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Biomedical subjects

R G Wilson

Publications and source records attributed to R G Wilson.

At least 19 recordsLinked to original sources
PubMed1995

Role of intraoperative cholangiography in laparoscopic cholecystectomy.

The results of a policy of selective cholangiography were assessed in 400 patients undergoing laparoscopic cholecystectomy. Preoperative endoscopic retrograde cholangiopancreatography (ERCP) was performed in 81 patients (20 per cent) of whom 31 (38 per cent) showed definite or possible evidence of stones in the bile duct. Seventeen of the 400 patients underwent intraoperative cholangiography and the majority of these (12) were normal. After a minimum follow-up of 1 year, 17 patients (4 per cent) have had ERCP for suspected residual duct stones. Eight (2 per cent) of these revealed stones and all were successfully treated with sphincterotomy and duct clearance. Preoperative and postoperative ERCP was not associated with mortality or major morbidity. No major duct injury occurred and none was diagnosed within 2 years of operation. Routine intraoperative cholangiography is not a necessary part of laparoscopic cholecystectomy in the presence of an efficient and safe ERCP service.

Adolescent↗
PubMed1995

Island advancement flaps in the management of anal fissures.

The classic high-pressure fissure responds well to lateral internal sphincterotomy. The management of recurrent fissures and those that occur in patients with weak sphincters is open to debate. An island advancement flap technique used in 21 patients is described with the above criteria. Preoperative median resting anal pressure was 66 (range 43-90) cmH2O and median maximal squeeze pressure was 132 (range 76-193) cmH2O, values that were significantly lower than in controls and those with classic fissure. Endoanal ultrasonography in 15 of these patients showed defects in the anal sphincters. All flaps healed primarily with preservation of sensation. Perfect continence was maintained in all patients. Follow-up was for a median of 18 (range 2-28) months. There were no serious complications. All fissures healed with minimal postoperative discomfort. This procedure provides a useful alternative for symptomatic anal fissures, in which a sphincter-weakening procedure might jeopardize continence.

Adult↗
PubMed1995

Case study: practical tools for improving needs-based health management and technology assessment. The PHC MAP series.

This paper outlines the need for and development of a practical set of tools to improve needs-based health management and technology assessment. International reports have documented the lack of adequate information for the managerial process in primary health care. The components of the Primary Health Care Management Advancement Program (PHC MAP) Series, designed for both manual and computer applications, are described. The series has been widely pretested and is currently being implemented by many government health services and nongovernmental organizations worldwide. Information is included indicating how the PHC MAP materials may be obtained.

Administrative Personnel↗
PubMed1993

Symptomatic outcome after laparoscopic cholecystectomy.

To evaluate the symptomatic outcome after laparoscopic cholecystectomy, a standard symptom questionnaire was sent to three patient groups at least 1 year after surgery: 115 patients had undergone laparoscopic cholecystectomy; 200 had undergone open cholecystectomy; and 200 had had inguinal hernia repair. Return of questionnaires was higher after laparoscopic cholecystectomy (100 of 115; 87.0 per cent) than the open procedure (167 of 200; 83.5 per cent) or hernia repair (163 of 200; 81.5 per cent). There was no difference in the number of patients who considered the operation to have cured or improved their preoperative symptoms after laparoscopic cholecystectomy (94 of 100; 94.0 per cent), open cholecystectomy (157 of 167; 94.0 per cent) or hernia repair (154 of 163; 94.5 per cent). Similar numbers considered their operation to have been a success (94.0, 95.2 and 94.5 per cent respectively). The prevalence of abdominal pain, nausea, flatulence, food intolerance and heartburn was similar in all groups of patients following operation. Diarrhoea occurred more often following laparoscopic (6.0 per cent) and open (4.2 per cent) cholecystectomy than hernia repair (1.2 per cent). Patients who underwent laparoscopic cholecystectomy tended to have a higher incidence of nausea or vomiting than those undergoing the open procedure, and consumed significantly more antacids (23.0 versus 12.0 per cent, P < 0.02). Laparoscopic cholecystectomy achieved the same rate of patient satisfaction as open cholecystectomy, with no apparent symptomatic advantage.

Cholecystectomy, Laparoscopic↗
PubMed1993

Abdominal aortic aneurysm: still missing the message.

