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Biomedical subjects

J P Masterton

Publications and source records attributed to J P Masterton.

15 recordsLinked to original sources
PubMed1992

Do burn patients have a silver lining?

Silver-containing pharmacological preparations have been used for many years in the prophylaxis and management of burn wound sepsis and, more recently, 1 per cent silver sulphadiazine cream (SSD) has been the treatment of choice for such problems. A prospective clinical study has been undertaken to determine the absorption and effects of the silver ion from SSD, with particular reference to hepatic and renal function. Twenty-two patients were studied. The silver assay was done by atomic absorption spectrophotometry with an attached graphite furnace. The detection level was 0.5 micrograms/l. The precision at 3.5 micrograms/l was 4.8 per cent and at 8.5 micrograms/l was 2.8 per cent. Silver was rapidly absorbed through the burn wound and serum silver levels were elevated in 20 patients. Silver was found to be deposited biochemically and electronmicrographically in the liver and kidneys of the only patient who died in the study group. Early hepatic dysfunction was present in all burns greater than 10 per cent total body surface area. Liver and renal function tests did not correlate with serum silver levels. A urinary threshold to silver excretion was seen at a serum silver level of 100 micrograms/l. This study demonstrates that silver is rapidly absorbed through burn wounds, is deposited in large amounts throughout the body but appears safe when used in the treatment of moderate burns. Whether the very high levels recorded in the subject who died were inherently detrimental will remain a matter for speculation.

Absorption↗
PubMed1991

Determination of silver in blood, urine, and tissues of volunteers and burn patients.

Silver sulfadiazine cream (SSD) has been used successfully in the management of burn wound sepsis. Silver deposition has been found in the skin, gingiva, cornea, liver, and kidney of patients treated with this cream, causing argyria, ocular injury, leukopenia, and toxicity in kidney, liver, and neurologic tissues. Monitoring concentrations of silver in blood and urine of patients receiving this treatment has become necessary, but sensitive and suitable methods adaptable to a clinical laboratory are still needed. We have developed a flameless thermal atomic absorption spectrophotometric method to measure silver concentrations in blood, urine, and other tissues. The detection limit is 0.4 microgram/L; the within-run precisions (CV) are 5.16%, 3.83%, and 2.79% for concentrations of 5, 13.5, and 42 micrograms/L, respectively; and the between-run precisions are 4.3% and 3.2% for concentrations of 13.5 and 42 micrograms/L. The concentrations of silver in blood, urine, liver, and kidney of subjects without industrial or medicinal exposure are less than 2.3 micrograms/L, 2 micrograms/day, 0.05 microgram/g wet tissue, and 0.05 microgram/g wet tissue, respectively. In SSD cream-treated burn patients, plasma concentrations may be as great as 50 micrograms/L within 6 h of treatment and can reach a maximum of 310 micrograms/L. Silver in urine is detectable after one day of treatment and may reach a maximum of 400 micrograms/day. After absorption, silver was found to be deposited in various tissues. Tissue silver concentrations in one burn patient who died of renal failure after eight days of treatment were 970, 14, and 0.2 micrograms/g wet tissue in cornea, liver, and kidney, respectively.

Aged↗
PubMed1979

A survey of adults with flame burns at a Melbourne hospital.

A prospective survey has been made of 81 patients with flame burns who were admitted to the Alfred Hospital, Melbourne, in the years 1973 and 1974. Young males who got burnt in and around their homes were most frequently encountered. Indications of the importance of predisposing conditions, flammable liquids and apparel in the burn incidents are discussed together with the need for extension of the survey.

Accidents, Home↗
PubMed1979

Ileorectal anastomosis for inflammatory bowel disease: 15-year follow-up.

A personal series (E.S.R.H.) of 37 patients with inflammatory bowel disease, treated by colectomy and ileorectal anastomosis 15 years or more ago, is reviewed. Twenty-one patients (57 per cent) continue to be in satisfactory condition. Patients subjected to the two-stage operation have a notably lower rate of conversion to ileostomy than those treated by one-stage colectomy. One patient developed a carcinoma of the rectal stump. This 15-year review leads support to the opinion that ileorectal anastomosis has an important place in the treatment of inflammatory bowel disease.

Colectomy↗
PubMed1979

Intestinal obstruction following operation for inflammatory disease of the bowel.

