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Biomedical subjects

N A Scott

Publications and source records attributed to N A Scott.

At least 19 recordsLinked to original sources
PubMed2006

Proximal loop jejunostomy is a useful adjunct in the management of multiple intestinal suture lines in the septic abdomen.

BACKGROUND: Bowel repair in the septic abdomen can be problematic. This study investigated the use of a proximal loop jejunostomy to protect injured or fistulated bowel that had been returned to the abdomen after repair and/or anastomosis. METHODS: Ten patients who underwent laparotomy for intra-abdominal sepsis and/or fistulation, followed by distal enteric repair and/or anastomosis and construction of a proximal defunctioning loop jejunostomy, were studied retrospectively. Seven patients had 21 intestinal suture lines returned to the peritoneal cavity in the presence of intra-abdominal sepsis (14 anastomoses, two enterotomy closures and five serotomy repairs). Two patients had a difficult relaparotomy for pelvic abscess (two distal anastomoses, one enterotomy closure and three serotomy repairs). The final patient had pelvic sepsis and radiation enteritis; the distal anastomosis was defunctioned by a loop jejunostomy. RESULTS: The median distance from the duodenojejunal flexure to the loop stoma was 80 (range 30-170) cm. All jejunostomies were closed via a local approach, a median of 11 (range 9-18) months after formation. There was no significant postoperative morbidity and no postoperative death. At a median follow-up of 7 (range 0.5-56) months eight patients had no requirement for nutritional support. CONCLUSION: Use of a loop jejunostomy to protect suture lines in the septic abdomen justifies consideration of this procedure in selected patients.

Abdomen↗
PubMed2006

Preoperative radiotherapy for operable rectal cancer--is a lower dose to a reduced volume acceptable?

AIMS: A retrospective audit was carried out to determine the rate of local recurrence (recurrent tumour within the lesser pelvis or the perineal wound) in 88 rectal cancer patients treated with 20 Gy/four fractions of adjuvant preoperative radiotherapy and curative surgery. MATERIALS AND METHODS: All patients were followed-up by clinical examination with rigid sigmoidoscopy at 6 monthly intervals if the rectum was intact, and computed tomography of the pelvis at 1, 2 and 5 years after surgery. In total, 171 patients with rectal cancer were identified under the care of one surgeon over a period of 11 years from May 1992 to April 2003. We excluded patients with rectal cancer from preoperative adjuvant radiotherapy if they had evidence at presentation of distant metastases, if they had fixed rectal tumours, were treated by local excision and had previous radiotherapy to the pelvis. On this basis, only 88 were considered for preoperative radiotherapy and curative resection with a median follow-up of 5.16 years. RESULTS: The 5-year survival by stage was Dukes A 96%, Dukes B 65% and Dukes C 36%. Overall, four patients (of 88) developed a recurrence within the lesser pelvis or the perineal wound, giving a local recurrence of 4.2% at 3 years (from a Kaplan-Meier graph). CONCLUSIONS: This single-centre audit suggests that a lower dose of radiotherapy to a smaller volume provides an acceptable local recurrence rate that compares very favourably with the well-publicised Swedish and Dutch trials of 25 Gy/five fractions. It was not the intention of this audit to suggest that this dose should be widely adopted. However, given the long-term gastrointestinal morbidity and risk of second malignancies, we advise caution when formulating even more intensive radiotherapy and chemoradiotherapy regimens for rectal cancer.

Adenocarcinoma↗
PubMed2005

Targets and elective colorectal cancer: outcome and symptom delay at surgical resection.

OBJECTIVE: To determine, for elective patients with colorectal cancer, if associations exist between the length of symptom history at surgical resection and Dukes stage, completeness of the surgical procedure and patient survival. PATIENTS AND METHODS: A prospective cohort study was undertaken. Five hundred and eighty-two patients with colorectal cancer, admitted for surgical resection after outpatient consultation, divided into four equal quartiles according to length of symptom history (short: n = 131, 0-103 days; medium: n = 136, 104-177 days; long: n = 136, 178-318 days; very long: n = 137, 319-1997 days). The main outcome measures used were the Extent of tumour (Dukes stage) at resection, completeness of resectional surgery (curative vs palliative), patient survival after resection. RESULTS: For patients undergoing elective surgical resection of colorectal cancer we did not find an association between Dukes stage and duration of patient history (Dukes stage C tumours were seen in 37% (CI: 26.2%-48.0%) of patients with a short symptomatic history as opposed to 34% (CI: 32%-62%) with a very long symptomatic history). Elective curative resection was not associated with a significantly different symptom duration than elective palliative resection (Palliative resections were performed in 24% (CI: 11.7%-36.4%) of patients with a short symptomatic history as opposed to 16% (CI: 2.4%-29.9%) with a very long symptomatic history). The median survival time for the four elective colorectal patient groups defined by length of symptomatic history was not significantly different - (short: n = 131, 4.3 years; medium: n = 136, 5.9 years; long: n = 136, 7.1 years; very long: n = 137, 5.0 years). CONCLUSION: Tumour extent, completeness of resection and patient outcome after elective colorectal cancer resection was not found to have an association with length of patient history at the time of surgery.

