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Biomedical subjects

H Ellis

Publications and source records attributed to H Ellis.

At least 37 records · Page 2Linked to original sources
PubMed2000

Post-operative consequences of glove powder used pre-operatively in the vagina in the rabbit model.

This study was undertaken to determine if a retrograde migration of glove powder (Biosorb(TM)) from the vagina into the abdominal cavity in combination with a subsequent intra-abdominal trauma could affect the development of adhesions. A rabbit model was used with one control and one test group. A total of 50 mg Biosorb(TM) was deposited intravaginally in the test cases before ovulation was induced. Three days later a laparotomy with a small standardized surgical trauma was carried out on the left Fallopian tube and the ipsilateral peritoneum. Ten days later the extent of intra-abdominal adhesions was evaluated. The presence of starch particles in cell smears and biopsies was also investigated. Significant differences in the formation of adhesions were found between the control and the test cases (P < 0.001). In the test group there were dense adhesions and in four cases the Fallopian tube was completely attached to the peritoneal wall. In the control cases only loose minor adhesions were found. This study indicates that the number of starch particles migrating from the vagina to the abdominal cavity is sufficient to enhance significantly the formation of post-operative adhesions. We therefore suggest that powder-free medical or surgical gloves should be used in obstetrics and gynaecology.

Abdomen↗
PubMed2000

The impact of adhesions on hospital readmissions over ten years after 8849 open gynaecological operations: an assessment from the Surgical and Clinical Adhesions Research Study.

OBJECTIVE: To investigate the epidemiology of, and the clinical burden related to, adhesions following gynaecological surgery. POPULATION: The Scottish National Health Service Medical Record Linkage Database was used to define a cohort of 8849 women undergoing open gynaecological surgery in 1986. METHODS: All readmissions for potential adhesion related disease in the subsequent 10 years were reviewed. MAIN OUTCOME MEASURES: Readmissions and the degree of adhesion involvement gave an indication of clinical burden and workload. The rate of readmission following the initial surgery determined the relative risk of disease related to adhesions. RESULTS: Two hundred and forty-five (4.5%) of 5433 readmissions following open gynaecological surgery were directly related to adhesions. 34.5% of patients were readmitted, on average 1.9 times, for a problem potentially related to adhesions or for further intra-abdominal surgery that could be complicated by adhesions. Readmissions related to adhesions continued throughout the 10 year period of the study. The overall rate of readmission was 64.0/100 initial operations. For readmissions directly related to adhesions, the rate was 2.9/100 initial operations. Operations on the ovary had the highest rate directly related to adhesions (7.5/100 initial operations), with an overall rate of readmission of 106.4/100 initial operations. CONCLUSIONS: Despite the conservative approach taken in this study, the clinical burden, workload and relative risk of readmissions related to adhesions following open gynaecological surgery was considerable. Post-operative adhesions have important consequences for patients, surgeons and the healthcare system. These results emphasise the need for more effective strategies to prevent adhesions.

Cohort Studies↗
PubMed1999

High-performance liquid chromatographic determination with amperometric detection of piroxicam in human plasma and tissues.

After repeated topical application of a piroxicam gel preparation to the knee, piroxicam was quantified in plasma, subcutaneous tissue, synovial capsule and synovial fluid, using specimens obtained during knee surgery. Electrochemical detection was used and the limit of quantification (LOQ) was 0.72 ng/ml in plasma at a signal-to-noise ratio of 10:1. The chromatographic method was optimised to determine piroxicam in all four matrices, and the analyte was quantified using a calibration line constructed from plasma calibration standards. Levels in subcutaneous tissue, synovial capsule and synovial fluid were compared to plasma steady-state levels and expressed as a ratio, in order to ascertain bioavailability.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1999

Adhesion-related hospital readmissions after abdominal and pelvic surgery: a retrospective cohort study.

