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Biomedical subjects

G Sunderland

Publications and source records attributed to G Sunderland.

15 recordsLinked to original sources
PubMed2006

Early experience with linezolid for infections in orthopaedics.

In infections following orthopaedic surgery, isolated staphylococci are reported to be methicillin resistant (MRSA) in up to 50% of cases. Linezolid, the first in a new class of antibiotics, has excellent efficacy against gram positive organisms that are resistant to other therapies and is 100% orally bioavailable. We report early results of its use for the treatment of resistant infections in orthopaedic practice. Infections were characterised according to the UK Nosocomial Infections National Surveillance Service classification of surgical infections as superficial, deep or organ/space. Osteomyelitis, joint sepsis and deep infection involving orthopaedic implants were included into the final category. Outcome was recorded as clinical, microbiological and blood parameter cure or fail. Over the 12-month study period, 54 patients received linezolid therapy, 41% of these had significant co-morbidity that might affect their ability to fight infection. Sixty-seven percent of infections were in association with implanted metal work. The majority of patients were treated with vancomycin for a short period before linezolid was used as oral 'switch' therapy for longer-term administration, allowing early discharge in all cases. MRSA was isolated in 87% of the patients treated. The mean length of linezolid therapy was 39 days (2-151). Clinical success was achieved in 90% of patients overall. Though there were no life-threatening complications, adverse event rates were significantly higher than those recorded in the literature, with 19% of patients needing to cease therapy. Linezolid offers an alternative to traditional treatments for resistant infections and can facilitate early discharge. Patients need to be monitored closely, particularly where long-term therapy is planned.

Acetamides↗
PubMed2005

The SCAR-3 study: 5-year adhesion-related readmission risk following lower abdominal surgical procedures.

OBJECTIVE: The Surgical and Clinical Adhesions Research (SCAR) and SCAR-2 studies demonstrated that the burden of adhesions following lower abdominal surgery is considerable and appears to remain unchanged despite advances in strategies to prevent adhesions. In this study, we assessed the adhesion-related readmission risk directly associated with common lower abdominal surgical procedures, taking into account the effect of previous surgery, demography and concomitant disease. METHODS: Data from the Scottish National Health Service medical record linkage database were used to assess the risk of an adhesion-related readmission following open lower abdominal surgery during April 1996-March 1997. RESULTS: Patients undergoing lower abdominal surgery (excluding appendicectomy) had a 5% risk of readmission directly related to adhesions in the 5 years following surgery. Appendicectomy was associated with a lower rate of readmission (0.9%), but contributed over 7% of the total lower abdominal surgery patient readmission burden. Panproctocolectomy (15.4%), total colectomy (8.8%) and ileostomy surgery (10.6%) were associated with the highest risk of an adhesion-related readmission. Overall, the risk of readmission was doubled in patients who had undergone abdominal or pelvic surgery within 5 years of the incident operation. A higher risk of readmission was also recorded in patients aged < 60 years compared with those aged > or = 60 yrs. The effect of gender was assessed. However, as the surgical codes used were found to be skewed towards women, these data have not been reported. Readmission risk was slightly higher in patients with concomitant peritonitis compared with patients without peritonitis. In contrast, Crohn's disease had no effect on risk. Patients with colorectal cancer had a lower risk of adhesion formation. However, this may have been due to the type of surgery performed in this patient group. CONCLUSION: The identification of high-risk patient subgroups may assist in effectively targeting adhesion-prevention strategies and the proffering of preoperative advice on adhesion risk.

Adolescent↗
PubMed2004

Colorectal surgery: the risk and burden of adhesion-related complications.

OBJECTIVES: Adhesions are associated with serious medical complications. This study examines the real-time burden of adhesion-related readmissions following colorectal surgery and assesses the impact of previous surgery on adhesion-related outcomes. PATIENTS AND METHODS: The study used data from the Scottish National Health Service Medical Record Linkage Database to identify three cohorts of patients who had undergone open colorectal surgery during the financial years 1996-97, 1997-98 and 1998-99. Each cohort was followed up for at least 2 years and the number and category of adhesion-related readmissions was recorded. The influence of any previous operations on adhesion-related readmissions was also determined by performing a subanalysis within the 1996-97 cohort of patients who had no record of abdominal surgery within either the previous 5 or 15 years. The relative risk of adhesion-related readmissions was also assessed. RESULTS: In the 1996-97 cohort, 9.0% of patients were readmitted within a year after surgery; 2.1% had complications directly related to adhesions and 6.9% had complications that were possibly related. After 4 years, 19.0% of patients were readmitted for reasons directly or possibly related to adhesions. Many patients were readmitted on more than one occasion and the relative risk of adhesion-related complications was 29.7 per 100 initial procedures over 4 years. In the subgroups that had no record of abdominal surgery within the previous 5 or 15 years, the relative risks of adhesion-related complications were 24.8% and 23.5%, respectively. There was no change in the rate of adhesion-related readmissions following colorectal surgery between 1996 and 1999. CONCLUSION: Colorectal surgery is associated with a considerable rate of adhesion-related readmissions. Preventative measures should be considered to reduce this risk.

