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Biomedical subjects

W H Isbister

Publications and source records attributed to W H Isbister.

At least 73 records · Page 4Linked to original sources
PubMed1989

Colostomy closure.

One hundred and forty-seven colostomies were closed in 146 patients at Wellington Hospital between 1 January 1978 and 1 January 1987. The majority of stomata were formed in patients with colorectal cancer. At least one additional significant procedure was undertaken at the time of stoma closure in 10 patients. The overall complication rate was highest in those patients undergoing closure of a sigmoid end-colostomy (50%). Three complications resulted in death (2%). Twenty-four patients (16.3%) developed wound infections. Five patients developed 'leaks' (3.4%). The use of prophylactic antibiotics appeared to reduce the rate of infection significantly. The highest rates of wound infection and leakage occurred in patients in whom drains were used. Wound infections increased hospital stay. Thirty-one non-bowel or wound-related complications occurred in 25 patients.

Colostomy↗
PubMed1989

Dysplastic and malignant areas in hyperplastic polyps of the large intestine.

The clinical and pathological findings in a patient with 3 adenocarcinomas of the colon, 16 pure hyperplastic polyps, 1 hyperplastic polyp with adenomatous elements and 1 hyperplastic polyp with malignant transformation to adenocarcinoma within an area of adenomatous dysplasia are described. The possibility of neoplastic transformation of hyperplastic polyps is discussed.

Adenocarcinoma↗
PubMed1988

Fine catheter peritoneal cytology for the acute abdomen: a randomized, controlled trial.

A randomized, controlled clinical trial, of sequential design, was undertaken to determine whether fine catheter aspiration cytology of the peritoneal cavity, using the percentage of neutrophils in the sample as the main test marker, reduces errors about urgent laparotomy in patients admitted to a surgical unit with acute abdominal pain. One hundred and forty-four patients with acute abdominal pain were studied. Of these, 26 were excluded because the test was unlikely to be useful and 20 did not consent. Conventional clinical assessment was undertaken and then the subjects were randomly allocated to have a peritoneal cytology test or not. After the test result was made available, the surgeon(s) decided whether to operate or continue conservative treatment. The correct decision was later ascertained by a blinded clinical referee. With the entry of the 98th patient the difference between the groups achieved the 5% significance level. The groups were well-matched in regard to demographic and other variables. The decision about urgent laparotomy was incorrect in only 8.2% of the test patients, compared with 28.6% of the others. It is concluded that fine catheter aspiration cytology of the peritoneal cavity is likely to reduce the numbers of unnecessary or delayed laparotomies when used in most patients admitted with acute abdominal pain.

Abdomen, Acute↗
PubMed1988

Improving the effectiveness of Society meetings and stimulating surgical research: an overview of a Surgical Research Society of Australasia workshop.

The Surgical Research Society of Australasia organized a workshop in October 1984 to consider how to maximize the effectiveness of the Society and its meetings. Four working parties addressed the aims and directions of the Society, the planning of meeting, the selection and presentation of papers, and education in surgical research. An overview of the workshop is presented in abbreviated form.

Australia↗
PubMed1988

The follow-up of patients following surgery for colorectal cancer--a personal view.

Few patients are cured of colorectal cancer at their original surgery (5-year survival steady at about 42%). Early tumours metastasize and local recurrence is only local in 10% of patients. There is no prospective controlled data relating to the aggressive treatment of liver metastases and metachronous tumours suitable for re-operation or operation for "cure" occur in less than 1% of patients. Less than 3% of patients diagnosed at follow up are suitable for re-operation for "cure". There is little evidence to justify the general follow up of all patients following resection for colorectal cancer. A limited colonscopic follow up of patients after resection of Duke's stage A and B lesions may be justified.

Colorectal Neoplasms↗
PubMed1987

A basic audit: knowledge and attitudes of teaching and nonteaching surgeons towards colorectal cancer.

