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Biomedical subjects

W A Corbett

Publications and source records attributed to W A Corbett.

16 recordsLinked to original sources
PubMed2006

Variance of surgeons versus pathologists in staging of colorectal cancer.

AIM: Accurate staging of colorectal cancer depends on adequate retrieval and reporting of lymph nodes in the specimen. The presence of positive lymph nodes is an indication for adjuvant therapy. Both surgeons and pathologists influence the number of lymph nodes that are retrieved and reported in specimens. Although several recommendations exist in the literature regarding the minimum number of lymph nodes required for reliable staging, the relationship of examined to infiltrated lymph nodes has not been clarified. The aims of this study were to examine variance among surgeons and pathologists in the retrieval and reporting of lymph nodes in colorectal cancer specimens; to examine the relationship between retrieved/examined lymph nodes and infiltrated lymph nodes; to identify in our own series the minimum number of retrieved lymph nodes required to secure accurate staging. METHODS: Cross-sectional study of 284 patients with colorectal cancer followed in our hospital and retrospective analysis of histopathology reports. Correlation analysis, ANOVA, and survival analysis were performed on the data. RESULTS: There were 127 patients with cancer of the rectum and 157 patients with cancer of the colon under follow-up. The median number of lymph nodes per specimen was 8 (range 0-29). There was no difference in the number of retrieved lymph nodes among 9 surgeons. There were 2 outliers among pathologists, with one reporting a mean of 11.4 (9.8-12.9) 95% CI nodes per specimen and another reporting a mean 4.9 (3.6-6.2) 95% CI nodes per specimen. Dukes and T stage did not affect the number of nodes. Correlation analysis revealed a linear correlation between the total number of reported lymph nodes and the existence of positive lymph nodes. From the correlation equation we calculated that, in order to have one positive node, a minimum of 8.4 nodes was required in the specimen. Therefore, in our group of patients, a minimum of 8.4 nodes was required for accurate Dukes staging. However, survival analysis did not show any difference between patients with more and patients with less than 9 reported lymph nodes. CONCLUSIONS: Variance among pathologists exists and may be at least as important as variance among surgeons. Specialisation of pathologists similar to that of surgeons as well as employment of new techniques may be required . There is a linear correlation between the number of examined lymph nodes and the presence of positive nodes in a colorectal cancer specimen. This linear correlation makes the calculation of the minimum number of lymph nodes possible. In our series a minimum of nine nodes must be examined. However, we have not demonstrated an effect of inadequate nodes numbers on survival, possibly because survival in colorectal cancer is multifactorial.

Analysis of Variance↗
PubMed2004

Evaluation of flexible sigmoidoscopy as an investigation for "left sided" colorectal symptoms.

BACKGROUND: Colonoscopy is the best way of imaging the colon with concurrent biopsy and treatment. However it is expensive, requires full bowel preparation, and carries a risk of complications. Flexible sigmoidoscopy is an alternative way to investigate symptoms that raise the suspicion of a lesion of the rectum or left colon. AIM OF THE STUDY: To evaluate flexible sigmoidoscopy as the main investigation for "left sided" colorectal symptoms. METHODS: The clinical records of 317 patients who were assessed at a colorectal specialist clinic and were thought to have a suspicion of a lesion of the rectum or left colon were retrospectively reviewed. All patients had flexible sigmoidoscopy as the primary investigation. Primary outcome was the diagnostic yield of flexible sigmoidoscopy and secondary outcomes were any additional colonic investigations required, failure rates, and complication rates. RESULTS: Three hundred and sixteen patients who had flexible sigmoidoscopy with the above criteria were retrospectively analysed. Twenty four procedures (7.6%) had to be abandoned because of poor bowel preparation. The examination was considered complete when it reached the splenic flexure, which was the case in 205 cases (65%). In 137 flexible sigmoidoscopies (43.3%) there were no abnormal findings. Of the remaining 179 a carcinoma of the rectum or colon was found in 28 cases (8.8%) and one or more polyps was found in 57 (18%) cases. On the basis of the findings it was calculated that 31% of the patients would require an additional investigation for further imaging of the right colon. DISCUSSION: Although flexible sigmoidoscopy has a high yield of pathologies when carried out by a specialist colorectal clinic, the presence of those pathologies makes the full imaging of the whole colon with an additional investigation necessary. Therefore the cost efficiency of flexible sigmoidoscopy is questionable. Although flexible sigmoidoscopy is indicated for certain patients, it cannot replace colonoscopy as the main investigation used by a specialist colorectal clinic.

