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Biomedical subjects

D S Quill

Publications and source records attributed to D S Quill.

15 recordsLinked to original sources
PubMed1998

Analgesia following appendicectomy--the value of peritoneal bupivacaine.

PURPOSE: Peritoneal inflammation is an important feature in many patients presenting with appendicitis. The contribution of peritoneal nerve fibres to pain experienced after appendicectomy has received little attention. METHOD: In this prospective double blind randomized study a consecutive series of 60 patients undergoing appendicectomy for suspected appendicitis were enrolled. A dose of 1.5 mg.kg-1 bupivacaine 0.5% was used. Group one patients received the entire dose of bupivacaine subcutaneously. Group two patients received half the dose subcutaneously (s.c.) and half the dose to the peritoneum. Pain scores were assessed pre-operatively and at 30 min, 12 and 24 hr post-operatively using a visual analogue scale. Time to first analgesia and total analgesia requirements in the first 24 hr were recorded. RESULTS: The patients receiving the s.c. combined with peritoneal bupivacaine had a lower pain score 30 min post-operatively (32 +/- 2 vs 54 +/- 4; P < 0.0001), a longer time to first analgesia (248 +/- 20 vs 164 +/- 17 min; P = 0.002) as well as lower opioid (68 +/- 5 vs 100 +/- 7 mg; P = 0.0002) and non steroidal analgesic requirements (65 +/- 6 vs 96 +/- 6 mg; P = 0.007) in the first 24 hr post-operatively. CONCLUSION: A combination of s.c. and peritoneal infiltration with bupivacaine is superior to skin infiltration alone in the relief of pain post appendicectomy.

Adult↗
PubMed1997

Swan Ganz catheter--all in a knot.

In this case report an unusual complication is described following insertion of a Swan Ganz catheter. A 79-year-old male patient experienced knotting of the catheter. Methods of avoiding this problem and removal of a knotted catheter are discussed.

Aged↗
PubMed1997

Thyroid disease in the west of Ireland: an atypical incidence of neoplasia.

This study was established to review the spectrum of thyroid disease presenting to a regional centre in the West of Ireland. Over a ten year period 414 thyroidectomies were performed. The most common histological diagnosis was nodular goitre (238 patients). There were 134 thyroid neoplasms; 87 (65%) adenomas, 40 (30%) carcinomas and 7 (5%) lymphomas. A breakdown of the cancers revealed 17 (36%) papillary and 14 (30%) follicular carcinomas with 7 (15%) lymphomas. Six (13%) patients presented with anaplastic tumors. Solitary nodules had a high cancer risk (25%) in comparison with multinodular or diffuse goitres (5%). Thyroiditis accounted for 38 cases while only 10 thyroidectomies were performed for Graves' disease.

Adenocarcinoma, Follicular↗
PubMed1992

Duodenal rupture with avulsion of the bile duct: an unusual injury.

Blunt abdominal trauma may give rise to infrequent and unusual patterns of organ damage requiring prompt and complete exploratory laparotomy if the full extent of injury is to be recognised. We present a case of avulsion of the common bile duct in association with duodenal rupture to illustrate the importance of this strategy.

Abdominal Injuries↗
PubMed1989

Ultrasonic screening for the detection of abdominal aortic aneurysms.

Detection of aortic aneurysms before they rupture is imperative if the mortality rate from this disease is to be reduced. Although large aneurysms frequently are palpable, small aneurysms--especially in obese patients--are seldom recognized on physical examination. Ultrasound, which is noninvasive, relatively inexpensive, and nearly 100 per cent accurate in identifying the presence or absence of aneurysms, is well suited to screening. In high-risk populations (patients over the age of 50 with coronary artery or peripheral vascular disease), ultrasonic screening is probably cost-effective.

Adult↗
PubMed1989

Carotid stump syndrome: a colour-coded Doppler flow study.

Colour-coded Doppler flow imaging (angiodynography) was performed on 29 patients with 30 internal carotid artery occlusions. Large internal carotid stumps were revealed as intravascular cul-de-sacs demonstrating vortices of blue flow reversal. Large carotid stumps or significant external carotid stenoses were present in nine patients (9 arteries). Such patients were significantly more likely to develop symptoms of cerebral ischaemia during follow up which averaged 18 months (P = 0.016; Fisher exact). These results support the concept of embolisation from the carotid bifurcation (residual stump or external stenosis) as a cause of episodic cerebral ischaemia following internal carotid occlusion. Angiodynography may prove to be a useful tool for selecting appropriate patients for treatment.

