Biomedical subjects

A L Polglase

Publications and source records attributed to A L Polglase.

5 recordsLinked to original sources

PubMed1992

Perineal proctectomy for rectal prolapse in elderly and debilitated patients.

This paper details the indications, operative technique and results of perineal proctectomy in the management of complete rectal prolapse in a high risk, elderly and debilitated group of patients. Eighteen procedures were performed by one surgeon (A.L.P.) on 16 consecutive patients over a 5 year period. Data collection was via: (i) retrospective analysis of hospital and office records; and (ii) response to a postal questionnaire by the patient, a relative or attending nursing staff. There were 14 females and two males with a mean age of 81 years. All patients had significant associated medical conditions. The interval from the time of a surgical procedure until review varied from 3 to 37 months with a mean follow-up period of 16 months. Total hospital stay varied between 6 and 20 days with a mean of 7 days. Eleven procedures were performed under general anaesthesia and seven under spinal anaesthesia. There was no postoperative mortality. One patient suffered an anastomotic haemorrhage that required operative intervention and another patient suffered a rectal stricture that necessitated dilatation. Two patients were re-operated for recurrent symptomatic prolapses at 34 and 36 months after the initial procedure. Continence improved in seven patients, worsened in one and was unchanged in the remaining patients. Fifteen of 16 patients were considered to have had a successful result from the operation with satisfactory control of the symptom of rectal prolapse. Perineal proctectomy is a low risk operative procedure for the elderly and debilitated group of patients in controlling complete rectal prolapse. If the condition recurs, the procedure can be repeated with equally low morbidity.

Aged↗

PubMed1991

Inguinal surgery for debilitating chronic groin pain in athletes.

OBJECTIVES: To identify and surgically treat correctable inguinal injuries in athletes with chronic groin pain and to assess the results of surgical treatment. DESIGN: Sixty-four athletes presented between March 1987 and January 1990 for treatment of chronic groin pain in which surgical exploration of the inguinal canal was considered necessary. Follow-up was performed by questionnaire. MAIN OUTCOME MEASURE: Patient self-assessment of the success of the operation, including postoperative pain, ability to return to active sport and any further treatment required. RESULTS: Sixty-four athletes were treated, Australian Rules footballers predominated (46/64, 72%). Eight athletes had bilateral groin pain. Fifty-nine (92%) reported an incipient onset of pain. The most common operative finding was of a substantially deranged posterior wall of the inguinal canal which was evident in 61/72 instances (85%). Apparent splitting of the conjoint tendon was found in 19 instances (26%) and previously occult indirect inguinal hernias were discovered in six (8%). Repair of the posterior wall of the inguinal canal was by the standard Bassini repair and Tanner slide or by plication of the transversalis fascia followed by a nylon darn. Follow-up by questionnaire of the 64 athletes revealed that 40 athletes (62.5%) considered themselves cured and had returned to competitive sport. Twenty athletes (31.3%) were partially satisfied with the results of their operation, and also able to return to active sport. Three athletes (4.7%) were dissatisfied with the operative result. One patient was lost to follow-up. CONCLUSION: The most common finding in athletes with chronic groin pain was a deficiency of the posterior wall of the inguinal canal. Surgical exploration and repair of the posterior wall of the inguinal canal in athletes with chronic debilitating groin pain achieved excellent or good relief of pain in 93.8% of athletes and improved physical performance.

Adolescent↗

PubMed1991

Aberrant expression of intestinal mucin antigens associated with colorectal carcinoma defined by a panel of monoclonal antibodies.

Small intestine mucin antigen (SIMA) is an oncofoetal antigen for the colon and is distinct from the normal large intestinal mucin antigen (LIMA). In the present study, a panel of anti-SIMA and anti-LIMA monoclonal antibodies (MAb) was used to charaterise altered mucin expression in colorectal adenocarcinomas, by immunohistochemistry and quantitative immunoassays of tissue extracts. These results are compared with CEA expression and correlated with various clinicopathological indices. All mucin MAb reacted with a high proportion of the 100 colon cancers of every stage, histological type (including non-mucinous cancers), differentiation, site, or size. Inappropriate SIMA production was detected by either anti-SIMA MAb 4D3 or 4A1, even in 85% of early stage cancers. MAb 4D3 reacted with a higher proportion of cancers of smaller size and better differentiation. At the subcellular level, both anti-SIMA MAb showed reactivity typical of normal mucin, i.e., goblet cell and extracellular mucin. The normal colonic antigen, LIMA, was also detectable in the majority of cases, but quantitatively overproduced in some cases and reduced in others. However, in contrast to SIMA, LIMA was detected in predominantly undifferentiated cancer cells but not in goblet cells. Heterogeneity of MAb reactivity between cases and complementarity within each cancer was frequently observed. Mucin reactive with at least one of the MAb was detected in all of the CEA-negative cancers. A high rate of inappropriate SIMA expression was also detected in the perineoplastic transitional mucosa (88%, c.f. CEA, 35%) and adjacent, morphologically normal mucosa (80% c.f. CEA, 24%), indicating biochemical changes similar to the cancer. This panel of anti-mucin MAb demonstrated altered mucin glycoprotein metabolism associated with the development and progression of most colorectal cancers, which emphasises their utility as indicators of neoplastic change in the colon, and their superiority to CEA.

Aged↗

PubMed1979

The autosuture surgical stapling instruments: preliminary experience.

Stapling instruments for gastrointestinal surgery are relatively new in the surgical armamentarium of Australian surgeons. In an attempt to assess their safety and handling characteristics laboratory experience has been obtained in dogs. This has shown that these instruments are effective and easily handled, although costly in routine use. It seems likely that they will provide an appropriate alternative to certain conventional anastomotic techniques.

Animals↗

PubMed1979

Purse string placement for staple anastomosis using the end-to-end anastomosis stapling instrument.

There may be technical difficulties in the use of recommended clamp for the insertion of the purse-string suture during the construction of an end-to-end staple anastomosis. Hand sewing the purse string eliminates some of the problems, but unless the suture is positioned within a few millimetres of the cut edge of the bowel, ischaemic tissue may be included in the staple line. In dogs, this leads to anastomotic dehiscence. The anastomosis may, however, be protected by excising the ischaemic tissue and reinforcing the staple line with sutures. An "over and over" purse-string technique is now preferred to minimize the risk of this occurring.

Animals↗