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Biomedical subjects

T J Archer

Publications and source records attributed to T J Archer.

11 recordsLinked to original sources
PubMed1996

Accuracy of general practitioner referrals to a breast clinic.

The large number of referrals for breast disease necessitates that some form of appointment stratification is carried out to try and ensure that those patients likely to have malignant disease are seen as soon as possible. A 6-month prospective study was carried out in which all new patient referral letters were assessed and graded on a three-point scale indicating the perceived likelihood of carcinoma. In all, 496 new patient referrals were assessed and graded. There were 94 classed as 'urgent' (representing a likely carcinoma), 186 as 'soon' (carcinoma unlikely but possible) and 216 as 'routine' (carcinoma very unlikely). The median waiting times to being seen in the outpatient department after referral were 6, 20 and 32 days, respectively, for the three groups. Of the patients, 56 (11.3%) were found to have a carcinoma; 41 (73.2%) of these had been placed in the 'urgent' group, 11 (19.6%) in the 'soon' group and 4 (7.1%) in the 'routine' group. All carcinomas in the routine group were coincidental findings. These results suggest that the information in the general practitioner referral letters may be used to reliably identify most patients with breast cancer, allowing appointment stratification and minimising any psychologically damaging delay before treatment.

Breast Neoplasms↗
PubMed1987

Random control trial of a short course of aspirin and dipyridamole (Persantin) for femorodistal grafts.

The effect of a short course of anti-platelet agents, started preoperatively, on the patency of femorodistal bypass grafts is unknown. One hundred and forty-eight such grafts were randomized to act as controls or to receive dipyridamole 200 mg b.d. for 48 h pre-operatively and dipyridamole 200 mg b.d. with aspirin 300 mg daily for 6 weeks after surgery. Patients were well-matched and the mean pre-operative pressure index of 0.37 rose to 0.78 during the first postoperative week. No deaths were attributable to the treatment. Ninety-three grafts were autogenous vein and the remainder were prosthetic (GORE-TEX (PTFE), human umbilical vein or externally supported Dacron). At 1 year autogenous vein cumulative patency was 75 per cent. Overall results showed higher patency in the treated group (P = 0.012) which was entirely accounted for by the difference between prosthetic dipyridamole and aspirin group (85 per cent patency) and prosthetic control groups (53 per cent patency, P = 0.005) and arose during the first postoperative month. There were 11 deaths and 8 amputations in the dipyridamole and aspirin group and 8 deaths and 12 amputations in the control group. It is concluded that a six week perioperative course of dipyridamole and aspirin allows the patency of prosthetic femorodistal bypass to approach that of autogenous vein, and the regimen therefore is recommended for patients who may require a prosthetic graft.

Aspirin↗
PubMed1981

Laparoscopy in general surgery.

The results of diagnostic laparoscopy under general anaesthetic in 81 general surgical patients have been reviewed. A tissue diagnosis was achieved in 25 of 42 patients (60 per cent) suspected to have widespread intra-abdominal malignancy with minimal preoperative investigation. Extensive investigation, excluding only computerized tomography, failed to achieve a diagnosis in 25 patients with an intra-abdominal mass. Subsequent laparoscopy allowed diagnosis of 22 of these patients (92 per cent). Severe persistent and unexplained abdominal pain in 14 patients was diagnosed at laparoscopy in only one patient (7 per cent) and the procedure did not influence the subsequent course of events in the remainder. There was no mortality and the morbidity (4.9 per cent) compares well with that of laparotomy in similar patients. Laparoscopy failed in 5 patients (6.2 per cent) due to the presence of dense intraperitoneal adhesions.

Abdomen↗
PubMedDate not supplied

Detection of dangerous malnutrition.

The assessment of malnutrition by simple methods was studied in 120 patients undergoing elective major abdominal surgery to determine which index was of the most value in predicting postoperative complications. Weight for height and weight loss were of little significant value; serum albumin less than 35 g/l was more significant (p less than 0.05) but predicted only a quarter of those patients who developed serious complications. Measurements of muscle stores by anthropometry (arm and forearm muscle circumference) predicted nearly half the patients (p less than 0.01). By far the most useful index was hand-grip dynamometry, which predicted 90% of those who developed complications (p less than 0.001). The incidence of serious complications was 6 times greater in those patients with a low grip strength. Hand-grip dynamometry appears to be a useful screening test of patients at risk, and a valuable additional test for nutritional assessment.

Anthropometry↗