Age and mortality in colorectal cancer.
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Age Factors↗
Biomedical subjects
L A Donaldson
Publications and source records attributed to L A Donaldson.
Cholecystectomy in the elderly: a prospective study.
The mortality and morbidity of 151 elderly patients (greater than 64 years of age) undergoing biliary surgery for benign disease were prospectively studied. The overall mortality was 3.3 per cent. This comprised a 0.77 per cent mortality in the elective group and a 19 per cent mortality in the emergency group. In spite of 77 per cent of the emergency group having a gangrenous gallbladder, a complication difficult to predict preoperatively, the majority of deaths were from cardiovascular disease. The overall incidence of common bile duct exploration was 36 per cent, which was similar in the elective and emergency groups. A comparison between the old (65-74 years) and the aged (over 74 years of age) revealed twice the number of emergency cases in the aged. Considering elective biliary surgery, there was no difference between the mortality, morbidity, or common bile duct exploration rate comparing the old with the aged. This suggests that elective biliary surgery is safe even in the aged.
Age Factors↗
Weight gain after cholecystectomy.
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Adolescent↗
The Biethium bridge--an advance in stoma care.
The majority of currently available colostomy bridges lie on the skin surface. Until their removal around the seventh postoperative day, they frequently prevent the formation of a complete seal between the appliance and the skin, resulting in faecal leakage. This is distressing to the new stoma patient. In contrast, the Biethium bridge is inserted subcutaneously producing a small, flush stoma to which the colostomy bag can easily be applied and therefore faecal leakage is no longer a problem. Our experience with 35 patients is described.
Adult↗
The role of the intensive care unit in a district hospital.
The evolution of an intensive care facility in a District General Hospital is recorded. Optimum use of the Unit was achieved by accepting both critically ill and high dependency care patients. This has been of benefit to both the staff and patients and may be reflected in the falling mortality of the critically ill surgical patient. High dependency care patients now only stay 1.3 days and there has been no mortality. In view of the ageing population and the cost of such units, this dual role in the District General Hospital Intensive Care Unit appears justified.
Adult↗
Auto suture surgical stapling techniques in the jejunoileal bypass operation for morbid obesity.
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Adult↗
A retrospective review of 89 stab wounds to the abdomen and chest.
This study compared the admission findings in 89 stab victims with the subsequent severity of their injury. The majority of patients were young males who arrived at hospital after 2300 h on a Friday, Saturday or Sunday and had consumed alcohol prior to admission. The presence of "clinical shock" or absent bowel sounds was invariably associated with significant injury. However, 64 of the 89 patients in this study had a normal blood pressure and audible bowel sounds at the time of admission. Thirty of the 64 patients had also suffered significant injury, which frequently was a perforated viscus. A diagnostic laparotomy should be readily performed in such patients in view of the high incidence of occult injury. Experienced anaesthetic support is necessary to ensure a low mortality from the actual laparotomy.
Abdominal Injuries↗
A serial histologic study of the development and progression of acute pancreatitis in the rat.
This study was undertaken for the purpose of a serial investigation of the development and progression of the light-microscopic changes of acute pancreatitis and histologic criteria for evaluating pancreatitis. Acute pancreatitis, similar to that found in man, was induced in rats with the use of a closed duodenal loop technique (n = 36). Control rats underwent a laparotomy with mobilization of the duodenum (n = 12). Animals were killed every 2 hours for 24 hours, and a detailed and independent histologic evaluation was made of each. Focal acinar necrosis proceeding to a vasculitis appeared within 2--4 hours before the infiltration of inflammatory cells. Thereafter, the extent of acinar necrosis closely reflected the vasculitis with the later development of the acute inflammation. By the sixteenth hour, these changes were graded as moderate pancreatitis, and by 24 hours the process represented severe hemorrhagic pancreatitis. Vascular changes and acinar necrosis preceded the inflammatory cell infiltrate. The pancreatitis has been quantitated into minimal, moderate, or severe by assessing the severity of edema, acute inflammatory infiltrate, and changes in the vessels, ducts, and acini.
Acute Disease↗
Incidence of gallstones and ischaemic heart disease in the West of Scotland.
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Cholelithiasis↗
Acute pancreatitis - ischaemia or hyperaemia?
There is no accepted specific treatment for acute pancreatitis in man in spite of extensive investigations. Evidence is presented based on histology, vascular and blood flow studies to support the hypothesis that acute pancreatitis is unlike most inflammatory conditions since a rapid and severe ischaemia develops in the pancreas. In dogs for example there is an instant and maintained reduction in pancreatic blood flow reducing by 72% at 3 hours. Various treatments have been advocated in acute pancreatitis. Based upon the effect of dextran 40 in improving pancreatic blood flow and percentage cardiac output, it would appear to be a treatment of choice in acute pancreatitis.
Acute Disease↗
The effect of Trasylol and vasopressin on experimental pancreatitis.
A dog model was established to measure the hemodynamic changes occurring during experimental pancreatitis. The effect of treatment with Trasylol and vasopressin, beginning 60 minutes after induction of pancreatitis was assessed by their effect on the pancreatic hemodynamics. The pancreatic arterial blood flow fell by 72 per cent in the dogs with induced pancreatitis and treated only with saline solution. In contrast, the pancreatic blood flow fell by 58 per cent in the Trasylol group and 80 per cent in the vasopressin group. In addition, vasopressin had a detrimental effect on the cardiac output. Neither treatment altered the changes noted in the systemic blood pressure. Trasylol had a slight beneficial effect on experimental pancreatitis when assessed by its effect on the pancreatic hemodynamics. In contrast, vasopressin had a detrimental effect on the pancreatic hemodynamics.