Colonic Diseases↗
PubMed2003

Evaluating a spoken dialogue system for recording clinical observations during an endoscopic examination.

Paper, keyboard or mouse-driven systems may not be suitable for data capture because of the hands-busy constraint imposed by an endoscopic examination. A Spoken Dialogue System (SDS) has a number of advantages when compared to keyboard and mouse-driven input modalities, particularly with respect to hands free and eyes-free control of a system. However, any emerging technology will never deliver improved organizational effectiveness if it is not accepted and used. The Technology Acceptance Model (TAM) provides a framework that helps explain the determinants of computer acceptance. This study, through the application of TAM, demonstrates a high level of user acceptance with clinicians wanting to use spoken dialogue technology for recording clinical observations during an endoscopic examination. Clinicians would also prefer to use a SDS for recording endoscopy rather than use a paper-based or keyboard and mouse-driven system. Using a clinical narrative during an endoscopic examination was also perceived to be a natural way to record findings. Relationships between basic TAM variables were confirmed and relationships between quality of dialogue measures and TAM variables were established.

Adult↗
PubMed1994

Non-steroidal anti-inflammatory induced diaphragm disease of the small intestine: complexities of diagnosis and management.

A 52-yr-old lady with RA on long term NSAIDs developed an iron-deficiency anaemia and subsequently presented with subacute intestinal obstruction. After intensive investigation, a diagnosis of diaphragm disease of the small intestine was made at laparotomy. The features of diaphragm disease and the difficulties with diagnosis and management of the condition are discussed.

Adult↗
PubMed1994

What happens to patients following open access gastroscopy? An outcome study from general practice.

BACKGROUND: Open access gastroscopy allows general practitioners to request a gastroscopy without prior referral to a specialist. The effect of open access gastroscopy upon patient management is poorly explored. Most studies have been hospital based and have focused on diagnostic yields and on means of tightening requests to reduce inefficient use. A user evaluation can only be made by measuring outcomes in primary care. AIM: A study was undertaken to determine the impact of open access gastroscopy in general practice and in particular, the value of a normal result. METHOD: All general practices in South Tees District Health Authority were asked to participate. Any of their patients who had had open access gastroscopy in the year prior to July 1990 were identified from the hospital computer and their general practitioner notes examined. Patient management during the year prior to the open access gastroscopy was compared with the year after. The main outcome measures were: detection rate and grade of lesion, change in graded score of prescribed drugs, consultation rate for dyspepsia and non-dyspepsia problems, and further hospital referral and investigations. Outcomes among those with normal and abnormal gastroscopy results were compared. RESULTS: The study sample comprised 715 patients, 36% of whom had a normal gastroscopy result, 34% a major abnormality and 26% a minor abnormality (4% of patients had miscellaneous diagnoses). It was found that 39% of all patients, and 60% of those with normal findings on open access gastroscopy had their drug treatment stopped or reduced in grade after the investigation. Of those with a major endoscopic abnormality 58% increased their treatment score. Consultations for dyspepsia in the year before and after gastroscopy fell by 57% overall among those with a normal gastroscopy result, by 37% among those with a minor finding and by 33% in those with a major finding. There was a 21% fall in consultations for all reasons among those with a normal gastroscopy result but those with a minor abnormality had a 23% increase in non-dyspepsia consultations. Of all patients 19% were referred to hospital subsequently. CONCLUSION: Open access gastroscopy has a major effect upon patient management in general practice, and a normal endoscopy result has an important an impact as an abnormal one. Open access gastroscopy is associated with a rationalization of drug therapy, reduced consultations and a low hospital referral rate.