Chi-Square Distribution↗
PubMed2004

Fistuloclysis can successfully replace parenteral feeding in the nutritional support of patients with enterocutaneous fistula.

BACKGROUND: Use of total parenteral nutrition (TPN) in patients with acute intestinal failure due to enteric fistulation might be avoided if a simpler means of nutritional support was available. The aim of this study was to determine whether feeding via an intestinal fistula (fistuloclysis) would obviate the need for TPN. METHODS: Fistuloclysis was attempted in 12 patients with jejunocutaneous or ileocutaneous fistulas with mucocutaneous continuity. Feeding was achieved by inserting a gastrostomy feeding tube into the intestine distal to the fistula. Infusion of enteral feed was increased in a stepwise manner, without reinfusion of chyme, until predicted nutritional requirements could be met by a combination of fistuloclysis and regular diet, following which TPN was withdrawn. Energy requirements and nutritional status were assessed before starting fistuloclysis and at the time of reconstructive surgery. RESULTS: Fistuloclysis replaced TPN entirely in 11 of 12 patients. Nutritional status was maintained for a median of 155 (range 19-422) days until reconstructive surgery could be safely undertaken in nine patients. Two patients who did not undergo surgery remained nutritionally stable over at least 9 months. TPN had to be recommenced in one patient. There were no complications associated with fistuloclysis. CONCLUSION: Fistuloclysis appears to provide effective nutritional support in selected patients with enterocutaneous fistula.

Adult↗
PubMed2004

Systematic review of genetic influences on the prognosis of colorectal cancer.

BACKGROUND: In terms of genetics, colorectal cancer is one of the best understood of all malignant diseases. Genetic influences on prognosis may have far-reaching implications, especially for the design of surgical and chemoradiotherapeutic regimens. However, their significance in determining prognosis remains unclear. This study aimed to review the literature on the specific role of key genes in determining the survival of patients with colorectal cancer. METHODS: A Medline search was carried out to identify all original scientific papers relating colorectal cancer genetics to patient survival, up to December 2002. Cochrane and Embase databases were also searched. Identified articles were retrieved and searched carefully for additional information. This review includes K-ras, p53, DCC, NM23 and DNA mismatch repair genes. RESULTS AND CONCLUSION: Conflicting evidence exists as to the prognostic significance of genes commonly implicated in the pathogenesis of colorectal carcinoma. Possible causes for such discrepancy include differences in study methods and laboratory techniques, variable duration of follow-up, statistical differences in study power, and heterogeneity in study populations. Future studies should adopt standardized protocols to define clinically relevant genetic observations.

Base Pair Mismatch↗
PubMed2004

Anastomotic technique and survival after right hemicolectomy for colorectal cancer.

AIM: To compare the long-term outcome of patients after right hemicolectomy for colorectal cancer undergoing ileocolonic reconstruction either by a sutured technique or by side-to-side stapled anastomosis. METHODS: Single surgeon series from 1992 to 2001 comprising 100 consecutive patients, 59 with hand sutured reconstruction and 41 undergoing TLC 55mm stapled side-to-side anastomosis. Details of gender, patient age, and elective versus emergency presentation, Dukes stage, and curative versus palliative resection were recorded prospectively. In addition, post-operative hospital stay and subsequent survival were determined by prospective protocol follow-up. RESULTS: Overall 24% of the patients studied presented as emergencies and underwent a palliative procedure. There were no anastomotic leaks in either the stapled or sutured groups. Hospital mortality was also not significantly different--stapled reconstruction, 7%, sutured reconstruction, 10% (p value 0.624). Overall long-term cancer outcome was the same for both anastomotic techniques, both stapled and sutured groups having a median survival of 2.9 years. CONCLUSIONS: Stapled ileocolonic reconstruction after right hemicolectomy for colonic carcinoma is a safe and reliable surgical technique associated with long-term cancer outcomes comparable with those obtained by the sutured anastomotic technique.

