PubMed Health⌕ Search

Biomedical subjects

D R Donaldson

Publications and source records attributed to D R Donaldson.

At least 19 recordsLinked to original sources
PubMed1995

'To bead or not to bead?'.

In subcuticular wound closure, the use of anchorage beads or knots to maintain opposition of wound edges is a common practice, but can lead to complications. One hundred and one abdominal subcuticular wound closures (44 vertical and 57 transverse) were prospectively studied and assessment of wound swelling was made by measuring the length of exposed suture at both ends of the wound, on successive days postoperatively. Results showed progressive reduction in the exposed suture length. We would suggest that if anchorage beads are used with subcuticular sutures then they should not be pulled tight as postoperative wound swelling will cause the beads to be drawn into the wound often resulting in a troublesome ulcer(s) at the end(s) of the wound.

Abdominal Muscles↗
PubMed1990

Self protection in surgery: the use of double gloves.

This study assesses the perforation rate of single and double gloves and thus the extent to which double gloving protects the surgeon from diseases transmissible from the patient. We have also investigated whether double gloving offers the patient extra protection by reducing wound sepsis. Two hundred adult hernia repairs were performed, the first 100 single gloved and the second 100 double gloved. Glove perforation rates were not significantly different between single gloves and the outer of the double gloves. Although 46 of 400 outer gloves were perforated there were only 15 inner glove perforations and only eight of these matched the outer perforations. The percentage of operations in which the latex protective barrier was breached was reduced from 31 per cent when the surgeon wore single gloves to 8 per cent with double gloves. Wound sepsis was not increased by glove perforation nor reduced by double gloving. While careful technique remains mandatory we conclude that double gloving offers increased protection to the surgeon operating on high risk infectious cases.

General Surgery↗
PubMed1990

Postanal repair: which patients derive most benefit?

Forty-two patients (37 women, 5 men; mean age 61 years) with varying degrees of anal sphincter dysfunction were treated by postanal repair. Results were analysed in relation to age, sex, presenting complaint and the results of preoperative anorectal physiological tests. Complete continence was restored in 13 (31%), while acceptable but slightly impaired control was achieved in a further 17 (40%). Twelve patients (29%) remained or became totally incontinent. The likelihood of a successful outcome was greater in those presenting with complete incontinence (77% improved) than in those retaining control of solid stool (29% improved, 29% unchanged, 43% worse). Age and sex had no effect on results but pudendal neuropathy, identified in 74% overall, slightly reduced the chance of success. In nine postoperative patients studied, neither the anorectal angle nor anal canal length bore any relation to the results of surgery.

Adult↗
PubMed1989

Appendicectomy at cholecystectomy--an appraisal.

The effect of incidental appendicectomy in patients undergoing elective biliary surgery has been studied prospectively in 430 patients. In 236 patients the appendix was removed at the time of biliary surgery; in 194 patients the appendix was not removed or had already been removed at a previous operation. There was no significant difference between the two groups with regard to the incidence of septic complications--especially wound infection--more general complications, or in the mean post-operative stay in hospital. Histological examination of the macroscopically normal appendices revealed a surprising incidence of pathology (greater than 50 per cent). Provided the patient receives routine antibiotic prophylaxis, there appears to be a case for removing the appendix at the time of cholecystectomy if it is readily accessible.

Adolescent↗
PubMed1988

Comparison of colonic reservoir and straight colo-anal reconstruction after rectal excision.

The clinical and physiological results in 13 patients having a colonic J reservoir-anal anastomosis (CR) and 15 consecutive patients having a straight colo-anal reconstruction (SC) have been compared. The groups were matched for age, sex, level of tumour and proximal and distal resection margins. The incidence of postoperative complications was similar in each group. The mean follow-up in CR patients was 7 +/- 4 months and 47 +/- 23 months in SC patients. Stool frequency per 24 h was less than or equal to 2 in all CR patients while it was greater than 2 in 40 per cent of the SC patients (P less than 0.05). Three CR patients and six SC patients had minor incontinence, all but one of the rest were fully continent. One patient had a major leak. There was no significant difference in mean resting anal voluntary contraction pressure in the two groups, with mean values within the normal range. The mean rectal sensitivity threshold volume in CR patients (83 +/- 30 ml) and SC patients (52 +/- 22 ml) was significantly different (P less than 0.05) as was the mean maximum tolerable volume (317 +/- 122 ml and 174 +/- 83 ml respectively, P less than 0.01). There was no significant difference in balloon expulsion testing, defaecating proctography or methyl cellulose evacuation in the two groups. The addition of a colonic reservoir appears to avoid the high stool frequency occurring in some patients after straight colo-anal anastomosis.

