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Biomedical subjects

J T Holmes

Publications and source records attributed to J T Holmes.

17 recordsLinked to original sources
PubMed1991

Carcinoma of the rectum: a 10-year experience.

A consecutive series of 303 patients with carcinoma of the rectum and distal sigmoid colon treated by a single surgeon over a 10-year period are reported. Of these, 202 underwent an anterior resection, 85 an abdominoperineal excision of the rectum and 16 a coloanal anastomosis. Surgery was considered palliative in 52 patients undergoing anterior resection and 24 undergoing abdominoperineal resection. The 30-day hospital mortality rate was six patients (3 per cent) for anterior resection and two patients (2 per cent) for abdominoperineal resection. Peroperative anastomotic testing demonstrated leakage in five stapled anastomoses; these were rectified and no clinical sequelae occurred. Two patients (1 per cent) developed a clinical anastomotic leak, one of which proved fatal; in each case the intraoperative test was negative. The overall 5-year survival rate was 64 per cent after anterior resection and 52 per cent after abdominoperineal resection; the median follow-up was 64 months. The incidence of local pelvic recurrence was 6.4 per cent after anterior resection and 14 per cent after abdominoperineal (not significant). These results confirm the success of sphincter-saving anterior resection combined with total mesorectal excision, routine full mobilization of the splenic flexure and cancercidal lavage of the distal rectum in the treatment of low rectal carcinomas; morbidity, local recurrence and survival are not compromised.

Adult↗
PubMed1991

Cervical intraepithelial neoplasia and squamous cell carcinoma of the anus in sexually active women.

Twenty-five patients with squamous cell carcinoma (SCC) of the anus have presented over an 8 year period; 18 were female. Six of 9 patients aged under 50 years were female. Five of these women had been treated for a previous cervical malignancy (2 invasive) and 4 practised anal intercourse; human papillomavirus (HPV) type 16 DNAs were isolated from their arcival anal/cervical paraffin sections. Signals were confined to the nuclei of the invasive anal SCC cells and the transformation zone of the cervix. HPV 6, 11 and 18 DNAs were not identified. Young women with cervical intraepithelial (CIN) III or invasive cervical SCC found in association with HPV infection are at risk of developing anal SCC (P less than 0.001; Fisher's exact).

Adult↗
PubMed1991

Colorectal anastomotic integrity after anterior resection: is there a role for intraoperative testing?

Two hundred and two consecutive patients having an anterior resection of the rectum were studied retrospectively to determine the usefulness of intraoperative anastomotic testing. Saline introduced via a rectal catheter was used to distend the rectum and any leaks demonstrated were oversewn. Of 119 stapled anastomoses there were two (1.7%) clinical leaks; in both cases intraoperative testing had been negative. Five patients (4.2%) had leaks demonstrated by intraluminal distension. These defects were rectified at the time of operation and no clinical sequelae followed, three patients having had a covering colostomy added. Eighty-three untested handsewn anastomoses were also reviewed; all had a postoperative recovery uncomplicated by a clinical leak. These results raise the question: does intraoperative anastomotic testing produce false positives and/or weaken the anastomosis? We believe that in the three patients who required the addition of a covering colostomy a clinical leak was avoided as a result of the intraoperative test. The technique is simple, effective and probably helps reduce leakage following colorectal anastomoses.

Adult↗
PubMed1990

Hartmann's procedure for carcinoma of rectum and distal sigmoid colon: 5-year audit.

During a 5-year period, 32 patients with colorectal carcinoma underwent a Hartmann procedure. Twenty operations were performed as emergencies for obstruction or peritonitis, and 12 for the elective treatment of colorectal malignancies. Of 22 surviving patients with potentially curable resections, 17 had restoration of colorectal continuity without complication. Five patients refused this option. Of the nine palliative procedures, seven patients developed a pelvic recurrence, one developed metastatic disease, and the remaining patient died after surgery. The median hospital stay was 17 days (range 8-48 days). There were two postoperative deaths (6%), both from pulmonary emboli. Thrombotic events occurred in three further patients, and wound sepsis in four. Other complications inherent to this procedure were individual cases of pelvic sepsis, anastomotic stricture, and a failed initial attempt at 'reversal'. These findings confirm that this operation is safe and effective in dealing with rectal and distal sigmoid colon malignancies with potential for local recurrence, and in those presenting as an emergency with obstruction or peritonitis, particularly when the operator is a surgical trainee.

Adult↗
PubMed1989

Intracranial abscess complicating diverticulitis with CT scan mimicking primary glioma.

The case of a 64 year old woman with diverticulitis complicated by a metastatic cerebral abscess is reported. Presentation was atypical and investigations were misleading; the computed tomographic scan was interpreted as showing a glioma. This case demonstrates that malignancy should never be assumed and the importance of making a histological diagnosis. Once the abscess was drained the patient made a full recovery with resolution of her neurological deficits.

Brain Abscess↗
PubMed1982

A comparison of intravenous and oral metronidazole as prophylactic in colorectal surgery.

In a prospective randomized double-blind trial we have compared oral (n = 46) and parenteral prophylaxis (n = 51) with metronidazole in elective colonic resection. All patients received oral or intravenous metronidazole, together with oral neomycin. The overall infection rate was 11.3 per cent. Six out of 46 patients in the oral group (13 per cent) had a wound infection postoperatively compared with 5 out of 51 patients who received intravenous metronidazole (9.8 per cent). These results suggest that there is no significant difference whether metronidazole is administered intravenously of orally as a prophylactic in elective colonic surgery.

Administration, Oral↗