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Biomedical subjects

D Bouchier-Hayes

Publications and source records attributed to D Bouchier-Hayes.

At least 127 records · Page 7Linked to original sources
PubMed1992

An association between hypocholesterolaemia and colorectal carcinoma in an Irish population.

A group of 114 Irish patients with primary adenocarcinoma of the large bowel had significantly lower serum cholesterol concentrations than an age and sex matched group drawn from the general population. The hypocholesterolaemiac trait was manifest in male and female patients. Rigorous control procedures established that it was neither an artefact of nutritional compromise nor of preoperative bowel preparatory protocols. The data suggested that the appreciable hypocholesterolaemia observed was not influenced by the pathological stage or degree of differentiation of the tumour.

Adenocarcinoma↗
PubMed1991

Infrarenal abdominal aortic disease: a review of the retroperitoneal approach.

Transabdominal exposure is the most widely used surgical approach to the infrarenal aorta. Over the last 30 years a number of surgeons have championed the retroperitoneal approach for repair of abdominal aortic aneurysms and aortoiliac occlusive disease using a variety of incisions. Several studies attest to the clinical superiority of this approach over the transabdominal route and recent evidence demonstrates reduced physiological disturbance with this technique. The retroperitoneal approach is suitable for all elective operations on the abdominal aorta, particularly in patients with high-risk aneurysms and in selected patients with symptomatic and ruptured aneurysms.

Aorta, Abdominal↗
PubMed1991

Reduced postoperative hospitalization after laparoscopic cholecystectomy.

An initial experience of laparoscopic cholecystectomy in 50 consecutive patients was reviewed and the results compared with those of a group of 25 patients who underwent laparotomy cholecystectomy during the 3 months before the introduction of laparoscopic cholecystectomy. Laparoscopic cholecystectomy was successfully performed in 44 of 50 consecutive patients in whom it was attempted. When compared with laparotomy, laparoscopy cholecystectomy was associated with longer mean (s.d.) anaesthesia, 155 (61) min versus 102 (31) min (P less than 0.001), shorter mean postoperative hospital stay, 3.5 (1.5) versus 8.8 (3.2) days (P less than 0.001), and reduced mean cost, pounds 895 (376) versus pounds 2210 (822) (P less than 0.001). Perioperative morbidity was also reduced following laparoscopy cholecystectomy (9 per cent versus 16 per cent) but not significantly so. Laparoscopic cholecystectomy is a safe, effective procedure which completely removes the gallbladder. It significantly reduces hospital stay, is cosmetically satisfactory and has financial benefits. We suggest that this technique be considered for all patients having cholecystectomy.

Adolescent↗
PubMed1991

Suture technique affects perianastomotic colonic crypt cell production and tumour formation.

Suture line recurrence is an important cause of failure after potentially curative resection for colonic carcinoma. Our aim was to determine whether suture technique affected the incidence of perianastomotic tumours in experimentally induced colonic cancer. Sprague-Dawley rats were randomized into three groups. A 1 cm longitudinal colotomy was repaired with four interrupted 6/0 polypropylene monofilament sutures, using either a transmural technique (n = 18) or a seromuscular technique (n = 18). Control animals (n = 18) had a sham laparotomy. All animals received nine, weekly, subcutaneous injections of azoxymethane (total dose 90 mg/kg) starting 6 weeks after laparotomy. Surviving animals were killed 32 weeks after laparotomy. Five animals from each group were given intraperitoneal bromodeoxyuridine (100 mg/kg) 1 h before being killed. At death, perianastomotic tumours occurred more frequently in animals with transmural sutures than in either controls or those with seromuscular sutures. This difference was associated with a greater mucosal bromodeoxyuridine crypt cell labelling index in the transmural suture group. We conclude that a transmural anastomotic suture technique promotes the development of experimental perianastomotic colonic tumours.

Anastomosis, Surgical↗
PubMed1991

Laparoscopic cholecystectomy in the scarred abdomen.

Laparoscopic cholecystectomy is rapidly becoming the definitive method for treating symptomatic gallbladder stones. Previous upper abdominal surgery is a relative contraindication to this technique. We describe a method for safely placing the trocars in a scarred abdomen, thus facilitating laparoscopic cholecystectomy in a wider group of patients.

Abdomen↗
PubMed1991

Improved wound healing with a modified electrosurgical electrode.