Adult↗
PubMed1988

Local depot methylprednisolone injection for painful anal Crohn's disease.

Treatment, by local depot methylprednisolone injection, of severe anal pain in Crohn's disease not associated with overt sepsis is reported. It has given dramatic relief in 5 patients, but has not been successful in 2 patients where anal disease was in continuity with severe rectal involvement. Treatment has been effective for greater than 1 yr, and no complication of the technique has been found on regular follow-up. When compared with previous attempts at treatment, the beneficial results attained with methylprednisolone injection suggest that the effect is more than a placebo response. Careful patient selection to exclude overt sepsis or severe rectal disease is recommended before proceeding to steroid injection.

Adult↗
PubMed1985

Acetylsalicylic acid and dipyridamole improve the early patency of aorta-coronary bypass grafts. A double-blind, placebo-controlled, randomized trial.

A total of 125 patients undergoing aorta-coronary bypass grafting for disabling angina were randomized to receive either 330 mg of acetylsalicylic acid (aspirin) plus 75 mg of dipyridamole three times daily or a placebo for 6 months postoperatively. In addition, all patients were given warfarin for 3 months. Repeat angiography was performed at 6 months in 103 patients. In the treatment group 95 grafts were implanted in 48 patients, of which 87 were patent (91.6% patency rate). This figure compares with 88 grafts patent out of 118 implanted in 55 patients in the placebo group (74.6% patency rate) (p less than 0.01). We conclude that antiplatelet therapy improves the early patency of saphenous vein aorta-coronary bypass grafts.

Adult↗
PubMed1984

Prevention of platelet deposition and thrombus formation on hemodialysis membranes: a double-blind randomized trial of aspirin and dipyridamole.

A double-blind crossover study comparing low-dose aspirin (ASA) and dipyridamole (DPM) (100 mg ASA + 75 mg DPM, t.d.s.), high-dose ASA and DPM (300 mg ASA + 75 mg DPM, t.d.s.), and placebo on platelet deposition and thrombus formation on hemodialysis membranes was undertaken in 17 long-term dialysis patients. The high-dose combination significantly reduced the fall in platelet count during dialysis and also significantly increased postdialysis heparin concentrations. Scanning electron microscopy of the Cuprophan membranes showed a reduction in platelet deposition and fibrin formation during both treatment schedules, but this was most marked with the high-dose combination. The results of this study indicate that there is a graded response to combined ASA-DPM treatment and that this can significantly reduce platelet consumption and contact activation of fibrin during hemodialysis with Cuprophan membranes.

Adult↗
PubMed1984

Does oxpentifylline ('Trental') have a place in the treatment of intermittent claudication?

In a randomized double-blind study, the clinical and haemorrheological responses of 40 patients receiving oxpentifylline (200 mg 3-times daily) were compared with those of 40 patients receiving placebo. The treatment period in both groups was 2 months. The parameters measured before and after treatment were: subjective response; claudication and maximum walking distances; ankle systolic indices; maximum blood flow in the lower limb by gravimetric plethysmography; plasma fibrinogen; erythrocyte deformability and whole blood viscosity. There was a significant increase (p less than 0.05) in mean erythrocyte deformability in the oxpentifylline group but not in the placebo group; this apparent difference between the groups, however, was not significant. The placebo group showed a significant improvement (p less than 0.05) in claudication distance and mean plasma fibrinogen concentration, but no such improvements were observed in the oxpentifylline group. There were no significant differences in either of the two groups with regard to the subjective response, ankle systolic indices, maximum limb blood flow or whole blood viscosity. It is concluded that oxpentifylline , when taken in oral form at the dose used in this study, increased erythrocyte deformability without conferring any clinical or haemorrheological benefit to patients with intermittent claudication.

Adult↗
PubMed1982

Does the type of suture material contribute to the strength of the lateral paramedian incision?

A prospective randomized trial was carried out on 231 consecutive laparotomies in which the lateral paramedian incision was used in all cases. Closure of the wound was identical except for the anterior rectus sheath where closure was randomized to (a) chromic catgut, (b) polyglycolic acid or (c) polypropylene. Follow-up for 1 year has revealed no wound dehiscences and only one incisional hernia (in the catgut group). We conclude that the lateral paramedian incision is inherently strong, and that this strength is due to splintage of the wound by the rectus abdominis muscle itself and is unrelated to the type of suture material used.

Abdomen↗