Dyspepsia↗
PubMed1993

Organising unrestricted open access gastroscopy in South Tees.

Increasing demand for upper gastrointestinal endoscopy has forced many clinicians to reconsider the policy of seeing all patients in a specialist clinic before gastroscopy. The following are considered essential in setting up an open access gastroscopy service. (1) Assessment of the need by examination of waiting times for the outpatient clinic and the proportion of patients requiring upper gastrointestinal endoscopy, and consultation with colleagues in general practice. During the first 2 years of the service the average waiting time for a medical gastrointestinal outpatient appointment has fallen from over 120 days to 37 days in this area. (2) An adequately staffed and equipped gastrointestinal unit with well motivated nurses (the workload will increase) and sufficient clinical support to allocate patients to the next available gastroscopy list is vital. A safe mechanism for relaying information back to the GP (including histology reports) is essential otherwise medicolegal problems could arise. Open access gastroscopy now accounts for 29% of the total endoscopy workload in South Tees. (3) Close cooperation between medical and surgical gastroenterologists must be achieved to ensure a uniform approach to the provision of this service and equal distribution of the endoscopy workload. This will require close examination of the potential numbers and may necessitate appointment of a clinical assistant or additional consultant. Clinical assistants perform just over 50% of the open access gastroscopies in South Tees and the waiting time has been kept short (average 17 days). (4) A comprehensive request form with guidelines for GPs and a specific box identifying whether the GP requires a report and brief advice only or follow up at the discretion of the endoscopist (often a clinical assistant) is required. (5) Management must be involved in identifying adequate resources. (6) Methods of monitoring requests and outcome measures to ensure effective audit must be established.

Endoscopy, Gastrointestinal↗
PubMed1985

The effects of a somatostatin analogue SMS 201-995 on hepatic haemodynamics in the cirrhotic rat.

The effects of a somatostatin analogue, SMS 201-995 on hepatic haemodynamics were studied in rats with dimethylnitrosamine-induced cirrhosis. An intravenous infusion of 1, 2 or 4 micrograms kg-1 body wt h-1 SMS 201-995 produced a rapid and sustained decrease in portal pressure, portal venous flow and liver blood flow without significantly altering arterial blood pressure or pulse. The reductions in portal pressure, portal venous flow and liver blood were accompanied by an increase in splanchnic vascular resistance. Portal venous resistance was not affected. Subcutaneous injection of 2 micrograms kg-1 body wt SMS 201-995 produced a gradual decrease in portal pressure, the maximum reduction occurring 18 min after administration. This reduction in portal pressure was sustained for a further 20 min. The results suggest that SMS 201-995 may be of value in the control of bleeding oesophageal varices. Furthermore, the prolonged duration of action of SMS 201-995 following its subcutaneous administration suggests that the analogue may be useful in the long-term management of portal hypertension in patients with cirrhosis.

Animals↗
PubMed1985

Effects of a somatostatin analogue SMS 201-995 on hepatic haemodynamics in the pig and on intravariceal pressure in man.

The effects of a somatostatin analogue, SMS 201-995, on hepatic haemodynamics in the pig and on intravariceal pressure in man were studied. An infusion of 250 micrograms/h SMS 201-995 significantly reduced portal pressure, portal venous flow and hepatic artery flow in the pig. These changes in hepatic haemodynamics were accompanied by a reduction in cardiac output, a reflex slowing of the heart and an increase in arterial blood pressure. Splanchnic vascular resistance was increased following SMS 201-995 administration but hepatic vascular resistance remained unchanged. Administration of 50 micrograms SMS 201-995 reduced the intravariceal pressure from 27.4 +/- 2.5 to 15.8 +/- 2.1 mmHg in 9 patients with cirrhosis and portal hypertension. Administration of 50 micrograms SMS 201-995 also reduced portal pressure from 29 to 22 mmHg in a patient undergoing an elective portacaval shunt. These results suggest that SMS 201-995 may be of value in the control of bleeding oesophageal varices. Furthermore, because of its prolonged duration of action SMS 201-995 may be useful in the long term management of portal hypertension in patients with cirrhosis.

