Biomedical subjects

S Tew

Publications and source records attributed to S Tew.

7 recordsLinked to original sources

PubMed2001

Differences in repair responses between immature and mature cartilage.

Cartilage has a poor reparative capacity although it is unclear as to what extent this may be dependent on age or maturation. In the current study, the cellular responses of chondrocytes to experimental wounding in vitro using embryonic, immature, and mature cartilage have been compared. In all cases, the response was consistent (a combination of cell death that included apoptosis and proliferation). The speed of response varied in terms of cell death with embryonic cartilage showing the most rapid response and mature cartilage showing the slowest response. Intrinsic repair as assessed by the ability to heal the lesion was not detected in any of the culture systems used. It was concluded that the poor repair potential of cartilage is not maturation dependent in the systems studied.

Animals↗

PubMed2000

Belching and bloating: facts and fantasy after antireflux surgery.

BACKGROUND: Fundoplication is commonly complicated by belching difficulty and abdominal bloating. Postoperative belching ability, however, is difficult to assess; subjective patient reporting is often used but may be unreliable. Manometric measurement of the gastro-oesophageal 'common cavity' is an objective marker of gastro-oesophageal gas reflux. METHODS: Twenty patients who had undergone Nissen fundoplication and 11 healthy controls underwent oesophageal manometry at rest and during gastric distension for 10 min with 750 ml of gas. RESULTS: Half of the patients reported an inability to belch; the other half reported varying degrees of belching difficulty, most of whom were rarely able to relieve bloating by belching. During gastric distension, none of the patients had transient lower oesophageal sphincter relaxation, while the controls had a median of 1 (range 0-1). Patients had fewer common cavities than controls; however, none of the belch urges experienced during gastric distension in patients was associated with a common cavity, compared with 48 per cent in controls. CONCLUSION: After fundoplication, patients do not belch as a result of gastro-oesophageal gas reflux; rather it may be due to oesophagopharyngeal reflux of swallowed air. Subjective reporting of belching ability is inaccurate and manometric measurement of common cavities provides a better means of assessment.

Adult↗

PubMed1997

The illness behavior of patients with gastroesophageal reflux disease with and without endoscopic esophagitis.

The aim of this study was to determine if patients who experience heartburn but have no objective evidence of gastroesophageal reflux disease are responding appropriately to their symptoms. One hundred and forty patients who had been referred for investigations of heartburn (75 males, 65 females, mean age 48 years) answered an Illness Behavior Questionnaire. All patients underwent pH monitoring tests, and endoscopy results were obtained for 119 patients. There was objective evidence of reflux disease on endoscopy or pH monitoring in 105 patients and no objective evidence of reflux in 35 patients. Sixty-six patients were endoscopy-'positive' while 53 patients were endoscopy-'negative'. The Illness Behavior Questionnaires for the four groups were analysed for seven scales of illness behavior and these were compared with reference populations. Patients with heartburn but no objective reflux were similar to those with heartburn and objective reflux on all scales of the Illness Behavior Questionnaire. The reflux group without endoscopic esophagitis also responded to their symptoms in the same way as those with endoscopic esophagitis. It is concluded that a patient's perception of symptoms in gastroesophageal reflux is probably not related to the degree of esophageal mucosal damage.

Adolescent↗

PubMed1997

A prospective study of the effect of fundoplication on primary and secondary peristalsis in the esophagus.

We studied 13 patients before and after Nissen fundoplication and compared them with 11 healthy volunteers and 12 other patients with dysphagia after fundoplication. Esophageal manometry was performed to assess primary and secondary peristalsis induced by esophageal distention with air and water boluses. In patients with reflux disease, secondary peristalsis was initiated at a median rate of 60% of distending episodes, propagation of the secondary peristaltic wave occurred in 40% and lower oesophageal sphincter relaxation occurred with 70% of secondary peristaltic waves. Fundoplication did not alter the initiation or propagation rate of secondary peristalsis but it decreased the median lower esophageal sphincter relaxation rate to 45% (P < 0.03). Fundoplication was not associated with a change in the amplitude of primary peristaltic waves even in patients complaining of dysphagia. In post-fundoplication patients, successful secondary peristaltic waves had significantly lower (P < 0.005) proximal and distal amplitude than primary peristaltic waves. We conclude that there is no improvement in primary or secondary peristalsis after fundoplication and dysphagia after fundoplication is not due to altered peristalsis.

