Biomedical subjects
Publications and source records attributed to S J Walker.
The surgical options for the treatment of axillary hidradenitis suppurativa are discussed. A new light-weight splint is described which will allow comfortable immobilisation of the shoulder at 45 degrees yet permit full forearm movement and adequate access to the axilla for dressings. We have found the splint of benefit in the management of this conditions by promoting the primary healing of split skin grafts.
A case of traumatic hemisomato-tmesis is presented. The line of complete transection passed obliquely from the suprapubic skin to the lumbosacral junction. There were associated visceral injuries. We describe our experience of such a case and review the surgical options in the light of the current literature.
Thirty five subjects underwent upper gastrointestinal endoscopy and multiple biopsy (30 patients, five normal subjects). A total of 11 biopsies per subject from four sites (oesophagus (three), gastric body (two), antrum (three), duodenum (three] were examined for inflammation and the presence of Campylobacter pylori and using standard methods of culture and by light (LM) and electron microscopy (EM). The organism was cultured from oesophageal biopsies in eight of 30 (27%) patients but could not be identified at this site by LM or EM. There was evidence of oesophageal inflammation in 20 patients which was associated with the local finding of C pylori in five (25%) including two of seven (29%) with Barrett's mucosa. Antral C pylori was present in 22 of 23 (96%) patients with chronic active gastritis. The organism was found in the antrum and oesophagus in four of 22 patients (18%), in the antrum and duodenum in four of 22 patients (18%) and in all three sites in a further two of 22 patients (9%). Antral C pylori was found in five of six patients with peptic ulceration. C pylori was cultured from the duodenum in six patients with confirmation by LN and EM in three, but only on areas of gastric metaplasia. The organism was not found in the normal group. This study indicates that C pylori may be irregularly isolated from the oesophagus and duodenum in patients with antral C pylori and chronic active gastritis. The role of C pylori in the oesophagus is most likely that of a commensal or contaminant.
Two patients with primary small cell carcinoma of the oesophagus were treated by multidrug chemotherapy followed by surgical resection. A partial response to chemotherapy was observed in both patients.
Selection of therapy for carcinoma of the proximal esophagus is controversial. We reviewed our experience with 41 patients with carcinoma of the esophagus within 24 centimeters of the incisor teeth to address this issue. Thirty-seven patients had squamous cell carcinoma, three had adenocarcinoma and one patient had a mucoepidermoid carcinoma. Seventeen patients underwent surgical therapy, which consisted of a resection in 15, colonic bypass in one patient and extracorporeal bypass in one. Ten patients underwent postoperative radiation therapy. Radiation therapy was the primary treatment in 23 patients and chemotherapy alone in one patient. The three month mortality rate was similar for patients with tumor resection and for those receiving radiation therapy as the primary treatment. Median survival time for patients undergoing resection and adjuvant radiation therapy was 12 months and seven months for those receiving only irradiation. Statistical analyses were not performed because patients with radiation only had more advanced disease, invalidating comparison. In terms of palliation, ten of the patients who had radiation therapy could eat solid food, seven could only swallow liquids and six had persistent, complete obstruction. All 12 of the survivors who had a resection were able to eat solid food. Although the one month mortality rate is higher for those treated surgically than with radiation therapy, the three month mortality rates are similar. Surgical treatment provides better palliation and a reasonable survival time and is preferred for patients with resectable disease who are physiologically fit enough to undergo operation. A benefit of postoperative adjuvant radiation therapy is undefined but probably present.
The organism Campylobacter pylori is frequently found in association with gastritis and peptic ulcer disease. Whether it is the cause, a contributory factor or a simple commensal is not known but there is evidence to support a pathological role. Current research may alter our understanding of the causes of upper gastrointestinal disease and have important implications for treatment.
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From the survey and research, it appears that sterile or non-sterile waterproof Indian ink used for tattooing patients produces few reported side effects and problems considering the number of patients tattooed. Marker pens also seem to be entirely suitable for patients and for radiotherapy centre requirements.
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We investigated the mechanism and significance of ST segment changes in inferior infarction by studying 100 patients with acute inferior infarction in whom body surface maps were recorded on admission. The magnitude of the maximum ST segment elevation (denoted Vmax) and magnitude of the maximum ST segment depression (denoted Vmin), as well as the ST depression on the standard 12-lead electrocardiogram were analyzed against morbidity and mortality (at a median follow-up time of 14 months). A value obtained by subtracting Vmax from Vmin correlated (p less than .0002) with outcome. Correlations were also found between Vmin and complications, Vmin and mortality, and between increasing levels of ST depression on the 12-lead electrocardiogram and mortality. The maps were also studied by grouping the 100 ST segment map patterns into five groups by cluster analysis techniques. One group showed marked anterior negativity and had 37% mortality compared with an overall 5% mortality for the remaining groups. The limited arteriographic and autopsy data available indicated that the findings of a diseased artery or arteries corresponded with the results of mapping. The mean map patterns of the five groups showed that, in most patients with inferior infarction, the standard chest leads V1 to V6 are over a region of steep voltage gradient. Small changes in the position of the standard chest lead can cause large changes in the displayed potentials. This study indicates that patients at high risk after acute inferior infarction can be identified by surface mapping on admission to the coronary care unit.
