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Biomedical subjects

D J Bowrey

Publications and source records attributed to D J Bowrey.

At least 19 recordsLinked to original sources
PubMed2006

Use of alarm symptoms to select dyspeptics for endoscopy causes patients with curable esophagogastric cancer to be overlooked.

BACKGROUND: In August 2004, the United Kingdom Department of Health advisory body published dyspepsia referral guidelines for primary care practitioners. These guidelines advised empiric treatment with antisecretory medications and referral for endoscopy only in the presence of alarm symptoms. The current study aimed to evaluate the effect of these guidelines on the detection of esophagogastric cancer. METHODS: The study reviewed a prospectively compiled database of 4,018 subjects who underwent open access gastroscopy during the years 1990 to 1998. The main outcome measures for the study were cancer detection rates, International Union Against Cancer (UICC) stage, and survival. RESULTS: Gastroscopy identified esophagogastric carcinoma in 123 (3%) of the 4,018 subjects. Of these 123 patients, 104 (85%) with esophagogastric cancer had "alarm" symptoms (anemia, mass, dysphagia, weight loss, vomiting) and would have satisfied the referral criteria. The remaining 15% would not have been referred for initial endoscopic assessment because their symptoms were those of uncomplicated "benign" dyspepsia. The patients with "alarm" symptoms had a significantly more advanced tumor stage (metastatic disease in 47% vs 11%; p < 0.001), were less likely to undergo surgical resection (50% vs 95%; p < 0.001), and had a poorer survival (median, 11 vs 39 months; p = 0.01) than their counterparts without such symptoms. CONCLUSIONS: The use of alarm symptoms to select dyspeptics for endoscopy identifies patients with advanced and usually incurable esophagogastric cancer. Patients with early curable cancers often have only dyspeptic symptoms, and their diagnosis will be delayed until the symptoms of advanced cancer develop.

Adult↗
PubMed2006

Defining the position of deep inguinal ring in patients with indirect inguinal hernias.

A preliminary survey of surgeons of all grades in our hospital revealed confusion about the position of the deep inguinal ring. Standard teaching is that the deep inguinal ring is lateral to the femoral artery. The aim of this study was to define the position of the deep ring in patients undergoing elective inguinal hernia repair. Thirty consecutive male patients undergoing indirect inguinal hernia repair under local anaesthesia were studied. The following landmarks were marked on the patient with a felt pen: anterior superior iliac spine (ASIS), femoral artery (FA), deep inguinal ring (DR), pubic tubercle (PT) and pubic symphysis (PS). The distance of each point from the ASIS was measured in centimetres. The relation of the femoral artery to the deep inguinal ring was confirmed by palpation through the deep ring during surgery. The femoral artery was consistently identified midway between the anterior superior iliac spine and pubic symphysis (mid-inguinal point). The deep inguinal ring was located medial (22/30) or above (8/30) the femoral artery, but never lateral. The mean distances from the anterior superior iliac spine to the deep ring and femoral artery were 8.8 and 7.7 cm, respectively. Contrary to standard teaching, this study demonstrates that the deep inguinal ring lies medial, not lateral, to the femoral artery. This may clarify some of the variations in textbook anatomy, and explain the difficulty in distinguishing direct and indirect inguinal hernias pre-operatively.

Adult↗
PubMed2005

A study to determine plasma antioxidant concentrations in patients with Barrett's oesophagus.

BACKGROUND: Dietary questionnaire studies have suggested that patients with oesophageal adenocarcinoma are deficient in antioxidants. It is not known whether the same holds true for patients with the precursor lesion, Barrett's oesophagus. AIMS: To evaluate the hypothesis that patients with Barrett's oesophagus are deficient in antioxidants compared with patients without evidence of Barrett's oesophagus. PATIENTS AND METHODS: Plasma antioxidant profiles (copper, selenium, zinc; vitamins A, C, and E; carotenoids) were determined for patients with Barrett's oesophagus (n = 36), patients with erosive oesophagitis (n = 32), and patient controls (n = 35). RESULTS: Patients with Barrett's oesophagus had significantly lower plasma concentrations of selenium, vitamin C, beta cryptoxanthine, and xanthophyll compared with the other groups. CONCLUSIONS: This study confirms the hypothesis that patients with Barrett's oesophagus are deficient in certain antioxidants.