BACKGROUND: Adhesions after abdominal and pelvic surgery are important complications, although their basic epidemiology is unclear. We investigated the frequency of such complications in the general population to provide a basis for the targeting and assessment of new adhesion-prevention measures. METHODS: We used validated data from the Scottish National Health Service medical record linkage database to identify patients undergoing open abdominal or pelvic surgery in 1986, who had no record of such surgery in the preceding 5 years. Patients were followed up for 10 years and subsequent readmissions were reviewed and outcomes classified by the degree of adhesion. We also assessed the rate of adhesion-related admissions in 1994 for the population of 5 million people. FINDINGS: 1209 (5.7%) of all readmissions (21,347) were classified as being directly related to adhesions, with 1169 (3.8%) managed operatively. Overall, 34.6% of the 29,790 patients who underwent open abdominal or pelvic surgery in 1986 were readmitted a mean of 2.1 times over 10 years for a disorder directly or possibly related to adhesions, or for abdominal or pelvic surgery that could be potentially complicated by adhesions. 22.1% of all outcome readmissions occurred in the first year after initial surgery, but readmissions continued steadily throughout the 10-year period. In 1994, 4199 admissions were directly related to adhesions. INTERPRETATION: Postoperative adhesions have important consequences to patients, surgeons, and the health system. Surgical procedures with a high risk of adhesion-related complications need to be identified and adhesion prevention carefully assessed.

Abdomen↗
PubMed1999

Level of termination of the spinal cord and the dural sac: a magnetic resonance study.

Previous studies concerning the level of termination of the human spinal cord have been carried out in unselected cadavers. We have used magnetic resonance imaging to determine this level of termination, and that of the dural sac, in normal living subjects. We found a wider range of the level of termination of both the spinal cord and dural sac and a higher median level of termination of each than is commonly described. These anatomical findings are of clinical relevance to clinicians practicing regional anesthesia.

Adult↗
PubMed1999

Psoas major and its controversial rotational action.

The action of psoas major muscle as a primary flexor of the hip joint is undisputed. However it is also variably reported as being a medial and a lateral rotator of the femur at the hip joint. The psoas and iliacus muscles, along with their common insertion, were isolated by dissection in six adult cadaveric specimens. The action of psoas muscle was assessed by pulling the muscle along its long axis and then observing the effects on rotation of the femur, with a visual estimation of the rotation in degrees. The experiment was repeated with the hip joint capsule removed. In the anatomical position, applied traction along the long axis of the muscle produced hip flexion with no rotational component. With the hip in the abducted position, traction produced flexion, adduction, and lateral rotation of the femur at the hip joint. In adduction of the hip, traction on psoas produced only flexion at the hip joint, with no rotation. In maximal flexion, traction also produced adduction. The results were unaffected by the removal of the joint capsule.

Aged↗
PubMed1999

A review of the management of small bowel obstruction. Members of the Surgical and Clinical Adhesions Research Study (SCAR).

Small bowel obstruction is a significant surgical problem and is commonly caused by postoperative adhesions. Patients suffering from this condition are often difficult to assess and require careful evaluation and management. Articles regarding the diagnosis, evaluation and management of small bowel obstruction have been identified from the Ovid, Embase and Silver Platter electronic databases and then reviewed by the authors. Particular emphasis has been placed on randomised controlled trials or large prospective series. Anecdotal reports or those containing small numbers have been largely excluded, but where they have been included it has been made clear in the text. The management of small bowel obstruction is predominantly the management of obstruction due to postoperative adhesions. The selective use of radiological techniques, such as water soluble contrast and CT studies, often help to characterise the nature of the obstruction and may even help with its resolution. Techniques involving the use of laparoscopy and barrier membranes may reduce morbidity but there is a need to evaluate these strategies further with prospective clinical trials.

Humans↗
PubMed1998

Dissecting room problem: prevalence of latex allergy among medical students.

