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Biomedical subjects

J P Thomson

Publications and source records attributed to J P Thomson.

At least 19 recordsLinked to original sources
PubMed1992

Management of familial adenomatous polyposis.

The management of FAP involves treatment of affected individuals and their families. Such an approach is best coordinated by registrars working in dedicated registries, in close collaboration with nurses, physicians, surgeons, clinical geneticists and others who become involved in the care of these patients. The large bowel of patients with FAP should be removed (totally or subtotally) by the third decade of life. Screening of other areas at risk is recommended to document the natural history of extracolonic manifestations and to allow study of the effects of intervention. Despite these other, sometimes life-threatening manifestations, a near to normal life span is possible in the majority of patients with FAP. The aims of management of the individual and of the family are to ensure that their quality of life is optimal, that support is provided in times of emotional need, that anxiety is minimized and that relatives are adequately screened and treated.

Adenomatous Polyposis Coli↗
PubMed1992

An evaluation of the penetration of cefuroxime axetil into human paranasal sinus tissue.

Nineteen patients presenting for sinus surgery were studied to evaluate the percentage penetration from serum to paranasal sinus tissue of a single orally administered dose of cefuroxime axetil. The methods and results are presented. Cefuroxime penetrates well into human sinus mucosa following oral administration and the concentrations obtained exceed minimum inhibitory concentrations of cefuroxime for the most common pathogens in sinusitis.

Administration, Oral↗
PubMed1991

Comparison of morbidity and function after colectomy with ileorectal anastomosis or restorative proctocolectomy for familial adenomatous polyposis.

Restorative proctocolectomy with an ileal reservoir (RPC) should prevent colorectal cancer in patients with familial adenomatous polyposis. Until this is confirmed its role compared with total colectomy and ileorectal anastomosis (IRA) will depend on the relative morbidity and postoperative bowel function after the two procedures. This was analysed in 99 patients (37 RPC, 62 IRA) operated on between 1977 and 1989. Morbidity was greater after RPC with subsequent ileostomy closure (median hospital stay, 24 versus 11 days; complications, 60 versus 21 per cent; reoperation, 29 versus 3 per cent; return to normal activity; 31 versus 14 weeks). There was little difference in bowel function; after IRA median frequency was 3/24 h and urgency (unable to wait 15 min) occurred in 50 per cent, compared with 4.5/24h and 17 per cent after RPC. Night evacuation occurred in 10 and 43 per cent respectively. IRA was performed in younger patients (median 19 versus 31 years) who had fewer bowel motions before operation (2 versus 5/24 h). The greater morbidity of RPC suggests that it should be restricted to patients at higher risk of developing later rectal cancer, including those unavailable for follow-up and those with large or confluent rectal polyps or with curable colon cancer at the initial colectomy.

Adenomatous Polyposis Coli↗
PubMed1991

Clinical and functional results of abdominal rectopexy for complete rectal prolapse.

Between 1977 and 1987, 53 patients underwent polyvinyl alcohol sponge rectopexy for complete rectal prolapse. The mean follow-up period was 36.7 months. Full thickness prolapse recurred in two patients (3.8 per cent). Infection around the prosthesis and faecal impaction developed in two patients each. Continence improved significantly after operation, particularly in those under 70 years of age (P = 0.028, chi 2 test) and nulliparous women (P = 0.026, chi 2 test). Bowel function was generally unchanged after rectopexy; in particular only eight patients (15 per cent) had significant postoperative constipation.

Adolescent↗
PubMed1991

A review of physical abnormalities in familial adenomatous polyposis.

Familial adenomatous polyposis (FAP) is an autosomal dominant condition wherein multiple polyps may be found in the gastrointestinal tract. Initially referred to as familial polyposis coli, it has become evident that virtually all patients with FAP develop adenomas in the upper gastrointestinal tract and thus the syndrome is now termed familial adenomatous polyposis. The number of associated conditions both malignant and benign has been increasingly recognized. Some of these lesions cause morbidity and mortality in affected individuals whilst others act as important clinical markers for identifying patients not yet expressing the phenotype. These abnormalities can arise from tissues of all three primary embryonic layers and are described in this paper.

Abnormalities, Multiple↗
PubMed1979

Pruritus ani: is anal sphincter dysfunction important in aetiology?