Over a 7-month period 50 patients presented to the vascular unit with a ruptured or acute symptomatic abdominal aortic aneurysm (AAA). Information regarding the 24 months before acute presentation was obtained from the patient, family doctor and relevant case records to determine whether an asymptomatic aneurysm had previously been diagnosed but the patient not referred to the vascular service, or whether the patient had undergone an examination at which an aneurysm might reasonably have been expected to be diagnosed. Thirteen patients (26 per cent) had previously had an AAA diagnosed but only five had been referred. Thirteen patients (26 per cent) had had a total of 16 inpatient hospital admissions without an asymptomatic aneurysm being diagnosed. Six patients (12 per cent) underwent abdominal examination for an unrelated complaint by the family doctor without an asymptomatic aneurysm being diagnosed. A significant impact on overall mortality from aortic aneurysm may be made by increasing the number of patients undergoing elective aneurysm repair. All doctors should assess aortic diameter in all patients over 50 years of age who undergo abdominal examination for whatever reason. All patients diagnosed as having an asymptomatic AAA should be referred to a vascular surgeon for assessment.

Acute Disease↗
PubMed1993

Laparoscopic cholecystectomy.

After laparoscopic cholecystectomy, the patient can expect a hospital stay of < 2 days and a return to work within 2 weeks. The associated operative mortality rate is low at < 0.2 per cent. The increased incidence of bile duct injury with the laparoscopic technique compared with open cholecystectomy is a cause for concern but such injuries should decrease with proper training in laparoscopic surgery. The use of operative cholangiography (whether routine, selective or never) is controversial but there is no evidence that routine cholangiography will prevent major bile duct injury.

Bile Ducts↗
PubMed1992

Laparoscopic cholecystectomy as a safe and effective treatment for severe acute cholecystitis.

OBJECTIVE: To evaluate the feasibility and safety of laparoscopic cholecystectomy in severe acute cholecystitis. DESIGN: Analysis of data collected prospectively from a consecutive series of 350 laparoscopic operations. SETTING: Two general surgical units in a teaching hospital. SUBJECTS: 31 patients with a diagnosis of severe acute cholecystitis based on clinical examination, investigation results, and operative findings. INTERVENTIONS: Initial intravenous fluids and broad spectrum antibiotics followed by laparoscopic cholecystectomy within 72 hours of presentation. MAIN OUTCOME MEASURES: Failure to complete the operation laparoscopically, length of postoperative stay in hospital, early postoperative morbidity, interval from operation to full activity, and return to work. RESULTS: Laparoscopic cholecystectomy was attempted in 19 patients with empyema of the gall bladder and 12 who had severe cholecystitis which failed to settle on medical management. A total of 29 operations were successfully completed with two conversions to open surgery. Two minor postoperative complications occurred, and one case of retained common bile duct stones with jaundice was treated by endoscopic retrograde cholangiopancreatography and papillotomy. Median postoperative hospital stay was two days, with return to normal activity in seven days and to work in two weeks. There were no deaths related to the operation. CONCLUSIONS: In the presence of severe acute cholecystitis laparoscopic cholecystectomy is feasible in most patients, with minimal risk of injury to surrounding structures and considerable benefits. It is recommended that laparoscopic cholecystectomy should be attempted in these patients when appropriate surgical skill is available.

Acute Disease↗
PubMed1992

Effect of the dietary fibre content of lifelong diet on colonic cellular proliferation in the rat.

The effect of the fibre content of lifelong (18 months) diets on proximal and distal colonic cellular proliferation and short chain fatty acid (SCFA) content was investigated in 40 rats. Rats were fed a low fibre diet (17 g/kg non-starch polysaccharides NSP) or the stock diet (133 g/kg NSP). The higher fibre fed rats had increased caecal and colonic total contents (p < 0.001) and SCFAs than the low fibre fed rats (caecal SCFAs: higher fibre rats 96.4 (6.8) mumol/g wet weight v low fibre 22.7 (3.0): p < 0.001, colonic SCFAs: higher fibre 52.3 (3.1) mumol/g wet weight v low fibre 6.9 (2.2) mumol/g wet weight: p < 0.001). Cellular proliferation was increased in the proximal colon (bromodeoxyuridine labelling index, higher fibre 9.3 v low fibre 8.4 p < 0.05; flow cytometry, % cells in S phase higher fibre diet 7.9 v low fibre 6.9; p < 0.01) and there was a shift of proliferating cells to a higher region in each crypt. There was no significant difference in the percentage of cells in S phase in the distal colon of rats in both diet groups. The proliferative zone, however, was expanded in the distal colon of the higher fibre diet fed rats. This study indicates that long term higher fibre intake in rats is associated with a modest increase in cellular proliferation in the proximal colon but not the distal colon.

Animals↗