Adenocarcinoma↗
PubMed2002

Monitoring land-use change effects on soil carbon in New Zealand: quantifying baseline soil carbon stocks.

We designed a soil carbon monitoring system for New Zealand using country-specific land use and soil carbon information. The system pre-stratifies the country by soil type, climate, and land use. Soils were placed in six IPCC soil categories; Podzols were added as they are widespread throughout New Zealand. Temperature was stratified into two categories, each spanning 7 degrees C. Moisture categories were based on water balance, and included five categories. Temperature and moisture stratification was based on the USDA Soil Classification system. Land use (10 categories) was based on 1980s survey data. Overall, 39 combinations of these three factors (cells) described 93% of the New Zealand landscape. Geo-referenced soil carbon data (carbon concentration and bulk density) were used to quantify average soil carbon for each of the 39 cells. Aggregating the polygons gave an estimated 1990 soil carbon baseline of 1152+/-44, 1439+/-73, and 1602+/-167 Mt C (mean+/-S.D.) for the 0-0.1, 0.1-0.3, and 0.3-1.0 m depth increments (not including forest floor carbon). The system described could also be used to quantify equilibrium changes in soil C associated with land-use change if land use is updated periodically.

Agriculture↗
PubMed2002

Systematic review of beating heart surgery with the Octopus Tissue Stabilizer.

The safety and efficacy of off-pump coronary artery bypass surgery with the aid of the Octopus Tissue Stabilizer (Octopus OPCAB), in comparison to conventional on-pump coronary artery bypass surgery (CPB-CABG), was examined by a systematic assessment of the peer-reviewed literature. The limited comparative data suggested that there was no difference in safety outcomes between Octopus OPCAB and CPB-CABG. The paucity of efficacy data reported in the higher level comparative studies meant that it was impossible to assess whether Octopus OPCAB was more efficacious than CPB-CABG. The evidence base for the procedure was deemed inadequate and an audit of the procedure was recommended.

Cardiopulmonary Bypass↗
PubMed2001

Perivascular inflammation after balloon angioplasty of porcine coronary arteries.

BACKGROUND: Inflammation has been suggested to play a role in vascular lesion formation after angioplasty. Whereas previous studies have focused on inflammatory reactions in the intima and media, less attention has been paid to adventitial and perivascular responses and their potential role in vascular remodeling. METHODS AND RESULTS: Balloon overstretch injury of porcine coronary arteries was performed with standard clinical angioplasty catheters. Vessels were examined from 0.5 hour to 14 days after injury by immunohistochemistry and in situ hybridization (ISH) for neutrophil and macrophage markers, cell adhesion molecules (P-selectin, E-selectin, and vascular cell adhesion molecule-1), and neutrophil-specific CXC chemokines (alveolar macrophage-derived neutrophil chemotactic factor [AMCF]-I/interleukin-8 and AMCF-II). Neutrophils accumulated in the adventitia surrounding the injury site from 2 hours to 3 days, followed by macrophages from 1 to 7 days after angioplasty. Inflammation was associated temporally with the expression of mRNAs encoding cell adhesion molecules and chemokines. The main inflammatory and proliferative foci were not limited to the adventitia but rather extended many millimeters away from the injured vessel throughout the surrounding adipose and myocardial tissues. CONCLUSIONS: Inflammatory responses after angioplasty of porcine coronary arteries occurred throughout the entire perivascular tissue. We hypothesize that perivascular inflammatory cells play a role in the recruitment and/or proliferation of adventitial myofibroblasts, possibly through the release of reactive oxygen species and/or cytokines, and thus contribute to vascular remodeling associated with postangioplasty restenosis.

Angioplasty, Balloon, Coronary↗
PubMed2001

Inhibition of vascular cell growth by X-ray irradiation: comparison with gamma radiation and mechanism of action.

