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Biomedical subjects

J Drumm

Publications and source records attributed to J Drumm.

At least 19 recordsLinked to original sources
PubMed1991

Identification of bile duct stones in patients undergoing laparoscopic cholecystectomy.

To identify patients with common bile duct stones, all patients considered for laparoscopic cholecystectomy in this unit undergo intravenous cholangiography (IVC) with tomography and, more recently, operative cholangiography. To date 100 consecutive patients with symptomatic gallstones have undergone laparoscopic cholecystectomy with no specific exclusion criteria. Eight patients of 100 were found to have duct stones on IVC with one false-positive. These IVC data were compared with data from 52 patients who also had operative cholangiograms performed. One stone was detected on operative cholangiography that was not identified on IVC. No additional information was gained from operative cholangiography. These data suggest that preoperative IVC is adequate for the detection of duct stones in patients considered for laparoscopic cholecystectomy.

Adolescent↗
PubMed1990

Is intrauterine growth retardation with normal umbilical artery blood flow a benign condition?

OBJECTIVE: To determine whether intrauterine growth retardation associated with normal umbilical artery blood flow is a benign condition. DESIGN: A prospective comparative study of growth retarded fetuses with normal and abnormal umbilical artery blood flow. SETTING: The fetal assessment clinic of a large maternity hospital in Ireland. PATIENTS: 179 Women with singleton pregnancies in which the fetal abdominal circumference, measured by ultrasonography, was below the fifth centile for gestation. MAIN OUTCOME MEASURES: Perinatal deaths, fetal distress requiring caesarean section, preterm delivery, cerebral irritation. RESULTS: Of 124 fetuses with normal flow, all physically normal fetuses survived but one baby had cerebral irritation; there were six preterm deliveries and four caesarean sections for fetal distress. Among 55 women with abnormal flow there were two midtrimester abortions, three perinatal deaths, and one case of cerebral irritation in physically normal fetuses. CONCLUSIONS: Intrauterine growth retardation associated with normal umbilical blood flow is a different entity from that associated with abnormal flow, normal flow being largely benign and abnormal flow carrying a serious risk of adverse outcome.

Cesarean Section↗
PubMed1989

Effect of Roux-en-Y biliary diversion on Campylobacter pylori.

To assess the effect of biliary diversion on gastric colonization by Campylobacter pylori, we undertook a retrospective histologic study of 24 patients with symptomatic bile reflux after peptic ulcer surgery, who had endoscopic gastric biopsies performed before and after a Roux-en-Y operation. The time interval between the preoperative and postoperative endoscopic examinations ranged from 0.8 to 9.8 yr (mean 4.7 yr). The partial gastrectomy specimen, which had been resected at the initial operation, was available for assessment in 12 patients (50%). Biopsy specimens were assessed for the presence of C. pylori and scored for severity of reflux gastritis by the use of a histologic grading system. Ten of the 12 partial gastrectomy specimens (83%) were C. pylori-positive. Only 13 of the 24 patients (54%) were C. pylori-positive before the Roux-en-Y operation, rising to 22 (92%) after biliary diversion (p = 0.008). The median reflux score was 6 in the partial gastrectomy specimens; it rose to 11 before the Roux-en-Y operation and fell again to 6 after biliary diversion (p less than 0.001). These results suggest that C. pylori may recolonize the gastric remnant after biliary diversion.

Adult↗
PubMed1987

Effect of Roux-en-Y reconstruction on the gastric emptying of a solid meal.

The gastric emptying of a solid meal was measured in 39 patients after Roux-en-Y reconstruction and compared with that in 27 patients after truncal vagotomy and pyloroplasty and that in 22 patients after Polya gastrectomy. There were no significant differences among the groups. It is concluded that despite the disruption of the normal motor pathway produced by the Roux-en-Y reconstruction it does not lead to clinically significant delay in gastric emptying.

Duodenogastric Reflux↗
PubMed1986

Emergency presentation and mortality from colorectal cancer in the elderly.

We have assessed the influence of age on the mode of presentation and perioperative mortality in 1033 patients with colorectal cancer. There were 522 patients (51 per cent) over 70 years (group I) and 511 patients (49 per cent) under 70 (group II). In group I, 301 patients (58 per cent) were admitted as emergencies compared with only 222 (43 per cent) in group II (P less than 0.001). Perioperative mortality was especially high in the elderly emergencies, 38 per cent, compared with 18 per cent for elective operations. Of the patients presenting as emergencies in either age group 66 per cent had localized "potentially curable' disease. The incidence of colorectal cancer is highest in the elderly. A larger number of these elderly patients present as emergencies and die from the consequences of complications of localized disease. Earlier diagnosis by pre-symptomatic screening is therefore especially desirable in these old patients.

Age Factors↗
PubMed1986

The pharmacokinetics and tissue penetration of imipenem.

