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Biomedical subjects

D W Burdon

Publications and source records attributed to D W Burdon.

At least 55 records · Page 3Linked to original sources
PubMed1984

Intragastric N-nitrosation is unlikely to be responsible for gastric carcinoma developing after operations for duodenal ulcer.

Three groups of patients studied after operations which had cured their duodenal ulcer were compared with a control group (no operation, n = 8). The surgical procedures included: proximal gastric vagotomy (n = 7), truncal vagotomy and pyloroplasty (n = 7), truncal vagotomy and antrectomy (n = 8). Samples of gastric juice were aspirated half hourly or hourly over 24 hours for measurement of pH, counts of all identified bacteria, nitrite and total N-nitrosocompounds. Although the pH over 24 hours was significantly higher after proximal gastric vagotomy (p less than 0.05) and truncal vagotomy and antrectomy (p less than 0.001) than controls, there was no difference between truncal vagotomy and pyloroplasty and controls. Counts of nitrate reducing bacteria over 24 hours were also significantly higher after truncal vagotomy and antrectomy than controls (p less than 0.1) but no differences were observed between the other groups. Only after truncal vagotomy and antrectomy was nitrite over 24 hours significantly increased compared with controls (p less than 0.01). Despite these higher values after truncal vagotomy and antrectomy, there was no significant difference in total N-nitrosocompounds between any of the four groups. Whereas bacterial counts and nitrite increased with pH, no correlation was found between total N-nitrosocompounds and pH. These results provide no evidence that exposure to total N-nitrosocompounds is increased after operations for duodenal ulcer.

Bacteria↗
PubMed1984

Mutagenicity in gastric juice.

Mutagenicity has been measured in the gastric juice of 228 patients using the Ames bacteriological test system; while mutagenicity in control and duodenal ulcer patients did not differ from saline controls, mutagenicity was significantly increased compared with controls in patients suffering gastric ulcer (p less than 0.002), carcinoma (p less than 0.002), and in patients after gastric resection (p less than 0.01). A transient rise in mutagenicity was seen following H2 antagonist ingestion (p less than 0.002). Increased levels of mutagenicity were found to correlate closely with gastric juice pH and bacterial count. Histidine concentrations in gastric juice did not explain the mutagenicity results.

Duodenal Ulcer↗
PubMed1983

A physiological appraisal of polyethylene glycol and a balanced electrolyte solution as bowel preparation.

Seventy-seven patients undergoing bowel preparation with either sennosides and rectal washout (S + RWO; n = 26) or polyethylene glycol and a balanced electrolyte solution (PEG + E) given orally (n = 25) or by nasogastric infusion (n = 26) have been studied. PEG + E was not associated with significant physiological change in electrolytes or blood gases. Patients tolerated PEG + E well and it provided a moderate to good bowel preparation in over 80 per cent of cases. PEG + E was not associated with a change in colonic microflora and was not associated with explosive mixtures of colonic gas due to hydrogen. It is therefore a safe, quick and efficient bowel preparation and provides a safer alternative to mannitol. The solution (PEG + E) man be used orally or by nasogastric infusion and does not require an accompanying intravenous infusion.

Adult↗
PubMed1983

A prospective randomized trial to compare mezlocillin and metronidazole with cefuroxime and metronidazole as prophylaxis in elective colorectal operations.

A prospective randomized trial has compared a broad spectrum ureidopenicillin with a broad spectrum cephalosporin for prophylaxis against the aerobic organisms encountered during elective colonic surgery. Even though only two doses of antibiotics were administered the incidence of severe sepsis was low. Severe wound infection occurred in three of the patients receiving mezlocillin and metronidazole (6 per cent) compared with six in the group receiving cefuroxime and metronidazole (13 per cent). Minor wound sepsis was recorded in 24 per cent of patients receiving mezlocillin and metronidazole compared with only 11 per cent after cefuroxime and metronidazole. There were two episodes of septicaemia, one in each group, and three abscesses, all of which occurred in patients receiving metronidazole and mezlocillin. The total number of surgically related infections was, however, significantly less with cefuroxime and metronidazole (N = 13) compared with mezlocillin and metronidazole (N = 23; P less than 0.03). Escherichia coli was the principal organism responsible for surgically-related postoperative sepsis: (22 isolates: 14 mezlocillin and eight cefuroxime) all of which sensitive to the agents used. Pseudomonas aeruginosa was recovered from 10 patients (three mezlocillin and seven cefuroxime), all of the isolates were resistant to both antibiotics and were associated with severe morbidity. There were 11 isolates of Staphylococcus spp. (nine mezlocillin and two cefuroxime: P less than 0.03). Postoperative diarrhoea occurred in six patients, all were in the group receiving cefuroxime and metronidazole. (Clostridium difficile was recovered from the stool in three of which one was associated with Cl. difficile cytotoxin.)

Adolescent↗
PubMed1983

Clinical and microbiological evaluation of piperacillin in elective biliary surgery.

Fifty patients undergoing electric biliary surgery were given piperacillin 2 g i.m. 2 h preoperatively followed by 2 g i.v. at the beginning of the operation. Venous blood and bile from the gall bladder and common bile duct were assayed for piperacillin. Blood levels exceeded 100 mg 1(-1) in all instances unless the protocol was not followed. Both gallbladder and common bile duct bile levels exceeded 50 mg 1(-1), and the only exceptions were due to poor penetration into three obstructed gallbladders. Common bile duct levels exceeded 50 mg 1(-1) even in the presence of obstructive jaundice. Only one patient developed a minor postoperative wound infection.