PURPOSE: Catheter-based delivery of gamma and beta radiation effectively inhibits restenosis. Major disadvantages of these radioisotopes include continuous emission; excessive depth of penetration, creating safety hazards (gamma); and inadequate penetration, limiting effectiveness (beta). Low-voltage X-rays have a distinct potential advantage, because the source is active only when current is applied, and depth of penetration is voltage dependent. This study was performed to determine if low-voltage X-rays inhibit smooth muscle and adventitial cell growth in vitro and to determine the molecular mechanisms involved in this cellular response. METHODS AND RESULTS: Vascular cells in culture were exposed to low-voltage X-ray radiation and analyzed for their subsequent ability to proliferate. X-ray irradiation caused a dose-dependent inhibition in proliferation, similar to the effect seen with equivalent doses of gamma radiation. The radiation-induced inhibition of proliferation did not appear to be related to apoptosis, but rather to delayed progression through the cell cycle, because a 65% increase in the proportion of cells in S phase was seen 24-96 h after X-ray exposure compared to control. Expression of p53, a cell cycle transcriptional activator, and p21, a cell cycle inhibitor, were significantly elevated after exposure to low-voltage X-rays, providing a potential mechanism for this delay. CONCLUSIONS: Low-voltage X-rays can effectively inhibit proliferation of vascular smooth muscle and adventitial cells. This inhibition is apparently due to a delay in progression through the cell cycle, which is mediated by increases in the levels of cell cycle inhibitors.

Animals↗
PubMed2001

Mechanisms of intestinal failure in Crohn's disease.

PURPOSE: The purpose of this study was to determine the mechanisms by which patients with Crohn's disease develop intestinal failure and, in particular, to assess the relative importance of severe primary disease, repeated uncomplicated elective small intestine resection, and resection performed as a consequence of intra-abdominal septic surgical complications. METHODS: This was a retrospective analysis of 41 patients with Crohn's disease referred to a specialized intestinal failure unit between January 1987 and September 1998 for permanent home parenteral nutrition. To compare the surgical activity in patient groups, a resection index was calculated by dividing the number of intestinal resections by the interval in years between the first resection for Crohn's disease and referral for management of intestinal failure. RESULTS: Extensive primary Crohn's disease was responsible for intestinal failure in 7 cases (17 percent). The remainder (n = 34, 83 percent) developed intestinal failure after intestinal resection. Nine of the "surgical" Crohn's patients developed intestinal failure after uncomplicated sequential resection, (median small-bowel length 65 (range, 60-120) cm) after a median of 3 (range, 2-8) operations over a median of 17 (range, 3-27) years. By contrast, the other 25 surgical Crohn's patients developed intestinal failure after multiple unplanned laparotomies for intra-abdominal sepsis (median small-bowel length 70 (range, 60-200) cm), with a median of 4 (range, 2-7) laparotomies performed over a median of 0.5 (range, 0.1 to 1.5) years (P < 0.001). The resection index for the 25 Crohn's patients undergoing laparotomies for intra-abdominal sepsis was significantly greater than that of the 9 patients who had planned sequential resections (2.1 (0.27-25) vs. 0.23 (0.1-1.0); P < 0.002, Mann-Whitney U test). CONCLUSION: Intestinal failure develops in Crohn's disease primarily as a result of complications of surgical treatment. The largest group of patients at risk consists of those who are undergoing multiple unplanned laparotomies to control intra-abdominal sepsis.

Adult↗
PubMed2001

Patient quality of life after successful restorative proctocolectomy is normal.

OBJECTIVE: To measure quality of life (QoL), using validated health status instruments, of patients with functioning IPAA for CUC. PATIENTS AND METHODS: Between 1986 and 1997, a total of 77 patients had an IPAA. Thirteen patients were excluded [6 excised, 3 awaiting ileostomy closure, 2 lost to follow up, 2 serious unrelated illnesses]. Postal survey using SF36 and EuroQol questionnaires. Age, sex, year of pouch construction and stool frequency were documented. RESULTS: Fifty-six patients (87.5%) replied. Male:female ratio; 3:2. Median age; 34 years (range 13-64). Median time since pouch construction; 4 years (range 1-10 years). Median SF36 scores (range); physical function 86.6 (0-100), physical role 81.6 (0-100), body pain 78.4 (22-100), general health 61.6 (5-100), vitality 57.6 (5-100), social function 75.4 (25-100), emotional role 83.5 (0-100), mental health 70.7 (16-100). All the SF36 scores were within the normal range, as were the EuroQol scores. Median EuroQol score (range); 0.85 (-0.07-1.0). Median EuroQol thermometer score (range); 83.3 (20-100). There was no correlation between objective QoL score and age, gender, stool frequency and year of pouch construction. CONCLUSION: The QoL for patients with a functioning IPAA for CUC measured using validated health status instruments is normal. Age, gender, stool frequency and year of construction do not affect QoL outcome after the IPAA for ulcerative colitis.

