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Biomedical subjects

C J Ingoldby

Publications and source records attributed to C J Ingoldby.

At least 19 recordsLinked to original sources
PubMed1998

A prospective randomized study of calcium alginate (Sorbsan) versus standard gauze packing following haemorrhoidectomy.

Post-haemorrhoidectomy pain is problematical but may be reduced by using less bulky haemostatic dressings in the anal canal. Fifty consecutive patients undergoing haemorrhoidectomy were prospectively randomized to receive either paraffin gauze/cotton gauze roll on calcium alginate (Sorbsan) roll as a post-operative pack. Post-operative pain was assessed at 6 h, on removal of rectal packing and at first bowel action. Haemorrhage was monitored at 6 h and removal of pack. There was no difference in the hospital stay between the two groups. Pain was significantly reduced at the time of removal/spontaneous discharge of rectal packing (P < 0.0001) and first post-operative bowel action (P = 0.0008) in the calcium alginate group. There was no significant difference in post-operative haemorrhage between the two groups. Calcium alginate dressings following haemorrhoidectomy effectively reduce post-operative pain compared to more bulky anal packs.

Alginates↗
PubMed1997

Laparoscopic and conventional repair of groin disruption in sportsmen.

BACKGROUND: Musculotendinous groin disruption is common in professional sportsmen. Diagnosis is difficult and management complicated by strong desires for early return to sporting activity. The possible role of laparoscopic repair in promoting early recovery was examined. METHODS: A series of patients with persistent pain that prevented sport for more than 3 months were treated surgically. Thirty repairs were performed on 28 players, 18 professional and nine amateur. Seventeen injuries were sustained playing rugby league, seven association football and four other sports. There were 14 conventional repairs (11 Lichtenstein) and 14 laparoscopic (two bilateral). All patients were discharged within 24 h. RESULTS: No player complained of severe postoperative pain. Seven of 14 patients who had laparoscopic repair denied experiencing any pain at all. Training was resumed within 4 weeks for nine of 14 patients who had a conventional repair and 13 of 14 who underwent laparoscopic repair. Full contact training restarted at a median 5 (range 1-6) weeks for conventional and 3 (range 1-9) weeks for laparoscopic repair (P < 0.05). Two players had persistent neuralgia after laparoscopic repair which settled by 2 months. One player had recurrent pain 5 months after laparoscopic repair, and one had a recurrent hernia 22 months after conventional repair. There were no wound problems. CONCLUSION: Laparoscopic repair appears as effective as conventional repair for sporting injuries, and merits further evaluation as a technique to permit early return to activity.

Athletic Injuries↗
PubMed1997

The management of pyloric stenosis in a district hospital.

Over a 10-year period, 80 infants were admitted with a diagnosis of pyloric stenosis. Seventy-nine underwent surgical pyloromyotomy (63 male, 16 female; mean age 5.6 weeks). Fifty-nine infants (75%) were operated upon by one of four consultant surgeons and 20 (25%) operations were undertaken by a registrar. Seventy operations (89%) were performed during normal working hours and thirty of these (43%) were placed first on the operating list. The mean length of stay was 6.9 days. Three infants required re-operation: there were two instances of wound dehiscence and one episode of bleeding from the edge of the pyloromyotomy. There were no deaths. The morbidity and mortality in this series was comparable with published results from specialist units.

Female↗
PubMed1990

Periampullary diverticula predispose to primary rather than secondary stones in the common bile duct.

Periampullary duodenal diverticula are known to be associated with an increased incidence of common bile duct stones. The nature of the association with gallstones remains uncertain. We have examined the incidence of periampullary diverticula and stones after cholecystectomy to determine whether the stones originate primarily in the common duct or migrate from the gallbladder under the influence of abnormal biliary motility. Six hundred and forty-one patients undergoing ERCP were studied. Ninety-five patients had diverticula (14.8%). Diverticula occurred more commonly in jaundiced patients, 47/95, (48.4%) than in patients with normal bilirubin 185/546 (33.8%) (p less than 0.01). Common duct stones were associated with the presence of a diverticulum in 41/95 patients (43%), compared with only 98/546 without a diverticulum (18%) (p less than 0.001). There was no difference in the incidence of common duct stones in association with a diverticulum between those who had had a cholecystectomy 20/41, and those with intact gallbladders, 21/54 (N.S.). Thus the absence of a gallbladder did not alter the high incidence of common duct stones. We conclude that the stones in the common duct are most likely to be primary stones which have formed as a result of periampullary dysfunction.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1990

Aortocaval fistulas and the use of transvenous balloon tamponade.

Six cases of acute aortocaval fistula are reported, which illustrate the difficulties of diagnosis and management in a rare life-threatening condition. Five cases arose from spontaneous rupture of aortic aneurysms and one from trauma. In four cases the diagnosis was made before surgery. Useful diagnostic features included inappropriate jugular venous distension in five patients, lower abdominal and trunk cyanosis in three patients and a palpable thrill in three patients. Preoperative diagnosis permitted attempts to control venous haemorrhage in three cases, one by balloons through the aortic sac and two by transvenous positioning of balloon catheters in the vena cava before aortic opening. The use of transvenous balloon catheters was found to be helpful in reducing haemorrhage. Four patients left hospital alive. Preoperative recognition of the signs of an acute aortocaval rupture and preliminary balloon tamponade appear to be valuable in the management of acute aortocaval fistulas.