Two studies were performed to investigate the penetration of imipenem into chemically induced inflammatory exudate and into peritoneal fluid. In the first study six volunteers received 500 mg of imipenem, alone and with 500 mg cilastatin. Little difference was noted in the pharmacokinetics or inflammatory fluid penetration of imipenem when given with or without cilastatin. The only significant alteration was the urine recovery (an increase from a mean of 14.7% to 55.6% in the presence of the enzyme inhibitor). The mean inflammatory fluid level of imipenem at 30 min was 6.2 mg/l (or 35% of the plasma level). The inflammatory fluid levels exceeded the plasma levels after 2 h. The overall penetration of imipenem/cilastatin into inflammatory fluid was 67.8% (+/- 13.8) and imipenem alone 73.2% (+/- 13.9). The mean elimination half-life of imipenem from plasma was 1.1 h and from inflammatory fluid 1.4 h (with or without cilastatin). In the second study, 29 patients received 1 g imipenem plus cilastatin before elective surgery and plasma and peritoneal levels were measured over 4 h. There was considerable penetration of the peritoneum, imipenem levels in excess of 30 mg/l being found 15 min after administration declining to 5-7 mg/l by 3-4 h. The mean percentage penetration was 73.4% (+/- 22.1). A brief review of the literature on imipenem tissue penetration is included.

Adult↗
PubMed1985

Metronidazole and Augmentin in the prevention of sepsis after appendicectomy.

Two hundred and fifty patients were admitted to a prospective randomized trial to compare the efficacy of Augmentin with metronidazole in the prevention of sepsis after appendicectomy. Pre-operatively they received either 500 mg metronidazole or 1.2g Augmentin intravenously. Those patients with gangrenous or perforated appendices received eight additional doses of the trial drug at 8 hourly intervals. Overall there were 13 wound infections in the Augmentin group (11 per cent) and 21 in the metronidazole group (18 per cent). The 90 per cent confidence limits for the overall 7 per cent difference in infection rates were +/- 8.5 per cent. There were high rates of wound infection in the gangrenous group (Augmentin 8 per cent versus metronidazole 19 per cent) and especially in the perforated group (Augmentin 33 per cent versus metronidazole 63 per cent). There was no statistically significant difference between the infection rates with the two antibiotics but our study suggests that Augmentin, which is active against both aerobes and anaerobes, may be more effective than metronidazole in reducing wound sepsis after appendicectomy.

Adult↗
PubMed1984

Choledochal cysts--report of three cases and review.

Three cases of choledochal cyst are presented, with a review of previous publications. We re-emphasize the diagnostic dilemma involved and discuss current surgical management. A new complication is illustrated and an association with polycystic kidneys is reported. Choledochal cysts are uncommon, but correct management ensures a symptom-free future for the patient. Recent reports support cyst excision if technically feasible.

Adult↗
PubMed1984

The management of acute colonic diverticulitis with suppurative peritonitis.

With improvement in the medical management of diverticular disease, perforation has become the most common indication for surgical intervention. It is a source of considerable morbidity and mortality and consequently has provoked a considerable and controversial challenge for surgeons. We are proposing that all patients found to have purulent peritonitis secondary to perforating diverticulitis at laparatomy, should be managed initially by a defunctioning transverse colostomy, drainage and the administration of appropriate antibiotics. Subsequent management should consist of simple closure of the colostomy following a check barium enema and the commencement of a high fibre diet. We substantiate this by reporting 20 cases from Dudley Road Hospital and 20 others mentioned in the current literature.

Acute Disease↗
PubMed1983

The penetration of amoxycillin/clavulanic acid into peritoneal fluid.

Thirty patients undergoing elective abdominal surgery were given 1 g amoxycillin plus 0 . 2 g clavulanic acid as a single intravenous injection at varying times prior to the operation. Sterile assay discs were placed on the peritoneal surface in order to measure peritoneal fluid levels of each agent. Simultaneous serum levels were also measured. A total of 44 simultaneous serum and peritoneal samples were analysed. There was rapid penetration of both agents into peritoneal fluid. The mean peritoneal fluid levels of amoxycillin were 84% (S.D. 34) of the serum level and 66% 42) for clavulanic acid. The peritoneal levels of both agents declined in parallel to the serum levels (the half-lives all being about 1 h) and the ratio of amoxycillin: clavulanic acid in serum and peritoneal fluid was similar to that as administered.

Amoxicillin↗
PubMed1983

The intraperitoneal penetration of temocillin.

The intraperitoneal penetration of temocillin was studied following a 1 g iv injection in 28 patients undergoing elective gastrointestinal surgery. Temocillin penetrated rapidly and during the first hour post administration the peritoneal level was 48% of the serum level. The mean peritoneal level of temocillin over the period of the study (3.5 h) was 49.1 mg/l. It was concluded that 1 g of temocillin twice daily would achieve sufficiently high intraperitoneal levels to inhibit susceptible pathogens.

Adult↗