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Biomedical subjects

D J Galloway

Publications and source records attributed to D J Galloway.

At least 19 recordsLinked to original sources
PubMed2006

Small bowel infarction in a patient with coeliac disease.

A 40 year old man was admitted with a four week history of intractable diarrhoea and abdominal pain. A clinical diagnosis of inflammatory bowel disease was supported by biopsies of colonic mucosa. There was no response to Mesalazine and over 12 days the patient became critically ill with diarrhoea, hypovolaemia, and peritonism. A laparotomy was performed and 130 cm of infarcted ileum was resected. Extensive investigations excluded thrombophilia and echocardiography excluded intracardiac thrombus. Postoperatively the patient continued to have diarrhoea and he was diagnosed with coeliac disease on the basis of positive antiendomysial and antitissue transglutaminase autoantibodies and duodenal histology. Although there is no proof that mesenteric infarction occurred as a direct consequence of coeliac disease, clinicians should be aware of this possibility.

Adult↗
PubMed2006

Prospective study of laparoscopic adjustable gastric banding in the west of Scotland.

UNLABELLED: Obesity is an increasing problem in Scotland and Laparoscopic Adjustable Gastric Bands (LAGB) are an effective method of weight reduction. Most outcome data are reported from high volume units with extensive experience or dedicated bariatric practice. We aimed to assess an experienced laparoscopic surgeon's outcome working outwith a dedicated bariatric practice in the west of Scotland. METHODS: All LAGB procedures performed by a single surgeon were prospectively assessed from 1997 to 2004. LAGB were inserted using pars flaccida approach. Patient selection was based on BMI >35 or significant obesity related co-morbidities. Outcomes included percentage excess weight loss (%EWL) and excess BMI loss (EBL). We assessed total operating time to assess the learning curve for LAGB placement. RESULTS: 125 patients were assessed (107 F:18 M). 123 patients were in regular follow-up (98%). Median age was 44 years (range 25-63). Mean follow-up was 34 months (range 11-91). Median initial BMI was 49 (range 37-73). 31% were BMI 35-45, 36% were BMI 45-50 and 33% were BMI>50. %EWL at 1,3 and 5 years was 45, 58 and 74, respectively. EBL at 1, 3 and 5 years was 11.7, 16.1, and 21.7, respectively. Complications included 4 converted procedures, 1 failed band insertion after conversion and re-operation for removal in five. Eight patients had tubing access port problems requiring intervention. The median overall total operation time was 80 minutes (range 50 - 160). CONCLUSIONS: In this cohort LAGB insertion by an experienced laparoscopic surgeon is safe with few re-operations. Satisfactory weight loss is obtained and patient compliance with follow-up is high.

Adult↗
PubMed2003

Randomized clinical trial comparing consultant-led or open access investigation for large bowel symptoms.

BACKGROUND: Referral of patients with large bowel symptoms is common and increasing. Currently most of these referrals are assessed at an outpatient clinic to determine the need and priority for investigation. METHODS: Over 21 months, 1131 patients referred by the general practitioner with large bowel symptoms were randomized. Patients in the consultant-led group were assessed by surgeons with a colorectal interest while those in the open access group underwent colonoscopy if they were 55 years or older and flexible sigmoidoscopy if younger. RESULTS: The most common symptom among referred patients was rectal bleeding (69.1 per cent) followed by change in bowel habit (48.8 per cent) and abdominal pain (32.3 per cent). There was a significant trend (P < 0.001) for patients in the consultant-led to have more investigations, and more patients in this group had no investigations (P < 0.001). Despite this, the percentage of patients with colonic or other pathology diagnosed was the same in both groups, 63.6 per cent in the consultant-led group compared with 61.8 per cent in the open access group (P = 0.558). Likewise the percentage of patients with cancer or other significant pathology was similar in both groups (13.9 versus 15.4 per cent; P = 0.532). The mean(s.d.) time to diagnose cancer or other significant pathology was 55.1(39.2) days in the consultant-led group compared with 57.4(33.6) days in the open access group (P = 0.514). The cost per patient was almost pound 105 more for patients in the consultant-led group. CONCLUSION: Patients referred by the general practitioner with large bowel symptoms should go directly to a properly managed and staffed open access large bowel investigation unit. This would enable most patients to have their investigations completed at one hospital attendance.

Ambulatory Care↗
PubMed1995

Efficacy of tumoricidal agents in vitro and in vivo.

