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Biomedical subjects

D W Storey

Publications and source records attributed to D W Storey.

30 records · Page 2Linked to original sources
PubMed1986

Complications associated with indwelling venous Hickman catheters in patients with hematological disorders.

During a 28 month period, 77 Hickman catheters were inserted in 66 patients with hematological disorders. Complete follow-up was possible for 72 catheter insertions. Catheters remained in situ for a median period of 77 days (range 5-474 days). Fourteen (19%) catheters required removal because of complications which included sepsis, blockage, or displacement. Catheter-related infection was the major complication and Staphylococcus epidermidis and diphtheroids (Corynebacterium species) were the organisms most commonly isolated.

Adolescent↗
PubMed1985

Endoscopic laser treatment of vascular anomalies of the upper gastrointestinal tract.

Vascular anomalies of the gastrointestinal tract are an important source of both acute and chronic blood loss. They present difficult management problems as they are often multiple, involving more than one part of the gastrointestinal tract, and may give rise to bleeds of increasing frequency and severity over a period of many years. We present the results of endoscopic argon and Nd YAG laser treatment of 18 patients with documented recurrent, severe haemorrhage from vascular lesions of the upper gastrointestinal tract with follow up of up to five years. Four patients with hereditary haemorrhagic telangiectasia, five with single angiodysplasias and three with multiple angiodysplasias have had their transfusion requirements reduced to minimal levels after one or more courses of laser treatment. Two of these have required no blood for over two years despite previous total requirements of 52 and 129 units of blood. Four patients were submitted to surgery (two in whom the laser failed to control haemorrhage and two who did not have immediate access to laser therapy at the time of severe bleed). Two of these, however, bled again soon afterwards. Two patients are still undergoing courses of laser therapy although have already shown reductions in transfusion requirements. Both lasers were effective. The Nd YAG laser appears to produce better long term results as its greater penetration makes it possible to ablate the main areas of vascular ectasia in the submucosa, although it does have a slightly higher risk of causing haemorrhage in the first few days after treatment.

Adult↗
PubMed1981

Controlled trial of argon laser photocoagulation in bleeding peptic ulcers.

The efficacy of argon laser photocoagulation in the endoscopic control of haemorrhage from peptic ulcers was tested in a controlled trial at two centres in London. Of 330 patients consecutively admitted with acute upper gastrointestinal tract haemorrhage, 76 were seen at endoscopy to have a peptic ulcer accessible to laser therapy and stigmata of recent haemorrhage. These patients were included in the trial. Identification of the exact source of haemorrhage within the ulcer crater was achieved by use of standard endoscopes with careful washing. Patients were stratified into three groups: ulcers with a visible vessel (52 total, 11 actively spurting); those without a vessel (17); and those with an overlying clot persisting after washing (7). Of the 52 patients with visible vessel, 8 of 24 treated with the laser and 17 of 28 control patients had a further haemorrhage. 7 control patients died after an episode of rebleeding, but no treated patients. Treated and control patients were well matched for other factors known to influence the case fatality rate. This is the first controlled trial to demonstrate a significant reduction in mortality by the use of a non operative treatment in patients with bleeding peptic ulcers.

Acute Disease↗
PubMed1981

Endoscopic prediction of recurrent bleeding in peptic ulcers.

We performed endoscopy within 24 hours of admission in 292 unselected patients admitted to the hospital for acute gastrointestinal hemorrhage. In 132 patients endoscopy revealed peptic ulcers, and in 117 full examination of the crater was possible. Visible vessels were identified in 56 patients (48 per cent); other stigmata of recent bleeding (such as oozing from the ulcer crater) were present in 21 (18 per cent), and no stigmata in 40 (34 per cent). Among the patients with either visible vessels or other stigmata of recent bleeding, 47 were randomly selected to be observed (without treatment) for evidence of further bleeding. Nineteen of 34 patients with visible vessels (56 per cent) had rebleeding, as compared with one of 13 (8 per cent) with other stigmata of recent hemorrhage; no patients with ulcers without visible vessels or other stigmata of recent hemorrhage bled further. We conclude that after bleeding occurs, visible vessels can be identified in a much higher proportion of ulcers than previously reported, and that rebleeding occurs almost exclusively in this type of ulcer, although only half the ulcers with visible vessels do in fact bleed further.

