Biomedical subjects
Publications and source records attributed to J S O'Rourke.
Sarcomas of the prostate are very rare. This article describes the radiological and histopathological findings of a case of prostatic stromal sarcoma, with the appearance of a phyllodes tumour with adenoid basal cell hyperplasia. Management and follow-up of this tumour are discussed.
Over a 14-year period, 435 patients underwent renal transplantation. Chronic rejection has occurred in 58 (13%) of all grafts and has accounted for 18% of all graft losses. After the first 6 months following transplantation, chronic rejection was the most common cause of graft failure, accounting for 40% of losses. The median time (interquartile range) from transplantation to graft failure was 3 years (2-5.5 years). Comparison of azathioprine versus cyclosporin treated patients showed no significant difference in the incidence of graft loss (Cox regression score 2.55, P = 0.11). Furthermore, there were significantly more grafts with deteriorating function owing to chronic rejection in cyclosporin-treated patients (n = 16, 11% of surviving grafts) than in azathioprine-treated patients (n = 2, 3% of surviving grafts). These data suggest that cyclosporin does not prevent the development of chronic rejection in renal transplants.
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We present an unusual diagnostic problem in a transplant patient whose failed renal transplant was found to contain undifferentiated carcinoma. When the patient later developed metastatic renal carcinoma, he began legal proceedings against the hospital for the transmission of a tumour with his renal transplant. He subsequently died of carcinomatosis. Post-mortem examination revealed acquired renal cystic disease in his native kidneys with a 1-cm adenocarcinoma arising from the wall of one of the cysts. We used DNA typing to determine the origin of the metastatic tumour and resolve the medico-legal problem.
The rationale for backup fistulae for patients on continuous ambulatory peritoneal dialysis (CAPD) is that many will require emergency haemodialysis and, subsequently, permanent haemodialysis. 42% of renal units in the UK have a policy of providing CAPD patients with backup arteriovenous fistulae. We have investigated whether this policy is justified. In our unit, of 176 patients who started CAPD between 1986 and 1989, most (73%) did not require haemodialysis over a median follow-up period of 4 years. Of the 153 backup fistulae created in 114 patients, only 10 were ever used for emergency haemodialysis. 23 other patients required emergency haemodialysis, but when required their fistulae were no longer functioning. The mean fistula patency times among patients in this study compared very favourably with those in other published work. This finding indicates that most fistulae are not available for emergency haemodialysis when required. 94% of fistulae were never used for haemodialysis. Hence it is no longer justifiable to create backup fistulae in CAPD patients.
BACKGROUND: The aim was to determine whether the transitional epithelium (TE) of the anal transition zone (ATZ) was involved by chronic ulcerative colitis (CUC) and whether preserving the ATZ preserves the disease. METHODS: Proctocolectomy specimens from 50 CUC patients and 50 patients with rectal cancer serving as controls were stained with alcian-blue to map the ATZ, and biopsy specimens containing adjacent TE and rectal mucosa were examined. RESULTS: The mean inflammation score (0, none; 4, severe) in TE of controls was 0.4, whereas in CUC it was 0.5. However, the mean inflammation score of the rectal mucosa within the ATZ was 0.2 in controls and 2.6 in CUC (P < 0.001). Rectal columnar epithelium extended past half of the maximum length of TE in 75% of patients (65-83%; 95% CI) and was within 1 cm of the dentate line in 89% (81%-94%). CONCLUSIONS: Although the TE of the ATZ was not inflamed, the rectal mucosa within the ATZ was. Moreover, rectal mucosa traversed half of the length of the ATZ in 75% of patients and was within 1 cm of the dentate line in fully 89%. Preserving the ATZ may preserve the disease in the majority of patients with CUC.
A group of 114 Irish patients with primary adenocarcinoma of the large bowel had significantly lower serum cholesterol concentrations than an age and sex matched group drawn from the general population. The hypocholesterolaemiac trait was manifest in male and female patients. Rigorous control procedures established that it was neither an artefact of nutritional compromise nor of preoperative bowel preparatory protocols. The data suggested that the appreciable hypocholesterolaemia observed was not influenced by the pathological stage or degree of differentiation of the tumour.
Four options are currently available to surgeons for the management of ulcerative colitis: the brooke ileostomy, ileorectostomy, Kock pouch, and ileal pouch-anal anastomosis. The latter comes closest to the ideal operation, as it is curative and physiological and restorative of quality of life. It is the authors' preferred alternative in most patients. Obstructive Crohn's disease of the small intestine can be ameliorated without loss of bowel by stricture plasty.
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A prospective study of all knee injuries seen at a Casualty Department was organized. A clinical diagnosis was made in each case, based on standardized criteria, and the subsequent progress followed. Meniscal tears tended to be over-diagnosed clinically. Many injuries thus classified settled in three to four weeks without further sequelae. Conversely, complete ligament tears were under-diagnosed and in particular these tended to be missed in the presence of a haemarthrosis. Examination under anaesthesia is recommended if there is any doubt concerning ligamentous stability and all unexplained haemarthrosis should have early examination under anaesthesia and arthroscopy. Among those injuries initially regarded as less serious e.g. traumatic synovitis, no serious pathology subsequently emerged.
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