Implantation of exfoliated tumour cells can give rise to local recurrence of colorectal cancer and it has been recommended that the bowel lumen be lavaged with a tumoricidal agent. This study identified which tumoricidal agents are currently used in Scotland and investigated their efficacy in vitro and in vivo. Cytotoxic efficacy was tested in vitro by a clonogenic assay and in vivo by a rat model with viable intraluminal tumour cells. Overall 70 per cent of surgeons used a tumoricidal agent during colorectal cancer surgery. Povidone-iodine, sodium hypochlorite and chlorhexidine-cetrimide were all effective at killing tumour cells in vitro but were all inactivated by the presence of 25 per cent whole blood in vitro. With 10(5) cells in vivo povidone-iodine and sodium hypochlorite significantly (P < 0.02) reduced the incidence of tumour growth while chlorhexidine-cetrimide had no significant effect. With 10(6) cells povidone-iodine had no effect on the incidence of tumour growth. Tumoricidal agents have effective cytotoxicity in vitro but are only weakly cytotoxic in vivo.

Animals↗
PubMed1995

Symptomatic outcome 1 year after laparoscopic and minilaparotomy cholecystectomy: a randomized trial.

In a randomized controlled trial, 299 patients were sent a symptoms questionnaire 1 year after laparoscopic (n = 151) or minilaparotomy (n = 148) cholecystectomy for symptomatic cholelithiasis. The response rate to the questionnaire from contactable patients was 86 per cent. In both groups, at least 90 per cent of patients reported that their symptoms were improved, and at least 93 per cent rated the success of their operation as 'excellent', 'good', or 'fair'. However, over half the patients reported abdominal pain, a quarter reported flatulence, and a quarter dyspepsia. The only difference between treatment groups was that a higher proportion of patients who underwent minilaparotomy reported heartburn (35 per cent versus 19 per cent, P = 0.005). Patients who reported a 'poor' outcome were more likely to have suffered a postoperative complication, had lower quality of life scores, and higher anxiety and depression scores. Both laparoscopic and minilaparotomy cholecystectomy result in symptomatic benefit in at least 90 per cent of patients with symptomatic cholelithiasis.

Abdominal Pain↗
PubMed1995

Comparison of manually constructed and stapled anastomoses in colorectal surgery. West of Scotland and Highland Anastomosis Study Group.

OBJECTIVE: The authors compared both the initial and the long-term outcomes of patients undergoing stapled and sutured colorectal anastomoses. SUMMARY BACKGROUND DATA: Sutured and stapled large bowel anastomoses are perceived to be equally safe, but concern has been raised about increased rates of tumor recurrence with the use of stapling instruments. METHODS: The outcome of patients with sutured and stapled colorectal anastomoses were compared in a prospective, multicenter, randomized study. Factors affecting long-term outcomes were assessed by both univariate and multivariate analysis. RESULTS: Seven hundred thirty-two patients were recruited. There was a significant increase in radiologic leakage in the sutured group (14.4% vs. 5.2%, p < 0.05), but there was no difference in clinical anastomotic leak rates, morbidity, or postoperative mortality. Tumor recurrence and cancer-specific mortality were higher in the sutured patients (7.5% and 6.7%, respectively) and in patients with anastomotic leaks. CONCLUSIONS: This study shows that suturing or stapling are equally safe in large bowel surgery. However, it also shows a long-term benefit of stapling in colorectal cancer patients.

Anastomosis, Surgical↗
PubMed1994

Plasma gastrin concentrations are normal in patients with colorectal neoplasia and unaltered following tumor resection.

BACKGROUND/AIMS: Previous studies have found that colorectal cancer patients have hypergastrinemia, but most have been inadequately controlled. Preoperative fasting and meal-stimulated gastrin levels were measured in patients with colorectal tumors (n = 42) and in carefully matched controls (n = 34). Helicobacter pylori status was assessed because it causes significant hypergastrinemia. METHODS: Plasma gastrin levels were measured by radioimmunoassay. Helicobacter status was assessed using the [14C]urea breath test and serology (immunoglobulin G). RESULTS: Preoperatively, fasting plasma gastrin levels were similar in patients with tumors (median, 55 ng/L; interquartile range, 45-82.5) and controls (77.5 ng/L; 53.7-137.5; P = 0.10). Similarly, peak gastrin levels were not significantly different in tumor patients (200 ng/L; 137.5-312.5) and controls (247.5 ng/L; 147.5-375; P = 0.21). The prevalence of H. pylori infection in patients with tumors (60%) and controls (53%) was similar in both groups. Five (20%) tumor patients who were H. pylori-positive preoperatively were negative postoperatively, and their median peak plasma gastrin level decreased from 200 ng/L to 140 ng/L. After these patients were excluded, fasting and peak plasma gastrin concentrations were similar preoperatively and postoperatively. CONCLUSIONS: When confounding factors are controlled for, plasma gastrin levels are not increased in colorectal cancer and do not decrease after curative resection. Previously noted decreases in gastrin levels after tumor resection may be attributable to loss of H. pylori infection in some patients, as noted here.

