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Biomedical subjects

M S Elliot

Publications and source records attributed to M S Elliot.

At least 19 recordsLinked to original sources
PubMed2001

Conventional optical microscopy of colloidal suspensions.

Optical microscopy can resolve detail at the larger end of the colloidal length scale, and to image suspensions at an individual particle level of resolution would allow the investigation of local behaviour in a way denied to the established scattering techniques. However, to achieve high-contrast single-particle resolution in dense suspensions that are thick enough to show behaviour the same as would be expected in the bulk is not a trivial exercise. We build on established advanced techniques of the conventional (i.e. non-confocal) light microscopy of phase objects to develop a suitable experimental protocol. Furthermore, we demonstrate the effectiveness of this protocol by means of an 'atlas' of the hard-sphere crystalline solid (where random stacking results in many complex facets), which should serve as a compendium for future study.

Bone Cements↗
PubMed1991

Severe colonic dysplasia in a child with familial adenomatous polyposis.

Familial adenomatous polyposis (FAP), is a genetic premalignant condition which, if untreated, will ultimately manifest with the development of colorectal carcinoma. It is a disease of young adulthood. Rectal and colonic polyps are seldom seen before 10 years of age. Screening of clinically asymptomatic relatives thus generally starts during the teenage years. Carcinoma of the colon is exceedingly rare in children with FAP. While all adult patients should be surgically treated before the appearance of any carcinoma, early detection of dysplasia is paramount. The present case history relates to an 8-year-old boy with FAP who was found to have a significant degree of dysplasia in a polyp. This case remains the exception and a uniform approach to the screening and treatment of patients with FAP is still encouraged.

Adenomatous Polyposis Coli↗
PubMed1986

Twenty year experience with familial polyposis coli in Cape Town.

Forty-nine patients undergoing surgery for familial polyposis coli (FPC) over a twenty year period are presented. Forty-three patients underwent total colectomy with ileorectal anastomosis (TC + IRA) and five patients subsequently developed a rectal carcinoma. The incidence of rectal carcinoma following TC + IRA appears to increase with time. There were significant postoperative complications secondary to adhesive obstruction and desmoid tumour recurrence. Upper gastrointestinal pathology has been detected by endoscopy in only one of nine patients, but the importance of upper gastrointestinal pathology is now appreciated. The problem of screening a widely distributed and closely knit community has been considerable. TC + IRA remains the operation of choice for the majority of patients with FPC, but a total colectomy with ileal reservoir and ileo-anal anastomosis is appropriate in some cases.

Adolescent↗
PubMed1986

Raising a colostomy--results of a prospective surgical audit.

A prospective surgical audit of all colostomies fashioned over a 1-year period in one hospital was conducted. Of one hundred and ten colostomies there were 56 loop and 52 end stomas. Following the formation of the colostomy a proforma was completed and the surgeon interviewed to document the precise surgical technique employed. Whilst in hospital the patients were regularly reviewed and the colostomies assessed by a surgeon and stomatherapist using a scoring system. Follow up was continued until closure of the colostomy or for a minimum period of 1 year. Only 53 (48%) of patients saw a stomatherapist preoperatively. This rate was higher in elective (86%) than in urgent cases (15%). The surgial technique used did not appear to influence the outcome of any given colostomy. However, failure to cruciate the posterior rectus sheath may predispose to stomal stenosis and the use of a subcutaneous polyethylene rod to support a loop colostomy often led to infection. Tension of the colostomy led to complications in 29 cases (26%), this was often the precipitating event to other complications and led to the only colostomy-related death. Registrars with experience of fewer than 5 colostomies received their training largely from other registrars rather than consultants. This prospective surgical audit has disclosed that fashioning a colostomy carries significant stoma related morbidity, most of which is potentially avoidable. Appropriate audit can contribute to the maintenance and improvement of surgical standards.

Colostomy↗
PubMed1986

The nutritional consequences and neoplastic potential of juvenile polyposis coli.

Case reports of three teenage patients with nonfamilial diffuse juvenile polyposis are presented to illustrate the considerable morbidity and significant growth retardation that may occur. Although generally considered to have no malignant potential, histologic findings revealed features ranging from adenomatous change to severe dysplasia. It is suggested that a conservative approach may not always be appropriate in this condition.

