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Biomedical subjects

R P Waldron

Publications and source records attributed to R P Waldron.

18 recordsLinked to original sources
PubMed1994

The extent of vitamin K deficiency in patients with cholestatic jaundice: a preliminary communication.

Eleven patients with cholestatic jaundice had measurements of plasma vitamin K1 performed. Seven of these 11 (64%) had subnormal levels. The prothrombin time (PT) was prolonged in three of 15 patients with cholestasis (20%), the patient with the longest PT had the lowest vitamin K1 level. A single intramuscular (im) dose of 10 mg vitamin K1 lowered the PT in 9/15 patients (includes correcting the three prolonged PTs). The initial mean plasma vitamin K1 level rose 24 h later, to a mean plasma level which was 33 times the upper limit of the normal physiological range. These preliminary results suggest that a majority of patients presenting with cholestatic jaundice have low tissue reserves of vitamin K1, and that guidelines for vitamin K1 therapy in patients with cholestatic jaundice should be revised.

Adult↗
PubMed1993

Preventable perioperative mortality from colorectal cancer.

Of 271 patients with primary colorectal cancer, 70 (26%) had detectable hepatic metastases. A primary tumour resection was possible for 225 (83%) of patients overall. Of the 46 patients with non resectable tumours, 38 (82%) had hepatic metastases. 23 (33%) of the patients with Dukes' D tumours died perioperatively relative to 13 (6%) of those with localised tumours (p < .001). Seventeen (70%) of the twenty three patients with Dukes' D cancers who died perioperatively had locally advanced disease but were not obstructed and had neither a resection or a stoma performed. Perioperative mortality is unacceptably high in patients with hepatic metastases but may be reduced by more specialised investigation of patients with suspected advanced disease to assess the degree of local dissemination and liver seeding prior to considering laparotomy.

Aged↗
PubMed1993

Diagnostic pitfalls of fine needle aspiration cytology for breast disease.

We analysed 1500 consecutive fine needle aspiration cytology (FNAC) specimens to ascertain the reasons for diagnostic failure. Of 221 tumours proven malignant following open biopsy, 184 (83%) were correctly diagnosed on FNAC. Of 1082 aspirates classified 'benign', 787 (73%) underwent open biopsy and of these 33 (4%) were diagnosed malignant. All three cases of ductal carcinoma in-situ (DCIS) and eight of 16 lobular carcinomas in this study were missed using FNAC alone. Twelve of the 22 patients with invasive carcinoma not diagnosed on cytology had tumours measuring less than 1 cm diameter. Six of 1500 FNAC reports (0.4%) gave false positive diagnoses, five were classified as 'suspicious of malignancy; and one as 'frankly malignant'. The overall sensitivity was 84%, specificity 99% and positive predictive value 97%. Though these results confirm the value of FNAC as a rapid means of diagnosing most breast cancers, it it unreliable in patients with invasive carcinomas less than 1 cm in diameter and for the detection of lobular and in-situ carcinoma.

Biopsy, Needle↗
PubMed1991

Massive incisional hernia: abdominal wall replacement with Marlex mesh.

Marlex (polypropylene) mesh was used to replace the abdominal wall in massive incisional herniation in 50 patients. Seventeen unsuccessful attempts at primary repair had previously been made on nine patients. Patient follow-up ranged from 6 to 120 months (mean = 45 months). There was minor hernia recurrence in four (8 per cent) patients. In each instance it was due to partial detachment of the peripheral fixation of the patch. Complications were: wound infection, four (8 per cent); wound seroma, two (4 per cent); wound haematoma, one (2 per cent); and wound sinus, six (12 per cent). Complications did not necessitate removal of the patch in any case. Inadequate peripheral attachment of the patch has been the only cause of hernia recurrence and should be avoidable.

Adult↗
PubMed1991

Colorectal carcinoma over 30 years at one hospital: no evidence for a shift to the right.

