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Biomedical subjects

A R Berry

Publications and source records attributed to A R Berry.

At least 19 recordsLinked to original sources
PubMed1994

Management of advanced rectal cancer.

If possible, palliative resection should be undertaken for advanced rectal cancer as it provides good relief of local symptoms; there is, however, little evidence that it prolongs survival. If palliative excision is not possible, endoscopic transanal resection may be used for obstructing lesions at or below the peritoneal reflection. Laser therapy is an alternative in the frail. Both procedures allow quick and effective relief of symptoms. These methods and other options for treating advanced rectal cancer are described in this review.

Combined Modality Therapy↗
PubMed1992

Acute colonic pseudo-obstruction.

The syndrome of acute colonic pseudo-obstruction is well delineated but its aetiology remains poorly understood and patients are still treated inappropriately. This article reviews the pathogenesis and surgical management of this condition. Early diagnosis is stressed as a pivotal factor in reducing morbidity and mortality.

Acute Disease↗
PubMed1992

Management variability in surgery for colorectal emergencies.

A prospective study was made of 92 patients who underwent emergency colorectal surgery during a 1-year period. A dedicated emergency theatre allowed half of the patients to be operated on between 09.00 and 17.00 hours with greater seniority of operating surgeons. The overall mortality rate was 14 per cent and the primary resection rate was 79 per cent. The mortality rate was 12 per cent for right-sided resection with anastomosis and 24 per cent for left-sided resection without anastomosis, including those undergoing Hartmann's procedure which had a 35 per cent mortality rate. Immediate left-sided anastomosis was performed safely in all 14 patients in whom it was attempted. Firms headed by consultants with and without a special interest in colorectal disease made differing use of primary resection and immediate anastomosis (67 versus 41 per cent, P less than 0.05) and Hartmann's (7 versus 25 per cent, P less than 0.05) and non-resectional (15 versus 29 per cent, P not significant) procedures. Retrospective surveys of perioperative deaths examine inadequate management and subsequent mortality rates, but do not reveal the significant morbidity rate that occurs in survivors. This audit revealed significant differences in the management of patients with colorectal emergencies between firms headed by specialist and non-specialist consultants. In order to minimize these differences we believe that recent advances in colorectal practice should be included in the training of all surgeons.

Adult↗
PubMed1992

Management of perianal sepsis in a district general hospital.

Perianal sepsis remains a common surgical problem. A total of 121 patients undergoing surgery for perianal abscess and/or fistulae over a 2-year period was studied. Of these, 50 patients (41.3%) had suffered from previous perianal sepsis (not necessarily resulting in hospital attendance). Ninety-one patients underwent incision and drainage of abscesses (ischiorectal and perianal) for the first time, whereas eight patients underwent drainage of recurrent abscesses. Fistulae were identified when the abscess was drained in 14 of 91 patients, and a further ten patients subsequently developed fistulae. Twenty-two patients presented with a discharging fistula. A high yield of bowel organisms was present in patients with coexisting fistulae (88%), recurrent abscesses (75%) and in those who subsequently developed fistulae (83%). We confirm that such a growth can be used to identify patients who will benefit from further examinations.

Adolescent↗
PubMed1990

Endoscopic transanal resection of rectal tumours--a preliminary report of its use.

Endoscopic transanal resection (ETAR) of rectal tumours is a simple and inexpensive procedure, well tolerated in elderly patients or those undergoing palliation. We have performed 137 ETARs in 81 patients with a 30-day mortality rate of 11.1 per cent and a postoperative complication rate of 15.3 per cent. Thirty-one patients (38 per cent) had ETAR for palliation: in this group rectal bleeding was abolished or improved in 66 per cent of patients, altered bowel habit (diarrhoea) corrected in 77 per cent of patients, faecal incontinence improved in 50 per cent of patients and rectal pain (including tenesmus) improved in 50 per cent of patients. Twenty-three patients (28 per cent) were treated for large benign rectal polyps: in this group symptoms were universally abolished. The technique is particularly suited to the management of these patients. Twenty-seven elderly patients with theoretically 'curable' rectal cancer underwent ETAR with a 78 per cent crude survival rate at 1 year. While long-term results remain to be assessed, ETAR appears a useful technique for treating selected patients with rectal tumours.

Aged↗
PubMed1990

Endoscopic sphincterotomy for the palliation of ampullary carcinoma.

Palliative endoscopic sphincterotomy was performed on 17 patients with adenocarcinoma of the ampulla of Vater. An endoprosthesis was inserted immediately after the sphincterotomy in four of the patients. Fourteen patients made uncomplicated recoveries from the procedure and their jaundice resolved completely. Early complications developed in three patients. One patient died from haemorrhage. Two patients, both of whom had an endoprosthesis, developed cholangitis. The endoprosthesis was removed and another inserted in one patient and the other underwent surgery. Both thereafter made uncomplicated recoveries. Jaundice subsequently recurred in eight patients and further endoscopic treatment was successful in five of these patients. Eleven patients died between 4 days and 23 months after the sphincterotomy with a median survival of 12 months. Four patients remain alive between 3 and 17 months after treatment. The results indicate that reasonable palliation can be achieved safely by endoscopic sphincterotomy.