Previous studies comparing standard electrosurgical (ES) electrode and steel scalpel (SS) wound healing have reported poor initial tensile strength, a delay in reaching maximum tensile strength and an increased inflammatory response in the ES wounds. The hypothesis that a smaller needle (modified) electrode would give better wound healing than a standard electrode was tested. Using histology as a parameter of wound healing, incisions created by a modified electrode, a standard electrode and a steel scalpel were compared. Sixty Sha Sha mice were divided into 10 groups. Standardised dorsal skin incisions were made using steel scalpel, standard and modified electrosurgical cutting electrodes. Mice were sacrificed on days 0, 1, 2, 3, 5, 7, 9, 14, 28 and 42. The incised skin was processed for standard and immunohistochemical staining. The standard ES wound had significantly higher numbers of polymorphonuclear leukocytes in comparison to the SS and modified ES wounds (p less than or equal to 0.01). However, macrophage numbers were found to be significantly lower in the ES wounds when compared to the SS wounds on days two and five (p less than or equal to 0.05). The fibroblast response was delayed by up to two days in the ES wounds when compared to the SS wounds. Epithelialisation was completed by day two in the SS and modified ES groups but was only complete by day three in the standard ES group (p less than or equal to 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1991

Pararectus retroperitoneal radical nephrectomy.

We describe a new pararectus retroperitoneal approach to the kidney, which allows easy identification and occlusion of the renal vessels before mobilization of the kidney. This approach potentially reduces morbidity, hospital stay and cost. The technique has been used in 4 cases of radical nephrectomy for tumor and in 1 for pyonephrosis.

Carcinoma, Renal Cell↗
PubMed1991

Are CT infarcts a separate risk factor in patients with transient cerebral ischaemic episodes?

CT cerebral infarcts have been reported in a number of studies of patients with transient ischaemic episodes. The hypothesis that these asignomatic infarcts, i.e. without associated clinical neurological deficit reflect the ability of the brain to limit the extent of neuronal damage through its collateral circulation was tested in 50 patients undergoing both CT scanning and cerebral angiography. Out of 50 patients there were 15 patients with a total of 17 infarcts on CT scan. Fourteen of 50 patients had evidence of diminished collateral reserve capacity on cerebral angiography. Ten of these 14 patients (71%) had CT evidence of infarction, in contrast to an incidence of five out of 36 patients (14%) without evidence of diminished collateral reserve. These results indicate that CT infarcts and collateral cerebral circulation must be evaluated as prognostic factors in patients with T.I.A.s.

Cerebral Angiography↗
PubMed1991

Laparoscopic cholecystectomy: a hundred consecutive cases.

Laparoscopic cholecystectomy is a new, minimaly invasive technique for removing the gallbladder which has several advantages over the traditional laparotomy cholecystectomy. We reviewed our initial experience with 100 consecutive patients in whom laparoscopic cholecystectomy was attempted. The indications for operation were biliary colic, chronic cholecystitis, acute gallbladder and gallstone pancreatitis. Laparoscopic cholecystectomy was successfully performed in 87 patients. Anaesthesia time was 144 +/- 52 min. There was no mortality while overall morbidity was 14%. One patient had a retained common bile duct stone. Postoperative hospital stay was 4.1 +/- 2.2 days and the mean time to full activity in a random sample of 25 patients was 13.7 +/- 11.7 days. Laparoscopic cholecystectomy is a safe effective procedure which removes the gallbladder. We suggest that this technique be considered in all patients undergoing cholecystectomy.

Adolescent↗
PubMed1990

Coagulopathy and abdominal aortic aneurysm.

Coagulopathy has been described in association with intact, ruptured and repaired abdominal aortic aneurysm. This review examines the relationship and its clinical significance and outlines current management strategies.

Aorta, Abdominal↗
PubMed1990

Electroretinography, retinal ischaemia and carotid artery disease.

