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Biomedical subjects

D J Leaper

Publications and source records attributed to D J Leaper.

At least 91 records · Page 5Linked to original sources
PubMed1983

Angiography as an index of healing in experimental laparotomy wounds and colonic anastomoses.

The vascular anatomy of healing wounds in rat abdominal wall and obstructed large bowel was examined by sequential angiography, with particular reference to the possibility of tissue necrosis following mass closure of the abdominal wall and of dehiscence after primary anastomosis in obstructed colon. In the abdominal wall, gross distortion of the vascular anatomy one to two weeks after mass closure was accompanied by a central wound zone which had an appearance suggestive of necrosis. By the fourth week after closure vascular anatomy was restored and "necrosis" completely resolved. In left colon that had been acutely obstructed for 72 h an increased risk of anastomotic failure was accompanied by delays in the appearance of new vessels and their growth across the anastomosis, as detected by colonic angiography. Mass closure should not be discarded because of the hypothetical risk of tissue necrosis. Primary anastomosis in acutely obstructed colon is contra-indicated because of risk of delayed healing.

Abdominal Muscles↗
PubMed1979

Colour lymphography in clinical surgery.

In 38 patients undergoing femoral artery profundaplasty and in 18 having simple mastectomy with pectoral node biopsy, a 6.2 per cent solution of sodium sulphan blue was injected peripherally to outline the lymph nodes in the groin or axilla. Nodes and vessels were easily seen and the technique is now in routine use.

Breast Neoplasms↗
PubMed1979

Breast cancer and prostaglandins: a new approach to treatment.

The effect of the non-steroidal inhibitor of prostaglandin synthesis, flurbiprofen, has been studied on a transplanted mouse mammary tumour of spontaneous origin. Daily administration of 2.5 mg/kg flurbiprofen signficantly reduced the growth of this NC adenocarcinoma transplanted subcutaneously into the right flank of WHT/Ht mice. Histological examination showed that primary tumours excised at 3 weeks from treated mice tended to have a more prominent lymphocytic infiltration. There was a non-significant tendency for mice treated with flurbiprofen alone to survive longer after tumour excision and to develop less local metastases, although scar recurrences seemed unaffected. The effect of adjuvant chemotherapy and local radiotherapy on local metastases and survival time tended to be greater when flurbiprofen was also given. This work supports and extends the basis for prospective clinical trials to evaluate the role of prostaglandins in human cancer and the value of prostaglandin synthesis inhibitors in cancer therapy.

Animals↗
PubMed1979

Cancer growth, response to treatment and survival time in mice: beneficial effect of the prostaglandin synthesis inhibitor flurbiprofen.

Adult mice were injected subcutaneously with cells from a syngeneic metastasizing mammary cancer. Daily treatment with flurbiprofen starting before injection of the cancer cells reduced tumour growth and lengthened the survival of mice whose tumours were excised at 3 weeks. When low doses of radiotherapy and chemotherapy were given, additional treatment with flurbiprofen starting 25 days after injecting the cancer cells substantially inhibited tumour growth.

Animals↗
PubMed1978

The role of antibacterial preparation of the intestine in the reduction of primary wound sepsis after operations on the colon and rectum.

A consecutive series of 320 patients undergoing operations on the colon and rectum, under the care of one surgeon, was studied to determine the influence of oral antibacterial preparation of the intestine on the incidence of postoperative wound sepsis. Thirty patients were excluded from the analysis, and the rates of major wound sepsis in the remaining 290 patients were 21.7 per cent when no antibacterial preparation was used; 18.6 per cent when the intestine was prepared with phthalylsulfathiazole and neomycin, and 1.6 per cent when the intestine was prepared with phthalysulfathiazole, neomycin and tetracycline. Other important determinants of the rate of wound sepsis were obesity and the use of cephaloridine prophylaxis. Results of bacteriologic studies showed the effectiveness of triple antimicrobial preparation of intestine against gram-negative aerobes and Bacteriodes species.

Anti-Bacterial Agents↗
PubMed1977

Single dose intra-incisional antibiotic prophylaxis of surgical wound sepsis: a controlled trial of cephaloridine and ampicillin.

In a series of 410 consecutive potentially contaminated operations, we have compared the relative efficacy of intra-incisional cephaloridine and ampicillin in single doses of 1 g in 2 ml of water. In high risk operations (ileocolorectal surgery, perforated appendicitis, or when the patient has 2-5 cm or more of subcutaneous fat at the site of the incision) cephaloridine prophylaxis resulted in a primary sepsis rate of 14 per cent compared with 36 per cent for ampicillin. In all other patients the two antibiotics were equally effective. Secondary sepsis, following discharge from the wound of a substance other than pus, was equally common in the two groups.

