Papers by William Isbister
BMJ, Mar 14, 1998
The magic of seven was reaffirmed in this journal in 1996 by Professor Ian Stewart (BMJ 1996;313:... more The magic of seven was reaffirmed in this journal in 1996 by Professor Ian Stewart (BMJ 1996;313:1570). After reading the editorial I began musing over my own personal relationship with the BMJ. I soon realised that it, too, was a function of seven, there being so far seven phases of the relationship. My father was a general practitioner in Old Trafford, and at one time an appreciative old patient had given him an antique desk which had a glass fronted bookcase on top of it. The bookcase had been separated from the desk and placed in our hall. Whenever I saw the bookcase it was piled to overflowing with unopened brown BMJ packages. I remember, too, how difficult it was to open a roll and how even more difficult it was to straighten the journal out in order to read it. Since my father was faced with a busy general practice in those war torn days of nightly air raids the rolls often ended unopened in the waste paper basket when I got my first chance to play with them. In 1952 I entered medical school, and it was not long before we were being encouraged to read our own journals and to take out a subscription for at least one of them. In those days there was no studentBMJ, and I declined to have a subscription of my own, thinking that I could easily look at my father’s journals. The contents seemed to be entirely irrelevant to my life as an undergraduate, and as I was studying for my second MB examination I could see no relevance for the journal at all. In 1958, to my parents’ delight and without much help from the BMJ, I graduated and became a house surgeon at my teaching hospital. I immediately joined the BMA and began to receive my own unopenable rolls. The difficulty with opening and straightening persisted, and being a keen young hospital doctor immersed in clinical problems, I had little time to examine what seemed to be the esoteric contents of a journal that had little meaning to me. As I came to the end of my preregistration year, the need to find my next job loomed large. I had already determined that I wished to become a surgeon, and so I turned to the surgical section of the classified advertisements in the BMJ for help. For the first time I found that the journal actually had some relevance for me. I continued to use it whenever I needed to change position. And when I returned from the United States to find that I was a time expired senior registrar, I turned to the BMJ with even greater vigour. I had, by this time, decided that I wished to pursue a career in academic surgery, although the change from the NHS to academia at this late stage proved to be quite difficult. I had enthusiastically but unsuccessfully attended several interviews for senior lecturer posts and, after an interview in Edinburgh, was taken aside by a senior member of the appointments committee who told me that it would be difficult to change streams in Britain and that I should be prepared to travel to wherever an academic surgical position became available. To my great delight, in my next BMJ I found an Australian university looking for a senior lecturer in surgery, and after a successful interview my wife and our three children set sail. In Australia my BMJ was delivered by airmail; it was much easier to unpack, but now it was missing the classified advertisements, something that I missed enormously. In my new position of responsibility I began intermittently to scan the journal, collecting several editions for one session and tearing out those papers concerning medical education and surgery that were of interest to me. During the succeeding 18 years, first as a senior lecturer and then as a professor, I managed without my advertisements and became an intermittent reader. “I am reading the journal in a way that might gain editorial approval” Now close to retirement, for the first time in my life I read the BMJ (still the airmail edition) regularly. I seem to have more time for editorials and news items. I read all the papers relating to my own discipline, although they are rather infrequent, and I scan the rest of the journal and read anything else that seems to take my fancy. I feel that for the first time in my life I am reading the journal in a way that might gain editorial approval. This may be due partly to my own increased experience and slowly acquired wisdom and partly to the fact that I seem to have a little more time. But perhaps the major reason is that the journal has now become not only easier to get out of the wrapping but more relevant and readable than it used to be during my own formative years. The penultimate phase of my relationship is an electronic one because now I can access the BMJ on the Internet. The classified advertisements are at last available again but, of course, they are also now of more interest than importance. It is nice to find that I once again have access to the complete journal. The final phase of this relationship will be to have a small contribution published in some part of the…
