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Biomedical subjects

D C Britton

Publications and source records attributed to D C Britton.

At least 19 recordsLinked to original sources
PubMed2001

Emergency surgery: atavistic refuge of the general surgeon?

A prospective audit of emergency soft-tissue surgery for an eight-week period revealed that general surgical emergency operations were more than twice as common as those undertaken in other soft-tissue specialties. The audit reveals that emergency general surgery needs an increase in resources, an increase in available staff and an increase in the role of the consultant general surgeon on call. An alternative solution would be to admit soft-tissue emergencies by specialty and develop specialist emergency services.

Emergencies↗
PubMed1997

An audit of hospital mortality after urgent and emergency surgery in the elderly.

An audit was carried out of 102 patients aged over 75 years undergoing urgent or emergency surgery in a district general hospital. The risk of death in hospital after general surgery (13 deaths in 49 patients) was greater than after orthopaedic surgery (two deaths in 53 patients) (P < 0.05). In particular, laparotomy carried a high in-hospital mortality: 12 of 25 patients undergoing laparotomy died. Risk of death after general surgery increased with increasing preoperative ASA class, increasing medical risk factors and duration of operation. Orthopaedic cases were fitter than the general surgical cases as determined by ASA class and the number of medical risk factors. NCEPOD has recommended increased involvement of senior medical staff in operations, reduced night-time operating and avoidance of futile surgery. A high proportion of cases were operated on and anaesthetised by higher specialist trainees and consultants. Death rate was not affected by the seniority of doctors involved, nor by the time of day the operation took place. General surgical deaths were predictable postoperatively in most cases, but preoperative prediction of outcome was not specific enough to alter management.

Aged↗
PubMed1994

An audit of the effect of a 24-hour emergency operating theatre in a district general hospital.

The recent introduction of a 24-hour emergency theatre for General Surgery provided an opportunity to audit its effect on emergency operating in a District General Hospital. Prior to its introduction much of the emergency operating was determined by theatre availability rather than clinical need. Half of the emergency operations were carried out between 10 pm and 8 am. This proportion was reduced to a third when a theatre was continually available. This had benefits for the patients in reducing their waiting time and also for the junior surgeons by increasing their sleep. A survey of the Region indicated that very few hospitals provided adequate emergency theatre facilities.

Emergencies↗
PubMed1990

Abdominocervical (transhiatal) oesophagectomy in the management of oesophageal carcinoma.

Fifty-four patients have undergone abdominocervical oesophagectomy for oesophageal carcinoma as an alternative to a conventional transthoracic approach. Their median age was 69 years, with a range of 38-90 years, and 39 per cent of patients had chronic cardiorespiratory disease. Lymph node metastases were found in 80 per cent of patients and transmural tumour spread in 91 per cent. Median duration of operation was 2.2 h (range 1.75-6.0 h), and median transfusion requirement was 2.5 units (range 0-8 units). Respiratory complications were common (41 per cent) and caused all six postoperative deaths (11 per cent). Other complications were atrial fibrillation (26 per cent), transient recurrent laryngeal nerve palsy (11 per cent), cardiac failure (2 per cent), stroke (2 per cent), subphrenic abscess (2 per cent) and empyema (2 per cent). There were two anastomotic leaks (4 per cent), clinically manifest as temporary salivary fistulae. There have been 32 deaths from recurrent carcinoma, with a median duration of survival of 14 months (range 4-53 months). Fifteen patients are still alive, with a median survival of 16.5 months (range 3-49 months); the current 3-year survival rate is 10 per cent. All patients resumed normal swallowing after operation, but 11 of them developed anastomotic strictures requiring a median of three dilatations. Avoidance of formal thoracotomy by the abdominocervical approach may allow more rapid oesophagectomy without increasing the risk of postoperative death and gives a quality of palliation at least equivalent to that of conventional transthoracic oesophageal excision.

Adenocarcinoma↗
PubMed1990

Value of a centralised approach in the management of haematemesis and melaena: experience in a district general hospital.