Adult↗
PubMed2003

The combined use of electrokinetic remediation and phytoremediation to decontaminate metal-polluted soils: a laboratory-scale feasibility study.

The use of a combination of electrokinetic remediation and phytoremediation to decontaminate two metal-polluted soils has been demonstrated in laboratory-scale reactors. One soil was heavily contaminated with copper, the other with cadmium and arsenic (2500 microg g(-1) Cu; 300-400 microg g(-1) Cd and 230 microg g(-1) As, respectively). Test reactors with two separated chambers, each with a capacity of 5.25 kg soil, were constructed, then the respective chambers were filled with either a mixture of the polluted soil and a control topsoil (75:25) or topsoil alone. Reactors were sown with perennial ryegrass (Lolium perenne cv Elka) and a constant voltage of 30 V was applied continually across the soils in each reactor. Soil sampling took place at the start and the end of the test run, whilst plant foliage was sampled after approximately 3 weeks (both reactors) 6 weeks (Cd soil reactor only) and at the conclusion of each test run (98 days Cu soil, 80 days Cd soil). Soil and plant metal concentrations were measured, together with soil pH. Results showed that in both soils there was a significant re-distribution of metals from anode to cathode in the test reactors, coupled with an enhancement of plant Cu uptake in the cathode region for the Cu soil. Patterns of plant Cd uptake were less clear cut and were not as clearly related to the redistribution of Cd measured in the soil. There was significant acidification of soil at the anode in each test reactor, but soil pH in other parts of the reactor changed little during the course of the experiment. Plant growth was affected at the anode, but was not affected in other parts of the reactor. There was no visual evidence of metal toxicity in the ryegrass in either polluted soil. Some effects on soil fungi were apparent, with a stimulation of Fusarium infection of ryegrass in the cathode region of all reactors and the appearance of sporophores of Coprinus in the same location. It is concluded that the combination of the two techniques represents a very promising approach to the decontamination of metal polluted soils that now requires validation in field conditions.

Arsenic↗
PubMed2001

Electrokinetic movement and biodegradation of 2,4-dichlorophenoxyacetic acid in silt soil.

The coupling of electrokinetic movement of an organic contaminant, 2,4-dichlorophenoxyacetic acid (2,4-D), through soil and its biodegradation in situ has been demonstrated. In a first experiment, the direction and rate of movement of 2,4-D were determined using homogeneously contaminated soil (864 mg 2,4-D/kg dry weight soil) compacted into six individual compartments, 6 cm long, 3 cm wide, and 4 cm deep. Each compartment was bordered by a carbon felt anode and a stainless steel cathode. The application of a current density of 3.72 A/m(2) led to migration of 2,4-D towards the anode at a rate of approximately 4 cm/day. In a second experiment, electrokinetic movement and biodegradation were combined in situ. Sterilized silt soil contaminated with ring-labeled 14C-2,4-D (811 mg 2,4-D/kg dry weight soil) was compacted into a single soil compartment, 22 cm long, 7 cm wide, and 4 cm deep, in a 4.5 cm region adjacent to the cathode. The remainder of the compartment was filled with sterilized soil (to a total weight of 1,015 g). Burkholderia spp. RASC c2 (1.88 x 10(11) cells), a tetracycline-resistant bacterium with chromosomally encoded degradative genes for 2,4-D, was inoculated into the soil at a position 14-16 cm from the cathode. The reactor was placed within a sealed perspex box, with a constant air flow connected to sodium hydroxide traps. Under an applied current density of 0.89 A/m(2), the pollutant moved towards the bacteria. As it reached the inoculated region, its concentration decreased in the soil and 14CO2 was recovered in the traps. At the end of the experiment, 87.1% of radiolabel had been removed from the soil, 5.8% of which was recovered as 14CO2. A third, control, experiment showed a significant contrast in the absence of an electric current, where a slow rate of diffusion controlled the movement of both 2,4-D and bacteria in the soil and biodegradation occurred at the interface between the diffusing fronts.