Latex gloves are in widespread use among preclinical medical and dental students in the dissecting room. Increasing numbers of cases of severe latex sensitivity are being reported. This study was carried out to assess the size of this problem among preclinical and clinical students. First-year students (196) and fifth-year students (155) of the United Medical and Dental Schools of Guy's and St. Thomas's Hospitals (UMDS) were asked to complete a questionnaire about symptoms related to allergy to latex gloves and associated risk factors. The prevalence of all self-reported symptoms was 9.6% overall with no significant difference between first- and fifth-year students. The prevalence of rash was significantly different; 2.6% in first-year and 8.5% in fifth-year students. Of those who reported symptoms, there was a significant excess of females and of individuals with eczema, hay fever, or a family history of atopic conditions, compared with those without symptoms. There was no difference between racial groups and no demonstrable link with a history of food allergy, previous surgery, or sensitivity to household rubber products. Only 2 of the 29 individuals with symptoms reported for skin-prick testing, one of whom demonstrated Type I hypersensitivity.

Dermatitis, Atopic↗
PubMed1998

Perinuclear anti-neutrophil cytoplasmic antibodies in ulcerative colitis after restorative proctocolectomy do not correlate with the presence of pouchitis.

BACKGROUND: Although perinuclear anti-neutrophil cytoplasmic antibody (p-ANCA) expression is strongly associated with ulcerative colitis, its relationship with the occurrence of pouchitis after restorative proctocolectomy is uncertain. METHODS: Serum p-ANCA was assayed using both indirect immunofluorescence and enzyme-linked immunosorbent assay (ELISA) in 49 patients, of whom 25 had, and 24 had not, developed pouchitis. Control sera were obtained from 15 healthy volunteers. RESULTS: By means of indirect immunofluorescence, p-ANCA was detected in 45.8% of patients without and in 48% with pouchitis (NS). Twenty-three (46.9%) of the 49 colitis patients were p-ANCA-positive, compared with none of the 15 controls (P < 0.01). By means of ELISA, p-ANCA positivity was present in 50% of patients without and in 68% with pouchitis (NS). CONCLUSION: Whereas p-ANCA was associated with ulcerative colitis as compared with normal individuals, it was not associated with pouchitis. Thus it is unlikely to be a suitable pre-operative marker to identify those patients who will develop pouchitis.

Adult↗
PubMed1997

CT anatomy of the mediastinal structures at the level of the manubriosternal angle.

The mediastinal structures said to lie on a horizontal plane at the level of the manubriosternal joint (manubriosternal plane) in the cadaver include the bifurcation of the trachea, the concavity of the arch of the aorta, and the azygos vein as it arches over the right principal bronchus to enter the superior vena cava. We have reviewed CT scans of the thorax in 51 subjects to determine 1) whether these structures lie consistently at this level in the living thorax and 2) the vertebral level of this plane. We found that the bifurcation of the trachea lay at the plane in 41% of subjects, that the plane passed through the concavity of the arch of the aorta in 49% of subjects, and that, although there was notable individual variation, the manubriosternal plane passed through the upper part of the fifth thoracic vertebra in 53% of cases.

Adult↗
PubMed1997

Simulation of Halocarbon Production and Emissions and Effects on Ozone Depletion

/ This paper describes an integrated model that simulates future halocarbon production/emissions and potential ozone depletion. Applications and historical production levels for various halocarbons are discussed first. A framework is then presented for modeling future halocarbon impacts incorporating differences in underlying demands, applications, regulatory mandates, and environmental characteristics. The model is used to simulate the potential impacts of several prominent issues relating to halocarbon production, regulation, and environmental interactions, notably: changes in agricultural methyl bromide use, increases in effectiveness of bromine for ozone depletion, modifications to the elimination schedule for HCFCs, short-term expansion of CFC demand in low use compliance countries, and delays in Russian Federation compliance. Individually, each issue does not unequivocally represent a significant likely increase in long-term atmospheric halogen loading and stratospheric ozone depletion. In combination, however, these impacts could increase peak halogen concentrations and long-term integral halogen loading, resulting in higher levels of stratospheric ozone depletion and longer exposure to increased levels of UV radiation.KEY WORDS: Halocarbons; Ozone depletion; Montreal Protocol; Integrated assessment

Journal Article↗
PubMed1997

Retrograde migration of starch in the genital tract of rabbits.