All patients presenting with acute upper gastrointestinal bleeding between November 1986 and April 1988 were admitted to a centralised joint medical/surgical unit, with a policy of early clinical and endoscopic assessment and rapid surgical intervention in those at high risk. Of the 430 patients admitted 69.5% were over the age of 60 and 30% had significant additional medical conditions. 50.4% were bleeding from peptic ulcers and one third had been taking non-steroidal anti-inflammatory agents. Fifty five patients underwent surgery, which in two thirds was carried out within 24 hours of admission, usually for continued bleeding. In patients with peptic ulcer the operation rate was 21.6%. Overall mortality was 3.7%, and in those with bleeding gastric or duodenal ulcers 5.5%; surgical mortality in the later group was 15.2%. All patients who died had serious concomitant pathology and 87% were over 70 years of age. Adoption of a centralised approach to management of haematemasis and melaena is feasible in a District General Hospital and associated with an improved survival.

Adult↗
PubMed1990

Surgical palliation for pancreatic cancer: will biliary bypass alone suffice?

Because a number of options are available to relieve the obstructed bile duct, stomach or both in patients with irresectable carcinoma of the pancreatic head, palliative surgery for this condition was reviewed retrospectively between 1971 and 1981 at the Royal United Hospital, Bath. One hundred and sixty-five patients underwent a biliary bypass procedure with (n = 37), or without (n = 128) gastric drainage. Thirty patients had a prophylactic gastroenterostomy to avoid gastric outlet obstruction: tumour encroachment made gastroenterostomy essential in seven others. After biliary bypass alone, operative mortality was 14%. After a concomitant gastroenterostomy, mortality was 27% (P less than 0.04). Within a year of biliary bypass alone, there was a 9% incidence of gastric outlet obstruction requiring gastric drainage, with an associated mortality rate of 18%. Survival after biliary bypass or biliary bypass with gastroenterostomy was equal (7-8 months). Except where gastric outlet obstruction is imminent, palliation for irresectable pancreatic head carcinomas should be by biliary bypass alone, because the addition of a gastroenterostomy almost doubles the mortality without any advantage in survival time.

Adenocarcinoma↗
PubMed1989

Experimental pancreatic cancer in the Syrian hamster: effect of cholecystectomy.

Because cholecystectomy stimulates hypertrophy and hyperplasia in the hamster pancreas, its effect on experimental pancreatic carcinogenesis was studied in this animal model. Forty female Syrian hamsters underwent cholecystectomy, while 40 others underwent sham operations. Two weeks later, 30 hamsters undergoing cholecystectomy and 30 hamsters undergoing sham operations received 4 weekly subcutaneous injections of N-nitroso-bis (2-oxopropyl) amine (BOP) (10 mg/kg). Remaining hamsters (n = 20) received equal volumes of 0.9% saline solution. A further 10 hamsters (controls) underwent no surgery and received no injections. Thirty weeks after the first BOP or saline injection the pancreas of hamsters that had undergone cholecystectomy was only 3% heavier than that of sham-operated animals, and there was no difference in the incidence of pancreatic cancer between BOP-treated hamsters that had undergone cholecystectomy and those that had undergone sham operations. In this study, cholecystectomy had no influence on BOP-induced pancreatic carcinogenesis in the Syrian hamster.

Animals↗
PubMed1987

Secondary arterio-enteric fistulae: a surgical challenge.

Ten cases of secondary arterio-enteric fistulae are described. There were nine graft enteric fistulae and one fistula involving the aortic suture line following elective resection of an infected graft. Only four of the patients initially received prophylactic antibiotics (single dose) at the original aortic reconstruction, and the vascular suture line had only been protected in two. Eight patients presented with bleeding and two with groin abscesses. One patient died before operation. Graft resection was undertaken in all patients and organisms were grown from six of eight grafts cultured. No patient died during operation but one died after 3 days. Axillofemoral bypass grafts were constructed in seven patients (four immediately after resection of prosthetic grafts and three within 4 days of operation). Only three of the eight patients who survived operation are still alive; two died of a ruptured aorta and one from a recurrent fistula. Two patients died of other causes. Four of five axillofemoral grafts in surviving patients subsequently occluded.

Aged↗
PubMed1984

Morphological study of antigen-sampling structures in the rat large intestine.