Acute Disease↗
Experimental acute pancreatitis: the changes in pancreatic oxygen consumption and the effect of Dextran 40.
A canine model was devised to measure the oxygen consumption of the pancreas in experimentally induced pancreatitis. Over the 120 minute investigation period the oxygen consumption fell by 63% in the presence of a diminishing pancreatic blood flow and constant arteriovenous percentage saturation across the pancreas. Dextran 40 has been previously shown to maintain the pancreatic circulation. Accordingly a second group of dogs was treated with Dextran 40 (1.5 ml/kg) 60 minutes after induction of the pancreatitis. This produced a significant increase in the pancreatic oxygen consumption and widening of the arteriovenous difference. Dextran 40 appears to reverse the hypoxia of the pancreas noted in acute experimental pancreatitis.
Acute Disease↗
Amylase activity in human bile.
The mean amylase level in 42 human bile samples was 154 IU/l and there was no significant difference in the amylase activity of 32 paired serum and bile samples. Estimation of the amylase thermolability of bile showed it to be similar to that of serum. This suggests that the amylase activity in bile may have filtered through the liver from the hepatic circulation rather than refluxed from the pancreatic duct. The presence of amylase in human bile provides further evidence that the liver might have a role in the regulation of serum amylase.
Amylases↗
Serial serum amylase levels in patients with pancreatic pseudocysts.
The incidence of hyperamylasaemia in serial serum amylase levels from patients with pancreatic pseudocysts is not well documented in the literature. Accordingly serial amylase levels were estimated in 5 patients with proven pancreatic pseudocysts. The majority of the values were normal or only minimally elevated. In contrast the amylase thermolability was persistently elevated and appeared to be a more sensitive measurement than serum amylase activity for indicating the presence of pancreatic pseudocysts.
Amylases↗
Amylase thermolability as a screening test for pancreatic pseudocysts.
Amylase thermolability was determined by heating sera from control patients and patients with acute pancreatitis and pancreatic pseudocysts at 65 degrees C for 15 min. Normal serum amylase was 44 per cent thermolabile, but increased to 84 per cent thermolability during the hyperamylasaemia of acute pancreatitis, and returned to normal on resolution of the pancreatitis. In 9 patients with a pancreatic pseudocyst, although the total amylase level had almost returned to normal limits, 79 per cent of the amylase remained thermolabile. Amylase thermolability appears to be a simple screening test for pancreatic pseudocyst formation secondary to acute pancreatitis.
Acute Disease↗
Experimental pancreatitis: Effect of plasma and dextran on pancreatic blood flow.
In spite of extensive investigations, many aspects of the hemodynamic changes occurring in acute pancreatitis are understood poorly. A dog model was established in which continuous measurements of pancreatic arterial blood flow, cardiac output, and mean arterial blood pressure were made using electromagnetic flow probes and a pressure transducer, respectively. Pancreatitis was induced and the animals were monitored for 3 hours. In addition, control animals (group I) without pancreatitis also were done. All animals 50 ml of saline in the first hours. Three methods of therapy then were instituted in the dogs with pancreatitis and their effects were recorded. group I 6 dogs control animals no pancreatitis saline 50 ml/hr group II 10 dogs saline 50 ml/hr group III 6 dogs plasma 15 ml/kg over 45 min then saline 50 ml/hr group IV 10 dogs saline 50 ml and 1.5 ml/kg of dextran 40/hr These results confirm the observations made previously using a transillumination technique--that the pancreatic circulation rapidly reduces in acute pancreatitis. Administration of plasma produced a significant (P less than 0.05) but transient increase in the cardiac output and pancreatic blood flow; however, the blood pressure remained low. Dextran 40 minimally increased cardiac output, but it significantly improved the blood pressure and maintained the pancreatic blood flow. Low-dose, low-molecular weight dextran 40 appears to help to maintain pancreatic blood flow in acute pancreatitis. The possible mechanisms concerning the made of action of dextran 40 will be discussed.
Animals↗
Amylase creatinine clearance ratio after biliary surgery.
The amylase creatinine clearance ratio (ACCR) is considered to be a more sensitive index of acute pancreatitis than the serum amylase level. Serial ACCR estimations were undertaken in 25 patients undergoing an elective cholecystectomy. Using accepted criteria, 28% of these patients developed, in the postoperative period, biochemical evidence of pancreatic gland damage, although the serum amylase level remained normal. This raised ACCR was particularly noted in patients who had undergone an exploration of the common bile duct. The ACCR would appear to be a more sensitive index of pancreatic gland disruption secondary to biliary surgery than the serum amylase level.
Acute Disease↗
A cause of misleading serum amylase concentrations in acute pancreatitis.
The operative discovery of acute pancreatitis associated with gross hyperlipidaemia but a normal or high elevated serum amylase concentration has been described. We report a case of acute pancreatitis in which serial dilutions of serum resulted in a 338% rise in the serum amylase concentrations. The importance of appreciating this effect of hyperlipidaemia on the serum level measurements in patients with acute pancreatitis is re-emphasised.
Acute Disease↗