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Biomedical subjects

R T Holl-Allen

Publications and source records attributed to R T Holl-Allen.

At least 19 recordsLinked to original sources
PubMed1988

Follicular carcinoma of the thyroid following radioactive iodine treatment for Graves' disease.

A 67 year old man presented with a well differentiated follicular carcinoma of the thyroid 17 years after he had been given radioactive iodine for Graves' disease. As this was insufficient to cure him he had continued to take propylthiouracil regularly. The tumour, which had completely replaced the thyroid, was apparently maintaining thyrotoxicosis. The implications of this management are discussed and it is concluded that antithyroid drugs should not be given on a long term basis after therapeutic radioiodine has been administered.

Adenocarcinoma↗
PubMed1986

A new approach to the surgical management of paralysis of the laryngeal nerve after thyroidectomy.

Recurrent nerve palsy, immediate or delayed, or unilateral or bilateral, is a recognized complication of operations upon the thyroid gland and is not considered to be remediable as a presumed consequence of division of the nerve (or nerves). Removal of sutures and neurolysis of the nerve have met with variable success in restoration of function. In a prospective study over a period of 14 years, paralysis after thyroidectomy was assessed in 31 patients. Five had undergone previous operations upon the thyroid gland, four of these patients had known unilateral paralysis and 26 underwent operations which involved exploring the nerves. Immediate removal of the sutures was followed by complete recovery in four of the patients. Fifteen nerves of 13 patients with delayed paralysis were operated upon within six months of the original procedure; ligatures were removed in four patients, the nerve of one patient was sutured and the remaining underwent neurolysis. Some recovery of function within six months was seen in 13 nerves. Nine nerves were operated upon up to one year later, three divided nerves were sutured, one suture around a nerve was removed and five nerves were freed from fibrous tissue; recovery of function was seen in only two nerves. Of all the nerves which were sutured, slight mass movement of the corresponding vocal cord was seen in two. The results indicate that immediate paralysis after thyroidectomy should be investigated immediately, not only to excluded severance but also to relieve, if possible, physical involvement of the nerve by suture or ligature; the outcome of the operation is often beneficial. The benefits of neurolysis when the onset of paralysis is delayed due to fibrosis surrounding the nerve is also discussed; earlier intervention is associated with better results. Direct suture of the divided nerve is not recommended.

Female↗
PubMed1984

Can nocturnal emergency surgery be reduced?

A prospective study of emergency operations was performed over three months in a district general hospital. Before starting surgery surgeons completed a questionnaire recording clinical details together with time of admission and were asked to state whether in their opinion the case could be safely deferred until the next morning assuming operating time was available. Of 251 operations performed, forms were completed for 244. According to the surgeons, 62 could have been safely deferred, and subsequent independent analysis indicated a further 24 could also have been safely postponed, giving a total of 86 cases (35%). Of the remainder, 71 were started between 2300 and 0900, and of these 51 (71%) were major operations requiring an experienced surgeon. The results suggest that, although the volume of nocturnal major surgery could not be reduced, the introduction of a daily emergency theatre session for cases seen during the day and those which could be deferred from the previous night would appreciably reduce the overall workload of nocturnal surgery at present done by the resident junior staff. This study will have important implications if, as has been suggested, the number of junior medical staff on call at night for emergencies is reduced.

Emergencies↗
PubMed1984

Combined preoperative antibiotic therapy and intraoperative topical povidone-iodine. Reduction of wound sepsis following emergency appendectomy.

Single doses of clindamycin hydrochloride and gentamicin sulfate given preoperatively, combined with intraoperative topical application of povidone-iodine were given to patients with perforated or gangrenous appendicitis. The incidence of wound sepsis was reduced from 36% to 5%; severe infections were reduced from 25% to 0% when compared with a control untreated group of patients. When used alone, povidone-iodine had little effect in these patients. No toxic effects of the antibiotics or antiseptic were recorded nor were any resistant strains of pathogenic organisms grown from cultures.

Administration, Topical↗
PubMed1984

Porcine dermal collagen repair of incisional herniae.

Dermal collagen implants have been used to repair large incisional hernias in 11 patients (7 women, 4 men). The youngest was 37 years and the oldest 67, with a mean age of 49.9 years. Single-, or double-layered dermal collagen was used to bridge the defect, secured with interrupted 3/0 Prolene. Postoperatively, three patients required single aspiration of seromas and one, exploration of a sinus to remove a suture. There were no recurrences during a median follow-up period of 4.75 years. It is suggested that collagen implants are a good alternative to other methods of repair.

Adult↗
PubMed1984

Delayed spontaneous recanalization of the vas deferens.

Eight patients were identified who had undergone successful vasectomy a mean of 4.6 years previously and in whom all were microscopically shown to have recurrent motile spermatozoa in their ejaculate. All had been referred following a pregnancy in their wives, and all agreed to undergo repeat vasectomy. Histological examination of the excised portions revealed the presence of spermatozoa in the distal end of one side; but also the presence of a well formed sperm granuloma in continuity with both divided ends of the vas. There does not appear to be any correlation with the suture previously used, nor incidence of infections or injury. Although recanalization is a recognized complication of vasectomy, the majority have occurred within months of the operation. The association of the delayed recanalization with sperm granuloma formation in these cases suggests an aetiological link, it being previously reported that such granuloma can develop up to six years postoperatively.

Adult↗
PubMed1984

Duodenal ulcer perforation whilst on cimetidine therapy.

Nine cases of perforation whilst patients received cimetidine therapy were identified and followed prospectively. There was a high correlation with the other major complications of duodenal ulceration: pyloric stenosis and haemorrhage. Initially, three of the nine patients had simple suture of the perforation, but eventually all required truncal vagotomy and a drainage procedure. The follow-up ranges from 6 months to 2.5 years and the results in the surviving patients are good. The preoperative identification of this group, being established medical failures with the high probability of requiring necessary definitive surgery, will aid the surgical management of this condition.

Adult↗
PubMed1984

Intravital methylene blue staining of parathyroid glands and tumours.

Previous intravital staining techniques for parathyroid localisation have met with variable success and complications. Modification of these techniques, employing a more consistent dose, combined with a prolonged infusion time has provided more uniform staining of normal and abnormal parathyroid tissue, other tissues showing little or no colour change. Locally induced oedema, not previously described, was found to be a great asset in the dissection of glands. In 38 of 40 patients (95%), 4 glands were demonstrated and in the remaining 2 cases, only 3 glands appeared to be present. One case alone has required reoperation, due to the presence of a fifth gland. Intra-thyroid and intra-thymic tumours were found easily, as was glandular tissue split accidentally. Apart from slight nausea in one patient, there were no complications attributable to the dye, in the series which included 12 patients with chronic renal failure. Uniformly normal postoperative serum calcium levels indicated the accuracy of the method. The technique is safe, inexpensive and easily reproducible, and would seem to have many advantages over other methods of tumour localisation.

Humans↗