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Biomedical subjects

R J Heald

Publications and source records attributed to R J Heald.

At least 73 records · Page 4Linked to original sources
PubMed1990

Hepatic resection for colorectal secondaries.

A postal survey of consultant surgeons in England and Wales was carried out to assess current attitudes towards screening for and treatment of hepatic metastases from primary colorectal carcinoma. The results showed that pre-, intra- and postoperative screening were inadequate. There was no consensus as to which patients would benefit from major hepatic resection for colorectal liver secondaries. Fewer than one-third of potentially operable patients underwent liver surgery.

Attitude of Health Personnel↗
PubMed1990

'Close shave' in anterior resection.

Of 192 anterior resections for rectal cancer performed over 10 years by one author (R.J.H.), 169 (88 per cent) included total mesorectal excision and all included lavage of the clamped distal rectum. Of this series, 152 (79 per cent) were classed as curative, 110 with a resection margin greater than 1 cm and 42 with a resection margin less than or equal to 1 cm. The group with a greater than 1 cm margin had a significantly lower Dukes' A to B ratio than the group with a margin less than or equal to 1 cm, although the proportion with Dukes' C lesions was similar in both groups (chi 2 = 6.712; P = 0.035). There were no local recurrences in the latter group (95 per cent confidence interval (CI) is 0-5.9 per cent) while there were four (3.6 per cent) in the former group (95 per cent CI is 0.8-7.4 per cent). There were no significant differences in recurrence rates, local and distant, between the two groups (Fisher's exact test, P = 0.2). Reduction of resection margin, provided total mesorectal excision and washout is properly performed, does not increase local recurrence or compromise survival.

Aged↗
PubMed1990

Sigmoid invasion as a late complication of mucinous cystadenoma of the appendix. Report of a case.

A cystic mass arising from the right iliac fossa was an incidental finding at laparotomy and was treated conservatively after a biopsy had shown no evidence of malignancy. Nine years later the patient presented with shock and colonic bleeding. A large cystic lesion arising from the vermiform appendix and invading the sigmoid colon was found and excised. Histologic examination indicated that the underlying lesion was an inflamed mucinous cystadenoma of the appendix. Frank invasion of viscera by such lesions has not previously been described. Complications of such lesions and their association with other colonic neoplasms are discussed.

Aged↗
PubMed1990

Operative and functional results of total mesorectal excision with ultra-low anterior resection in the management of carcinoma of the lower one-third of the rectum.

Eighty-one patients underwent anterior resection with curative (n = 57) or palliative (n = 24) intent for tumors below 7 centimeters from the anal verge. If a right angled clamp could be applied below the tumor at operation after full mobilization of the mesorectum and rectum, the procedure was performed in preference to abdominoperineal excision. The mean follow-up time was 4.8 years. Of the curative group, 26 had lesions within 5 centimeters of the anal verge. Thirty-one per cent were Dukes' A; 37 per cent, B, and 32 per cent, C lesions. The margin of distal clearance ranged from 2 to 35 millimeters. In five patients, squamous mucosa was observed in the distal doughnut. Serious postoperative complications occurred in 17 per cent of the curative series, one-half of which occurred within the first two years of the study period. In six patients, the temporary colostomy has not been closed. The incidence of local recurrence in the curative series was 3.5 per cent, and the over-all survival rate was 81 per cent at five years. Full continence was achieved within two years of closure of the colosomy in 85 per cent of the patients. In the palliative group, 11 of the 19 patients had temporary colostomies and 80 per cent were continent within six months of operation. The technique of total mesorectal excision and sphincter preservation by stapled coloanal anastomosis in the treatment of carcinomas of the lower one-third of the rectum may be an alternative to abdominoperineal excision. The final decision in such instances is made intraoperatively. The operative and functional results are satisfactory, but it is difficult to anticipate the patients who will not do well by preoperative criteria. Even in palliative procedures, low anterior resections provided satisfactory continence. Serious postoperative complications were more likely to occur if full mobilization of the splenic flexture was not routinely performed.

Adult↗
PubMed1990

Achievement of stomal continence in one-third of colostomies by use of a new disposable plug.

A multicenter trial was established to assess the use of a new disposable colostomy plug in achieving stomal continence during four weeks in patients with established colostomies. Forty-six of the 100 patients evaluated completed the trial, of whom 41 stated that they would wish to use the system regularly. Twenty-nine of the 41 continue to use the plug daily since the trial finished. The remainder withdrew mainly during the early stages of the trial because of leakage (ten patients), discomfort (11) or difficulties (12), all largely related to extrusion of the plug from the colostomy. There were no discernible features to predict in whom the plug was beneficial. Patients who irrigated the colostomy retained the plug longer (16.5 hours), on average, than those with natural evacuation (8.5 hours). However, even in the latter, the time increased with use of the system (week 1, 7.5 hours; week 4, 9.8 hours). Longer periods of retention of the plug appeared to be associated with improved stomal continence. Results from this trial confirm the potential of the Conseal Colostomy System incorporating a disposable colostomy plug to restore continence and improve life-style in more than one-third of patients with colostomies.

