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Biomedical subjects

J S Gani

Publications and source records attributed to J S Gani.

18 recordsLinked to original sources
PubMed2000

Randomised controlled trial of ultrasonography in diagnosis of acute appendicitis, incorporating the Alvarado score.

OBJECTIVES: To determine whether diagnosis by graded compression ultrasonography improves clinical outcomes for patients with suspected appendicitis. DESIGN: A randomised controlled trial comparing clinical diagnosis (control) with a diagnostic protocol incorporating ultrasonography and the Alvarado score (intervention group). SETTING: Single tertiary referral centre. PARTICIPANTS: 302 patients (age 5-82 years) referred to the surgical service with suspected appendicitis. 160 patients were randomised to the intervention group, of whom 129 underwent ultrasonography. Ultrasonography was omitted for patients with extreme Alvarado scores (1-3, 9, or 10) unless requested by the admitting surgical team. MAIN OUTCOME MEASURES: Time to operation, duration of hospital stay, and adverse outcomes, including non-therapeutic operations and delayed treatment in association with perforation. RESULTS: Sensitivity and specificity of ultrasonography were measured at 94. 7% and 88.9%, respectively. Patients in the intervention group who underwent therapeutic operation had a significantly shorter mean time to operation than patients in the control group (7.0 v 10.2 hours, P=0.016). There were no differences between groups in mean duration of hospital stay (53.4 v 54.5 hours, P=0.84), proportion of patients undergoing a non-therapeutic operation (9% v 11%, P=0.59) or delayed treatment in association with perforation (3% v 1%, P=0.45). CONCLUSION: Graded compression ultrasonography is an accurate procedure that leads to the prompt diagnosis and early treatment of many cases of appendicitis, although it does not prevent adverse outcomes or reduce length of hospital stay.

Acute Disease↗
PubMed2000

Use of an ambulance-based helicopter retrieval service.

BACKGROUND: John Hunter Hospital is the major trauma centre for a region covering more than 25,000 square kilometres. The helicopter primary retrieval service for trauma is paramedic staffed and protocol driven. The aim of the present study was to assess the overtriage rate created by such protocols, and to assess the benefit to patient outcomes that may be attributable to the service. METHODS: The John Hunter Hospital trauma database was used to identify all cases arriving by helicopter in 1996, as well as their demographic details, injury severity score, details of the accident and outcome. An expert panel reviewed the medical records for the 184 primary retrievals. Using a consensus model, estimates of time delay or saving were calculated and likelihood of benefit, no benefit or harm was assessed. RESULTS: A total of 3087 trauma patients were assessed at John Hunter Hospital in 1996, of which 8% arrived by helicopter. Of the primary retrievals, 67.6% had an injury severity score of 9 or less, with only 17.9% having a score of 16 or greater. Twelve patients were discharged from Emergency and 36% were discharged within 48 h. The overall mortality was 5.0%. Twenty-five per cent of patients were retrieved within 35 km of John Hunter Hospital with minimal attributable benefit. Overall 1.7% of patients were felt to have been potentially harmed, 17.3% to have benefited and 81.0% to have had no attributable benefit related to the helicopter use. CONCLUSIONS: Although the majority of retrievals are for minor injuries, the service provides benefit for the region. There is potential for harm, however, where base hospitals are overflown in situations where patients have airway compromise, and where patient transfer is delayed due to helicopter activation. Primary helicopter tasking to trauma cases within 35 km of the major trauma centre is seldom beneficial.

Adolescent↗
PubMed2000

Biliary symptom scoring as a method of selecting patients for cholecystectomy.

BACKGROUND: A group of patients referred to general surgeons for the treatment of gall bladder stones was studied to evaluate the role of a numerical symptom scoring system (biliary symptom score (BSS)) as a tool to improve the assessment of patients and reduce the incidence of post-cholecystectomy symptoms. METHODS: Fifty-seven patients with gallstones and abdominal symptoms referred to general surgeons were studied. All patients were interviewed by a surgeon in training independently from the treating surgeon and given a subjective and objective assessment of their symptoms (using the BSS); they were then categorized into biliary, non-biliary and possible biliary groups. The results of the interviews remained unknown to the treating surgeon throughout the period of study. The symptom status of all patients was reevaluated 6-12 months later; the patients' outcome was compared with their initial objective score and the subjective assessment by the independent assessor and with the treating surgeon's initial assessment. RESULTS: Fifty-one patients were able to be analysed. Subjective independent assessment and BSS were closely correlated (phi = 0.89). Use of the BSS improved the accuracy of the independent assessor from 53% (subjective assessment) to 69%, but this was at the cost of recommending cholecystectomy in 30% of the patients with non-biliary symptoms. The accuracy of experienced consultant general surgeons was 98% with a single case of post-cholecystectomy syndrome (2%). CONCLUSION: Numerical BSS improves diagnostic accuracy for a surgeon in training by reducing the number of patients classified with possible biliary symptoms, but it remains significantly less accurate than the subjective clinical assessment of an experienced consultant general surgeon.