Adolescent↗
PubMed1985

Sigmoid exclusion: a new technique in the management of radiation-induced fistula.

Colovesical and colovaginal fistulas following irradiation for pelvic malignancy represent a formidable surgical problem. Although complex surgical procedures to close the fistulas and restore continence have been described, often a defunctioning colostomy with an associated urinary conduit is the only feasible option. Three patients who have successfully undergone an original procedure (sigmoid exclusion) are presented. Sigmoid exclusion restores continence but avoids a permanent stoma. The involved sigmoid colon was isolated on its mesentery ensuring that the area incorporating the fistulas was not disrupted. The ends of the isolated sigmoid colon were closed and bowel continuity then restored by a colorectal or colo-anal anastomosis. Following closure of a temporary colostomy the patients were continent with no ill effects or sepsis from the excluded colon. This procedure has the dual advantage of restoring continence yet avoiding both an urinary conduit and a permanent colostomy, and represents a useful advance in the surgical management of radiation induced colonic fistulas.

Adult↗
PubMed1985

Adult Hirschsprung's disease: results of the Duhamel procedure.

Hirschsprung's disease is a rare condition in the adult. The case reports of 39 patients managed by the Duhamel procedure were reviewed. One-third of the patients underwent at least one abdominal surgical procedure before the correct diagnosis was made. The operative mortality of the Duhamel procedure was zero. In 29 patients no defunctioning procedure was used to protect the anastomosis. The incidence of anastomotic dehiscence was 13 per cent. Thirty-six of the thirty-nine patients have excellent functional results.

Adolescent↗
PubMed1985

Primary suture of the perineal wound using constant suction and irrigation, following rectal excision for inflammatory bowel disease.

Thirty-four consecutive patients with inflammatory bowel disease underwent proctectomy with primary closure of the perineal wound. Throughout this period neither preoperative perineal sepsis nor intraoperative soiling was a contraindication to primary closure. An overall primary healing rate of 82% was obtained. It appears that the commonest cause of perineal wound breakdown is the inability of the suction catheter to drain all the serous fluid from the perineal space, resulting in discharge from the suture line and wound breakdown.

Adolescent↗
PubMed1984

Early detection of colorectal cancer using faecal occult blood tests.

Five thousand and twelve asymptomatic patients over the age of 40 years who were on a normal diet were asked by their general practitioners to perform a Hemoccult (Röhn Pharma (Noristan] faecal occult blood test over 3 days. Of the 3 422 patients (68%) who completed the test, 99 (3%) had a positive result. The patients with a positive result then again performed the Hemoccult test, this time over 6 days on a restricted diet. Thirty-two of these patients had a positive result on the second test. Only the 32 patients who had a positive result for the second test were fully investigated (including double-contrast barium enema and colonoscopy); 27 patients (84%) were found to have neoplastic disease. Twelve had invasive carcinoma (9 Dukes' A, 2 Dukes' B and 1 Dukes' C), 6 of these also having 10 adenomas, while the other 15 had 27 adenomas which were identified and removed at colonoscopy. Barium enema missed 3 carcinomas (all Dukes' A) and identified only 16 (43%) of the 37 adenomas. Those patients found to have a negative result for the second Hemoccult test are being followed up.

Adenocarcinoma↗
PubMed1984

Carcinoma of the colon and rectum in patients under 30 years of age.

A 15-year study of large-bowel carcinoma at Groote Schuur Hospital revealed 47 patients who presented at the age of 29 years or younger. Only 1% of the White patients with large-bowel carcinoma were in this age group (similar to other Western series), whereas a much higher incidence was seen in Coloured patients (9%). We found a large number of young Coloured patients with high-grade tumours and lymph node invasion. In spite of surgery, chemotherapy and radiotherapy the prognosis for this group in particular remains extremely poor.

Adolescent↗
PubMed1984

Abdominoperineal resection of the rectum for carcinoma at Groote Schuur Hospital, Cape Town, 1971-1982.

Abdominoperineal excision of the rectum remains the accepted treatment for the majority of lower rectal adenocarcinomas. Despite advances in surgery and anaesthesia, survival has not improved over the last 40 years. Over a 12-year period the overall 5-year survival rate for patients undergoing abdominoperineal excision for adenocarcinoma of the rectum at Groote Schuur Hospital, Cape Town, was 39%. The incidence of complications associated with the operation remains high (36%). The major causes of morbidity still originate in the urinary tract and the perineal wound. Further techniques which may improve the overall survival are briefly reviewed.

