Biomedical subjects
M C Parker
Publications and source records attributed to M C Parker.
Adhesion-related hospital readmissions after abdominal and pelvic surgery: a retrospective cohort study.
BACKGROUND: Adhesions after abdominal and pelvic surgery are important complications, although their basic epidemiology is unclear. We investigated the frequency of such complications in the general population to provide a basis for the targeting and assessment of new adhesion-prevention measures. METHODS: We used validated data from the Scottish National Health Service medical record linkage database to identify patients undergoing open abdominal or pelvic surgery in 1986, who had no record of such surgery in the preceding 5 years. Patients were followed up for 10 years and subsequent readmissions were reviewed and outcomes classified by the degree of adhesion. We also assessed the rate of adhesion-related admissions in 1994 for the population of 5 million people. FINDINGS: 1209 (5.7%) of all readmissions (21,347) were classified as being directly related to adhesions, with 1169 (3.8%) managed operatively. Overall, 34.6% of the 29,790 patients who underwent open abdominal or pelvic surgery in 1986 were readmitted a mean of 2.1 times over 10 years for a disorder directly or possibly related to adhesions, or for abdominal or pelvic surgery that could be potentially complicated by adhesions. 22.1% of all outcome readmissions occurred in the first year after initial surgery, but readmissions continued steadily throughout the 10-year period. In 1994, 4199 admissions were directly related to adhesions. INTERPRETATION: Postoperative adhesions have important consequences to patients, surgeons, and the health system. Surgical procedures with a high risk of adhesion-related complications need to be identified and adhesion prevention carefully assessed.
Joint surgical/palliative care ward round in a district general hospital.
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Endoluminal stenting of obstructed colorectal tumours.
A series of patients were selected to evaluate the clinical efficacy of a new self expanding metallic endoprosthesis in the management of left-sided colonic obstruction. The aim was to reduce the morbidity and mortality associated with the surgical management of patients with distal colonic obstruction. Six patients with complete sigmoid colon obstruction were managed with the Wallstent Enteral Endoprosthesis [Schneider (USA) Inc.]. Four underwent subsequent elective colonic resection, while two were placed for palliation. Stent placement was successful in all cases with resulting bowel decompression and there were no procedural complications. All four patients with resectable tumours avoided emergency surgery. Stenting allowed time for medical improvement and staging investigations in this group. Two patients with advanced metastatic colonic carcinoma were successfully palliated. We found the Wallstent Enteral Endoprosthesis to be safe and effective in relieving obstruction in patients with resectable colonic tumours, permitting elective surgery and avoiding a temporary stoma. It can also be used to palliate those patients with advanced disease.
A review of the management of small bowel obstruction. Members of the Surgical and Clinical Adhesions Research Study (SCAR).
Small bowel obstruction is a significant surgical problem and is commonly caused by postoperative adhesions. Patients suffering from this condition are often difficult to assess and require careful evaluation and management. Articles regarding the diagnosis, evaluation and management of small bowel obstruction have been identified from the Ovid, Embase and Silver Platter electronic databases and then reviewed by the authors. Particular emphasis has been placed on randomised controlled trials or large prospective series. Anecdotal reports or those containing small numbers have been largely excluded, but where they have been included it has been made clear in the text. The management of small bowel obstruction is predominantly the management of obstruction due to postoperative adhesions. The selective use of radiological techniques, such as water soluble contrast and CT studies, often help to characterise the nature of the obstruction and may even help with its resolution. Techniques involving the use of laparoscopy and barrier membranes may reduce morbidity but there is a need to evaluate these strategies further with prospective clinical trials.
Emergency abdominal surgery in the elderly.
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Early postoperative feeding after elective colorectal surgery is not a benefit unique to laparoscopy-assisted procedures.
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In situ observation of streptavidin-biotin binding on an immunoassay well surface using an atomic force microscope.
