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Boules M, Haskins IN, Farias-Kovac M, Guerron AD, Schechtman D, Samotowka M, O'Rourke CP, McLennan G, Walsh RM, Morris-Stiff G. What is the fate of the cholecystostomy tube following percutaneous cholecystostomy? Surg Endosc 2016; 31:1707-1712. [PMID: 27519595 DOI: 10.1007/s00464-016-5161-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 07/27/2016] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Cholecystectomy is the preferred treatment for acute cholecystitis with percutaneous cholecystostomy (PC) considered an alternative therapy in severely debilitated patients. The aim of this study was to evaluate the efficacy and outcomes of PC at a tertiary referral center. METHODS We retrospectively reviewed all patients that had undergone PC from 2000 to 2014. Data collected included baseline demographics, comorbidities, details of PC placement and management, and post-procedure outcomes. The Charlson comorbidity index (CCI) was calculated for all patients at the time of PC. RESULTS Four hundred and twenty-four patients underwent PC placement from 2000 to 2014, and a total of 380 patients had long-term data available for review. Within this cohort, 223 (58.7 %) of the patients were male. The mean age at the time of PC placement was 65.3 ± 14.2 years of age, and the mean CCI was 3.2 ± 2.1 for all patients. One hundred and twenty-five (32.9 %) patients went on to have a cholecystectomy following PC placement. Comparison of patients who underwent PC followed by surgical intervention revealed that they were significantly younger (p = 0.0054) and had a lower CCI (p < 0.0001) compared to those who underwent PC alone. CONCLUSIONS PC placement appears to be a viable, long-term alternative to cholecystectomy for the management of biliary disease in high-risk patients. Old and frail patients benefit the most, and in this cohort PC may be the definitive treatment.
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Affiliation(s)
- M Boules
- Department of Hepato-Pancreato-Biliary Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Avenue, A100 Cleveland, OH, 44195, USA.
| | - I N Haskins
- Department of Hepato-Pancreato-Biliary Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Avenue, A100 Cleveland, OH, 44195, USA
| | - M Farias-Kovac
- Department of Hepato-Pancreato-Biliary Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Avenue, A100 Cleveland, OH, 44195, USA
| | - A D Guerron
- Department of Hepato-Pancreato-Biliary Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Avenue, A100 Cleveland, OH, 44195, USA
| | - D Schechtman
- Department of Hepato-Pancreato-Biliary Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Avenue, A100 Cleveland, OH, 44195, USA
| | - M Samotowka
- Department of Hepato-Pancreato-Biliary Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Avenue, A100 Cleveland, OH, 44195, USA
| | - C P O'Rourke
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - G McLennan
- Department of Interventional Radiology, Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
| | - R M Walsh
- Department of Hepato-Pancreato-Biliary Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Avenue, A100 Cleveland, OH, 44195, USA
| | - G Morris-Stiff
- Department of Hepato-Pancreato-Biliary Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Avenue, A100 Cleveland, OH, 44195, USA
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Wood S, Morris-Stiff G, Barton K, Hassn A. 42. Optimising an enhanced recovery programme for oesophagectomy: A stepwise evolution. Eur J Surg Oncol 2014. [DOI: 10.1016/j.ejso.2014.08.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Appleton ND, Bailey DM, Morris-Stiff G, Lewis MH. Neutrophil to Lymphocyte Ratio Predicts Perioperative Mortality Following Open Elective Repair of Abdominal Aortic Aneurysms. Vasc Endovascular Surg 2014; 48:311-6. [DOI: 10.1177/1538574413519713] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: This study assesses the predictive value of neutrophil to lymphocyte ratio (NLR) in relation to 30-day and overall mortality following open abdominal aortic aneurysm (AAA) repairs. In addition, it assess assesses any correlation between NLR and age, size of the AAA and gender. Methods: Patients undergoing elective or urgent open repair of their AAA by a single surgeon during a 10-year period were included. A pre-operative NLR of >5 was regarded as abnormal. Results: 350 consecutive patients underwent AAA repair. 52 had an NLR>5. 30-day mortality rate was 12/52 (23%) in the NLR>5 group and 20/298 (6.7%) in the NLR<5 group (p = 0.0007). All deaths in the NLR>5 group were due to myocardial infarction. The median NLR was higher in those that died within 30 days at 4.2 [IQR: 2.6-7.5] versus 2.8 [IQR: 2.1-3.8] (p = 0.0001). Overall mortality at 10 years, in the NLR>5 group - 26/52 (50%) was significantly greater than that of the NLR<5 group - 102/298 (34.2%) (p = 0.043). Median NLR of those dying during follow-up was significantly higher in those with a baseline NLR>5 at 3.2 (IQR 2.5-4.6) versus 2.6 (IQR: 2.0-3.6) in those surviving (p = 0.00004). No difference was found between NLR and age, aneurysm size or gender. Conclusion: Pre-operative NLR>5 appears to be a significant predictor of both 30-day mortality and long-term outcome in elective and urgent open AAA surgery. It is plausible the NLR is identifying a group with sub-clinical cardiovascular disease at risk of peri-operative myocardial infarction.
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Affiliation(s)
- N. D. Appleton
- Department of Surgery, Royal Glamorgan Hospital, Ynysmaerdy, Llantrisant, United Kingdom
| | - D. M. Bailey
- Neurovascular Research Laboratory, Faculty of Health, Science and Sport, University of South Wales, Pontypridd, United Kingdom
| | - G. Morris-Stiff
- Department of Surgery, Royal Glamorgan Hospital, Ynysmaerdy, Llantrisant, United Kingdom
| | - M. H. Lewis
- Department of Surgery, Royal Glamorgan Hospital, Ynysmaerdy, Llantrisant, United Kingdom
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Morris-Stiff G, Teli M, Khan PY, Ogunbiyi SO, Champ CS, Hibberd R, Brown R, Bailey DM, Winter RK, Lewis MH. Internal Carotid Artery Occlusion. Vasc Endovascular Surg 2013; 47:603-7. [DOI: 10.1177/1538574413500539] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: To determine the incidence of recanalization of the occluded internal carotid artery (ICA) and establish its natural history. Methods: Patients with duplex-confirmed ICA occlusions were identified, and a subgroup offered repeat scanning. The antemortem condition and cause of death of patients who died were recorded. Results: Of 153 patients identified, 77 underwent follow-up at a median of 35 months (interquartile range [IQR]: 14-61).In all, 8 (10.3%) demonstrated recanalization at a median of 53 months (IQR: 35-114). Of 8, 7 underwent carotid endarterectomy with histopathological confirmation of recanalization. Of the 153 patients, 45 (29%) had further neurological events, and 38 (25%) were within the territory of the occluded ICA. In all, 76 patients died, and of the 53 with a confirmed cause of death, 12 (23%) were attributed to a cerebrovascular accident corresponding to the territory of the occluded artery. Conclusion: Recanalization of ICA occlusion is common and leads to significant neurological events. Duplex ultrasound follow-up appears mandatory.
