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Biomedical subjects

D M Sedgwick

Publications and source records attributed to D M Sedgwick.

17 recordsLinked to original sources
PubMed2005

The impact of an extreme sports event on a district general hospital.

BACKGROUND: Extreme sports events are increasing in popularity, particularly in mountainous areas throughout Great Britain. Emergency medical care for these events is usually provided by voluntary organisations, providing event side first aid and referring patients to nearby District General Hospitals. The Fort William Mountain Bike Race is part of the UCI World Cup Series: 173 competitors racing in cross country, downhill and 4X events. The Belford Hospital provides year round medical care for the Lochaber community, which frequently swells during the tourist season. The hospital has 8300 new attendances per annum, 35 patient reviews per 24 hrs. METHODS AND RESULTS: We have reviewed the impact of the event on the local hospital. In total 52 riders reported 61 injuries. The hospital treated 24q (14%) riders. Retrospective analysis of attendances has revealed 19 riders attended on race days, increasing attendees by up to 28%. 46% of injured riders were seen at the A &E department, 1 rider requiring admission for observation and 1 rider required inter-hospital transfer Injury patterns (knee 20%, hand/wrist 18% and shoulder 18%) were similar to other reported series. CONCLUSIONS: We believe that extreme sports events can have considerable impact on small district general hospitals. Additional triage and staffing resources should be utilised and event organisers should anticipate the additional problems they present to the local community. District General Hospitals continue to provide a substantial contribution to the provision of health care for extreme sports within the UK.

Adolescent↗
PubMed1994

Juvenile onset inflammatory bowel disease: height and body mass index in adult life.

OBJECTIVE: To establish the frequency of permanent growth failure in juvenile onset inflammatory bowel disease. DESIGN: Measurement of height and weight in a geographically based cohort at a mean of 14 (range 5.2-29.5) years after diagnosis. Comparison with data from surveys of British adults in 1980 and 1987. SETTING: NHS hospitals throughout Scotland. SUBJECTS: 105 Children admitted to hospital during 1968-83 who fulfilled diagnostic criteria for Crohn's disease or ulcerative colitis and lived in specified regions. 87 were aged over 18 and living in Britain at follow up. MAIN OUTCOME MEASURES: Height, weight, body mass index, and sexual maturity. RESULTS: All patients were sexually mature. 67 of the 70 patients examined were of normal height, and three women with Crohn's disease were abnormally short. Weight and body mass index were normal in all patients with ulcerative colitis. Patients with Crohn's disease had significantly lower weight than those with ulcerative colitis (men 66.8 (9.5) kg v 78.4 (13.8) kg, P = 0.04; women 51.5 (8.2) kg v 63.0 (12.1) kg, P < 0.02) irrespective of disease activity. Body mass index was also significantly lower than the normal distribution (P < 0.01). Growth retardation was not mentioned as a problem for any of the 17 patients interviewed only by telephone. CONCLUSIONS: Despite growth retardation in the teenage years most young people with inflammatory bowel disease will eventually achieve normal height. Reasons for lower weight in patients with Crohn's disease remain to be established.

Adult↗
PubMed1994

Pathogenesis of acute radiation injury to the rectum. A prospective study in patients.

In a prospective investigation of the clinical and pathological effects of pelvic radiotherapy on the rectum, nine patients (age range 58-77 years) had symptoms assessed weekly during radical treatment for bladder and prostatic tumours, and at 2, 4 and 12 weeks after treatment. Stool frequency increased in all patients from a mean of 1.7 per day before treatment to 5.0 per day at 4 weeks (P < 0.05). Seven patients developed liquid stools during treatment; 6 had pain on defaecation, 8 had urgency of defaecation, all experienced tenesmus and 3 had episodes of faecal incontinence. One patient had symptoms of such severity that treatment was interrupted. Virtually all symptoms had resolved by 12 weeks after treatment. Sigmoidoscopy with biopsy of anterior and posterior rectal walls was performed before treatment began, at 2 weeks and 4 weeks during treatment, and 4 and 12 weeks after treatment. All patients during treatment had evidence of acute inflammatory damage with hyperaemic, oedematous mucosa and failure of healing of biopsy sites. Histological examination of the rectal biopsies revealed the well described characteristic mucosal changes with crypt cell damage, inflammatory cell infiltrate and loss of crypts. In 2 of 7 cases studied, pathology was still abnormal at 3 months. Radiation injury to bowel is an underemphasised cause of morbidity and further prospective studies are required to determine methods of reducing normal tissue damage and ameliorating symptoms.

