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M Birks

Publications and source records attributed to M Birks.

5 recordsLinked to original sources
PubMed2003

The incidence and causes of permanent stoma after anterior resection.

AIMS: Defunctioning stomas are used following anterior resection to guard against the serious consequences of anastomotic leak such as pelvic sepsis and generalized peritonitis. This study aims to determine what proportion of patients undergoing anterior resection have a defunctioning stoma, how many of these patients do not have their stoma closed, and the reasons for this. METHODS: All patients undergoing a resection for rectal cancer in our institution in a five year period (January 1995 to December 1999) are included in the study. Anterior resection was performed on 154 patients, divided into 76 anterior resections (AR) and 78 low anterior resections (defined as the anastomosis within 6 cm of the anal verge). The data from these patients were analysed retrospectively. RESULTS: Of the total of 154 patients undergoing anterior resection, 59 (38%) were defunctioned, divided into 33 with loop ileostomy and 26 with loop colostomy. Five of these patients had not had their stoma closed at a median follow up of four years (range 1.5-6.5 years). The reasons for non closure were anastomotic stricture (2), metastatic disease (2), and patient choice (1). When comparing AR and LAR, 16% of patients had a defunctioning stoma after AR, compared with 60% after LAR (P < 0.01). CONCLUSION: Anterior resection is being performed for very low rectal tumours in order to avoid a permanent stoma. However we have found that 8% of patients who are defunctioned with a stoma at anterior resection will not have their stoma closed, and conclude that patients should be warned of this pre-operatively.

Aged↗
PubMed2001

Topical diltiazem ointment in the treatment of chronic anal fissure.

BACKGROUND: Chronic anal fissure has traditionally been treated surgically. Initial enthusiasm for chemical sphincterotomy has waned because of poor outcomes with glyceryl trinitrate ointment. In this study the use of topical 2 per cent diltiazem ointment has been investigated as an alternative method of chemical sphincterotomy. METHODS: A prospective assessment of 71 consecutive patients with a chronic anal fissure treated with 2 per cent topical diltiazem ointment for a median duration of 9 (range 2--16) weeks was performed. RESULTS: Fifty-one patients (75 per cent) experienced healing of the fissure after 2--3 months of treatment with topical diltiazem. Seventeen patients who did not heal were treated for a further 8 weeks with topical diltiazem. Eight of these patients subsequently healed with diltiazem. Fifty-nine of 67 patients who completed follow-up therefore healed on diltiazem ointment. Four patients experienced perianal dermatitis and one patient experienced headaches. No other side-effects were recorded. After a median of 32 (range 14--67) weeks' follow-up following completion of treatment, 27 of 41 patients available remain symptom free. Six of seven patients with recurrent fissure were treated successfully by repeat chemical sphincterotomy. CONCLUSION: Topical 2 per cent diltiazem ointment used as an agent for chemical sphincterotomy for chronic anal fissure offers significant healing rates but does not have a significant side-effect profile, which may aid compliance to treatment. Early recurrences are common but usually amenable to further chemical sphincterotomy.

Administration, Topical↗
PubMed1997

Going the distance.

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Education, Nursing, Continuing↗
PubMedDate not supplied

A clinical trial of the effectiveness of water as a conductive medium in electrocardiography.

A clinical trial was conducted in three hospitals to determine if common tap water is suitable for use as a conductive medium in electrocardiography (ECG). It compares two consecutive ECG recordings of 100 patients, the first recordings were obtained with water as the conductive medium, the second tracings used the electroconductive gel Redux Creme. Analysis involved comparison of the height of the R wave in lead V4 and tracing reports from a cardiologist 'blind' to the medium used. Results indicated that there was no statistically significant difference in the conductive ability of the two media. Analysis of the clinical performance of the media indicated that in 82% of the traces water was equal to or better than gel in clarity, and in 90% of traces water was equal to or better than gel in suitability for diagnosis. One implication of the study is the possibility of significantly reducing the cost of ECG procedures while ensuring the quality of tracings remains at a clinically acceptable level.

Electric Conductivity↗