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Affiliation(s)
- G. Morris-Stiff
- Department of Surgery, Royal Glamorgan Hospital, Llantrisant, United Kingdom
| | - M. Teli
- Department of Surgery, Royal Glamorgan Hospital, Llantrisant, United Kingdom
| | - P. Y. Khan
- Department of Surgery, Royal Glamorgan Hospital, Llantrisant, United Kingdom
| | - S. O. Ogunbiyi
- Department of Surgery, Royal Glamorgan Hospital, Llantrisant, United Kingdom
| | - C. S. Champ
- Department of Pathology, Royal Glamorgan Hospital, Llantrisant, United Kingdom
| | - R. Hibberd
- Department of Radiology, Royal Glamorgan Hospital, Llantrisant, United Kingdom
| | - R. Brown
- NHS Wales Informatics Services, Cardiff, United Kingdom
| | - D. M. Bailey
- Neurovascular Research Laboratory, Faculty of Health, Science and Sport, University of Glamorgan, Pontypridd, United Kingdom
| | - R. K. Winter
- Department of Radiology, Royal Glamorgan Hospital, Llantrisant, United Kingdom
| | - M. H. Lewis
- Department of Surgery, Royal Glamorgan Hospital, Llantrisant, United Kingdom
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Farid SG, Iqbal A, Khan S, Morris-Stiff G. Comment on Mallappa et al.: preoperative neutrophil to lymphocyte ratio >5 is a prognostic factor for recurrent colorectal cancer. Colorectal Dis 2013; 15:909-10. [PMID: 23692051 DOI: 10.1111/codi.12195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2013] [Accepted: 01/08/2013] [Indexed: 02/08/2023]
Affiliation(s)
- S. G. Farid
- Northampton General Hospital; Cliftonville, Northampton; NN5 5NQ; UK
| | - A. Iqbal
- St James University Hospital; Beckett Street; Leeds; LS9 7TF; UK
| | - S. Khan
- Northampton General Hospital; Cliftonville, Northampton; NN5 5NQ; UK
| | - G. Morris-Stiff
- St James University Hospital; Beckett Street; Leeds; LS9 7TF; UK
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Yanni F, Mekhail P, Morris-Stiff G. A selective antibiotic prophylaxis policy for laparoscopic cholecystectomy is effective in minimising infective complications. Ann R Coll Surg Engl 2013; 95:345-8. [PMID: 23838497 PMCID: PMC4165137 DOI: 10.1308/003588413x13629960045959] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2013] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION It has been demonstrated previously that the identification of bactibilia during cholecystectomy is associated with the presence of one or more risk factors: acute cholecystitis, common duct stones, emergency surgery, intraoperative findings and age >70 years. Current evidence-based guidance on antibiotic prophylaxis during laparoscopic cholecystectomy (LC) is based on elective procedures and does not take into account these factors. The aim of this study was to assess the effectiveness of a selective antibiotic prophylaxis policy limited to high risk patients undergoing LC with the development of port site infections as the primary endpoint. METHODS One hundred consecutive patients undergoing LC under the care of a single consultant surgeon during a one-year period were studied prospectively. Data collected included patient demographics (age, sex) as well as details of the history of gallstone disease to determine those with complex disease and risk factors for bactibilia. A single dose of antibiotics (second generation cephalosporin and metronidazole) was administered on induction to patients with a risk factor present. Information relating to all radiologically or microbiologically confirmed infections was documented. RESULTS Eighty-four of the patients were female and the mean age was 47.7 ±16.0 years. Nineteen LCs were performed as emergencies and the remainder were elective procedures. A risk factor for bactibilia was present in 35 patients. A wound infection was identified in four cases, two of which were Staphylococcus aureus (one methicillin resistant), one was a coagulase negative Staphylococcus and one wound cultured a mixed anaerobic growth. Three of the infections occurred in patients receiving prophylaxis (2 staphylococcal and 1 anaerobic) at intervals of 7, 14 and 19 days respectively. One patient with a body mass index of 32kg/m² in the 'no prophylaxis' group developed a coagulase negative staphylococcal infection at 10 days. No intra or extra-abdominal abdominal infections were identified. CONCLUSIONS This study has demonstrated that restricting antibiotic prophylaxis to high risk patients has no detrimental effects in terms of increasing the rate of infections in those with no risk factors. Furthermore, the act of not prescribing to low risk patients will limit costs and the risk of adverse events. It will also reduce the risk of resistance and clostridial infections in this cohort.
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Farid SG, Gechev Z, Couch D, Morris-Stiff G. Re. Mroczkowski et al.: Laparoscopy in the surgical treatment of rectal cancer in Germany 2000-2009. Colorectal Dis 2013; 15:760-1. [PMID: 23517092 DOI: 10.1111/codi.12217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 12/21/2012] [Indexed: 02/08/2023]
Affiliation(s)
- S. G. Farid
- Northampton General Hospital; Cliftonville; Northampton; NN5 5NQ; UK
| | - Z. Gechev
- Northampton General Hospital; Cliftonville; Northampton; NN5 5NQ; UK
| | - D. Couch
- Northampton General Hospital; Cliftonville; Northampton; NN5 5NQ; UK
| | - G. Morris-Stiff
- Northampton General Hospital; Cliftonville; Northampton; NN5 5NQ; UK
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Morris-Stiff G, Baker A, Breen A, Smith A. Number of failed organs and response to therapy determine outcome in patients with acute pancreatitis requiring level 1 organ support. Crit Care 2012. [PMCID: PMC3363805 DOI: 10.1186/cc10994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Somasekar K, Foulkes R, Morris-Stiff G, Hassn A. Acute pancreatitis in the elderly - Can we perform better? Surgeon 2011; 9:305-8. [DOI: 10.1016/j.surge.2010.11.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Accepted: 11/02/2010] [Indexed: 01/08/2023]
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Morris-Stiff G, Moawad M, Appleton N, Davies G, Hicks E, Davies C, Lewis MH. Long-term clinical outcome following lower limb arterial angioplasty. Ann R Coll Surg Engl 2011; 93:250-4. [PMID: 21477442 DOI: 10.1308/147870811x566394] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The aim of this study was to determine the clinical outcome of lower limb arterial angioplasty in a busy district general hospital practice. PATIENTS AND METHODS All angioplasties performed from January 1999 to December 2004 were identified and data collected included cardiovascular risk factors, indications for and complications of angioplasty, limb salvage and patient survival rates, and clinically significant re-stenoses. RESULTS 471 interventions were performed in 385 patients (231 men, 154 women). The median age was 67.9 years (range: 39-93 years). Indications for angioplasty were critical ischaemia (n=247, 52%) and lifestyle-limiting intermittent claudication (n=224, 48%). Stenotic lesions accounted for 378 (80%) cases and occlusion for 93 (20%). Radiological success was obtained in 417 (88.5%), improving to 93.6% if only those in whom access was achieved were included. Post-angioplasty complications were observed in 42/471 (9.1%) of interventions. The actual patient survival at 1, 2, and 3 years was 87.4%, 85.1% and 83.2% respectively. Indication for angioplasty and the number of lesions present were identified as risk factors for outcome on multivariate analysis. The cumulative post-angioplasty patency rates at 1, 2 and 3 years were 86.0%, 83.1% and 81.6% respectively. The only factor associated with patency was the mode of presentation. CONCLUSIONS Angioplasty for lower limb peripheral vascular disease can be performed safely and efficaciously with a high technical success rate and a low complication rate. The patient survival and post-angioplasty patency data reflect the progressive and multi-site nature of the underlying disease process.
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Affiliation(s)
- G Morris-Stiff
- Department of Surgery, Royal Glamorgan Hospital, Ynysmaerdy, Llantrisant, UK
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11
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Alazzawi S, De Rover WS, Morris-Stiff G, Lewis MH. Erect chest radiography in the setting of the acute abdomen: essential tool or an unnecessary waste of resources? Ann R Coll Surg Engl 2010; 92:697-9. [PMID: 20650038 PMCID: PMC3229383 DOI: 10.1308/003588410x12699663904998] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2010] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION It has been suggested that changes to the training schemes of junior doctors and the increased pressure on emergency departments to manage their patients within a limited time might increase the number of unnecessary investigations performed on emergency admission patients. This, in turn, may lead to an increased number of investigations with normal results. In this study we try to analyse the role of the chest X-ray (CXR) as a diagnostic tool in patients presenting with acute abdominal pain. PATIENTS AND METHODS A retrospective study was performed of the request forms and results of all chest radiography performed on patients admitted on the emergency surgical intake with acute abdominal pain through utilisation of the prospectively maintained electronic radiology database. The indications were compared to the guidelines published by the Royal College of Radiologists (RCR) which have been adopted as the standard of care. RESULTS A total of 334 chest X-rays were identified of which only 23 (7%) had new findings. Four (1%) patients had free gas under the diaphragm. Of the CXRs, 258 (77%) were reported normal whilst 53 (16%) had old changes which were described in their hospital records and previous radiographs. Of the CXRs with new findings, only 20 were clinically significant and, of these, four (1%) were surgically significant. CONCLUSIONS The majority of CXRs performed on emergency surgical admissions with abdominal pain are unnecessary. By obtaining a clear history, performing a thorough clinical examination and following the RCR guidelines most of the CXRs could be avoided. This would lead to less radiation exposure, reduce delays to diagnosis, and provide significant financial savings.
