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Biomedical subjects

M W Flowers

Publications and source records attributed to M W Flowers.

12 recordsLinked to original sources
PubMed1988

Concentrations of serotonin in plasma--a test for appendicitis?

We assessed the value of measuring serotonin (5-hydroxytryptamine) in plasma (by HPLC) in the diagnosis of acute appendicitis. Values for patients with subsequently confirmed appendicitis (11-145 nmol/L, median 70 nmol/L) significantly (P congruent to 0.005) exceeded those for patients with abdominal pain in whom appendicitis was only a possible diagnosis (2-45 nmol/L, median 20 nmol/L). The results for appendicitis patients were bimodally distributed, with low results found in patients where surgery revealed gangrenous appendicitis with little viable appendicular tissue. We conclude that measuring serotonin may be of value in confirming or excluding the diagnosis of early acute appendicitis where the physical signs are equivocal, and thus helps reduce unnecessary appendectomies. However, serotonin is of little help in diagnosing gangrenous appendicitis, where physical signs are more likely to be clearcut.

Appendectomy↗
PubMed1985

Screening for acute pancreatitis: a rapid assay for plasma lipase.

A simple agglutination test for plasma immunoreactive lipase has been evaluated in 101 patients. A positive agglutination reaction was observed if, and only if, plasma lipase exceeded 300 micrograms/l. The test was positive in all 23 patients with acute pancreatitis who were tested on the day of admission to hospital, in one patient with a pancreatitic pseudocyst and in one patient with hyperamylasaemia and hyperlipasaemia due to a perforated duodenal ulcer. The simplicity and reliability of this test make it suitable as an urgent diagnostic investigation for acute pancreatitis.

Acute Disease↗
PubMed1984

A simple screening test for acute pancreatitis.

A urinary test strip for amylase (Rapignost-Amylase) was compared with plasma amylase assay in samples of urine and plasma collected on the day of admission to hospital from 23 patients with acute pancreatitis and 38 patients with other causes of acute abdominal pain. Plasma amylase was greater than 1200 IU/l in 24 patients (23 with pancreatitis and 1 with a perforated duodenal ulcer) and all were Rapignost-Amylase positive. Twenty-nine of the remaining patients were Rapignost-Amylase negative, but there were eight "false positives' with plasma amylase levels of 86-474 IU/l. The Rapignost-Amylase test is of potential value to screen for clinically occult acute pancreatitis.

Acute Disease↗
PubMed1981

Aerobic and anaerobic bacteriology of subcutaneous abscesses.

Pus from 84 patients with subcutaneous abscesses was examined for aerobic and anaerobic bacteria: organisms were recovered from 70 (83.3 per cent). In 13 no organisms were seen in the Gram-stained smears and the cultures showed no bacterial growth. Staphylococcus aureus was the most prevalent organism (n = 44), isolated in 43 in pure culture, in marked contrast to the anaerobic organisms which almost invariably were associated with mixed cultures. All patients were treated by the primary suture method. Half of them were not given preoperative antibiotics and 3 developed bacteraemia and 1 septicaemia. Blood isolates were of S. aureus of the same phage type as pus isolates. The other patients received one infection of 300 mg of clindamycin phosphate 30 min to 1 h before surgery. From this group only one patient, with a perianal abscess, developed Escherichia coli bacteraemia. The levels of clindamycin in the abscess aspirate were inhibitory for S. aureus, bacteroides, streptococci and other Gram-positive bacteria but not for E. coli.

Abscess↗
PubMed1980

Antibiotics in surgical treatment of acute abscesses.

A four-way, double-blind, prospective trial of treatment of abscesses by incision, curettage, and primary closure with and without antibiotic cover (clindamycin injection before operation or capsules after operation, or both) was conducted. There was no appreciable difference in mean healing time between the patients given both the antibiotic injection and the antibiotic capsules and those given the injection and placebo capsules, whereas healing times in those given the placebo injection and antibiotic capsules or placebo only were appreciably longer. Four of the patients who were not given the antibiotic injection developed bacteraemia; one patient who was given the antibiotic injection also developed a bacteraemia, but this was caused by clindamycin-resistant bacteria. These results show that a single injection of an effective antibiotic before operation is sufficient to protect the patient against bacteraemia and permit optimum healing.

Abscess↗
PubMed1980

Long-term recovery from tetanus: a study of 50 survivors.

A follow-up study of 50 patients treated in the tetanus unit of the General Infirmary at Leeds from 1961 to 1977 showed that 29 patients had regained normal health, nine were still improving, but 12 considered that their health had been permanently impaired. In only two of these 12, however, was the deterioration serious and unequivocally linked to their illness and treatment. All but five of those previously working had returned to full employment. Sixteen patients had unpleasant memories of the illness and treatment, 19 had psychological after effects, and one suffered serious damage to mental function. Little evidence was found of pulmonary dysfunction after the disease and its treatment, and although all the patients showed a tracheal stricture of some degree, few had directly associated disabilities. The cause of stricture is multifactorial, the surgical technique being only one. A formal surgical closure of the trachea (if a flap has been used) and of the tissue of the neck in layers should lessen residual disability from the scar and strictured areas.

Aged↗
PubMed1979

Intensive care in tetanus: management, complications, and mortality in 100 cases.

One hundred cases of tetanus were treated in the intensive care unit of Leeds General Infirmary during during 1961--1977. In 90 patients disease was severe enough to require paralysis and artificial ventilation; a further three needed tracheostomy but not paralysis; and in seven the condition was mild, requiring sedation only. Ten patients died, but all deaths were attributable to complications of treatment rather than to the disease itself and were theoretically avoidable. No evidence of permanent neurological damage from tetanus was found. In 65 patients a wound was the source of infection, most of which were minor, often receiving no medical attention. In five patients the source was probably varicose ulcers of the leg. Such patients, if lacking immunity, are at risk, particularly when farming or gardening. Only two patients had received a full course of tetanus toxoid, in one case eight years and in the other three years before injury; neither received a booster dose at the time of injury and in the second tetanus was mild. Of the 35 patients who did seek medical attention at the time of wounding, 21 received prophylactic antibiotics and 25 tetanus toxoid, but none received equine or human antitetanus serum. Early resort to tracheostomy and paralysis in severe tetanus resulted in a favourable mortality of 10% in the series. To implement such a policy full intensive-care facilities, with a trained nurse to care for each patient, must be available at all times.

Adolescent↗