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Biomedical subjects

S R Thomson

Publications and source records attributed to S R Thomson.

At least 55 records · Page 3Linked to original sources
PubMed1998

Sequelae of cholecystojejunostomy for benign intrapancreatic biliary strictures.

The case histories of 5 patients who presented with recurrent jaundice following cholecystojejunostomy for biliary decompression of benign intrapancreatic strictures were studied. Four developed episodes of severe cholangitis 2-9 years after their initial operation. A subsequent surgical intervention was undertaken in 3 patients, 2 of whom died from cholangitis. The fourth patient experienced 3 episodes of cholangitis, declined surgical intervention and died. The fifth patient presented 4 months after the first procedure with a transient cholangitis. Cholelithiasis and cholangitis may take several years to develop but seem inevitable when cholecystojejunostomy is used to decompress benign biliary obstruction. Its use in suspected benign biliary obstruction should be abandoned.

Adult↗
PubMed1997

Review of 1198 cases of penetrating cardiac trauma.

BACKGROUND: This study was a clinicoforensic analysis of the prevalence and outcome of traumatic cardiac injuries in Durban. METHODS: Between 1990 and 1992, 1198 patients sustained cardiac trauma. Seventy (6 per cent) reached hospital alive and 1128 (94 per cent) were taken directly to the mortuary. Seven hundred victims had suffered stab wounds, 494 gunshot wounds and four blast injuries. Gunshot injuries increased from 34 per cent in 1990 to 50 per cent in 1992. The mean (s.d.) age was 30.5 (5.4) years and the majority (91 per cent) were men. RESULTS: Thirty-five (50 per cent) of those who reached hospital alive died, including all four gunshot victims. Significant factors associated with survival were isolated injury, the presence of cardiac tamponade (univariate and multivariate analysis), right ventricular injury, single cardiac chamber injury and absence of pleural breach (univariate analysis alone). Delay in operative intervention was associated with a higher mortality rate. When analysing the patients who did not reach hospital alive, 202 (18 per cent) with tamponade due to an isolated stab wound were identified as a subset who might have been saved with prompt treatment. CONCLUSION: An increasing number of gunshot injuries in combination with delays in reaching hospital and in receiving treatment accounted for the high mortality rate in this unselected series.

Adolescent↗
PubMed1996

Lymphocyte subsets in the endometrium of genitally normal mares and mares susceptible to endometritis.

The density and distribution of MHC Class II positive cells and subpopulations of lymphocytes were studied in the endometrium of genitally normal mares and mares susceptible to endometritis. In genitally normal mares, more MHC Class II positive cells were present in the epithelium and stratum compactum during oestrus than dioestrus. Significantly more CD4+ and CD8+ lymphocytes were present in the stratum compactum than in the stratum spongiosum. CD4+ lymphocytes were present in greater numbers than CD8+ lymphocytes in the stratum compactum but approximately equal numbers were present in the stratum spongiosum and in lymphoid aggregates. Occasional CD4+ and CD8+ cells were seen in the luminal and glandular epithelium. Infrequently, B cells were present in the endometrium and were not observed in the epithelium. Numbers of T and B cells did not appear to be affected by cycle stage. In mares with endometritis, the densities of CD4+, CD8+ and B cells were significantly increased. Large aggregates of lymphoid cells which contained approximately twice as many CD4+ cells as CD8+ cells were present in the endometrium of these mares and all 3 subclasses of lymphocyte were seen occasionally in luminal and glandular epithelium.

Animals↗
PubMed1996

Immunolocalization of aromatase P-450 in ovarian tissue from pregnant and nonpregnant mares and in ovarian tumours.

Aromatase P-450 (P-450arom) is a crucial regulatory enzyme that is necessary for conversion of androgens to oestrogens. Corpora lutea and follicles were obtained from the ovaries of cyclic mares and from mares at day 20 and days 40-70 of pregnancy. The presence of P-450arom within specific cell types was investigated by immunostaining to determine potential sites of oestrogen synthesis. Immunoreactivity for P-450arom was confined to the granulosa layer of non-atretic follicles > 5 mm in diameter and to corpora lutea at all stages of the oestrous cycle and during pregnancy. These findings confirm that aromatization of androgens occurs within the granulosa cells of the preovulatory follicle of the mare and that the corpus luteum of the mare has the capacity for oestrogen production if adequate androgen substrate is available. Granulosa cells in ovarian tissue from three mares with granulosa cell tumours showed little staining for P-450arom which suggests that these tumours have little aromatizing capacity.

Animals↗
PubMed1996

Prospective audit of multiple penetrating injuries to the colon: further support for primary closure.