Forty-three patients whose principal symptom was pruritus ani were studied. Twenty-eight had anal disease, while in 15 no such disease could be shown. Maximum resting pressures and transient and sustained pressures of the anal canal in response to rectal distension were measured by manometry. Although the maximum resting pressure in the patients with no disease was about the same as that in the group with disease, the pressures recorded in response to rectal distension were significantly lower. These results show that the anal sphincter relaxes in response to rectal distension more readily in patients with no anal disease. Hence soiling may occur, which may be a factor in the genesis of pruritus ani.

Adult↗
PubMed1979

Recurrent unilateral swelling of the parotid gland.

The clinical features of 109 patients with recurrent unilateral parotid swelling (24 patients with Sjögren's disease were excluded) have been analysed to explore the best system of management. The cause was definitely a parotid duct calculus in 36 patients, and evidence is presented that the same diagnosis probably applied to another 59 patients. Features suggesting a diagnosis of calculus included age (greater than 29 years); duration of the attacks of pain (less than 24 hours); cessation of salivation on the affected side; and a spurt of saliva heralding the relief of symptoms. Only three patients in the definite calculus group (8.3%) had no physical signs. However, had physical examination not included inspection and palpation of the parotid duct and its orifice from within the mouth 75% of the proven calculi would have been missed. The intraoral and anteroposterior plain radiographs are likely to be helpful, and sialography even more so. A sialographic appearance of a stricture in the main duct with proximal dilatation is usually due to a claculus. It would appear that calculi are the cause of recurrent unilateral parotid swelling (after exclusion of Sjögren's disease) in an overwhelming proportion of patients with this symptom.

Adult↗
PubMed1978

The relationship between the rate of gastric emptying and the dumping syndrome.

Following an oral hypertonic glucose challenge, gastric emptying and changes in plasma volume were measured in 15 subjects before and in 36 subjects after a truncal or selective vagotomy with a drainage procedure. The symptoms experienced during the test were noted, and the postoperative patients divided into two groups, (a) 20 patients who experienced dumping symptoms during the test and (b) 16 patients who did not. Gastric emptying was significantly faster and the fall in plasma volume significantly greater in those patients who experienced symptoms after the ingestion of hypertonic glucose than in those who did not, clearly demonstrating that the dumping syndrome is associated with an increased rate of gastric emptying. In addition, there was a significant positive correlation between the rate of gastric emptying and the fall in plasma volume.

Dumping Syndrome↗
PubMed1978

The treatment of perianal and anal condylomata acuminata: a new operative technique.

Seventy-five patients have been treated for condylomata acuminata by means of a new operative approach which results in the preservation of the maximum amount of normal tissue. The technique has proved to be simple to perform, it has minimal complications and causes the patient little in the way of discomfort. Three out of 4 patients treated have no significant recurrent wart formation.

Adult↗
PubMed1977

Fissure-in-ano: the initial management and prognosis.

The results of treatment of 188 consecutive new patients with a primary diagnosis of fissure-in-ano presenting to the Outpatient Department of St Mark's Hospital are reviewed. One-third underwent operation as the primary treatment and were not studied further. Of the remaining patients who underwent non-operative treatment only, one-half were initially cured. Follow-up at 4 years showed that this cure was maintained in half of these cases, suggesting that there is a place for treatment with a dilator in the correctly selected case. The presence of a sentinel skin tag or a fibrous anal polyp is shown to have a statistically significant association with operative treatment. The use of a paediatric sigmoidoscope to diagnose a fibrous anal polyp is recommended.

Adolescent↗
PubMed1977

Treatment of sessile villous and tubulovillous adenomas of the rectum: experience of St. Mark's Hospital. 1963-1972.

Between 1963 and 1972, 121 new patients were treated at St. Mark's Hospital for a sessile villous or tubulovillous adenoma of the rectum. Thirty patients (25 per cent) were found to have simultaneous neoplastic lesions in the large intestine. Sphincter-preserving operations were performed whenever possible, and the various methods of treatment used are analyzed. Fourteen patients (11.6 per cent) had postoperative complications, and three patients died. Twenty-six patients are know to have had further benign tumor at the same site during the follow-up period.

Adenoma↗
PubMed1977

Hemorrhoidectomy--how I do it: current views in Britain.

It is clear that there is no uniform treatment for hemorrhoids in Britain. Indeed, there is often considerable debate about the merits and disadvantages of the various methods available. It would seem that a more scientific way of assessing the management of patients is needed so that the various therapeutic measures may be properly evaluated, comparing like with like. It may then be possible to tailor the treatment for each individual more accurately, in order to confer the maximum benefit.

Cryosurgery↗