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T N Walsh

Publications and source records attributed to T N Walsh.

71 records · Page 4Linked to original sources
PubMed1989

Diurnal insulin and glucose profiles following transplantation of fresh and cryopreserved canine pancreatic islets.

Dispersed islet autotransplants (fresh and cryopreserved) can produce normal fasting insulin and glucose concentrations. Following an intravenous glucose challenge, however, the insulin response is impaired and glucose clearance delayed. This study examines the diurnal insulin and glucose response to feeding in recipients of fresh islet autografts (n = 6), recipients of cryopreserved islet autografts (n = 3), normal unoperated controls (n = 10) and insulin treated pancreatectomized diabetic dogs (n = 7). Mean fasting insulin and glucose levels were similar in all groups. After feeding, insulin profiles in both transplant groups were near normal while significant hyperinsulinaemia occurred in insulin treated diabetic dogs. Mild postprandial carbohydrate intolerance was observed in transplant recipients but glycosylated haemoglobin levels were similar (mean(s.d.] to normals (6.88(0.86) per cent, 6.86(0.5) per cent respectively). Dispersed islet autotransplantation with portal insulin delivery produces near normal insulin and glucose profiles suggesting that this may represent a suitable treatment for insulin dependent diabetes.

Animals↗
PubMed1989

Surgery in the treatment of varicose veins.

To identify variables which might influence the results of varicose vein surgery, a ten-year retrospective study was carried out on 612 patients undergoing varicose vein surgery. Patient symptomatology, type of venous insufficiency and operator experience were examined and correlated with the results of surgery. The female-to-male ratio was 2:1. The mean age was 47 years for women, 45 years for men. A family history of varicose veins was recorded in 74% of patients. A history of previous deep venous thrombosis was reported in 5% of cases, but in the sub-group of patients with stasis ulceration, the incidence was 9%. Cosmetic appearance was the commonest presenting complaint (54%), while ulceration was relatively infrequent (14%). There was moderate-to-marked improvement in 86% of cases at one year. This was sustained in 79% at three years, in 75% at five years and in 74% at ten years. There was no correlation between the type of venous insufficiency or the presenting complaint, and the result of surgery. Operator experience had the most significant effect on the outcome of surgery (P less than 0.001). Our findings indicate that varicose vein surgery offers most patients a satisfactory result. The only significant variable was operator experience. We strongly recommend closer supervision of junior staff performing this type of surgery, particularly as a large proportion of these patients (25% in this study) are operated on by the more junior staff.

Consumer Behavior↗
PubMed1987

Malignant duodenocolic fistula. Report of a case and review of the literature.

Malignant duodenocolic fistulas are rare; the most common cause is carcinoma of the ascending or hepatic flexure of the right colon. Thirteen cases reported to date have been treated by right hemicolectomy combined with a Whipple procedure, with a 46 percent 2.5-year survival. A case is reported in which stapling devices facilitated an extended Whipple procedure.

Colonic Diseases↗
PubMed1987

Dispersed pancreatic graft cryopreservation in the dog: in vivo assessment of preservation protocols.

Dispersed canine pancreatic grafts were cryopreserved and the in vivo function was studied following intrasplenic autotransplantation. Four protocols were employed, examining the effects of cooling and thawing rates and cryoprotectant (dimethylsulfoxide) concentration on graft survival. The degree of graft injury by each protocol was assessed by examining the requirement for exogenous insulin following transplantation. Cooling at 5 degrees C/min and thawing at 80 degrees C/min allowed three successful grafts from seven when thawed at 80 degrees C/min using 1.4 or 2 M Me2SO but only one success from eight when thawed at 8 degrees C/min. Of the seven experiments where successful preservation was achieved graft injury was estimated as less than 50% in four but for three it was probably greater than 50%. Each protocol exhibited considerable variability of islet survival. When sufficient islet mass was transplanted to restore fasting euglycaemia, graft function, as assessed by glucose-stimulated insulin release and intravenous glucose disposal, was identical to fresh grafts. Successful graft implantation, however, does not guarantee indefinite survival as six of seven grafts in this study became exhausted within 13 months of implantation.