Reduction in the amplitude of oscillatory potential (OP) on the B wave of an electroretinogram (ERG) is a sensitive index of experimental retinal ischaemia and is being used clinically to evaluate the progression of diabetic retinopathy. This study assessed whether electroretinography could detect retinal ischaemia in a group of patients with normal fluorescein angiograms and carotid atherosclerosis. Two groups of patients were studied. Group A (n = 15) had carotid atherosclerosis on duplex ultrasonography while a matched control group B (n = 15) had normal vessels. All patients in Group A had flurorescein angiograms. ERGs were recorded bilaterally using a Ganzfeld stimulator and Medelec oscilloscope. The OP amplitudes were determined using the peak-nadir method. Of the 60 eyes examined, 18 had abnormal OPs and all of these occurred in Group A; ten associated with ipsilateral non-stenosing carotid lesions and eight with critical stenoses. Twelve had normal OPs in Group A, only one of which was associated with severe disease. The mean OP amplitudes were 292 mu and 198 mu in Group A and 172.89 mu and 115.6 mu in Group B (P less than 0.005 Wilcoxon Rank Sum Test). (Two readings reflect Medelec readings before and after computer adjustments.) This study demonstrates by electroretinography significant retinal ischaemia in the presence of normal fluorescein angiography in patients with proven carotid artery disease. Further evaluation is required to determine the relative importance of flow reduction and silent micro-embolisation in the genesis of this ischaemia particularly in relation to pre- and postoperative evaluation.

Carotid Artery Diseases↗
PubMed1989

Prophylactic antibiotic use in four Dublin teaching hospitals.

A retrospective study of 266 surgical patients revealed that 55% received antibiotics. Of these, 71% had prophylactic and 29% therapeutic courses. Twenty-five per cent of prophylactic courses were started post-operatively, 65% were continued for more than 24 hours, 28% were administered by an inappropriate route and 10% were started more than two hours pre-operatively. Of all courses of antibiotics ordered, 67% had no record of intended duration on the prescription. In 4% of courses the surgeon's orders were not followed. This study demonstrates widespread suboptimal use of antibiotic prophylaxis in a variety of surgical specialties.

Anti-Bacterial Agents↗
PubMed1989

The influence of collateral vascularisation on haemodynamic performance during abdominal aortic surgery.

The extent of periaortic collateral vascularisation has been proposed as a possible mechanism of an altered haemodynamic response to infra-renal aortic cross-clamp in patients undergoing by-pass grafting for aorto-iliac occlusive disease (AOD) compared with patients undergoing abdominal aortic aneurysm (AAA) resection. The haemodynamic responses following clamping, during the clamp time and following clamp release were studied in 18 patients undergoing AAA resection and 12 patients undergoing bypass grafting for AOD. The role of preoperative aortography in predicting cardiovascular performance during aortic vascular surgery was assessed. During the cross-clamp period LVSWI and CI decreased while SVR increased in the AAA group while the AOD group showed an improved CI, stable LVSWI and reduced SVR, which correlated with the extent of periaortic vascularisation on preoperative aortography. Chronic collateral circulation associated with AOD may permit continuous lower extremity perfusion during aortic cross-clamp. The extent of periaortic collateralisation may influence the choice of monitoring techniques and anaesthetic management.

Aged↗
PubMed1989

Heparin kinetics in vascular surgery.

Currently there is little information available about the efficacy of heparin during vascular surgery or of the effects of surgical trauma on heparin kinetics. This study was undertaken to evaluate the kinetics of heparin therapy during vascular surgery. Nine patients undergoing major vascular surgery (one carotid, one common iliac and seven aortic operations) were studied both preoperatively and intra-operatively, each patient acting as his own control. Following determination of control activated partial thromboplastin time (APTT) and plasma heparin levels, heparin (100 u/kg body weight) was administered intravenously. Heparin dosage ranged form 4500 units to 8600 units with a mean dose of 6500 units. Plasma heparin and APTT levels were then measured at 10 minute intervals for 1 hour and 20 minute intervals for a second hour. The mean pre-operative and intra-operative APTT levels at ten minutes attained maximal values of 6.6 +/- 3.7 and 8.8 +/- 1.7 times the control respectively. At the end of 2 hours the mean APTT remained greater than 2.5 times the control in both groups. Mean plasma heparin level was 0.83 +/- 0.04 units at 10 minutes and was almost identical in both groups. Heparin level was not a reliable indicator of anticoagulant effect as most patients achieved the same levels but had markedly differing APTT results. The results of this study suggest that excessive doses of heparin may be used in vascular surgery and that surgical trauma does not significantly alter sensitivity to heparin.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1989

Surgical management of adrenal disease.

This study reviews the surgical management of adrenal disease over a 23 year period in a Dublin teaching hospital. Nineteen patients were diagnosed as having either Medullary or Cortical disease. Ultrasound and CAT Scan proved highly accurate in pre-operative tumour localisation. This analysis highlights the atypical presentation of phaeochromocytoma, the accuracy of Ultrasound and CAT Scan in tumour localisation and the importance of peri-operative monitoring.

Adolescent↗