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Biomedical subjects

Peter E M Butler

Publications and source records attributed to Peter E M Butler.

At least 19 recordsLinked to original sources
PubMed2006

Cases of chemical assault worldwide: a literature review.

We reviewed 24 studies of chemical burns by means of assault in the last 40 years. We describe 771 cases of chemical assault in total. Jamaica had the largest absolute number of cases. Bangladesh had the highest reported incidence. Male victims were more common, with the exception of Bangladesh and Taiwan. The youngest cohort was from Bangladesh. The role of gender, agents used and legislation were discussed. We identified two broad motives; increases in violent crime and use as a crime of passion in disputes between men and women.

Adult↗
PubMed2006

Forehead flap method for total nasal reconstruction.

One of the very first recorded methods developed over the ages to correct the mutilating deformity of rhinectomy was the forehead flap. While many other techniques have also been devised, this surgical method has stood the test of time better than any other. Further refined during the 20th century, it has now become the gold standard for obtaining the best results in nasal reconstruction. We present an illustrative case of a young man who was assaulted outside a night club and who suffered a clean separation of the nasal pyramid from the facial plane. We highlight the novel use of osseous, as opposed to cartilaginous, reconstruction of the upper lateral cartilages, which has not previously been reported in the literature.

Adult↗
PubMed2006

Smoking and wound healing problems in reduction mammaplasty: is the introduction of urine nicotine testing justified?

We sought to prove a significant relationship between cigarette smoking and wound healing problems in reduction mammaplasty patients, to show the effect of stopping smoking before the procedure, and to justify the implementation of urine nicotine testing preoperatively. One hundred and seventy-three consecutive patients aged 16 to 67 years underwent bilateral reduction mammaplasty in our institution over 26 months. Patients were advised to stop smoking at least 4 weeks prior to surgery. Records were reviewed and smoking habits reconfirmed via telephone. Wound problems were registered when intervention was necessary. Smokers made up 38.5% of the cases. Wound healing problems showed statistical significance (P < 0.05) between smokers (55.4%) and nonsmokers (33.7%). More than 75% of smokers admitted denying smoking within 4 weeks of surgery. Trend analysis revealed a significant association of wound healing problems for those who stopped longer than 4 weeks (33.3%), those who stopped less than 4 weeks (52.6%), and those who persisted until the operation (67.7%). Smoking increased wound healing problems after bilateral reduction mammaplasty. The introduction of compulsory urine nicotine testing at the preadmission clinic and prior to the operation will provide objective verification of patients' smoking history, minimize morbidity, and enable healthcare cost savings.

Adolescent↗
PubMed2006

Informed consent for facial transplantation.

Now that partial face transplantation has been performed, attention is focused on likely functional, aesthetic and immunological outcomes, and full facial transplantation is the likely next step. Facial transplantation has been the source of ethical debate, a key part of which focuses on valid informed consent. We review the process of informed consent in health settings, assessing how applicable the current standards are for facial transplantation. The factors which need to be assessed during the screening programme are outlined. We conclude that both individual and process factors are important in obtaining consent for radical new procedures, and outline our own gold standard for ensuring informed consent in facial transplantation.

Consent Forms↗
PubMed2006

Variations in clinical audit collection: a survey of plastic surgery units across the British Isles.

INTRODUCTION: Clinical audit is a requirement of good medical and surgical practice and is central to the UK Government's plans to modernise the NHS. MATERIALS AND METHODS: A survey was conducted to assess clinical audit data collection and collation within plastic surgery departments across the UK. The survey identified a variety of different data collection and collation methods, with extensive differences between plastic surgery departments. Those responsible for data collection and its funding were also identified by the survey. RESULTS: Results were obtained from 45 plastic surgery departments. Of the 45 departments surveyed, 12 collect data prospectively, whereas 26 units collect data retrospectively. The remaining departments collect data using a combination of methods. Of the units surveyed, 28 collect data on paper-based systems, with only 13 units using electronic applications. The personnel responsible for data collection were identified as being junior doctors. Departments collecting data prospectively do so from a greater number of sources than those collecting data retrospectively. CONCLUSIONS: This survey has focused on plastic surgery. The authors believe that similar results would be obtained from a survey of other surgical specialties. A huge variation in all parameters relating to the collection and collation of clinical audit data is seen. There are few standards within this specialty for data collection. Much work must be done in order to reach targets set by the UK Government.

Data Collection↗
PubMed2005

Human melanomas express functional P2 X(7) receptors.