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Affiliation(s)
- S Alazzawi
- Department of Surgery, Royal Glamorgan Hospital, Llantrisant, UK
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Gomez D, Sangha VK, Morris-Stiff G, Malik HZ, Guthrie AJ, Toogood GJ, Lodge JPA, Prasad KR. Outcomes of intensive surveillance after resection of hepatic colorectal metastases. Br J Surg 2010; 97:1552-60. [PMID: 20632325 DOI: 10.1002/bjs.7136] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND The impact of computed tomography (CT)-based follow-up for the detection of resectable disease recurrence following surgery for colorectal liver metastases (CRLM) was evaluated. METHODS Some 705 patients undergoing resection of CRLM between January 1993 and March 2007 were included. Surveillance comprised 3-monthly CT (thorax, abdomen and pelvis) in the first 2 years after surgery, 6 monthly for 3 years and annually from years 6 to 10. Survival differences following recurrence between patients managed surgically and palliatively were determined, and the cost was calculated. RESULTS Five-year disease-free and overall survival rates were 28.3 and 32.3 per cent respectively. Of 402 patients who developed recurrence within 2 years, 88 were treated with liver resection alone and 36 with lung and/or liver resection. Their 5-year overall survival rates were 31 and 30 per cent respectively, compared with 3.9 per cent in 278 patients managed palliatively (P < 0.001). For each 3-month interval during the first year of follow-up, patients with recurrence treated surgically had better overall survival than those treated palliatively. The cost of surveillance that identified 124 patients amenable to further resection was 12,338 pounds per operated recurrence. Assuming that patients with recurrence gained 5 years' survival, the mean survival gain was 4.28 years per resection and the cost per life-year gained was 2883 pounds. CONCLUSION Intensive 3-monthly CT surveillance after liver resection for CRLM detects recurrence that is amenable to further resection in a considerable number of patients. These patients have significantly better survival with a reasonable cost per life-year gained.
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Affiliation(s)
- D Gomez
- Hepatobiliary and Transplantation Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Zia MK, Morris-Stiff G, Luhmann A, Jeffries R, Ehsan O, Hassn A. Safety and application of laparoscopic gastrectomy for benign gastric disease and gastric cancer. Ann R Coll Surg Engl 2010; 93:17-21. [PMID: 20810021 DOI: 10.1308/003588410x12771863936963] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Laparoscopic gastrectomy is rapidly expanding despite reservations by some surgeons regarding its safety and radicality. The aim of this study was to evaluate patients undergoing laparoscopic gastrectomy for both benign and malignant disease with particular emphasis on technical feasibility, safety, effectiveness and complications. PATIENTS AND METHODS Review of prospectively collected data of patients who underwent laparoscopic gastrectomy from May 2005 to September 2009 under the care of one consultant surgeon. RESULTS A total of 61 laparoscopic gastrectomies were performed (35 men and 26 women) with a median age of 68 years (range, 41-90 years). There were 39 distal gastrectomies (19 adenocarcinoma, 6 gastrointestinal stromal tumour [GIST], 4 benign gastric outlet obstruction, 4 high-grade dysplasia in gastric adenomas, 4 non-healing ulcers, 2 gastric antral vascular ectasia [GAVE]); 15 sub-total gastrectomies (13 adenocarcinomas, 2 GIST); and 7 total gastrectomies (5 adenocarcinomas, 1 GIST, 1 carcinoid). Median follow-up was for 48 months (range, 1-72 months). There was one death, two major and six minor complications. All patients with complications made a satisfactory recovery. CONCLUSIONS Laparoscopic gastrectomy is associated with a low mortality (1.75%) and major morbidity (3.50%). Although technically demanding, especially when a D2 lymphadenectomy is performed, our results have shown that tailored laparoscopic resection based on tumour characteristics with either D1 or D2 lymphadenectomy results in good surgical and oncological outcomes.
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Affiliation(s)
- M K Zia
- Department of General Surgery, Princess of Wales Hospital, Bridgend, UK
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Appleton ND, Bosanquet D, Morris-Stiff G, Ahmed H, Sanjay P, Lewis MH. Extra-anatomical bypass grafting--a single surgeon's experience. Ann R Coll Surg Engl 2010; 92:499-502. [PMID: 20522294 DOI: 10.1308/003588410x12664192076890] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Extra-anatomical bypass grafting is a recognised method of lower limb re-vascularisation in high-risk patients who cannot tolerate aortic cross clamping, or in those with a hostile abdomen. We present a single surgeon series of such procedures and determine relevant outcomes. PATIENTS AND METHODS A retrospective review was performed on a prospectively maintained database of patients undergoing femoro-femoral or axillo-femoral bypass surgery between 1986 and 2004. RESULTS Patency rates for femoral (n = 28; 32%) versus axillary (n = 59; 68%) bypass procedures at 1 month, 1, 3 and 5 years were (92% vs 93%), (69% vs 85%), (60% vs 72%) and (55% vs 67%), respectively. Patient survival rates for the corresponding procedures and time intervals were (96% vs 90%), (96% vs 67%), (85% vs 45%) and (73% vs 38%) and revealed a significantly lower survival rate in those undergoing axillary procedures (P = 0.002). Limb salvage rates were calculated at (100% vs 91%), (96% vs 84%), (96% vs 81%) and (92% vs 81%) with no statistically significant difference found between the two groups (P = 0.124). Two-thirds of the patients who required major amputation died within 12 months of surgery. CONCLUSIONS Acceptable 30-day morbidity, long-term primary patency and survival rates are obtainable in patients suitable for extra-anatomical bypass surgery despite having significant co-morbidities. We have shown 5-year patency rates in those that survive axillary procedures to be as good as those undergoing femoral procedures. Furthermore, surviving patients who evade amputation within a year have an excellent chance of long-term limb salvage.
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Affiliation(s)
- N D Appleton
- Department of Surgery, Royal Glamorgan Hospital, Ynysmaerdy, Llantrisant, UK
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15
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Morris-Stiff G, Gomez D, de Liguori Carino N, Prasad K. Surgical management of hepatocellular carcinoma: Is the jury still out? Surg Oncol 2009; 18:298-321. [DOI: 10.1016/j.suronc.2008.08.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2008] [Accepted: 08/19/2008] [Indexed: 02/07/2023]
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Morris-Stiff G, D'Souza J, Raman S, Paulvannan S, Lewis MH. Update experience of surgery for acute limb ischaemia in a district general hospital - are we getting any better? Ann R Coll Surg Engl 2009; 91:637-40. [PMID: 19785938 DOI: 10.1308/003588409x12486167521271] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The aims of this study were to audit results of a 10-year experience of surgery for acute limb ischaemia (ALI) in terms of limb salvage and mortality rates, and to compare results with a historical published series from our unit. PATIENTS AND METHODS All emergency operations performed during the period 1993-2003 were identified from theatre registers and patient notes reviewed to determine indications for, and outcome of, surgery. Data were compared to a similar cohort who underwent surgery from 1980 to 1990. RESULTS There was a 33% increase in workload from 87 to 116 patients between the two time periods. The number of patients with idiopathic ALI reduced (24% versus 4%; P < 0.05), and there were fewer smokers (71% versus 39%; P < 0.05) and a greater number of claudicants (17% versus 35%; P < 0.05) in those treated from 1993-2003. Latterly, more patients underwent pre-operative heparinisation (33% versus 80%; P < 0.05), received prophylactic antibiotics (14% versus 63%; P < 0.05), and had anaesthetic presence in theatre (46% versus 88%; P < 0.05). There was also a reduction in local anaesthetic procedures (80% versus 41%; P < 0.05). Despite increased pre-operative (15% versus 47%; P < 0.05) and on-table imaging (0% versus 16%; P < 0.05) technical success did not improve. Whilst complication rates were identical at 62%, there were fewer cardiovascular complications in the recent cohort. The 30-day mortality rate for embolectomy fell from 45% to 33%. Multivariate analysis revealed age > 70 years, prolonged symptom duration, ASA score > or = III, lack of prophylactic antibiotics, absence of an anaesthetist, and operations performed under local anaesthetic to be associated with increased risk of mortality. Factors adversely affecting limb salvage included prolonged duration from symptom onset to operation, and a history of claudication or smoking. CONCLUSIONS Despite improvements in pre- and peri-operative management, arterial embolectomy/thrombectomy remains a procedure with a high morbidity and mortality. Further attempts to improve outcome must be directed at early diagnosis and referral as delay from symptom onset to surgery is a major determinant of outcome.