Adenocarcinoma↗
PubMed1989

Emergency surgery for complicated diverticular disease. A five-year experience.

Ninety-three patients who underwent surgery were studied retrospectively over a five-year period for complications of diverticular disease, including free perforation in 32 patients (with fecal peritonitis in 8), inflammation or peritonitis in 22 patients, an abscess in 11 patients, and intestinal obstruction in 14 patients. Sixty-eight patients (73 percent) had systemic symptoms and signs consistent with serious sepsis. There has been a growing popularity of the Hartmann procedure throughout the study period. The overall 30-day mortality rate was 10.8 percent. Because of a high proportion of poor-risk patients, the Hartmann group fared particularly badly compared with those who had other operations, with a 28 percent mortality rate, 69 percent incidence of major complications, and one third of the survivors having a permanent colostomy. Other operative procedures are discussed, but until prospective data become available, it is unlikely that the widespread popularity of the Hartmann procedure will decline. Therefore, the importance of meticulous attention to technical detail is stressed if results are to improve.

Aged↗
PubMed1989

Endoscopic sphincterotomy for bile duct stones: an institutional review of 272 patients.

The results of the first 283 endoscopic sphincterotomies (ES) attempted in Oxford for bile duct stones are described. Endoscopic sphincterotomy was achieved in 272 patients (96%) and complete duct clearance was achieved in 88% of these patients; an overall success rate of 85%. Complications occurred in 26 patients (10%), five of whom required an emergency laparotomy. Eight patients died within 30 days of ES but only two deaths were attributed directly to the procedure. Although the sphincterotomies were performed by several endoscopists in varying stages of training, the results are similar to those from other large reports. In the last year of the study (1987), 58 patients were referred from within the Oxfordshire District which suggests an annual demand for ES for bile duct stones of 11 patients per 100,000 of population.

Adult↗
PubMed1989

Comparison of the value of emergency mesenteric angiography and intraoperative colonoscopy with antegrade colonic irrigation in massive rectal haemorrhage.

The investigation of massive rectal haemorrhage has routinely included emergency mesenteric angiography to identify the site of bleeding in preparation for surgery. Nine cases over 18 months were identified from the angiography register and reviewed retrospectively. Angiography demonstrated the bleeding point in only one case, rendering colonoscopy unnecessary. However, that patient became shocked, requiring six units of blood during angiography. A second patient suffered cardiac arrest during angiography. The mean time taken was 1 1/2 h constituting a considerable delay before proceeding to surgery. On-table colonoscopy with antegrade lavage showed the bleeding site in seven out of nine cases and the mean time for operation was 3 h. One patient stopped bleeding spontaneously and there was one postoperative death from an unrelated cause. We conclude that there is no place for emergency mesenteric angiography in massive acute large bowel haemorrhage and that early surgery with antegrade colonic lavage and on-table colonoscopy is the treatment of choice.

Acute Disease↗
PubMed1988

Epidermal growth factor (EGF) and hormones stimulate phosphoinositide hydrolysis and increase EGF receptor protein synthesis and mRNA levels in rat liver epithelial cells. Evidence for protein kinase C-dependent and -independent pathways.

Epidermal growth factor (EGF) stimulated the rapid accumulation of inositol trisphosphate in WB cells, a continuous line of rat hepatic epithelial cells. Since we previously had shown that EGF stimulates EGF receptor synthesis in these cells, we tested whether hormones that stimulate PtdIns(4,5)P2 hydrolysis would increase EGF receptor protein synthesis and mRNA levels. Epinephrine, angiotensin II, and [Arg8]vasopressin activate phospholipase C in WB cells as evidenced by the accumulation of the inositol phosphates, inositol monophosphate, inositol bisphosphate, and inositol trisphosphate. A 3-4-h treatment with each hormone also increased the rate of EGF receptor protein synthesis by 3-6-fold as assessed by immunoprecipitation of EGF receptor from [35S]methionine-labeled cells. Northern blot analyses of WB cell EGF receptor mRNA levels revealed that agents linked to the phosphoinositide signaling system increased receptor mRNA content within 1-2 h. A maximal increase of 3-7-fold was observed after a 3-h exposure to EGF and hormones. The phorbol ester, 12-O-tetradecanoylphorbol 13-acetate (TPA), which activates protein kinase C also stimulated EGF receptor synthesis. Pretreatment of WB cells for 18 h with high concentrations of TPA "down-regulated" protein kinase C and blocked TPA-directed EGF receptor mRNA synthesis. In contrast, the effect of EGF on EGF receptor mRNA levels was not significantly decreased by TPA pretreatment. Epinephrine-induced increases in EGF receptor mRNA were reduced from 4- to 2-fold. Similarly, 18 h TPA pretreatment abolished the effect of TPA on EGF receptor protein synthesis but did not affect EGF-dependent EGF receptor protein synthesis. The 18-h TPA pretreatment diminished by 30-50% the induction of receptor protein synthesis by epinephrine or angiotensin II. We conclude that in WB cells EGF receptor synthesis can be regulated by EGF and other hormones that stimulate PtdIns(4,5)P2 hydrolysis. In these cells, EGF receptor synthesis appears to be regulated by several mechanism: one pathway is dependent upon EGF receptor activation and can operate independently of protein kinase C activation; another pathway is correlated with PtdIns(4,5)P2 hydrolysis and is dependent, at least in part, upon protein kinase C activation.