Adult↗
PubMed1998

Comparative experience of a simple technique for laparoscopic chronic ambulatory peritoneal dialysis catheter placement.

BACKGROUND: Chronic ambulatory peritoneal dialysis (CAPD) is now an established technique for renal dialysis. Patients with renal failure cope poorly with major surgery and it is vital that the dialysis catheter tip is sited accurately in the pelvis if long-term catheter function is to be achieved. Laparoscopic placement of CAPD catheters may have potential advantages for renal patients by avoiding the morbidity of a laparotomy. METHODS: A retrospective audit was performed of all CAPD catheters inserted at the John Hunter Hospital over a 2-year period. Results of laparoscopically inserted catheters and those placed at laparotomy were compared. RESULTS: Sixty catheters were inserted, 30 laparoscopically and 30 at laparotomy. The mean operative time was 41 min in the laparoscopic patients and 57 min in the laparotomy patients (P = 0.0001). The mean total dose of narcotic administered postoperatively was significantly less in the laparoscopic group (5 mg vs 65 mg, P = 0.00002). There were three minor peri-operative complications in the laparoscopic group and seven peri-operative complications in the laparotomy group, three required reoperation and one resulted in the patient's death. There were no significant differences in the incidence of exit-site infection, catheter blockage, peritonitis, and overall catheter survival, although the laparoscopically placed catheters had been followed up for a shorter period (10 vs 16 months). CONCLUSIONS: This laparoscopic technique is safe and effective. Postoperative pain was less than for open placement. Laparoscopically placed catheters had a low incidence of peri-operative complications. Medium-term patency is similar to conventionally placed catheters. This procedure requires no additional equipment to that available for laparoscopic cholecystectomy and takes less time than the open operation.

Adult↗
PubMed1998

Can sincalide cholescintigraphy fulfil the role of a gall-bladder stress test for patients with gall-bladder stones?

BACKGROUND: Patients referred to general surgeons for the treatment of gall-bladder stones were studied to evaluate the role of sincalide cholescintigraphy as a gall-bladder stress test in an effort to identify a group of patients whose pain was non-biliary in origin and who would not be improved by cholecystectomy. METHODS: Ten asymptomatic controls and 57 patients with gallstones and abdominal symptoms were studied. All patients were interviewed by an independent assessor who identified a group of patients in whom the role of gallstones in their presentation was uncertain (clinically possibly biliary group). All patients and controls underwent sincalide cholescintigraphy. The surgeons remained blinded to the study results throughout the study period. All patients were re-evaluated 6-12 months later to establish the ultimate diagnosis based on their therapeutic response. RESULTS: Several parameters of gall-bladder function were studied from analysis of the sincalide cholescintigram. Lag time, ejection period, ejection rate and ejection fraction did not differ significantly among controls, patients proven to have non-biliary disease and patients proven to have biliary disease. There were significant differences in mean gall-bladder filling fraction between proven biliary and proven non-biliary groups. However, the group of patients with clinically possibly biliary symptoms could not accurately be separated into those who benefited from cholecystectomy and those who improved without surgery on the basis of this parameter. CONCLUSIONS: Significant differences in gall-bladder filling fraction between symptomatic and asymptomatic gallstone patients were identified suggesting reduced gall-bladder compliance in symptomatic patients. However, the sincalide cholescintigram failed to emerge as a useful gall-bladder stress test. Even in the 1990s, assessment by an experienced surgeon appears to be the most appropriate way to select patients for cholecystectomy.

Abdominal Pain↗
PubMed1996

Intensive care unit admissions following laparoscopic surgery: what lessons can be learned?

BACKGROUND: Laparoscopic surgery has been widely embraced, often without adequate data concerning the range and incidence of complications. In the present series, our experience of complications requiring Intensive Care Unit (ICU) admission following laparoscopic surgery is described. METHODS: The records of patients requiring ICU admission at John Hunter Hospital (JHH) following laparoscopic surgery over a 39 month period were retrospectively reviewed by an independent multidisciplinary panel. RESULTS: Twenty-three ICU admissions were identified. Twenty-one followed general surgical laparoscopic procedures and two followed gynaecological laparoscopies. Ten cases were operated on initially at JHH and 13 were transferred from other hospitals. During the study period, 2444 laparoscopic surgical cases were performed at JHH; 725 general surgical procedures (1.37% admitted to ICU) and 1719 gynaecological procedures (no ICU admissions). Twelve cases suffered surgical complications (including five gastrointestinal tract perforations and three biliary tract injuries) and 11 cases were admitted for non-surgical problems. In 75% of surgical complications there was delay in diagnosis of more than 24 h. The duration of ICU stay for surgical complications (16.4 days) was significantly longer than for the non-surgical group (3.9 days). CONCLUSION: There was a greater likelihood of ICU admission following general surgical rather than gynaecological laparoscopy. Fifty-two per cent of the admissions were for surgical complications. Surgical complications are characterized by delay in diagnosis and longer ICU admission periods. Strategies to prevent some of these complications are discussed.

