Biomedical subjects

R Symmonds

Publications and source records attributed to R Symmonds.

6 recordsLinked to original sources

PubMed2001

Breast conservation in the treatment of breast cancer: community-based experience.

BACKGROUND: Results of large, randomized studies in the 1980s established wide excision and radiation as an accepted breast cancer treatment approach. We evaluated our initial results with this treatment in the community setting. METHODS: We evaluated the frequency and outcome of breast conservation treatment in 303 women with invasive ductal carcinoma from 1985 to 1995. RESULTS: The frequency of breast conservation treatment increased from 9% during 1985 to 1989 to 24% during 1990 to 1995. With a median follow-up of 4.7 years, there were 19 (6%) ipsilateral recurrences. Metastatic disease occurred in 23 patients (8%). Overall 5-year survival was 95%, and 5-year recurrence-free survival was 90%. Twelve patients died of breast cancer. CONCLUSIONS: Increased use of breast conservation in our community practice parallels the national trend, with similar treatment results. Our findings suggest the successful integration of research-proven innovations into community practice.

Breast Neoplasms↗

PubMed1993

Combined laparoscopic and endoscopic management of cholelithiasis and choledocholithiasis.

With the advent of laparoscopic cholecystectomy, optimal management of common duct stones remains controversial. Seven hundred six patients underwent laparoscopic cholecystectomy in our institution from January 1990 through January 1992. From this group of patients, 50 were identified as having clinical or radiographic evidence of common duct stones. Thirty-one patients demonstrated preoperative risk factors for common duct stones and underwent preoperative endoscopic retrograde cholangiopancreatography (ERCP). The risk factors included jaundice (19%), pancreatitis (23%), elevated liver function tests (52%), and ultrasound evidence of choledocholithiasis (6%). Preoperative ERCP was performed in 94% of patients. There were two failures due to periampullary diverticula. Common duct stones were identified in 18 patients (62%) and successfully removed by endoscopic sphincterotomy in all of these patients. Nineteen patients were found to have unsuspected common duct stones on intraoperative cholangiography. Eighteen patients (95%) underwent successful ERCP and endoscopic sphincterotomy with stone extraction. Overall, major morbidity was 2% and included one patient who experienced endoscopic sphincteroplasty. The three endoscopic failures were managed by open common duct exploration, laparoscopic duct exploration, and combined laparoscopic and open common duct exploration. We conclude that combined laparoscopic and endoscopic therapy is a viable option for the management of cholelithiasis with choledocholithiasis.

Cholangiopancreatography, Endoscopic Retrograde↗

PubMed1992

Prospective, randomized trial of inpatient vs. outpatient bowel preparation for elective colorectal surgery.

A prospective, randomized trial of inpatient vs. outpatient bowel preparation for elective colorectal surgery was performed in 100 consecutive patients. Bowel preparation was standardized for both groups and consisted of 4 liters of Colyte (Reed & Carnrick, Piscataway, NJ) and oral neomycin and Flagyl (G. D. Searle & Co., Skokie, IL) the day before surgery. Patients were randomized into four subcategories: ileocolostomy, colocolostomy, abdominal perineal resection, and other. Tap water enemas were administered on the morning of surgery to ensure and adequate mechanical preparation. Ninety-six percent of the inpatient group and 97 percent of the outpatient group were able to drink three-fourths or more of the oral lavage preparation (P = 0.789, Fisher's exact text). A mean of 2.26 tap water enemas was required to achieve clear returns for the inpatient group, compared with 2.28 tap water enemas for the outpatient group (P = 0.221, Fisher's exact test). The adequacy of the bowel preparation as graded by the primary surgeon was good (84 percent), fair (12 percent), and poor (4 percent) in the outpatient group (P = 0.673, Fisher's exact test). Wound infection developed in 4 percent of the inpatient group and 4 percent of the outpatient group (P = 1.0, Fisher's exact test). Anastomotic leak of intra-abdominal abscess was seen in one patient in each group (P = 1.0, Fisher's exact test). We conclude that outpatient bowel preparation is as effective as inpatient bowel preparation for elective colorectal surgery and offers the advantage of cost savings and shorter hospitalization.

Adult↗

PubMed1992

What are the contraindications for laparoscopic cholecystectomy?

Acute cholecystitis, morbid obesity, and previous upper abdominal surgery have been reported as relative contraindications to laparoscopic cholecystectomy. An analysis of 706 laparoscopic cholecystectomies performed at our institution was undertaken to determine if these relative contraindications led to increased morbidity, an increased rate of conversion to the open technique, or longer operating time. One hundred ninety-seven patients demonstrated one or more relative contraindications to laparoscopic cholecystectomy. Morbidity was not increased in patients with these risk factors, but conversion to open cholecystectomy was required in a greater percentage of patients with acute cholecystitis. We favor an attempt at laparoscopic cholecystectomy in patients with these risk factors; however, they should be counseled as to the increased risk of conversion to open cholecystectomy in the presence of acute cholecystitis.

Abdomen↗

PubMed1991

Laparoscopic cholecystectomy: a multicenter study.

Laparoscopic cholecystectomy has been developed as an alternative to open cholecystectomy for the treatment of symptomatic cholelithiasis. A collaborative study of 261 patients undergoing laparoscopic cholecystectomy at three Texas institutions was performed to determine the effectiveness and safety of this technique. There were 65 males and 196 females with a mean age of 49 years (range 17-94 years). Acute cholecystitis was present in 38 patients and chronic cholecystitis in 223 patients. Mean length of surgery was 80 minutes (20 min to 4 hr). Fifteen patients were converted to the open technique intraoperatively due to bleeding, adhesions, or difficulty of dissection. There were no perioperative deaths and morbidity was 3% including urinary retention, small bowel obstruction, arrhythmia, wound infection, and bile leakage. There were no common duct injuries. Hospitalization ranged from outpatient surgery to 7 postoperative days with a mean of 1.2 days. We conclude that laparoscopic cholecystectomy can be performed safely and with low morbidity and offers shorter hospitalization and postoperative recovery.

Adolescent↗

PubMed1983

Coexisting carcinoid tumor and Crohn's disease.

Several malignancies have been described occurring simultaneously with regional enteritis. Only four examples of coexistent carcinoid and Crohn's disease have been described worldwide. In this report, two new cases of simultaneous Crohn's disease and carcinoid tumor, diagnosed and treated within a single month, are presented. In one instance, a segment of terminal ileum contained regional enteritis, carcinoid tumor, and a small focus of adenocarcinoma.

Adenocarcinoma↗