Adult↗

PubMed1997

Fine-needle aspiration biopsy of parotid lesions: comparison with frozen section.

BACKGROUND: Opinions vary as to the necessity for fine-needle aspiration biopsy (FNAB) in parotid tumours. The present study reflects the experience gained over a 12-year period and shows the accuracy of a diagnostic FNAB, and improved results with experience. METHODS: Between 1983 and 1995, 201 parotid lesions were excised by one surgeon(AGP) and a prospective database was established. Fine-needle aspiration biopsy was performed prior to surgery in 195 lesions and frozen section was performed in 159 lesions. RESULTS: The FNAB was diagnostic in 129 (66%) specimens and its sensitivity for malignancy was 90% and specificity was 100% (excluding non-diagnostic FNAB, where there was insufficient cellular material for reliable diagnosis or where specific tissue diagnosis could not be given). The positive predictive value was 100% and the negative predictive value was 98%. Of interest, the positive predictive value of diagnostic FNAB for pleomorphic adenomas was 99%. A specific tumour diagnosis could not be made on the FNAB sample in 37 specimens; 11 of these lesions were histologically confirmed as malignant after excision. Frozen section was diagnostic in 144 specimens (91%). Its sensitivity for malignancy was 96% and specificity was 99%. The positive predictive value was 96% and negative predictive value 99%. A specific tumour diagnosis could not be made on frozen section in 15 specimens including six cases in which malignancy was finally reported. The positive predictive value of diagnostic frozen section for pleomorphic adenomas was 99%. CONCLUSIONS: A diagnostic FNAB is an accurate and useful tool in the management of parotid lesions. An FNAB diagnosis of pleomorphic adenoma obviates the need for frozen section. The performance of FNAB in parotid tumours does not in any way preclude the necessity of surgical removal of such lesions except in exceptional circumstances.

Adolescent↗

PubMed1995

Papillary thyroid carcinoma arising in thyroglossal duct cysts: incidence and management.

The incidence and pathological features of papillary thyroid carcinoma arising in the thyroglossal duct cysts were reviewed and compared with papillary thyroid carcinoma arising elsewhere in the thyroid gland. In the 30 year period 1964 to 1993 there were 90 thyroglossal duct nodules or cysts treated surgically at the Endocrine Surgical Unit, Royal North Shore Hospital, Sydney, Australia. There were four cases of papillary thyroid carcinoma in this group (4.4%). In the same period 2814 cases presented with clinical single thyroid nodules which were treated surgically. There were 182 cancers in this group of which 121 were papillary thyroid carcinomas (4.3% of total cases). This is identical to the incidence seen in the thyroglossal duct. We conclude that the incidence of papillary thyroid carcinoma arising in the thyroglossal duct is no different to that arising elsewhere in the gland. The difference in number of carcinomas related only to the volume of follicular thyroid tissue present in the gland proper. That being the case, there is no reason to treat these cancers differently from papillary thyroid carcinoma elsewhere in the gland.

Adult↗

PubMed1994

Reoperation after failed antireflux surgery.

Between 1978 and 1992, 61 patients were operated on for new or recurrent problems after antireflux surgery. Indications for reoperation were recurrent reflux in 50 patients (associated with dysphagia in 14), dysphagia alone in six and postprandial pain in five. At reoperation the cause of the problem was apparent as anatomical breakdown of the repair in 19 patients, gastric pull-through (slipped Nissen procedure) in 14 and paraoesophageal hernia in six. In 18 patients the cause of the symptoms was not readily apparent. Reoperation consisted of fundoplication alone in 27 patients, fundoplication with pyloroplasty in eight, fundoplication with proximal gastric vagotomy in four, a Collis-Nissen procedure in 11 (four also had pyloroplasty), a Roux-en-Y procedure in four, total gastrectomy in one and reduction of a paraoesophageal hernia in six. Of the 20 patients with some form of destruction of the gastric outlet six experienced troublesome dumping symptoms and in two this was severe. Two patients died from cardiac causes after surgery. Of the remaining 59 patients, 51 rated the procedure as successful. Repeat antireflux procedures can give results almost as good as those of primary antireflux surgery. However, pyloroplasty and gastric resection should be avoided if at all possible.

Adult↗