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Biomedical subjects

M H Gough

Publications and source records attributed to M H Gough.

At least 19 recordsLinked to original sources
PubMed1989

Cryptorchidism.

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Cryptorchidism↗
PubMed1987

Prospective randomized controlled trial of urethral versus suprapubic catheterization.

Sixty-six patients requiring catheterization in the course of general surgical operations were randomly allocated into two groups. Of the 34 patients catheterized urethrally 16 developed urinary tract infections whereas of the 32 suprapubically catheterized patients only 2 developed an infection (P less than 0.001). Five patients required recatheterization after removal of their urethral catheters. There were no major complications associated with the use of suprapubic catheters. We propose that, when catheterization is required during a general surgical procedure, the suprapubic route is to be preferred.

Catheters, Indwelling↗
PubMed1987

Cushing's syndrome in pregnancy: the timing of definitive treatment.

Cushing's syndrome in pregnancy is rare but associated with a high fetal loss rate, premature labour and excessive maternal morbidity. There has been controversy regarding the safety and efficacy of surgical treatment during pregnancy. We describe two further cases, both due to adrenal adenomas, in whom the diagnosis was made at 28 and 31 weeks gestation. Both cases suffered from severe myopathy. The first case was not treated during pregnancy and developed wound and urinary infections after caesarean section and subsequent adrenalectomy. An incisional hernia in the caesarean section scar has been repaired twice. The second had an adrenalectomy when 29 weeks pregnant with rapid resolution of the features of Cushing's syndrome, particularly the myopathy, and had an uneventful vaginal delivery. The second case, and a review of those previously described, indicates that surgical treatment during pregnancy is safe and significantly reduces fetal losses, premature labour and maternal morbidity.

Adenoma↗
PubMed1987

Anatomical findings at orchiopexy.

The anatomical findings at orchidopexy for cryptorchid testis were recorded for 60 boys aged between 6 months and 18 years. In 11 patients (18.3%) bilateral cryptorchidism was present. At operation, atrophied testicular tissue was found in two patients and one testis was found to be absent; 69.1% (47/68) of the remaining testes were found in the superficial inguinal pouch at operation, 27.9% (19/68) were in the inguinal canal, one was in the femoral triangle and one was high in the scrotum. In 35 testes (51.5%) there was an associated hernial sac. In 54 testes (79.4%) the gubernaculum testis was attached to an anatomical site other than the lower scrotum. In 26 (38.2%) there was a fascial block to descent into the scrotum and one or other of these findings was present in 64 testes (94.1%). These findings suggest that failure to establish a patent route from the superficial inguinal region to the scrotum and the passage of the gubernaculum along this route are the abnormalities responsible for failure of testicular descent.

Child↗
PubMed1986

Undescended testis: the effect of treatment on subsequent risk of subfertility and malignancy.

The literature was reviewed for information on the long-term effects of cryptorchidism on fertility and cancer incidence. In unilateral cryptorchidism, treatment policies of orchidopexy alone, or of human chorionic gonadotrophin (hCG) therapy followed, if necessary, by orchidopexy, have resulted in similar levels of reduced fertility (15% azoospermia, and an additional 30% oligospermia, ie, sperm count less than 20 X 10(6)/mL). Very similar results were observed in unilateral cryptorchid men who had had no treatment (and were still cryptorchid at semen examination). In contrast, no untreated bilaterally cryptorchid men have normal fertility (sperm count greater than 20 X 10(6)/mL), whereas of those treated, a quarter have normal fertility. In some series, as many as half of the bilateral cryptorchid testes descended following hormonal treatment; a finding that could be attributed, at least in part, to the frequent difficulty in deciding on clinical examination, whether these testes are truly cryptorchid. There is little evidence that operation early rather than late within the age range of 4 to 14 years has any effect on subsequent fertility. Histologic studies suggest that orchidopexy should be carried out before age 2, but there are almost no follow-up data with which to evaluate the results of early operation. Since there is evidence that orchidopexy may result in testicular atrophy in a small proportion of cases, a trial of luteinizing hormone-releasing hormone (LHRH) may be advisable. There is little information available concerning the effect of age at orchidopexy on the subsequent risk of testicular cancer. Testes that cannot be brought into the scrotum should be excised.

Age Factors↗
PubMed1986

The use of laparoscopy in the management of right iliac fossa pain.

Fourty-six patients with a clinical diagnosis of acute appendicitis were laparoscoped before exploration. As a result the diagnosis was revised in 10 patients (22%). With experience the laparoscopic features of appendicitis can be recognised confidently so reducing the number of normal appendices removed.

Abdomen↗
PubMed1985

A randomized controlled trial of prophylactic cytotoxic chemotherapy in potentially curable breast cancer.

A randomized controlled trial of the value of oral adjuvant cytotoxic chemotherapy in the treatment of potentially curable breast cancer has been in progress in the Oxford Region since 1977. Eighty-seven patients were allocated to treatment with melphalan 0.2 mg/kg for 5 consecutive days every 6 weeks for 2 years; 98 patients were allocated to treatment with oral combination therapy consisting of melphalan 10 mg daily for 5 consecutive days, plus methotrexate 15 mg and 5-fluorouracil 250 mg on the first day, courses being repeated every 6 weeks for 2 years; and 88 patients were allocated to a control group which received no adjuvant chemotherapy. So far, 125 patients have suffered a recurrence of breast cancer and 85 have died. No statistically significant differences in outcome are apparent between the three treatment groups, although there is some indication of a beneficial effect of chemotherapy on disease-free interval in pre-menopausal women. Toxic effects of treatment, notably nausea, vomiting and bone marrow depression, have been moderately severe. In our view, the beneficial effects of current adjuvant cytotoxic chemotherapy, if any, are too modest to justify the suffering which such treatment can cause at a time when a woman with breast cancer might otherwise expect to feel physically well.

Adult↗
PubMed1984

The surgical treatment of hyperinsulinism in infancy and childhood.

Hyperinsulinaemic hypoglycaemia in infancy may be transient or persistent. Persistent hypoglycaemia is caused by nesidioblastosis of the pancreas, a diffuse pancreatic endocrine abnormality involving all the endocrine tissue, or by an islet cell adenoma. The cause of nesidioblastosis is not known but unless controlled its hypoglycaemic effects lead to convulsions, mental retardation or death. Patients with transient hyperinsulinaemic hypoglycaemia, and some with persistent hypoglycaemia, respond to medical therapy but those with an adenoma and many of those with nesidioblastosis will require partial or total pancreatectomy. The surgical treatment of six infants and a child is discussed. Five infants had nesidioblastosis; one infant and one nine-year-old girl had an islet cell adenoma. It is suggested that in the very young when there is no evidence of an insulinoma, resection at the initial operation should be greater--up to 90 per cent--than the previously recommended 75 per cent.

Adenoma, Islet Cell↗