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Biomedical subjects

D S Evans

Publications and source records attributed to D S Evans.

At least 19 recordsLinked to original sources
PubMed2002

Day-case laparoscopic hernia repair in a single unit.

BACKGROUND: Laparoscopic groin hernia repair has been shown to be a safe, well-tolerated procedure. Here, we report a series of patients who underwent laparoscopic transabdominal preperitoneal (TAPP) mesh repair as day cases. RESULTS: We performed 984 repairs on 769 patients, 218 had bilateral repairs. Mean operating time was 25 min for unilateral and 38 min for bilateral repairs. Three were converted, and 39 required admission. Five were readmitted more than 48 h postoperatively. Three required reoperation for small bowel obstruction from herniation through a peritoneal defect. Only 57% of patients required analgesia for a mean of 1.9 days after discharge. Recovery times were similar for unilateral and bilateral herniae. Eight hernias have recurred to date. CONCLUSIONS: Laparoscopic hernia repair is suitable for day-case surgery for unilateral, bilateral, and recurrent herniae. TAPP repair allows inspection of the contralateral groin, with repair of defects as necessary.

Adolescent↗
PubMed2002

A comparison of the imaging properties of CCD-based devices used for small field digital mammography.

The objective imaging characteristics of three systems that use charge coupled devices (CCD) for small-field digital mammography (SFDM) have been compared in terms of spatial resolution and signal to noise ratio. The results indicate that although they are designed for nominally the same tasks of stereotactic localization and spot imaging these detectors have significantly differing physical imaging properties. Imaging system design parameters such as the phosphor screen type and thickness, screen configuration and method of optically coupling the phosphor to the CCD have significant effects on the imaging performance of the detectors.

Humans↗
PubMed2002

Informal care: the views of people receiving care.

Informal care is perceived to be the best option for people who require assistance to look after themselves. National and international studies of informal care have focused on the carer, not on the care provided, or the needs and experiences of the care recipients. In the present study, 55 people receiving informal care (21 males and 24 females, mean age = 67.6) were surveyed to determine the type of assistance that they receive, perceptions of the quality of their care, feelings about being looked after by a carer and their perceptions of the services which would be useful. A random sample of 531 households were selected as part of a larger study into informal care in the west of Ireland. A total of 98 carers were identified and 55 of the people they looked after were well enough to participate in the study. Over two-thirds of carers assisted with household chores (e.g. cleaning, preparing meals and shopping). Other activities which carers assisted with included keeping the person safe from household accidents (62%), personal care (42%), and dressing and undressing (31%). Whilst most were very satisfied with the quality of care, a minority reported dissatisfaction, and stated that their carer showed signs of anger and frustration. Common concerns related to the health of the carer, their safety when the carer is not available and the cost of being cared for. Financial support for the person receiving care and the carer were the main priorities for these individuals. The present study points to a need for greater involvement of care recipients in planning services relating to informal care, and support and access to health professionals for people receiving care. People receiving care are also concerned about the level of financial support for themselves and their carers.

Adolescent↗
PubMed2001

To repair or not to repair incidental defects found on laparoscopic repair of groin hernia: early results of a randomized control trial.

BACKGROUND: During laparoscpic transabdominal preperitoneal (TAPP) repair of unilateral groin hernias, a significant proportion of patients are found to have unsuspected hernias (incidental defects) on the contralateral side without any clinically demonstrable signs. The reported incidence is 10% to 25%, and controversy exists about the routine repair of these hernias. We present the early results of a prospective randomized study designed to follow the clinical behavior of incidental defects. METHODS: For this study, 32 consecutive men found to have incidental defects on the contralateral side during laparoscopic TAPP repair of groin hernias were prospectively randomized into two categories. In 16 patients (control group), the defects were repaired simultaneously, and in another 16 patients (trial group), surgical repair was not performed. Subsequently, five consecutive patients found to have incidental defects were included in the trial group. Hence, the total number of patients with unrepaired defects was 21. All the patients subsequently were followed up in the clinic and examined by an independent clinician to detect any clinically demonstrable hernias. RESULTS: The median follow-up was 15 months for the control patients and 12 months for the trial patients. During this time, demonstrable hernias developed in 6 patients of the trial group (28.6%). CONCLUSIONS: This study demonstrated that despite a short follow-up period, a significant proportion of incidental defects will progress to a symptomatic hernia if left untreated. Hence, their simultaneous repair is justifiable on the grounds that it reduces the number of operations and hospital visits, and thus the cost to the National Health Service. It also is of major benefit to the patient.