Organized lymphoid tissue in the rat colon exists as clusters (colonic lymphoid patches) of intramucosal and submucosal follicles in the proximal, mid, and distal colon, interspersed by solitary follicles. The follicular lymphoid cells of colonic lymphoid patches are separated from the gut lumen by a highly specialized lymphoepithelium which lacks mature goblet cells. Cells of this epithelium are of two types: those characterized by an electron-dense cytoplasm, large numbers of apical vesicles and lysosomes, and prolonged extensions of the apical cytoplasm forming thin partitions between the gut lumen and underlying intercellular spaces; and cells with a less electron-dense cytoplasm, distorted mitochondria, and little endoplasmic reticulum. Both cell types bear normal microvilli and have numerous lateral membrane processes which penetrate large intercellular spaces. A ferritin-India ink label infused into the colonic lumen was preferentially adsorbed onto the surface of this follicle-associated epithelium. Indigenous colonic bacteria were observed penetrating the superficial cytoplasm of the electron-dense cells where they were enclosed in lysosomes and digested. An antigen-sampling role is proposed for the colonic lymphoid patch epithelium.

Animals↗
PubMed1984

Intervention in large bowel carcinogenesis--does screening improve prognosis?

Cancer of the large bowel is the second most common malignant tumour in the western world, with approximately 20,000 new cases registered each year in England and Wales. No improvement in the survival figures has occurred in the past 30 years, and since 1970 the number of deaths per annum in Great Britain has been rising. The prognosis of the disease is related directly to the degree of centrifugal spread of the tumour. Patients with cancer limited to the bowel wall have a corrected 5-year survival of about 90%, whereas those with tumours with lymphatic spread have a 5-year survival of about 30%. The prognosis for early colorectal tumours is therefore good, but a method of identifying such lesions is required. If early tumours bleed, the detection of occult blood in the faeces may be a valuable screening test for colorectal cancer. In one town, 8,925 asymptomatic people over the age of 40 were invited to be screened for faecal occult bleeding using Haemoccult slides. The invitation was accepted by 2,439 patients, a compliance rate of 27%. On Haemoccult screening 121 patients were positive initially, but 39 of these were found to be false-positive after further investigation. Haemoccult therefore gives a false-positive incidence of 30%. Twelve tumours of the bowel were identified, eight polyps and four cancers. Another patient who had been negative in the screening survey was identified within 2 months of the end of the experiment as having large-bowel cancer. This means that Haemoccult gives a false negative rate, in our hands, of 20%. The ability of a cancer screening procedure to identify and cure early tumours depends upon the compliance of the population, the sensitivity of the test and the availability of effective treatment. The poor compliance of our population and the disappointing sensitivity of Haemoccult mean that occult blood screening for early large bowel cancer remains theoretically possible but practically inefficient.

Barium Sulfate↗
PubMed1984

The organisation and evaluation of an open-access dysphagia clinic.

We describe our experience in organising an open access dysphagia clinic. Any patient with dysphagia for solids of at least one week's duration can be seen within one week of referral. One hundred and nine 'new' patients were referred in the first year. Fifty-five (50.4%) had peptic or malignant strictures. The majority of these received definitive treatment within ten days of the date of referral. This system of referral and treatment improves the speed of detection and treatment of patients with oesophageal stenosis.

Adult↗
PubMed1983

Manual dilatation of the anus and elastic band ligature: an effective short stay alternative to formal haemorrhoidectomy for prolapsing haemorrhoids.

Fifty patients with second or third degree haemorrhoids were treated by manual dilatation of the anus (MDA) and elastic band ligature under general anaesthesia. All patients had prolapsing haemorrhoids at presentation associated with bleeding in 46, and pain in 39. A final review by questionnaire was undertaken one to three years later, at which time 44 patients remained symptom-free. Forty-three had experienced only mild or moderate discomfort postoperatively. Mean time from operation to pursuing all normal activities was 10 days. MDA and elastic band ligature under GA is a simple, quick and effective alternative to haemorrhoidectomy in the treatment of second and third degree haemorrhoids.

Adult↗