Ampicillin↗
PubMed1977

Abdominal wound closure: a trial of nylon, polyglycolic acid and steel sutures.

Failures after abdominal wound closure (early dehiscences and late incisional hernias) are due to breakage of sutures, slippage of knots or tearing out of sutures from the tissues. The suture-holding capacity of the entire thickness of muscle and aponeurosis is nearly twice that of the anterior rectus sheath, and deep bites (1-0 cm from the cut edges) are nearly twice as secure as bites of 0-5 cm. In a random controlled clinical trial of 357 major laparotomies, closure with either layered monofilament nylon or mass polyglycolic acid or steel resulted in 2 burst abdomens (0-56%), 10 incisional hernias due to suture failure (3-4%) and 8 incisional hernias caused by deep sepsis (2-7%). There were no statistically significant differences among the treatment groups, but 1 patient in the nylon and 3 in the steel groups had persistent sinuses until their sutures were removed.

Abdomen↗
PubMed1976

A clinical index for selection of breast cancer patients for adrenalectomy.

Selection of patients with disseminated breast cancer for endocrine surgery has not been facilitated by sophisticated biochemical techniques. The present study was designed to produce a method of prognosis based exclusively on clinical data. Eighteen features were studied in 95 patients who underwent adrenalectomy and oophorectomy, and correlated with their degree of response to produce predictive variables. In a further group of 90 patients a prognostic score (the sum of the predictive variables) was calculated. There were 17 patients who scored less than 0 and in no case was a good response to endocrine surgery achieved. There were 40 who scored over 10, 29 of whom had a good response. The remaining 33 scored between 0 and 10 and there was no correlation between score and response. This predictive system offers significant advantages over accepted methods of clinical assessment (chi2 = 6-61, P less than 0-02). When patients with a score between 0 and 10 are excluded, its advantages are even more obvious (chi2 = 11-26, P less than 0-001). Patients who are likely to respond to endocrine surgery can be selected by clinical parameters alone, and total failure to respond can be forecast with complete accuracy. Between these two there is a third group whose response is unpredictable.

Adrenalectomy↗
PubMed1975

Computer-aided diagnosis of lower gastrointestinal tract disorders.

This paper reports a survey of human and computer-aided diagnosis in a prospective consecutive series of 301 patients admitted to the hospital with lower gastrointestinal tract disease. At initial outpatient contact (at which time endoscopy was customarily performed), the clinicians' diagnostic accuracy was 64.5%. After biopsy, radiology, and other investigative procedures, the clinicians' preoperative diagnostic accuracy rose t0 82.7%. When data from the house surgeon's case notes were fed into the computer, its diagnostic prediction proved accurate in 77% of the 301 patients, and when details of the outpatient endoscopy were added to the house surgeon's case notes, the computer's diagnostic accuracy rose to 84.7%. It is suggested that computer-aided analysis may have a limited part to play in discriminating between the common causes of lower gastrointestinal disorders in routine clinical practice.

Adolescent↗
PubMed1974

Human and computer-aided diagnosis of abdominal pain: further report with emphasis on performance of clinicians.

This paper reports a controlled trial of human and computer-aided diagnosis in a series of 552 patients with acute abdominal pain. The overall diagnostic accuracy of the computer-aided system was 91.5% and that of the senior clinician to see each case was 81.2%. However, the clinician's diagnostic performance improved markedly during the period of the trial. The proportion of appendices which perforated before operation fell from 36% to 4% during the trial, and the negative laparotomy rate dropped sharply. After the trial closed in August 1972 these figures reverted towards their pretrial levels.It is suggested that while computer-aided diagnosis is a valuable direct adjunct to the clinician dealing with the "acute abdomen," he may also benefit in the short-term from the constant feedback he receives and from the disciplines and constraints involved in communicating with the computer.

Abdomen↗
PubMed1973

Clinical diagnostic process: an analysis.

An analysis of observations made during 1,307 diagnoses by a total of 28 clinicians (503 diagnoses in real life, and 804 on simulated patients) concerned primarily the interview of patients suffering from abdominal pain. Interviews ranged from 10 to 35 questions, and from "stereotyped" procedures, in which identical (and often irrelevant) questions were asked to each patient, to "adaptive" interviews, in which specific relevant questions were put to each patient. Senior clinicians tended to ask fewer, more relevant questions than their junior counterparts; and urgent cases were dealt with in a more adaptive fashion than routine cases in outpatients. Disappointingly, there was considerable difference between real-life and simulated situations. From these results it is suggested (a) that the "diagnostic process" does not exist, (b) that any automated diagnostic system must be flexible to accommodate the wishes of a variety of clinicians, and (c) that studies based on artificial clinical situations should be treated with extreme caution.

Abdomen↗