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Biomedical subjects

L R Jenkinson

Publications and source records attributed to L R Jenkinson.

At least 19 recordsLinked to original sources
PubMed1992

Evaluation of the Alvarado score in acute appendicitis.

Use of the Alvarado scoring system was assessed prospectively in a consecutive series of 215 patients with suspected appendicitis over a 12 month period at the University Hospital of Wales, Cardiff. In comparison the high negative appendicectomy rate during the year prior to the study was reduced considerably with the scoring system without increasing morbidity or mortality.

Adult↗
PubMed1991

A more physiological alternative to total fundoplication for the surgical correction of resistant gastro-oesophageal reflux.

The incidence of mechanical complications associated with the Nissen fundoplication has prompted evaluation of an anti-reflux procedure designed to be simpler and more physiological, and encompassing a broader view of the many factors involved in the anti-reflux mechanism. Preliminary assessment of the first 100 patients with a mean follow-up of 3.5 years showed symptomatic improvement in 96 per cent and complete relief in 85 per cent. A further 100 patients were studied using formal symptom scoring, endoscopy, manometry and pH monitoring performed before operation and 3 months after operation. Similar clinical results were accompanied by improvement in endoscopic oesophagitis in 95 per cent, complete healing in 74 per cent and restoration of the pH profile to physiological levels in 84 per cent. Troublesome mechanical complications comprised a 2 per cent incidence of dysphagia, but there was no gas bloat or inability to belch or vomit, which may relate to the restoration of lower oesophageal sphincter characteristics close to those of 30 asymptomatic controls. The procedure is simpler to perform than total fundoplication, is well tolerated and is applicable to patients with reflux stricture and impaired oesophageal body motility. The results of this study support the hypotheses that effective reflux control can be achieved without total fundoplication by attention to several factors of known relevance to the anti-reflux mechanism, and that restoration of characteristics of the lower oesophageal sphincter close to physiological levels results in a lower incidence of mechanical complications.

Adult↗
PubMed1989

Burns management and junior staff--what do they know?

This study examines the ability of junior doctors to initiate the management of burned patients. One hundred and twenty-four junior doctors were assessed using a questionnaire. Eighty per cent of the sample had had undergraduate lectures on the subject and 43 per cent had experience of managing patients with major burns. Despite this only 3 per cent could correctly carry out all the steps necessary to estimate the fluid requirements of a burned patient. Theoretical knowledge of the 'Rule of Nines' was adequate but 10 per cent of the sample made mathematical errors when supplied with a burns formula and the appropriate values. We suggest that postgraduate instruction be given to junior staff and that burns charts include details of a burns formula and an illustrative example of the calculation required.

Burns↗
PubMed1989

Symptoms and endoscopic findings--can they predict abnormal nocturnal acid gastro-oesophageal reflux?

Nocturnal gastro-oesophageal reflux is known to be particularly damaging to the oesophageal mucosa, being associated with stricture formation and columnarisation. At present, this can only be detected by prolonged intra-oesophageal pH monitoring. A total of 50 patients with endoscopic oesophagitis were evaluated by ambulatory pH monitoring to detect the presence of nocturnal reflux. Whether certain symptoms in the presence of a hiatal hernia would identify those patients with reflux at night was investigated. Thirty-three patients had nocturnal reflux, two-thirds of whom had a hiatal hernia. Heartburn at night was of limited value (specificity = 65%) in detecting acid reflux whereas regurgitation and cough showed greater specificity (88% and 100% respectively) but lacked sensitivity (45% and 12% respectively). The combination of nocturnal symptoms and a hiatal hernia in patients with endoscopic oesophagitis correctly identified 58% of patients with nocturnal reflux and was highly specific (100%). This study has confirmed that symptoms and endoscopic findings can detect a significant proportion of 'at risk' patients, but the remainder will require pH monitoring to assess their pattern of acid exposure.

Cough↗
PubMed1988

Gastro-oesophageal reflux associated with nifedipine.

A 57-year-old woman presented with a 3-week history of dysphagia for solids, 6 months after starting treatment with nifedipine. Endoscopy demonstrated oesophagitis and a benign oesophageal stricture. Twenty-four-hour ambulatory pH monitoring demonstrated decreased acid reflux 8 weeks after withdrawal of nifedipine, with coincidental symptomatic and endoscopic improvement. Nifedipine may induce, or aggravate, pre-existing, gastro-oesophageal reflux.

Adult↗
PubMed1985

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↗
PubMed1985

Management of gallstones in a district general hospital.

This survey reviews 815 consecutive patients undergoing surgery for benign biliary disease. There were no deaths following elective operations and the overall mortality was 0.7 per cent. One-third of patients had one or more complications. The mortality in patients having common bile duct exploration (n = 160) by one or more methods was 2.5 per cent (4 patients) with 46 per cent of these patients having complications. Of 95 patients undergoing duct exploration and postoperative T-tube cholangiography, 7 had unexpected residual calculi after initial cholecystectomy. Five have had further surgery to clear the duct. All patients having duct surgery alone for retained stones (n = 24) had previously had cholecystectomy with or without supraduodenal duct exploration. Of all patients undergoing choledochoduodenostomy or transduodenal sphincter exploration only one has returned with evidence of retained calculi. Patients with choledocholithiasis were examined in an attempt to identify a high risk group. These were found to be elderly patients, having emergency surgery for sepsis and on whom more than one duct procedure was performed (mortality 10 per cent).

Adolescent↗
PubMed1985

Early elective cholecystectomy--an alternative to early cholecystectomy in acute cholecystitis?

Currently there are two forms of management for patients with acute cholecystitis. Conservative treatment during the acute episode and readmission after 6-8 weeks for elective surgery and early cholecystectomy during the emergency admission. An alternative treatment would be elective surgery before the acute episode which should reduce morbidity and mortality. This study has identified those patients who are likely to present with acute biliary disease so that they can be selected for elective surgery shortly after their attendance in outpatients.

Acute Disease↗
PubMed1984

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↗