Angiotensin II↗
PubMed1988

Management of major colonic haemorrhage.

Major colonic haemorrhage remains a difficult diagnostic and therapeutic problem. We propose that those patients who continue to bleed after resuscitation are best served by immediate laparotomy. High flow antegrade irrigation and intra-operative colonoscopy can then be used to localize the site of bleeding and allow appropriate excisional surgery rather than blind colonic resection.

Algorithms↗
PubMed1988

Early postoperative endoscopic sphincterotomy for retained biliary stones.

Endoscopic sphincterotomy was attempted on 18 patients with retained biliary stones. Endoscopy was performed within 2 weeks of the operation in 13 patients and within 3 weeks in 5 patients. A T-tube was present in 14 patients and 6 patients had multiple stones. Sphincterotomy and complete duct clearance was achieved in 17 patients (94%) and a complication (haemorrhage) occurred in one patient (6%).

Adult↗
PubMed1987

Prospective randomized controlled trial of urethral versus suprapubic catheterization.

Sixty-six patients requiring catheterization in the course of general surgical operations were randomly allocated into two groups. Of the 34 patients catheterized urethrally 16 developed urinary tract infections whereas of the 32 suprapubically catheterized patients only 2 developed an infection (P less than 0.001). Five patients required recatheterization after removal of their urethral catheters. There were no major complications associated with the use of suprapubic catheters. We propose that, when catheterization is required during a general surgical procedure, the suprapubic route is to be preferred.

Catheters, Indwelling↗
PubMed1987

Carcinoid tumour of the ampulla of Vater presenting as acute pancreatitis.

The first report of a carcinoid tumour of the ampulla of Vater causing acute pancreatitis is presented. The pancreatitis resulted from ampullary obstruction and diversion of the bile through the pancreas. Endoscopic retrograde cholangiopancreatography established the correct diagnosis, making this the first occasion in which a carcinoid tumour of the ampulla of Vater has been correctly diagnosed before surgery.

Ampulla of Vater↗
PubMed1986

Perineal and pelvic morbidity following perimuscular excision of the rectum for inflammatory bowel disease.

One hundred and fifteen patients who were treated by a proctocolectomy in Oxford between 1972 and 1984 for inflammatory bowel disease have been studied. All the patients had the rectum removed by the technique of perimuscular dissection which was introduced in 1972 in an attempt to overcome the problems associated with the previous types of proctectomy. The method has been shown to be safe; the operative mortality was 1.7 per cent. The most worrying potential complications due to permanent autonomic nerve damage (i.e. impotence and urinary incontinence), which previously have been recorded as occurring in a significant percentage of patients, were completely prevented by the method of dissection. One man suffered transient impotence which responded to psychiatric treatment. There were no long term urinary tract or sexual problems. Postoperative complications occurred in 37 per cent of patients, perineal wound infections being the most common (25.7 per cent). Perineal healing, however, was achieved in 75 per cent of patients by the time of their discharge from hospital. The mean length of postoperative hospital stay was 19 days in patients with ulcerative colitis and 15 days in patients with Crohn's disease. Our rate of perineal healing is better than has been recorded using other operative techniques.

Adolescent↗
PubMed1986

Changing pattern of lower limb amputation for vascular disease.

In 1980 a review of lower limb amputation over a 3.5 year period between 1974 and 1978 was reported from our centre. More recently 193 amputations were performed for peripheral vascular disease over a similar 3.5 year period, representing an increase of 33 per cent in the amputation rate during the last 6 years. This cannot be explained by the increasing age of the population alone. Fewer below-knee amputations (BKA) (33.0 per cent) and more Gritti-Strokes amputations (GSA) (32.0 per cent) were performed and the overall incidence of re-amputation for stump breakdown was 13.5 per cent. Twenty-eight per cent of below-knee amputation stumps required re-amputation at higher levels, but when successful were associated with a 75 per cent incidence of rehabilitation with an artificial limb. Eight per cent of GSA stumps required re-amputation and were associated with a twenty-eight per cent incidence of successful rehabilitation. Thirty-seven per cent of patients had undergone reconstructive vascular surgery before amputation. Of the 26 patients requiring re-amputation 58 per cent had undergone arterial reconstruction in an attempt to salvage the limb (chi 2 = 5.65, P less than 0.02) and in 26.9 per cent of cases this was performed within the week before amputation. We feel that injudicious attempts at arterial reconstruction, when amputation appears inevitable, may adversely affect the subsequent level of amputation and jeopardize rehabilitation.

Age Factors↗