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Affiliation(s)
- G Morris-Stiff
- Department of Surgery, Royal Glamorgan Hospital, Llantrisant, Rhondda Cynon Taf, UK
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Khan AZ, Ching R, Morris-Stiff G, England R, Sherridan MB, Smith AM. Pleuropancreatic fistulae: specialist center management. J Gastrointest Surg 2009; 13:354-8. [PMID: 18972169 DOI: 10.1007/s11605-008-0699-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2008] [Accepted: 09/08/2008] [Indexed: 01/31/2023]
Abstract
BACKGROUND AND AIMS Internal pancreatic fistulae are uncommon sequelae of severe acute pancreatitis. Due to their low prevalence, experience in the management of this condition remains sparse outside specialist centers and management remains controversial. We report our experience with pleuropancreatic fistulae (PPF). PATIENTS Six patients (three males, median age 34 years [range, 32-74 years]) with PPF were managed in our unit over a 24-month period from April 2006 to April 2008. The etiology of pancreatitis was alcohol (four), gallstones (one), and unknown cause (one). All patients had documented pleural effusions with amylase content >1,000 iu/dl. RESULTS All patients underwent computerized tomography (CT) and magnetic resonance imaging (MRI) cross-sectional scanning to identify the site of ductal disruption. CT alone was able to identify the disruption in four cases and a combination of CT and MRI localized the ductal disruption in all patients. Five of six patients required ERCP and placement of a pancreatic duct (PD) stent. No patient required pancreatic surgery and all patients remain well at a median follow up of 39 weeks. CONCLUSION Pleuropancreatic fistulae can present a challenging diagnostic dilemma. A multi-disciplinary approach addressing nutritional support and endotherapy allows successful non-operative resolution within specialist units.
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Affiliation(s)
- A Z Khan
- Royal Marsden Hospital, London, UK
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Al-Allak A, Jones R, Stiff R, Dharmasena D, Morris-Stiff G. Long-term outcome of continuous ambulatory peritoneal dialysis (CAPD) peritonitis: surgery can be avoided. Ann R Coll Surg Engl 2008; 91:118-22. [PMID: 19102818 DOI: 10.1308/003588409x359088] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Continuous ambulatory peritoneal dialysis (CAPD) has become the preferred method of home dialysis for patients with end-stage renal failure. Peritonitis is a common and serious complication and requires prompt diagnosis and treatment. The aim of this study was to assess what proportion of patients with CAPD peritonitis that required surgical intervention for on-going sepsis or for peritonitis-related bowel obstruction. PATIENTS AND METHODS All patients presenting with a first episode of CAPD peritonitis during the 5-year period from 1994-1998 were identified from a prospectively maintained database. Data collected included patient demographics, details of peritonitis episodes and their treatment, and details of any surgical intervention undertaken. RESULTS A total of 500 episodes were identified in 168 patients of whom 162 had complete follow-up representing 488 peritonitis episodes. Sixty-three patients experienced one episode of peritonitis, 33 two episodes, 20 had three episodes, and 46 had more than three episodes. None of the patients underwent surgery either primarily or for complications of the infective episode. A total of 465 episodes were due to a single organism (95%) and the remainder were due to multiple organisms (5%). The most common causative organisms were Gram-positive cocci (308 episodes; 71%) followed by Gram-negative bacilli (106 episodes; 24%). In 55 patients (34%), the same organism was implicated in consecutive admissions. Patients with autosomal dominant polycystic kidney disease (ADPKD), whilst accounting for 12 of 169 (7%) patients in the cohort, experienced 23 of 125 (18.4%) episodes of peritonitis by Gram-negative cocci. Such infections were seen in 8 of 12 (66.7%) ADPKD patients and accounted for 23 of 40 (57.5%) infections experienced by the ADPKD patients. CONCLUSIONS Whilst CAPD peritonitis is a common problem in the renal failure population, with almost 100 episodes per year, it would appear that most episodes can be managed using intraperitoneal antibiotics without the need for surgical intervention.
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Affiliation(s)
- A Al-Allak
- Department of Surgery, Princess of Wales Hospital, Bridgend, UK
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Al-Allak A, Sarasin S, Key S, Morris-Stiff G. Authors' Response. Ann R Coll Surg Engl 2008. [DOI: 10.1308/003588408x321828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- A Al-Allak
- Department of Surgery, Princess of Wales Hospital Bridgend, UK
| | - S Sarasin
- Department of Surgery, Royal Glamorgan Hospital Ynysmaerdy, Llantrisant, Rhondda Cynon Taf, UK
| | - S Key
- Department of Surgery, Royal Glamorgan Hospital Ynysmaerdy, Llantrisant, Rhondda Cynon Taf, UK
| | - G Morris-Stiff
- Department of Surgery, Royal Glamorgan Hospital Ynysmaerdy, Llantrisant, Rhondda Cynon Taf, UK
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Morris-Stiff G, White A, Gomez D, Toogood G, Lodge JPA, Prasad KR. Thrombotic complications following liver resection for colorectal metastases are preventable. HPB (Oxford) 2008; 10:311-4. [PMID: 18982144 PMCID: PMC2575678 DOI: 10.1080/13651820802074431] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2008] [Indexed: 12/12/2022]
Abstract
BACKGROUND Surgery for colorectal liver metastases (CRLM) can be expected to be associated with a significant rate of thromboembolic complications due to the performance of long-duration oncologic resections in patients aged 60 years. AIMS To determine the prevalence of clinically significant thrombotic complications, including deep venous thrombosis (DVT) and pulmonary embolus (PE), in a contemporary series of patients undergoing resection of CRLM with standard prophylaxis. MATERIAL AND METHODS A prospectively maintained database identified patients undergoing resection of CRLM from January 2000 to March 2007 and highlighted those developing thromboembolic complications. In addition, the radiology department database was reviewed to ensure that clinically suspicious thromboses had been confirmed radiologically by ultrasound in the case of DVT or computed tomography for PEs. RESULTS During the period of the study, 523 patients (336 M and 187 F) with a mean age of 65 years underwent resection. A major hepatectomy was performed in 59.9%. One or more complications were seen in 45.1% (n=236) of patients. Thrombotic complications were seen in 11 (2.1%) patients: DVT alone (n=4) and PE (n=7). Eight of 11 thrombotic complications occurred in patients undergoing major hepatectomy, 4 of which were trisectionectomies. Patients were anti-coagulated and there were no mortalities. CONCLUSIONS The symptomatic thromboembolic complication rate was lower in this cohort than may be expected in patients undergoing non-hepatic abdominal surgery. It is uncertain whether this is due entirely to effective prophylaxis or to a combination of treatment and a natural anti-coagulant state following hepatic resection.
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Affiliation(s)
- G. Morris-Stiff
- Departments of Hepatobiliary and Transplant Surgery, St James's University HospitalLeedsUK
| | - A. White
- Departments of Hepatobiliary and Transplant Surgery, St James's University HospitalLeedsUK
| | - D. Gomez
- Departments of Hepatobiliary and Transplant Surgery, St James's University HospitalLeedsUK
| | - G. Toogood
- Departments of Hepatobiliary and Transplant Surgery, St James's University HospitalLeedsUK
| | - J. P. A. Lodge
- Departments of Hepatobiliary and Transplant Surgery, St James's University HospitalLeedsUK
| | - K. R. Prasad
- Departments of Hepatobiliary and Transplant Surgery, St James's University HospitalLeedsUK
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Patel NNB, D'Souza J, Rocker M, Townsend E, Morris-Stiff G, Manimaran M, Magee TR, Galland RB, Lewis MH. Prioritisation of vascular outpatient appointments cannot be based on referral letters alone. Surgeon 2008; 6:140-3. [PMID: 18581748 DOI: 10.1016/s1479-666x(08)80108-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Vascular referrals include patients with conditions varying from varicose veins of cosmetic nuisance to patients with critical ischaemia, transient ischaemic attacks and abdominal aortic aneurysms. A large number of such referrals are received each week from general practitioners. It is important to prioritise patients with conditions that need to be dealt with quickly. OBJECTIVE We prospectively reviewed referral letters to two vascular units, one in South Wales and one in the Oxford region to assess whether prioritisation can be made on the basis of referral letters. MATERIAL AND METHODS All GP referral letters were studied for four months. Only patients with lower limb ischaemic symptoms were included. Degree of urgency requested by the GP was also noted. RESULTS Of 174 referrals for potential lower limb ischaemia analysed, 145 (83%) proved to be due to peripheral vascular disease. Of these 145 referrals, 72% were referred for claudication. Only 37% and 13% respectively mentioned claudication distance and/or rest pain. Risk factors with reference to diabetes, hypertension, hyperlipidaemia, ischaemic heart disease, atrial fibrillation, cerebrovascular disease and smoking were made in 19%, 43%, 23%, 23%, 10%, 14%, 31% of letters respectively. Clinical signs were poorly documented, with 90% of referrals failing to mention presence or absence of critical ischaemic signs. The GP's own assessment of urgency was not stated in 66% of letters, without which only 3% of patients were seen in the clinic within four weeks, compared with 22% in those in whom urgency was stated. Six per cent of patients when reviewed in outpatients were found to have sufficiently severe symptoms to warrant immediate admission. Regional variation was observed with 57% of Royal Glamorgan Hospital referral letters documenting degree of urgency compared with only 23% of Royal Berkshire Hospital letters (p = < 0.0001). CONCLUSION Most referral letters were poorly documented with regard to key symptoms, risk factors and clinical signs. The degree of urgency was often not stated. The creation of referral protocols is now being considered.
