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Biomedical subjects

Z Rayter

Publications and source records attributed to Z Rayter.

32 records · Page 2Linked to original sources
PubMed1991

Ultrasound and HIDA: scanning in evaluating bile leaks after cholecystectomy.

Ultrasound and 99Tcm-HIDA scanning were compared in the evaluation of postoperative biliary leakage after cholecystectomy. In thirty-five patients the abdomen was scanned and imaged on the first postoperative day. Isotope activity in the right upper quadrant and whole abdomen was determined to obtain an activity ratio. Ultrasonography was also performed. Accumulation of 99Tcm-HIDA in the gall bladder bed or over the surface of the liver was regarded as evidence of a bile leak. Eleven patients had abnormal 99Tcm-HIDA images (activity ratios of 0.20-0.77, mean 0.51) but only five patients had loculated fluid on ultrasound scanning. Twenty-four patients had normal 99Tcm-HIDA images (activity ratios of 0-0.17, mean 0.21), but fifteen of these had loculated fluid on ultrasound scanning. We conclude that bile leaks occur in 30% of patients following cholecystectomy and are best detected by 99Tcm scanning rather than ultrasonography.

Adult↗
PubMed1990

Preoperative cytology and mammography in patients with single-duct nipple discharge treated by surgery.

Microdochectomy has been the routine management for single-duct nipple discharge. Our review of 176 consecutive patients surgically treated between 1975 and 1988 revealed eight patients with in situ carcinomas and seven with infiltrative carcinomas. Seventeen patients had multiple papillomas, two had atypical hyperplasia and two had atypical epitheliosis. Case selection for surgery has recently been advocated. In our study, nipple discharge cytology was helpful in 67 per cent of cases with underlying malignant pathology. Mammography was found to be unreliable, alerting suspicion in only two of 15 cases.

Adolescent↗
PubMed1990

Pseudomembranous colitis after abdominal aortic aneurysm repair.

We report three patients who developed pseudomembranous colitis following aortic aneurysm resection. Colonic ischaemia can occur after such surgery and ischaemic colonic mucosa is known to be more susceptible to damage by bacteria and their toxins. This colonic ischaemia together with the antibiotic prophylaxis used may render aortic aneurysm patients susceptible to pseudomembranous colitis. It is important to distinguish pseudomembranous from ischaemic colitis in these patients as specific and effective drug therapy can be given to those with the pseudomembranous type.

Aged↗
PubMed1990

An unusual omental hernia.

A unique case of a type of omental hernia is presented, which caused small bowel obstruction. The hernia is described and possible aetiological factors discussed.

Aged↗
PubMed1990

In-situ carcinoma of the breast.

This article elucidates the clinical and pathological features of both ductal and lobular in-situ breast carcinoma. It quantifies the risk of invasive disease developing and outlines different treatment options with results as presently known.

Breast Neoplasms↗
PubMed1990

Comparison of conservative surgery and radiotherapy with mastectomy in the treatment of early breast cancer.

We have compared overall survival, and local and distant recurrence-free survival in patients with early breast cancer treated by mastectomy, with patients treated by wide local excision and radiotherapy. To do this, we reviewed a consecutive, unselected series of patients presenting with early breast cancer (T0-T2, N0-N1b, UICC) between 1973 and 1981 to one surgeon (J.-C.G.) and one radiotherapist (H.T.F.). The mean follow-up was 9 years (minimum 6 years, maximum 14 years). Only 9 patients received any adjuvant therapy. At 10 years the relapse-free survival was 65% for both groups of patients; the overall 10-year survival was 70% for patients treated by wide local excision and radiotherapy, and 67% for patients treated by mastectomy. The actuarial loco-regional recurrence rate at 10 years was 15% for patients treated by wide local excision and 13% for patients treated by mastectomy. There were no significant differences in overall survival, loco-regional and distant relapse-free survival between the two groups of patients. Our results support other reports that conservative surgery and radiotherapy in early breast cancer does not adversely affect long-term prognosis.

Adult↗
PubMed1990

Preparation of the bowel before elective surgery using a polyethylene glycol solution at home and in hospital compared with conventional preparation using magnesium sulphate.