Anz Journal of Surgery, Feb 1, 1995
ABSTRACT
Anz Journal of Surgery, Aug 1, 1995
All patients with pilonidal disease (abscess or sinus) managed surgically ('l... more All patients with pilonidal disease (abscess or sinus) managed surgically ('laying open') between 1975 and 1990 in the Colorectal Service, University Department of Surgery, Wellington School of Medicine were reviewed. A total of 323 operations (177 males, 146 females) were performed in 311 patients. Seven males and 5 females required two operations before satisfactory healing was achieved (recurrence rate 3.8%). Males were older than females (mean, 26.4 vs 21.5 years). One patient's wound bled following surgery and required immediate repacking. There were no other wound problems. One hundred and seventy-seven patients presented acutely with pilonidal abscess and 146 patients presented with pilonidal sinus. Patients with pilonidal abscess were younger than those with pilonidal sinus (male, 25.8 vs 26.9 years and female, 20.8 vs 23.5 years). There were proportionately more Maori patients who presented acutely. 'Laying open' under general anaesthesia seems to be a safe and successful method for managing pilonidal disease in all but the few patients in whom multiple operations have been performed previously or in those in whom healing has failed to occur. Based on our initial experience of 'day case' surgery the procedure could safely be done on an outpatient basis.
The Lancet, Dec 1, 1986
Fine-catheter aspiration cytology of the peritoneal cavity was successfully undertaken in 25 of 2... more Fine-catheter aspiration cytology of the peritoneal cavity was successfully undertaken in 25 of 27 hospital inpatients with acute abdominal pain because it was not clear whether they required urgent laparotomy. Cytological specimens were prepared by the cyto-sieve technique. The main test criterion was the percentage of neutrophils in the peritoneal cell sample. The decision before the test about urgent laparotomy was correct in 14 of the 27 patients, whereas the decision after the test was correct in 26 of the 27 patients (p = 0.001). 4 patients were saved unnecessary laparotomy and 8 further delay in laparotomy.
PubMed, 1998
Full text is available as a scanned copy of the original print version.
Anz Journal of Surgery, Aug 1, 1995
Acute ischaemic colitis is a well recognized complication following abdominal aortic surgery. It ... more Acute ischaemic colitis is a well recognized complication following abdominal aortic surgery. It may occur spontaneously in older patients and is probably due to diffuse or localized obliterative arterial disease. In contrast, acute ischaemic proctitis is a rare clinical problem. It is caused by an acute surgical or thromboembolic interruption of the major blood supply and or collateral circulation of the rectum. Minor ischaemia may result in superficial mucosal ulceration whereas a major ischaemic episode will result in rectal necrosis with perforation. Acute rectal necrosis has not been reported as a complication following anterior resxtion of the rectum. This paper details a patient who developed necrosis of the rectum and the anal canal following anterior resection of the rectum for cancer of the recto‐sigmoid junction.
Journal of Gastroenterology and Hepatology, Nov 1, 1998
Non‐specific Inflammatory Bowel disease (IBD) is infrequently seen in the Arabs of the Arabian Pe... more Non‐specific Inflammatory Bowel disease (IBD) is infrequently seen in the Arabs of the Arabian Peninsula. This paper documents the presentation and initial management of 101 such Arabs treated for inflammatory bowel disease between 1976 and 1994. Medical records were examined and patients were classified according to the Organisation Mondiale de Gastroenterologie diagnostic scoring system. Sixty‐seven patients had mucosal ulcerative colitis, 28 Crohn's disease (CD) and six indeterminate colitis; age range 2–71 years. Three patients had a family history of (IBD). The diagnosis was made by a combination of the patients’ history, physical, radiological, endoscopic and histological examination; however, eight patients were not examined endoscopically and one in four patients was not biopsied at presentation. Thirty‐nine patients did not receive any treatment prior to referral. One in three patients was first treated as inpatients. Giardia, Amoeba, Salmonella, Shigella or Schistosoma were detected in the stools of 36 patients at presentation. Following appropriate treatment, these infections were eliminated but the patients’ symptoms persisted. Six patients who were thought to have gastrointestinal tuberculosis were subsequently diagnosed with CD. Ten patients had extraintestinal manifestations of their IBD and 11 had side effects (osteoporosis, Cushingoid features and growth retardation) from steroid treatment at other hospitals. Diagnosis was often delayed because infectious diarrhoea was common and awareness was low. Patients were referred late and some had developed complications of therapy.
