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Biomedical subjects

J Jeacock

Publications and source records attributed to J Jeacock.

28 records · Page 2Linked to original sources
PubMed1989

Early diagnosis in colorectal cancer still no benefit?

Delay to diagnosis from first symptom has been assessed in 332 patients with colorectal cancer treated by the three general surgeons in Trafford Health Authority. Delay was divided into three parts; that due to (a) the patient, (b) the general practitioner and (c) the hospital. There was no significant difference in delay between Dukes stage B and C patients but there was a significant difference in survival at two years between these two stages. Delay for patients with risk factors as family histories or diverticular disease was not significantly different to patients without these factors. When compared to other series delay has been shortened, particularly general practitioner and hospital delay. Fewer patients presented as emergencies and a greater proportion of patients had disease at an earlier stage. However, these favourable aspects are not reflected in an improved survival at 2 years.

Colorectal Neoplasms↗
PubMed1989

Early diagnosis in colorectal cancer. Still no benefit?

Time to diagnosis from first symptoms has been assessed in 332 patients with colorectal cancer treated by the three general surgeons in Trafford Health Authority. When compared with other series, delay to diagnosis has been shortened, particular general practitioner and hospital delay. Fewer patients presented as emergencies and a greater proportion of patients had early-stage disease. There was no significant difference in delay times between Dukes' stage B and C patients but there was a significant difference in survival at 2 years between these two stages. Delay times for patients with risk factors, family histories or diverticular disease were not significantly different from times in patients without these factors.

Adult↗
PubMed1989

Comparison of two prophylactic single-dose intravenous antibiotic regimes in the treatment of patients undergoing elective colorectal surgery in a district general hospital.

Two hundred and twenty-nine patients were entered into a study to compare the effectiveness and safety of two single-shot antibiotic regimes in patients undergoing elective colorectal surgery in two district general hospitals. A single shot of intravenous (IV) latamoxef disodium was as effective as an IV combination of cefuroxime and metronidazole in control of wound infection following elective large bowel surgery when given as a bolus at the time of anaesthetic induction. The incidence of major wound infection was 6% and was evenly distributed in the two treatment groups. Half the major wound infections were associated with faecal fistulae. A single shot of IV antibiotic at the time of anaesthetic induction was safe, simple and an effective prophylaxis against major wound infection. There was a low incidence (1.3%) of serious postoperative bleeding and no serious adverse reactions were noted. The overall mortality was 9%. Death was significantly related to elderly patients, a poor performance status, operative contamination and wound infections.

Aged↗
PubMed1988

Prediction of choledocholithiasis using a pocket microcomputer.

A computerized method, using a small pocket computer, has been used to predict the presence of choledocholithiasis in a prospective series of 239 patients undergoing cholecystectomy. From an initial data base of 424 patients 36 factors were evaluated and the most important 2 of these were determined by multivariate analysis for use in the prospective analysis. Satisfactory operative cholangiograms were a prerequisite to evaluation of the statistical method and were obtained in 90.4 per cent of cases. Using the computerized method a common bile duct stone would have been overlooked in only 1 patient but 17 unnecessary explorations would have been carried out. The overall accuracy of the computerized method was 92.5 per cent. When the method was applied to a further study of 97 patients from a separate centre the overall accuracy was 85.6 per cent. If the method was used to aid selective use of operative cholangiography, cholangiograms would be performed in 20 per cent and stones would be overlooked in less than 1 per cent.

Cholangiography↗
PubMed1985

The biliary tract in patients with acute gallstone pancreatitis.

