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Biomedical subjects

R J Moorehead

Publications and source records attributed to R J Moorehead.

At least 37 records · Page 2Linked to original sources
PubMed1991

Current management of trauma to the pancreas.

This review examines pancreatic trauma and its management in the light of recent experience. The incidence, mechanism, classification, diagnosis, treatment and complications of pancreatic trauma are discussed. The difficulty in establishing the diagnosis is addressed and possible solutions are provided. The case for conservative surgery in the absence of pancreatic duct damage is outlined. The importance of draining all pancreatic injuries is emphasized.

Abscess↗
PubMed1991

Hepatic trauma and its management.

This review examines the current management of trauma to the liver. The incidence, mechanism, classification, diagnosis, treatment and complications of hepatic trauma are discussed. Diagnosis of hepatic injury may be difficult and specific investigations are suggested. Non-operative treatment and the strict criteria necessary to identify suitable patients for this are assessed. The recent trend to conservative surgery in hepatic trauma is reviewed. Aggressive resuscitation and early control of bleeding are crucial and are emphasized.

Humans↗
PubMed1991

Carcinoma of the gallbladder: a diagnostic challenge.

Since the introduction and availability of abdominal ultrasound and computed tomography, 38 patients have been admitted to the Department of Surgery, Queen Mary Hospital, University of Hong Kong with a subsequently confirmed histological diagnosis of carcinoma of the gallbladder. The majority of patients presented with abdominal pain, anorexia or weight loss, jaundice, and anaemia or an abdominal swelling. Abnormal liver function tests were found in 70-90%. Cholangiography, ultrasound and particularly computed tomography helped to confirm clinical suspicion when performed but 23 patients (61%) had an inaccurate diagnosis made before surgery. Operative intervention was only of benefit when the carcinoma was confined to the gallbladder (median survival after cholecystectomy alone 13 months; other procedures 2 months; P less than 0.01). Carcinoma of the gallbladder carries a poor prognosis but ultrasound and computed tomography can help select patients for appropriate treatment (surgery, endoscopic stenting, radiotherapy, chemotherapy) if clinical suspicion is raised.

Adult↗
PubMed1990

Does preoperative computed tomography scanning aid assessment of oesophageal carcinoma?

In this study 50 patients (36 male, 14 female) with oesophageal carcinoma have been examined preoperatively by computed tomography. Three parameters were assessed, nodal involvement, invasion of adjacent organs, and metastatic disease. For all patients the computed tomography findings were correlated with the subsequent surgical and pathological findings. Sensitivity for both invasion and node involvement is low (36% to 67%). Specificity however, is high (85% to 95%). Computed tomography is therefore relatively reliable when it predicts a 'negative result' for either invasion or node involvement. However, its predictive value for a positive result is not as reliable.

Adult↗
PubMed1990

Gangrene in esophageal substitutes after resection and bypass procedures for carcinoma of the esophagus.

In 760 resection and bypass procedures for esophageal cancer, 30 patients (3.9%) developed gangrene in the esophageal substitute. The incidence in resection cases was similar to those who were bypassed. The important factors in its development were the length and type of organ used as an esophageal substitute. Gangrene was almost exclusively seen when the upper anastomosis was in the neck; the lowest incidence occurred when stomach was used (1%), while the highest was seen with jejunum (11.3%) and colon (13.3%).

Anastomosis, Surgical↗
PubMed1990

Wound sepsis in 10,000 surgical patients.

A twelve year prospective wound audit was undertaken in an academic surgical unit. Data from 10,000 operations were analysed. Overall, wound infection rates decreased during this time. Infection rates in contaminated wounds in particular fell from 19.2% to 4.7%. This decrease in wound infection may be related in part to a change in the antibiotic prophylactic regimen and in part to the institution of the wound sepsis audit which provided regular information on the unit infection rates. This audit permitted early detection of adverse trends, and may have had a direct influence on surgical techniques.

Cephalosporins↗
PubMed1989

Combined arterial and venous intraluminal shunting in major trauma of the lower limb.

A road accident victim was admitted in shock with an injured lower limb virtually dismembered at mid-thigh level. The early use of intraluminal shunts bridging both femoral artery and vein permitted an unhurried but logical sequence of wound debridement, bone stabilisation and optimal vascular repair rendering fasciotomy unnecessary. This approach led to an uncomplicated survival of the limb with eventual return of function.

