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Biomedical subjects

I Pickford

Publications and source records attributed to I Pickford.

7 recordsLinked to original sources
PubMed2003

An assessment of surgeons' abilites to site colostomies accurately.

AIMS: The ability of surgeons to site a colostomy is assessed in a clinical model. In addition, the tuition received by surgical trainees in stoma siting is also reviewed. MATERIALS AND METHODS: Eleven surgeons (trainees--six, colorectal subspeciality interest--two) were asked to site an end colostomy on nine patients using an adhesive disc (diameter--1cm). The position of the stoma was then measured on the 'x' and 'y' axis of a 2cm box grid, (maximum error--1cm) which was placed on the abdomen and centred on the umbilicus. The positions were then compared with that chosen by the stoma nurse who was taken as the gold standard. Results were compared using ANOVA and the Mann Whitney--U test. A telephone questionnaire was then undertaken to review the training of junior surgeons. RESULTS: There was variance present within the group of surgeons studied (p<0.01). Trainees and consultants had a similar accuracy in stoma-siting (p<0.2). Consultants with a colorectal subspeciality interest were better at placing stomas than those with a general interest (p<0.002). Badly placed stomas were three times more likely to be too low than too high (p<0.002). Thirty of 37 trainees reported receiving no undergraduate training from a specialist stoma nurse. Ninety per cent received postgraduate training from another surgeon while a specialist nurse trained only 35%. CONCLUSION: There was no difference between trainees and consultants in their ability to site a colostomy. However, surgeons with a subspeciality interest chose stoma sites that were more consistent with the specialist nurse than general surgeons. Training is haphazard and ability is frequently assumed rather than proven.

Clinical Competence↗
PubMed1999

Failure to improve outcome in acute mesenteric ischaemia: seven-year review.

OBJECTIVE: To determine whether the prognosis of acute mesenteric ischaemia has changed over the past seven years. DESIGN: Retrospective study. SETTING: Teaching hospital, Scotland. SUBJECTS: 57 patients who presented to this hospital between January 1987 and December 1993 with acute mesenteric ischaemia. MAIN OUTCOME MEASURES: Morbidity, mortality and prognostic features. RESULTS: 46 of the 57 patients died. Only 18(32%) patients were accurately diagnosed before operation or death. Clinical presentation, white cell count, and serum amylase activity were not helpful in the diagnosis. Only 3 patients had mesenteric angiography, and none were given lytic agents or vasodilators. CONCLUSION: Mortality from acute mesenteric ischaemia has not changed during the past two decades and in the absence of an accurate diagnostic test is unlikely to do so.

Acute Disease↗
PubMed1996

Allelic imbalance at NME1 in microdissected primary and metastatic human colorectal carcinomas is frequent but not associated with metastasis to lymph nodes or liver.

Allelic imbalance at the NME locus on chromosome 17q21 was analyzed in colorectal cancer patients using a highly polymorphic microsatellite repeat sequence within NME1 itself. Duplicate samples of carcinoma and adjacent normal tissue was obtained by microdissection from 6 to 7-microns paraffin sections of 94 primary carcinomas (treatment years 1979-1993) and available lymph node and liver secondaries. In 55 patients informative (heterozygous) at this locus, allelic imbalance was examined in primary and secondary carcinomas. Microsatellite instability prevented assessment of allelic balance in two cases, and there was no evidence of homozygous loss at NME1 in any case analyzed. Allelic imbalance at the NME locus in carcinomas was frequent (27/53; 51%), and concordant results were obtained between primary carcinoma and secondary deposits in 30 of 33 (91%) cases. Three discordant cases showed allelic imbalance in secondary deposits but not the primary lesion. Although frequent, allelic imbalance at NME1 had no relationship to Dukes' stage at presentation or with subsequent hepatic metastasis, nor with the primary carcinoma site (proximal versus distal), tumor size, or mitotic or apoptotic index. Moreover, neither disease-free nor overall survival differed between patients with carcinomas showing NME1 allelic imbalance and patients with carcinomas that did not. Our results show that although allelic imbalance is frequent at the NME locus in primary and secondary colorectal carcinomas, there is no evidence to link this with clinical or pathological features or with metastatic potential. Microsatellite PCR and microdissection of enriched populations of carcinoma cells allowed uniformly successful analysis of samples from archival formalin-fixed paraffin-embedded tissue up to 15 years old and clear assessment of allelic imbalance in tumor specimens. Target sequences (e.g., microsatellites and minisatellites) up to approximately 200-250 bp may be reliably analyzed for allelic balance, suggesting that this method is of general utility in the genetic analysis of primary and metastatic neoplasia.

Adenocarcinoma↗
PubMed1992

Tumour metastasis.

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Disease Models, Animal↗
PubMed1988

Genetic aspects of tumour metastasis.

The application of techniques for the transfer of genetic material between cells when used with recombinant DNA technologies and gene cloning procedures hold exciting possibilities for the genetic analysis of the metastatic behaviour of tumour cells. So far these genetic studies have produced confusing results, but some of the problems have been defined more clearly. For a more complete understanding of the metastatic phenotype a more critical analysis of the models used to mimic the process and a greater appreciation of the deficiencies in the techniques applied to study it are necessary.

Animals↗
PubMed1977

Malnutrition in surgical patients. An unrecognised problem.

Indices of nutritional state were measured in 105 surgical patients. The indices were chosen to give information on protein-calorie malnutrition, anaemia, vitamin deficiency. Abnormal values for the various indices were common in the group as a whole and most frequent (50%) in patients who were still in hospital more than a week after major surgery. These patients had a high frequency of anaemia, vitamin deficiency, weight-loss, loss of arm-muscle bulk, and low plasma levels of transferrin and albumin. These abnormalities had gone almost entirely unrecognised, even in patients with sepsis after major surgery, who would benefit from improvement in nutritional state.

Adolescent↗