In order to determine surgeons' knowledge of colorectal cancer in New Zealand and to see whether this knowledge was related to clinical practice a questionnaire was sent to all general surgeons on the New Zealand Medical Register. One hundred and twenty-three responses were received and analysed. Surgeons involved in student teaching had a better knowledge of this cancer than their nonteaching colleagus. There was a significant association between knowledge and attitudes towards screening, polyp removal and occult blood testing.

Adult↗
PubMed1987

Colonoscopy--a ten year Wellington experience.

Between April 1975 and December 1985, 870 colonoscopies have been performed at Wellington Hospital. A cause of gastrointestinal blood loss was identified in 61% of patients examined for this reason. Ninety-eight percent of patients with longstanding total mucosal ulcerative colitis were able to be managed nonsurgically. The diagnostic problem was resolved colonoscopically in 99% of patients with radiological abnormality. Seven hundred and seventy-six polyps and four polypoid carcinomata were removed endoscopically. A further four patients were referred for surgery following incomplete removal of polypoid carcinomata but no residual tumour was found in the resected bowel. It is suggested that strict criteria be employed in the selection of patients for colonoscopy.

Colonic Diseases↗
PubMed1987

Automated leucocyte adherence inhibition testing in patients with colorectal cancer.

This paper details our initial experiences with a semi-automated leucocyte adherence inhibition (SALAI) assay in patients with colorectal disease. Two assay systems were used. Leucocytes from blood donors and patients with different colorectal diagnoses were tested for sensitization to colorectal tumour extracts, and leucocytes from healthy blood donors were assayed with serum from blood donors or patients to determine whether the serum itself contained factors which would react with the non-sensitized leucocytes in the test system. The sensitivity of the SALAI assay using patients' leucocytes was 64%, and the specificity was 68%. Discriminant analysis did not affect the sensitivity of the assay for colorectal cancer (64%), although the specificity was increased for all patients except those with malignant disease other than colorectal cancer. The sensitivity of the SALAI assay using patients' serum was 50% but the specificity was 74%. Discriminant analysis increased the sensitivity of this assay to 80% but specificity was reduced to 61%. Thus, the SALAI assay with patients' serum, although potentially more advantageous than the assay using patients' leucocytes in the clinical setting, was less specific. Furthermore, samples from patients with early colorectal cancers were less reactive making the serum assay unsuitable for screening asymptomatic patients. The SALAI assay using patients' leucocytes, however, has a higher sensitivity than most reported variations of the assay but a slightly lower specificity. It is suggested that the SALAI assay is preferable to other methods for leucocyte adherence inhibition (LAI) testing.

Antigens, Neoplasm↗
PubMed1987

A simple method for the management of anorectal abscess.

All patients referred to the University Department of Surgery in Wellington with anorectal abscess were managed by simple de Pezzer drainage. The catheter used was between 3-5 mm in diameter and was inserted when possible under local anaesthetic. Ninety-seven patients have presented with anorectal abscess. After exclusion of those patients with intersphincteric abscess, 91 have been managed in this way with a male : female ratio of 2.8 : 1. a perianal abscess was present in 76 patients. General anaesthesia was necessary in 18 patients and 16 of these patients were admitted to hospital. Twelve patients were admitted for underlying medical problems. One patient had Crohn's disease. Over half of the patients had symptoms which had lasted for 4 days or less and 22 patients had antibiotics prescribed by their local practitioners. There was no past history of anorectal sepsis in 75 patients. Sixty-two of the catheters were removed in less than 15 days. Of the patients who were drained under local anaesthetic only eight said that the pain was so intolerable that they would opt for a general anaesthetic in the future. Thirty-five patients returned to their normal activities or work within 5 days and 68 were back at work 14 days after drainage. One abscess was inadequately drained. Twenty-two patients developed fistulae within the follow-up period. It is suggested that this simple technique is safe and reliable, is well tolerated by patients, results in minimal hospitalization and an early return to work.

Abscess↗
PubMed1987

The management of patients with pilonidal disease--a comparative study.

