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Biomedical subjects

S P Huddy

Publications and source records attributed to S P Huddy.

16 recordsLinked to original sources
PubMed2001

A prospective study of genito-urinary dysfunction after surgery for colorectal cancer.

OBJECTIVE: To establish the incidence of impotence and urinary dysfunction after different forms of pelvic and colorectal surgery. PATIENTS AND METHODS: Over a period of one year, 78 consecutive patients, mean age 66.8 years (range 43-91 years), underwent surgery for colorectal cancer. Genito-urinary function was studied by clinical assessment and a postoperative questionnaire. RESULTS: Pre-operatively all males except one claimed to be potent. Of the 56 patients who had operations on the sigmoid colon and rectum, 12 (21.4%) developed urinary dysfunction; 6 (5 males, 1 female) had increased frequency while 6 (4 females, 2 males) had stress incontinence. Four (12.9%) of the 31 male patients became impotent. Of the control 22 patients who had had operations on the ascending colon, one female developed stress incontinence and none of the male patients developed impotence. CONCLUSION: Although the introduction of autonomic nerve sparing techniques and total mesorectal excision (TME) may have lowered the incidence of genito-urinary dysfunction after rectal surgery, there remains a degree of morbidity compared to procedures where the rectum is not mobilized.

Journal Article↗
PubMed1996

Self-administered disposable micro-enemas before outpatient sigmoidoscopy.

Many colorectal carcinomas can be diagnosed by rigid sigmoidoscopy. One important limiting factor in the usefulness of this investigation is the presence of faeces; another is inability to negotiate the recto-sigmoid bend. 101 patients (47 men) were sent a Microlax enema with instruction to use it before their first attendance in the outpatient department. The grade of preparation [on a scale of 0 (empty rectum) to 3, with grades 0 and 1 providing an adequate view], height achieved with the sigmoidoscope and whether or not the extent of the examination was limited by faeces were recorded. These data were compared with results in 78 patients (38 men) who did not receive any special preparation. There were no serious difficulties with self-administration. An adequate view was obtained in 89 (88%) of those who had received an enema and in 41 (53%) of those who were unprepared (P < 0.001, chi 2 test). The height achieved and the percentage of patients in whom the sigmoidoscopy was not limited by faeces were also significantly increased. The mailing of micro-enemas to patients who are likely to need sigmoidoscopy is a cheap measure that increases diagnostic yield and saves reattendances.

Ambulatory Care↗
PubMed1993

Lymph node metastases in early rectal cancer.

Local excision of early rectal tumours is an attractive proposition, avoiding the morbidity and mortality of major resection and possible permanent stoma. This study was designed to investigate the incidence of lymph node metastases associated with tumours that are locally confined to the bowel wall. A total of 454 rectal excision specimens were reviewed. Twenty-two (20 per cent) of 109 patients with tumours locally confined to the bowel wall had metastases in local lymph nodes, although 14 of these had only one or two involved nodes. Three of 27 patients with tumours that did not penetrate through the submucosa had lymph node metastases. Less well differentiated tumours were more likely to have metastasized but there was no significant difference in the height or size of tumours or in the depth of invasion between patients with or without lymph node metastases.

Humans↗
PubMed1993

Bupivacaine infiltration after haemorrhoidectomy.

The effect of a locally infiltrated solution of bupivacaine was studied in 30 patients undergoing haemorrhoidectomy. A standard Milligan-Morgan haemorrhoidectomy, with preoperative infiltration of adrenaline solution (1:200,000), was performed. The patients were randomized to receive local four quadrant perianal infiltration of 20 ml of 0.5% bupivacaine or normal saline. Analgesia was available on demand postoperatively. There was no significant difference between the groups with respect to visual analogue pain scores, analgesic requirement, time to first bowel action or duration of hospital stay. Bupivacaine as a local infiltration in this situation does not confer analgesic effect into the postoperative period.

Adult↗
PubMed1991

Gastrointestinal complications in 4473 patients who underwent cardiopulmonary bypass surgery.

