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Biomedical subjects

J P Garner

Publications and source records attributed to J P Garner.

At least 19 recordsLinked to original sources
PubMed2006

Sub-specialization in general surgery: the problem of providing a safe emergency general surgical service.

BACKGROUND: The increasing subspecialization of general surgeons in their elective work may result in deskilling and create problems in providing expert care for emergency cases. To evaluate the size of the problem this study determined how often complex emergency surgical cases are treated by general surgeons working outside their own elective subspecialty. METHOD: In a district general hospital in the south of the UK serving a population of 550 000 where there is almost complete subspecialization within general surgery, 1554 patients having emergency general surgical operations were studied in a one-year review. The time an operation occurred, the seniority of the operating surgeon, the subspecialty interest of the consultant responsible for the case compared with the specialist nature of the operation was determined. RESULTS: Of 1554 patients having emergency general surgical operations, 23% (352/1554) were of a high category of complexity. Ninety were vascular procedures and were dealt with by specialist vascular surgeons on a separate rota. Of the remaining 262 operations, 78 (30%) did not match the subspecialty of the consultant surgeon responsible for their care; 56 (72%) of these occurred out of hours of which 14 (18%) had a consultant surgeon present and scrubbed in the theatre; one per month of the study. Seventy-three percent (57/78) of these were complex colorectal operations. CONCLUSION: The mismatch between the subspecialist elective interests of the consultant general surgeon and out of hours specialist major surgery needing consultant involvement occurred infrequently, and was mainly due to major lower gastrointestinal cases managed by upper gastrointestinal and breast surgeons. This has important implications for the future training of general surgeons and the provision of an emergency nonvascular general surgical service.

Emergency Service, Hospital↗
PubMed2005

Is herniography useful?

Herniography has been used for 25 years in the diagnosis of occult herniation but has not gained widespread acceptance in the UK, despite studies confirming its high sensitivity and specificity for occult hernias and an excellent record of safety and patient acceptability. The traditional approach in the UK to suspected occult groin herniation has been surgical exploration. This study examined the use of herniography in a single district general hospital to assess its impact in limiting unnecessary groin explorations and allowing discharge of patients without hernias. The case notes of 90 successive patients referred for herniography by the department of general surgery in a single UK district general hospital over an 18-month period were reviewed. Eighty-seven completed examinations were analysed in which 23 hernias were diagnosed in 20 patients. Thirteen patients have undergone hernia repair with resolution of symptoms. There were no false positive examinations, although two inguinal hernias were incorrectly diagnosed radiologically as femoral hernias; there were two false negative examinations where additional hernias were found at laparoscopic repair. There were no reported complications. Twenty-four patients were discharged directly from the surgical clinic after a negative herniogram. Thirty patients were referred to other specialities. No patient had undergone groin exploration after a negative herniogram. Herniography is a useful tool in assessing obscure groin pain and potential occult herniation. It can reliably rule out the presence of a hernia and avoid the need for surgical exploration. Many patients with a negative herniogram can be reassured and discharged, whilst others may be referred on to other specialities safe in the knowledge that an occult hernia has been excluded.

Adult↗
PubMed2005

The use of Flammacerium in British Burns Units.

INTRODUCTION: Flammacerium (cerium nitrate-silver sulphadiazine) is marketed throughout Europe, but is only available in UK on a named patient basis. Anecdotally it is widely used in civilian burns units across the country despite the regulatory constraint, although little literature exists regarding its use in UK. We designed a postal survey to assess the use of Flammacerium countrywide and whether its 'named patient only' designation causes problems in treating burns patients. METHODS: Postal questionnaires were sent to the directors of the 18 adult burns units listed by the British Burns Association, requesting information on the use of Flammacerium. The indications and limitations of its use were recorded, as were any problems obtaining supplies. Finally, burns units were asked if they would like to see Flammacerium fully licensed in this country. RESULTS: Replies were received from 14 units (response rate=78%). Six units use Flammacerium frequently, six occasionally and two units never use it. It is used in those patients not undergoing early wound excision and closure because of co-morbidity, general age or frailty, paucity of donor sites or mixed depth pattern burns. It was generally used in the belief that it reduces the inflammatory response to burn injury (8/12), decreases bacterial colonization (10/12) and provides a firm eschar for easier wound management (11/12). Although 8 units had no problems with supplies of the agent, 10 respondents indicated they would like to see Flammacerium fully licensed in UK.

