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Biomedical subjects

H J Scott

Publications and source records attributed to H J Scott.

At least 19 recordsLinked to original sources
PubMed1998

The use of laparoscopy in a case of appendiceal cystadenoma presenting as pseudomyxoma peritonei in an inguinal hernial sac.

A case is reported of a patient with a benign appendiceal neoplasm presenting incidentally with mucin in an inguinal hernial sac. Only one such case of a benign tumour, and one such case of cystadenocarcinoma, have previously been reported. In neither of these cases was laparoscopy used in diagnosis or staging of the disease. We review the management of such cases in light of recent proposed changes to pathological classification.

Adult↗
PubMed1997

Short-term low dose intracoronary diltiazem administered at the onset of reperfusion reduces myocardial infarct size.

BACKGROUND: Currently, controversy exists regarding the use of calcium-channel blockers in the treatment of acute myocardial infarction (AMI), due to apparent conflicting results from clinical trials and animal models. One hypothesis to explain such a discrepancy proposes that the timing and duration of drug administration might influence its cardioprotective effect. Pretreatment with calcium-channel blockers or their administration during coronary artery occlusion is associated with the diminished infarct size in animal models. While verapamil failed to reduce infarct size when the drug was given at the onset of reperfusion, similar effects of low dose diltiazem are not known. METHODS AND RESULTS: This experiment evaluated the effect of intracoronary short term low dose diltiazem administration given immediately with postischemic myocardial reperfusion. Yorkshire swine underwent thoracotomy and 50 min of left anterior descending (LAD) occlusion, followed by 3 h of reperfusion. In the first group, diltiazem (2.5 mg diluted in 60 cc saline) was infused into the LAD over 12 min, beginning with the onset of reperfusion (n=8). In the second group, animals received saline instead of diltiazem and served as controls (n=6). Infarct size was 0.13+/-0.06 g/kg of body weight for diltiazem group, and 0.42+/-0.04 g/kg for controls (P=0.01). CONCLUSIONS: Short-term low dose diltiazem delivered exclusively during early reperfusion can significantly diminish infarct size in swine. Local intracoronary diltiazem may be valuable adjunct in patients subject to myocardial ischemia/reperfusion during coronary artery bypass grafting, primary angioplasty for AMI, or thrombolysis for AMI if given immediately after restoration of coronary blood flow.

Animals↗
PubMed1997

Perforated diverticulitis following extra-abdominal surgery.

The peritonitis of perforated diverticular disease is a life-threatening condition. We report three cases where it occurred following unrelated extra-abdominal surgery and where surgical intervention proved to be the correct course of management. All cases were treated with a Hartmann's procedure; this is probably the safest option for purulent peritonitis in patients who are a high operative risk and have recently undergone major surgery.

Aged↗
PubMed1996

Ileal pouch-anal anastomosis: pregnancy, delivery and pouch function.

OBJECTIVE: To evaluate the pregnancies, deliveries and functional results of patients who have undergone and ileal pouch-anal anastomosis. DESIGN: A retrospective survey by questionnaire. SETTING: The study was conducted at a university hospital. SUBJECTS: Twelve women who had undergone an ileal pouch-anal anastomosis at the Inflammatory Bowel Disease Centre, Mount Sinai Hospital and who had subsequently become pregnant, were identified from the hospital records. A follow up questionnaire was completed by all subjects. RESULTS: Twelve patients had 16 deliveries. There were 10 vaginal deliveries and 6 caesarian sections. There were no pouch-related complication during the 16 pregnancies and there were two postpartum complications. CONCLUSIONS: Pregnancy is safe in women with an ileal pouch-anal anastomosis. Functional results are altered minimally. Vaginal delivery is safe and obstetric reasons should determine whether a caesarian section is performed.

Adolescent↗
PubMed1996

Evaluation of surgery for perianal Crohn's fistulas.