The biliary tract has been prospectively studied in a consecutive series of 769 patients undergoing surgery for gallstones to determine whether differences exist between subjects with and without a history of acute pancreatitis. The incidence of acute gallstone pancreatitis (AGP) was 7.7 per cent and men with gallstones were significantly more likely to develop pancreatic inflammation. Operations on patients with AGP were accompanied by a higher mortality rate which was almost entirely due to the severity of the disease at the time of surgery. The earlier operations were performed after the onset of pancreatitis the more often stones were found in the common bile duct and at the ampulla. Patients with AGP had smaller and more numerous gallbladder stones in association with a wider cystic duct that controls. The common bile duct diameter in patients with AGP was independent of the presence of choledochal calculi implying either previous temporary obstruction to the biliary tree or a dilated duct ab initio. Pancreatic duct reflux was far more commonly observed on the cholangiograms of patients with AGP and in these patients reflux occurred into a wider pancreatic duct, at a greater angle and was associated with a longer functioning common channel. No patient developed recurrent pancreatitis following biliary surgery. These features strongly support the concept of gallstone migration and suggest that patients with gallstones who develop acute pancreatitis have essential differences in their biliary tree which mechanically facilitate migration of calculi.

Acute Disease↗
PubMed1980

Peripheral retinal ablation in the treatment of proliferative diabetic retinopathy during pregnancy.

The course of proliferative diabetic retinopathy involving the optic disc was followed, and the response to peripheral retinal photocoagulation monitored by argon laser in 11 patients during and after 13 pregnancies. Traditional obstetric practice assumes that pregnancy is a stimulus to irreversible progression of proliferative diabetic retinopathy, and that timely abortion and sterilisation are essential in order to achieve control of the neovascular process. Extensive photocoagulation will cause significant regression of neovascular complexes in 63% of cases, and it confers sufficient benefits to make ophthalmic indications for therapeutic abortion and sterilisation no longer tenable.

Adult↗
PubMed1979

Leucocyte ascorbate levels and postoperative deep venous thrombosis.

Forty-four general surgical patients were included in a prospective, randomized double-blind controlled trial of ascorbic acid (500 mg b.d.) or placebo for 7 days before operation. This was to test the hypothesis that vitamin C may reduce the instance of deep venous thrombosis postoperatively. Venous blood samples were taken before entering the trial, just immediately before surgery, on the day of operation and on three further occasions at 3-day intervals postoperatively for leucocyte ascorbic acid concentration (LAC). Venous thrombosis was diagnosed using the 125I-fibrinogen test and the leg scans interpreted by Roberts' criteria. There was no significant difference in the incidence of DVT between the treatment and placebo groups. In those with DVT (n = 23) the mean LAC on the day of operation was not significantly different from that in those without DVT. However, on the sixth and ninth postoperative days LAC levels were significantly lower in the DVT group. These results suggest that the administration of ascorbic acid preoperatively does not reduce the incidence of DVT, but a striking decrease in the LAC levels in the DVT patients is in keeping with the hypothesis that the initial event in the pathogenesis of DVT is adherence of leucocytes to the venous endothelium.

Ascorbic Acid↗
PubMed1977

Peripheral retinal ablation in the treatment of proliferative diabetic retinopathy: a three-year interim report of a randomised, controlled study using the argon laser.

A randomised controlled trial is reported of 94 patients with a symmetrical proliferative diabetic retinopathy involving the optic disc, who were treated by a peripheral retinal ablation technique using the argon laser. A highly significant difference in mean cumulative deterioration of visual acuity and blindness was shown in all but the late stages of the disease process between treated and untreated eyes. The untreated eyes exhibited far worse results. The earlier photocoagulation is initiated in the course of the proliferative process in this disease to control or preferably eliminate optic disc neovascularisation, the better the visual prognosis.

Blindness↗
PubMedDate not supplied

Developing and evaluating clinical supervision in the United Kingdom.

This paper provides an overview of the definitions and meaning given to clinical supervision in the United Kingdom. In addition, reference and examples from evaluation research undertaken by the University of Manchester are given which offers insight into the content, focus and purpose of clinical supervision in a variety of clinical specialities. Comment is offered on the value of research and the limitations and possibilities for research methods in evaluating clinical supervision.

Clinical Competence↗