Adult↗
PubMed1989

Management of the pelvic space following low anterior resection.

Four cases of low anterior resection without pelvic drainage are described. The outcome was unsatisfactory in three of the four patients. The role of pelvic drains and omentum in the management of the pelvic space following low anterior resection for rectal cancer is reviewed and discussed. Pelvic drains are required to remove blood and omentum may be used to fill the pelvic space. Pelvic collections are related to anastomotic leakage and the optimal management of the pelvic space can reduce the incidence of this complication. A suggested regimen for management of the pelvic space after low anterior resection is outlined.

Aged↗
PubMed1989

Long-term recurrence patterns following proximal gastric vagotomy.

Two hundred and forty-two consecutive patients were prospectively followed up following elective proximal gastric vagotomy (PGV) for duodenal, pyloric or prepyloric ulceration. There was no operative mortality and no case of lesser curve necrosis. Five to 15 years follow-up have been completed. One hundred and eighty-three patients were assessable (80% of survivors) and 29 of 33 symptomatic patients attended for endoscopy. Fourteen recurrent ulcers had been diagnosed previously and six new recurrences were diagnosed, giving a total recurrence rate of 11%. Seven of these were transient/innocuous and 13 (7%) were chronic/malevolent recurrences. The majority (70%) of recurrences occurred in the first 5 years of follow-up and only one recurrence occurred later than 10 years' follow-up. More than half (56%) of the operations were performed utilizing Burge intra-operative testing and 44% without Burge testing. No difference in recurrence rates was apparent between these two groups. In seven patients with pyloric or prepyloric ulceration, three (43%) developed a chronic recurrence. PGV is a safe, surgical treatment for duodenal ulceration, offering acceptable recurrence rates and a very low mortality and low incidence of side-effects. The majority of recurrences occur early in the follow-up period. Burge intra-operative testing provides no clear reduction in recurrence rates. PGV should not be used for pyloric or prepyloric ulceration.

Adolescent↗
PubMed1986

Randomised trial of compliance with screening for colorectal cancer.

A randomised trial of compliance with screening for colorectal cancer by means of the haemoccult test was conducted in Farnborough and Basingstoke districts. In each of the 14 participating practices (41 general practitioners) 25 852 men and women aged between 40 and 70 years were randomly allocated by household to one of six groups. The group determined the method of invitation to screening: a letter and the test were sent to the patient, or a letter with an appointment to attend the surgery was sent, or during a routine consultation the general practitioner invited patients to participate, and some patients received an educational booklet about bowel disorders and screening. Of the 17 824 people who were offered screening, 7545 (42%) complied. Compliance was significantly affected by the method of invitation, but not by whether an educational booklet was received, and was highest (57%) in the group that was offered the haemoccult test during a routine consultation (the "opportunistic" approach). In this group the compliance rate achieved by individual general practitioners ranged from 26% to 82%. Compliance was significantly higher in Farnborough, in the older (55-70) age group, in women, and in households in which two or more people were offered screening. The higher compliance in Farnborough may be explained by the higher proportion of older people and by the higher proportion of people living in households of two or more in the population that was offered screening. The fact that the screening programme in Farnborough was offered to the whole community and that the researcher may have acted as a facilitator were probably also important. One per cent of the patients screened had a positive test, and 24 (38%) of the 63 patients who were positive and were investigated in hospital had neoplastic disease. The yield was 1.2 cancers and 1.2 benign adenomas (1 cm or larger in size) per 1000 people screened. This low yield is likely to be a consequence of the relatively young age group screened.

Adult↗
PubMed1986

Recurrence and survival after total mesorectal excision for rectal cancer.

A 7 1/2-year consecutive series is presented from a district hospital with a policy of referring all rectal carcinomas to one surgical firm. The performance of lower anterior resections has limited the rate of abdominoperineal excision with permanent colostomy to 11%. Of 115 patients in whom curative resection was attempted, 69 had anastomoses below 5 cm and 39 had mural resection margins of less than 2.5 cm. Surgical priority, however, was given to complete excision of the visceral rectal mesentery or mesorectum. At an average of 4.2 years postoperatively, three pelvic recurrences have developed but there have been no staple-line recurrences in patients who had "curative" surgery. The corrected cumulative probability of survival at 5 years is 87% and the tumour-free survival by Dukes stage is A 94%, B 87%, and C 58%. Patients with low tumours did no less well than those with high tumours, when treated by anterior resection. On this evidence, it is often safe to limit mural clearance and thus preserve the anal sphincters, provided that the mesorectum is excised intact with the cancer.

Follow-Up Studies↗