PURPOSE: This study was designed to evaluate the operative treatments performed on patients with perianal Crohn's disease at a tertiary referral colorectal university hospital and to determine the efficacy of management by assessing patient satisfaction. METHODS: A retrospective survey included 59 patients with perianal Crohn's disease who had undergone surgery during the period of 1991 to 1993, inclusive. RESULTS: Twenty-seven patients were treated by laying the fistula open (81 percent successful), and another 27 cases were treated with a loose seton (85 percent successful). Five cases were complicated fistulas and underwent diversionary stomas as part of a primary procedure. Overall success rate, as judged by patient satisfaction, was 83 percent. CONCLUSION: Conservative surgery has a role in management of perianal Crohn's disease. Patient satisfaction can be achieved without complete healing. Better preoperative assessment may improve results further.

Adolescent↗
PubMed1995

Thoracoscopic repair of a transmural rupture of the oesophagus (Boerhaave's syndrome).

Transmural spontaneous oesophageal rupture was first described in 1724 by Boerhaave and in 1946 Barrett was the first to describe successful surgical treatment for this condition. The advent of minimal access surgery has seen a minimally invasive approach to many well recognized surgical conditions and we report a thoracoscopic repair of a spontaneously ruptured oesophagus.

Aged↗
PubMed1995

'Surgical mules': the smuggling of drugs in the gastrointestinal tract.

The presentation to surgical units of patients carrying illegal drugs in the gastrointestinal tract is a frequent occurrence at hospitals sited close to international airports. Drugs, usually heroin or cocaine, are wrapped in cellophane packets or condoms. The packages are intracorporeally concealed by being swallowed or passed into the rectum. The majority of drug traffickers carrying intracorporeal drug packages do not require any medical intervention. Recent reports have suggested that these patients are best treated expectantly avoiding any operative procedures. However, the quantity of drug in any one of the ingested packets is usually above the toxic dose and acute drug toxicity, as well as bowel obstruction, can result in fatalities. We report a series of five patients who presented over a period of 2 years to a hospital close to Heathrow International Airport, London. The presentation and treatment are reviewed and the management of such 'surgical mules' discussed. We have shown that conservative treatment is appropriate providing bowel obstruction or package perforation has not occurred.

Adult↗
PubMed1995

Colectomy: the role of laparoscopy.

Laparoscopically assisted colonic surgery was performed in 23 patients in the last 12 months. In all cases, after an initial diagnostic laparoscopy, the colon was mobilized laparoscopically. The mesenteric and bowel division was performed extracorporeally, as was the anastomosis. No deaths occurred. There was a 13% complication rate; one patient suffered a late (10 days) anastomotic dehiscence at home, and two patients had postoperative upper respiratory chest infections. The mean number of lymph nodes excised for malignant cases was 12, and the total mean postoperative hospital stay was 7 days. The laparoscopic dissection required 40% of the operating time. Although this is our initial experience, we conclude that laparoscopically assisted bowel surgery replaces one operation with two, is more costly, requires a longer-lasting anaesthetic, and in our hands appears to offer little additional benefit to the patient compared with conventional surgery.

Adult↗
PubMed1994

Adenocarcinoma of the duodenum with a duodeno-colic fistula occurring after childhood Wilms' cancer.

A case of a 44 year old man with a duodeno-colic fistula secondary to an adenocarcinoma of the second part of the duodenum is described. An asymptomatic leiomyoma of the second part of the duodenum was also present. The patient had been treated successfully for a right Wilms' cancer in childhood with surgery and radiotherapy. There are no previous reports of a duodenal carcinoma arising following a Wilms' tumour and cases of gastrointestinal adenocarcinoma arising as second malignancies following Wilms' tumours are reviewed. The aetiology of duodeno-colic fistulas is reviewed. Duodenal carcinoma is a unusual cause of duodeno-colic fistulas and this case may be unique in that respect.

Adenocarcinoma↗
PubMed1993

Characterization of pulsed-dye laser-mediated vasodilatation in a rabbit femoral artery model of vasoconstriction.