We have developed computer algorithms that enable epicardial potential distributions to be calculated from electrocardiographic body surface data. To validate this inverse transformation we obtained body surface maps during the ST segment in 55 patients with acute infarction who subsequently underwent coronary arteriography and we constructed epicardial ST segment potential distributions for each patient. From the unlabeled epicardial maps one of us predicted the coronary artery that would be found to be involved in the infarction. These predictions were compared with the results of coronary arteriography and this showed that the analysis of the epicardial map correctly predicted the coronary artery involved in 40 of 55 patients (72.7%). In another eight patients the anatomy was partially predicted. In the 15 patients in whom the prediction was incorrect or partially correct (27.3%), 11 had critical disease or occlusions of the predicted coronary artery but the infarct-related artery was incorrectly identified. This verifies that sensible epicardial potential maps can be calculated from body surface electrocardiographic data, and that these data are sufficiently accurate to predict the vessel involved in acute infarction.
An automated method of modelling the electrical properties of the human thorax from horizontal section data such as computerized tomographic scans has been used to develop both forward and inverse transformations between epicardial and body surface potential distributions. Eleven torso models with varying geometry and organ configurations have been studied. For the forward calculations, a standard dipole-like source is placed along the axis of the heart. Inverse calculations are performed using a measured body surface potential distribution and are based on a division of the surface of the heart into 25 source regions, producing epicardial potentials on these regions. A regularization method is used to stabilize the inverse solutions. Both forward and inverse solutions show substantial differences between models. These findings imply that matching models with patient geometry may be necessary in order to use such solutions in a clinical setting.
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A number of plating and enrichment media proposed for the isolation of Yersinia enterocolitica from foodstuffs were examined for their ability to recover the type strains of Y. enterocolitica sensu stricto, Y. intermedia, Y. frederiksenii and Y. kristensenii. Nine selective plating media were evaluated for the quantitative recovery of the type strains in pure culture, and their inhibition of other organisms typical of both milk and enteric microfloras. Cefsulodin-irgasan-novobiocin (CIN) agar, incubated for 48 h at 25 degrees C, allowed a high recovery of all the Yersinia spp. and was the most selective medium. The same four type strains were added to UHT milk that had been previously inoculated with bacteria to simulate either freshly drawn or cold stored milk microfloras. Twenty-six enrichment procedures (including cold enrichment, selective enrichment at higher temperatures, two-step procedures and a post-enrichment alkali treatment) were assessed for the efficiency of recovery of the Yersinia spp. Pre-enrichment in trypticase-soy broth (TSB) for 24 h at 22 degrees C followed by selective enrichment in bile-oxalate-sorbose (BOS) medium for 5 d at 22 degrees C and plating on CIN agar (48 h at 25 degrees C) allowed the greatest increase in the numbers of Yersinia spp. and maximum inhibition of the competing microflora.
Yersinia enterocolitica and Y. enterocolitica-like bacteria were frequently isolated from samples of both raw bulked milk (34/150) and farm bottled (raw) milk (5/20). These bacteria were also found to contaminate creamery pasteurized milk (6/100 samples) and farm pasteurized milk (4/50 samples). Although Y. enterocolitica was the most commonly isolated species, Y. intermedia and Y. frederiksenii were also frequently obtained (52, 31 and 15% of isolates, respectively). Also, one atypical strain was identified as Y. aldovae. The Y. enterocolitica strains were largely biotype 1 (20/27) including five strains which could ferment lactose. One third of the Y. enterocolitica strains were not typable, but of those which were, the serotypes were 0:34 (18.5%), 0:5.27 (18.5%), 0:6.3 (15%), 0:4 (11%) and 0:7 (4%). Pre-enrichment in trypticase-soy broth (TSB) (at 22 degrees C for 24 h) followed by selective enrichment in bile-oxalate-sorbose broth (at 22 degrees C for 6 d) allowed the recovery of 92.3% of all isolates, as compared with 15.4% using cold enrichment in TSB at 4 degrees C for 21 d.
We have reviewed 105 Liverpool Mark II knee replacements in 71 patients to assess survival and long-term results. Assessment was both clinical and radiological, using a modification of the British Orthopaedic Association knee function assessment chart, and analysis was by the survivorship method as advocated by Tew and Waugh. The follow-up period was between 13 and 113 months with 42 prostheses being in situ for over six years. Eight knees (7.6%) have been revised or arthrodesed because of infection or loosening, giving a cumulative success rate of 89% after seven years based on prosthesis survival alone. Of the remaining knees, 71.1% were either free of pain or caused only minimal pain. The cumulative success rate as judged by the stricter criteria of the prosthesis being in situ and causing little or no pain suggested a 50% survival between 73 and 96 months. Most patients (77.3%) were enthusiastic or satisfied with their results. Complications included deep wound infection (8.6%), and loosening which needed further surgery (11.4%).