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Biomedical subjects

D T Hansell

Publications and source records attributed to D T Hansell.

At least 19 recordsLinked to original sources
PubMed1996

Laparoscopic-assisted reversal of Hartmann's procedure: a simplified technique and audit of twelve cases.

Laparoscopic-assisted reversal of Hartmann's procedure was performed in 12 patients over a 2-year period. The group comprised three patients with colonic carcinoma and nine with diverticular disease, their mean age being 62 years (range 40-73). In all twelve cases, intestinal continuity was successfully restored, without conversion to open surgery, in a median anesthetic time of 165 min (range 110-240). One patient required a temporary defunctioning colostomy and two other patients had three complications. The median postoperative hospital stay was 8 days (range 5-12). We report a retrospective audit of this consecutive series of 12 patients, showing that laparoscopic-assisted reversal of Hartmann's is technically feasible. We also give details of the morbidity associated with the technique.

Adult↗
PubMed1995

Actinomycosis presenting as carcinoma.

Actinomycosis is rare compared to carcinoma, but the two conditions can present with very similar clinical pictures. Two cases of actinomycosis are reported, one thoracic and one pelvic-abdominal which presented as carcinoma and proceeded to surgery without a histological diagnosis having been established.

Actinomycosis↗
PubMed1991

Early endoscopic sphincterotomy for retained bile duct stones after gallbladder surgery.

Endoscopic sphincterotomy (ES) was performed in 36 patients (age range 33-88 years; median 63 years) with retained bile duct stones after cholecystectomy (32 patients) or cholecystostomy (4 patients). The median time interval between surgery and ES was 28 days (range 10-216 days). At the time of ES, 23 patients had a T-tube in situ. Clearance of the bile duct was achieved by T-tube irrigation in 15 patients, and by basket or balloon extraction in seven patients. Spontaneous clearance of the duct after ES occurred in 12 patients, while two patients required widening of the sphincterotomy to allow successful basket extraction. Complications occurred in four patients (11%). Two patients sustained significant haemorrhage from the ES site and subsequently died. One patient developed mild acute pancreatitis while another had persisting cholangitis before and after ES. Both of these patients recovered with conservative management. While ES performed soon after gallbladder surgery allows for early bile duct clearance, the small but significant risk of potentially lethal haemorrhage suggests that its use should be reserved for patients in whom other non-operative methods have failed or are inappropriate.

Adult↗
PubMed1991

Prostaglandins in the treatment of reflux oesophagitis: double-blind placebo controlled clinical trial.

The efficacy of the prostaglandin analogue, rioprostil, in the treatment of reflux oesophagitis has been assessed in a double-blind, randomized, placebo-controlled trial of 25 patients with endoscopic and histological evidence of reflux oesophagitis. At the beginning and end of the study, endoscopic appearances were graded 0-4 (0 = no oesophagitis, 4 = severe oesophagitis) and the symptoms of heartburn, regurgitation, pain and dysphagia were each graded 0-3 (0 = none, 3 = severe). Fourteen patients received rioprostil, 300 micrograms twice daily, and 11 patients received identically marked placebo for a period of 12 weeks. At the end of the study there were no significant differences between the groups in mean (s.d.) endoscopic grading (rioprostil 2.4 (1.3); placebo 1.9 (0.9)) and mean (s.d.) cumulative symptom score (rioprostil 2.5 (3.1); placebo 2.6 (1.5)). Five patients in the rioprostil group reported diarrhoea. Rioprostil had no significant benefit over placebo in the treatment of reflux oesophagitis.

Double-Blind Method↗
PubMed1990

Peritoneal mesothelioma.

We report two patients who presented with small bowel obstruction secondary to peritoneal mesothelioma. The difficulties in establishing this diagnosis at an early stage are illustrated. Recent advances in the management of peritoneal mesothelioma are reviewed.

Adult↗
PubMed1989

Effect of nutritional status on acute phase protein response to elective surgery.