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Affiliation(s)
- N N B Patel
- Royal Glamorgan Hospital, Llantrisant, Ynysmaerdy, Rhondda Cynon
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D’Souza J, Patel N, Rocker M, Townsend E, Morris-Stiff G, Magee T, Galland R, Lewis M. Management of cardiovascular risk factors by primary care physicians in patients with peripheral arterial disease. Surgeon 2008; 6:144-7. [DOI: 10.1016/s1479-666x(08)80109-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Morris-Stiff G, Bhati C, Olliff S, Hübscher S, Gunson B, Mayer D, Mirza D, Buckels J, Bramhall SR. Cholangiocarcinoma complicating primary sclerosing cholangitis: a 24-year experience. Dig Surg 2008; 25:126-32. [PMID: 18446034 DOI: 10.1159/000128169] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2007] [Accepted: 12/26/2007] [Indexed: 12/13/2022]
Abstract
AIM To report the prevalence and outcome of cholangiocarcinoma arising in primary sclerosing cholangitis for a British tertiary referral centre. METHODS All patients diagnosed with primary sclerosing cholangitis and concurrent cholangiocarcinoma were identified from a prospectively maintained departmental database, and the mode of presentation, management and outcome were determined. RESULTS Of 370 patients with primary sclerosing cholangitis, 48 patients (13%) were diagnosed with a cholangiocarcinoma within a median time of 0.51 months (range: 0-73.12) from presentation to the unit. Mode of presentation included: inoperable tumours (n = 14); incidental findings in transplant hepatectomy specimens (n = 13); primary sclerosing cholangitis follow-up (n = 9); transplant work-up (n = 5); transplant waiting list (n = 5); suspected tumour confirmed at transplant (n = 1), and incidental finding at cholecystectomy (n = 1). The diagnosis was confirmed by: radiology-guided biopsy (n = 27); MRI (n = 3); CT (n = 2); laparoscopy or laparotomy (n = 2), and frozen section at transplant (n = 1). Management consisted of: transplantation (n = 14, including 1 abandoned); hepatic resection (n = 8), and palliation through stenting (n = 26). The overall median survival of the cohort was 4.9 months (range: 0.09-104.5). Median survival ranged from 2.6 months (range: 0.09-35.3) for palliation to 7.6 months (range: 0.6-99.6) for transplantation and 52.8 months (range: 3.7-104.5) for resection. There was no difference in survival between the transplant and resection groups (p = 0.14). CONCLUSIONS Cholangiocarcinoma is a common finding in primary sclerosing cholangitis and regular screening of this cohort of patients at referring centres is advocated to detect early tumours, as surgical treatment at an early stage offers significantly better outcomes for this cohort of patients.
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Affiliation(s)
- G Morris-Stiff
- Department of Hepatobiliary and Liver Transplant Surgery, Queen Elizabeth Hospital, Birmingham, UK.
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Al-Allak A, Sarasin S, Key S, Morris-Stiff G. Wedding rings are not a significant source of bacterial contamination following surgical scrubbing. Ann R Coll Surg Engl 2008; 90:133-5. [PMID: 18325213 DOI: 10.1308/003588408x242051] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Despite some evidence that the wearing of rings may increase the microbial load, there is currently nothing to suggest that viable bacteria remain following a standard surgical scrub. The aim of the study was to examine the distribution and type of microbial flora seen on the hands of doctors following a standard surgical scrub. MATERIALS AND METHODS Ten surgeons and 10 anaesthetists, all of whom wore wedding rings on the fourth finger of their left hand, participated in the study. Each individual was asked to 'scrub-up' as for their normal first scrub of the day. Following completion of washing, the wedding ring was removed, its internal circumference swabbed and the swab placed in a culture medium. Volunteers placed each hand palm-down on separate agar plates. The plates were incubated and the number of colonies counted and classified. RESULTS The culture plates of one of the anaesthetists were damaged in transit leaving a total of 19 subjects for analysis. In all the palm imprint plates, coagulase-negative staphylococci were grown. One surgeon grew coagulase-negative staphylococci from the ring swab. A Candida spp. from the right hand of one surgeon was grown. There was no statistically significant difference between the number of colony-forming units (CFUs) cultured from the right and left (ring-wearing) hands of the surgeons (P = 0.260) and anaesthetists ( P = 0.345). There was no statistical difference in CFUs when surgeons were compared with anaesthetists (P = 0.383 for right hand and P = 0.234 for left). CONCLUSIONS This preliminary study would suggest that a traditional band wedding ring is not a source of a bacterial load following a standard surgical scrub procedure and, as such, there is no requirement for their removal pre-operatively.
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Affiliation(s)
- A Al-Allak
- Department of Surgery, Princess of Wales Hospital, Bridgend, UK.
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25
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Morris-Stiff G, Coxon M, Ball E, Lewis MH. Atherosclerotic axillary artery aneurysm. MINERVA CHIR 2008; 63:61-63. [PMID: 18212728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
True aneurysms of the axillary artery are rare, most pulsatile masses in the region being pseudoaneurysms. The present study reports a case of a true atherosclerotic axillary artery aneurysm arising in a 65 year old lady which presented with a short history of a painless pulsatile mass and sensory defecit in the hand in the absence of limb trauma. Following preoperative imaging to determine the anatomic details, she underwent repair of the aneurysm and made an excellent symptomatic recovery.
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Affiliation(s)
- G Morris-Stiff
- Department of Surgery, Royal Glamorgan Hospital Ynysmaerdy Llantrisant, Rhondda Cynon Taf, UK
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Morris-Stiff G, Hassn A. Laparoscopic paraoesophageal hernia repair: fundoplication is not usually indicated. Hernia 2008; 12:299-302. [PMID: 18214636 DOI: 10.1007/s10029-008-0332-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2007] [Accepted: 12/18/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Paraoesophageal hernias are an uncommon but important diaphragmatic defect due to a high prevalence of associated complications. The advent of laparoscopic surgery has popularised the surgical management of this condition, although the optimal technique has yet to be defined. The aim of this cohort study was to assess the necessity of an anti-reflux procedure in addition to the crural repair. METHODS Details of all patients undergoing laparoscopic paraoesophageal hernia repair were collected prospectively paying particular attention to the details of the operative procedure and outcome, including the development of early complications. All patients were followed for six months and symptoms related to hernia recurrence or technical failure including dysphagia and reflux were noted. RESULTS Twenty-three consecutive patients underwent laparoscopic paraoesophageal hernia repair. The first 11 patients (Group 1) routinely underwent an additional anti-reflux procedure, whereas the later cohort (Group 2) did not (chi-squared P<0.05). At six months, nine of eleven patients in Group 1 reported dysphagia, in two cases requiring dilatation, but this complication was not seen in those in Group 2. Two patients reported reflux at six-month follow-up; this was controlled in both cases by a low dose of a proton pump inhibitor. CONCLUSION Laparoscopic repair of paraoesophageal hernias is an effective treatment with excellent short-term results and no recurrences. Our experience would suggest that an anti-reflux procedure is not always indicated and may indeed be detrimental to symptomatic outcome.
