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Biomedical subjects

D J Byrne

Publications and source records attributed to D J Byrne.

At least 19 recordsLinked to original sources
PubMed1992

Cost-effectiveness analysis of the use of chlorhexidine detergent in preoperative whole-body disinfection in wound infection prophylaxis.

A total of 3482 general surgical patients entered a trial in which they had a chlorhexidine or placebo detergent shower three times before elective clean wound or potentially contaminated surgery. Patients who showered with a chlorhexidine detergent (N = 1744) had a significant reduction in skin flora compared with those who showered with a placebo detergent (N = 1738). The majority of wound infections occurred outside hospital (312 outpatient infections vs. 201 inpatient infections). Wound infection rates were similar in the chlorhexidine and placebo groups (5.79% vs. 5.75% for inpatient infections and 8.54% vs. 9.38% for outpatient infections). The average hospital cost of both non-infected and infected patients was higher in the chlorhexidine group. The average cost of a non-infected chlorhexidine patient was 847.95 pounds as opposed to 804.60 pounds for a non-infected placebo patient, whilst the average cost of an infected patient was 1459.70 pounds (chlorhexidine) and 1414.22 pounds (placebo). A cross-match comparison of patients undergoing vascular surgery revealed no statistical significance in the difference between the two experimental groups. Patients were matched for age, sex, type of operation and surgeon. We conclude that preoperative whole-body disinfection with a chlorhexidine detergent is not a cost-effective treatment for reducing wound infection.

Adolescent↗
PubMed1992

Adverse influence of fibrin sealant on the healing of high-risk sutured colonic anastomoses.

The effect of fibrin glue sealing on sutured colonic anastomoses was studied using a 'high-risk' colon anastomosis model in the rat. Animals (n = 104) were randomized to have their sutured anastomosis sealed with fibrin glue or left untreated. They were assessed clinically until they were killed on the fourth day after surgery when contrast radiology, detailed post-mortem examination, anastomotic bursting pressure (ABP) and assessment of adhesion formation were performed. The clinical outcome was worse in the glued group (toxic or death from sepsis: 18 versus seven in the non-glued group; P = 0.0354), which also showed a significantly higher moderate to major leak rate (17 versus two in the non-glued group; P = 0.0009). The median ABP was significantly higher in the glued anastomosis group (96 versus 68 cmH2O in the non-glued group; P = 0.0367). Excessive perianastomotic adhesion formation was significantly greater in the glued group. Microscopic examination showed an extremely intense inflammatory reaction in the glued anastomoses compared with that in the untreated group. These results indicate that sealing of a sutured anastomosis with fibrin glue containing an antiproteinase impairs healing the of anastomotic wound, probably by resisting the ingrowth of vascular granulation tissue during the early stages of repair.

Anastomosis, Surgical↗
PubMed1991

Fallen stock.

Explore the source record for details and available documents.

Animal Welfare↗
PubMed1991

Effect of fibrin glues on the mechanical properties of healing wounds.

Tissue glues are important in clinical practice. Fibrin based glues have many advantages over non-biological adhesives. The optimum formulation of these glues measured by their effect on mechanical properties of healing wounds has not been determined. Using a model involving standard dorsal skin incisions in adult male Wistar rats various glue formulations were compared by varying the fibrinogen, thrombin and factor XIII concentrations. Calcium (40 mumol/ml) and aprotinin (3000 kallidinogenase inactivator units, KIu/ml) concentrations were kept constant. Animals were killed at 8 days and wounds excised. Standard strips of these wounds were mechanically tested using an Instron tensiometer and the stress, strain, elasticity and work required to rupture wounds were calculated. Results indicate that a fibrin glue with a fibrinogen concentration of approximately 39 g/l and a thrombin concentration of 200-600 units/ml with no added factor XIII will result in wounds with significantly increased stress, energy absorption and elasticity values.

Animals↗
PubMed1991

The effect of whole body disinfection on intraoperative wound contamination.