Bowel preparation by conventional methods is time-consuming and unpleasant for both patient and staff. In addition, it requires admission to hospital several days before surgery. Preparation using oral polyethylene glycol solution is more acceptable and can easily be adapted so that the patient can perform the procedure at home before admission to hospital. In a prospective series we have compared the efficacy of preparation at home using polyethylene glycol with similar preparation in hospital and with a standard bowel preparation based on magnesium sulphate. Preparation was better after polyethylene glycol and this was significant when performed at home (P less than 0.01). There was no effect on either electrolytes or haematological parameters, but polyethylene glycol did result in a rise in the number of colonic Streptococcus faecalis seen. This rise was not seen with magnesium sulphate (P less than 0.001).

Administration, Oral↗
PubMed1989

Bile leaks after simple cholecystectomy.

Drains after cholecystectomy are used commonly to avoid biliary leaks and subsequent peritonitis. Thirty-five patients who had had cholecystectomy without drainage underwent 99mTc-labelled dimethylphenylcarbamoylmethyliminodiacetic acid (HIDA) and ultrasound scans the morning after surgery. Biliary leaks detected by positive HIDA scans occurred in 11 patients. Subhepatic fluid collections were seen on 20 ultrasound scans. There was no relation between biliary leaks and subhepatic collections. Many of the collections were not seen on the HIDA scan, suggesting that they contained blood and not bile. Many of the patients with bile leaks showed no fluid collection. Clinical complications were few and evenly distributed between those with positive and negative scans. We conclude that bile leaks are not an occasional event but occur after 31 per cent of undrained cholecystectomies and that these bile leaks remain clinically unimportant.

Bile↗
PubMed1989

Expression of membrane glycoproteins in normal keratinocytes and squamous carcinoma cell lines.

Con A acceptor glycoproteins were analyzed by 2D-PAGE and 125I-Con A overlay in three squamous carcinoma cell lines and compared with those in the simian virus (SV40)-transformed keratinocyte cell line SVK-14 and in normal keratinocytes. The majority of the glycoproteins identified by this technique were expressed at similar levels in all of the cells examined, independent of the culture conditions used. A cell surface glycoprotein gp34 (MW 34 kDa, pI 5.1) was increased in the tumor cells compared with normal keratinocytes and expression varied with the culture density. Another glycoprotein, gp21 (MW 21 kDa, pI 6.3), was found to be increased in expression in normal keratinocytes and stratified hyperconfluent cultures of squamous carcinoma cell lines. This paper describes the potential of this technique to identify membrane glycoproteins which may be expressed as a function of proliferation or differentiation.

Carcinoma, Squamous Cell↗
PubMed1989

The fate of bone marrow micrometastases in patients with primary breast cancer.

Using an immunocytochemical technique, micrometastases have been found in the bone marrow of approximately 26% of patients with primary breast cancer at the time of initial surgery. To determine the fate of these cells, both in patients receiving and not receiving adjuvant therapy, multiple bone marrow aspirates were repeated in 82 patients at a median time of 18 months after surgery but prior to overt relapse. In both treated and untreated patients micrometastases were only found in one of 45 (2%) and one of 37 (3%) patients, respectively. However, when multiple marrow aspirates were taken from patients with local recurrence the incidence of micrometastases was 19% (three of 16), and this increased to 30% (three of ten) in patients with disease at distant sites other than bone, and 100% (ten of ten) in patients with radiologically proven bony disease. Three of 11 (27%) patients in whom the primary tumor remained in situ while receiving adjuvant therapy before definitive surgery had micrometastases at the time of diagnosis and at follow-up 3 months later. These results suggest that many of the micrometastases from breast cancer patients are the result of "shedding" of cells from the primary carcinoma and that a proportion are not viable. The technique is currently insufficiently sensitive to accurately monitor adjuvant therapy in breast cancer patients.

Antineoplastic Agents↗
PubMed1984

Gastrogastric intussuscepting leiomyomas.

Two cases of gastrogastric intussusception of leiomyomas are presented. Intussusception of a fundal mass into the gastric antrum can cause a confusing appearance on the double-contrast barium study. Intermittent intussusception was seen on fluoroscopy in 1 case.

Aged↗