Adenosine 5'-triphosphate is known to function as a potent extracellular messenger, producing its effects via a distinct family of cell surface receptors. Different receptor subtypes have been shown to modulate different cellular functions such as proliferation, differentiation and apoptosis. We have investigated the functional expression and apoptotic action of the P2 X (7) receptor in human malignant melanoma tissue and cells. Incubation of cells with the potent P2 X (7) receptor agonist 2'-3'-O-(4-benzoyl-benzoyl) adenosine 5'-triphosphate leads to a decrease in cell number, which is dose-dependent and reversible by the antagonist 1-N,O-bis-[5-isoquinoline-sulfonyl]-N-methyl-L-tyrosyl)-4-phenyl-piperazine. Synthesis of the P2 X(7) receptor by these cells has been established by reverse transcriptase-polymerase chain reaction, immunohistochemistry, immunocytochemistry and cellular accumulation of the fluorescent DNA-binding dye YO-PRO-1. The P2 X(7) receptors have been shown to mediate apoptotic actions of extracellular nucleotides and represent a novel target for melanoma therapy.

1-(5-Isoquinolinesulfonyl)-2-Methylpiperazine↗
PubMed2005

How do we assess microsurgical skill?

How does one demonstrate competence in microsurgery? This will become an increasingly more important question as further reforms in surgical training and revalidation are implemented. Any assessment of competence should include an assessment of technical skill, but there is presently no validated objective assessment technique to do this. We examine the ideal characteristics of an assessment technique and review the methods currently being validated and which could be applicable to microsurgical skills.

Clinical Competence↗
PubMed2005

Training in microsurgical skills: Does course-based learning deliver?

Practical skill training courses are an increasingly popular method of teaching surgical skills. Few data are available from instructional courses indicating how successful they are at imparting practical skills to those individuals who attend them. We aimed to identify the skill benefits gained by trainee surgeons attending a 5-day microsurgical skills course. A global scoring system was devised to objectively assess the level of skill employed by trainees to complete an arterial microvascular anastamosis. Vessel patency, anastamotic construct, and care of tissue in the surrounding operative field were taken into account. Postoperative tissue viability and physiological vessel function following anastamosis were also investigated. The majority of surgeons (60%) exhibited an increase in their level of microsurgical skill during the course. The remaining candidates remained static or deteriorated. Attendance at this microsurgical training workshop resulted in an improvement in microsurgical skills in most trainees. In-course assessment by training courses would allow identification of individuals requiring further training or skill refinement.

Anastomosis, Surgical↗
PubMed2005

Artificial nerve conduits in peripheral-nerve repair.

Injuries to the nervous system are the result of mechanical, thermal, chemical or congenital pathologies and, if function is not restored, they lead to loss of muscle function, pain and impaired sensation. Current treatment modalities essentially coapt the two nerves ends together or place a nerve graft between the cut ends. However, clinical results have never been optimal, and therefore a quest for better options has taken place. In this review article we look at the synthetic and biomimetic options currently being tested as potential nerve grafts.

Animals↗
PubMed2005

Psychosexual function in women who have undergone reduction mammaplasty.

BACKGROUND: Reduction mammaplasty substantially alleviates physical and psychological symptoms of mammary hyperplasia, but the effect on psychosexual function has not been analyzed so far. The aim of this study was to assess the impact of this common procedure on both operative and psychosexual satisfaction. METHODS: All women who underwent reduction mammaplasty (n = 90) at the Royal Free and University College London Hospitals between 1997 and 2000 were sent a series of questionnaires on their psychosexual health and satisfaction with operative outcome and postoperative sexual function. RESULTS: Of the 80 women who responded (response rate, 89 percent), 76 percent were satisfied with their operative results. Postoperative sexual satisfaction was improved in 28 percent, worsened in 19 percent, and unchanged in 53 percent of patients. Nobody dissatisfied with surgical outcome reported improved sexual satisfaction. A strong correlation was found between these two main outcome measures and General Health and Female Sexual Function Index scores. Significant correlations were also noted for breast shape, sensation, and symmetry (p < 0.001) and change in nipple sensation (p < 0.01). In contrast, breast size and scars did not significantly affect patient operative and sexual satisfaction (p > 0.1). When compared with the satisfied group, women unhappy with surgical results were more likely to suffer from postoperative anxiety (58 versus 18 percent) and depression (42 versus 8 percent). CONCLUSIONS: This study confirms that operative outcome following breast reduction does correlate with postoperative psychosexual function, mental health, and some breast parameters. Now that the link is identified, a prospective analysis may clarify the precise relationship between the patient's preoperative psychological status and operative and psychosexual satisfaction.

Adult↗
PubMed2004

Composite tissue allotransplantation--a new era in plastic surgery?

Composite tissue allotransplantation (CTA) holds great potential for reconstructive surgery. The recent hand transplants have made this a clinical reality. However, concerns about CTA have divided the medical community. The current transplants require life-long immunosuppression, which could place the recipients at risk of serious complications. In addition despite potent immunosuppression, chronic rejection may still negate any early favourable results. This article will outline the clinical experience of CTA, the major problems of the technique and the potential solutions to these problems.

Graft Rejection↗