Adult↗
PubMed2004

The role of staging investigations for oesophago-gastric carcinoma.

AIMS: To study the frequency with which unresectable disease was identified on pre-operative staging investigations in patients with oesophago-gastric carcinoma, and to audit whether a staging protocol had reduced the rate of exploratory surgery. METHODS: Ninety-eight patients with oesophageal carcinoma, 89 patients with adenocarcinoma of the gastro-oesophageal junction (GOJ) and 68 patients with gastric carcinoma were staged according to a protocol of computerised tomography, laparoscopy and endoscopic ultrasound. RESULTS: The frequency with which each investigation identified unresectable disease was as follows: (a) computerised tomography-oesophagus 12/67, GOJ 13/58, stomach 10/60; (b) laparoscopy-oesophagus 3/22, GOJ 5/45, stomach 8/23; and (c) endoscopic ultrasound-oesophagus 15/55, GOJ 3/30. By tumour location, rates of exploratory surgery were 1/18 for the oesophagus, 12/35 for the GOJ and 4/42 for the stomach. All of the staging failures in patients with GOJ carcinomas related to posterior tumour extension into the lesser sac. CONCLUSIONS: Staging investigations precluded resection in one-third of patients, the greatest yield being for laparoscopy in gastric carcinoma. In spite of this, 18% of patients undergoing surgical intervention underwent exploratory surgery alone, notably patients with GOJ carcinoma.

Adenocarcinoma↗
PubMed2003

Histological changes in the oesophageal squamous mucosa: correlation with ambulatory 24 hour pH monitoring.

AIMS: To determine the value of squamous mucosal histology in the assessment of patients with gastro-oesophageal reflux symptoms. METHODS: Sixty six patients with reflux symptoms underwent endoscopy with oesophageal biopsy, manometry, and 24 hour oesophageal pH testing. The following histological features were assessed in squamous mucosa: the degree of basal cell hyperplasia, the degree of papillary zone elongation, and the density of neutrophil and eosinophil infiltration. Comparisons were made between the histological findings and the oesophageal function tests. RESULTS: The correlation between the traditionally accepted histological markers of gastro-oesophageal reflux disease in squamous mucosa and 24 hour pH testing was predominantly negative, with the exception of neutrophil inflammation in the squamous mucosa of patients with complicated reflux disease. CONCLUSIONS: This study was unable to confirm the value of the Ismail-Beigi criteria as histological markers of acid reflux. By inference, biopsy of the oesophageal squamous mucosa is of limited value in the assessment of patients with reflux symptoms.

Adult↗
PubMed2001

Risk factors and the prevalence of trocar site herniation after laparoscopic fundoplication.

BACKGROUND: Although there have been case reports describing trocar site herniation after laparoscopic fundoplication, its overall prevalence and the risk factors for its development are unclear. METHODS: The records of 320 patients undergoing primary laparoscopic fundoplication as treatment for gastroesophageal reflex disease (GERD) or hiatal hernia between 1991 and 1999 were reviewed retrospectively. Placement of the initial supraumbilical trocar was by the open Hassan technique in all patients. RESULTS: Nine patients (five male) with a mean age 54 years (range, 37-75) developed trocar site herniation, for an overall prevalence of 3%. The mean interval between surgery and diagnosis was 12 months (range, 4-21). In all patients, the hernia occurred at the supraumbilical camera port site. Patients with trocar hernias tended to have a higher body mass index (BMI) than those without hernias (mean BMI, 29.4 kg/m2 vs 27.2 kg/m2, p = 0.13). None of the patients developed intestinal obstruction as a consequence of herniation. To date, all but one of the hernias have been repaired. Six of them required the insertion of a prosthetic mesh. CONCLUSIONS: The prevalence of trocar site herniation after laparoscopic fundoplication was minimal at 3%. All hernias occurred at the midline supraumbilical port, the only site where open trocar insertion was employed. As a consequence of these observations, we have developed a new method of open trocar placement. This method utilizes a paramedian skin incision and separate fascial incisions through anterior and posterior rectus sheathes, with retraction of the rectus abdominis muscle laterally.

