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Biomedical subjects

T E Bucknall

Publications and source records attributed to T E Bucknall.

At least 19 recordsLinked to original sources
PubMed2003

Cutaneous ectopic breast calcification in a haemodialysis patient.

This case report details the unique breast calcification and swellings of a 61-year-old lady. The ectopic breast calcification was a result of chronic renal failure and hyperparathyroidism secondary to vesiculo-ureteric reflux nephropathy. Subcutaneous nodules were also noted around her ileostomy (from surgery due to Crohn's disease) and abdominal wall. Mammogram revealed calcified breast discs and lobules with extensive vascular calcification. Histological biopsies revealed extensive calcium deposition (benign). Cutaneous deposition of calcium oxalate has been described in 13 patients world wide, usually involving fingers, ears, or nose. Two of these report breast involvement, but this is described as less extensive and more focal calcification on clinical findings and mammography. This case report describes a rare condition with extraordinary mammographic images.

Breast↗
PubMed1998

Modern trends in breast cancer therapy: towards less lymphoedema?

AIMS: To review from the evidence, with special reference to axillary node management, whether the incidence of lymphoedema following breast cancer treatment is falling in modern breast practice. CONCLUSIONS: The incidence of lymphoedema does seem to be reducing with modern approaches to breast cancer management. Axillary treatment seems to determine its development but more studies looking specifically at this problem are needed.

Arm↗
PubMed1998

Argon beam coagulation as an adjunct in breast-conserving surgery.

The development of a haematoma after wide excision of breast tumours is not uncommon. Suction drainage is commonly used to prevent this but often increases the hospital stay and can create unsightly wounds. Argon beam coagulation is a new technique which permits large 'raw' areas to be coagulated with minimal tissue damage. We believe that this technique may reduce the development of haematomas and seromas after breast surgery. We present our initial results using argon beam coagulation after wide excision of breast tumours in 80 patients without suction drainage. One patient required a single aspiration of a seroma at the site of breast lump excision and none required surgical drainage. Argon beam coagulation appears a useful adjunct in breast surgery and may help reduce hospital stay.

Adult↗
PubMed1989

A clinical trial of tissue adhesive (histoacryl) in skin closure of groin wounds.

The use of tissue adhesives has been widely studied since the 1960s. Since then they have found use in specialties like plastic surgery, neurosurgery, ENT surgery and dental surgery. Several papers have reported their safe use, both clinically and experimentally, particularly of the newer homologue n-butyl/2-cyanoacrylate (Histoacryl). In this study 43 patients (46 wounds) whose operations involved a groin incision were randomised into two groups for skin closure either with Dexon subcuticular suture (23 wounds) or Histoacryl glue (23 wounds). We found that both sets of wounds healed well with no wound infections or excessive inflammation when assessed at one week and four weeks. However the glued wounds had consistently better cosmesis scores (mean score 4.71 at four weeks) compared to the subcuticular Dexon wounds (mean score 4.00 at four weeks) and P value of less than 0.05. We feel that there is a place for tissue adhesives in skin closure for some general surgical wounds.

Adolescent↗
PubMed1987

Removal of skin staples in an emergency.

We have highlighted this problem as there are situations where skin staples have to be removed rapidly, for example where bleeding and subsequent respiratory distress develop following neck surgery. A survey of junior hospital staff showed that many doctors had never removed skin staples nor were aware how best to remove them in the event of an emergency. Using skin simulation we compared the time to remove sutures and staples, and found it takes 55% longer to remove skin staples. Where the standard staple remover is not immediately available, an artery forceps, correctly applied, is just as quick.

Dermatologic Surgical Procedures↗
PubMed1985

Transurethral resection of the prostate and bladder neck incision: a review of 700 cases.

Transurethral resection (TUR) is regarded as the treatment of choice for relief of outflow tract obstruction in the male, but bladder neck incision (BNI) is an acceptable alternative when the gland is small. Seven hundred cases of TUR/BNI have been reviewed (TUR = 388; BNI = 312). BNI was performed when the gland was less than 35 g and where there was no clinical suspicion of malignancy. The operative details of our single incision technique are given. While the patients in the BNI group were younger, catheter stay was shorter, there was less infection, a significantly reduced need for blood transfusion and a satisfactory outcome in terms of control and need for further surgery. BNI is a technically simpler procedure than TUR and is easy to teach and learn. Results show it is safe and effective for patients in acute retention as well as those treated electively and it is the operation of choice for small benign prostates.

Adult↗
PubMed1985

Wound healing in abdominal operations.

For the practicing surgeon as yet there is no ideal suture and no perfect antibacterial substance. Therefore, the technique of wound and suture handling is extremely important. Gentleness is the key, and the surgeon should think in terms of what is happening to the cells in the area of repair. Gentleness will result in less dead tissue, fewer unwanted adhesions, less subsequent infection and, therefore, improved healing.

Abdomen↗
PubMed1984

Assessment of sutures for use in colonic surgery: an experimental study.

Following injury, normal colon takes approximately 30 days to regain full breaking strength. This healing period can be lengthened by local infection. Colonic anastomoses are likely to be contaminated by intraluminal organisms, and suture material in such a situation is known to potentiate the development of sepsis. Experiments were designed to evaluate six suture materials used in colonic surgery to determine which retained adequate tensile strength and which excited least inflammatory response. The results indicate that absorbable sutures, with the exception of polydioxanone, lose strength too rapidly for use alone. Braided materials, notably silk, produce a prolonged tissue response and harbour bacteria. Monofilament materials are unreactive and appear least likely to delay healing. Polydioxanone, which is monofilament and absorbable, is recommended for use in the colon.