Aged↗
PubMed1994

Dose-response studies of depletion and repopulation of rat intestinal mucosal mast cells after irradiation.

The effects of radiation on gut mucosal mast cells (MMC) and tissue eosinophils were examined. Groups of rat were given single doses of whole-body irradiation from 0.5 to 5 Gy. Serum rat mast cell protease II (RMCPII) concentration showed a significant dose-dependent fall after 1 Gy on day 3 and 1.5 Gy on day 7. MMC counts and tissue RMCPII values on day 7 decreased significantly by 70% after 1 Gy and were undetectable with larger doses. Rat with normal and expanded MMC populations were irradiated or given anaphylaxis. Serum RMCPII concentrations did not change after irradiation, but there was a 10-fold increase in RMCPII after anaphylaxis. Tissue eosinophils in jejunum were 50% of control at 7 days after 2 Gy, and this effect was progressively more marked with higher doses. Similar effects on MMC and eosinophils were demonstrated in ileum, ascending colon and rectum. After 4.5 Gy, repopulation of the gut with MMC did not occur until week 3-4 postirradiation and MMC counts were still 50% below those of controls at 5 weeks postirradiation. Counts of tissue eosinophils 5 weeks after 4.5 Gy irradiation had returned to control levels in jejunum but were still significantly depleted in colon. These experiments show that the high radiosensitivity of rat intestinal MMC is dose dependent, similar at four different levels in the gastrointestinal tract and does not lead to immediate release of granule protease; repopulation with MMC does not begin until at 3 weeks postirradiation.

Anaphylaxis↗
PubMed1994

Morbidity of juvenile onset inflammatory bowel disease: effects on education and employment in early adult life.

Seventy young adults (50 with Crohn's disease (CD) and 20 with ulcerative colitis (UC) (from a geographically derived cohort of patients with juvenile onset inflammatory bowel disease were interviewed and examined at a mean of 14 (range 5.2-29.5) years after diagnosis. Details of education and employment were collected as part of a structured clinical interview. Although 57% had had periods of absence from school of two months or more, their school examination pass rates were similar to those of the healthy population. The achievements of CD patients were consistently better than those of the UC group. In 15 patients, relapses of inflammatory bowel disease had adversely affected examination performance or prevented them from sitting school examinations. Extra tuition in hospital had been provided for only four patients, and three others had had privately arranged tuition at home. Fifty per cent proceeded to full time higher education. At the time of review, seven patients were full time students, one was a university research fellow, 47 were in full time and three in part time employment, one was self employed, four were housewives, and only six were involuntarily unemployed. All four unemployed CD patients attributed this to inflammatory bowel disease, but other factors were relevant in the unemployed UC patients. Few had direct evidence of rejection by employers on health grounds, though some did not declare their illness to prospective employers.

Adult↗
PubMed1991

Gastric cancer in Scotland: changing epidemiology, unchanging workload.

OBJECTIVE: To determine the changes in incidence of and mortality from gastric cancer in Scotland between 1978 and 1987 and in the operative workload in Lothian between 1979 and 1988. DESIGN: Analysis of national incidence statistics for gastric cancer derived from the Scottish national cancer registry, deaths from gastric cancer recorded by the registrar general for Scotland, and Lothian surgical audit data. SETTING: Scotland and Lothian Health Board area. PATIENTS: Patients in Scotland with gastric cancer during 1978 to 1987 inclusive; patients in Scotland with gastric cancer recorded on their death certificate as cause of death during 1978 to 1987; patients who had an operation in Lothian for gastric cancer during 1979 to 1988. MAIN OUTCOME MEASURES: Changes in incidence of and mortality from gastric cancer in Scotland from 1978 to 1987 and in the number of operations performed for gastric cancer in Lothian from 1979 to 1988. RESULTS: Mortality from gastric cancer in Scotland fell by about 25% over the 10 years. The incidence and standardised incidence of gastric cancer showed a marginal decline of about 9%. The differences in trends between incidence and mortality were significant (p less than 0.05). CONCLUSIONS: This study shows that the surgical workload associated with gastric cancer is not declining. This is because the incidence has remained almost static, which may be due to the relative increase in the numbers of older people in the population, who are at greater risk of developing gastric cancer. Gastric cancer should not be regarded as a disease in decline. Incidence and workload should determine resources allocated to this disease rather than mortality statistics.