Bacteria↗
PubMed1983

Metronidazole need not be combined with an aminoglycoside when used for prophylaxis in elective colorectal surgery.

A prospective randomized controlled study has compared prophylactic intravenous metronidazole alone with the combination of metronidazole and gentamicin in 100 patients having elective colorectal surgery. There was no significant difference in mortality, infection, dehiscence or postoperative stay between the antibiotic groups. Postoperative sepsis was almost entirely due to aerobic organisms but was associated with minimal morbidity. A significantly higher rate of anastomotic dehiscence and postoperative infection was seen where the quality of bowel preparation was judged to be poor.

Abscess↗
PubMed1983

Evaluation of mezlocillin in elective gastrointestinal surgery.

We report the interim results of two trials to evaluate the place of mezlocillin in elective intestinal operations. Sixty-four operations for gastro-oesophageal disease have been performed where patients were randomly allocated to mezlocillin or cefuroxime. Wound sepsis occurred in 19% of the mezlocillin patients compared with 3% of those receiving cefuroxime. Seventy-three operations have been performed for colorectal cancer in whom three doses of antibiotic were used for prophylaxis. Patients were randomly allocated to mezlocillin and metronidazole or cefuroxime and metronidazole. The rates of abdominal wound sepsis in the groups were 15% and 12% respectively. Post-operative Clostridium difficile colitis occurred in four of the cefuroxime patients, compared with none of those receiving mezlocillin. Mezlocillin appears to be a safe and effective antibiotic when used in combination with metronidazole in colorectal resections for cancer.

Cefuroxime↗
PubMed1982

Randomized controlled trial of colestipol in antibiotic-associated colitis.

Thirty-eight patients with severe antibiotic-associated postoperative diarrhoea were entered into a randomized controlled trial to compare colestipol (an ion exchange resin) in 17 patients with placebo (sherbet) in 21 patients. Clostridium difficile or its toxin was present before treatment in 12 of the colestipol group, compared with only 5 in the placebo group. Because of the low incidence of Cl. difficile or its toxin, the placebo group data from 22 patients receiving placebo in a previous trial (9 of whom had Cl. difficile or toxin) were included for comparison. Neither colestipol nor placebo had any influence on the faecal excretion of Cl. difficile or its toxin. Colestipol was clinically no better than placebo. In view of the persistent faecal excretion of Cl. difficile toxin, ion exchange resins cannot be recommended for the treatment of antibiotic-associated colitis.

Anti-Bacterial Agents↗
PubMed1982

Clinical trials of the efficacy and duration of antibacterial cover for elective resection in inflammatory bowel disease.

A prospective double-blind placebo controlled trial was performed to test the values of 24-h cover with metronidazole and gentamicin in 57 patients requiring elective resections for inflammatory bowel disease (phase 1). The short term antimicrobial cover was not associated with a reduction in the incidence of postoperative sepsis. A further group of 30 patients who received metronidazole and gentamicin cover for 5 days (phase 2) was therefore studied and the results were compared with phase 1. There was a significant reduction in the incidence of sepsis in the patients receiving 5-day postoperative antibiotic cover compared with the placebo group.

Adult↗
PubMed1982

Clostridium difficile toxin in acute diarrhoea complicating inflammatory bowel disease.

The incidence of Clostridium difficile cytotoxin has been studied in 69 consecutive patients with inflammatory bowel disease complicated by severe diarrhoea or ileostomy flux during 74 admissions to hospital. The cytotoxin was identified in only four patients, all of whom had received antimicrobials. Clostridium difficle, but not cytotoxin, was identified in 10 of 43 admissions. This followed antimicrobial prophylaxis to cover a recent operation in two patients, and five were on long-term sulphasalazine. Only three patients with Clostridium difficile had not received an antimicrobial within one month of the study. Isolation of Clostridium difficile alone is of doubtful pathological significance, as it spontaneously disappeared without treatment in all patients.

Adult↗
PubMed1982

Incidence and microbiology of abdominal and pelvic abscess in Crohn's disease.

The incidence of abdominal and pelvic abscess is reported from a consecutive series of 111 patients undergoing 124 resections for Crohn's disease. Preoperative abscesses were found as a complication of Crohn's disease in 13 patients (10%) and 8 were clinically unsuspected. The majority of preoperative abscesses were confined to one site (localized to bowel, psoas sheath, pelvis, or in the abdominal wall). All preoperative abscesses occurred in patients requiring an emergency or urgent operation. Patients with a preoperative abscess had significantly lower serum albumin levels and significantly increased serum alkaline phosphatase values than the patients without an abscess. Postoperative abscesses occurred in 17 patients (14%) and six were multiple. Five of the postoperative abscesses occurred in patients who had had a preoperative abscess; these recurrent abscesses all presented 6-14 wk after an uncomplicated initial operation. The principal bacterial isolates were Escherichia coli (54%), Bacteroides fragilis (44%), enterococci (41%), and viridans streptococci (31%). The incidence of abscess was unrelated to the use of preoperative steroid therapy.

Abdomen↗