This study in a rabbit model simulates contamination with glove powder in association with a routine gynaecological examination. Large individual variations of powder contamination were found and there were no overall statistically significant differences between the control and experimental animals. The findings are supported by the observation that some but not all women develop adhesions after gynaecological surgery. Analyzes of variances indicate differences in the migration of starch particles in the genital tract with the highest amount of particles found three days after starch contamination of the vagina. Since no adhesions were observed, there would probably need to be an ongoing post surgical or post infectious inflammation in the tissue, when the starch particles are added. Starch powder from latex gloves can cause adhesions and increase the risk of latex allergy in healthcare workers. Retrograde migration in the genital tract cannot be excluded, powdered examination products should be eliminated from the gynecologicla examination room.

Animals↗
PubMed1997

Surgical glove hazards: a commentary.

Surgical contaminants of many kinds, including glove powder, cause granuloma formation. This is particularly well documented in the peritoneal cavity, but has been demonstrated in most anatomic sites. In addition, systemic manifestations result from the absorption of the latex protein antigens onto the starch powder on the surgical gloves, which is aerosolized when the gloves are donned or removed.

Dermatitis, Occupational↗
PubMed1997

The clinical significance of adhesions: focus on intestinal obstruction.

Postoperative adhesions occur after almost every abdominal surgery and are the leading cause of intestinal obstruction, accounting for more than 40% of all cases and 60% to 70% of those involving the small bowel. This contrasts with earlier experience in the Western World and current practice in the Third World, where abdominal operations are infrequent, hernias remain untreated, and strangulated hernia is common. These are among the findings of prospective and retrospective studies on adhesions conducted at the Westminster Medical School, University of London, London, UK, and of other published studies on the clinical consequences of postoperative intra-abdominal adhesions and resultant intestinal obstruction. In an analysis of 210 patients who had undergone at least one previous abdominal operation, 92.9% had postsurgical adhesions. This is not surprising, given the extreme delicacy of the peritoneum and the fact that apposition of two injured surfaces nearly always results in adhesion formation. Problems resulting from postsurgical adhesions create a considerable workload. At Westminster Hospital over 24 years, intestinal obstruction accounted for 0.9% of all admissions, 3.3% of major laparotomies and 28.8% of cases of large or small bowel obstructions. A 1992 British survey reported an annual total of 12,000 to 14,400 cases of adhesive intestinal obstruction. In 1988 in the United States, admissions for adhesiolysis accounted for nearly 950,000 days of inpatient care. Risk factors, such as type of surgery and site of adhesions, as well as timing and recurrence rate of adhesive obstruction, remain unpredictable or poorly understood. The type of surgery most frequently leading to adhesive obstruction includes colonic, and especially rectal surgery, appendicectomy, and gynecological procedures. Laparoscopy does not seem to eliminate the risk of adhesions and adhesive obstruction. Adhesions involving the small intestine occur less frequently than those involving the omentum, but are more likely to become obstructive. Follow-up of over 2,000 laparotomies at the Westminster Hospital demonstrated that 1% of patients developed adhesive obstruction within one year of surgery, and half of these occurred within the first postoperative month. However, obstruction may occur at any time, and some 20% of cases appeared more than 10 years later. Recurrent obstruction following adhesiolysis is common, but actuarial tables still need to be constructed. Adhesive obstruction is clinically challenging, since there is no simple way to differentiate between adhesive and strangulated obstructions. Mortality rates escalate from 3% for simple obstructions to 30% when the bowel becomes necrotic or perforated.

Abdomen↗