PubMed Health⌕ Search

Biomedical subjects

B D Hancock

Publications and source records attributed to B D Hancock.

12 recordsLinked to original sources
PubMed1990

Audit of major colorectal and biliary surgery to reduce rates of wound infection.

OBJECTIVE: To reduce the rates of wound infection for major colorectal and biliary surgery. DESIGN: Prospective audit of antibiotic prophylaxis by keeping copies of typed notes of operations and annotating them at discharge and at first follow up visit and annual review of prophylactic regimen according to yearly rate of wound infection and modification if necessary. SETTING: The work of one consultant surgeon working in a district general hospital. PATIENTS: All patients having major colorectal resection during 1976-89 (400) and cholecystectomy during 1981-9 (500). MAIN OUTCOME MEASURES: Wound infection, defined as any discharge from the wound as detected by observation during inpatient stay and by specific questioning at the first follow up visit six weeks later. RESULTS: Serial changes in prophylaxis for colorectal surgery resulted in a progressive reduction in the rate of wound infection from 43% in 1976, with no prophylaxis, to 1% during 1986-9 with single intravenous doses of metronidazole and cefuroxime intraoperatively and with lavage of the peritoneal cavity and wound with 0.1% tetracycline. During 1981-7, with no prophylaxis, the rate of infection in biliary surgery was 12% whereas in 1988-9, after the introduction of lavage with tetracycline alone, the rate was reduced to 2%. IMPLICATIONS AND ACTION: Simple prospective audit identified the need for changes in antibiotic prophylaxis; successive rounds of audit resulted in improved rates of wound infection, and lavage with 0.1% tetracycline seemed to be a major factor in achieving this.

Anti-Bacterial Agents↗
PubMed1987

Pleomorphic adenomas of the parotid: removal without rupture.

A personal series of 64 new pleomorphic adenomas of the parotid were removed with a very low rate of capsular rupture (1.6%) using a flexible approach. The aim was to remove the tumour with a covering of normal parotid where possible after exposing the trunk and appropriate branches of the facial nerve. Exposure of the capsule, however, was unavoidable in some situations, as in deep tumours, those in contact with the nerve and in very superficial tumours. Great care must be taken to avoid capsular rupture and, provided this is done, long term recurrence rates of less than 2% can be expected.

Adenoma↗
PubMed1978

Internal sphincter and haemorrhoids: a pathological study.

Histological examination of the lower margin of the internal sphincter has demonstrated an increased amount of fibrous tissue in patients with haemorrhoids compared with controls. This finding may be of relevance to the treatment of haemorrhoids by maximal anal dilatation.

Anal Canal↗
PubMed1978

Lord's procedure.

Explore the source record for details and available documents.

Anal Canal↗
PubMed1977

The internal sphincter and anal fissure.

The activity of the internal anal sphincter in patients with fissure has been studied by measuring anal pressure and motility with a small balloon probe. The mean maximum anal pressure in 12 patients with fissure (116-8 +/- 21-8, s.d., cm H2O) was significantly higher than that in 40 control subjects (85-0 +/- 20-5 cm H2O; P less than 0-01). Ultra-slow pressure waves were present in 80 per cent of the patients and in 5 per cent of the controls. Both the high pressure of ultra-slow waves were due to abnormal activity of the internal sphincter. This could be corrected equally well by either dilatation or lateral subcutaneous sphincterotomy.

Anal Canal↗
PubMed1977

Internal sphincter and the nature of haemorrhoids.

Internal anal sphincter activity has been studied in 84 patients with haemorrhoids and 40 asymptomatic subjects. Activity was estimated by measuring maximum resting anal pressure with a water filled anal balloon probe 7 mm in diameter connected to a strain gauge pressure transducer. There was greater activity of the internal sphincter in patients with haemorrhoids than in controls, but there was no significant relationship between sphincter activity and duration of symptoms, predominant symptom (bleeding or prolapse), severity of symptoms, history of pain, history of straining at stool, or size of haemorrhoids. Straining at stool occurred significantly more often in patients whose main complaint was prolapse than in those whose main complaint was bleeding. Anal dilatation reduced sphincter activity and the best clinical results were obtained in those with the most active sphincter. An internal sphincter abnormality may be an aetiological factor in some patients but there must be other factors as well. Straining at stool may determine whether bleeding or prolapse is the predominant symptom.

Adult↗
PubMed1976

Measurement of anal pressure and motility.

A fine open perfused system and a closed balloon system for the measurement of anal pressure and motility have been compared. Measurements were made in 40 normal subjects and 84 patients with haemorrhoids. The rate of perfusion had a marked effect on the recorded pressure and motility details. The motility pattern was seen most clearly with the balloon probe and the pressure recorded was reproducible and easy to measure, making this a convenient method for recording activity of the internal anal sphincter. Anal motility in normal subjects was characterised by slow pressure waves (10-20/min). The frequency was fastest in the distal anal canal and this frequency gradient may represent a normal mechanism to keep the anal canal empty. Ultra slow pressure waves (0-6-1-9/min) were seen in 42% of patients with haemorrhoids and 5% of normal subjects and arose from a synchronous contraction of the whole internal sphincter.

Anal Canal↗
PubMed1975

The internal sphincter and Lord's procedure for haemorrhoids.

Anal pressure and motility have been measured in 56 patients with haemorrhoids and 40 asymptomatic subjects. The anal pressure of patients with haemorrhoids (93-6 cm H2O) was very significantly higher than that of the controls (66-8 cm H2O; P less than 0-001). Ultra-slow pressure waves (amplitude 25-100 cm H2O, frequency 0-9-1-6/min) were present in 39 per cent of patients with haemorrhoids, but in only 7-5 per cent of the controls (P less than 0-001). Ultra-slow waves are present under anaesthesia with the voluntary muscles paralysed and are associated with the highest anal pressure, and so, represent abnormal activity of the internal anal sphincter. Measurements after anal dilatation showed complete abolition of ultra-slow wave activity and a very significant drop in pressure. One year after dilatation 19 patients had a mean anal pressure of 62 cm H2O. Very good results were obtained unless the haemorrhoids were so large that they prolapsed at times other than defaecation. Lord's procedure is a rational treatment since it corrects an underlying overactivity of the internal sphincter.

Adult↗