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Biomedical subjects

D E Holmlund

Publications and source records attributed to D E Holmlund.

At least 19 recordsLinked to original sources
PubMed1995

Dipslide culture in colonic surgery: a tool for assessment of surgical performance and a guide to antibiotic use.

We evaluated a bacterial culture system for the assessment of surgical performance during colorectal operations, and for assessing the impact of selective postoperative antibiotics in contaminated cases. Surgically related infections were recorded and their risk factors were estimated, using univariate and multivariate methods, in 1079 patients undergoing elective colorectal operations. (Study period 1 was prospective, controlled and randomized, and study period 2 was prospective and open). All the patients were given metronidazole, 1 g i.v., at induction of anaesthesia and 12 h postoperatively. The number of colony-forming units (CFU) on an intraoperative dipslide culture was classified as 0, 1-4 or > or = 5 (n = 591, 183 and 305). Patients with > or = 5 CFU were randomized to receive either no further antibiotics or cefuroxime (1.5 g, i.v. every 8 h for 2 days) during the first study period (30 months). During the second period (84 months), all patients with > or = 5 CFU were to be given cefuroxime. Increasing age (p = 0.014), postoperative transfusion of packed red blood cells (p < 0.001), and high bacterial numbers (p < 0.001) were independently associated with infection. Surgeon-related rates of operative bacterial contamination varied between 12 and 50% (p < 0.001). In patients given only metronidazole, the likelihood of infection rose as the density of bacteria in the wound increased according to a sigmoid dose-response curve (5.1, 9.8 and 47.5% with CFU 0, 1-4 and > or = 5, respectively). In the category with > or = 5 CFU, 265 patients were treated with cefuroxime and 23 (8.7%) subsequently had infections [corrected]. Of 40 patients with > or = 5 CFU who did not receive cefuroxime postoperatively, 19 developed infections (p < 0.001, relative risk 5.47; 95% confidence interval 3.29-9.10). In conclusion, dipslide culture can identify patients at high risk of infection after colonic operations. It can be used to assess surgical performance. The addition of postoperative antibiotic cover for aerobic bacteria, detected by the dipslide, reduced the risk of infection more than 5-fold and almost eliminated the risk of contamination.

Adolescent↗
PubMed1988

Predictors of intraoperative bacterial contamination and postoperative infection in elective colorectal surgery.

This prospective study of 238 patients undergoing colorectal operations attempted to identify the risk factors for intraoperative bacterial contamination and postoperative infection. The degree of contamination was assessed by the recovery of Enterobacteriaceae spp. or Staphylococcus aureus in peritoneal irrigation fluid using dip-slides. Uni- and multivariate analyses comprised 17 parameters. Intraoperative contamination was strongly associated with postoperative infection (P less than 0.001). Abdominal drains were correlated with contamination (P = 0.019), but not with infection. Decompressive colostomy was over-represented in patients with contamination (P less than 0.001) but contributed to infection independent of its association with contamination (P less than 0.05), as did advanced age (P less than 0.05).

Adolescent↗
PubMed1986

Selective cefuroxime prophylaxis following colorectal surgery based on intra-operative dipslide culture.

The concept of a very limited effective period for prophylactic antibiotic action was challenged in a prospective, controlled and randomized study featuring a simplified method for assessing the degree of contamination in the operative field during colorectal surgery. The 226 patients were given 1 g metronidazole IV on induction of anaesthesia and 12 h postoperatively. Following standardized saline irrigation of the abdominal cavity, a uriculture dipslide was dipped in the residual fluid just before abdominal closure. The dipslide was incubated for 18 h, and colony counts of coliforms and Staphylococcus aureus were made. The number of colony-forming units (CFU) was classified as 0, 1-4 or greater than or equal to 5 (n = 123, 33 and 70). The patients with CFU greater than or equal to 5 were randomized to receive cefuroxime (1.5 g IV/8 h for 2 days) or no more antibiotics. In the patients given only metronidazole, the incidence of postoperative infections rose with the colony counts (5.7, 9.1 and 41.2 per cent with CFU 0, 1-4 and greater than or equal to 5). Addition of cefuroxime reduced the 41.2 per cent infection rate to 8.3 per cent (P = 0.003). The method thus identified a high-risk group in which a short postoperative course of cefuroxime significantly lowered the rate of sepsis.