Adult↗
PubMed2000

The transabdominal pre-peritoneal (TAPP) inguinal hernia repair: a trip along the learning curve.

Laparoscopic inguinal hernia repair is a new but accepted method of treatment for this common condition. It has several distinct advantages over traditional open types of repair but also has the potential for complications not found with open repair. We have performed over 1700 laparoscopic repairs in our unit and modified the technique over the last 5 years whilst auditing our results. We present a description of the technique and describe the common complications we have experienced and the methods we have employed to reduce these complications.

Hernia, Inguinal↗
PubMed1996

Day-case laparoscopic hernia repair.

Some 114 patients (median age 52 years) underwent laparoscopic hernia repair as a day-case procedure. Twenty-one patients had bilateral and 11 recurrent hernias. Some 113 patients underwent transabdominal preperitoneal mesh repair but one required conversion to open operation. Mean operating time was 24 min for unilateral and 38 min for bilateral repair. In an operating session of 3.5 h, up to five patients (mean 4.4) underwent surgery and as many as seven hernias were repaired. More than 10 per cent of patients were found to have a previously undiagnosed hernia on the opposite side. A total of 111 patients were discharged home on the day of surgery. Major complications included one omental bleed and one small bowel obstruction. Seroma was the commonest minor complication and occurred in 7 per cent of patients. More than 35 per cent of patients needed no postoperative analgesia. To date there has been one recurrence (follow-up range 2-18 months).

Adult↗
PubMed1993

Effects of the Iditarod Sled Dog Race on serum thyroid hormones and body composition.

Cold exposure, activity and energy deficit have been associated with changes in body composition and/or changes in serum thyroid hormones. Because these conditions are present during the Iditarod Sled Dog Race, 10 volunteer participants were studied before and after the race. Body composition, total thyroxine (TT4), free thyroxine (FT4), total triiodothyronine (TT3), and free triiodothyronine (FT) levels were determined. There was a significant decrease in body weight (p < 0.05) and a decrease in body fat (p < 0.01). There were no significant changes in TT4, FT4, TT3 or FT3. On the basis of this study, it can be concluded that the strenuous activity of the Iditarod mitigates against the classic perturbation in thyroid axis brought on by the hypocaloric state.

Body Composition↗
PubMed1990

Mycotic aneurysm caused by group B streptococcus: a cautionary tale of management problems and a rare organism.

We report a case of mycotic aneurysm of the femoral artery which highlights the diagnostic features and management problems of the condition. Our patient required emergency ligation of the artery for life-threatening haemorrhage and subsequently his leg was not viable. The alternative treatment options of simple ligation and excision versus ligation, excision and immediate bypass grafting of the artery are discussed. The causative organism, beta-haemolytic group B streptococcus (S. Agalactiae), is an extremely rare cause of embolic mycotic aneurysm. This rarity is unexplained and is surprising since this organism is a well-known cause of infective endocarditis, which can be complicated by mycotic aneurysms. Mycotic aneurysms may become more common because of the rise of intravascular drug abuse, which combines the risk factors of vessel trauma, endocarditis and immunosuppression, notably from HIV infection.

Aneurysm, Infected↗
PubMed1983

Single dose metronidazole with and without cefuroxime in elective colorectal surgery.

Seventy patients undergoing elective colorectal surgery for malignant and inflammatory bowel disease were allocated randomly to one of two groups. Patients in group 1 were given, after induction of anaesthesia, a single dose of metronidazole 500 mg i.v. Patients in group 2 were given in addition a single dose of cefuroxime 1.5 g i.v. Of 34 patients in group 1, 4 (11.8 per cent) developed postoperative infection. Of 36 patients in group 2, 5 (13.6 per cent) developed postoperative infection. No significant difference was noted in the incidence of postoperative sepsis between the two treatment groups.

Adolescent↗
PubMed1978

Reduction of skin bacteria in theatre air with comfortable, non-woven disposable clothing for operating-theatre staff.

Conventional loose-weave cotton operating garments were compared with clothing of a non-woven fabric to test their efficacy in reducing the dispersal of skin bacteria into theatre air. When men wore operating suits made of the non-woven fabric dispersal of skin bacteria was reduced by 72%. When all the operating-theatre staff wore suits and dresses of this fabric air bacterial counts during operating sessions were reduced by 55%; no reduction occurred when the fabric was worn by only the scrubbed team. The lowest levels of microbial contamination of the air in the operating theatre occurred when both the unscrubbed and scrubbed theatre staff wore clothes of non-woven fabric.

Air Microbiology↗