Attitude of Health Personnel↗
PubMed2005

Cerium nitrate in the management of burns.

BACKGROUND: The introduction of early excision of the burn eschar has contributed to a reduction in burn-related mortality but is not appropriate in all circumstances. Cerium nitrate has been used since 1976, usually in combination with silver sulphadiazine, to improve outcome where early excision is not performed. However, has still not gained universal acceptance. The evidence for its use is reviewed. METHODS: A MEDLINE search was performed for the years 1966-2003 using keywords 'cerium', 'sulphadiazine', 'Flammacerium', 'lanthanides' and 'topical therapy for burns'. The reference lists of key articles were then sifted for other relevant articles. RESULTS: Cerium has been shown to reduce mortality and morbidity in the treatment of severe burns. This benefit is derived from its action on the burn eschar. It binds and denatures the lipid protein complex liberated from burnt skin that is responsible for the profound immunosuppression associated with major cutaneous burns. It has only limited antimicrobial properties. CONCLUSIONS: Cerium nitrate is an excellent topical treatment for most cutaneous burns not undergoing immediate excision and closure.

Animals↗
PubMed2005

Effect of sand and wood-shavings bedding on the behavior of broiler chickens.

The purpose of this study was to determine the effect of 2 different bedding types, sand and wood shavings, on the behavior of broiler chickens. In experiment 1, 6 pens were divided down the center and bedded half with sand and half with wood shavings. Male broilers (10/pen) were observed by scan sampling at 5- or 12-min intervals throughout the 6-wk growth period during the morning (between 0800 to 0900 h), afternoon (1200 to 1500 h), and night (2300 to 0600 h). There was a significant behavior x substrate x week interaction during the day (P < 0.0001) and at night (P < 0.0002). Drinking, dustbathing, preening, and sitting increased in frequency on the sand side but decreased on the wood shavings side during the day, as did resting at night. In general, broilers performed a greater proportion of their total behavioral time budget on the sand (P < 0.0001) as they aged. Broilers used the divider between the 2 bedding types to perch; perching behavior peaked during wk 4. In experiment 2, male broilers were housed in 8 pens (50 birds/pen) bedded only in sand or wood shavings. Bedding type had no effect on behavioral time budgets (P = 0.8946), although there were age-related changes in behavior on both bedding types. These results indicate that when given a choice, broilers increasingly performed many of their behaviors on sand, but if only one bedding type was provided they performed those behaviors with similar frequency on sand or wood shavings.

Aging↗
PubMed2004

Environmental enrichment and development of cage stereotypy in Orange-winged Amazon parrots (Amazona amazonica).

Stereotypies are abnormal repetitive behaviors that often develop in animals housed in impoverished environments. Stereotypy represents the interaction of several complex developmental phenomena. To characterize the temporal nature of stereotypy increase (escalation) and decrease (attenuation), we monitored changes in stereotypy performance in young Orange-winged Amazon parrots reared either in barren cages or cages provided with enrichments designed to facilitate foraging and locomotion. Unenriched parrots developed significantly more stereotypy than enriched parrots, and the mean time to stereotypy onset and the rate and magnitude of stereotypy increase also differed between the two groups. We then provided enrichment to the birds that had been reared in the barren cages. Following a 4-week delay, stereotypy was significantly reduced. These results show that stereotypy can be both prevented and reversed with appropriate environmental modification and illustrate how studying this behavior at many points over time can provide insights into its ontogeny.

Animals↗
PubMed2004

A comparative study of envelope mastectomy and immediate reconstruction (EMIR) with standard latissimus dorsi immediate breast reconstruction.