The aim of this study was to assess the effect of nutritional status on the acute phase protein response to elective surgery. Matched pairs of patients with gastric or colorectal cancer were studied. Undernourished patients (body-weight less than 80 per cent of ideal and triceps skinfold thickness less than 65 per cent of standard) were matched with controls (body-weight greater than 95 per cent of ideal and triceps skinfold thickness greater than 80 per cent of standard) for age, sex, type of pathology and surgery. Blood samples taken preoperatively and on days 1-5 after operation were analysed for C-reactive protein, alpha 1-antitrypsin, alpha 1-acid glycoprotein, albumin, prealbumin and transferrin. There was no significant difference in any of the preoperative protein concentrations between the two groups although undernourished patients tended to have lower transferrin concentrations (mean +/- s.e.m., 2.2 +/- 0.3 g/l) than the control group (2.9 +/- 0.1 g/l). C-reactive protein response was significantly smaller in the undernourished group than in the control group (P = 0.05, Mann-Whitney U test). The responses of the other acute phase proteins did not differ between the two groups. There was no difference in the length of hospital stay after operation when undernourished patients (mean +/- s.e.m., 17.7 +/- 3.0 days) were compared with controls (14.3 +/- 3.6 days). Undernourished patients therefore have an attenuated C-reactive protein response to elective surgery. The significance of this in relation to morbidity and mortality in severely ill patients requires further investigation.

Acute-Phase Proteins↗
PubMed1989

Endoscopic sphincterotomy for bile duct stones in patients with intact gallbladders.

Endoscopic sphincterotomy was performed in 121 patients (age ranged 34-92 years; median 80 years) with intact gallbladders and bile duct stones. Clearance of the duct by basket or balloon extraction was attempted in 97 patients (80 per cent) and achieved in 93 of these patients (96 per cent). In 24 patients the duct was left to empty spontaneously and this occurred in 22 patients. Immediate complications due to endoscopic sphincterotomy occurred in five patients (two haemorrhage, two perforation, one haemorrhage and perforation). Of the 101 patients reviewed 12-72 months (median 24 months) after endoscopic sphincterotomy, 76 (75 per cent) have remained asymptomatic throughout the follow-up period. Eighteen patients (18 per cent) required cholecystectomy for recurrent gallbladder symptoms 1-24 months after endoscopic sphincterotomy. One of the asymptomatic patients underwent cholecystectomy on the advice of his consultant. A further seven had recurrent biliary colic or cholangitis necessitating enlargement of the sphincterotomy and further stone retrieval in three of these patients. Endoscopic sphincterotomy is an effective treatment for bile duct stones in high risk patients, but subsequent cholecystectomy is required in a significant number of patients owing to continuing gallbladder symptoms.

Adult↗
PubMed1989

The utilisation of peripherally-administered intravenous nutrient solutions.

The utilisation of three peripherally-administered intravenous nutritional regimens has been evaluated in 42 patients on the first four days following surgery for colorectal cancer. A standard dextrose-saline (DS) regimen (n = 16) has been compared with an amino-acid (AA) regimen (n = 12) and a regimen consisting of glucose, amino-acid and fat (GAF) (n = 14). Fat and carbohydrate oxidation was calculated pre- and post-operatively using indirect calorimetry. Patients receiving AA showed a fall in carbohydrate oxidation (p < 0.01) and a rise in fat oxidation (p < 0.05) post-operatively, whereas no significant changes in fat and carbohydrate oxidation occurred in the DS and GAF groups. Cumulative nitrogen balance (NB) for the first four post-operative days was significantly better (p < 0.01) in the AA group (-10.3 +/- 3.8 g; mean +/- s.e.m.) than in the DS group (-25.3 +/- 3.1 g), due to an improved NB in the AA group on the first and second days only. Cumulative NB in the GAF group (+7.7 +/- 2.3 g) was significantly better (p < 0.01) than in the other two groups. Where the provision of peripheral intravenous nutritional support is desired, the use of a combination of glucose, amino-acid and fat is recommended.

Journal Article↗
PubMed1989

Comparison of various predictive formulae for the estimation of resting energy expenditure.