Polystyrene microtitre wells are commonly used as supports for the enzyme-linked immunosorbent assay (ELISA) method of biomolecular detection, which is employed in the routine diagnosis of a variety of medical conditions. We have used an atomic force microscope (AFM) to directly monitor specific molecular interactions between individual streptavidin and biotin molecules on such wells. This was achieved by functionalising an AFM probe with biotin and monitoring the adhesive forces between the probe and a streptavidin coated immunoassay well. The results demonstrate that the AFM may be employed as an analytical tool to study the interactions between biomolecules involved in immunoassay systems.
Intestinal obstruction in patients with advanced malignant disease.
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Polyposis: the Peutz-Jeghers syndrome.
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A novel organic solvent-based coupling method for the preparation of covalently immobilized proteins on gold.
A novel organic solvent-based coupling method has been developed for the covalent immobilization of biological material to gold surfaces. The method employs the polar organic solvent anhydrous 2,2,2-trifluoroethanol as the reaction medium and involves dissolution of the protein (catalase) in the solvent allowing protein coupling to proceed under basic conditions in a dry organic environment. The advantage of this method is that protein attachment is favored over hydrolysis of the coupling reagent. We have shown qualitatively and quantitatively that following attachment to the gold surface a significant proportion of the enzyme catalase remains catalytically active (at least 20-31%).
Primary osteosarcoma of the breast.
Osteosarcoma is a rare primary breast tumour. We report on a 55-year-old woman who presented with a left breast lump and a mammogram suggestive of carcinoma. At lumpectomy, a 3 cm mass was removed. Histology was consistent with primary osteosarcoma. There was satisfactory surgical clearance and no evidence of metastasis. She received four courses of adjuvant post-operative chemotherapy and remains free of disease at 14 months from diagnosis.
Endoscopic sphincteroplasty for the management of duct stones.
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Repair of rectocoele using Marlex mesh.
A new operation for rectocoele which places Marlex mesh in the rectovaginal septum is described in four women, of whom three have normal defaecation and one is improved but still needs occasionally to use digital perineal pressure. The aetiology of rectocoele is discussed.
Restorative proctocolectomy in patients after previous intestinal or anal surgery.
Restorative proctocolectomy is now established as the procedure of choice in many patients with ulcerative colitis or familial polyposis coli as well as in some patients with multiple colorectal tumors, ischemia, trauma, or congenital abnormalities. Some patients, however, may have had previous pelvic, abdominal, or perineal surgery, which might be considered a contraindication to restorative proctocolectomy. In a consecutive series of 73 private patients undergoing restorative proctocolectomy under one surgeon, we have reviewed in detail 13 who had had previous "significant" abdominal, pelvic, or anal surgery. Eight patients had previously had surgery for fistula-in-ano or fissure-in-ano, two had had an anal sphincter repair, and three had undergone possibly compromising abdominal or pelvic surgery prior to restorative proctocolectomy. Twelve of the 13 made an uncomplicated recovery from restorative proctocolectomy, although one has since died from carcinomatosis. One patient died after closure of an ileostomy from a combination of enterocutaneous fistula, infection, bleeding, and a perforated duodenal ulcer. One patient developed sepsis, necessitating removal of the pouch, and is classified as a failure. Two of the remaining 11 have had minor long-term functional problems with nocturnal fecal incontinence, and one patient needs to catheterize the pouch to evacuate, but all three patients prefer a pouch to an ileostomy. Restorative proctocolectomy can be performed successfully even after previous pelvic, abdominal, or anal surgery with an acceptable complication rate when compared with pouch surgery in the uncompromised patient.
The 'Jaykay' stoma flange cutter.
One of the many difficulties associated with stoma management is that of cutting the hole in the appliance to fit neatly and precisely around the mucocutaneous border. A new stoma flange cutter has been designed which facilitates the cutting or the enlargement of holes in stoma flanges to the exact size required. This equipment may be of use to partially sighted or manually disabled patients as well as to those able patients who would prefer an easier method of cutting the hole in their stoma flange. It may also be of use in operating theatres to enable theatre nurses to cut flanges more accurately and quickly for patients with colostomies, ileostomies or urinary conduits.
Outcome of stapled revision of retracted ileostomy.
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