PubMed Health⌕ Search

Biomedical subjects

A D Irving

Publications and source records attributed to A D Irving.

14 recordsLinked to original sources
PubMed1991

Postsplenectomy sepsis and its mortality rate: actual versus perceived risks.

A collective critical review of the literature on postsplenectomy sepsis from 1952 to 1987 has been undertaken. The reports cover a cohort of 12,514 patients undergoing splenectomy but of these only 5902 reports were sufficiently detailed to allow a useful analysis. The incidence of infection after splenectomy in children under 16 years old was 4.4 per cent with a mortality rate of 2.2 per cent. The corresponding figures for adults were 0.9 per cent and 0.8 per cent respectively. The present analysis of well documented patients has shown that severe infection after splenectomy for benign disease is very uncommon except in infants (infection rate 15.7 per cent) and children below the age of 5 years (infection rate 10.4 per cent). Many of these reported postsplenectomy infections may have been coincidental. It is also apparent that children contract a different type of infection after splenectomy than adults, predominantly a meningitis which is less frequently fatal. Adults, in contrast, appear to develop a septicaemic type of illness associated with a higher mortality rate. This survey has also shown that children are reported to be more susceptible to pneumococcal sepsis than to infection caused by any other organism. Although the removal of the spleen in otherwise normal people does not appear to be associated with an increased frequency of infection, the presence of a coexistent disorder, notably hepatic disease, can increase the risk substantially.

Age Factors↗
PubMed1990

The role of the spleen in the immune response following naturally acquired exposure to encapsulated bacteria.

Female New Zealand White Rabbits following splenectomy (n = 9), splenectomy with 50% splenic autotransplantation (n = 8) and sham laparotomy (n = 9) have been serially exposed to type 2 Streptococcus pneumoniae and Haemophilus influenzae by aerosol inhalation. Animals were sampled for 3 weeks after exposure and the IgG and IgM type-specific antibody response measured by enzyme-linked immunosorbent assay. Haemophilus influenzae initiated a substantial anti-haemophilus IgG response which was not diminished by splenectomy. The anti-haemophilus IgM response was present in sham-operated animals, absent following splenectomy, and partially restored by splenic autotransplantation. Type 2 Streptococcus pneumoniae induced a minimal IgG and IgM antibody response in all animals irrespective of the presence or absence of a spleen. The results support the role of the spleen in mediating IgM production against polysaccharide encapsulated bacteria. The differential degree of immune response produced by the two organisms may explain in part the differential frequency with which these two organisms infect man following splenectomy.

Animals↗
PubMed1989

Perforated jejunal diverticulitis.

Perforated jejunal diverticulitis is very rare. We describe two cases seen in one surgical unit in a four month period. The problems in early diagnosis are discussed and the need for prompt surgical intervention emphasised if mortality is to be reduced.

Aged↗
PubMed1989

Blood clearance and tissue distribution of 99Tc-labelled pneumococci following splenectomy in rabbits.

Female New Zealand White rabbits, following sham laparotomy, total splenectomy and splenectomy with 50% splenic autotransplantation, have been injected intravenously with 99Tc-labelled type 2 Streptococcus pneumoniae. The blood clearance of isotope has been measured and the numbers of circulating bacteria quantitated by blood culture. On sacrifice of the animals the tissue uptake of the isotope has been measured. The results indicate 98% bacterial clearance from the blood within 7 min. The liver is the principal organ for reticuloendothelial uptake of the bacteria accounting for 60% of the total injected dose; 15% of the isotope clearance occurred in the lungs, and the spleen contributed only 3% of the total bacterial clearance. There was no difference in the observed pattern of clearance following splenectomy and following splenic reimplantation. Following the uptake of the bacteria in the tissues, the isotope dissociated from the bacterium and was excreted in the urine. The secondary rise in blood isotope level consequent upon this release was not accompanied by a secondary bacteraemia.

Animals↗
PubMed1987

Mechanical bowel preparation for colonic resection and anastomosis.

In a series of 72 consecutive elective and emergency colectomies with primary anastomosis, all pre- and perioperative mechanical preparation of the bowel was omitted and the patient covered only by a single peroperative intravenous dose of cefuroxime and metronidazole. No anastomotic dehiscence was clinically apparent and wound infection was noted in only 8.3 per cent of patients.

Adult↗
PubMed1979

Needle aspiration of the breast with immediate reporting of material.

Needle aspiration with immediate cytological reporting has been practised in a breast clinic for one year. Patients benefit by receiving immediately the provisional diagnosis and, when indicated, appointments for metastatic surveys. Close co-operation between surgeon and cytologist has resulted in increased skill in aspiration, better preparation of samples, and greater accuracy in interpretation of reports. Since 5% of clinically benign lesions have proved malignant, even on immediate reporting, we would recommend cytological examination of all breast lumps.

Biopsy, Needle↗
PubMed1978

Laparoscopic assessment of the jaundiced patient: a review of 53 patients.

Laparoscopy in the investigation of patients with jaundice allows visualization of intra-abdominal pathology, target biopsy of intra-abdominal lesions and percutaneous fine-needle cholangiography, all to be carried out at the one procedure. Formal laparotomy can then be planned electively or avoided completely in appropriate cases. In our experience we have found laparoscopy with percutaneous fine-needle cholangiography and biopsy to be a useful procedure in the diagnosis and management of jaundiced patients.

Adolescent↗
PubMed1976

Pleural empyema in association with renal sepsis.

Five cases of pleural empyema in association with perinephric abscess or renal infection are presented. This represents 4 per cent of a series of 122 pleural empyemas, or 30 per cent of empyemas with subdiaphragmatic aetiology. It is suggested that the renal tract should be investigated in all cases of recurrent or non-resolving pleural empyema of uncertain aetiology.

Abscess↗
PubMed1976

Single layer anastomosis in the gastrointestinal tract.

Anastomotic leakage, often followed by serious morbidity or death, is an important complication of resection of the intestine. If surgical technique and judgment are sound, anastomotic leakage seldom occurs. In 205 elective, single layer anastomoses of stomach to duodenum, of small intestine, of colon and of colorectum, clinically apparent leakage did not occur except in one of 52 patients after colorectal anastomosis. After resection of the intestine performed as an emergency procedure, anastomotic leakage occurred but was infrequent and could clearly be attributed to poor judgment or technique. The results are presented to support a conviction that anastomotic leakage need seldom occur if surgical technique and judgment are sound and to draw attention anew to the efficacy and safety of single layer anastomosis.

Adolescent↗
PubMed1975

Single layer anastomosis after rectosigmoid resection.

Anastomosis after resection of the rectosigmoid colon is often followed by leakage at the suture line. When occult leakage discovered on routine contrast study is included incidence rates of over 50 per cent have recently been reported. A single layer interrupted seromuscular inverting technique was used for the anastomosis after elective rectosigmoid resection in 52 consecutive patients. The total incidence of suture line leakage was 6 per cent. Therefore a high incidence of anastomotic dehiscence in the rectum can be avoided and it is concluded that a single layer technique is sound.

Aged↗