The accuracy of the Harris-Benedict (HB), Kleiber and Robertson-Reid predictive formulae and the Fleisch tables in estimating resting energy expenditure (REE) has been assessed in 114 cancer patients and 54 patients with nonmalignant illness. The effects of weight status and disease on the predictive ability of the formulae were assessed by comparison of the estimated REE value with that measured by indirect calorimetry. Underestimation of measured REE by greater than 10% occurred in 6-62% of patients, depending on the formula used. Weight loss did not affect predictive ability, whereas the presence of cancer resulted in inaccurate prediction of REE in female patients. Using a multiple comparison procedure, the Fleisch tables were the most accurate in all groups, while the HB formula was least accurate in male patients, irrespective of weight status or disease status. The use of predictive formulae and tables are inappropriate for the accurate estimation of REE in individual patients.

Journal Article↗
PubMed1989

Maintenance cimetidine instead of surgery for duodenal ulcer: the first decade.

Fifty five patients with severe longstanding dyspepsia originally selected as candidates for elective duodenal ulcer surgery were instead entered into a maintenance cimetidine study. Forty six have been reviewed after 10 years. Twenty patients had required surgery, all in the first three years, but six of them had proven or suspected recurrent ulceration during follow up. Twenty six patients avoided surgery, either with continuous cimetidine 400 mg nocte or intermittent full dose cimetidine. Of the 17 on continuous maintenance cimetidine, six had proven or suspected recurrent ulceration responding to full dose cimetidine. All nine patients on intermittent cimetidine experienced symptomatic relapse within eight to 12 weeks of drug withdrawal. By using cimetidine, 64% of patients selected for surgery have avoided operation over this 10 year period, although none has had drug free remission.

Adult↗
PubMed1989

Gastric leiomyosarcoma: two unusual cases.

Two cases of gastric leiomyosarcoma, which presented unusually with lower abdominal masses, are described. The difficulties in the preoperative diagnosis of this rare malignancy are discussed.

Aged↗
PubMed1989

Clinical investigation of acute lower gastrointestinal haemorrhage.

Over a four-year period (1984-1987) nine consecutive patients presented with acute lower gastrointestinal haemorrhage requiring emergency investigation with scintigraphy (using radionuclide-labelled blood-pool agent), angiography or colonoscopy or a combination of these. Angiography in two patients was unhelpful. Of three colonoscopic examinations, two were technically unsatisfactory. In two patients with persistent bleeding requiring urgent surgery, scintigraphy located the bleeding site pre-operatively, while in five patients with negative scintigraphy bleeding settled spontaneously without operative intervention. The relative merits of the above investigations are discussed.

Acute Disease↗
PubMed1988

Influence of whole body protein turnover rate on resting energy expenditure in patients with cancer.

Whole body protein turnover and resting energy expenditure are measured simultaneously in weight stable and weight losing patients with lung (n = 22) or colorectal cancer (n = 38). These results were compared with those from weight stable and weight losing non-cancer controls (n = 22). Rates of whole body protein turnover were calculated from the plateau isotopic enrichment of urinary ammonia and urea following a primed, continuous, 24-h infusion of [15N]glycine. Resting energy expenditure was measured by indirect calorimetry. All groups of cancer patients had significantly elevated rates of whole body protein turnover (P less than 0.05) and synthesized, on average, 1.9 g/kg/day more protein compared with weight stable non-cancer controls. In contrast, the resting energy expenditure of cancer patients and controls was similar. Moreover, there was no correlation between individual rates of whole body protein turnover. Thus, although cancer patients had rates of whole body protein turnover which were 50-70% greater than controls, this did not result in a measurable increase in resting energy expenditure. The assumption that elevation of whole body protein turnover or resting energy expenditure causes weight loss in cancer patients must be an oversimplification. An acute phase protein response was observed in the majority of cancer patients. Although the presence of such an inflammatory response did not correlate with the rate of whole body protein turnover, the role of inflammatory mediators in the pathogenesis of disturbed protein metabolism in cancer patients merits further investigation.

Aged↗
PubMed1988

Survey of antibiotic prophylaxis in gastrointestinal surgery in Scotland--5 years on.