Animals↗
PubMed1987

An epidemic of pseudomembranous colitis: importance of person to person spread.

Twenty three cases of pseudomembranous colitis (PMC) occurred in three hospitals in 10 months. Retrospective analysis shows that they represented a single epidemic with a readily traceable chain of person-to-person contact within and between hospitals. Most patients had severe pre-existing illness and all had broad spectrum antibiotics, including either ampicillin/amoxycillin, a broad spectrum cephalosporin (particularly cefotaxime), or both. All patients had severe diarrhoea and all responded to vancomycin, but relapse occurred in five. Ten patients eventually died, principally because of underlying disease rather than from PMC. Failure to find fibrin thrombi in blood vessels in biopsies and the scanty distribution of non-invasive bacteria supports the concept of mucosal damage by bacterial toxin, rather than by direct infection, or ischaemia. Although environmental colonisation cannot be excluded, the observed pattern of spread suggests a major role for direct person-to-person crossinfection in the spread of disease in this outbreak.

Aged↗
PubMed1984

Islet cell transplantation in diabetic dogs: studies of graft function and storage.

Islet cell transplantation is a potential treatment for insulin-dependent diabetes (IDD), assuming that physiological hormone release results in biochemical normality which, in turn, reduces the incidence of long-term diabetic complications. These experiments sought to create a metabolic model of IDD in a large animal and investigate the effects of insulin therapy and islet transplantation. After demonstrating the success of transplantation, further studies examined the feasibility of creating multiple grafts from a single donor and their long-term preservation. The totally pancreatectomized dog, treated with suboptimal insulin therapy was biochemically identical to human IDD and, when more appropriate doses of insulin were administered, metabolic improvements occurred without restoring normality. Islet cell autotransplants rendered such animals metabolically normal apart from persisting impairment of glucose tolerance. The isolation technique permitted the production of at least two recipient grafts and some success was achieved after graft cryopreservation. The experiments confirm the theoretical background to islet transplantation and demonstrate its applicability in a large animal model before allotransplantation.

Animals↗
PubMedDate not supplied

Laparoscopic repair of a strangulated Bochdalek hernia.

BACKGROUND: Bochdalek herniae are rare. They are usually repaired by open abdominal surgery or by a thoracic video-assisted approach. When strangulated and in a compromised patient the options are fewer. AIM: To describe a case treated by a laparoscopic approach. RESULTS: The procedure was technically difficult, but the patient recovered without recurrence. CONCLUSION: Laparoscopic repair is possible even with strangulation.

Aged↗
PubMedDate not supplied

Effect of tumour and chemoradiotherapy on oesophageal motility.

BACKGROUND: The contribution of dysmotility to dysphagia in oesophageal cancer is unclear. AIM: To examine oesophageal motility in patients with oesophageal carcinoma and to assess the effect of chemoradiotherapy on motility. METHODS: Stationary manometry and 24-hour pH-metry were performed in 12 patients with oesophageal carcinoma and one week following completion of chemoradiotherapy using 5-fluorouracil (5-FU), cisplatin and 40Gy radiotherapy. RESULTS: All patients had abnormal motility prior to treatment. Peristalsis was impaired in 11 patients with a mean (SD) of 25% (9) of waves normally propagated. Eight patients had 20% or more simultaneous waves. Following chemoradiotherapy, the percentage of waves normally propagated increased from 25% (9) to 521% (10) (p < 0.03) and normal peristalsis was restored in four patients. The percentage of simultaneous waves decreased from 38% (11) to 21.6% (10) (p = 0.129) while the percentage of dropped or increased waves decreased from 20% (11) to 8.3% (4) (p = 0.264). CONCLUSIONS: Oesophageal motility is disturbed in oesophageal cancer. Dysphagia in oesophageal cancer may be partly explained by oesophageal dysmotility. This is improved by chemotherapy.

Adenocarcinoma↗
PubMedDate not supplied

The sinister significance of dysphagia.