Solitary colon injuries are being increasingly managed by intraperitoneal primary closure. The optimal management of the colon wound in multiple injuries of the colon, which have a high mortality, has not been determined. From 1983-1989, 668 patients sustained colonic injuries. In 71 of these patients the colon was injured at more than one site. Of the 597 single injuries to the colon, 472 (79%) were due to stabs and 102 (17%) to gunshot wounds. Sixty-eight men and three women sustained injuries at more than one site in the large intestine. The median age of patients was 26 years (range 13-66). In 61 patients the colon was injured at two sites and in seven patients at three sites. Three patients had more than three sites injured. The injuries were inflicted by: gunshots 35 (49%); stabs, 30 (42%); shotguns, three; and blunt trauma, three. Forty-one patients were treated by intraperitoneal primary closure (IPC) and 30 by a colostomy procedure or exteriorization of the primarily sutured colon (EPSC). Penetrating Abdominal Trauma Index (PATI) scores were high at 32 +/- 6, and were similar for all methods of colon wound management. Twenty-four patients were suffering from shock on admission, 13 of those patients were treated by primary repair and 11 were treated by an exteriorization procedure. Individuals treated by an exteriorization procedure stayed in hospital significantly longer, 45 days versus 21 days (P < 0.004) and had a higher mortality rate, five deaths versus one death (P < 0.04) than those patients who were primarily repaired. Intraperitoneal primary closure of all wounds is the method of choice for the majority of multiple injuries. Colostomy procedures or EPSC contribute to morbidity and mortality.

Adult↗
PubMed1995

Restoration of continuity following pancreaticoduodenectomy.

Current controversies surrounding restoration of gastrointestinal continuity after pancreaticoduodenectomy are reviewed. The optimum method of reconstruction following this procedure remains debatable, particularly with regard to the pancreatic anastomosis. Pylorus-preserving pancreaticoduodenectomy is increasing in popularity. Pancreaticogastrostomy is associated with at least as low a morbidity rate as pancreaticojejunostomy and is a safe alternative.

Anastomosis, Roux-en-Y↗
PubMed1995

Morphological aspects of microarterial anastomoses: a comparison of nylon with polydioxanone.

The morphological appearance of longitudinally sectioned rat femoral arteries was determined in intact arteries and from 3 to 435 days after vessel division and anastomosis with either 9/0 gauge nylon or polydioxanone (PDS) in 26 animals. The purpose of the study was to establish the mechanisms and compare the quality of healing after microarterial anastomosis and to determine whether PDS was degraded before sufficient anastomotic healing had taken place. The results revealed that there was no difference in the process of healing or quality of anastomosis with either suture material. From 3 to 21 days post anastomosis, there was a progressive separation of the ends of vessels within the developing scar. Anastomotic patency was established and maintained at first by an adventitial overgrowth of fibroblasts and undifferentiated adventitial cells and later by the growth of a smooth myocyte scar that stretched between the cut ends of the vessel and over the intima in the form of elongated circumferential plaques. The vessel was morphologically healed by the 21st day. The sutures served little or no purpose in maintaining anastomotic integrity after the 5th day, being situated in the scar forming between the separating vessel ends. PDS was present within the vessel wall up to 120 days post anastomosis and was certainly intact at the time of morphological healing, suggesting that this material is safe as a microvascular suture.

Anastomosis, Surgical↗
PubMed1995

Gastroduodenal intussusception of a stromal gastric tumour.

An elderly patient presented with intermittent vomiting. The cause was a gastric tumour causing gastroduodenal intussusception. On excision and histological examination this was found to be a stromal tumour of uncertain malignant potential ('STUMP').

Aged↗
PubMed1994

Iatrogenic and accidental colon injuries--what to do?

PURPOSE: This study was designed to formulate management guidelines for a variety of rare iatrogenic and accidental injuries to the colon and rectum. METHODS: This review collates the available evidence in the literature. RESULTS: Both investigative and therapeutic maneuvers involving the colon, particularly endoscopy and radiographic contrast studies, are the most common cause of significant injury although the incidence is low. Even less common are injuries produced, at open surgery and minimally invasive surgery, by foreign bodies, enemas, or compressed air. The mechanisms and management of these injuries are discussed in detail. CONCLUSIONS: Evidence exists to support that a nonoperative approach is safe for the majority of injuries, particularly when the colon is "clean" at the time of injury. Adequate resuscitation, observation, and repeated reassessment are mainstays of a conservative policy. Operation is essential for progression of abdominal signs. Patients with established peritonitis at the time of presentation or with an unprepared bowel are best served by prompt operation.

Barium Sulfate↗
PubMed1994

Measurement by ELISA of equine alpha-1-proteinase inhibitor in uterine flushings from mares.