Patients with pilonidal disease presenting at Wellington Hospital between 1979 and 1982 have been studied retrospectively. Of 218 admissions, 113 were for pilonidal sinus and 105 for pilonidal abscess. Fifty-five sinuses and 82 abscesses were 'laid open'. Hospital stay, recurrence rates and costs were considerably lower in those patients who were laid open. It is suggested that laying open is the procedure of choice for patients with both pilonidal abscess and sinus.

Abscess↗
PubMed1987

A simple surgical audit.

A simple microcomputer based surgical audit system, written by one of the authors and implemented on a Tandy model IV microcomputer, is described. The system allows data from 2000 patients to be stored on a single disc. Data stored can be easily analysed and used to audit clinical activity.

Computers↗
PubMed1986

A comparison of the macrophage migration inhibition (MMI) assay and the semi-automated leucocyte adherence inhibition (SALAI) assay.

The present study was undertaken in order to compare simultaneously the semi-automated leucocyte adherence inhibition (SALAI) assay with the two-stage macrophage migration inhibition (MMI) assay in patients with colorectal disease. Eighty-six patients were assayed simultaneously in the MMI assay and the SALAI assays using patients' leucocytes and 83 patients were assayed simultaneously in the MMI assay and the SALAI assay using patients' serum. The SALAI assay using patients' leucocytes was more sensitive (70% vs 40%) and more specific (87% vs 73.3%) than the MMI assay. The SALAI assay was simple to perform, allowed many replicate samples and was more specific and sensitive in relation to the detection of colorectal cancer than other more commonly advocated tests. It may be useful as a screening test for colorectal cancer and it is suggested that further studies should be undertaken in this area.

Colonic Neoplasms↗
PubMed1986

Local recurrence and the EEA stapler--examination of a predictive model.

The overall local recurrence rate following resection of colorectal cancer with restoration of continuity with staples in Wellington was 24%. Nine of 11 patients with local recurrence following resection of rectal tumours had distant metastases at the time of diagnosis of their local recurrence. Using a predictive model to retrospectively estimate the probability of local recurrence it was found that nine of these 11 patients would have been expected to have had a lower local recurrence rate had they undergone abdominoperineal resection of the rectum initially. Since local recurrence is simply a local manifestation of systemic disease in 90% of patients, however, it is suggested that patients would prefer restoration of bowel continuity in preference to rectal excision and stoma formation, there being such little survival advantage for the latter procedure. The utility of the predictive model is therefore questioned.

Adult↗
PubMed1986

Colorectal cancer: knowledge and attitude of surgeons in New Zealand.

In order to determine surgeons' knowledge of colorectal cancer (CRC) in New Zealand, a questionnaire was sent to all general surgeons on the New Zealand Medical register. One hundred and thirty-three responses were received and 123 were analysed. In general, respondents seemed to have a better detailed knowledge of CRC than Australian physicians and surgeons, although trends were similar and knowledge was patchy and in some areas poor. The value of rectal examination and sigmoidoscopy in relation to the detection of colorectal neoplasia was overestimated. Knowledge of faecal occult blood testing was such as to preclude useful evaluation of test results. The findings have serious implications for medical education.

Adult↗
PubMed1986

Perianal mucinous adenocarcinoma: a clue to its pathogenesis.

The case of a 49 year old male patient who presented with perianal mucinous adenocarcinoma is presented. This is a rare anal tumour with a low grade, well-differentiated histological pattern. Its pathogenesis remains obscure, although a long antecedent history of fistula in ano and associated perianal sepsis is characteristic. The exact etiological relationship with anal fistula is not clearly established. The upper rectum is usually spared. Perianal Paget's disease is often seen in association with the tumour. Metastases occur late and spread is usually to the inguinal group of lymph nodes. Clinical diagnosis is often delayed and difficult. Treatment is abdominoperineal resection with block dissection of the inguinal lymph nodes if the glands are involved.

Abscess↗