Search PubMed⌕ Search

Biomedical subjects

T N Evans

Publications and source records attributed to T N Evans.

At least 19 recordsLinked to original sources
PubMed2000

Reducing the demand for admission to intensive care after major abdominal surgery by a change in anaesthetic practice and the use of remifentanil.

We have used a remifentanil-based anaesthetic for patients undergoing major abdominal surgery who would normally have gone to the intensive care unit in this hospital. Avoiding intensive care unit admission was considered an advantage as a shortage of intensive care unit beds was leading to the cancellation of operations. We first used remifentanil as part of a safety and efficacy study. The aim was to see if the rapid and complete awakening obtained when using this drug would allow us to avoid the need for admission to an intensive care unit and use a high dependency unit instead. This was shown to be practicable. In comparison with a group of patients matched retrospectively for the type of operation before remifentanil was used there was a reduction in the length of time (mean+/- SD) patients' lungs were ventilated (612+/-417 vs. 9.9+/-28.9 min P< 0.0001). There was no saving in cost ( pound808.71+/- pound187.06 vs. pound795.27+/- pound253.49). When remifentanil was used routinely (after the safety and efficacy study), there were significant reductions in the time to tracheal extubation (612+/-417 vs. 4+/-10 min P < 0.0001) and costs (808.71I vs. 392.10 I P < 0.0001) compared with other patients in whom it was not used. Patients waiting for a liver transplant were also being cancelled when a donor organ became available because of the shortage of intensive care unit beds. Based on our other experience with remifentanil, we used a similar anaesthetic technique for these patients. It proved possible to extubate the trachea in 12 of 15 patients at the end of the operation. No patient needed re-intubation. The need for intensive care and therefore cancellation of surgery was reduced. In contrast, only one patient's trachea was extubated immediately after surgery in the group of patients anaesthetized before the introduction of remifentanil. A remifentanil-based technique in combination with a change in organization has therefore enabled us to avoid admission to the intensive care unit for these patients.

Abdomen↗
PubMed1994

Mucinous adenocarcinoma arising in a neovagina.

The development of carcinoma in a neovagina is a rare occurrence. A case of mucinous adenocarcinoma of a neovagina is presented. A neovagina was formed in 1945 to correct a congenital anomaly. Subsequently the patient developed a chronic rectovaginal fistula. It is thought that the mucinous adenocarcinoma developed as a result of chronic inflammation secondary to the fistula. Although rare, development of a malignancy in ectopic tissue can occur. Clinicians need to be aware of this as they follow these patients.

Adenocarcinoma, Mucinous↗
PubMed1985

Psychologic aspects of vaginal agenesis.

An assessment of the psychologic aspects of total vaginal agenesis was done on 54 patients. Emotional reactions to the diagnosis and treatment varied with the age of the patient and her relationship with her parents. Some were initially depressed, questioning themselves as females and their futures as wives and mothers. Sterility was the most difficult aspect to accept. Postoperative compliance with dilator use varied with the extent of the preparation for surgery and the extent of the open, supportive relationships with the staff and family. Prolonged counseling, with monitoring of emotional reactions and reinforcement with factual information, was a vital part of the medical management and had an impact on the final result.

Adolescent↗
PubMed1982

The stimulus-induced release of 5-hydroxytryptamine and tryptophan from superfused rat brain synaptosomes.

The synthesis of 5-hydroxytryptamine (5-HT) from 3H-tryptophan in rat forebrain synaptosomes was studied. Synaptosomes which had been preincubated with 3H-tryptophan were perfused with Krebs solution and the release of tryptophan, 5-HT and 5-hydroxyindoleacetic acid (5-HIAA) was determined. K+ depolarization induced a Ca2+ -dependent release of 5-HT and tryptophan but had no effect on 5-HIAA efflux. This finding suggests that the release of tryptophan is unlikely to be a non-specific effect of depolarization.

Animals↗
PubMed1982

Pregnancy following repair of anal and vaginal atresia and bladder exstrophy.

Pregnancy following surgical correction of bladder exstrophy with anal and partial vaginal atresia is extremely rare. These defects, plus the absence of the pubic symphysis and anatomic deficiencies of the urogenital diaphragm, pose extraordinary obstetric and surgical problems. This report is based on the experience of a 21-year-old patient who had successful pregnancy following curative repair of these defects. Progressive uterine prolapse occurred during pregnancy to the extent that at the time of delivery the presenting part of the fetus was below the pelvic outlet. Cesarean section was performed at 36 weeks' gestation when the cervix was 4 cm dilated with a single footling breech presentation. Postpartum surgical management of the uterine and vaginal prolapse is described.

Adult↗
PubMed1982

Intrafascial abdominal and vaginal hysterectomy: a reappraisal.