Abdomen↗
PubMed2000

Laparoscopic esophageal surgery.

In its 9-year history, laparoscopic esophageal surgery has become second only to gallbladder surgery in the frequency of minimally invasive procedures performed in routine surgical practice. Laparoscopic fundoplication has assumed a central role in the surgical treatment of gastroesophageal reflux. Laparoscopic myotomy has emerged as the optimal form of therapy for achalasia, and staging laparoscopy has been identified as an important adjunct to the preoperative evaluation of esophageal and gastroesophageal junction carcinoma. Laparoscopic paraesophageal hernia repair and remedial laparoscopic antireflux surgery currently are gaining acceptance. Laparoscopic gastroplasty, esophagectomy, and diverticulectomy are undergoing clinical trials, and their roles remain to be defined.

Diverticulum, Esophageal↗
PubMed2000

Gastroesophageal reflux disease in asthma: effects of medical and surgical antireflux therapy on asthma control.

OBJECTIVE: To critique the English-language reports describing the effects of medical and surgical antireflux therapy on respiratory symptoms and function in patients with asthma. METHODS: The Medline computerized database (1959-1999) was searched, and all publications relating to both asthma and gastroesophageal reflux disease were retrieved. RESULTS: Seven of nine trials of histamine-receptor antagonists showed a treatment-related improvement in asthma symptoms, with half of the patients benefiting. Only one study identified a beneficial effect on objective measures of pulmonary function. Three of six trials of proton pump inhibitors documented improvement in asthma symptoms with treatment; benefit was seen in 25% of patients. Half of the studies reported improvement in pulmonary function, but the effect occurred in fewer than 15% of patients. In the one study that used optimal antisecretory therapy, asthma symptoms were improved in 67% of patients and pulmonary function was improved in 20%. Combined data from 5 pediatric and 14 adult studies of anti-reflux surgery indicated that almost 90% of children and 70% of adults had improvement in respiratory symptoms, with approximately one third experiencing improvements in objective measures of pulmonary function. CONCLUSIONS: Fundoplication has been consistently shown to ameliorate reflux-induced asthma; results are superior to the published results of antisecretory therapy. Optimal medical therapy may offer similar results, but large studies providing support for this assertion are lacking.

Adult↗
PubMed1999

Peer-reviewed publication following presentation at a regional surgical meeting.

OBJECTIVES: The aim of the study was to investigate the proportion of publications arising from work presented at a regional surgical meeting. DESIGN: A list of all presentations to the Welsh Surgical Society 1983-95 was compiled and a detailed search made of the Medicine Database. The surgical topic of each presentation, the date of presentation, the date of publication and the journal of publication were recorded. SETTING: University Hospital of Wales. RESULTS: Four hundred and ninety-six papers were presented to the society, of which 402 (81%) were by trainees. The most frequent topics of presentation were colorectal (15%), vascular (15%) and hepato-pancreatico-biliary (11%). Two hundred and thirty-three papers (47%) have been published in peer-reviewed journals. The most popular journals for publication were Annals of the Royal College of Surgeons of England (19%), British Journal of Surgery (16%) and Journal of the Royal College of Surgeons of Edinburgh (8%). The median time from presentation to publication was 17.0 months (interquartile range 10.0-27.5 months). CONCLUSIONS: Regional surgical meetings have an important role in the annual surgical calendar and they are the ideal initial setting for presentation by trainees.

Education, Medical, Continuing↗
PubMed1999

Endosonographic staging of 100 consecutive patients with esophageal carcinoma: introduction of the 8-mm esophagoprobe.