Cefuroxime↗
PubMed1986

Dip slide culture of intraoperative peritoneal irrigation fluid for prediction of septic complication in elective colorectal surgery.

A controlled prospective study of a simplified technique, the dip slide culture method, for assessment of bacterial concentration in peritoneal irrigation fluid at the end of an elective colorectal operation is presented. The prediction of postoperative surgical infection based on intraoperative culture was compared between this method and a standard streak-plate technique in 190 patients. One gram of metronidazole was given intravenously as prophylaxis on induction of anesthesia and 12 h postoperatively. Intraoperative growth of members of the family Enterobacteriaceae or Staphylococcus aureus was strongly correlated to infection (P less than 0.001). By using this finding as a single criterion for the prediction of sepsis, sensitivity and specificity for the dip slide method were 70.8 and 94.3%, respectively, compared with 79.2 and 94.6%, respectively, for the streak-plate method. Of the 24 infections, 20 (83.3%) were correctly predicted when a combination of the two methods was used. An increasing number of Enterobacteriaceae or S. aureus in the dip slide culture resulted in a steady rise in the rate of infections from 5.7% at 0 CFU to 57% at greater than or equal to 80 CFU compared with 4.1% at 0 CFU/ml and 45.4% at greater than or equal to 800 CFU/ml with the streak-plate method. The differences were statistically significant at the greater than or equal to 5 CFU level with regard to wound infection (P less than 0.001) and deep surgical infection (P less than 0.01). It is concluded that the dip slide is a simple, rapid, and reliable method for the routine assessment of bacterial contamination in colorectal operations.

Bacteria↗
PubMed1986

Microflora of the gallbladder related to duration of acute cholecystitis.

The microflora of the bile and wall of the gallbladder was prospectively investigated in 104 nonselected consecutive patients treated with early cholecystectomy for acute cholecystitis after an average hospital stay of 1.8 days. The chief purpose was to relate the findings of cultures to duration of the illness. Special attention was paid to anaerobic isolation techniques. The cultures yielded 107 strains, representing 36 species, with overall agreement between four different sampling procedures. Aerobic gram-negative rods predominated, followed by streptococci and anaerobes (48, 31 and 15 per cent, respectively). The incidence of positive culture results (always greater than or equal to 10(6) colon forming units per milliliter) was 81 per cent among the patients who underwent operation within two days from the onset of symptoms and 50 to 65 per cent after longer preoperative intervals. The shorter interval was significantly more often associated with growth solely of anaerobes (p = 0.03). Postoperative sepsis was caused by biliary bacteria and not related to preoperative duration of illness. Appropriate perioperative antibiotic coverage significantly reduced sepsis--3 versus 20 per cent (p = 0.05).

Acute Disease↗
PubMed1984

Plesiomonas shigelloides in acute cholecystitis: a case report.

Plesiomonas shigelloides was isolated as the sole pathogen from gallbladder bile and wall in a 58-year-old woman with acute cholecystitis. The patient developed an unusual postoperative complication characterized by culture-negative discharge from the wound in combination with extensive abdominal cellulitis and afebrility. Agglutinating antibodies to P. shigelloides were demonstrated in the serum of the patient by the microscopic Widal agglutination test.

Acute Disease↗
PubMed1982

Effects of saline load, Roentgen contrast medium and indomethacin on diuresis and pelvic pressure in the acute obstructed kidney. An experimental study.

In anaesthetised pigs indomethacin (2.5 mg/kg body weight) immediately reduced pelvic pressure above unilaterally and bilaterally totally occluded ureters. Repeated administration of the same dose caused a cumulative reduction of pelvic pressure. In animals with a kidney working against a partial obstruction of the ureter, indomethacin reduced urine production by more than 50% within 15 to 30 min. It was also shown that the effect of indomethacin on the pelvic pressure was dependent on the fluid load of the animals. Rapid infusion of saline or X-ray contrast medium counteracted the pressure fall induced by indomethacin.