Anz Journal of Surgery, Jun 1, 1992
This study compares colorectal cancer from the King Faisal Specialist Hospital and Research Cente... more This study compares colorectal cancer from the King Faisal Specialist Hospital and Research Center (KFSHRC) Tumour Registry in patients under and over 40 years and contrasts the data with registry data from New Zealand (NZ). Between 1975 and 1989 622 patients were registered at KFSHRC and 528 were Saudi. Three hundred and twenty-one were male and 207 were female. The average ages were 55.3 and 49.6. One hundred and nineteen were less than 40 years. More patients with proximal lesions were less than 40 years. Of the young patients 8.3% had small tumours (less than 4 cm) compared with 24.9% of patients over 40. Mucinous and signet ring carcinomata were more common in the young. Tumours were less well differentiated in younger patients. There were more young patients with 'localized' disease and nodal involvement. Older patients had more distant metastases. Of patients registered in NZ 5.5% were young compared with 23% of Saudi patients. In both countries localized disease was more common in the young. Nodal involvement was more frequently seen in the young in the Kingdom of Saudi Arabia (KSA) whereas the opposite was true in NZ. Distant metastases were more common in the old in the KSA but there were more young patients with metastases in NZ. In both countries young females with rectal tumours were more common but this ratio was reversed in the old. This study suggests that colorectal cancer may be more aggressive in the young in KSA but there was no evidence that the disease was more aggressive in young New Zealanders. Differences in the epidemiology of the disease in the young and old were found in both countries.
British Journal of Cancer, 1974
The leucocyte adherence inhibition (LAI) test, previously described for the detection of cell med... more The leucocyte adherence inhibition (LAI) test, previously described for the detection of cell mediated immunity and serum blocking factors associated with murine tumours, has now been adapted for use with human cancer patients. Blood leucocytes from these patients, mixed in vitro with antigenic extracts of tumours of the same type, had their normal adherence to glass surfaces diminished. This inhibition was reversed (blocked) by the addition of the patients' own sera. Both LAI and blocking were tumour-type specific, but showed complete cross-reactivity within each type of tumour (melanoma, colon carcinoma, mammary carcinoma). The LAI test could be of great value in diagnosis and evaluation of treatment, since it seems to reproduce consistently the findings made by more elaborate techniques but has the advantage of being simple, rapid and inexpensive.
Annals of Saudi Medicine, May 1, 1992
This study documents the epidemiological aspects of squamous cell carcinoma of the anus and anal ... more This study documents the epidemiological aspects of squamous cell carcinoma of the anus and anal canal as it has presented to the King Faisal Specialist Hospital and Research Centre (KFSH&RC). Thirty-eight (33 Saudis) patients, 24 males and 14 females were studied. They ranged in age from 32 to 100 years. Twenty-four had anal canal tumors and 12 had anal margin cancers. Riyadh, the Eastern Province or Medina provided most patients and the majority presented with bleeding, a lump or pain. Symptom duration ranged from one month to more than two years. Fourteen had previous anal problems. There was an almost equal distribution of lesions between the anterior and posterior halves of the anus. Nineteen had clinically normal inguinal nodes. Thirty had squamous cell carcinoma (epidermoid) and eight had cloacogenic/basiloid tumors. Most tumors were either moderately or poorly differentiated. Twenty-eight presented with T3 or T4 tumors and only ten presented with T1 or T2 tumors. Five had evidence of metastases at initial presentation. Eight were treated by abdominoperinal resection of the rectum. A diversion colostomy was performed in six. Fifteen received radiotherapy alone but only three were treated by chemotherapy alone. Combination chemotherapy and radiotherapy was given to 14. More males than females had both anal canal and anal margin tumors. Patients with anal margin tumors were on average ten years older. There were twice as many with anal canal as anal margin tumors. There were more node-positive patients with anal margin tumors. Anal canal tumors were less well-differentiated. Follow-up was inadequate.