Endoscopy↗
PubMed1981

Proximal gastric vagotomy after five years.

A follow-up of 93 patients with chronic duodenal ulceration treated by proximal gastric vagotomy without drainage five to nine years previously shows a high incidence of confirmed recurrent ulceration of 16.1%. In addition, there have been patients with transient recurrent ulceration, and a small group with persistent dyspeptic symptoms but in whom no ulcer has been demonstrated. The operation is commendable for its lack of side-effects, but the high incidence of recurrent or persistent symptoms may lead to some reservations about its general application in the treatment of chronic duodenal ulceration.

Adult↗
PubMed1981

Argon laser photocoagulation for upper gastrointestinal haemorrhage: is technique the key to success?

Reports of endoscopic laser photocoagulation have been enthusiastic. However, many technical factors influence the results and discussion of these in the literature has been very limited. We describe the problems encountered in treating 71 patients with bleeding peptic ulcers, and our solutions to them. Failures were due to problems of access and identification of bleeding points, as much as to the laser itself. Results were improved by meticulous endoscopic washing of the ulcer crater and care in setting the laser. These technical factors must be optimised before the true efficacy of this treatment can be assessed in a controlled, randomised clinical trial.

Argon↗
PubMed1980

NdYAG laser photocoagulation in the dog stomach.

Considerable discussion still centres around the relative merits of the Argon and Neodymium Yttrium Aluminum Garnet (NdYAG) lasers for the endoscopic treatment of gastrointestinal haemorrhage, although both are undoubtedly effect. We have carried out experiments to elucidate which factors determine the safety and efficacy of NdYAG laser photocoagulation. Histological studies on normal gastric mucosa showed that the depth of tissue damage depended mainly on the total incident laser energy, whereas the effectiveness of photocoagulation of induced gastric ulcers in heparinised animals depended on the laser power and the exposure time used. Optimum haemostasis with minimum tissue damage was obtained using pulses of 300 to 500 ms duration with energies of 25 to 40 J. We consider these parameters safe and effective for use in pilot clinical studies.

Animals↗
PubMedDate not supplied

Developments in surgical oncology--past, present, and future trends.

The historical development of integrated treatment programs for locally advanced or aggressive cancers, for which the results of surgical excision or radiotherapy are unsatisfactory, is reviewed. Chemotherapy should be used first (induction chemotherapy), while tumour vasculature is intact; intra-arterial infusion gives a greater regional effect. Central residual tumour may be eradicated by subsequent radiotherapy and/or surgery. Regional induction chemotherapy is particularly useful in treating locally advanced stage III breast cancer, locally advanced head and neck cancer, gastric cancer, and locally advanced sarcomas and melanomas of the limbs. A team approach, involving surgical and medical oncologists, radiotherapists, immunologists, and others should improve the results in these patients.

Combined Modality Therapy↗
PubMedDate not supplied

Lessons learnt in the management of aortoenteric fistulae.

Secondary aortoenteric fistula may be treated directly by local repair or by excision of all prosthetic material with extra-anatomic revascularisation. We have reviewed our experience with 14 aorto-enteric fistulae encountered between 1960 and 1984. Two patients who were not treated surgically died. Direct repair was attempted in seven patients, two of whom had no prosthetic material present and survived. Five patients had prosthetic grafts which were not removed and four died from recurrent aortic haemorrhage. There were five other patients who had prosthetic grafts which were removed prior to extra-anatomic reconstruction. Three of these died in the peri-operative period, two from sepsis but only one from aortic stump bleeding. The operative mortality was 58%. The overall survival was only 36% (5 of 14 patients) but there was less chance of recurrent aortic haemorrhage when all prosthetic graft material was removed and direct repair avoided.

Adult↗