2,4-Dichlorophenoxyacetic Acid↗
PubMed2000

Fluid collections detected by ultrasound following uncomplicated colorectal surgery.

The aim of the study was to assess the incidence and site of intraperitoneal fluid collections following uncomplicated colorectal surgery and to identify factors relating to the presence of such collections. 38 patients (22 males) with a mean age of 67 years (range 38-85 years) undergoing uncomplicated colorectal procedures were studied prospectively. Patients underwent abdominal and pelvic ultrasound on Day 3 and Day 7 following surgery. The number, site and volume of collections were recorded. Ultrasound-detected fluid collections were present in 26% on Day 3 and 25% on Day 7 following laparotomy. The presence of a collection was not related to the amount of residual volume after peritoneal lavage with normal saline prior to operative closure, to intraoperative blood loss or to the presence of drains. The right upper quadrant was the commonest site of intraperitoneal collections. In the absence of additional clinical signs, the presence of such collections is not an indication for intervention.

Adult↗
PubMed1997

Training initiative list scheme (TILS) for minimal access therapy: the MATTUS experience.

The objective of the MATTUS intercollegiate exercise was to set up and audit a training initiative list scheme (TILS) by which funds are awarded to Trust hospitals for operative sessions used specifically for the training of staff in minimal access therapy (MAT). A prospective centralized audit of TILS involving nine Trust hospitals in Scotland over a 12-month period (1 March 1995-end of February 1996) was carried out. These hospitals had contracted for 510 4-h training sessions (389 for minimal access surgery, 121 for allied interventional techniques) by MATTUS accredited consultant tutors. The scheme covered training in technical competence for Minimal Access Surgery (MAS), interventional flexible endoscopy and interventional radiology within Scottish Hospitals. The main outcome measures used in the audit were trainee completion rates, conversion rates, morbidity and mortality, assessment of training received by trainees and assessment of aptitude by the trainers. The results were as follows. Of 510 sessions, 482 (95%) were completed within the deadline. Of these, 463 sessions were audited (367 for MAS, 69 for flexible endoscopy and 27 for interventional radiology). During these sessions, 817 operations/procedures were performed (781 training and 36 developmental). A total of 544 operations were performed during 339 MAS training sessions and 237 radiological/flexible endoscopy procedures in 96 MAT training sessions. The trainee was the principal operator in 643 (82%) procedures and completed the task in 581 (74%) cases. Four per cent of the MAS operations (22/544) required conversion. Post-operative complications occurred in 42 out of 817 patients (5%). Four patients, all with advanced malignancy, died within 30 days of the procedure. Trainees graded 355 sessions as excellent, 109 good, two as average and one as unsatisfactory. The tutors graded their trainees' aptitude to perform the operation as excellent in 34%, good in 53%, average in 11% and poor in < 1%. The training initiative list scheme which allows unhurried training in MAT by consultant tutors using operating sessions that are extra to the service lists is operationally and educationally viable. Furthermore, it can be implemented within a pre-determined budget. The audit of TILS has also demonstrated that the immediate clinical outcome of patients is not compromised by this type of training.

Education, Medical, Graduate↗
PubMed1994

Laparoscopic versus minilaparotomy cholecystectomy: a randomised trial.

Although laparoscopic cholecystectomy has rapidly become routine practice in the UK, there has been no rigorous comparison of it with open cholecystectomy. In our trial, 302 patients were randomised to laparoscopic or minilaparotomy cholecystectomy. Recovery after surgery was assessed by length of hospital stay, outpatient review at 10 days and 4 weeks, and patient questionnaires 1, 4, and 12 weeks after surgery. The mean operation time was 14 min shorter for minilaparotomy, while median post-operative hospital stay was 2 days shorter after laparoscopic cholecystectomy. The hospital costs were about 400 pounds greater for the laparoscopic procedure. Laparoscopic patients returned to work in the home sooner; at 1 week, they had better physical and social functioning, were less limited by physical problems, and had less pain and depression. At 4 weeks, only physical functioning and depression scores were better in the laparoscopic group, and by 3 months there were no differences. Laparoscopic patients were more satisfied with the appearance of their scars. The incidence of complications after both procedures was 20%. Compared to minilaparotomy cholecystectomy, laparoscopic cholecystectomy results in shorter hospital stay, less postoperative dysfunction, and quicker return to normal activities, but is more costly.

Activities of Daily Living↗
PubMed1994

Laparoscopic and minilaparotomy cholecystectomy: a randomized trial comparing postoperative pain and pulmonary function.