Vasoconstriction is a clinical problem associated with invasive vascular procedures, microvascular reconstruction and subarachnoid hemorrhage. We sought to characterize the ability of pulsed-dye laser irradiation to reverse and prevent vasoconstriction in an anesthetized rabbit model of surgically and pharmacologically induced vasoconstriction. Five groups of experiments were performed to study the effect of pulsed-dye laser irradiation delivered through a 320 microns core ball-tip fiber into the femoral artery. The studies demonstrated that pulsed-dye irradiation can reproducibly cause vascular dilatation. The zone of vasodilatation propagated equally proximal and distal to the site of irradiation within the vessel. When saline was infused into the vessel to replace flowing blood during delivery of laser irradiation, no significant vasodilatation occurred. After laser irradiation reversed surgical and pharmacologic vasoconstriction, the vessel was resistant to further pharmacologic vasoconstriction. This resistance to pharmacologic vasoconstriction did not occur if the vessel was pharmacologically predilated before delivery of laser irradiation. Pathologic analysis of the vessels revealed endothelial damage and mild to moderate medial necrosis, most significant at the site of energy delivery. These studies provide characterization of pulsed-dye laser-mediated vasodilatation in an in vivo model. Delivery of pulsed-dye laser energy has potential clinical application and warrants further investigation.

Absorption↗
PubMed1993

The influence of diagnostic and therapeutic laparoscopy on patients presenting with an acute abdomen.

The role of laparoscopy in the management of patients presenting to one surgical firm with an acute abdomen is discussed. Sixty-seven laparoscopies have been performed over an 18 month period and it has altered the diagnosis in 19.4% of cases and the management in 13.4% of cases. At laparoscopy the diagnosis of appendicitis was made in 37 patients (81% had attempted laparoscopic appendicectomies); pelvic inflammatory disease in 15 patients; torted fimbrial cyst in two patients; and free pus in the right lower peritoneum as a result of a perforated appendix was seen in two patients. Normal laparoscopy was performed in five patients and four patients who presented with a perforated duodenal ulcer had the diagnosis confirmed at laparoscopy, in three cases the perforation was oversewn laparoscopically. Two laparoscopies were performed on trauma patients; one stabbing and one blunt trauma to the right hypochondrium. It has been demonstrated that diagnostic laparoscopy is a useful adjunct to the general surgeon's armamentarium. It is suggested that the skill of laparoscopy is passed on to junior trainee surgeons who can use this technique to help attain a diagnosis in patients presenting with an acute abdomen.

Abdomen, Acute↗
PubMed1992

Attitudes and experiences of human immunodeficiency virus-positive patients to surgery and surgeons.

The issues regarding screening and identification of patients at risk for human immunodeficiency virus (HIV) infection before surgery continue to be discussed, and there is a need for information regarding attitudes of both surgeons and patients to this issue. A population of HIV-positive patients attending a genitourinary medicine clinic were given an anonymous questionnaire to review their experiences of attending for operation. Of 174 patients who replied, 52 had undergone a total of 65 procedures. In all but three of the operations, the HIV status was made known to the surgeon.

Adult↗
PubMed1992

Ruptured abdominal aortic aneurysm presenting with acute urinary retention.

Ruptured abdominal aortic aneurysm classically presents with abdominal pain radiating to the back, a pulsatile abdominal mass and circulatory collapse. However, other symptoms may be the only presenting complaint. We report the case of a patient who presented with a history of acute retention of urine relieved by catheterisation, but who then developed clinical features more typical of abdominal aortic aneurysm rupture.

Aged↗
PubMed1991

Histological study of white blood cells and their association with lipodermatosclerosis and venous ulceration.

The number of white blood cells per mm2 has been determined in serial histological slides taken from punch biopsies of skin from the goiter region in patients with varicose veins. In eight patients the varicose veins were complicated by lipodermatosclerosis of the skin, and in a further six there was a history of ulceration. In uncomplicated varicose veins there was a median of 6 white blood cells per mm2, in patients with lipodermatosclerosis there were 45 white blood cells per mm2, and where there was a history of ulceration, 217 white blood cells per mm2. No change in white blood cell content was observed after the venous pressure was raised for 30 min by sitting the patient with the lower limb dependent. White blood cell infiltration of the skin is associated with lipodermatosclerotic changes caused by venous insufficiency.

Humans↗