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Biomedical subjects

S W Gould

Publications and source records attributed to S W Gould.

At least 19 recordsLinked to original sources
PubMed2000

Surgical management of polypoid lesions of the gallbladder.

BACKGROUND: With improvements in ultrasonography more polypoid lesions of the gallbladder (PLGs) are being detected. The management of these is controversial. METHODS: The demographic, radiological and pathological data of 38 patients with ultrasonographically detected PLGs were reviewed. A Medline search for such lesions was performed and a review of the literature is presented. RESULTS: Thirty-four patients underwent cholecystectomy and four were advised against or declined operation. Of the 34 who had cholecystectomy, 11 had macroscopic and histopathologically proven PLGs. Of these, seven had cholesterol polyps, two had adenomas, one had a carcinoid tumour and one had an adenocarcinoma of the gallbladder. One patient had a histopathologically normal gallbladder. The remainder had chronic cholecystitis with or without gallstones. All of the patients with neoplastic lesions of the gallbladder had solitary polyps greater than 1.0 cm in diameter. CONCLUSION: A protocol for the management of ultrasonographically detected PLGs is proposed. In this protocol it is suggested that patients with a PLG should undergo surgery if they are symptomatic, or if the PLG is 1.0 cm or more in diameter.

Adult↗
PubMed2000

Upright dynamic MR defaecating proctography in an open configuration MR system.

We describe our experience evaluating an MR proctography technique using an open 0.5 T MR system. Evacuation of a gadolinium-containing rectal contrast agent was dynamically imaged in the upright position using a fast gradient echo sequence. Anatomical and functional abnormalities were documented. Results from 40 patients who underwent this technique are reported. The method is proposed as an alternative to conventional fluoroscopic proctography.

Adult↗
PubMed1999

Laparoscopic surgery in a 0.5-t interventional magnetic resonance unit.

BACKGROUND: Intraoperative imaging using magnetic resonance imaging (MRI) is now possible in interventional MR (IMR) units. Magnetic resonance imaging has potential advantages over other methods used to guide surgery. These advantages include visualization of structures deep to the two-dimensional endoscopic image and clarification of surgical anatomy. This study investigates the feasibility of laparoscopic surgery with intraoperative imaging within an IMR unit. METHODS: The procedures were performed in a 0. 5-T General Electric IMR scanner. Surgical ergonomics and intraoperative imaging were investigated by performing 10 laparoscopic cholecystectomies on porcine livers in a simulator using magnet-safe laparoscopic instruments and an ultrasonic scalpel for dissection. Intraoperative MR cholangiography (MRC) was performed using T2-weighted fast-spin-echo (FSE) and single-shot fast-spin-echo (ssFSE) techniques with maximal intensity projection (MIP) reconstruction. Two laparoscopic cholecystectomies then were performed on human patients with intraoperative MRC using similar techniques. RESULTS: The simulated procedures allowed the development of surgical techniques appropriate to this environment. Both FSE and ssFSE produced reasonable quality intraoperative images. Both patient procedures were performed without complication. The FSE imaging was of poor quality. However, ssFSE produced intraoperative images of the gallbladder with partial visualization of the extrahepatic biliary tree. CONCLUSIONS: Laparoscopic surgery in an IMR unit is technically possible. Currently, intraoperative MRC is difficult, and FSE imaging is very subject to movement artifact. However, the faster ssFSE, with further development, may be a useful technique for intraoperative imaging of the biliary tree during MR-guided surgery.

Adult↗
PubMed1999

Rigid videosigmoidoscopy vs conventional sigmoidoscopy. A randomized controlled study.

BACKGROUND: Not only is rigid sigmoidoscopy uncomfortable for patients, but visualisation of the rectosigmoid junction and sigmoid colon is successful in only 40-70% of examinations. A novel fine-bore rigid videosigmoidoscope is described and then compared with a rigid conventional sigmoidoscope for patient discomfort and length of insertion. METHOD: A total of 58 patients were examined with both sigmoidoscopes in a random order. Discomfort was scored on a visual analogue scale; length of insertion was scored by the surgeon. Patients were blinded to which sigmoidoscope was being used. The images from the video examination were transmitted in real time for a second opinion in a different hospital. RESULTS: The mean (SD) insertion distance of the videosigmoidoscope was 23.2 (5.9) cm, which was significantly further than with the conventional sigmoidosocpe 16.5 (3.8) cm (p < 0.01). The discomfort on a visual analogue score for the videosigmoidoscope was 3.0 (1.8), which was significantly less than for the conventional sigmoidoscope 5.5 (2.7) (p < 0.01). The five users of the equipment (four surgeons and one colorectal nurse practitioner) preferred the videosigmoidoscope for image quality and ease of examination. CONCLUSIONS: A thinner, longer, rigid videosigmoidoscope is a more effective means of looking at the proximal sigmoid colon. Despite being inserted further, it caused less discomfort than the conventional sigmoidoscope. High-quality video images can be recorded or transmitted for real-time teleconsultation.