Adult↗
PubMed1985

High fibre diet in symptomatic diverticular disease of the colon.

Over the past decade fibre supplementation has achieved widespread acceptance in the management of symptomatic diverticular disease, although the efficacy of this treatment has been debated. We have conducted a retrospective review of 72 patients admitted to hospital with symptomatic diverticular disease over a ten year period in order to determine whether or not high fibre diet afforded protection against the development of complications, necessity for surgery or persistence of symptoms. Fifty-six patients were treated non-operatively, of these 43 received advice concerning a high fibre diet but only 31 patients complied. The 12 patients who failed to take additional fibre and the 13 patients who never received dietary advice (25 patients) formed the non high fibre group. Those treated with fibre supplementation fared significantly better in developing fewer complications and required less surgery (P less than 0.05). At the time of follow-up review patients on a high fibre diet reported significantly fewer symptoms (P less than 0.05).

Dietary Fiber↗
PubMed1984

Lymph node imprint cytology for the rapid assessment of axillary node metastases in breast cancer.

Lymph node imprint cytology was performed on 86 nodes from 13 consecutive patients with breast cancer undergoing simple mastectomy with axillary node sampling, and a prospective comparison with paraffin section was made. The results showed a diagnostic sensitivity and specificity of 0.93 and 0.98 respectively. The predictive value of a positive result was 0.98. This technique can be used to identify patients with Stage I disease rapidly, thereby allowing their exclusion from treatment with peri-operative chemotherapy.

Axilla↗
PubMed1984

Experimental colon neoplasia enhanced by extract of sperm (protamine).

An experimental study of colorectal tumorigenesis in inbred rats given the potent carcinogen dimethylhydrazine has shown that protamine, given before any tumours had developed, significantly enhanced the development of large bowel tumours (100% incidence). Those animals having no adjuvant therapy or who received either heparin or 5-fluorouracil (alone or in combination) had an approximate 50% incidence of such tumours.

Adenocarcinoma↗
PubMed1983

Surgical operation rates: a twelve year experience in Stockton on Tees.

A review of twelve years surgical practice in a district in the North East of England is presented. During this period 63 562 surgical operations were undertaken. Analyses of these operations show that the amount of elective general surgery undertaken has almost doubled and the rate of emergency general surgery has remained remarkably constant. There has been a significant increase in the number of gallbladder, varicose vein and minor general surgical procedures performed. There has also been a significant increase in urological surgery and in orthopaedic surgery which has doubled over the study period.

Adolescent↗
PubMedDate not supplied

Papillary carcinoma in a thyroglossal duct remnant--a review of thyroglossal surgery in a regional centre in the west of Ireland.

A review of thyroglossal duct remnants presenting to a regional centre in the West of Ireland was undertaken. Over a 15 yr period, 25 patients were operated on for duct remnants. The mean age was 19.6 yr and ranged from 3 to 68 yr. There were 16 (64 per cent) males and 9 (36 per cent) females. Seventeen (68 per cent) patients were less than 20 years at the time of surgery. Four patients presented with a sinus and the remainder with a cystic lesion. Two patients experienced recurrent disease. One patient, a 41 yr old female, had a papillary carcinoma of a thyroglossal cyst. There were no clinical features distinguishing this patient from those with benign cystic remnants of the thyroglossal duct. The possibility of carcinoma in older patients, in particular females, presenting with thyroglossal cysts emphasises the importance of performing a formal Sistrunk's operation. It reduces the risk of recurrence of the cyst and may reduce the risk of recurrence of the tumour as the duct may provide a route for the spread of tumour.

Adolescent↗
PubMedDate not supplied

Escaped faecalith causing a persistent psoas abscess.

Faecaliths have been widely implicated in the aetiology of acute appendicitis. According to Shaw, stones are formed in the appendix with greater frequency than in either the gall bladder or the urinary tract. In spite of this, faecaliths appear to cause few complications outside the appendix. We report an unusual complication resulting from an escaped appendiceal faecalith.

Adult↗