Coloproctology, Apr 1, 2003
ABSTRACT Introduction:At some time, every general surgeon will be faced with the task of trying t... more ABSTRACT Introduction:At some time, every general surgeon will be faced with the task of trying to decide what to do with a patient who presents with rectal cancer and unresectable distant metastases. What advice should be given? Should the primary tumor be resected despite the incurability of the disease? Should only a defunctioning stoma be raised or should the patient be just treated symptomatically? In an attempt to answer some of these questions the management and outcomes of all patients with rectal cancer and distant metastases, who were primarily referred to the colorectal unit for surgery, were examined.Patients and Methods:The database was searched for patients who underwent primary surgery for rectal cancer in the presence of metastatic disease. The charts of the patients identified were examined and their morbidity, mortality and survival were determined.Results:Over an 8-year period 22 patients (average age 54 years) underwent rectal resectional surgery in the presence of metastatic disease. There were 13 men and nine women. The commonest complaint was rectal bleeding. All patients had chest radiographs. Four pulmonary metastases were identified. 19 abdominal and pelvic CT scans were performed and eight showed evidence of metastases.Skeletal radiographs in two patients showed evidence of bone metastasis. At operation, intraperitoneal metastases were found in 18 patients. Nine of these patients were not identified preoperatively.Six patients underwent abdominoperineal resection, nine anterior resection and seven a Hartmanns procedure. Eight patients (36.4%) developed a significant postoperative complication and one died 42 days after surgery. The mean length of hospital stay was 18.6 days.Nine patients received preoperative radiotherapy. Four patients had palliative radiotherapy, two for bony, one for liver and one for peritoneal metastases.The Patients were followed up for a mean of 1.1 years. During the follow-up, eleven returned to the emergency room (ER) on 24 occasions. Two patients required readmission. No patient had further rectal bleeding. The mean survival was 1.3 years.Conclusions:Patients with rectal cancer and unresectable distant metastases can be successfully palliated by resection of the primary tumor with low morbidity and mortality. The early involvement of a palliative care team facilitates patient management and helped patients enjoy what remained of the rest of their lives at home, in comfort and with good symptom control.Einfhrung:Irgendwann im Laufe des Berufslebens wird jeder Allgemeinchirurg vor die Frage gestellt, wie er einen Patienten behandeln soll, der an einem Rektumkarzinom mit nicht resezierbaren Fernmetastasen leidet. Wie soll dabei vorgegangen werden? Sollte der Primrtumor reseziert werden trotz der Unheilbarkeit der Erkrankung? Sollte nur ein ableitendes Stoma angelegt oder der Patient nur symptomatisch behandelt werden? Um einige dieser Fragen beantworten zu knnen, wurden die Behandlung und die Ergebnisse aller Patienten mit Rektumkarzinom und Fernmetastasen untersucht, die primr in eine Abteilung fr Kolorektalchirurgie aufgenommen worden waren.Patienten und Methoden:Die Datenbank wurde nach Patienten durchsucht, die sich einer primren Operation wegen eines Rektumkarzinoms bei Vorliegen von Fernmetastasen unterzogen hatten. Die Krankenbltter der entsprechenden Patienten wurden ausgewertet und ihre Morbiditt, Mortalitt und die berlebenszeiten bestimmt.Ergebnisse:ber einen Zeitraum von 8 Jahren unterzogen sich 22 Patienten (Durchschnittsalter 54 Jahre) einer Rektumresektion bei Vorhandensein von Fernmetastasen. Es handelte sich um 13 Mnner und neun Frauen. Das hufigste Symptom stellten