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Biomedical subjects

H E Lockhart-Mummery

Publications and source records attributed to H E Lockhart-Mummery.

At least 19 recordsLinked to original sources
PubMed1990

Operative and functional results of total mesorectal excision with ultra-low anterior resection in the management of carcinoma of the lower one-third of the rectum.

Eighty-one patients underwent anterior resection with curative (n = 57) or palliative (n = 24) intent for tumors below 7 centimeters from the anal verge. If a right angled clamp could be applied below the tumor at operation after full mobilization of the mesorectum and rectum, the procedure was performed in preference to abdominoperineal excision. The mean follow-up time was 4.8 years. Of the curative group, 26 had lesions within 5 centimeters of the anal verge. Thirty-one per cent were Dukes' A; 37 per cent, B, and 32 per cent, C lesions. The margin of distal clearance ranged from 2 to 35 millimeters. In five patients, squamous mucosa was observed in the distal doughnut. Serious postoperative complications occurred in 17 per cent of the curative series, one-half of which occurred within the first two years of the study period. In six patients, the temporary colostomy has not been closed. The incidence of local recurrence in the curative series was 3.5 per cent, and the over-all survival rate was 81 per cent at five years. Full continence was achieved within two years of closure of the colosomy in 85 per cent of the patients. In the palliative group, 11 of the 19 patients had temporary colostomies and 80 per cent were continent within six months of operation. The technique of total mesorectal excision and sphincter preservation by stapled coloanal anastomosis in the treatment of carcinomas of the lower one-third of the rectum may be an alternative to abdominoperineal excision. The final decision in such instances is made intraoperatively. The operative and functional results are satisfactory, but it is difficult to anticipate the patients who will not do well by preoperative criteria. Even in palliative procedures, low anterior resections provided satisfactory continence. Serious postoperative complications were more likely to occur if full mobilization of the splenic flexture was not routinely performed.

Adult↗
PubMed1981

Anal fistulas in Crohn's disease.

Anal fistulas were recorded in 112 patients out of a series of 329 patients with Crohn's disease admitted to St Mark's Hospital for the first time between 1965 and 1976. Only 13 of 112 patients had small bowel disease alone. The remainder all had involvement of some part of the large bowel. There were 125 fistulas in the 112 patients. No treatment was attempted for 47 fistulas (38 per cent). Most patients had low fistulas which were treated by conventional techniques and healed successfully. Limited surgery was often successful in curing the symptoms of patients with more difficult fistulas. Anal lesions were the major reason for surgery in only a third of the patients who finally underwent excision of the return.

Crohn Disease↗
PubMed1979

Prophylactic peroperative intravenous metronidazole in elective colorectal surgery.

In a prospective double-blind randomised trial 83 patients undergoing elective colorectal surgery were given either preoperative intravenous metronidazole or intravenous normal saline. No other antimicrobials were given. Bowel preparation was the same for both groups. Deep post-operative wound sepsis occurred in 6 of 44 (13-6%) patients on metronidazole but in 20 of 39 (51-2%) control untreated patients. Anaerobes were responsible for all cases of deep sepsis in the metronidazole group (in 5 of the 6 cases aerobes were also isolated), and for 16 of the 20 cases of deep sepsis in the control group (all with aerobes). Superficial infection in the metronidazole group was caused by aerobes. Anastomotic leakage occurred in 5 of the 6 patients who developed deep sepsis on metronidazole and in 10 of 20 patients on placebo. Peroperative intravenous metronidazole dramatically reduced postoperative sepsis but failed to prevent infection in the presence of anastomotic breakdown.

Bacterial Infections↗
PubMed1978

The treatment of early colorectal cancer by local excision.

An analysis is presented of 143 patients with early colorectal carcinoma treated by local excision between 1948 and 1972 at St Mark's Hospital. The tumours are considered in three groups; colonic tumours, pedunculated rectal tumours and non-pedunculated rectal tumours. The importance of careful clinical assessment and accurate pathological examination is emphasized. Local excision of the tumours, using various operative techniques, gave good results and this method of management can be recommended in the carefully selected case.

Colonic Neoplasms↗
PubMed1976

The results of surgical treatment for carcinoma of the rectum of St Mark's Hospital from 1948 to 1972.

The surgical treatment of 3163 patients seen at St Mark's Hospital with a single adenocarcinoma of the rectum in the years 1948-72 is described and the results analysed. In 2948 patients (93-2 per cent) the primary tumour was removed. The operative mortality fell from 7-0 per cent in the years 1948-52 to 2-1 per cent in 1968-72. The proportion of restorative operations has risen steadily over the years to a level of 41-1 per cent in the years 1968-72. There were 2410 operation survivors in the years 1948-67. The crude 5-year survival rate in the whole group was 47-1 per cent (corrected figure 56-7 per cent), and 56-6 per cent (corrected figure 68-4 per cent) for the 1931 survivors of radical operations. Comparison of results for patients surviving radical synchronous combined excision and radical anterior resection shows a significant difference in the two groups: in the former the crude 5-year survival rate was 52-7 per cent (corrected figure 63-8 per cent), and in the latter group the respective figures were 66-7 and 79-4 per cent. A higher proportion of Dukes' A and B cases and of low grade tumours are shown as the pathological background to the more favourable prognosis for patients surviving radical anterior resection.

Adenocarcinoma↗
PubMed1973

Non-restorative surgery in the treatment of Crohn's disease of the large bowel.

This study gives detailed information on the two principal groups of patients undergoing excisional surgery with a permanent artificial stoma for Crohn's disease of the large bowel. During the years 1952-71, 64 patients were treated by total proctocolectomy and ileostomy and 26 patients by excision of the distal large bowel and colostomy. In the group of patients undergoing proctocolectomy, there were two postoperative and six late deaths. Of the 56 patients alive at the end of the follow-up period (average length of follow-up 8.1 years), four had shown evidence of recurrent disease. In each case this occurred following a staged proctocolectomy and at, or immediately proximal to, the ileostomy: the shortest interval between surgery and recurrence was just under 10 years. AMONG THE PATIENTS TREATED BY EXCISION OF THE DISTAL LARGE BOWEL, THERE WERE TWO UNRELATED LATE DEATHS: with an average duration of follow up of 7.3 years, recurrent disease occurred in only one of the 24 patients alive at the concluding date for this study.

Adolescent↗
PubMed1970

Familial polyposis coli associated with extracolonic abnormalities.

The pedigree of a polyposis coli family, in which several individuals had extracolonic abnormalities associated with the condition, is presented. Some of the problems encountered in management are discussed. The literature is reviewed and a simple classification of the extracolonic abnormalities is suggested.

Abdominal Neoplasms↗