BACKGROUND: Latissimus dorsi breast reconstruction has problems with scars at the donor site and on the reconstructed breast. We report the feasibility and aesthetic results of Envelope Mastectomy and Immediate Reconstruction (EMIR), which utilises a single lateral mammary fold incision. PATIENTS AND METHODS: Between 2001 and 2002, 20 EMIRs were performed in 19 patients, one as a staged bilateral procedure. Twenty consecutive patients, matched for body habitus, who had undergone standard latissimus dorsi breast reconstruction by the same surgeon from 1996 to 2000 were used as controls. Patient satisfaction was assessed using a validated Body Image Scale. Standard post-operative photographs were scored by three independent observers. RESULTS: Length of stay and complication rates were equivalent between both groups. Cosmetic self-assessment scores on the Body Image Scale and scores by the independent observers were satisfactory for both groups but no statistically significant difference was observed between groups. CONCLUSIONS: EMIR is a technically feasible and cosmetically acceptable method of immediate breast reconstruction.

Breast Neoplasms↗
PubMed2004

Tissue engineering in surgery.

The demands for repair and renewal of worn out or injured human tissue continue to increase and it is now apparent that this demand cannot be met from human donors. A partial solution may be found in living related and trans-species transplantation but these approaches invoke the problems of disease transfer and ethical dilemmas. Tissue engineering is a new technology that seeks to meet these increasing demands by utilising novel cell culture methods in vitro to provide tissue replacements in vivo. This article reviews the current state of tissue engineering and its potential for use in surgery.

Animals↗
PubMed2003

Prepare for an SpR interview.

By the time you attend an interview for a military SpR number you should have no real problems but it pays to be prepared. Begin preparations early, reading widely and talk to as many people as possible. Your consultants will have a useful viewpoint on the proceedings and may be able to help you refine your answers to the common questions. Arrive at your interview in a smart and timely fashion and answer questions with confidence and common sense. Avoid confrontation and bluff and be courteous at all times, whatever you may be feeling inside and thank the interview panel as you leave.

Humans↗
PubMed2003

Organise a clinical trial.

Organising a clinical trial is a major undertaking involving a lot of hard work before during and after the study takes place and such trials are one endeavour where there are no short cuts. Cutting corners in an effort to save time, money or effort is usually quite obvious to the assiduous journal reader who will rubbish the conclusions and tarnish one's reputation for scientific validity. By taking time to carefully think through each stage and possible eventuality of ones plans it is possible to avoid many of the stumbling blocks that interfere with the conduct of a successful trial. Consideration of the contents of this article may help to clarify matters when organising ones first clinical trial or one may wish to attend one of a growing number of courses that give instruction in many of these matters.

Clinical Trials as Topic↗
PubMed2003

Some recollections of Porton in World War 1. Commentary.

Chemical weapons now regularly feature in news reports and the threat from them has become widely recognised by the public at large. Terrorist actions such as the Tokyo subway incident in 1995, coupled with the persistent use of agents such as sulphur mustard and Sarin by the Iraqi regime over the last 20 years in the Iran/Iraq war and against the Kurds of Northern Iraq, make it easy to think that chemical weapons are a new phenomenon. This paper reminds us that many chemical agents were developed during WWI; indeed the first use of a chemical agent was the release of chlorine gas--a choking agent--by the Germans over the battlefields of Ypres in 1915. Porton Down remains at the very heart of chemicals and biological weapons research, albeit in a purely defensive capacity; few of the old buildings remain and the idyllic lifestyle in the Officer's Mess at Idmiston Manor has long since disappeared. These recollections provide a fascinating insight into scientific research at the time of World War I.

Bioterrorism↗
PubMed2003

Varicose veins--an old dog and some new tricks.

There are many new methods to treat varicose veins being tried and tested around the world, many using patented techniques. They would appear to demonstrate many of the features a military surgeon might deem beneficial for treating a service population, a rapid return to duties amongst them. There are some significant drawbacks. All of these modalities need to offer long-term evidence of efficacy to demonstrate advantage over current standard. The endovenous therapies utilise expensive equipment that limit their introduction and provide a potential for novel complications as well as novel therapy. Modified sclerotherapy as described here has many advantages; it is incredibly cheap, minimally invasive and easily repeatable--in fact planned re-intervention is used in some protocols. Until long-term results are available, it would seem premature to recommend any of these new treatments for use in service personnel with primary varicose veins. Military vascular surgeons will await these results with interest, as the service population would have much to gain from a modality that reliably treats the veins and ensures a swift return to service.