Humans↗
PubMed1999

Sigmoidoscopy in a nurse-practitioner community clinic using telemedicine.

We evaluated the feasibility of remote endoscopy in a community setting. Realtime teleconsultation and telesigmoidoscopy were carried out by a nurse practitioner at a community clinic while a colorectal specialist was present at the main hospital. Rigid video-sigmoidoscopes were used and the images were transmitted via ISDN lines at 384 kbit/s. Over three months, 32 patients (mean age 35 years; 19 men and 13 women) with bleeding per rectum took part in the study. Evaluation was carried out using satisfaction questionnaires for the patients, the nurse practitioner and the clinicians. The mean grade for clarity of intraluminal views was 3.5 (1 poor, 4 excellent). Only two cases had views graded less than 3, due to the presence of excessive faecal residue. All the patients were satisfied with the teleconsultation and video-endoscopy and would return for a similar visit. User satisfaction was also high on the part of the nurse practitioner and the clinician.

Adult↗
PubMed1999

Surgical intervention in acute pancreatitis: indications, techniques and complications.

Acute pancreatitis is a disease with a significant morbidity and mortality. It has been reported as the principal diagnosis in 2% of hospital admissions with abdominal pain in the UK. The incidence is in the range of 200 to 300 cases per million population per year, but it is probably increasing. The overall mortality rate is 10 to 12%. The management of the disease and its complications requires close co-operation between surgeon, radiologist and gastroenterologist. There have been a number of improvements in the management of acute pancreatitis in the last decade.

Journal Article↗
PubMed1997

Perforated colonic carcinoma presenting as epididymo-orchitis and Fournier's gangrene.

Epididymo-orchitis is a relatively common diagnosis in elderly men, often related to prostatic outflow obstruction. A 70-year-old man presented with a 4-day history of swelling and pain in the scrotum, fevers, dysuria and frequency. He had severe symptoms of prostatic hypertrophy. Physical examination and urine microscopy confirmed the diagnosis of left epididymo-orchitis and antimicrobial therapy was commenced. Subsequently, however, he developed severe necrotizing fasciitis (Fournier's gangrene) of the scrotum requiring surgical debridement, and at laparotomy, a perforated carcinoma of the sigmoid colon was found at the level of the left deep inguinal ring. Despite further radical surgery the gangrene extended, his condition deteriorated and he died. There has been no other similar case reported in the literature, and thus, although rare, intra-peritoneal causes of infection should be considered in patients with Fournier's gangrene.

Aged↗
PubMed1997

Recurrent melanoma of the leg and polypoid lesions of the gallbladder--a management dilemma.

Isolated limb perfusion (ILP) is a well-tolerated method of regional chemotherapy for melanoma, with response rates ranging from 40-80%, used to treat recurrences or metastases confined to the limb from which the original tumour was excised. We present the case of a 75-year-old woman with a third recurrence of melanoma of the left leg, referred for ILP, in whom staging investigations revealed two probable malignant polypoid lesions of the gallbladder (PLG). These were thought likely to represent metastatic melanoma. In view of the diagnostic difficulty, she underwent laparoscopic cholecystectomy together with left superficial femoral ILP. Multiple papillary adenomatosis, with dysplasia ranging from mild to severe, and with areas of invasive adenocarcinoma, were found on gallbladder histology. No previous case of this combination of tumours has been reported. This case provides evidence of an adenoma-carcinoma sequence, and to our knowledge no previous case has been reported with both carcinoma and the full range of dysplasia from mild to severe within the same gallbladder. The use of minimally invasive surgery allowed the ILP to be performed at the same operation. The pathology, natural history and place of laparoscopic surgery in the management of PLG is discussed.

Adenocarcinoma↗
PubMed1997

The interventional magnetic resonance unit--the minimal access operating theatre of the future?

Interventional magnetic resonance units give the surgeon the potential to use intraoperative imaging to guide the surgical procedure. The advantages of magnetic resonance (MR) over other intraoperative imaging modalities include excellent soft tissue resolution, lack of ionizing radiation and the ability to reconstruct images in any desired plane. Postulated advantages include the ability to confirm adequate tumour resection, reduction in procedure magnitude and complication rate, shortened inpatient stay and the development of novel minimally invasive techniques including the use of thermal energy to destroy lesions. Fully MR compatible anaesthetic and patient monitoring equipment is available. However, before the MR-guided minimally invasive surgery can become a reality, much work is required in the assessment and development of MR compatible surgical instrumentation and equipment. This review describes the testing and development of instruments and equipment for MR image-guided surgery that we have undertaken. We describe the techniques we employ for open and minimal access surgery within this unique environment. The difficulties of operating within such an environment and the safety issues that this engenders are discussed. The current applications of intraoperative MR in the main surgical specialities are reviewed, and possible future areas of development for MR-guided minimally invasive surgery described.

Endoscopy↗