Many recent reports in the North American literature have documented an increase in the ratio of proximal to distal colorectal cancers with an increase in right-sided lesions. In order to assess trends in the distribution of large bowel carcinoma at our hospital we reviewed the files of 1553 patients who presented with primary colorectal carcinoma over a 30-year period. Thirty-nine percent of patients were over 70 years old and 51% were in the 50-69 year age group. Seventy five percent of the carcinomas were left-sided, 22% right-sided and caecal carcinomas accounted for 18%. This distribution varied only slightly over the study period. Left-sided lesions were more common in males (55%: p less than 0.005), and right-sided lesions were more common in females (57%: p less than 0.005). Caecal carcinoma was more common in patients over 69 years old than in younger patients (p less than 0.001). In elderly females (greater than 69 years) 30% of colorectal carcinomas occurred in the caecum. These findings may have important implications for the investigation of patients with suspected colorectal disease or for screening programmes.

Adenocarcinoma↗
PubMed1991

Descending thoracic aorto-bifemoral bypass graft: a safe alternative in the high risk patients.

A fifty-nine year old male presented with disabling intermittent claudication. A Translumbar Aortogram was performed showing ".....total occlusion of the abdominal aorta just distal to the level of the renal arteries". As a direct result of this invasive radiological procedure, he subsequently developed acute pancreatitis and a pancreatic abscess necessitating open surgical drainage. Re-vascularisation of his aortic occlusion was deferred for fifteen months when a Descending Thoracic Aorta Bifemoral (DTAB) bypass was performed--thus avoiding the insertion of foreign, sterile, arterial prosthesis in a previously infect abdominal cavity.

Acute Disease↗
PubMed1988

Pathophysiological sequelae of hepatic artery ligation: an experimental study.

The effects of ligation of the proper hepatic artery were studied in 40 rats. The serum transaminase and bilirubin levels were elevated significantly at 24 h following surgery but had returned to normal by the 7th postoperative day. The serum albumin level was significantly reduced at 24 h and remained low for a further 2 weeks. There was no histological abnormality in the liver following hepatic artery ligation. It would appear that there is an early return to normal function following hepatic artery ligation.

Animals↗
PubMed1987

Clinical follow-up and treatment of locally recurrent colorectal cancer.

Following 630 potentially curative resections, three patients had reoperations for metachronous tumors and 36 for local recurrences. Twenty-four of the latter were identified at follow-up clinic, but 12 presented as emergencies with obstruction. At reoperation only five patients had obvious hepatic metastases. Further colon resections were performed in ten patients. Nine of the 36 survived more than 12 months and three are alive and well over five years after reoperation.

Colonic Neoplasms↗
PubMed1986

Emergency presentation and mortality from colorectal cancer in the elderly.

We have assessed the influence of age on the mode of presentation and perioperative mortality in 1033 patients with colorectal cancer. There were 522 patients (51 per cent) over 70 years (group I) and 511 patients (49 per cent) under 70 (group II). In group I, 301 patients (58 per cent) were admitted as emergencies compared with only 222 (43 per cent) in group II (P less than 0.001). Perioperative mortality was especially high in the elderly emergencies, 38 per cent, compared with 18 per cent for elective operations. Of the patients presenting as emergencies in either age group 66 per cent had localized "potentially curable' disease. The incidence of colorectal cancer is highest in the elderly. A larger number of these elderly patients present as emergencies and die from the consequences of complications of localized disease. Earlier diagnosis by pre-symptomatic screening is therefore especially desirable in these old patients.

Age Factors↗
PubMed1986

Mortality in patients with obstructing colorectal cancer.

Of 1,033 patients with colorectal carcinoma, 238 (23%) presented with obstruction. The majority of tumours (74%) were potentially curable (Dukes B/C) at presentation. Tumours situated at the splenic flexure, transverse or descending colon were most likely to obstruct. Perioperative mortality was high following either primary resection (31%) or fashioning of a defunctioning stoma alone (25%) but was twice as high (40%) in patients over 70 than those under 70 (20%). Cardiorespiratory complications accounted for 55% of this mortality, while fatal technical complications occurred in 19%. Sixty seven patients (28%) had two operations, 51 patients (21%) had three operations.

Aged↗