This study was designed to provide anatomic and physiologic evaluation of the intrafascial approach to hysterectomy. Anatomy of the pericervical fascia and its relationship to the fascial and muscular layers of the vagina and the cardinal and sacrouterine ligaments were studied in human and nonhuman primates. The effect of hysterectomy on the length, configuration, and axis of the vagina was evaluated using vaginal casts. Intrafascial abdominal and vaginal hysterectomies have many advantages. Damage to the urinary tract and bowel is minimized. Separation and later closure of the pericervical fascia may allow more effective hemostasis, obliterate dead space, decrease the area of raw surfaces, and separate the vaginal cuff from the retroperitoneal space. These are the principal factors in the prevention of postoperative infection. Intrafascial hysterectomy preserves the complex anatomic relationships between the endopelvic fascia and the vagina. It provides good vaginal support and preserves or improves the length, configuration, and axis of the vagina. Intrafascial hysterectomy is indicated only for treatment of benign disease.

Adolescent↗
PubMed1981

Vaginal malformations.

Of 254 patients with vaginal malformations, 167 had total vaginal agenesis and 87 had lesser defects. Incidence, embryogenesis, etiology, and associated anomalies are described. Improvements in surgical management have diminished complications and improved results. Preoperative investigation and preparation of the patient and prolonged postoperative supervision and support are critical.

Female↗
PubMed1981

Caesarean section: a 15-year review of changing incidence, indications, and risks.

During 15 years (1965 through 1979), 9,718 cesarean sections were performed at Hutzel Hospital. This report concerns the indications, incidence, morbidity, and mortality. Dystocia, fetal distress, and breech presentations were the most common indications for primary cesarean section. The incidence rose from 9.8% to 16.8% during this study. Forceps deliveries dropped from 47.5% to 12.0% and vaginal breech deliveries decreased from 86% to 35%. Spinal anesthesia was used in 90%. Caesarean section hysterectomies were performed in 128. The most common indications were carcinoma in situ of the cervix, uterine leiomyoma, and hemorrhage. Puerperal sepsis and urinary tract and wound infections were the major causes of morbidity. Perinatal mortality decreased from 40% to 29%. There were 10 maternal deaths. Sepsis was the major cause of death. At least four deaths could have been avoided if ultra-high-risk patients had not been pregnant in the first place.

Adolescent↗
PubMed1981

Vaginal morphology following hysterectomy.

This study was designed to gain more information about morphology of the vagina after hysterectomy. The prospective clinical observations of patients subjected to abdominal or vaginal extrafascial or intrafascial hysterectomy with or without correction of anatomical urinary stress incontinence were included. The length, configuration and axis of the vagina were determined using a vaginal cast technic. Vaginal casts were prepared prior to and 6 months to 4 years after surgery. The gross appearance of the vagina after hysterectomy is affected by understanding normal pelvic anatomy an physiology, careful preoperative evaluation of pelvic defects, proper planning and competent performance of surgery. Proper handling of the endopelvic fascia and its condensations, the cardinal and sacrouterine ligaments, corrects preexisting weakness, provides vaginal suspension and prevents future vaginal disfigurement. Inadequate surgical technics result in magnifying preexisting weakness of pelvic supports. Successful surgery involves correcting the levator complex by reducing and shifting the levator hiatus ventrally. Reconstruction of the perineal body is essential. This study suggests a relationship between successful surgical treatment of urinary stress incontinence and reconstruction of pelvic supportive structures, with restoration of the physiological vaginal axis.

Female↗
PubMed1979

Ten-year review of hysterectomies: trends, indications, and risks.

This report concerns the indications, morbidity, and death associated with 6,435 consecutive abdominal and vaginal hysterectomies at Hutzel Hospital during a 10 year period. There was an extraordinary number of high-risk patients included in this group. Morbidity and postoperative bleeding were more common following vaginal rather than abdominal hysterectomy. These complications were also more common when the operation was performed during the proliferative phase of the menstrual cycle. There were 17 deaths. Thromboembolic complications were the major cause of death. Selective use of prophylactic antibiotics and low-dose heparin and reduction in the number of blood transfusions by preoperative endocrine and hematinic therapy may reduce the postoperative morbidity and mortality rates. Probably few operations will ever contribute as much to improving the quality of life of women as do indicated hysterectomies. However, the added risk do not seem to justify utilizing this operation for the sole purpose of sterilization in preference to simpler and safer procedures.

Adult↗
PubMed1977

Incongruities.

Explore the source record for details and available documents.

Biological Evolution↗
PubMed1976

Sexually transmissible diseases.

There is a widespread recrudescence of venereal disease. The possible reasons for this are discussed. Each disease is then considered from the viewpoints of clinical course, diagnosis, and treatment. Treatment failures are discussed in detail, immunity is covered, and recommendations for the future conclude the presentation.

Adolescent↗