Endoscopic ultrasound of esophageal carcinoma is conventionally performed using the 13-mm fiberoptic/ultrasound echoendoscope. However, the large diameter results in an inability to negotiate the primary tumor in 25% of patients. The aim of this study was first to determine whether use of the 8-mm esophagoprobe would overcome this problem and second to evaluate the accuracy of the smaller diameter instrument. One hundred consecutive patients with esophageal cancer underwent initial gastroscopy. Based upon the degree of luminal stenosis, patients were staged with either the conventional echoendoscope (luminal diameter > or = 15 mm) or the esophagoprobe (luminal diameter < 15 mm). The primary tumor was successfully negotiated in all subjects (echoendoscope 30, esophagoprobe 70) so that T- and N-staging was accomplished in every patient. Esophageal dilatation was performed in 12 patients (12%). The procedure was well tolerated and there were no complications, in particular no patient suffered esophageal perforation. The accuracy of the esophagoprobe for T-staging was 90% (19 out of 20) and that for N-staging was 75% (15 out of 20). This was similar to the accuracy of staging with the conventional echoendoscope, 90% (9 out of 10) for T-stage and 90% (9 out of 10) for N-stage. The esophagoprobe can safely and accurately stage patients with esophageal carcinoma, including those with high-grade stenoses.

Adult↗
PubMed1999

Current state, techniques, and results of laparoscopic antireflux surgery.

The introduction of laparoscopic fundoplication has dramatically changed the face of antireflux surgery. Central to the success of laparoscopic fundoplication is careful preoperative patient evaluation and attention to surgical technique. Emerging evidence has questioned the long-term durability of laparoscopic partial fundoplications underscoring the place of laparoscopic Nissen fundoplication as the procedure of choice for most patients. The technique of laparoscopic Nissen fundoplication should incorporate crural closure, complete fundic mobilization by short gastric vessel division, and the creation of a short, loose fundoplication by enveloping the anterior and posterior fundic walls around the esophagus. Relief of typical reflux symptoms can be anticipated in over 90% of patients. The outcome of atypical reflux symptoms is less predictable, on average two thirds of patients benefiting. The cost of laparoscopic fundoplication compares favorably to long-term medical therapy and open fundoplication. Current trends indicate that laparoscopic fundoplication is being used increasingly as an alternative to long-term medical therapy.

Costs and Cost Analysis↗
PubMed1999

The antioxidant profiles of patients with recurrent acute and chronic pancreatitis.

OBJECTIVE: It has been suggested that patients with chronic pancreatitis have antioxidant deficiencies. It is unclear whether these antioxidant deficiencies also occur in patients with recurrent acute pancreatitis and whether this condition represents an intermediate state between normality and chronic pancreatitis. The aim of this study was to determine the antioxidant profiles of patients with pancreatitis (recurrent acute and chronic) and to compare their profiles with a control population. METHODS: The antioxidant profiles of patients with chronic pancreatitis (n = 27) and recurrent acute pancreatitis (n = 11) were determined and compared with the antioxidant profiles of control subjects (n = 19). The following parameters were measured in blood: trace elements (selenium, copper, zinc), vitamins A and E, and carotenoids (alpha-carotene, beta-carotene, xanthine, beta-cryptoxanthine, lycopene). RESULTS: Patients with chronic pancreatitis had significantly lower plasma concentrations of selenium, vitamin A, vitamin E, beta-carotene, xanthine, beta-cryptoxanthine, and lycopene compared with both control subjects and patients with recurrent acute pancreatitis (p < 0.05). There were no significant differences between the antioxidant profiles of patients with chronic pancreatitis due to alcohol excess and patients with idiopathic chronic pancreatitis, or between the antioxidant profiles of patients with recurrent acute pancreatitis and control subjects. CONCLUSIONS: Patients with chronic pancreatitis had evidence of multiple antioxidant deficiencies. The antioxidant profiles of patients with recurrent acute pancreatitis did not differ from those of control subjects, discounting the hypothesis that recurrent acute pancreatitis represents an intermediate state between normality and chronic pancreatitis.

Acute Disease↗