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Biomedical subjects

J P Cochrane

Publications and source records attributed to J P Cochrane.

16 recordsLinked to original sources
PubMed2002

Modifications to the double-staple technique for oesophago-jejunal anastomosis.

A new instrument is described that makes a small modification to the anvil of an Ethicon circular stapler, allowing it to be more easily withdrawn through a cross-stapled oesophagus. This allows the double-stapling technique for oesophago-jejunal anastomoses to be completed safely through the hiatus, even many centimetres inside the chest. The technique has been used on 17 anastomoses without difficulty, clinical leak or subsequent stricture. Several of these patients would have needed a thoracotomy to complete the anastomosis had it not been for this instrument.

Adenocarcinoma↗
PubMed1986

Race-linked differences in serum concentrations of dapsone, monoacetyldapsone and pyrimethamine during malaria prophylaxis.

Serum concentrations of dapsone (DDS), monoacetyldapsone (MADDS), the principal acetylated metabolite of DDS, and pyrimethamine (PYR) were measured in 55 Caucasian adults (31 males, 24 females) and 159 Papua New Guinean adults (140 males, 19 females) following the oral administration of Folaprim (100mg DDS; 12.5mg PYR). Blood samples were collected at mean sampling times of eight hours after medication and 18 hours before the next weekly dose for malaria prophylaxis. Clearance of DDS and MADDS from serum were significantly faster (p less than 0.001) in Caucasians than in Papua New Guineans. Significantly lower (p less than greater 0.001) serum concentrations of PYR were found in Papua New Guineans than in Caucasians at both sampling times, an observation which may reflect differences in the bioavailability of PYR between the two racial groups. The theoretical implications of these results are that Caucasians may be more susceptible to PYR-resistant Plasmodium falciparum malaria than Papua New Guineans whilst Papua New Guineans may be more susceptible to P. vivax; malaria than Caucasians.

Adolescent↗
PubMed1981

The surgical treatment of radiation injuries after radiotherapy for uterine carcinoma.

The outcome of serious radiation injuries to the pelvic viscera in 400 patients treated by radiotherapy for carcinoma of the uterus between January 1974 and December 1978 has been reviewed. Twenty-eight instances of serious radiation damage have been found, 13 of predominantly small bowel damage, 11 of predominantly large bowel damage and 4 of bladder damage. Many patients had involvement at multiple sites. Fourteen patients have died, and 9 survivors have artificial abdominal stomas. Leaking anastomoses and progressive sepsis were major problems in the postoperative period and could be related either to inadequate resection of irradiated bowel or to damage to other organs at operation. The possibilities of earlier diagnosis and better surgical procedures are discussed.

Adult↗
PubMed1981

Arginine vasopressin release following surgical operations.

A study of plasma arginine vasopressin (AVP) concentrations in 16 patients undergoing uncomplicated cholecystectomy was carried out to determine the relative importance of the various stimuli to AVP secretion during and after an operation. Eight of the 16 patients were given a high epidural blockade from T4 and T12 and blood samples were taken before, at frequent intervals during and for two days after operation for determination of plasma AVP and osmolarity; systolic blood pressure was measured each time a blood sample was taken. In the 16 patients there was a 1.8-fold rise of plasma AVP after induction of anaesthesia (from 1.7 pmol/l median basal value to 13.1 pmol/l) and an 8.8-fold rise after skin incision, the highest concentration during operation being 102 pmol/l. There was no significant difference in AVP concentrations, urine volumes or plasma osmolality in the control and epidural groups. Systolic blood pressure fell in all patients during operation by between 14 and 54 per cent, the fall being significantly greater in the epidural group. Notwithstanding the evidence that certain nervous impulses do cause an increased secretion of AVP during operation, these results clearly show that in the absence of such stimuli there is still an increased secretion, almost certainly caused by a fall in the blood pressure.

Adult↗
PubMed1980

Value of outpatient follow-up after curative surgery for carcinoma of the large bowel.

The records were reviewed of 406 patients with carcinoma of the large bowel who had been treated at the Middlesex Hospital during 1958-62. Of these patients, 180 were followed up regularly in this hospital after radical surgery, and from six months to 15 years after operation they were seen 2319 times; 71 developed a recurrent carcinoma but, of these, 41 recurrences (58%) were diagnosed at times other than those of the patients' routine outpatient appointments, although they were being regularly reviewed. Only one patient with recurrence appeared to have been cured by further surgery. For the present, adequate education of patients in the symptoms of early recurrence, with instruction to return if any of these develop, is likely to be more effective than the unsatisfactory and time-consuming routine follow-up still used in many hospitals.

Anus Neoplasms↗
PubMed1980

Wound healing after laser surgery: an experimental study.

Healing after carbon dioxide laser incisions has been assessed in three animal experiments. Nine incisions in pig skin were found to be significantly weaker after 7 days than similar incisions made with a scalpel, but stronger than those made with a cutting diathermy. Laser excision of skin discs in pigs provided a satisfactory base to take split-skin grafts, but graft take around the edges was less complete than after scalpel excisions. Division and anasto mosis of the colon of 75 rats showed that the laser produced anastomoses that were as strong after 7 days as those produced by scalpel or diathermy division, but the laser did not produce the narrowing of the lumen that occurred with diathermy. It is concluded that if epithelial surfaces are particularly thick and slow to cut with the laser than thermal damage will impair healing, but that in general epithelial surfaces need not be avoided in laser surgery.

Animals↗
PubMed1980

Malignant melanoma: significance of disease-free interval.

One hundred and six patients dying of malignant melanoma have been studied to test alternative explanations of long disease-free intervals following primary excision. The time intervals from excision to relapse with local, lymphatic-borne or blood-borne recurrences do not correlate with the subsequent survival of the patient. If the experimental technique is valid, it supports the hypothesis that a long latent interval following primary excision represents a variable period of growth restraint followed by reactivation of disease rather than a period of continuous tumour growth throughout the disease-free interval.

Humans↗
PubMed1980

Ruptured spleen.

Splenic rupture is a common intra-abdominal injury and is usually diagnosed without difficulty by clinical examination alone. It is in patients with multiple injuries, especially if they are unconscious, that there may be a delay in diagnosis unless the condition is carefully sought. Peritoneal lavage is the most helpful diagnostic aid in difficult cases. Urgent laparotomy is required as soon as splenic rupture is diagnosed and in most cases splenectomy is a life-saving procedure. However, the asplenic state carries small but measurable risks, especially for children. Surgeons dealing with abdominal trauma should familiarize themselves with the techniques of splenic repair so that these can be safely applied to certain selected cases.

Humans↗
PubMed1979

The effect of epidural analgesia on postoperative sodium balance.

The effect of a high epidural blockade on postoperative sodium (Na) retention has been studied in 8 patients undergoing cholecystectomy, with a further 8 patients, who received conventional anaesthesia and analgesia, acting as a control group. Preoperatively, all the patients received 90 mmol of Na per day and were in Na balance at the start of operation; this intake was continued for 48 h after the operation by intravenous infusion, and the epidural blockade was maintained with regular supplements of bupivacaine throughout. In addition to urine Na excretion and blood pressure changes, plasma levels of aldosterone, cortisol, renin activity and glucose were measured at appropriate intervals. The Na retention in both the epidural and control groups was the same (139 mmol and 135 mmol respectively at 48 h), but there were significant differences in the measurements of all the other factors. It is concluded that the epidural was providing effective blockade, but that the factors which cause Na retention were not affected by the epidural blockade. These results are at variance with another study of the effect of epidural blockade on postoperative Na retention (Bevan, 1971), and the possible reasons for this are discussed.

Adult↗