BACKGROUND: Upper abdominal surgery is associated with severe postoperative pain and a concomitant reduction in pulmonary function and oxygen saturation. Laparoscopic cholecystectomy is said to result in less postoperative pain compared with open cholecystectomy. METHODS: In a pragmatic, randomized trial, postoperative pain, opiate analgesic consumption, oxygen saturation, and pulmonary function (forced vital capacity, forced expiratory volume in 1 second, and peak expiratory flow rate) were assessed after laparoscopic (n = 67) and minilaparotomy (n = 65) cholecystectomy. RESULTS: Compared with minilaparotomy cholecystectomy, laparoscopic cholecystectomy was associated with lower linear analogue pain scores (median 40 vs 59, p < 0.001), lower patient-controlled morphine consumption (median 22 vs 40 mg, p < 0.001), a smaller reduction in postoperative pulmonary function (mean peak expiratory flow rate 64% of preoperative value vs 49%, p < 0.001), and better oxygen saturation (mean 92.9% vs 91.2%, p = 0.008). CONCLUSIONS: This study confirms that the postoperative pain and pulmonary changes associated with upper abdominal surgery are significantly reduced by the laparoscopic technique. These findings suggest that laparoscopic cholecystectomy may result in a reduced risk of postoperative pulmonary complications.

Adult↗
PubMed1989

Imipramine and alprazolam treatment of lactate-induced acute endogenous distress in nonhuman primates.

The authors studied the response of 10 macaque monkeys to administration of sodium lactate, a panicogenic agent used in human panic disorder research, after treatment with the tricyclic antidepressant imipramine, the triazolobenzodiazepine alprazolam, or placebo. Both drugs effectively blocked the lactate-induced acute endogenous distress responses that had been reliably observed in the monkeys before drug treatment. Only alprazolam significantly reduced the occurrence of conditioned situational anxiety responses observed in the home cage. The alprazolam monkeys appeared to be sedated compared to the imipramine and placebo groups, and tremor and temporary exacerbation of anxious behaviors were observed during alprazolam withdrawal.

Alprazolam↗
PubMed1988

Taste preferences of squirrel monkeys and bonnet macaques for Polycose, maltose and sucrose.

The taste preferences of adult male squirrel monkeys and bonnet macaques for Polycose, maltose, and sucrose solutions were compared in 24 hr/day solution vs. water tests. Solution concentrations of 0.01 M, 0.05 M, 0.10 M, and 0.20 (Polycose) or 0.50 M (maltose and sucrose) were tested. The squirrel monkeys displayed a stronger preference for sucrose than for maltose or Polycose. In fact, at most concentrations tested, the squirrel monkeys did not consume more maltose or Polycose than water. The bonnet macaque monkeys, on the other hand, displayed preferences for maltose and Polycose that were as strong as their sucrose preference. Also, the bonnet macaques' maltose and Polycose preferences exceeded those of the squirrel monkeys. The two species did not reliably differ in their sucrose preferences. The results suggest that bonnet macaques, like rats, have taste receptors for starch-derived polysaccharides, whereas the squirrel monkeys, like humans, may lack such receptors. The taste preference profiles are consistent with the natural food preferences of the two monkey species.

Animals↗
PubMedDate not supplied

Evaluation of an opacity lensometer for determining corneal clarity following excimer laser photoablation.

The appearance of haze in the central cornea following photoablation with a 193 nm excimer laser is an important factor in the postoperative course of this procedure. Data from 37 human eyes treated with photorefractive keratectomy, 4 eyes treated with phototherapeutic keratectomy, and 5 untreated eyes were used to evaluate the ability of a commercially available opacity lensometer to provide an objective measure of corneal clarity. We found that the opacity lensometer was able to detect light scattered from the cornea but was not sufficiently sensitive to distinguish reliably among excimer-treated eyes with degrees of corneal haze evaluated as clear, trace, or 1+ by slit-lamp microscope examination. In untreated, clear corneas, the values obtained with the opacity lensometer in eyes measured with and without a clear contact lens were within one unit of each other for any given eye, but values from eye to eye varied over a range of six units. In a test simulating different amounts of corneal haze using contact lenses evenly coated with nail polish enamel, the log-transformed opacity lensometer values varied directly with percent light scattering as determined by spectrophotometry. These results suggest that the opacity lensometer measurements are reliable and reproducible, but that in the human cornea something is being measured by the opacity lensometer that is not taken into account in clinical slit-lamp microscope evaluation. Overall, it appears that, in its present form, this instrument is not useful to measure corneal clarity after excimer laser photoablation.

Contact Lenses↗