Rektumblutungen dar. Bei allen Patienten wurde ein Rntgenthorax durchgefhrt. Dabei wurden vier Lungenmetastasen entdeckt. Von Abdomen und Becken wurden 19 CT-Scans durchgefhrt, wobei in acht Fllen Metastasen nachgewiesen werden konnten.Rntgenaufnahmen des Skeletts zeigten bei zwei Patienten das Vorhandensein von Knochenmetastasen. Intraoperativ fanden sich bei 18 Patienten intraperitoneale Metastasen, von denen neun properativ nicht identifiziert worden waren.Bei sechs Patienten erfolgte eine abdominoperineale Resektion, in neun Fllen eine anteriore Resektion und in sieben eine Hartmann-Operation. Bei acht Patienten (36,4%) entwickelte sich eine signifikante postoperative Komplikation, einer verstarb 42 Tage nach der Operation. Der durchschnittliche Krankenhausaufenthalt betrug 18,6 Tage.Bei neun Patienten wurde properativ eine Strahlentherapie durchgefhrt. Bei vier Patienten erfolgte die Radiotherapie nur palliativ, in zwei Fllen wegen Metastasen in den Knochen, in einem Fall wegen Metastasen in der Leber und bei einem wegen peritonealer Metastasen.Die Patienten wurden durchschnittlich 1,1 Jahre nachuntersucht. Whrend des Nachuntersuchungszeitraumes mussten elf Patienten bei 24 Gelegenheiten notfallmig behandelt werden. Zwei Patienten wurden erneut stationr aufgenommen. Bei…
Anz Journal of Surgery, 1986
Studies on cell mediated immunity in patients with colo-rectal cancer: leucocyte migration inhibi... more Studies on cell mediated immunity in patients with colo-rectal cancer: leucocyte migration inhibition test using allogenic 3M KCL extract.
Anz Journal of Surgery, Mar 1, 1988
The Surgical Research Society of Australasia organized a workshop in October 1984 to consider how... more The Surgical Research Society of Australasia organized a workshop in October 1984 to consider how to maximize the effectiveness of the Society and its meetings. Four working parties addressed the aims and directions of the Society, the planning of meetings, the selection and presentation of papers. and education in surgical research. An overview of the workshop is presented in abbreviated form.
Anz Journal of Surgery, Apr 1, 1998
Anz Journal of Surgery, May 1, 1975
ABSTRACT
Anz Journal of Surgery, Feb 1, 1999
Annals of Saudi Medicine, Jul 1, 1999
Surgical trainees often feel that their operative training is inadequate--trainers usually do not... more Surgical trainees often feel that their operative training is inadequate--trainers usually do not share this view. The distribution of colorectal operative surgical workloads between consultants and trainees was examined over a 15-year period in the Colorectal Service at the Wellington School of Medicine. Consultants performed 947 operations and trainees performed 1012 operations. The average age of patients operated on by trainees was lower than that of those operated on by consultants. Trainees performed more emergency surgery. Anorectal surgery, except fistula surgery, was more commonly performed by trainees, whereas abdominal colorectal surgery was more commonly performed by consultants. Trainees had lower postoperative morbidity and mortality rates. The diseases predominantly treated by consultants and trainees differed. Twenty-four percent of patients with colorectal cancers and 25% of patients with diverticular disease were managed operatively by trainees. Yearly trainee workloads for minor anorectal conditions were similar to those of trainees in the USA. Although this small colorectal audit provides some information about trainees' operative experience, until all surgical procedures performed by all surgical trainees are accurately audited and criteria for adequacy of operative training are clearly stated, it will not be possible to say whether our training programs provide adequate operative training or not.
Uploads
Papers by William Isbister