Acute small-intestinal obstruction is not an uncommon complication following excisional operation for inflammatory disease of the bowel. In the Monash series the most common cause was adhesion formation. Stoma problems accounted for a small number. There was a special tendency for the complication to appear soon after the excisional surgery. A significant mortality rate accompanied obstructive complication and, over the long term, one in five patients needed further surgery for a recurrence.

Adolescent↗
PubMed1979

Delayed diagnosis of carcinoma of the rectum and sigmoid.

In a large series of patients with carcinoma of the sigmoid colon and rectum there was a delay in diagnosis due to misinterpretation of the physical signs in 36 cases (2.3%). The causes of the misdiagnosis were haemorrhoids, radiological misinterpretation, and chronic inflammatory disease. A miscellaneous variety completed the series. A study of the survival of those patients in whom there was a delay in diagnosis shown that it is most unlikely that it actually affected adversely the prognosis of these patients.

Diagnostic Errors↗
PubMed1979

Cephaloridine prophylaxis in resection of the large intestine.

A controlled prospective clinical trial of cephaloridine chemoprophylaxis in resection of the large intestine was undertaken between 1974 and 1978. Data were available on 159 of 177 unselected patients. All were operated on by one surgeon. Three groups were studied: intraabdominal resection and anastomosis (102 patients); pullthrough resection and anastomosis (30 patients): and resection, with colostomy or ileostomy, without anastomosis (27 patients). In the total patient series cephaloridine reduced wound infection from 38.3% to 15.4% (P less than 0.003). There was no significant decrease in intraabdominal infection. In the group of patients undergoing intraabdominal resection and anastomosis the would infection rate was reduced from 40.0% to 14.9% (P less than 0.01). Cephaloridine reduced wound infection from 50.0% to 21.4% (P = 0.05) in those patients in whom drainage tubes were inserted. A decrease in the incidence of faecal fistula from 10.9% to 4.3% was not significant. Wound infections were not reduced significantly after pullthrough excisions or resections without anastomosis. The results support the routine prophylactic use of cephalosporins in patients undergoing intraabdominal resection of the large intestine with anastomosis.

Cephaloridine↗
PubMed1979

The autosuture surgical stapling instruments: preliminary experience.

Stapling instruments for gastrointestinal surgery are relatively new in the surgical armamentarium of Australian surgeons. In an attempt to assess their safety and handling characteristics laboratory experience has been obtained in dogs. This has shown that these instruments are effective and easily handled, although costly in routine use. It seems likely that they will provide an appropriate alternative to certain conventional anastomotic techniques.

Animals↗
PubMed1979

Purse string placement for staple anastomosis using the end-to-end anastomosis stapling instrument.

There may be technical difficulties in the use of recommended clamp for the insertion of the purse-string suture during the construction of an end-to-end staple anastomosis. Hand sewing the purse string eliminates some of the problems, but unless the suture is positioned within a few millimetres of the cut edge of the bowel, ischaemic tissue may be included in the staple line. In dogs, this leads to anastomotic dehiscence. The anastomosis may, however, be protected by excising the ischaemic tissue and reinforcing the staple line with sutures. An "over and over" purse-string technique is now preferred to minimize the risk of this occurring.

Animals↗
PubMed1977

The natural history of benign ulcer of the rectum.

The cause of benign ulcer of the rectum is obscure, and there are varying views as to its pathogenesis. It is usually found to have a clinical onset in young adults of either sex. On sigmoidoscopy, the lesion has a characteristic appearance. The ulcers are, most often, solitary but more than one ulcer can be present. Diagnosis at biopsy is not essential, but distinctive changes can be seen in tissue from both the ulcer itself or the mucosa adjacent to the ulcer. Clinically and histologically recognizable preulcerative and nonulcerative phases are seen. Despite the benign nature of the ulcer, it may persist unchanged for many years, often associated with rectal prolapse. In general, medical and surgical methods of treatment have proved unsatisfactory.

Adolescent↗
PubMed1976

The sleep habits, personality and academic performance of medical students.

The academic performance of 104 fourth-year medical students was assessed in relation to their sleep habits reported in a questionary and their scores on the Minnesota Multiphasic Personality Inventory. Poorer academic performance was related significantly to later times of waking up in the morning, particularly at weekends, and to subjectively poorer quality sleep, but not to the amount of sleep usually obtained. Poor academic performance was related also to scores on scales 3 (hysteria), 4 (psychopathic deviate) and 8 (schizophrenia) of the MMPI. Simple enquiries about sleep habits may make it easier for students who are at greatest risk of academic failure to be identified and helped.

Australia↗