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Biomedical subjects

D Failes

Publications and source records attributed to D Failes.

7 recordsLinked to original sources
PubMed1979

Fibreoptic colonoscopy. Indications, results and complications.

Fibreoptic colonoscopy was commenced in the Edward Wilson Colon and Rectum Unit at Sydney Hospital in June, 1973. The experience of the first five years of its use is reported. Six hundred and twenty-six examinations have been performed in 568 patients. Fibreoptic colonoscopy has been of particular value in the diagnosis and treatment of colonic polyps. A total of 318 polyps were removed from 184 patients. Their distribution, size and histological features are recorded. Eight complications occurred in the 628 examinations (1.6%). There were six colonic perforations (1.2%) with one death, and two significant haemorrhages (0.4%). This incidence of complications is acceptably low, especially in view of the great benefits obtained by the patient from fibreoptic colonoscopy. The newer instruments, especially the medium length Olympus MB3 colonoscope, have greatly facilitated the examination and, combined with increasing experience, may significantly lower the incidence of complications in the future.

Adolescent↗
PubMed1979

Elective resection for diverticular disease.

A series of 119 patients undergoing elective resection for diverticular disease has been reviewed. The indications for resection were classified into two major groups--those with severe infections ("complicated" diverticulitis), comprising 58 patients, and those with minimal infections, comprising 61 patients. The majority of the resections were limited to the sigmoid colon (101 patients). Fifteen patients underwent left hemicolectomy, whilst three had total colectomy. Thirty-six patients (30%) had a proximal defunctioning stoma--18 prior to resection and 19 at the time of resection. Anastomotic defects were noted in 15 patients (12.6%), but these were of clinical significance only in eight (6.7%). There were two deaths (1.7%) and 17 wound infections (14.3%). The group classified as "complicated" diverticulitis included the great majority of the patients requiring colostomy (32 out of 37), almost all those with anastomotic defects (14 out of 15), and most of the patients who had postoperative complications.

Acute Disease↗
PubMed1979

Rectal prolapse.

One hundred and twenty-seven patients with complete rectal prolapse have been reviewed. The condition occurred more commonly in females than males (105 to 22), and at an older age in females (mean age 55 years compared with 40 years for males). Although the diagnosis is usually obvious, the importance of recognizing occult prolapse is stressed, especially in association with benign rectal ulcer, localized proctitis and colitis cystica profunda. Examination of the patient in the squatting position may assit in showing occult prolapse. Associated incontinence occurred in 33 patients (26%). Since 1971 the policy of this Unit has been to perform a Ripstein repair for complete rectal prolapse wherever possible. One hundred and two Ripstein repairs have not been performed. A minimum follow-up period of two years is available for 53 patients, of whom 50 (94%) have had their prolapse cured. Control of prolapse usually improves continence; however, seven (13%) remained incontinent despite surgery. The Ripstein repair is strongly advocated as the most effective operation for cure of complete rectal prolapse.

Adolescent↗
PubMed1979

Ileostomy reconstruction.

A study of 47 patients undergoing ileostomy reconstruction is presented. The most common indications were recession (15 patients) and a desire for a continent type of ileostomy (12 patients). Less frequent indications were stenosis (6 patients), parastomal ulceration (6 patients), prolapse (4 patients), unsatisfactory siting (3 patients), and parastomal hernia (1 patient). Refashioning of the ileostomy at the same site was possible in 17 patients, whilst repositioning at a new site was required in 30 cases. In 28 of these laparotomy was carried out to enable repositioning, but in two cases resiting was performed without laparotomy. After the original operation, reconstruction may become necessary at any time from a few months to over 20 years.

Adolescent↗
PubMed1979

The surgical treatment of anal incontinence.

This study is review of 31 patients undergoing surgery for anal incontinence. Three groups of patients are defined--those with incontinence due to trauma (nine patients), to a combination of trauma and degeneration (five patients), and to degeneration alone (17 patients). Two surgical techniques were used--either a direct repair of the anal sphincter or a postanal repair of the levator ani muscles and external sphincter (Parks operation). In the trauma group and the combined group the more common method used was a direct repair (ten patients)--five underwent a Parks operation. In the degeneration group all but one patient underwent a Parks operation. A defunctioning proximal colostomy was carried out in only four patients--all with incontinence due to trauma. Satisfactory continence was restored in 80% of these patients. Although this is a small series, the results are considered worthwhile and greater awareness and use of the above technique is recommended.

Adult↗
PubMed1976

The Kock continent ileostomy: a preliminary report.

A review is presented of seven patients who have undergone a continent type of ileostomy, as described by Professor Kock. There has been no mortality. Two of the early patients had considerable difficulty with the functioning of the valve and required re-operation. No patient in the series now wears an external appliance. Six of the seven are fully continent; the seventh reports occasional leakage, but is satisfied with the operation. The operation is considered to be still under trial, but is regarded as having great potential and likely to be much more widely practised in the future.

Adult↗