Journal Article↗
PubMed2001

Colorectal patients and cardiac arrhythmias detected on the surgical high dependency unit.

INTRODUCTION: Surgical high dependency unit (SHDU) care is becoming an integral feature of colorectal surgical practice. Routine ECG monitoring is a feature of surgical care in this setting. The aim of this study was to determine the incidence and outcome of cardiac arrhythmias detected in an SHDU population of colorectal patients. PATIENTS AND METHODS: 226 patients over a 12 month period were admitted to a 6-bedded SHDU under the care of 3 colorectal surgeons. A total of 29 patients (13%) had significant arrhythmias on ECG monitoring (median age 74 years, range 35-88 years). Pre-existing ischaemic heart disease was present in 9 patients--colorectal cancer and inflammatory bowel disease accounted for the underlying problem in the majority of these patients. RESULTS: Equal numbers of supraventricular and ventricular arrhythmias were detected--atrial fibrillation being the most commonly detected abnormality. Therapeutic intervention (electrolyte correction and anti-arrhythmic agents) was required in 23 patients. One patient required DC shock for ventricular fibrillation. Seven patients were transferred to the heart care unit or intensive care unit to manage their cardiac problems. Two patients died as a result of their cardiac problem, 27 were discharged home alive--3 on long-term anti-arrhythmic therapy. CONCLUSIONS: The postoperative environment of colorectal patients has been radically altered by the introduction of the SHDU. If colorectal surgeons are to remain central to the postoperative care of their patients, all surgical staff will require training in the recognition and protocol prevention and management of cardiac arrhythmias. Certification of colorectal surgeons in advanced life support is more relevant to colorectal surgery than certification in trauma care.

Adult↗
PubMed2000

Repeated oestrus synchronisation of beef cows with progesterone implants and the effects of a gonadotrophin-releasing hormone agonist at implant insertion.

A group of 97 spring-calving beef cows were initially oestrus synchronised with controlled internal drug release (CIDR) intravaginal progesterone implants inserted for nine days and a prostaglandin injection on day 7. Approximately half the cows were given 10 microg buserelin when the implants were inserted, and they all received a single fixed-time artificial insemination (AI) 56 hours after the withdrawal of the implants. The overall pregnancy rate to the first synchronised AI was 55 per cent, the buserelin-treated cows having a pregnancy rate of 63 per cent compared with 47 per cent in the untreated cows (P>0.05). Sixteen days after the first synchronised AI all the cows were re-implanted with used CIDR implants which were removed five days later, and the cows received a second synchronised AI on days 23 to 24. Cows which received the second AI were implanted with new CIDR devices 16 days later and these were removed after five days and the non-pregnant cows received a third synchronised AI. The pregnancy rates to the second and third synchronised services were 74 per cent and 75 per cent, respectively.

Administration, Intravaginal↗
PubMed2000

The staged management of complex entero-urinary fistulae.

OBJECTIVE: To present the results of the staged management of complex entero-urinary fistulae. PATIENTS AND METHODS: Ten patients with complex entero-urinary fistulae were reviewed; all patients were referred to a national intestinal failure unit after failed treatment in other centres. Each patient was treated in three stages. The acute stage involved proximal defunctioning and distal drainage of both the gastrointestinal and urinary tracts to isolate the fistula, together with the eradication of sepsis. The recovery stage involved total parenteral nutrition, organ support, radiological planning of surgical reconstruction and intensive nursing. The reconstructive stage followed when the patient was stable, nutritionally replenished and intra-abdominal sepsis was controlled. Surgery was undertaken jointly by urological and gastrointestinal surgeons. RESULTS: The fistulae were treated successfully in all patients, with functional restoration in four, and/or diversion of the gastrointestinal and urological tracts in six. The mean (range) time to reconstruction was 5 (1-20) months. There were no postoperative deaths. CONCLUSION: A staged multidisciplinary approach with delayed reconstruction can achieve a successful outcome in the management of complex entero-urinary fistulae.

Adult↗