Aged↗
PubMed1989

Inappropriate use of metronidazole in gastrointestinal surgery.

Pharmacokinetic data suggest that current treatment regimens of metronidazole in abdominal surgery are not always appropriate. We have examined antibiotic concentrations during emergency and elective surgery using a specific and sensitive high pressure liquid chromatography assay. Serum and tissue concentrations were measured after intravenous infusion during intra-abdominal surgery and after suppositories given before appendicectomy. After intravenous dosage, bactericidal concentrations were reached in serum (13.6 +/- 7.8 micrograms/ml), bowel (9.0 +/- 6.6 micrograms/g), tumour (9.9 +/- 7.1 micrograms/g) and subcutaneous fat (4.9 +/- 3.2 micrograms/g). After suppositories the concentrations were: serum 4.6 +/- 2.7 micrograms/ml, appendix 1.1 +/- 0.6 micrograms/g, fat 1.5 +/- 0.9 micrograms/g and peritoneal fluid 4.7 +/- 4.3 micrograms/g. These values were obtained at a mean interval of 86.9 +/- 27.5 min following administration of the drug. Serum concentrations were measured during post-surgical infusion of 500 mg i.v. 8 or 12 hourly. Mean concentrations after 8 hourly doses were 16.3 +/- 4.85 micrograms/ml pre-dose and 28.7 +/- 6.76 micrograms/ml post-dose, with evidence of drug accumulation by detection of metabolites. Twelve hourly infusions gave pre-dose levels of 7.4 +/- 3.86 micrograms/ml and post-dose levels of 17.1 +/- 3.69 micrograms/ml. Metronidazole (500 mg) intravenously at induction of anaesthetic gives effective prophylactic concentrations in all tissues including tumour, but a metronidazole 1 g suppository before appendicectomy does not provide reliable tissue concentrations. Metronidazole (500 mg) i.v. 12 hourly gives effective bactericidal concentrations of the drug and is more economical.

Aged↗
PubMed1989

Late results of endoscopic sphincterotomy for bile duct stones in elderly patients with gall bladders in situ.

Endoscopic sphincterotomy was undertaken in 186 patients with common bile duct stones and an intact gall bladder who were considered unfit for surgery. One hundred and seventy one patients had jaundice of whom 18 also had clinical cholangitis. The mean age of treated patients was 79.7 years (range 27-92) and only 13 were aged less than 60. Sphincterotomy was successful in 185 (99%) and complete clearance achieved in 172 (92.5%). Early complications occurred in nine patients (4.8%) of whom three died (1.6%). The patients have been followed on average for 32 months (range six to 72 months). Eighteen patients have subsequently required cholecystectomy (9.6%), with six major complications, but no deaths. There have been 27 natural deaths and 156 patients remain alive and symptom free. Endoscopic treatment alone is safe and effective in the majority of frail and elderly patients and can reduce the need for surgery in this high risk group.

Aged↗
PubMed1987

Endoscopic needle aspiration cytology: a new method for the diagnosis of upper gastrointestinal cancer.

A technique for obtaining needle aspiration cytology specimens from upper gastrointestinal lesions at endoscopy is described. The validity of the technique was initially confirmed by applying it to resected gastric carcinomas. Thirty seven endoscopically visualised lesions were then sampled by forceps biopsy, brush and needle cytology. Ten lesions were subsequently found to be carcinomas. Needle aspiration produced identifiable malignant cells from seven of these lesions. In two it was the only sampling method which provided the correct diagnosis. This technique may be a useful addition to conventional endoscopic sampling methods, particularly where tumours lie deep to normal mucosa, or necrotic slough.

Biopsy, Needle↗
PubMed1986

A comparison of methods of removing inhibitors to the chromogenic Limulus assay in normal and jaundiced blood.

A comparative study was performed of methods of removing inhibitors to the quantitative chromogenic method of Limulus assay for endotoxin in normal and jaundiced plasma. Chloroform treatment failed to remove inhibitors in normal and jaundiced plasma and did not prevent inhibition of colorimetry by bilirubin. Perchloracetic acid (PCA) treatment decolourised jaundiced samples but gave unreliable results due to poor pH control. Boiling and dilution gave reliable results in jaundiced and normal plasma without significant loss of sensitivity and is the method of choice.

Chloroform↗
PubMed1986

Impact of vascular surgery on community mortality from ruptured aortic aneurysms.