Adult↗
PubMed1989

Cholecystectomy and the development of colorectal neoplasia: a prospective study.

One hundred asymptomatic patients over 60 years of age who had cholecystectomy carried out at least 10 years earlier underwent double contrast barium enema and sigmoidoscopy. The incidence of colorectal adenomas and carcinomas was compared with age and sex matched controls undergoing routine post mortems. In the post-cholecystectomy group 12% had tumours (8 adenomas greater than 1 cm in diameter, 4 carcinomas). In the control group 3% had tumours (3 adenomas); P = 0.02. This study confirms that patients with a history of cholecystectomy have an increased risk of developing colorectal adenomas and carcinomas.

Adenoma↗
PubMed1987

Assessment of ornithine decarboxylase activity in rectal mucosa as a marker for colorectal adenomas and carcinomas.

We have investigated the role of ornithine decarboxylase activity in rectal mucosa as a marker for colorectal neoplasia. Biopsies of normal rectal mucosa were taken from 18 patients with adenomas greater than 1 cm diameter, 11 with carcinomas and 16 controls. The mean ornithine decarboxylase activity in normal rectal mucosa of adenoma patients, 6.52 nmol CO2 released h-1 (mg cell protein)-1, was significantly lower than that in controls, 16.8, P = 0.006. The difference in rectal ornithine decarboxylase activities between cancer patients, 3.58, and controls was also significant, P = 0.001. These preliminary results suggest that ornithine decarboxylase may be a useful marker in screening for colorectal neoplasia.

Adenocarcinoma↗
PubMed1987

Relationship between duodenal bile acids and colorectal neoplasia.

To investigate a possible relationship between bile acids and colorectal neoplasia duodenal bile acids were analysed in 50 patients with colorectal adenomas and 14 with carcinoma. Using gas liquid and high performance liquid chromatography a small, but significant increase in the proportion of chenodeoxycholic acid was found in the bile of adenoma patients compared with controls (mean % +/- SD 31.0 +/- 10.8, 26.4 +/- 8.3, p = 0.01). The difference in the proportions of chenodeoxycholic acid correlated with increasing malignant potential of the adenomas as determined by increasing size, histological type, degree of dysplasia and number present. In carcinoma patients an increase in the proportion of chenodeoxycholic acid was also observed compared with controls (mean % +/- SD, 47.2 +/- 9.6, 28.0 +/- 4.5, p less than 0.01). The proportions of other bile acids in those with adenoma or carcinoma were normal.

Adenoma↗
PubMed1986

Does cholecystectomy predispose to colorectal cancer? A case control study.

A case-control study of 598 patients with colorectal cancer (296 men, 302 women) admitted from January 1974 to October 1983 was undertaken. Patients were matched for age and sex, with controls admitted for unrelated conditions. All information was obtained from the hospital records. In men, there was no evidence of an increased risk of colonic cancer after cholecystectomy relative to men without cholecystectomy. There was some evidence of an increased risk in women (relative risk = 1.7; 95 percent confidence interval, 1.0 to 3.1) and this was highest when the tumor was in the right colon (P less than 0.005). This study confirms previous observations that cholecystectomy leads to an increased risk of right-sided colonic tumors in women but not in men. The apparent difference between the sexes may be explained by the low rate of cholecystectomy in the men examined.

Cholecystectomy↗
PubMed1985

Thymectomy for myasthenia gravis.

The results of 14 years' experience in the surgical treatment of myasthenia gravis are reported. Twenty-one patients (14 female, 7 male) underwent thymectomy for myasthenia gravis between 1971 and 1984. The mean age of the patients was 33 years (range 14 - 57 years). The median duration of symptoms prior to surgery was 18 months (range 5 months to 35 years). The mean follow-up was 5.3 years. There were no post-operative deaths: 76% obtained benefit from thymectomy. The patients' age, sex, duration of symptoms and histology of the thymus gland did not correlate with the result of treatment. This series suggests that, while thymectomy is often beneficial in the treatment of myasthenia gravis, there are no accurate predictors of the outcome following surgery.

Adolescent↗