. All these patients were subjected to emergency laparotomy. Absence of significant bleeding or trauma was observed at laparotomy in 3/11 (27%) and 1/13 (8%) in the lavage and minilaparoscopy groups respectively. Although both procedures were highly sensitive for the detection of significant intra-abdominal injury (100%), the specificity was 83% for peritoneal lavage and 94% for minilaparoscopy. The predictive value of a positive minilaparoscopic examination was 92% as opposed to a positive predictive value of 72% for peritoneal lavage.

Abdominal Injuries↗