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Biomedical subjects

M G Davies

Publications and source records attributed to M G Davies.

At least 19 recordsLinked to original sources
PubMed1992

Audit of open cholecystectomy in a district general hospital.

This retrospective study audited all non-malignant biliary surgery carried out in a district general hospital between January 1985 and December 1990. Surgery was performed on 722 patients: 555 (77 per cent) were women and 167 (23 per cent) were men. The mean(s.d.) age of the patients was 49(16) years. Elective admissions accounted for 70 per cent of cases and 30 per cent were emergency admissions. Ultrasonography confirmed the diagnosis in 93 per cent of cases. An elective operation was performed in 542 patients and 180 patients underwent an urgent or emergency operation. Simple cholecystectomy was performed on 616 patients (85 per cent); 92 (13 per cent) also underwent common bile duct exploration and 14 (2 per cent) had an additional unrelated procedure. The mean(s.d.) hospital stay was 12.3(6.3) (range 4-34) days. There was one perioperative death. The general overall morbidity rate was 25 per cent and the procedure-related morbidity rate was 7 per cent. For simple cholecystectomy (n = 630) there were no deaths; the general morbidity rate was 15 per cent and the procedure-related rate was 3 per cent.

Adolescent↗
PubMed1992

A review of the nature and activity of a general surgical service in Ireland.

The steady increase in hospital costs has led to demands for closer scrutiny of activity levels, workloads and outcomes. This study sought to examine these parameters in a typical district general surgical unit in this country. In the five year period 1985-89, 11,227 inpatient and 3,354 outpatient procedures were performed; 83% of the inpatient procedures were elective and 17% were emergency surgical operations. All inpatient procedures were categorized: minor (41%), intermediate (42%) and major (17%). A prospective one year review in 1990/1991 confirmed the accuracy of the retrospective data. During that year 2,335 inpatient operations and 765 outpatient operations were performed, of which 80.5% of the inpatient operations were elective and 19.5% were emergency procedures. Of these 16.6% were major, 34.4% intermediate and 49% were minor operations. 60% of the operations were performed by consultants. The in-hospital surgical mortality for the 1 year prospective review was 1.35% and the perioperative mortality was 0.64%. The overall operation morbidity rate was 9% and the procedure-related morbidity was 4.7%. The wound infection rate was 2%. Of the common operations performed throughout the six year study period appendicectomies and external hernia operations accounted for 20% of the caseload; 14% were urological, 7% were breast and 6% were biliary operations. The average waiting time for elective admissions was less than 4 weeks. The average length of hospital stay and the bed occupancy rates did not change.

General Surgery↗
PubMed1991

EEG and event related potentials in hepatic encephalopathy.

In recent years, there have been considerable developments in the application of EEG and event related potential technology to the diagnosis and assessment of hepatic encephalopathy in cirrhotic patients. A review of the literature on this subject is reported. The visually interpreted EEG is only of benefit in the late stages of hepatic encephalopathy. EEG spectral analysis allows identification of all stages of the condition. Brainstem auditory evoked responses are normal in encephalopathy. Visual evoked responses show an increase in the latency and eventual loss of individual component waves as encephalopathy progresses. Somatosensory evoked responses show a progressive prolongation of peak and inter-peak latency which correlates with the severity of encephalopathy. The auditory P300 evoked response shows an increased latency with the development of hepatic encephalopathy. Event related potentials provide objective diagnostic markers of the development of hepatic encephalopathy. The increased use of this technology in the assessment of patients with this condition should be of clinical benefit in its management.

Electroencephalography↗
PubMed1991

Infrainguinal polytetrafluoroethylene grafts: saved limbs or wasted effort? A report on ten years' experience.

Two-hundred and twenty-four infrainguinal polytetrafluoroethylene reconstructions were performed for critical ischemia over a 10 year period: 48 to the above-knee popliteal artery, 113 to the below-knee popliteal artery, and 63 to the tibial vessels. The cumulative patency rates were 84 +/- 6% and 63 +/- 9% for above-knee popliteal, 53 +/- 5% and 35 +/- 7% for below-knee popliteal, 45 +/- 6% and 30 +/- 9% for tibial vessels at one and five years respectively. Limb salvage rates were 81 +/- 6% and 73 +/- 9% (above-knee popliteal), 69 +/- 5% and 57 +/- 9% (below-knee popliteal), 64 +/- 7% and 32 +/- 10% (tibial vessels) at one and five years respectively. Graft occlusion did not result in limb loss in 32 cases. Preoperatively, 54% of the patients had limited mobility while 43% were regarded as severely restricted. At follow-up, 57% of the patients were considered to be independent, 26% had limited mobility, and 17% were still severely restricted. Polytetrafluoroethylene provides good short-term limb salvage and improved mobility in patients with critical ischemia and poor life expectancy. Its use is well worth the effort.

Activities of Daily Living↗
PubMed1991

Surgical audit under scrutiny--a prospective study.

