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Biomedical subjects

D Schache

Publications and source records attributed to D Schache.

9 recordsLinked to original sources
PubMed2003

Diagnosis of angiodysplasia on the caudal aspect of the pylorus: need for side-viewing endoscopy.

Recurrent gastrointestinal bleeding in patients with upper gastrointestinal angiodysplasia is common after treatment. This probably is related to the difficulty identifying all the lesions because they frequently are multiple and can be located in areas not easily visualized with forward-viewing endoscopy. We report two cases of patients with gastrointestinal bleeding in whom angiodysplasia as found at surgical enteroscopy on the caudal aspect of the pylorus that could not be identified with forward-viewing endoscopy. The lesions were ablated at the time of surgery or subsequently after location with side-viewing endoscopy, and no further bleeding occurred.

Angiodysplasia↗
PubMed2001

Young patients with colorectal cancer: how do they fare?

BACKGROUND: Younger patients with colorectal cancer (CRC) have long been thought to have a poorer prognosis than older patients. Recent overseas reports, however, have disputed this. The aim of the present study was to conduct a review of data on patients with colorectal cancer collected over a 29-year period at Princess Alexandra Hospital (PAH) to ascertain the outcome of a younger subset of patients at this hospital. METHODS: The PAH Colorectal Project records on 2495 patients with malignancies of the colon, rectum and anus who were treated and followed since 1971, were analysed to determine clinical presentation, treatment and outcome. A group of 61 patients with colo-rectal adenocarcinoma was identified who were aged less than 40 years at presentation. Their clinical data were then compared with the larger group of older patients. RESULTS: There were 30 male and 31 female patients in the younger group. A positive family history was the most consistent risk factor, present in 34% of patients. Despite this, only one patient out of 61 had been diagnosed as a result of a screening programme. The Australian Clinico-Pathological Stage (ACPS), histology and distribution of tumours corresponded to that of the older patients. The overall 5-year survival among younger patients was 53%. The 5-year survival rates in younger patients were better than that for older patients for ACPS A and B, reaching statistical significance for both of these stages. CONCLUSIONS: Our results indicate that younger patients with colorectal cancer have the potential to do just as well as older ones. With the influence of a family history of colorectal cancer being very apparent in this group, greater emphasis should be placed on an adequate screening programme for them.

Adenocarcinoma↗
PubMed1996

Laparoscopic versus open appendectomy: prospective randomized trial.

A prospective randomized trial comparing laparoscopic appendectomy with open appendectomy in patients with a diagnosis of acute appendicitis was conducted between October 1992 and April 1994. Of the 158 patients randomized, 7 patients were excluded because of protocol violations (conversion to laparotomy in 4, appendix not removed in 3). The 151 patients randomized to either a laparoscopic (n = 79) or an open appendectomy (n = 72) showed no difference in sex, age, American Society of Anesthesiology (ASA) rating, or previous abdominal surgery. The histologic classification of normal, catarrhal, inflamed, suppurative, and gangrenous appendicitis was not different between the two groups. Conversion from laparoscopic to open appendectomy was necessary in seven patients (9%) who had advanced forms of appendiceal inflammation. When compared to open appendectomy the laparoscopic group had a longer median operating time (63 minutes versus 40 minutes), fewer wound infections (2% versus 11%), less requirement for narcotic analgesia, and an earlier return to normal activity (median 7 days versus 14 days). There was no difference in morbidity, and both groups had a median time to discharge of 3 days. Laparoscopic appendectomy is as safe as open appendectomy; and despite the longer operating time, the advantages such as fewer wound infections and earlier return to normal activity make it a worthwhile alternative for patients with a clinical diagnosis of acute appendicitis.

Adolescent↗
PubMed1990

Hepatic resection for colorectal secondaries.

A postal survey of consultant surgeons in England and Wales was carried out to assess current attitudes towards screening for and treatment of hepatic metastases from primary colorectal carcinoma. The results showed that pre-, intra- and postoperative screening were inadequate. There was no consensus as to which patients would benefit from major hepatic resection for colorectal liver secondaries. Fewer than one-third of potentially operable patients underwent liver surgery.

Attitude of Health Personnel↗
PubMed1989

Management of the pelvic space following low anterior resection.

Four cases of low anterior resection without pelvic drainage are described. The outcome was unsatisfactory in three of the four patients. The role of pelvic drains and omentum in the management of the pelvic space following low anterior resection for rectal cancer is reviewed and discussed. Pelvic drains are required to remove blood and omentum may be used to fill the pelvic space. Pelvic collections are related to anastomotic leakage and the optimal management of the pelvic space can reduce the incidence of this complication. A suggested regimen for management of the pelvic space after low anterior resection is outlined.

Aged↗
PubMed1987

Atherosclerotic popliteal aneurysms with particular regard to the contralateral side.

A retrospective analysis of 75 patients with 103 atherosclerotic popliteal aneurysms, seen at Princess Alexandra Hospital, Brisbane, was undertaken to assess the results of management and the most appropriate approach to the contralateral popliteal aneurysm. These patients were seen between January 1968 and December 1985. There were no females, the mean age was 66.3 years and 36% of the patients had bilateral popliteal aneurysms. There was a high incidence of other associated aneurysms, abdominal aortic (21), femoral (12) and isolated iliac (3). Thrombosis in a popliteal aneurysm was the most common reason for presentation initially (48%), followed by detection of a lump in the popliteal fossa (22.6%), embolic phenomena (10.6%) and ruptured popliteal aneurysm (four cases). The most common presentation for contralateral aneurysms was detection of a lump in the popliteal fossa. Management of the contralateral popliteal aneurysm was classified as early, elective repair (n = 14) and no surgery or surgery delayed until the development of symptoms (n = 14). Outcome was classified as successful, retained and fully functional limb at follow-up; or failure, amputation or debilitating ischaemia. There was one failure among those undergoing early elective repair and seven failures among those undergoing no or delayed surgery (P = 0.033, Fisher's Exact Test). There were 79 reconstructions. Bypass and ligation (n = 54) resulted in two amputations and two long-term occlusions, interposition augmented vein graft (n = 15) in two amputations and no long-term occlusions and interposition Dacron grafts (n = 10) with no amputations and three long-term occlusions.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