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Affiliation(s)
- G Morris-Stiff
- Department of Surgery, Princess of Wales Hospital, 1 Golygfa'r Eglwys, Maesycoed, Pontypridd, Rhondda Cynon Taf, Bridgend CF37 1JL, Wales, UK.
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Abstract
INTRODUCTION Gastric outlet obstruction (GOO) is a frequent feature of advanced pancreatic carcinoma. Self-expandable metal stents (SEMS) allow the condition to be managed outside by endoscopy rather than surgical bypass. The aim of this study is to report our experience in a district general hospital with SEMS for palliation of pancreatic carcinoma-related GOO. PATIENTS AND METHODS All patients admitted with or developing GOO secondary to pancreatic adenocarcinoma between January 2004 and December 2005 were identified. Notes were retrieved to determine the efficacy of stenting including: complications of the procedure, length of stay, readmissions and long-term patency. RESULTS Of 39 new cases of pancreatic cancer, 9 patients presented with (n=6) or developed (n=3) duodenal obstruction. In one patient, previous gastric surgery restricted access. Stenting was attempted in 8 patients (4 M and 4 F) with a mean age of 63 years (range 42-76 years). In one case, the duodenal invasion was too extensive to allow passage of the guide-wire and open bypass was performed. Stenting was successful in the remaining seven patients with no early complications. The median hospital stay post-procedure was 7 days (range 5-11 days). One patient was re-admitted after 11 weeks with recurrent duodenal obstruction and a second stent was placed. The median survival post-stenting was 10 weeks (range 3-28 weeks). CONCLUSIONS SEMS allows patients to leave hospital quickly and return to daily activities, albeit for the short term. The procedure requires an experienced interventional endoscopist but can be accomplished safely in the DGH setting.
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Affiliation(s)
- G. Morris-Stiff
- Department of Surgery, Princess of Wales HospitalCoity Road, BridgendWalesUK
| | - A. Hassn
- Department of Surgery, Princess of Wales HospitalCoity Road, BridgendWalesUK
| | - W. T. Young
- Radiology, Princess of Wales HospitalCoity Road, BridgendWalesUK
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Morris-Stiff G, Tan YM, Vauthey JN. Hepatic complications following preoperative chemotherapy with oxaliplatin or irinotecan for hepatic colorectal metastases. Eur J Surg Oncol 2007; 34:609-14. [PMID: 17764887 DOI: 10.1016/j.ejso.2007.07.007] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2007] [Accepted: 07/16/2007] [Indexed: 01/14/2023] Open
Abstract
AIMS The aim of this article is to review the current state of knowledge in relation to the development of chemotherapy associated steatohepatitis (CASH) and sinusoidal obstruction syndrome (SOS) occurring following the administration of irinotecan and oxaliplatin respectively to patients with colorectal liver metastases and also to highlight potential concerns relating to other new agents. METHODS An electronic search was performed of the medical literature using the MEDLINE database to identify relevant articles related to the incidence, aetiology, pathology and effects of CASH and SOS outcome in patients undergoing hepatic resection. RESULTS CASH and SOS are relatively common findings in liver resection specimens following the administration of irinotecan and oxaliplatin-based regimes being reported in up to 50% and 20% of cases respectively. Whilst the aetiology and pathological changes are well-described, the relationship between the presence of these pathologies and outcomes is less well defined. The data in relation to SOS following oxaliplatin is limited but there may be an increased morbidity associated with the presence of SOS. There is significantly more evidence that the presence of CASH is associated with an increased morbidity and possibly mortality following hepatic resection as a result of the development of liver failure. Further studies are required to clarify these early observations. CONCLUSIONS The frequent identification of distinct pathological entities in association with oxaliplatin and irinotecan chemotherapy means that patients undergoing liver resection following treatment with these agents should be carefully monitored to accurately determine the morbidity and mortality attributable to the use of these agents. Furthermore, additional studies are required to clarify risk factors for the development of CASH and SOS so that certain regimens can be avoided in at risk populations thus reducing hepatic damage and increasing the chances of cure and survival following liver resection.
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Affiliation(s)
- G Morris-Stiff
- Department of Hepatobiliary Surgery, St James Hospital, Leeds, UK.
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Davies S, Morris-Stiff G, Lewis MH. Gastric duplication cyst mimicking a pancreatic pseudocyst in a patient with chronic pancreatitis. Int J Surg 2007; 6:e70-1. [PMID: 17499033 DOI: 10.1016/j.ijsu.2007.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2007] [Revised: 03/08/2007] [Accepted: 03/12/2007] [Indexed: 02/09/2023]
Affiliation(s)
- S Davies
- Department of Surgery, Royal Glamorgan Hospital, Ynysmaerdy, LLantrisant, Rhondda Cynon Taf, CF72 8XR, Wales, UK
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Morris-Stiff G, Tamijmarane A, Tan YM, Shapely I, Bhati C, Mayer D, Buckels J, Bramhall S, Mirza D. 243 ORAL Survival advantage in ampullary carcinoma: tumour biology or lead-time bias due to tumour morphology? Eur J Surg Oncol 2006. [DOI: 10.1016/s0748-7983(06)70678-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Koukoutsis I, Bellagamba R, Morris-Stiff G, Wickremesekera S, Coldham C, Wigmore SJ, Mayer AD, Mirza DF, Buckels JAC, Bramhall SR. Haemorrhage following pancreaticoduodenectomy: risk factors and the importance of sentinel bleed. Dig Surg 2006; 23:224-8. [PMID: 16874003 DOI: 10.1159/000094754] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2006] [Accepted: 05/25/2006] [Indexed: 12/22/2022]
Abstract
AIM To document the prevalence and to evaluate the management strategies of haemorrhagic complications following pancreaticoduodenectomy (PD). METHODS All patients who underwent PD from 1/2000 to 10/2005 and experienced at least one episode of haemorrhage during the 30 first days postoperatively were recorded. Etiology of haemorrhage, treatment strategy and mortality rate were recorded and analyzed. RESULTS A total of 362 patients underwent PD during this period and 32 (8.8%) had haemorrhage postoperatively of whom 15 died (47% mortality rate). Primary intraluminal haemorrhage was recorded in 13 patients, primary intra-abdominal haemorrhage in 5 patients and secondary haemorrhage in 14 patients. Successful management of haemorrhage with angioembilization occurred in 2 patients in the study group. Statistical analysis revealed sepsis and sentinel bleed as risk factors for post-PD haemorrhage and pancreatic leak and sentinel bleed as risk factors for secondary haemorrhage (p < 0.05). CONCLUSIONS Haemorrhage after PD is a life-threatening complication. Sepsis, pancreatic leak, and sentinel bleed are statistical significant factors predicting post-PD haemorrhage. Sentinel bleed is not statistically significant associated with postoperative mortality, but with the onset of secondary haemorrhage. The effectiveness of therapeutic angioembolization was not demonstrated in our study.
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Affiliation(s)
- I Koukoutsis
- Liver Unit, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK
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Morris-Stiff G, Stiff RE, Morris-Stiff H. Abdominal radiograph requesting in the setting of acute abdominal pain: temporal trends and appropriateness of requesting. Ann R Coll Surg Engl 2006; 88:270-4. [PMID: 16719997 PMCID: PMC1963673 DOI: 10.1308/003588406x98586] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The biannual turnover of house surgeons has long been dreaded by paramedical staff because of fears of increased workloads generated by 'untrained' junior doctors. The aim of this study was to address this issue by examining both the quantity and quality of requests made for emergency abdominal radiographs made by 'experienced' house surgeons during the month of July and by the 'novices' during August. PATIENTS AND METHODS All adult patients undergoing abdominal radiography (AXR) following admission as emergencies via the surgical directorate with abdominal signs were identified prospectively. The reports of the AXRs were reviewed to determine the total number of requests and the number of positive findings for the two groups. In addition, the hand-written request forms were recovered to determine the suitability of the requests according to nationally-accepted guidelines produced by the Royal College of Radiologists (RCR). RESULTS During the study period, a total of 252 radiographs were performed consisting of 98 in July and 154 in August. The number of unreported films in each month were similar at 11 (11.2%) and 16 (10.4%), respectively, leaving 87 reported radiographs in July and 138 in August. There was no difference in the number of radiographs with positive findings (excluding degenerative spinal disease) for July (n = 19; 22%) and August (n = 33; 24%). Of the 225 reported films, RCR guidelines were followed in only 73 (32%) of 225 cases. When guidelines were adhered to, positive findings were identified in 56 (76.7%) of 73 cases whereas when guidelines were not followed positive findings were seen in only 13/139 (8.9%) of AXRs. CONCLUSIONS We have demonstrated that the popular myth of the 'August syndrome' is unsubstantiated at least using the surrogate marker of abdominal radiograph requests. The worrying finding of a high number of unacceptable indications for the performance of abdominal radiographs deserves urgent attention both in terms of its financial implications and with regards reducing radiation exposure. A programme of education is proposed to emphasise the RCR guidelines with re-audit to assess adherence to the guidelines.