An enzyme linked immunosorbent assay (ELISA) was developed and used to estimate the concentrations of the serine proteinase inhibitor, alpha-1 proteinase inhibitor (API), in uterine flushings recovered from mares at different stages of the oestrous cycle and before and after the induction of experimental endometritis. There was a significant increase in the concentrations of API and albumin relative to total protein in flushings recovered during oestrus compared with dioestrus but no difference was observed in the concentrations of these proteins relative to total protein before and after the induction of endometritis. A regression analysis revealed a significant correlation between the concentrations of albumin and API in the flushings examined, suggesting that the API was derived entirely from serum and was not produced locally in the uterus.

Animals↗
PubMed1993

Smooth muscle tumours of the stomach: clinicopathological aspects.

From 1984 to 1989 the clinicopathological aspects of 21 patients with smooth muscle tumours of the stomach were reviewed. Ten patients had leiomyomas: 7 males, 3 females, average age 53 +/- 8 years. Four out of seven leiomyomas presenting with haematemesis were diagnosed correctly by an endoscopist but biopsy was positive in only two patients. Three leiomyomas were found incidently at laparotomy, and a total of nine leiomyomas were resected with a cuff of normal stomach. Their size ranged from 2 to 20 cm. All patients who underwent local resection are alive. Eight patients had leiomyosarcomata: 3 males, 5 females, average age 62 +/- 9 years. Six of these patients had an epigastric mass and four had haematemesis or melaena. The remaining patient in this group presented with dysphagia. Seven of these patients, who had no evidence of metastatic disease, underwent exploratory laparotomy. In four, palliative resections of the stomach and distal oesophagus were performed. In two, exogastric lesions involving colon and liver respectively were resected en bloc with a cuff of stomach. In one, biopsy alone was carried out. Two patients in this group are alive 1 and 2 years following surgery. Adjuvant treatment was not given to any of our patients. The remaining three tumours comprised a smooth muscle tumour of undetermined malignant potential whose clinical behaviour was unpredictable, and two leiomyoblastomas which mimicked malignant tumours in their presentation.

Aged↗
PubMed1992

Post-traumatic abdominal mucormycosis.

Gastrointestinal mucormycosis, an opportunistic fungal infection, is a rare complication of trauma. We report on four patients who developed this frequently fatal condition after delayed treatment of intra-abdominal sepsis and discuss the aetiology, diagnosis and management of the disease.

Abdominal Injuries↗
PubMed1992

Management options in malignant obstruction of the left colon.

Three of every 20 patients with carcinoma of the colon present with obstruction. The prognosis in the patient with malignant left colon obstruction is worse than for those with nonobstructing lesions, without adding the burden of a colostomy. Whenever feasible, acute obstruction should be treated by definitive resection with primary anastomosis and staged procedures reserved for only a few. How the former is achieved is open to debate. Whether or not the removal of all fecal matter from the colon is necessary before anastomosis is questionable and needs further appraisal. The risk of a metachronous lesion developing is highest in young patients with polyps or a previously resected carcinoma. The high risk patients would be best served by a subtotal colectomy. The choice of procedure must be tailored to each patient and the final decision made at the time of operation. An experienced colonic surgeon is needed to judge which option is most appropriate.

Carcinoma↗
PubMed1992

Chronic pancreatitis with biliary obstruction.

In a 4-year review of 509 patients with chronic pancreatitis, the incidence of clinically manifest fixed common bile duct (CBD) stenosis was 9% (45 patients). In 76% this was alcohol related, and pancreatic calcification was present in 51%. All patients presented with unrelenting jaundice and five (11%) had cholangitis. The mean serum bilirubin (165 +/- 108, normal 0-17 mumol/l), alkaline phosphatase (1790 +/- 1143, normal 73-207 U/l) and gamma glutamyl transferase (798 +/- 660, normal 7-64 U/l) were markedly raised. Diabetes occurred in 8 (18%). A biliary drainage operation was performed in 43 patients and 11 had concomitant pancreaticojejunostomy. Endoscopic retrograde cholangiopancreatography (ECRP) provided valuable information preoperatively in outlining both biliary and pancreatic disease in selecting patients for dual ductal drainage. Minor complications not related to biliary anastomosis occurred in 14%. Four patients died (9%), two from pseudocyst-related haemorrhage. Jaundice was successfully relieved in all and did not recur during follow-up. No secondary biliary cirrhosis was encountered, but varying degrees of portal fibrosis were present in 75% of liver biopsies. The commonest biliary pathogen was E. coli. It is recommended that a biliary bypass operation be performed when the diagnosis is radiologically confirmed and no improvement occurs within 1 month.

Adult↗