Animals↗
PubMed1985

Cellular function in liver and muscle during hemorrhagic shock in primates.

The results of this study demonstrated that muscle ATP levels were sustained in hemorrhagic shock despite marked deterioration of muscle function as indicated by a decline in PD. This indicated that energy depletion was not the primary basis of the cellular dysfunction in hemorrhagic shock. Cellular dysfunction and metabolic abnormalities in the liver occurred earlier during the course of hemorrhagic shock than in muscle. Other studies were cited in which it was suggested that inhibition of the membrane bound sodium and potassium active transport mechanism is the likely cause of tissue electrolyte and fluid shifts observed during prolonged periods of hemorrhagic shock.

Adenosine Triphosphate↗
PubMed1983

Neutrophil migratory activity in severe hemorrhagic shock.

Sepsis continues to be a major cause of patient death following hemorrhagic shock. To explain this increased susceptibility to infection on a cellular level, neutrophil function was studied in nine adult baboons subjected to severe hemorrhage. Neutrophil migratory activity was found to be significantly decreased immediately after hemorrhage (P less than 0.05 vs control) and continued to decline throughout the experiment. After an initial small decline, neutrophil adherence increased to significant levels after 4 h of hypotension (P less than 0.05 vs control). The present data support the hypothesis that increased susceptibility to infection after sustained hemorrhage is a result of impaired neutrophil function.

Animals↗
PubMed1981

The effect of increasing end-expiratory pressure on extravascular lung water.

The objective of this study was to define the response of extravascular lung water (EVLW) to different levels of positive end-expiratory pressure (PEEP) following a standardized oleic acid injury to the lung. All animals responded to the injection of intravenous oleic acid by the rapid development of hypoxemia. There was a twofold increase in EVLW during the first 3 hours after oleic acid injection which remained stable during the remainder of the experiment, including periods on PEEP. Intrapulmonary shunt (Qs/Qt) increased significantly (P less than 0.001) during the first hour following oleic acid injection. PEEP therapy resulted in an immediate decrease in Qs/Qt and amelioration of the hypoxemia. Return to zero PEEP resulted in a rapid decrease in PaO2 with concomitant increase in Qs/Qt by the end of the experiment. The oxygen transport in the animals did not improve significantly with the addition of PEEP. This was due to the decrease in cardiac output that more than offset the effects of a diminished Qs/Qt with PEEP. This study indicates that the mechanism by which PEEP improves oxygenation does not appear to be mediated by effect on lung water. The study also emphasizes the importance of determining oxygen transport when managing patients on PEEP.

Animals↗
PubMed1981

Measurement of lung water in inhalation injury.

Pulmonary inhalation injury is a major cause of morbidity and mortality rates in burn victims. But the pathophysiology of parenchymal inhalation injury has not been fully elucidated. In this study, extravascular lung water volume (EVLW) was measured in burn patients with and without inhalation injury. Patients with parenchymal inhalation injury (group II) had elevated admission extravascular lung water volumes (10.12 +/- 3.43 ml/kg), whereas patients without parenchymal injury (group I) had significantly lower lung water values (3.91 +/- 1.49 ml/kg). Both accumulation of EVLW and ventilation-perfusion abnormalities in the group II patients occurred within hours of smoke inhalation. But the severity of inhalation injury did not consistently correlate with the elevation of EVLW. This indicated that both interstitial edema and ventilation-perfusion imbalance contributed, in varying degrees, to the pathophysiology of inhalation injury. In this study, the general clinical criteria for inhalation injury--presence of facial or oropharyngeal burns, carboxyhemoglobin levels, carbonaceous sputum, or closed space injury--did not differentiate patients with airway injury only from those with parenchymal injury. Patients in both groups who died of sepsis had significant (P less than 0.01) increases in EVLW 24 to 48 hours after the clinical onset of sepsis. The normal hydrostatic pressures in these septic patients suggested that the increase in EVLW observed with sepsis was due to an increase in pulmonary capillary membrane permeability.

Adult↗