The results of a 5-year follow-up survey of the use of prophylactic antibiotics in gastrointestinal surgery in Scotland are reported. There have been significant increases in the routine use of prophylactic antibiotics during elective cholecystectomy (21% to 53% of surgeons; P less than 0.001) and appendicectomy (49% to 79% of surgeons; P less than 0.001). In addition a substantial number of surgeons used prophylactic antibiotics in selected high risk patients undergoing biliary tract surgery and gastroduodenal surgery.

Anti-Bacterial Agents↗
PubMed1986

The effects on resting energy expenditure of different tumor types.

The presence of a malignant tumor is said to influence the resting energy expenditure (REE) of the host. This study assesses the hypothesis that different tumor types exert differing effects on REE. REE was measured using indirect calorimetry in 84 cancer patients. Fifty-one patients had colorectal cancer, 22 had gastric cancer, and 11 had non-small cell bronchial cancer. For each tumor type, REE correlated significantly with body weight and lean body mass (LBM). The slope of the regression line for the bronchial cancer patients was significantly different from the colorectal (P less than 0.02) and gastric (P less than 0.02) cancer patients when REE was related to LBM. When related to body weight, the slope of the line of the bronchial cancer patients was significantly different from that of the gastric cancer patients only (P less than 0.05). The bronchial cancer patients had a significantly higher REE than the colorectal (P less than 0.005) and gastric (P less than 0.02) cancer patients when REE was expressed in terms of body weight. However, when corrected for LBM, no significant differences in REE were found between the groups. The presence of hepatic metastases did not influence REE in any of the tumor groups. Differing relationships between REE and indices of body size have been detected in differing tumor types. Consequently, the use of heterogeneous cancer groups may be inappropriate in studies of REE and cancer.

Aged↗
PubMed1986

Effects of hepatic metastases on resting energy expenditure in patients with colorectal cancer.

There are frequent reports that cancer causes an increase in resting energy expenditure (REE), and the presence of hepatic metastases is said to increase REE further. The effect of tumour burden on REE has been measured in 24 patients before and following surgery for colorectal cancer. Fifteen patients had a 'curative' resection whereas nine patients were found to have hepatic metastases at the time of surgery. No significant differences in REE were found between the groups either before surgery or at follow-up, by which time all 15 curative resection patients were tumour free and the remaining nine had progression of their hepatic disease. It is concluded that neither surgical removal of the primary tumour nor progression of metastatic hepatic disease significantly alters REE in patients with colorectal cancer.

Aged↗
PubMed1986

The relationship between resting energy expenditure and weight loss in benign and malignant disease.

The relationship between cancer, weight loss, and resting energy expenditure (REE) has been investigated in 136 patients using indirect calorimetry. Ninety-one patients had gastric, colorectal, or nonsmall cell bronchial neoplasm, seven patients had other malignancies, and 38 patients had nonmalignant illness. Four groups were studied: weight stable cancer patients (CWS: N = 56), weight losing cancer patients (CWL: N = 42), weight stable patients with nonmalignant illness (NCWS: N = 22), and weight losing patients with nonmalignant illness (NCWL: N = 16). In each group REE correlated significantly with body weight, metabolic body size, and lean body mass (LBM: estimated from total body water measurements). The closest correlation was between REE and lean body mass, with the slope of the CWL regression line differing significantly from that of the CWS (p less than 0.05) and NCWS (p less than 0.02) groups. However, there was no difference in REE expressed as kcal/kg LBM/d between the groups. The slopes of the regressions between REE and LBM were almost identical when all cancer patients were compared with all patients with nonmalignant illness. However, when all weight stable patients were compared with all weight losing patients, there was a highly significant difference between the slopes of the regressions (p less than 0.005). This indicates that the weight losing state rather than the presence or absence of cancer is responsible for an alteration in the relationship between REE and LBM. There were no differences in REE between the different tumor types. It is concluded that REE is not elevated in patients with gastric, colorectal, or nonsmall cell bronchial cancer. Elevation of REE contributes very little to the etiology of cancer cachexia.

Aged↗