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Affiliation(s)
- G Morris-Stiff
- Department of Surgery, University Hospital of Wales, Cardiff, UK.
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Abstract
INTRODUCTION We have previously presented a patient with massive small and large bowel infarction and demonstrated that even with only a few inches of remaining small bowel an almost normal life-style and diet is possible. PATIENT Recently, we have looked after a young and otherwise fit female patient who suffered mesenteric venous gangrene of the whole small bowel from the Ligament of Treitz to the caecum. In order to achieve gastro-intestinal continuity and to avoid the torrential fluid loss associated with high fistula, an anastomosis between the stomach and the transverse colon was formed. RESULTS We are surprised to find that despite the extensive resection our patient maintains a good quality of life and is able to look after her young family.
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Affiliation(s)
- A D Thomas
- Department of Surgery, Royal Glamorgan Hospital, Llantrisant, UK
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Abisi S, Morris-Stiff G, Hill SM, Roberts A, Williams G, Puntis MCA. Autoimmune pancreatitis: an underdiagnosed condition in Caucasians. ACTA ACUST UNITED AC 2006; 12:332-5. [PMID: 16133704 DOI: 10.1007/s00534-005-0995-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2004] [Accepted: 04/10/2005] [Indexed: 10/25/2022]
Abstract
Unlike in Japan, autoimmune pancreatitis is uncommon in the Western world, particularly in Europe. We report the first case of a Caucasian male with typical features of autoimmune pancreatitis in the UK. Recognizing autoimmune pancreatitis as a new clinical entity in Europe will change the management of many patients who have been labelled as having acute or chronic pancreatitis.
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Affiliation(s)
- S Abisi
- Hepatopancreaticobiliary Unit, Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
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Morris-Stiff G, Haynes M, Ogunbiyi S, Townsend E, Shetty S, Winter RK, Lewis MH. Is Assessment of Popliteal Artery Diameter in Patients Undergoing Screening for Abdominal Aortic Aneurysms a Worthwhile Procedure. Eur J Vasc Endovasc Surg 2005; 30:71-4. [PMID: 15933986 DOI: 10.1016/j.ejvs.2005.02.046] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE The aim of this study was to assess whether screening of popliteal arteries in patients undergoing ultrasound screening of their abdominal aortas was worthwhile. METHODS All male patients undergoing ultrasound screening for abdominal aortic aneurysm (AAA) during the period February 2000 to June 2002 were offered scanning of their popliteal arteries. All scans were performed by a single, trained operator using a Sonosite 180. RESULTS Four hundred and forty-nine patients underwent screening and thus 898 popliteal arteries were assessed. The mean aortic diameter was 2.1 standard deviations (SD) 0.5 cm and the upper limit of normal (2 SD) was 2.7 cm. The mean diameter of the popliteal arteries was 0.74 SD 0.11 and the upper limit of normal was 0.96 cm. Thirty patients had aortic diameters greater than 2.5 cm (ectatic or aneurysmal aortas) but based on a popliteal diameter of 2 cm, no popliteal aneurysms were detected. However, 39 (4.3%) popliteal arteries measured > or = 1 cm (> mean+2 SD); 3/60 (5%) in the ectatic/AAA subgroup and 36/838 (4.3%) in the non-AAA subgroup. CONCLUSIONS This study has shown that, using conventional definitions, the imaging of popliteal arteries during screening for AAAs does not detect any popliteal aneurysms and is thus of limited value. However, if a definition of popliteal aneurysm of > or = 1 cm (based on mean+2 SD) is used then 39/898 (4.3%) of arteries would be regarded as having abnormal diameters and may require surveillance.
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Affiliation(s)
- G Morris-Stiff
- Department of Surgery, Royal Glamorgan Hospital, Unysmaerdy, Llantrisant, Rhondda Cynon Taf, UK.
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Morris-Stiff G, Ball E, Torkington J, Foster ME, Lewis MH, Havard TJ. Registrar operating experience over a 15-year period: more, less or more or less the same? Surgeon 2005; 2:161-4. [PMID: 15570819 DOI: 10.1016/s1479-666x(04)80078-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Concerns have been raised on the effects that recent changes in junior doctor work patterns may have on the breadth and depth of operative exposure achieved during specialist registrar training. This study aimed to determine whether there was any justification for these concerns by assessing whether there have been significant changes in either the number of cases or the case mix operated upon by registrars over the course of the past fifteen years. METHODS A retrospective review of theatre records was undertaken, looking at the caseload of the registrars working for the same two consultant surgeons at one district general hospital in four one-year periods (1986-7; 1991-2; 1998-9; 2001-2). The number, subspecialty, and time of each operation were recorded. RESULTS Whilst operating experience for the first three periods of the study was static, the most recent assessment point has demonstrated a significant reduction in trainee routine operative experience and also a small reduction in the emergency workload performed by both firms. There was also a significant change in the elective case mixes corresponding to consultant sub-specialisation during this period. In addition, there were notable changes in the nature of the emergency workload and a reduction in the number of cases performed after midnight. CONCLUSION SpRs trained during the Calman era appear to be gaining less operative experience than their predecessors in both the elective and emergency settings. With further changes in working patterns currently being implemented, major changes to SpR programmes are required if surgeons are to be adequately trained.
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Affiliation(s)
- G Morris-Stiff
- Department of Surgery, Royal Glamorgan Hospital, Ynysmaerdy, Llantrisant, CF72 8XR, Rhonda Cynon Taf
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Ogunbiyi SO, Morris-Stiff G, Sheridan WG. Giant mature cyst formation following mesh repair of hernias: An underreported complication? Hernia 2004; 8:166-8. [PMID: 14735327 DOI: 10.1007/s10029-003-0201-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2003] [Accepted: 11/27/2003] [Indexed: 11/25/2022]
Abstract
BACKGROUND Numerous complications have been described following the implantation of synthetic meshes during hernia repair; one of the rarest, with only three reported cases, is giant mature fibrous cyst formation. Our clinical experience with this complication has led us to believe that it may be more common than previously thought. METHODS Surgical operation notes and pathology archives were reviewed for the period January 1998-January 2002 to determine the prevalence of mature cyst formation following mesh repair of hernias. RESULTS Out of 1100 hernia repair operations involving the use of synthetic meshes in our institution during the period of study, five developed histologically confirmed mature fibrous cysts giving a prevalence of 0.45% for this complication. CONCLUSION The formation of a giant mature cyst following mesh repair of hernias is an underreported complication.
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Affiliation(s)
- S O Ogunbiyi
- Department of General Surgery, West Wales General Hospital, SA31 2AF, Carmarthen, Wales United Kingdom.
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Morris-Stiff G, Steel A, Savage P, Devlin J, Griffiths D, Portman B, Mason M, Jurewicz WA. Transmission of donor melanoma to multiple organ transplant recipients. Am J Transplant 2004; 4:444-6. [PMID: 14962000 DOI: 10.1111/j.1600-6143.2004.00335.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Malignant melanoma represents the most common tumour responsible for donor-derived post transplantation malignancies. We report the varied presentation and outcome of three graft recipients (two kidney and hepatic) who developed metastatic melanoma following cadaveric organ transplantation from a single multiorgan donor. Two of the recipients presented with symptomatic metastatic lesions and the third patient, despite being carefully monitored, developed evidence of metastatic cutaneous melanoma. Two of the patients died as a direct result of their melanomas. The recipients of corneal and cardiac grafts remain disease-free. We conclude that despite careful screening, donor-derived tumours remain a not uncommon clinical entity. The identification of a lesion in one recipient should prompt immediate examination and investigation of the remaining recipients of multiorgan donations.