Adenocarcinoma↗
PubMed1984

Faecal occult blood testing in the detection of colorectal cancer.

5012 asymptomatic patients over the age of 40 years were asked by their general practitioners to perform a Hemoccult faecal blood test over 3 days. 3422 patients on a normal diet completed the test (a compliance rate of 67 per cent). Ninety-nine patients (3 per cent) had a positive result. Those patients with a positive result then underwent a second Hemoccult test over 6 days on a restricted diet. Thirty-two patients had a positive result on repeat testing (1 per cent). Only those patients who were positive on the second testing were fully investigated (including double contrast barium enema and colonoscopy). Twenty-seven patients on investigation were found to have neoplastic disease (84 per cent). Twelve had invasive carcinomas (nine Dukes' A, two Dukes' B, one Dukes' C) and thirty-seven adenomas were identified and removed at colonoscopy (barium enema missed three carcinomas--all dukes' A and only identified sixteen of the thirty-seven adenomas, 43 per cent). Those patients found to be negative after the second Hemoccult test are being followed up.

Adenocarcinoma↗
PubMed1983

Central venous catheterization for parenteral nutrition. Experience at Groote Schuur Hospital.

The aim of this study was to determine the incidence of complications of catheterization for total parenteral nutrition (TPN) in patients of the Parenteral Nutrition Unit of Groote Schuur Hospital. During the 2-year study period, 218 central venous catheters were inserted in 170 patients. The preferred technique of percutaneous infraclavicular subclavian venepuncture with subsequent subcutaneous tunnelling using a silicone elastomere catheter is described. The incidence of major complications of catheter insertion was 4,5% (pneumothorax 4, subclavian artery puncture 6). There was a 2,7% incidence of catheter malpositioning (requiring repositioning) at initial insertion. The mean duration of catheterization was 12,9 days. During this period there was a 6,9% incidence of mechanical complications (occluded lines 13, extravascular infusion 2). Catheter-related sepsis was suspected in 37 cases (16,9%) and all these catheters were removed, but in only 7 cases (3,2%) was the sepsis proved to be catheter-related. There was no correlation between the duration of catheterization and the development of catheter-related sepsis. Furthermore, there was no increase in the incidence of catheter sepsis in patients with sepsis before catheterization.

Catheterization↗
PubMed1982

Radical restorative surgery for poorly differentiated carcinoma of the mid-rectum.

A retrospective study was made to compare the results of restorative surgery with those of total rectal excision in the treatment of patients with a poorly differentiated adenocarcinoma of the middle third of the rectum (between 8 and 12 cm from the anal verge). Of 1163 patients presenting between 1963 and 1975, 42 with poorly differentiated tumours at this level were followed up after treatment by a radical (i.e. curative) operation. Twenty-eight underwent total rectal excision and 14 anterior resection. Examination of the preoperative biopsy correctly established the histological grade in 17 (40 per cent) of 42 cases. Pathological examination of the resected specimens showed a slightly higher proportion of Dukes' C2 tumours and those with venous invasion removed by total rectal excision, but the extent of local spread among tumours removed by either operation was similar. There was no operative mortality. Ten out of 28 patients treated by total rectal excision (36 per cent) and 6 out of 14 treated by anterior resection (43 per cent) were alive at 5 years. One patient developed a histologically proved local recurrence after anterior resection; no other proved local recurrence was recorded. It would appear, therefore, that where radical surgery is possible, anterior resection offers as good a prospect of cure as total rectal excision for poorly differentiated tumours of the mid-rectum.

Adenocarcinoma↗
PubMed1981

The management of anal carcinoma.

In a 20-year survey of anal carcinoma at Groote Schuur Hospital 55 cases were studied retrospectively. Patients of mixed race with anal margin carcinoma had a median age 29 years below that of Whites with anal margin carcinoma. Patients in these two groups with anal canal carcinoma had the same median age. Anal margin tumours were smaller than anal canal tumours at presentation and had a substantially better 5-year survival rate. The approach to treatment of these conditions is outlined.

Adult↗