APACHE↗
PubMed1993

Scanning tunnelling microscopy of collagen I reveals filament bundles to be arranged in a left-handed helix.

Collagen I is the most abundant protein found in the body. Its quaternary structure has been extensively characterised and consists of filaments arranged into bundles. In this study we used scanning tunnelling microscopy to image the collagen I filaments and fibrils directly. The images suggested that filaments are arranged into a left-handed helical structure with a periodicity of about 10nm. Such a structure potentially adds increased tensile strength to the collagen fibrils.

Animals↗
PubMed1992

Acute gastrocnemius myositis. Another extraintestinal manifestation of Crohn's disease.

OBJECTIVE: To present the first case in Australia of skeletal muscle inflammation as a manifestation of Crohn's disease. CLINICAL FEATURES: A 50-year-old man was admitted to hospital with a two-week history of bloody diarrhoea, weight loss of 3 kg, soreness of his calf and thigh muscles, and night sweats. A clinical diagnosis of acute Crohn's gastrocnemius myositis was made. Muscle biopsy was not performed. INTERVENTION AND OUTCOME: He was prescribed hydrocortisone by the intravenous route, which was replaced by prednisone by mouth. The myositis resolved completely within 48 hours. CONCLUSION: Corticosteroids are an effective treatment for this rare extraintestinal manifestation of Crohn's disease. Invasive investigations can be reserved for those who fail to respond.

Administration, Oral↗
PubMed1992

Adhesion to thrombospondin by human embryonic fibroblasts is mediated by multiple receptors and includes a role for glycoprotein 88 (CD36).

Fetal embryonic fibroblasts attach and spread on thrombospondin (TSP). Adhesion is tight and focal adhesion plaques and "spots" are formed. We have investigated the receptors responsible for this adhesion. Unstimulated cells express the vitronectin receptor on their surface and this beta 3 integrin molecule contributes to adhesion. Another putative receptor for TSP, termed glycoprotein (GP) 88, which exists as a cytoplasmic pool in unstimulated cells becomes surface expressed when these cells are plated on TSP and localizes to areas of cell adhesion. Western blot analysis of cell lysate confirms GP88 as a TSP binding protein. Studies with fucoidan indicate that the heparan sulfate proteoglycan, known to function as a receptor for TSP, appears to contribute substantially to the TSP attachment of these cells and may be the receptor most important in the initial phases of TSP interaction.

Antibodies, Monoclonal↗
PubMed1991

Use of the fistula assessment monitor to detect stenoses in access fistulae.

Twenty-three unselected hemodialysis patients with functioning access arteriovenous fistulae were studied prospectively to determine the best technique for detecting stenoses within the fistulae. Combined clinical assessment and fistula assessment monitoring were compared with transbrachial angiography. Fistula assessment monitoring was more accurate (96%) than combined clinical assessment (accuracy, 52%) in stenosis detection. Complications of angiography occurred in 17% of patients; there were no complications of fistula assessment monitoring. Fistula assessment monitoring was better than combined clinical assessment in predicting clinical outcome for arteriovenous fistulae over 6 months and was as good as angiography. Routine fistula assessment monitoring could reduce inappropriate angiography and detect clinically significant silent stenoses. It is an ideal method for monitoring arteriovenous access fistulae.

Angiography↗
PubMed1990

Efficacy of double versus single gloving in protecting the operating team.

Double-glove perforation rates and perforation rates in standard single-gloved operating teams were compared, in order to determine whether double gloving provides additional protection for the operating team. Patients were randomized to undergo surgery with a double-gloved or single-gloved operating team. All gloves worn during the operation were tested for perforations by water-filling and individual digital distension; 115 single-gloved operations and 103 double-gloved operations were performed. There were 841 individual operating team members 'at risk'. In the single-glove group, 20.8% of individuals had perforations, but only 2.5% had perforations in both inner and outer gloves (dual perforation) in the double-glove group (P less than 0.0001). The surgeon was most at risk of glove perforation (34.7% of cases in the single-glove group, 3.8% dual perforation in the double-glove group). Longer operations were associated with increased risk of glove perforation. Double-gloving significantly reduces the risk of skin contamination by blood and body fluids and is recommended for all high risk cases.

General Surgery↗