Laparoscopy for undescended testes: embryological considerations.
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Adult↗
Biomedical subjects
W A Brough
Publications and source records attributed to W A Brough.
Amyloid tumour of the colon.
A case of amyloid tumour of the colon and the first in association with a carcinoma is reported. A previously healthy 65 year old man presented with non-specific symptoms of lower abdominal pain and flatulence without rectal bleeding. A clinical diagnosis of diverticular disease was made and colonoscopy performed. Two lesions (one at 15 cm and the other at 30 cm from the anal margin) were found on endoscopy and removed. On histology, the lesion at 15 cm was a moderately differentiated adenocarcinoma and that at 30 cm contained amyloid. Further tests (standard tinctorial methods and immunohistochemistry) revealed the 30 cm lesion to be an amyloid tumour of the colon of AL (lambda) type. When biopsy of an atypical, large, solitary colorectal lesion reveals amyloid deposition, the possibility of an amyloid tumour should be considered and the lesion resected.
Adenoma, Villous↗
Teaching laparoscopic surgery: the need for guidelines.
There is a risk that minimally invasive surgery will fall into disrepute unless adequate steps are taken to reassure the public. Some form of accreditation after a recognised training scheme would go a long way towards allaying these fears. The cost of training surgeons must be addressed. Adequate training will probably pay dividends in reduced litigation. The royal colleges should be responsible for maintaining standards of teaching on recognised courses, setting criteria for accreditation, and supervising a national audit of all laparoscopic procedures.
Accreditation↗
Pancreaticojejunostomy for severe symptomatic chronic pancreatitis.
The role of operation, particularly pancreaticojejunostomy, in the treatment of abdominal pain from chronic pancreatitis is controversial, but relief of pancreatic duct obstruction may decrease the rate of pancreatic organ failure. Our results over 6 years in 13 carefully selected patients suggest that pancreatic drainage does relieve pain but is less effective in preventing pancreatic exocrine failure. Pain was the indication for operation in all patients.
Abdominal Pain↗
The value of the rectus abdominis myocutaneous flap in the treatment of complex perineal fistula.
Complex perineal fistula and persistent perineal sinus are difficult to treat. We describe our experience with wide excision of the diseased perineum using a combined abdominoperineal approach. Ten patients were reconstructed by a rectus abdominis myocutaneous flap (n = 7), rectus abdominis muscle flap (n = 2), and omental graft (n = 1). Primary healing was achieved in all cases. A median follow-up of 18 months (range 6-54 months) has shown no recurrence of perineal disease or associated abdominal incisional hernia. There were no perioperative deaths. We propose that the rectus abdominis myocutaneous flap is indicated if large amounts of perineal skin has to be sacrificed. When less skin is removed a repair with greater omentum or rectus muscle alone is adequate. The abdominoperineal approach together with filling the residual pelvic cavity with well-vascularized tissue allows definitive treatment to be carried out in one stage.
Abdominal Muscles↗
An improved technique of J pouch construction and ileoanal anastomosis.
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Anal Canal↗
Percutaneous extraction of retained common bile-duct stones via the T-tube track.
A total of 86 procedures were performed in 58 patients referred in the postoperative period, for percutaneous stone extraction through the T-tube track. In 43 patients, the stone or stones were extrahepatic, intrahepatic in nine, and both intrahepatic and extrahepatic in six patients. Of the 58 patients with residual bile-duct stone(s), 48 (83%) were treated successfully by percutaneous removal, seven (12%) had an endoscopic sphincterotomy following unsuccessful T-tube track extraction, one (2%) had a re-operation and two (3%) remain with residual stones. No major complications occurred in this series. In contrast to endoscopic sphincterotomy, percutaneous T-tube extraction of retained bile-duct stones is associated with no mortality and low morbidity and is advocated as the procedure of choice in the presence of a T-tube.
Adult↗
Percutaneous drainage of subphrenic biliary collections using a Ring-McLean sump catheter.
This communication reports three consecutive cases of subphrenic biliary collections, resulting from biliary procedures. All were successfully treated percutaneously using a 16 French Ring-McLean sump drainage catheter without the need for secondary surgical intervention. Although percutaneous drainage of fluid collections is now commonplace, this is the first reported use of this drainage catheter for subphrenic biliary collections.
Adult↗
The surgical factors influencing duodenogastric reflux.
The surgical factors influencing duodenogastric reflux have been assessed in dog and man using the biliary radiopharmaceutical 99mTc-EHIDA. Cholecystectomy led to a significant increase in the amount of reflux (P less than 0.01), but the combination of truncal vagotomy and pyloroplasty in addition to cholecystectomy produced a greater amount of reflux (P less than 0.01). In man, cholecystectomy also resulted in a significant increase in the amount of reflux (P less than 0.01). In ten control subjects reflux occurred but the amount was small and was not significantly different from the modified highly selective vagotomy group (n = 20). Symptomatic patients after truncal vagotomy and pyloroplasty (n = 16) showed a significant increase in the amount of reflux (P less than 0.002) but the combination of vagotomy and pyloroplasty in addition to cholecystectomy (n = 15) demonstrated the greatest amount of reflux (P less than 0.002). Similarly the addition of cholecystectomy to highly selective vagotomy (n = 9) showed a significant increase in the amount of reflux (P less than 0.02). Reconstruction of the pylorus (n = 8) was not a satisfactory procedure for the prevention of reflux but antrectomy and Roux-en-Y biliary diversion (n = 8) resulted in a significant reduction in the amount of reflux (P less than 0.001) and this was associated with clinical improvement.
Animals↗
The effect of cholecystectomy on duodenogastric reflux in dogs and humans.
A prospective study of the effect of cholecystectomy on duodenogastric reflux (DGR) in dogs and humans has been performed and compared with patients presenting with persisting symptoms following cholecystectomy several years earlier. After an intravenous injection of 99mTc EHIDA, assessment of DGR was made by measuring Bilirubin Output and the percentage of 99mTc EHIDA recovered in gastric juice over fifteen minute periods. Cholecystectomy resulted in a significant increase in both amount and frequency of DGR in dogs and patients. Patients with persisting symptoms following cholecystectomy showed the greatest amount and frequency of DGR. We suggest that increased DGR may be an aetiological factor in some patients with persisting symptoms following cholecystectomy.
Animals↗
The effect of cholecystectomy on duodenogastric reflux in patients with previous peptic ulcer surgery.
Duodenogastric reflux (DGR) has been assessed in healthy volunteers, patients after vagotomy and pyloroplasty, and in patients following vagotomy and pyloroplasty in addition to cholecystectomy. DGR has been assessed using bilirubin output and 99mTc EHIDA recovered in gastric juice. The control group demonstrated reflux but the quantity was small. Symptomatic patients after truncal vagotomy and pyloroplasty (V + P) showed a significant increase in DGR (P less than 0.002) when compared with the control group but the greatest reflux was seen in symptomatic patients following truncal vagotomy + pyloroplasty + cholecystectomy (P less than 0.002). AS with pyloric preservation showed no significant increase in reflux but the addition of cholecystectomy increased both frequency (P less than 0.001) and amount of reflux (P less than 0.001). We suggest that cholecystectomy when combined with a pylorus preserving or destroying procedure increases DGR and that such increased reflux may be an important factor in gastritis following peptic ulcer surgery.
Bilirubin↗
Atypical (endometrial) carcinoma of the prostate.
Three cases of atypical (endometrial) carcinoma of the prostate are reported. In the light of the uncertain response to oestrogen therapy, all three patients were treated with radical radiotherapy.
Adenocarcinoma↗