As part of a large whole body disinfection (WBD) trial two small sub-groups of patients who showered preoperatively with either a 4% chlorhexidine (CHX: N = 29) or placebo (N =27) detergent were studied to assess intraoperative wound contamination. The groups were well matched for age, sex and length of surgery. A membrane filter contact technique was used for bacterial recovery from the wounds after the initial skin incision and before wound closure. The membrane filters were incubated aerobically on blood agar plates with a CHX neutralizer for 48 h at 37 degrees C and colonies were counted. The results show a significant difference, between the bacterial counts at the start and end of surgery in the CHX and placebo groups. There was no difference in bacterial counts at the start of surgery between the CHX and placebo groups. There was a significant difference in the bacterial counts at the end of surgery between the CHX and placebo groups. These results indicate that preoperative WBD with CHX reduces intraoperative wound contamination but the effect of this on postoperative wound sepsis rates awaits the results of a large WBD trial.

Adult↗
PubMed1991

Effects of whole body disinfection on skin flora in patients undergoing elective surgery.

Bacterial skin flora were studied in two groups of patients having three showers with either a 4% chlorhexidine detergent solution (Group A, N = 57) or a placebo detergent (Group B, N = 58). Previous reports on the efficacy of chlorhexidine in decreasing bacterial counts on the skin were confirmed and the time taken to recolonization (median 5 days; range 1-10 days) was in broad agreement with previous reports. However, concern regarding the colonization of the skin of the patients in the chlorhexidine group by potential pathogens during the recolonization period appears unfounded as there was no significant difference in the incidence of non-resident skin flora between the chlorhexidine (17/57; 30%) and the placebo (14/58; 24%) groups. These non-residents are generally lost from the skin before discharge in the chlorhexidine group but nine patients in the placebo group had abnormal skin flora at discharge from hospital. All those patients tested after discharge had lost the non-resident flora within 2 weeks of discharge. The results of this study indicate that recolonization of the skin after whole body disinfection does not present a clinical problem.

Adolescent↗
PubMed1991

Use of an antibacterial powder spray to prevent post prostatectomy urinary infection.

To prevent ascending urinary infection in patients following transurethral prostatectomy, we have studied the use of a topical antibacterial agent applied to the groin and external genitalia. A prospective randomized controlled trial was conducted, with 50 patients being treated by daily application of a 2% polynoxylin powder, and 50 patients acting as untreated controls. Patient age and duration of catheterization were similar in the treated and untreated groups. No significant benefit was seen in the treated cohort (P greater than 0.05) in terms of reduction in postoperative urinary infection.

Administration, Topical↗
PubMed1991

Recurrent strangulated obturator hernia.

A case of recurrent strangulated obturator hernia is presented. The difficulty in diagnosing obturator hernia and the high mortality associated with strangulation are highlighted from a literature review. A high index of suspicion in older patients presenting with intestinal obstruction without an obvious cause, possibly combined with CT scanning of the pelvic region, may lead to earlier diagnosis and operation and a more favourable outcome in such cases.

Aged↗
PubMed1990

CA72-4: a new tumour marker for gastric cancer.

To date, tumour markers for gastric cancer have proved unreliable. In this study the value of a new serum marker, CA72-4, was compared with the serum activities of carcinoembryonic antigen (CEA) and CA19-9 in a consecutive series of patients with gastric cancer. The results show that the CA72-4 assay is significantly better at separating stage I and II disease from normal controls (P less than 0.01) than CEA (n.s.) or CA19-9 (n.s.). CA72-4 also gave better differentiation between patients with positive and negative nodes (P less than 0.01) and between those who were serosa positive and negative (P less than 0.01). CEA differentiated between patients with positive and negative nodes (P less than 0.05) but CA19-9 could not. CA19-9 and CEA could not discriminate between patients who were serosa positive and negative. In this study, at a specificity of 95 per cent, the sensitivities of CEA, CA19-9 and CA72-4 were 0.25, 0.41 and 0.94 respectively. These preliminary findings indicate that CA72-4 is a reliable tumour marker of disease stage and activity in gastric cancer. Further longitudinal studies are required for full evaluation of its clinical utility.