Adult↗
PubMed1993

Comparative study of abdominal incision techniques.

The characteristics of surgical incisions made with an electrosurgical technique were compared with those made using conventional methods in a prospective randomized trial. In particular, the claim that the method of incision may influence postoperative pain was investigated. A total of 101 consecutive patients receiving full-length midline laparotomy incisions for gastrointestinal resection were studied. A record was kept of the time required to make the incision and blood loss as well as postoperative pain (using a linear analogue scale), ventilatory function and requirement for analgesia. There were 50 patients in group 1 (scalpel; 15 men, 35 women) and 51 in group 2 (electrocautery; 26 men, 25 women). The groups were similar in age, body-weight, diagnosis and the type of surgical procedures being performed. Incision time was similar in the two groups but median blood loss during incision was significantly less in group 2 patients than in group 1 (10 versus 25 ml, P < 0.0001). Linear analogue pain scores were not significantly different between the groups at any stage after operation. The same was true of postoperative ventilatory function and requirement for analgesia. A total value for morphine use during the entire postoperative period was derived for each group and the median was 1.55 mg/kg for group 1 compared with 1.49 mg/kg for group 2. The electrosurgical method is associated with less blood loss during incision, although this study has failed to confirm any reduction in postoperative pain or requirement for analgesia in these patients.

Abdominal Muscles↗
PubMed1992

Early postoperative contrast radiology in the assessment of colorectal anastomotic integrity.

The predictive value and safety of early postoperative radiological assessment of colorectal anastomotic integrity is controversial. In this study, 233 patients with colorectal or left sided colonic anastomoses had water soluble contrast enemas performed in the early postoperative period (mean: day 7 postoperatively, range: days 4-14). A total of 40 radiological leaks were recorded but only 12 of these patients had clinical signs of anastomotic dehiscence. Furthermore, 11 patients who had normal contrast enemas subsequently developed a clinical anastomotic leak. There were therefore 28 (12.0%) false positive and 11 (4.7%) false negative results giving values for the specificity and sensitivity of the radiological investigation of 86.7% and 52.2% respectively. Only 3 patients (1.3%) developed a clinically apparent anastomotic complication following a contrast enema. We conclude that while radiological assessment of distal large bowel anastomoses in the early postoperative period appears to be a safe procedure, it provides little useful clinical information with regard to early postoperative morbidity. Recent work has, however, suggested that radiological anastomotic integrity may be relevant to long term outcome following surgery for colorectal cancer.

Adult↗
PubMed1992

Intra-luminal tumour cells and peri-anastomotic tumour growth in experimental colonic surgery.

Most loco-regional tumour recurrences following colorectal cancer surgery are extra-luminal. This study was designed to determine the conditions necessary for viable intra-luminal tumour cells to give rise to extra-luminal tumour growth in an experimental animal model. When carcinoma cells were injected into the colonic lumen in the absence of a colonic wound, tumour growth was rare (1 of 24 animals). However, when tumour cells were injected intra-luminally either in the presence of an apparently watertight colotomy repair or prior to the transmural insertion of interrupted sutures, peri-anastomotic +/- widespread peritoneal tumour growth was consistently observed. Tumour growth did not occur on the mucosa of the bowel. These findings suggest that viable intra-luminal tumour cells can migrate across a clinically intact experimental large bowel anastomosis or along transmural suture tracts to give rise to extra-luminal tumour growth.

Anastomosis, Surgical↗
PubMed1991

Recurrence of colorectal cancer after sutured and stapled large bowel anastomoses.

The purpose of this study was to compare surgical stapling and manual suturing techniques with respect to the incidence of tumour recurrence in patients with colorectal cancer: 294 patients undergoing potentially curative resections for colorectal cancer were randomly allocated to receive sutured (n = 142) or stapled (n = 152) anastomoses. The mean (s.e.m.) incidence of tumour recurrence at the end of 24 months was 29.4(4.4) per cent in the sutured group, compared with 19.1(3.9) per cent in the stapled group (P less than 0.05). The corresponding rates for cancer-specific mortality at 24 months were 22.3(4.1) per cent and 10.9(3.0) per cent respectively (P less than 0.01). A multiple regression analysis revealed that the influence of anastomotic technique on recurrence and mortality rate was independent of tumour stage. These results suggest that in colorectal cancer surgery the use of stapling instruments for anastomotic construction could be associated with a reduction in the incidence of recurrence and mortality rate by as much as 50 per cent.

