Biomedical subjects

J A Surrell

Publications and source records attributed to J A Surrell.

7 recordsLinked to original sources

PubMed1994

Pilonidal disease.

It is the author's preference and recommendation that an acutely infected pilonidal abscess be urgently drained with a simple incision and drainage procedure that is not necessarily viewed as definitive treatment. The patient should be so instructed. The definitive treatment of chronic pilonidal disease can be accomplished in a variety of ways, but our recommendation is excision of all infected tissue and sinus tracts through an elliptical incision with either marsupialization of the wound or beveling of the skin edges. Both marsupialization and beveling serve to minimize the chance of premature skin closure and promote complete healing of the site from the inside out. Weekly postoperative follow-up is strongly encouraged to assess progress and promote proper wound healing.

Debridement↗

PubMed1991

The bottom end. Handling of the perineal wound after abdominoperineal resection.

There are a number of options for handling the perineal wound following abdominoperineal resection, including open packing or primary closure with suction drainage. Open packing has not been widely accepted, fearing that it may delay perineal wound healing. The purpose of this paper, therefore, was to retrospectively evaluate, the experience at Ferguson Hospital with abdominoperineal resection from 1977 through 1986. The study population consisted of 288 patients undergoing abdominoperineal resection for rectal adenocarcinoma. Forty-six patients had the perineal wound closed primarily and 242 had the perineal wound packed open. Ninety-four patients had the pelvic peritoneum left open and 194 underwent closure of the pelvic peritoneum. Overall operative mortality was 2.1 per cent, and there was no significant difference between primary closure and open packing of the perineal wound with respect to hospital stay, operating time, operative blood loss, perioperative mortality, incidence of postoperative bowel obstruction, incidence of postoperative complications, or average time for perineal wound healing. Therefore, it would appear that packing the perineal wound following abdominoperineal resection is a viable means of handling the bottom end.

Adenocarcinoma↗

PubMed1989

Safe resection for diverticular disease of the colon.

A retrospective study of 83 patients undergoing surgery for diverticular disease over two years at a colorectal specialty hospital was undertaken to assess the safety of resection. No patient had free perforation. Eighty-nine percent of 46 patients with neither abscess nor fistula underwent resection and primary anastomosis, the remainder undergoing other resectional therapy; there was no mortality in this group. Of the 37 patients with abscesses, fistulas, or both, all had resections with or without primary anastomoses and one of these 37 patients died (2.7 percent mortality). In the entire series of 83 patients, the operative mortality was 1.2 percent, although 69 percent had morbidity. Resection can be performed safely for diverticulitis, and primary anastomosis can be safely added in uncomplicated and selected complicated cases.

Abscess↗

PubMed1989

Colorectal anastomotic stenosis. Results of a survey of the ASCRS membership.

Anastomotic stenosis is a poorly understood and underexamined complication of gastrointestinal surgery, reportedly most frequent in the coloproctostomy. In order to better define this problem, a questionnaire was sent to members of the American Society of Colon and Rectal Surgeons regarding patients with gastrointestinal anastomotic stenosis. A total of 123 patients with intestinal anastomotic stenosis were analyzed. Eighty-two anastomoses were stapled and 41 were handsewn. Nearly all stenoses occurred in the distal bowel (70 rectal, 23 sigmoid colon). Preoperative risk factors identified were obesity (28 patients) and abscess (12 patients). Incomplete "doughnuts" were noted in 12 patients. Postoperative anastomotic leaks (15 patients), pelvic infection (13 patients), and postoperative radiation (7 patients) were believed to be contributing factors. Dilatation, using a variety of techniques, was the sole treatment for 65 patients, however, intra-abdominal surgery was necessary in 34 patients. Large intestinal anastomotic stenosis probably occurs most commonly following coloproctostomy (both with handsewn and stapled anastomoses). Dilatation alone resulted in adequate treatment in most patients in the study. Major surgery was required to correct this problem in a significant number of patients (28 percent) in this series. The true incidence of anastomotic stenosis in colorectal surgery is unknown and warrants further study.

Adult↗

PubMed1988

An assessment of colostomy irrigation.

One hundred patients with permanent sigmoid colostomies were surveyed to determine their satisfaction and success with the "irrigation" technique of colostomy management. Most patients who irrigate their colostomies achieve continence. Odors and skin irritation are minimized. The irrigation method is economical, time efficient, and allows a reasonably liberal diet. It avoids bulky appliances and is safe. In appropriately selected patients, the irrigation technique is the method of choice for management of an end-sigmoid colostomy.

Adult↗

PubMed1987

Effects of microwave radiation on living tissues.

Prompted by an alleged case of child abuse resulting from microwave oven burns and the discovery of one other case, an animal model was chosen to explore microwave burn characteristics upon living, perfusing tissue. Anesthetized piglets were exposed to radiation from a standard household microwave oven for varying lengths of time, sufficient to result in full-thickness skin and visceral burns. Characteristic burn patterns were grossly identified. Biopsies studied with both light and electron microscopy demonstrated a pattern of relative layered tissue sparing. Layered tissue sparing is characterized by burned skin and muscle, with relatively unburned subcutaneous fat between these two layers. These findings have important forensic and patient care implications.

Animals↗

PubMed1987

Microwave oven burns to children: an unusual manifestation of child abuse.

Two children sustained full-thickness burns as a result of being placed in microwave ovens. Well demarcated burns occurred on the skin surfaces closest to the microwave-emitting devices. Morbidity was limited to complications of direct thermal effects. One of the children sustained a distinctive pattern of relative sparing of tissue layers without electrical burn features, such as nuclear streaming and charring, at the entrance site. In both instances eventual identification of this unusual etiology was initiated by child abuse concerns.

Burns↗