Animals↗
PubMed1983

The choice of a suture to close abdominal incisions.

Burst abdomen, incisional hernia and sinus formation continue to bedevil the surgeon. Significant associated factors include postoperative wound infection and the suture material used. A series of experiments was therefore designed to test suture materials for their use in infected abdominal would closure. The nearest to the ideal, is a monofilament nonabsorbable suture (monofilament nylon). It has a low infectivity, resulted in satisfactory would tissue strength when used in infected wounds, and retained its strength. Infected, braided sutures of silk, nylon and polyglycolic acid even after 70 days were seen to contain bacteria and polymorphonuclear cells when examined electron microscopically. Absorption of silk and polyglycolic acid and encapsulation of non-absorbable braided nylon was delayed by the presence of infection. Monofilament nylon, in contrast, was unaffected, a fibrous capsule having formed by 10 days even in the infected state.

Abdominal Muscles↗
PubMed1983

Factors influencing wound complications: a clinical and experimental study.

Burst abdomen, incisional herniation, sinus formation and post-operative wound infection continue to bedevil the surgeon. A prospective study of 1129 laparotomy wounds defined the extent of the problem; 1.7% incidence of dehiscence, 7.4% herniation and 6.7% sinus formation, all significantly associated with wound infection. Mass closure reduced the dehiscence rate from 3.8% to 0.76%. Infection reduced wound strength in a rat laparotomy model due to a decrease in fibroblast concentration and activity. A monofilament non-absorbable suture was shown experimentally to be the most suitable suture for closing infected abdominal wounds. Electron microscopy demonstrated bacteria in the interstices of infected multifilament sutures. A randomised clinical trial comparing polyglycolic acid and monofilament nylon in the closure of abdominal wounds confirmed the experimental findings; polyglycolic acid resulted in a significantly higher wound failure rate with no decrease in sinus formation. A mass closure technique using monofilament nylon is recommended for laparatomy closure and efforts should continue to reduce wound sepsis.

Animals↗
PubMed1982

Burst abdomen and incisional hernia: a prospective study of 1129 major laparotomies.

Burst abdomen and incisional herniation are continuing problems for the general surgeon. A prospective study was carried out to define the extent of the problem. Over five years from 1975 to 1980 a total of 1129 major laparotomy wounds in adults were assessed at regular intervals for 12 months after operation. There were 19 burst abdomens (1.7%) and 84 incisional hernias (7.4%). The introduction of the mass-closure technique reduced the incidence of burst abdomen from over 3% in 1975 to 0.95% in 1979. It did not, however, improve the rate for incisional hernias, which was 7.6% in 1979. Many factors are associated with incisional herniation: old age, male sex, obesity, bowel surgery, type of suture, chest infection, abdominal distension, and, most important, wound infection. More work is needed to find the ideal method of wound closure, and efforts should be made to eliminate wound infection.

Female↗
PubMed1981

Abdominal wound closure: choice of suture.

Experiments were designed to test suture materials for their use in potentially infected abdominal wound closure. The nearest to the ideal, at present available, is a monofilament nonabsorbable suture, the one tested being monofilament nylon. The suture retained adequate strength in the infected and noninfected state over a 70-day period. This is particularly important as infection has been shown to result in low wound strength in the early phases of healing. The monofilamentous nature of this suture represented an advantage when sutures were examined electronmicroscopically. Infected, braided sutures viewed for the first time by electronmicroscopy were shown to contain bacteria and polymorphonuclear cells, even after 70 days implantation. The normal absorption and encapsulation of these sutures was delayed by the presence of infection. Polyglycolic acid had marked strength when new but rapidly weakened after implantation. This together with slowed absorption in the infected state is a disturbing feature in terms of wound failure and sinus formation respectively.

Abdomen↗
PubMed1981

Abdominal wound closure--a comparison of monofilament nylon and polyglycolic acid.

The incidence of burst abdomen, incisional herniation, and sinus formation after a vertical abdominal incision was studied in a prospective randomized trial that compared two suture materials--monofilament nylon and polyglycolic acid. Laparotomy wounds were closed with a continuous mass suture technique. Of the 210 patients studied, 15 died between 10 days and 6 months postoperatively with their wounds intact. The remaining patients were followed up for 6 months or longer. The two groups were well matched for known risk factors. The 104 patients in the polyglycolic acid group had a 12.5% wound failure rate (1 burst abdomen and 12 hernias), but the 106 patients in the nylon group had only a 4.7% wound failure rate (1 burst abdomen and 4 hernias) (P = 0.04). There was a significant association between the rate of infection and sinus formation, but there was no difference between the incidence of these complications between the two groups. Closure of abdominal wounds with absorbable sutures does not appear to be justified, and we suggest that nylon and the mass closure technique be used for all abdominal wound closures. Other etiologic factors significantly associated with wound failure include male sex and postoperative chest complications. However, infection remains the most significant postoperative complication because the incidence of incisional hernias and sinus formation would be reduced by the elimination of wound sepsis.

Adolescent↗