Aged↗
PubMed1991

Anastomotic leaks in colorectal cancer surgery: a risk factor for recurrence?

This study examines anastomotic leaks as a potential influence on the long term outcome of patients with colorectal cancer. 167 patients were studied who had clinical and radiological assessment of anastomotic integrity in the post-operative period, following potentially curative resections for left-sided colonic or rectal cancer. There was no evidence of a leak in 135 of these patients, while the remaining 32 developed a clinical and/or a radiological leak. At the end of a mean follow-up of 25 months, 15 patients with leaks (46.9%) developed tumour recurrence, compared with 25 of those without any leak (18.5%; p less than 0.001). Cancer specific mortality at 24 months was also significantly higher for patients with leaks (36.9% +/- 9.7% versus 12.6% +/- 3.3%; p less than 0.001). The influence of anastomotic leaks on the outcome was independent of tumour stage. These results suggest that in patients undergoing surgery for colorectal cancer development of an anastomotic leak is significantly associated with a poorer long-term outcome.

Aged↗
PubMed1991

Anastomotic suture materials and experimental colorectal carcinogenesis.

Local tumor recurrence following restorative surgery for colorectal cancer may occasionally result from the promotion of a neoplastic lesion in a zone of proliferative instability adjacent to the anastomosis. The aim of this study was to compare the influence of three anastomotic suture materials, including stainless steel (as a model of surgical stapling), on colorectal carcinogenesis in an experimental animal model. The transmural implantation of stainless steel sutures into the distal descending colon of albino Swiss rats during the postinitiation phase of tumor induction resulted in significantly fewer animals exhibiting perianastomotic tumors 12 weeks later (3 of 21 animals) when compared with either polyamide (Nurolon; Ethicon, Edinburgh, United Kingdom) (14 of 20 animals; P less than 0.001) or polyglycolic acid (Dexon Plus; Davis and Geck, Gosport, United Kingdom) sutures (17 of 21 animals; P less than 0.001). The findings were similar when the same materials were used to resuture a longitudinal colotomy. For both operative procedures, the type of suture material had no influence on the incidence of large bowel tumors distant from the anastomotic site. These results suggest that stainless steel staples may promote fewer perianastomotic large bowel tumors than certain more conventional suture materials and, therefore, may be safely employed in colorectal cancer surgery.

Animals↗
PubMed1989

Anastomotic suture materials and implantation metastasis: an experimental study.

Suture implantation of viable exfoliated malignant cells may be responsible for local recurrence (implantation metastasis) of colorectal cancer. In this study, four anastomotic materials (braided polyamide, braided polyglycolic acid, monofilament polypropylene and monofilament stainless steel) were compared with respect to their ability to entrap and transfer free Mtln3 carcinoma cells from the colonic lumen of a rat. The braided materials transferred greater numbers of cells than did the monofilament sutures (P less than 0.001), but significant differences were also observed between polyglycolic acid and polyamide (P less than 0.001) and between polypropylene and stainless steel (P less than 0.05). Secondly, the firm adherence of tumour cells to the suture materials was assessed by an in vitro technique. The Mtln3 cells were found to adhere in significantly greater quantities to the braided sutures than to the monofilaments (P less than 0.001) and this was supported by in vivo tumour growth studies. These findings may have implications for colorectal cancer surgery in man.

Adenocarcinoma↗
PubMed1989

Adjuvant multimodality treatment of rectal cancer.

It has long been recognized that curative surgery as the sole treatment for rectal cancer yields disappointing results. There is now a growing body of evidence from prospective randomized clinical trials to support the role of adjuvant therapy for patients whose primary tumour has spread through the rectal wall or has associated lymph node involvement. Carefully planned radiation therapy with adequate doses and fields can reduce the risk of locoregional failure. Chemotherapeutic agents delivered either systemically or regionally may also contribute to better disease control and survival. A number of diagnostic and therapeutic issues still need to be addressed in order to use the available adjuvant treatment methods most appropriately. Efforts to refine patient selection, to enhance therapeutic effect and to minimize toxicity are likely to improve the outlook for patients with resectable rectal cancer.

Antineoplastic Agents↗