Thirty-nine gastrointestinal complications occurred in 35 of 4473 patients (0.78 per cent) who underwent surgery involving cardiopulmonary bypass during an 8-year period. The mortality rate when one of these complications occurred was 22 (63 per cent) representing 11.5 per cent of the 191 deaths from all causes in the series. The relative risk of developing a gastrointestinal complication was 1:249 when the heart was not opened, 1:66 when it was and 1:5 after cardiac transplantation. Gastrointestinal bleeding (n = 20) was the most common complication of whom nine (45 per cent) died, followed by intestinal infarction (n = 12) with eight (67 per cent) deaths and acute pancreatitis (n = 6) all of whom died. There was one death after surgery for gastrointestinal bleeding (n = 7). No patient survived bowel infarction without operation but resection was possible in five of the eight who underwent surgery, four of whom survived. The results demonstrate that surgical intervention is not associated with undue mortality but inappropriate conservative therapy is poorly tolerated in this high-risk group.

Acute Kidney Injury↗
PubMed1991

Investigation and diagnosis of hypertrophic pyloric stenosis.

Forty-nine infants who underwent investigation or surgery for hypertrophic pyloric stenosis (HPS) over a 30-month period were reviewed. Significant weight loss was present in 18 infants, of whom 16 had HPS. A test feed was performed in 46 infants with 1 of 27 false positive and 6 of 29 false negatives. An ultrasound examination was performed in 34 infants with 4 of 23 false positives and 1 of 11 false negatives. It is recommended that if the test feed is positive then surgery should be performed, otherwise an ultrasound examination can be used as a screening test but a positive result should be confirmed by other means before surgery.

False Negative Reactions↗
PubMed1990

Small bowel complications of metastatic lung carcinoma.

A case of small bowel perforation and a case of small bowel obstruction as a result of metastatic lung carcinoma are presented. The surgical management of each is discussed. The patient who presented with small bowel perforation died in the immediate post-operative period, while the patient who presented with small bowel obstruction is alive and well six months later. Patients with primary lung carcinoma who present with an acute abdomen should be treated by standard surgical principles irrespective of their primary pathology.

Aged↗
PubMed1990

Preparation of the bowel before elective surgery using a polyethylene glycol solution at home and in hospital compared with conventional preparation using magnesium sulphate.

Bowel preparation by conventional methods is time-consuming and unpleasant for both patient and staff. In addition, it requires admission to hospital several days before surgery. Preparation using oral polyethylene glycol solution is more acceptable and can easily be adapted so that the patient can perform the procedure at home before admission to hospital. In a prospective series we have compared the efficacy of preparation at home using polyethylene glycol with similar preparation in hospital and with a standard bowel preparation based on magnesium sulphate. Preparation was better after polyethylene glycol and this was significant when performed at home (P less than 0.01). There was no effect on either electrolytes or haematological parameters, but polyethylene glycol did result in a rise in the number of colonic Streptococcus faecalis seen. This rise was not seen with magnesium sulphate (P less than 0.001).

Administration, Oral↗
PubMed1989

Is intravenous cholangiography an alternative to the routine per-operative cholangiogram?

Ultrasonography, although an accurate method of detecting stones within the gall bladder, is unreliable for the detection of bile duct stones for which per-operative cholangiography remains the standard investigation. Fifty seven patients undergoing elective cholecystectomy had both a pre-operative intravenous cholangiogram and per-operative cholangiography. The pre-operative investigation is shown to be at least as effective in the detection of common bile duct stones and only missed a duct stone in one patient. The substitution of pre-operative intravenous cholangiography for routine per-operative cholangiography would result in a significant reduction in operating time, may provide advance knowledge on the biliary anatomy and would allow advance planning of the likely procedure. It is suggested that pre-operative intravenous cholangiography, carried out on the day of admission, should be considered as a preferred alternative investigation to per-operative cholangiography.