The workload of aortic surgery in a district increased fourfold over 10 years as the incidence of aneurysm rupture rose from 7 to 17/100,000. Of 260 patients with ruptured aneurysms 101 reached hospital alive (38 per cent) of which 52 (52 per cent) survived, an overall survival rate of 19.8 per cent. Despite increasing experience, mortality after emergency surgery did not improve, suggesting outcome was largely determined by the patient's condition and age. Only 5 of 90 patients aged over 75 survived aortic rupture at home. In consequence overall community mortality did not improve in the period studied. Survival after elective surgery was 95 per cent, suggesting that efforts to improve survival should be directed towards identifying and treating the disease before rupture occurs. The commonly stated figure of 50 per cent survival for ruptured aortic aneurysms is an overestimate, due to neglect of patients dying at home.

Age Factors↗
PubMed1985

Unusual presentations of branchial cysts: a trap for the unwary.

Twenty-three cases of branchial cysts seen over 4 years are described. Only 11 patients presented with simple non-tender fluid swellings of the neck. Five patients presented with tender masses during infections and were diagnosed as acute abscesses. Seven patients presented with hard fixed masses mimicking lymphadenopathy. None of these were diagnosed correctly before surgery. Misdiagnosis led to significant morbidity from persistent cervical discharges. One patient had a partial nerve palsy. Infection of branchial cysts was common in this series and caused difficulties in diagnosis due to thickening of cysts walls following chronic inflammation in lymphoid tissue.

Adolescent↗
PubMed1985

Colonoscopy related endotoxemia.

A pilot study of 20 patients who underwent colonoscopy was performed to investigate the occurrence of endotoxemia related to the procedure and its clinical significance. With the use of the limulus lysate method of assay, endotoxemia was demonstrated in 25 per cent of the patients during colonoscopy and 65 per cent afterwards, but was not associated with either concomitant bacteremia or any ill effects. The appearance of endotoxin in significant concentration in the presence of normal liver function and with no overt focus of infection, suggests that substantial absorption of bacterial products which originate in the intestine occur, but under normal circumstances cause no demonstrable deleterious effects.

Adolescent↗
PubMed1984

Endotoxemia in human obstructive jaundice. Effect of polymyxin B.

A clinical trial was undertaken to study endotoxemia in 14 patients with obstructive jaundice given the antiendotoxin polymyxin B, 13 patients with obstructive jaundice who were not given the antiendotoxin , and 13 nonjaundiced control patients undergoing comparable surgery. Endotoxins were detected by the limulus assay. Endotoxemia did not occur in the nonjaundiced patients but was common before (68 percent), during (70 percent), and after (81 percent) surgery in the jaundice patients. Thirty-six percent of the jaundiced patients had postoperative oliguria. Endotoxemia before surgery was associated with death after surgery, all deaths occurring in patients who were endotoxemic before operation (p less than 0.05). Polymyxin B infusion had no effect on endotoxemia or outcome. Measurement of indicators of fibrinolysis, soluble fibrin, and fibrin degradation products showed no prognostic significance. We conclude that preoperative endotoxemia is an important predictor of outcome in patients who undergo surgery for jaundice.

Bilirubin↗
PubMed1984

Is pentagastrin-stimulated secretion mediated by histamine?

Patients with duodenal ulcer disease received either a two hour pentagastrin infusion test or a similar test with the addition of a bolus of cimetidine, 200 mg, after one hour of pentagastrin. Pentagastrin induced secretion of acid and histamine, the secretion patterns of the two being similar. Total histamine output in the gastric aspirate in the first hour of pentagastrin infusion was related to total acid output (r = 0.58, p less than 0.01). A similar correlation was observed during the second hour of pentagastrin infusion (r = 0.61, p less than 0.05). Plasma histamine concentration rose to a peak coinciding with maximal acid secretion. After cimetidine blockade, gastric acid fell rapidly but gastric histamine output did not change. Plasma histamine concentration increased further. These results suggest that pentagastrin induced gastric histamine release is not affected by an acid inhibiting dose of cimetidine. Cimetidine caused histamine release into the circulation in both healthy volunteers and patients after total gastrectomy. The rise in plasma histamine concentration, however, was transient. In contrast, during pentagastrin infusion, the plasma histamine concentration remained high. These data support the hypothesis that histamine release induced by pentagastrin is a major stimulant of gastric acid secretion.

Cimetidine↗
PubMed1984

Gastric histamine release during insulin and pentagastrin infusion in patients with duodenal ulcer.

Thirteen patients with proven duodenal ulcer were studied by a combined insulin/pentagastrin gastric secretion test. Acid output, gastric histamine output, and plasma histamine levels were measured. There were no significant changes in gastric or plasma histamine levels during insulin-induced acid secretion (median basal 0.62 nmol 10 min-1; median highest fraction 0.89; median basal plasma 4.87 nmol 1-1; median highest plasma 6.89). After pentagastrin infusion there was an immediate increase in gastric histamine to a peak (median 1.62 nmol 10 min-1 p less than 0.01) followed by a fall and then a second peak (median 3.18 p less than 0.002). The biphasic nature of the gastric histamine release is unexplained. The occurrence of acid secretion without histamine release during insulin infusion suggests that the changes induced by pentagastrin are not simply a passive "washout" of histamine during acid secretion. The lack of histamine release during insulin infusion is not compatible with the theory that histamine is the common final transmitter to the parietal cell.

Adult↗