Adult↗
PubMed1991

Population-based study of surgery in juvenile onset Crohn's disease.

A geographically based cohort of 68 children with Crohn's disease was derived by sampling from Scottish Hospital In-patient Statistics. Surgical histories were examined and analysed by actuarial methods, and the nature of major operations performed was compared with operations for Crohn's disease in the Lothians' Surgical Audit. Fifty-four of the 68 patients were treated surgically, with a total of 135 operations (71 major, 64 minor). Fifty per cent of the cohort had a major operation within 5 years of onset of symptoms; median time to a second operation was 4 years. The types of major operation performed in juvenile onset patients differed significantly from those recorded in the Lothians' audit, with a high rate of exploratory laparotomy in younger patients (12 cases). With a mean follow-up of 7 years, 12 patients (18 per cent) have a permanent stoma. There were five deaths, three postoperative. This study highlights the frequency of surgical intervention in young people with Crohn's disease.

Adolescent↗
PubMed1991

Population-based study of surgery in juvenile onset ulcerative colitis.

A geographically based cohort of 37 children with ulcerative colitis has been derived by sampling from Scottish Hospital In-patient Statistics. Surgical histories were examined and analysed by actuarial methods, and the major operations performed were compared with operations for ulcerative colitis in the Lothians' Surgical Audit. Fourteen of the 37 patients had a total of 26 operations (15 major, 11 minor). Sixteen per cent had major surgery within 5 years of onset of symptoms, and the types of operation were similar to those recorded in Lothians' Surgical Audit. Operation rate was significantly lower than that for a parallel cohort of patients with Crohn's disease. With a mean follow-up of 7.4 years, seven (19 per cent) patients have a permanent stoma and there has been one death.

Adolescent↗
PubMed1991

Improving results in the treatment of gastric cancer: an 11-year audit.

Of 280 patients presenting to one hospital with gastric cancer between 1975 and 1985, 97 (35 per cent) did not undergo surgery and 29 per cent (54 out of 183) of those who did had no resection performed. The 30-day operative mortality rate in the study period was 15 per cent (28 out of 183) but in the subsequent 4-year period this fell to 7 per cent (5 out of 69). The survival rate correlated significantly with depth of invasion but not with tumour site or degree of differentiation. The incidence of early gastric cancer in this series was 5 per cent but the 5-year survival rate in this group was 52 per cent suggesting that the true incidence might be even lower. The overall 5-year survival rate in our area 20 years ago was only 5.2 per cent but in this series it was 11 per cent overall and 24 per cent after resection, and with actuarial correction 15 per cent overall and 28 per cent after resection. The continuing improvement in operative mortality rates and in 5-year survival rates gives grounds for optimism, but the disease must be diagnosed earlier if this improvement in outlook is to continue.

Adult↗
PubMed1983

Domiciliary gallows traction for femoral shaft fractures in young children. Feasibility, safety and advantages.

Over 15 years (1967 to 1982) 140 uncomplicated femoral shaft fractures in children under four years of age were successfully treated using Bryant's traction. Forty of these children were treated after the introduction of the domiciliary management policy in 1976; 13 children were managed at hospital and 27 were managed at home. No significant complications occurred. The advantages to the family, and the safety and economy of domiciliary management lead us to recommend its adoption in favourable cases. Treatment at home relies on an efficient and experienced home nursing service. Possible complications of the injury and treatment with recommendations to prevent them are discussed.

Age Factors↗
PubMedDate not supplied

A follow-up study of the ingestion of gellan gum by humans, with special reference to the absence of eosinophilia.