Animals↗
PubMed1978

Indomethacin in the treatment of ureteral colic.

Based on a theoretical analysis of the genesis of ureteral colic, it was assumed that indomethacin, a potent prostaglandin synthesis inhibitor, ought to be useful in the treatment of patients with an obstructing ureteral stone. Experimental studies and clinical observations have verified this assumption.

Animals↗
PubMed1977

Knot properties of surgical silk: Model study.

The knot properties of surgical silk of different dimensions and from different manufacturers have been studied. Large variations were found. It is proposed that the differences are due mainly to the braiding technique. Only very few surgical silk sutures can be securely tied with a square (reef) knot today. A knot with three square throws is therefore recommended for modern surgical silk.

Bombyx↗
PubMed1977

Suture technic and suture-holding capacity. A model study and a theoretical analysis.

The suture-holding capacity (SHC) of six representative surgical suture materials was analyzed. The single loop, the far-and-near, and the near-and-near suture technics were used in the study. The SHC was found to depend on: (1) the coefficient of friction between the suture strand and the tissue; (2) the distensibility of tied and untied fiber; (3) the holding capacity of the knot used; and (4) the strength of the untied strand. Knot-holding capacity (KHC) was of the greatest importance when the single loop technic was used and when the friction between the suture strand and the tissue was low. When the near-and-near or the far-and-near technic was used, the SHC was influenced little by the strength of the knot, especially when the coefficient of friction between strand and tissue was high. The near-and-near suture technic produced the strongest sutures for all materials except Dexon, for which the far-and-near technic produced the strongest sutures. With a correct suture and tying technic, one can optimally use the strength of the suture material and one can use thin strands.

Humans↗
PubMed1976

Physical properties of surgical suture materials: Stress-strain relationship, stress-relaxation and irreversible elongation.

The stress-strain relationship, the stress-relaxation and the irreversible elongation of different suture materials were investigated. It was found that the distensibility of the fibers varied greatly. Most fibers were found to be chiefly elastic but some fibers were elastic when a moderate load was applied and plastic when the load increased. Some fibers, especially Prolene, were plastic also when moderate load was applied. The importance of information concerning these and other physical properties of surgical suture material is pointed out. In the future, surgeons will not have to accept suture materials with unknown physical properties but will demand fibers with defined properties for every purpose.

Elasticity↗
PubMed1976

Retained bile duct stones.

Residual bile duct stones were found in 69 out of 4078 patients subjected to cholecystectomy. In 5 of these patients the outcome of the residual stones was unknown, but in 64 patients the complete course of events could be followed. In 32 patients the stone(s) were lodged in the intrahepatic ducts; in 15 patients the stones were overlooked owing to incomplete or technically unfeasible post-explorative cholangiographies; in 12 patients the stones were not visualized in good peroperative cholangiograms and in 5 patients the stones were misinterpreted as air bubbles. Spontaneous passage of the retained stones was verified in 24 patients. In 40 patients re-exploration was performed. Organic changes in the bile duct wall, a large (greater than or equal to 10 mm) and solitary stone were factors that precluded spontaneous passage. Re-exploration of residual bile duct stones, especially during the first month after the primary surgery, was found hazardous. If possible re-exploration should not be performed earlier than 4-6 weeks after the primary operation.

Aged↗
PubMed1975

Appendico-vesical fistula. Case report.

Two cases of appendico-vesical fistula are reported. In one patient a spontaneous healing with fibrosis of the appendix had probably occurred. The incidence and clinical features of this fistula are presented. The diagnosis is difficult. The average length of time between the initial symptoms and the diagnosis is measured in years. In many patients the correct diagnosis is probably never made and in some patients the fistula eventually heals spontaneously. The condition is probably not as rare as is stated in the literature.

Adolescent↗