Adult↗
PubMed1990

Rationalizing whole body disinfection.

As part of the preparation for a large prospective trial investigating the effect of preoperative whole body disinfection on the postoperative wound infection rate, this preliminary volunteer study was carried out to establish (a) the optimum number of preoperative washes required to achieve a maximum level of skin disinfection and (b) if showering or bathing is a more efficient method of skin disinfection. Ten healthy volunteers were recruited. The results show a significant decrease (p less than 0.005) in the skin flora after the first and second showers (a decrease of 93.55% and 77.49% respectively), but no further significant fall with subsequent showers. There was a significant fall (p less than 0.005) in skin flora after a single bath (a decrease of 70.98%) with subsequent baths producing no further significant reduction in skin flora. From these results it is recommended that three preoperative showers with 4% chlorhexidine detergent be used as an optimum preoperative whole body disinfection regimen. Three showers ensures against less thorough washing by the patients compared to the healthy volunteers in the study and fits easily into a preoperative regimen.

Adult↗
PubMed1990

Highly selective vagotomy: use of a ligature carrier.

A ligature carrier for use in typing the neurovascular bundle along the lesser curve of the stomach during highly selective vagotomy is described. This is presented as a safe and efficient way of performing this part of the operation.

Humans↗
PubMed1989

Postoperative wound scoring.

Assessing postoperative wound sepsis rates is important from both an economic and an audit point of view. Most definitions of wound sepsis are too narrow and too subjective and wound scoring systems that have been developed to counteract these deficiencies suffer from a lack of objectivity, making valid comparisons between wound sepsis rates in different institutions impossible. The ASEPSIS scoring system is a definite advance in this area and its proven reproducibility makes it invaluable in multicentre trials assessing wound sepsis. However, it has limitations, mainly associated with the underlying assumption regarding the linearity of the ASEPSIS index. It is felt that by closely examining ASEPSIS wound scores from a large number of patients it may be possible to improve this scoring system.

Antisepsis↗
PubMed1989

Parathyroid hyperplasia associated with thymoma.

The case of a 65 year old female with myasthenia gravis and hypercalcaemia is presented. Failure of medical control of the myasthenia necessitated thymectomy at which time parathyroid exploration was also carried out. This revealed parathyroid hyperplasia and a thymoma. This association has not been previously documented in the literature.

Aged↗
PubMed1988

How informed is signed consent?

The assurance that patients fully understand the information given to them before they sign the consent form for operation has never been validated in this country. One hundred patients were interviewed by an independent medical observer in one surgical unit in a teaching hospital between two and five days after their operation. Although all the patients interviewed were fully aware that they had had an operation, 27 did not know which organ was operated on and 44 were unaware of the exact nature of the surgical procedure. A significantly higher age group was observed in the group of patients who were unaware of the basic facts relating to their operation, and the problem was encountered most commonly in patients over the age of 60. Because of the medical and legal importance the findings of this pilot study warrant further large scale investigations.

Age Factors↗
PubMed1988

Highly selective vagotomy: a 14-year experience.

Since August 1971, 244 highly selective vagotomies were performed for pyloric and duodenal ulceration by one surgeon (W.A.F.M.). There was one postoperative death. Twenty (8 per cent) patients were lost to follow-up. The remaining 223 patients were followed up for 1 to 14 years (mean 4.2 years). On the modified Visick grading system 83.4 per cent were Visick I or II and 16.6 per cent were Visick III or IV. The failures were mainly recurrences. The recurrence rate was 11.2 per cent. Certain factors were examined to try to elucidate those influencing recurrence rate but no significant prognostic indicator was found. Acid studies were analysed and no significant relationship between these and the development of a recurrence could be found. The second 100 vagotomies were better than the first as judged by the results of studies of insulin-stimulated acid. Finally, we question whether all recurrences should automatically be regarded as treatment failures and the patients classified as Visick IV.

Adolescent↗