Adult↗
PubMed1988

Prevention of acute gastric erosions in the rat by novel semi-synthetic amphipathic analogues of pepstatin.

Pepstatin is a potent aspartyl proteinase inhibitor which is virtually insoluble in physiological media. Five semi-synthetic amphipathic analogues of pepstatin, prepared by N terminal substitution of native pepstatin with hydrophilic oligopeptides, have been assessed for their ability to protect the mucosa in two animal models of acute gastric erosions. Concentrations of approximately 90 pmol/mg were achieved in the rat gastric mucosa after oral administration of a 20 mmol solution. These levels are theoretically adequate to inhibit all pepsin like proteinase activity (including zymogens). Each pepstatin analogue was tested by intragastric administration in a controlled hypotension/luminal acid animal model of acute gastric erosions in a group of six animals. All the inhibitors tested produced marked mucosal protection, as measured by a mucosal damage index, compared with control animals (control mean 241, range 100-420; Pepstatinyl-Gly-Orn-Orn-Cys (10 mmol) mean 3, range 0-8, p less than 0.01; Pepstatinyl-Gly-Cysteic acid-Cysteic acid (10 mmol) mean 5, range 0-21, p less than 0.01; Pepstatinyl-Gly-Lys-Lys (10 mmol) mean 18, range 0-60, p less than 0.01; Pepstatinyl-Gly-Cysteic acid-Cysteic acid (1 mmol) mean 24, range 0-86, p less than 0.01; Pepstatinyl-Gly-Orn-Orn-Cys (1 mmol) mean 57, range 0-116, p less than 0.01; Pepstatinyl-Gly-Asp-Asp (1 mg/ml suspension) mean 68, range 19-126, p less than 0.01; Pepstatinyl-Arg-OMe (1 mmol) mean 93, range 4-142, p less than 0.05, Pepstatinyl-Gly-Lys-Lys (1 mmol) mean 157, range 70-286, NS). In a platelet activating factor/20% luminal ethanol model of erosions the pepstatin analogues again provided mucosal protection although this only reached statistical significance for one of three compounds tested.

Animals↗
PubMed1988

The surgical treatment of intestinal obstruction due to left sided carcinoma of the colon.

Forty two consecutive patients who underwent surgery for an obstructing carcinoma of the left colon over a 5 year period were studied retrospectively. Twelve patients underwent an initial defunctioning procedure with no hospital deaths but with four deaths after a mean follow-up of 25 months. Of the 30 patients who had a primary tumour resection, 7 died during the first hospital admission and a further 4 during a mean follow-up period of 23.7 months. The hospital mortality following primary resection was related to the site and timing of the anastomosis. During the first hospital admission 3 of 5 patients died after colocolic anastomosis, 3 of 10 died following ileocolic anastomosis, but only 1 of 15 died in those who did not have a primary anastomosis performed. The mean hospital stay of patients undergoing a delayed resection was 41 (s.e. (mean) 2.8) days compared to 24 (s.e. (mean) 2.8) days in those undergoing a primary resection. Primary tumour resection with a delayed anastomosis is recommended on the basis of these findings.

Adult↗
PubMedDate not supplied

Management of solitary iliac aneurysms.

Eleven patients with isolated iliac artery aneurysms, presenting over a 10 year period, have been reviewed. Ten patients underwent surgery, of whom 3 had ruptured their aneurysms. Four patients had a solitary aneurysm, while the remaining 6 had 14 aneurysms between them. There was no operative mortality but 2 patients died of late vascular complications (after 4 and 12 months), 1 after proximal ligation only of an internal iliac artery aneurysm, and 1 after proximal and distal ligation and bypass of the common/external iliac artery for an aneurysm involving both the common and internal iliac arteries. Five patients had internal iliac artery aneurysms, and in 4 of these distal control was not achieved. Four patients died from unrelated disease (after 2-6 years). Safe control of internal iliac artery aneurysms cannot be achieved without distal internal iliac control.

Aged↗