Surgical audit must be shown to improve clinical practice and patient outcome if its widespread introduction is to be enthusiastically embraced by surgeons. Retrospective studies on hospital activity by their nature are often incomplete and unreliable. A 12-month prospective review (July 1990-June 1991) of the activity, morbidity and mortality that occurred within a district general surgical unit is analysed. During the study period, 3,927 patients were admitted to the unit, of whom 1,649 were elective and 2,278 (58%) were emergency cases. 48 patients (1.2%) were transferred to external specialist centres. 41% of the admissions did not require surgery. There were 2,335 in-patient and 765 out-patient operations performed. Using the BUPA classification (n = 3100), there were 388 major (12.5%), 802 intermediate (25.9%) and 1910 minor (61.6%) procedures. There were 15 perioperative and 38 non-operative (27 metastatic carcinoma) deaths. 80% of the perioperative deaths were high risk, elderly patients with acute abdominal pathology. 369 complications (39 in non-operative cases) were recorded among both in- and out-patients: 212 systemic, 133 local/wound and 24 major/life threatening. The perioperative mortality rate was 0.6%. The operative morbidity rate was 9.0% and the procedure-related morbidity 4.7%. The wound infection rate was 2%. In a non-specialist, general surgical unit with a broad case mix, it is possible to provide a standard of care and practice that produces very low mortality and an acceptable morbidity rate.

Hospital Bed Capacity, 300 to 499↗
PubMed1991

Surgical emergencies in Ireland. An audit of the emergency surgical caseload of an Irish district general hospital.

Emergency cases are an increasing part of the workload of a general surgical unit. Little accurate quantitative data is presently available on the nature and impact of this workload on a typical district general surgical service. This study reports the results of a prospective one year audit of the emergency cases dealt with by a typical Irish district general surgical service. The general surgical service admitted 2,278 patients acutely, which represented 58% of the total number of admissions to the service. Eighteen patients required immediate transfer for specialist neurosurgical (11), vascular (6) or plastics (1) treatment. Of those cases admitted 1,396 (61.3%) were males and 882 (38.7%) were females. There were 1,786 (78%) adults and 492 (21.6%) paediatric cases. Abdominal pain (48.0%), head injury (23.8%) and urological problems (11.0%) accounted for the majority of the caseload. Within the abdominal pain group, the pre-dominant diagnoses were non-specific abdominal pain (36.0%), appendicitis (19.5%), cholecystitis/obstructive jaundice (10.8%) and peptic ulcer disease (10.0%). There were 456 emergency operations performed, representing 19.5% of all the inpatient general surgical procedures. 328 (72%) of these were performed out of normal working hours. Only 12% of the procedures were major. The commonest operations were appendicectomy (51%), abscess drainage (13%), wound toilet (13%) and laparotomy (11%). The emergency peri-operative mortality was 1.1%. The positive appendicectomy rate was 92%.

Emergencies↗
PubMed1979

The efficacy of histamine antagonists as antipruritics in experimentally induced pruritus.

1. The antipruritic ability of histamine (H1 and H2) antagonists alone and in combination in experimentally induced pruritus has been investigated in 12 normal human volunteers. 2. A combination of cimetidine (H2 anatagonist) and chlorpheniramine (H1 antagonist) proved effective in suppressing itch that was artificially induced by the application of papain and histamine. 3. The combination was more effective than chlorpheniramine or cimetidine alone or placebo. 4. The results suggest that both H1 and H2 receptors are involved in the mediation of pruritus.

Adult↗
PubMed1979

Atopic disease and dermatitis herpetiformis.

Patients with dermatitis herpetiformis were found to have an increased incidence of atopic disorders compared to an age and sex matched control group. The increase in incidence was statistically significant for atopic eczema and any atopic disorder. Serum immunoglobulins (including IgE) were estimated in forty-five dermatitis herpetiformis patients and no significant abnormalities were found.

Adolescent↗
PubMed1978

The fatty acid composition of skin and plasma lipids in Refsum's disease.

The fatty acid composition of the skin and plasma lipids is described in a patient severely affected by Refsum's disease whose plasma phytanic acid concentration was very high (3.1 mg/ml). In the epidermal lipids, especially in the phospholipid fraction, phytanic acid tended to replace linoleic acid and to some extent arachidonic acid. In some respects the changes in the skin in Refsum's disease resemble those of essential fatty acid deficiency.

Cholesterol↗
PubMed1978

Epidermal metabolism in heredopathia atactica polyneuritiformis (Refsum's disease).

The epidermal metabolic activity of a patient with a marked generalized ichthyosis associated with heredopathia atactica polyneuritiformis has been investigated. Both the in vivo labeling index and the in vitro rates of incorporation of radioactively labeled thymidine, proline, histidine and acetate were increased relative to normal indicating a high rate of epidermopoiesis. Thin-layer chromatographic analysis of 14C-acetate containing lipid extracts revealed qualitative changes compared with normal. In particular, altered proportions of radioactivities were incorporated into the triglyceride and phospholipid moieties. However, as abnormal patterns of lipogenesis are also seen in autosomal dominant ichthyosis, these changes are probably a reflection of disordered keratinization.

Acetates↗
PubMed1978

Dermo-epidermal relationships in pyogenic granulomata.

The epidermis of pyogenic granulomata is presented with an unusual problem of distorted dermoepidermal relationships. In this study we have attempted to delineate the problem and have studied the way in which the epidermis copes with its difficulties. Sixteen pyogenic granulomata with (where possible) paralesional skin (and for comparison ten Campbell de Morgan spots) were studied by cell kinetic techniques. High labelling indices were found in the epidermis and in the endothelium in the pyogenic granulomata (contrasting strikingly with the findings in the Campbell de Morgan spots). A variable morphological response was found ranging from hyperplasia with parakeratosis to epidermal thinning and atrophy. Possible mechanisms for the epidermal changes are discussed and it is suggested that the data produced from this and similar studies may aid the understanding of dermo-epidermal interaction in a variety of common skin disorders including psoriasis.

Adolescent↗