Following a 7-day control period, during which sampling was carried out on two occasions (days 1 and 8), 10 female and 10 male healthy volunteers consumed a weight of gellan gum corresponding to 175 mg/kg body weight for 7 days (days 8-14) followed by 200 mg gellan gum per kg body weight for a further 14 days (days 15-28). The total period of ingestion (21 days) was followed by a further 7-day control period (days 29-36). 'Control' samples for haematology and plasma clinical chemistry were therefore secured on days 1, 8 and 36, and 'test' samples were secured on days 15, 22 and 29. In addition, 24 h samples were monitored by urinalysis, and 24 h faecal samples were monitored for occult blood three times each week. The major objectives were to supplement the data for gellan gum obtained previously, particularly in respect of changes in eosinophil concentrations, and to re-examine the responses of two male volunteers who had given indications of eosinophilia in a previous study. There was no such response by them, or by any of the other 18 volunteers, on this occasion.

Adult↗
PubMedDate not supplied

Dietary effects of propylene glycol alginate in humans.

Following a 7-day control period, five male volunteers consumed a weight of propylene glycol alginate corresponding to 175 mg/kg body weight for 7 days, followed by 200 mg propylene glycol alginate per kg body weight for a further 16 days. Measurements before and at the end of the 23-day period of dietary supplementation showed that propylene glycol alginate had little effect on faecal parameters (pH, water content, daily wet and dry weights). The dietary transit time remained constant for three volunteers, increased for one, and decreased for one. The ingestion of propylene glycol alginate had no significant effect on (a) haematological indices, (b) plasma biochemistry parameters, (c) urinalysis parameters, (d) blood glucose and plasma insulin concentrations, (e) breath hydrogen concentrations. No allergic responses were reported by, nor observed in, any of the volunteers. The study therefore indicates that the ingestion of propylene glycol alginate at a high level for 23 days caused no adverse dietary or physiological effects; in particular, the enzymatic and other sensitive indicators of adverse toxicological effects remained unchanged.

Adult↗
PubMedDate not supplied

Dietary effects of sodium alginate in humans.

Following a 7-day control period, five male volunteers consumed a weight of sodium alginate corresponding to 175 mg/kg body weight for 7 days, followed by 200 mg sodium alginate per kg body weight for a further 16 days. Measurements before and at the end of the 23-day period of dietary supplementation showed that sodium alginate acted as a faecal bulking agent for all volunteers, giving a significant (p less than 0.01) increase in daily wet weight, and also increases in the water content and daily dry weight, but no change in faecal pH. Although the dietary transit time remained constant for two volunteers, it decreased for two, and increased slightly for one, with little resulting change in the overall mean value. The ingestion of sodium alginate had no significant effect on (a) haematological indices, (b) plasma biochemistry parameters, (c) urinalysis parameters, (d) blood glucose and plasma insulin concentrations, (e) breath hydrogen concentrations. No allergic responses were reported by, nor observed in, any of the volunteers. The study therefore indicates that the ingestion of sodium alginate at a high level for 23 days caused no effects other than those normally associated with a polysaccharide bulking agent; in particular, the enzymatic and other sensitive indicators of adverse toxicological effects remained unchanged.

Adult↗
PubMedDate not supplied

Juvenile-onset inflammatory bowel disease: predictors of morbidity and health status in early adult life.

We interviewed and examined 70 young adults (50 Crohn's disease, 20 ulcerative colitis) from a geographically derived cohort of patients with juvenile-onset (< or = 16 years) inflammatory bowel disease at a mean of 14 years (range 5.2-29.5) after diagnosis. Patients with initially ileo-colonic Crohn's disease spent significantly longer in hospital than other groups. Thirty-nine Crohn's disease and 10 ulcerative colitis patients have had major surgery, with permanent stomas in 15 cases of Crohn's disease and seven of ulcerative colitis. In Crohn's disease the disease was still active at the time of review in 16 of 50 patients (10 of 20 women), whereas only two of the 20 patients with ulcerative colitis had active disease. The data show that the high early morbidity of juvenile-onset inflammatory bowel disease continues into adult life, with particularly severe and disabling manifestations in women with Crohn's disease.

Adolescent↗