• Effect of abdominal irradiation on growth in boys treated for a Wilms' tumor.

      Wallace, W Hamish B; Shalet, Stephen M; Morris-Jones, P H; Swindell, Ric; Gattamaneni, Rao; Department of Endocrinology, Christie Hospital, Manchester, England. (1990)
      To study the effect of abdominal irradiation on spinal growth in childhood we have measured final height, sitting height, and leg length in 30 male survivors of a Wilms' tumor. Twenty-one patients received whole abdominal irradiation by either megavoltage therapy (MV: n = 11) or orthovoltage therapy (OV: n = 10); the remainder received flank irradiation. To examine the effect of the adolescent growth spurt on the irradiated spine we have followed prospectively seven patients who received whole abdominal irradiation and nine patients who received flank irradiation through puberty. Compared to a normal population there is a modest reduction in median final standing height SDS (H.SDS: -1.15) accompanied by a marked reduction in median final sitting height SDS (S.HT SDS: -2.41) with no apparent effect on median subischial leg length SDS (SILL.SDS: 0.04). This reduction in spinal growth is reflected by a strongly positive disproportion score (DPS; [SILL SDS-S.HT SDS] + 2.81). The incidence of scoliosis after abdominal irradiation has been low (10%). During puberty there is a significant fall in median sitting height SDS after both whole abdominal (median fall: -0.9, P = 0.02) and flank irradiation (median fall: -1.85, P = 0.01), and this is reflected in a significant increase in disproportion (DPS: whole abdominal; median rise +1.4, P = 0.02: flank, median rise +1.34, P = 0.01). After MV irradiation there is a significant correlation between the degree of disproportion and the age at treatment (P less than 0.0005). The younger the patient is at treatment the more severe is the restriction on spinal growth and the shorter and more disproportionate they become as an adult. The estimated eventual loss in potential height from abdominal irradiation at the age of one is 10 cm and at five years is 7 cm.
    • The inpatient burden of abdominal and gynecological adhesiolysis in the US.

      Sikirica, V; Bapat, B; Candrilli, S D; Davis, K L; Wilson, Malcolm S; Johns, A; Shire Pharmaceuticals, Wayne, PA 19087, USA. (2011)
      Adhesions are fibrous bands of scar tissue, often a result of surgery, that form between internal organs and tissues, joining them together abnormally. Postoperative adhesions frequently occur following abdominal surgery, and are associated with a large economic burden. This study examines the inpatient burden of adhesiolysis in the United States (i.e., number and rate of events, cost, length of stay [LOS]).
    • Ovarian failure following abdominal irradiation in childhood: the radiosensitivity of the human oocyte.

      Wallace, W Hamish B; Shalet, Stephen M; Hendry, Jolyon H; Morris-Jones, P H; Gattamaneni, Rao; Department of Endocrinology, Christie Hospital, Manchester. (1989-11)
      Ovarian function has been studied sequentially since 1975 in 19 patients treated in childhood for an intra-abdominal tumour with surgery and whole abdominal radiotherapy (total dose 30 Gy). Eleven patients received chemotherapeutic agents that are not known to cause gonadal dysfunction. All but one patient have developed ovarian failure with persistently elevated gonadotrophin levels (FSH and LH greater than 32 IU/litre) and low serum oestradiol values (less than 40 pmol/litre) before the age of 16 years. The majority (n = 12) did not progress beyond breast stage 1 without sex steroid replacement therapy. As the number of oocytes within the ovary declines exponentially by atresia from approximately 2,000,000 at birth to approximately 2000 at the menopause, we have been able to estimate that the LD50 for the human oocyte does not exceed 4 Gy.
    • Postoperative adhesions: ten-year follow-up of 12,584 patients undergoing lower abdominal surgery.

