Duncan Stewart

Duncan Stewart
Betsi Cadwaladr University Health Board, Wrexham · Upper GI Surgery

MD

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37
Publications
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Publications

Publications (37)
Article
Introduction The Glasgow Blatchford score is a risk scoring tool used to predict the need to treat patients presenting with upper gastrointestinal bleeding. NICE guidelines suggest patients with a score of zero can be considered for safe early discharge. Aims/Background As far as we know there are no UK studies validating this scoring system. We ai...
Article
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The incidence and management of peptic ulcer disease have changed considerably since the first surgical interventions, carried out less than a century ago. Operative techniques refined during the early second half of the 20th century have become almost obsolete in today’s practice for two principal reasons. Firstly, understanding of the aetiology o...
Article
A sixty-one year old man was referred with a history of progressive dysphagia, vomiting and weight loss with some back pain. Upper gastrointestinal endoscopy and biopsies revealed a gastro-oesophageal junction adenocarcinoma. Despite the absence of metastatic disease on computed tomography, positron emission tomography demonstrated multiple vertebr...
Article
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As well as being relatively rare, osseous metastases from colorectal cancer are frequently asymptomatic and represent a late manifestation of disease. We report a case of an unidentified, asymptomatic coccygeal metastasis discovered on histological processing of the resection specimen from a patient with locally advanced rectal cancer treated with...
Article
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Although unusual, chyle leak following oesophagectomy is a recognised complication affecting 2-4% of patients. We describe the hitherto unreported sequelae of a chyle leak causing cardiovascular compromise secondary to pericardial tamponade 13 days after Ivor-Lewis oesophago-gastrectomy.
Article
22034 Background: The phosphatidylinositol-3 kinase (PI3K)/Akt (PKB) pathway is activated in many solid tumours, and plays a central role in cell survival. Recent evidence indicates that hypoxia induces upregulation and activation of the PI3K/Akt pathway. Once activated, Akt phosphorylates a variety of downstream substrates, including the pro-apopt...
Article
To examine the short- and long-term results of right extrapleural pneumonectomy (EPP) for malignant pleural mesothelioma (MM) via median sternotomy or thoracotomy. We analysed the results of EPP in consecutive patients with early stage MM undergoing a radical surgery protocol for MM over a 7-year period. Initially thoracotomy, but later median ster...
Article
We sought to examine the distribution and prognostic implications of nodal metastasis in patients undergoing extrapleural pneumonectomy for malignant mesothelioma in a specialist center. We have examined the lymphadenectomy specimens from 92 consecutive cases of malignant mesothelioma undergoing extrapleural pneumonectomy from September 1999 throug...
Article
Although pulmonary resections have been performed through median sternotomy, this approach for extrapleural pneumonectomy in the management of malignant pleural mesothelioma has not been described. We assessed the feasibility of a median sternotomy approach as an alternative to thoracotomy in right-sided resections. Over a 15-month period, this app...
Article
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Akt, a Serine/Threonine protein kinase, mediates growth factor-associated cell survival. Constitutive activation of Akt (phosphorylated Akt, P-Akt) has been observed in several human cancers, including lung cancer and may be associated with poor prognosis and chemotherapy and radiotherapy resistance. The clinical relevance of P-Akt in non-small cel...
Article
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With the increasing incidence of malignant pleural mesothelioma and renewed interest in radical surgery as a therapeutic option, we have examined our experience of extra-pleural pneumonectomy, to document the incidence and management of its peri-operative complications. This analysis was conducted using prospectively entered data contained within t...
Article
We sought to determine whether or not there are differences in disease progression after radical or nonradical (debulking) surgical procedures for malignant pleural mesothelioma. Over a 49-month period, 132 patients with malignant pleural mesothelioma underwent surgery. Fifty-three underwent extrapleural pneumonectomy and 79 underwent nonradical pr...
Article
To assess whether cervical mediastinoscopy is necessary before radical resection of malignant pleural mesothelioma (MPM). Patients who underwent radical excision of MPM in a 48-month period were prospectively followed for evidence of disease recurrence and death. Histological evidence of extra pleural lymph node metastases was correlated with survi...
Article
Exposure to asbestos is the most frequent, but not exclusive, cause of malignant mesothelioma. Clinical features include dyspnea, cough, nonspecific chest pain, weight loss and night sweats. Diagnosis may be complicated by histologic difficulties. Thoracoscopic techniques are proving beneficial, but no one method of imaging has proven superior, and...
Article
To assess the use of contrast-enhanced magnetic resonance imaging (CEMRI) in addition to computed tomography in the pre-operative assessment of patients for radical surgery in malignant pleural mesothelioma. Over a 45-month period, 51 of 76 patients assessed (69 men and seven women), underwent extra-pleural pneumonectomy or radical pleurectomy/deco...
Article
Colonic obstruction is a very rare complication of gallstone disease. A case is described in a 63-year-old female patient. Radiological investigation, including plain abdominal X-ray and contrast studies, aided in the diagnosis.

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