BACKGROUND: The majority of patients presenting with oesophageal cancer have symptoms for more than three months and advanced disease at presentation. Most appear unaware of the significance of dysphagia as a symptom. Cancer awareness programmes focus on symptoms such as lumps and bleeding. AIM: To sample the level of public awareness of the potentially sinister significance of the symptom of dysphagia. METHODS: A community survey was conducted using a questionnaire to evaluate the subjects' impression of the significance of dysphagia, and compare it with their perception of the significance of breast lump. Patients were stratified to male and female, under and over 45 years. RESULTS: There were 164 subjects interviewed. Seventy-five per cent stated that they would visit their doctor within one week of developing dysphagia compared with 87 per cent questioned about a breast lump (96 per cent females, 80 per cent males). Only 17 per cent felt that cancer was a probable explanation for dysphagia compared with 80 per cent who would consider cancer a likely cause of breast lump. CONCLUSION: There is evident need of an awareness programme of the potential significance of dysphagia if prognosis for oesophageal cancer is to be improved.

Adult↗
PubMedDate not supplied

Impact of emergency admissions on elective surgical workload.

BACKGROUND: Day case surgery is the most cost-effective approach for all minor, most intermediate and some major surgery. AIMS: To examine the effect of the current 'escalation' policy of opening the surgical day ward to A&E admissions at the expense of planned surgery. PATIENTS AND METHODS: A retrospective study was carried out on all elective general surgical operations planned for January through March 2003. The number of cases cancelled and the reasons for cancellation were documented. RESULTS: The total number of patients booked for surgery was 836, 66.6% of which were day cases (557 patients). Overall 338 patients accounting for 40.4% of all planned cases were cancelled. Day case cancellations accounted for 68.9% of all cancellations (233 patients). Bed unavailability was the main reason due to the overflow of A&E admissions, accounting for 92% of cancelled patients and 73.8% of day ward cancellations. CONCLUSIONS: The cancellation of surgery creates untold hardship for patients who plan their working and family lives around the proposed operation date. Most are cancelled at less than 24 hours notice. The cost implications to the community are immense but have not been calculated. The separation of emergency and planned surgery is essential through adequate observation ward access.

Ambulatory Surgical Procedures↗
PubMedDate not supplied

Designing a medical Web site.

BACKGROUND: A web site is a valuable shop window for any medical unit with something to sell or something to say. AIMS: The aim of this report is to outline the basic steps of web page design for the individual or unit with limited financial resources. METHODS: There are two ways of designing a web site. A reputable web design company can be employed, but this is usually expensive. Alternatively, a web site can be designed in-house using commercial software, following a few simple steps. The basic requirements are a personal computer, software that is available on most computers and access to a few peripheral items of hardware. An outline of the page design should first be put down on paper. This can be transferred to a computer file using a web page design program. This file is then sent to a server for publication on the World Wide Web (WWW). CONCLUSION: Designing and publishing a web page can take time and effort, but the rewards can be great and the results will reflect the message and motto of the unit.

Humans↗
PubMedDate not supplied

Thoracoscopic sympathectomy.

Surgical sympathectomy has traditionally been achieved by 'open' surgical techniques. The transaxillary, cervical, or dorsal approaches have not been without morbidity and cosmetically have been found to be less than ideal. The main indication for sympathectomy in most units is palmar and axillary hyperhidrosis refractory to medical treatment, although it has been used with some success in troublesome causalgia. Use of sympathectomy in Raynaud's disease remains disappointing. In our unit thoracoscopic sympathectomy has been performed since 1980. A CO2 pneumothorax is initially created in the usual manner. This is followed by electrocoagulation of the sympathetic chain under direct vision using a unipolar diathermy. The lung is then reinflated under direct vision. Chest drains are not inserted. Both sides are performed at the same sitting, and the patient usually leaves hospital the following day. The functional and cosmetic results are excellent on short and long term follow-up with few side effects. Permanent Horner's syndrome has not been reported using this technique. As with all upper limb sympathectomies, patients should be warned of possible compensatory hyperhidrosis. Embracing the tenets of minimally invasive surgery, thoracoscopic sympathectomy should be considered the approach of choice for surgical sympathectomy.

Axilla↗