      Parker, M C; Ellis, H; Moran, B J; Thompson, Jeremy N; Wilson, Malcolm S; Menzies, D; McGuire, A; Lower, A M; Hawthorn, R J; O'Briena, F; et al. (2001-06)
      PURPOSE: Postoperative adhesions are a significant problem after colorectal surgery. However, the basic epidemiology and clinical burden are unknown. The Surgical and Clinical Adhesions Research Study has investigated the scale of the problem in a population of 5 million. METHODS: Validated data from the Scottish National Health Service Medical Record Linkage Database were used to define a cohort of 12,584 patients undergoing open lower abdominal surgery in 1986. Readmissions for potential adhesion-related disease in the subsequent ten years were analyzed. The methodology was conservative in interpreting adhesion-related disease. RESULTS: In the study cohort 32.6 percent of patients were readmitted a mean of 2.2 times in the subsequent ten years for a potential adhesion-related problem. Although 25.4 percent of readmissions were in the first postoperative year, they continued steadily throughout the study period. After open lower abdominal surgery 7.3 percent (643) of readmissions (8,861) were directly related to adhesions. This varied according to operation site: colon (7.1 percent), rectum (8.8 percent), and small intestine (7.6 percent). The readmission rate was assessed to provide an indicator of relative risk of adhesion-related problems after initial surgery. The overall average rate of readmissions was 70.4 per 100 initial operations, with 5.1 directly related to adhesions. This rose to 116.4 and 116.5, respectively, after colonic or rectal surgery-with 8.2 and 10.3 directly related to adhesions. CONCLUSIONS: There is a high relative risk of adhesion-related problems after open lower abdominal surgery and a correspondingly high workload associated with these readmissions. This is influenced by the initial site of surgery, colon and rectum having both the greatest impact on workload and highest relative risk of directly adhesion-related problems. The study provides sound justification for improved adhesion prevention strategies.
    • Practicalities and costs of adhesions.

      Wilson, Malcolm S; Department of Surgery, Christie Hospital, Manchester, UK. malcolm.wilson@christie.nhs.uk (2007-10)
      In spite of postoperative adhesions being common there appears to be a reluctance to use anti-adhesion products routinely. This article compares the incidence of adhesions with other conditions in order to identify the level of risk. The health economics surrounding adhesion-related disease are described. This combined information may be of help to convince health practitioners of the need to take a more active role in adhesion prevention. The SCAR project has identified the risk of adhesion-related disease. This is compared with published risks of other common clinical situations. An economic model first described by the author in 2002 has been revised with 2006 costs [1]. The SCAR data demonstrates a directly related risk of re-admission in certain groups of 9.4% over 5 years [2]. The frequency of including this fact in the consenting process is low (<15%) [3]. Legal precedent has identified a risk of >2% warrants inclusion in the consent process; failure to do so could be considered negligent [4]. Use of an anti-adhesion product with a cost of 130 euros with an efficacy of 25% in 1 year in the UK could save over 40 million euros over a 10-year period. Adhesion risk is frequent enough to include in consent. Failure to do this and avoidance of treatment, which may reduce adhesions will have major financial consequences on healthcare systems.
    • Radiation exposure to patients during radiological examinations of the gastro-intestinal tract: intrahospital dose variations.

      Tole, N M; Regional Department of Medical Physics and Bioengineering, Christie Hospital and Holt Radium Institute, Manchester (1984-04)
      Skin and gonad doses have been measured in 144 adult patients undergoing barium meal and barium enema examinations at a University Teaching Hospital. Intrahospital variations are discussed and their implications for national dose surveys considered. It is suggested that, due to differences in leakage and scattered radiation levels, overcouch tube machines may deliver higher doses to organs outside the useful beam than undercouch units. The study also points towards increased film consumption in GIT studies.
    • The role of computed tomography of the abdomen in the diagnosis and staging of patients with lymphoma.

      Crowther, Derek; Blackledge, G; Best, J; Christie Hospital and Holt Radium Institute, Manchester (1979-10)
    • Upper abdominal lymphadenopathy as first presentation of relapse, identified by ultrasonography, in patients treated for small cell (oat cell) bronchogenic carcinoma.

      Smith, David B; Johnson, Richard J; James, Roger D; Thatcher, Nick; Cancer Research Campaign Department of Medical Oncology, Christie Hospital & Holt Radium Institute, Manchester M20 9BX, UK. (1985-04)
      Ten patients treated for 'limited' stage small cell lung cancer presented during follow-up with epigastric or back pain together with nausea and/or vomiting. Upper abdominal lymphadenopathy was shown to be the first symptomatic site of relapse. A single fraction of radiotherapy provided a convenient, effective form of palliation. Ultrasound scanning proved an accurate, readily available technique for the diagnosis of this form of intra-abdominal disease.