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Affiliation(s)
- G Morris-Stiff
- University of Wales College of Medicine, Cardiff, Wales, UK
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Abstract
BACKGROUND Hyperhomocysteinemia is a recognised independent risk factor in the genesis of atherosclerotic diseases. However, very little is known about the relationship between homocysteine and abdominal aortic aneurysm (AAA). Vitamins, namely B12 and folic acid have been implicated in the regulation of plasma homocysteine levels. However, there has been no prospective study that has analysed the relationship of AAA and plasma homocysteine in light of serum vitamin levels. AIMS To study the relationship between plasma homocysteine, serum B12 and folic acid levels, and AAA. METHOD Case control study including 38 AAA patients and 36 controls. Fasting homocysteine, B12 and folic acid were determined in serum separated within 1 h of blood collection using a fluorescence polarisation immunoassay technique (FPIA). RESULTS Twenty-six (68%) of the AAA patients had elevated levels of homocysteine compared to 2 (6%) in the case control group. The mean homocysteine level in the AAA group was 19.4 micromol/L (SE +/- 1.1) (95% CI 17.17-21.65) and in the control group was 10.9 micromol/L (SE +/- 1) (95% CI 9.95-11.88) (p<0.001). Mean vitamin B12 levels in the AAA and the controls was 332.11 pg/L (SE +/- 16.44) and 414.33 pg/L (SE +/- 19.72), respectively (p<0.004). Mean folic acid in the AAA was 8.02 (SE +/- 0.71) and the control was 9.8 etagm/L (SE +/- 0.69), (ns). CONCLUSION This study confirms significantly higher levels of plasma homocysteine in AAA patients but lower levels of B12. Use of supplemental vitamins that should lower plasma homocysteine may modify vascular disease progression. Clinical trials in this direction are warranted.
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Affiliation(s)
- A A Warsi
- Royal Glamorgan Hospital, Ynysmaerdy, Llantrisant, Rhondda Cynon Taff, S Wales, UK
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Ogunbiyi SO, Coxon M, Morris-Stiff G, Ram R, Lewis MH. Non-arteritic anterior ischaemic optic neuropathy: A new indication for carotid endarterectomy. Phlebology 2002. [DOI: 10.1007/bf02638607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Ogunbiyi SO, Coxon M, Morris-Stiff G, Ram R, Lewis MH. Non-Arteritic Anterior Ischaemic Optic Neuropathy: A New Indication for Carotid Endarterectomy. Phlebology 2002. [DOI: 10.1177/026835550201700311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We present a case of non-arteritic anterior ischaemic optic neuropathy (NAION) associated with ipsilateral internal carotid artery stenosis, in a patient who presented with sudden loss of vision. This patient underwent a carotid endarterectomy and reported both subjective and objective improvement in vision in the immediate postoperative period and a complete resolution of symptoms at 6 weeks follow-up. This case raises the question of a new indication for carotid endarter-ectomy in selected cases of NAION.
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Affiliation(s)
- S. O. Ogunbiyi
- Department of Surgery, Royal Glamorgan Hospital, Llantrisant, Rhondda, UK
| | - M. Coxon
- Department of Surgery, Royal Glamorgan Hospital, Llantrisant, Rhondda, UK
| | - G. Morris-Stiff
- Department of Surgery, Royal Glamorgan Hospital, Llantrisant, Rhondda, UK
| | - R. Ram
- Department of Surgery, Royal Glamorgan Hospital, Llantrisant, Rhondda, UK
| | - M. H. Lewis
- Department of Surgery, Royal Glamorgan Hospital, Llantrisant, Rhondda, UK
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Abstract
Patients with concomitant abdominal aortic aneurysm (AAA) and intra-abdominal malignancy present a clinical dilemma because of the difficulty in deciding which pathology to address first. As this scenario is not commonly encountered, clear guidelines are not available to help in the decision-making process. Surgery for malignancy has been said to increase the risk of postoperative aneurysm rupture, but simultaneous cancer surgery and primary repair of the aneurysm may carry the risk of prosthetic graft infection. This paper describes a further complication that may arise in the setting of concomitant intra-abdominal malignancy carcinoma and AAA, namely peripheral embolism.
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Affiliation(s)
- K Somasekar
- Royal Glamorgan Hospital, Llantrisant, Rhondda, Cynon Taff CF72 8XR
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Abstract
Over the past three decades major advances have been made in the diagnosis and management of mesenteric ischaemia. Early identification and treatment of this condition has reduced its mortality and morbidity. This review discusses the causes, preliminary and definitive investigations, and treatment protocols relating to gut ischaemia.
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Affiliation(s)
- S Shetty
- Department of General Surgery, Royal Glamorgan Hospital, Llantrisant CF72 8XR
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Morris-Stiff G, Rees J, Woodsford P, Lewis M. Vascular 03. Br J Surg 2002. [DOI: 10.1046/j.1365-2168.89.s.1.10_3.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Balachandra S, Morris-Stiff G, Sheridan W. Six of the Best, Colorectal 22. Br J Surg 2002. [DOI: 10.1046/j.1365-2168.89.s.1.16_6.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Morris-Stiff G, Marshall S, Haldar N, Welsh K, Quiroga I, Jurewicz W. Transplantation 05. Br J Surg 2002. [DOI: 10.1046/j.1365-2168.89.s.1.29_5.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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McLaren A, Morris-Stiff G, Casey J. Issues of consent in renal transplantation. Ann R Coll Surg Engl 2001; 83:343-6. [PMID: 11806563 PMCID: PMC2503410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND Renal transplantation is a semi-elective procedure. The specific risks of surgery are well-known. Obtaining informed consent is a complex process made more complicated in transplantation by the long-term nature of some of the risks involved. METHODS A questionnaire survey was conducted of consultant transplant surgeons to establish current practice regarding the levels of information and risks discussed as part of the consent process. RESULTS Responses were received from 47 (76%) of consultants. Risks were discussed by a range of individuals. Pre-assessment clinics were used by 70% of units to start the process. Only 74% routinely discussed malignancy and only 75% the risks of cytomegalovirus infection. Risks with individual organs were discussed by 32 (68%)--particularly HLA match, cold ischaemia, sensitisation, donor age and caused of donor death. CONCLUSIONS The current practice identified by this study falls broadly within General Medical Council guidelines on informed consent. There is wide variation in current practice which is highlighted and discussed in relation to case law and the levels of risk that a patient should expect to be informed of.
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Affiliation(s)
- A McLaren
- High Wycombe General Hospital, Buckinghamshire, UK
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Quiroga I, Morris-Stiff G, Baboo R, Darby CR, Lord RH, Jurewicz WA. Differential homocysteine levels in renal transplant patients receiving neoral versus tacrolimus. Transplant Proc 2001; 33:1209-10. [PMID: 11267261 DOI: 10.1016/s0041-1345(00)02389-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- I Quiroga
- Welsh Transplant Research Group, Cardiff, United Kingdom
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Janezic AL, Bukilica M, Jones GV, Khanna R, Morris-Stiff G, Jurewicz WA. Alternatively spliced variants of IL-2 mRNA in sequential transplant kidney core needle biopsies. Transplant Proc 2001; 33:383-6. [PMID: 11266873 DOI: 10.1016/s0041-1345(00)02059-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- A L Janezic
- Welsh Transplantation Research Group, Department of Surgery, UWCM, Cardiff, UK
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Quiroga I, Morris-Stiff G, Baboo R, Griffiths D, Baboola K, Moore R, Darby C, Lord R, Jurewicz AW. The new Banff classification of renal transplant biopsies: a major impact on the adequacy of the cores taken. Transplant Proc 2001; 33:1154-5. [PMID: 11267234 DOI: 10.1016/s0041-1345(00)02439-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- I Quiroga
- Renal Transplant Unit, University Hospital of Wales, Cardiff, United Kingdom
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