Humans↗
PubMed2003

Froelich, fertility and a French emperor. Commentary on 'Napoleon's sex life' by Maj Gen F M Richardson.

This article, some forty-odd years old now sheds an interesting light on one of the great men of history; whether he was homosexual or not I think matters little, as he will be remembered for his Empire building and battles far more than his penis and prowess. The fact that a medical condition can tentatively be put forward as a mitigating circumstance against his less laudable behaviours, is of interest more for the value of the medical detective work that was involved, than the expunging of the blemishes from his legend. As a testament to the breadth of interest portrayed by the Journal all those years ago I feel it is a splendid reminder that articles other than randomised controlled trials or evidence based guidelines still make for enjoyable, if not directly practical, relevant reading.

Famous Persons↗
PubMed2003

The lateral accessory saphenous vein - a common cause of recurrent varicose veins.

BACKGROUND: Varicose veins commonly recur after surgery and present a large burden to the NHS. The aim of this study was to demonstrate that the lateral accessory saphenous vein is the commonest cause of groin recurrence of varicose veins and we discuss a possible anatomical reason for this. PATIENTS AND METHODS: The case notes of all patients presenting to two vascular surgeons with recurrent varicose veins over a 3-year period were studied. All limbs were assessed by duplex ultrasound scanning. These scans were reviewed to identify the site of recurrence. When recurrence occurred in the groin, the scans were further evaluated to identify the cause of groin recurrence. RESULTS: A total of 216 limbs in 186 patients were evaluated over a 36-month period. Of these, 141 (65%) demonstrated a recurrence in the groin: 56 (26%) recurrences were due to either incompetent thigh or calf perforators and there were 19 (9%) cases of saphenopopliteal or short saphenous vein incompetence. Out of 141 groin recurrences, 61 (43%) were due to a persistent lateral accessory saphenous vein. CONCLUSIONS: The lateral accessory saphenous vein is the commonest cause of recurrence in the groin of varicose veins. It should be looked for specifically during pre-operative assessment duplex scanning and at primary surgery. If identified at operation, we believe it should be either stripped or avulsed to reduce the risk of recurrence.

Adult↗
PubMed2002

Reliability and validity of a modified gait scoring system and its use in assessing tibial dyschondroplasia in broilers.

1. The gait scoring system for broilers developed by Kestin et al. (Veterinary Record, 131: 190-194, 1992) has been widely used to evaluate leg problems. The many factors and measures associated with this scale have empirically established its external (biological) validity. However, published test-retest (within-observer) reliabilities are poor, and inter-observer reliabilities are unknown. We evaluated several modifications to this scale aimed at improving its objectivity and reliability. 2. Eighteen naïve observers scored a standardised video of birds exhibiting varying degrees of lameness, either using Kestin et al.'s system, or our modified system. 3. Test-retest reliability (0.906) for Kestin et al.'s system was higher than previously reported. Inter-rater reliability was also good (0.892). The modified system offered significantly better test-retest (0.948) and inter-rater reliabilities (0.943), without incurring costs in terms of time taken or difficulty of use. The systems were consistent, assigning individual birds the same score on average. 4. It is concluded that the modified system offers the advantages of reduced error within and between studies. 5. In a second experiment, we used our modified scoring system to examine the relationship between tibial dyschondroplasia (TD) and gait score in 267 selected broilers. 6. Neither the presence nor severity of TD affected gait score, suggesting that, at least in this strain of broilers, other leg problems like slipped tendons or torsional deformities had more influence on gait impairment than did TD.

Animals↗
PubMed2002

An anomalous median nerve avoiding injury in a gunshot wound to the antecubital fossa.

We report the case of a 19 year old man who received a gunshot wound to the soft tissues of his left elbow. He presented with an ischaemic hand due to transection of the brachial artery bifurcation anterior to the elbow joint. He was spared an associated median nerve injury by an anomalous course of the nerve through the antecubital fossa.

Adult↗