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Biomedical subjects

N A Matheson

Publications and source records attributed to N A Matheson.

At least 55 records · Page 3Linked to original sources
PubMed1984

Emergency surgery for diverticular disease complicated by generalized and faecal peritonitis: a review.

There is little uniformity in either the indications for operation, the classification of the pathology or the operative management of generalized or faecal peritonitis secondary to perforated diverticular disease. Nevertheless, this review has shown a clear advantage both in terms of immediate mortality and morbidity for primary resection over conservative operations in which the colon is retained in the abdomen. We propose that, when a clinical diagnosis of localized sepsis secondary to diverticular disease is made, the management should be nonoperative with systemic antibiotics and supportive therapy. Operation should be reserved for those patients with obvious generalized peritonitis or failure of conservative treatment. When operation is necessary the affected sigmoid loop should be resected and the operation completed as a Hartmann's procedure in all but the most favourable circumstances when a primary anastomosis may be considered after on-table irrigation of the colon.

Abscess↗
PubMed1983

A comparison of highly selective vagotomy with truncal vagotomy and pyloroplasty--one surgeon's results after 5 years.

In a prospective randomized trial highly selective vagotomy (HSV) was compared with truncal vagotomy and pyloroplasty (TVP). One surgeon performed all the operations. Ninety-eight per cent of patients were reviewed by two physicians after 20-97 mth (mean 61 mth). Fifty-nine of 68 patients (87 per cent) had an excellent or very good result after HSV (Visick grades I and II) compared with 48 of 69 (70 per cent) after TVP (P less than 0.05). There was 1 proven recurrence after HSV and 4 after TVP. Diarrhoea, including mild symptoms, occurred in 5 patients (7 per cent) after HSV and in 27 (39 per cent) after TVP (P less than 0.001). Severe diarrhoea did not occur after HSV but was present in 4 patients (6 per cent) after TVP (P less than 0.001). Flatulence, epigastric fullness and weight loss were also significantly more common after TVP. On average HSV took 72 min to perform compared with 44 min for TVP (P less than 0.001). Transient dysphagia occurred in 19 patients after HSV compared with 8 after TVP (P less than 0.05). HSV gave better results than TVP and was associated with a low recurrence rate (1.5 per cent at a mean of 5 yr). Although technically more demanding, HSV in our hands is a better operation than TVP for uncomplicated duodenal ulcer.

Adult↗
PubMed1983

Late onset hypothyroidism after subtotal thyroidectomy for hyperthyroidism: implications for long term follow-up.

A follow-up register has been used in Aberdeen and Dundee to record early and late onset hypothyroidism occurring in a large population of post-thyroidectomy patients treated for hyperthyroidism. In one centre, in a total of 1170 patients, the prevalence of postoperative hypothyroidism, at the time of entry to the register, was 41 per cent. Of these early cases of hypothyroidism 93 per cent occurred within 18 months of operation. Results are presented from a 12-year prospective study of patients treated in two centres, who were euthyroid when entered on the follow-up register. In one centre, based on 683 patients, the 10-year incidence of late onset hypothyroidism estimated by actuarial methods was 7.4 per cent (95 per cent confidence limits, 3.8-11.1); in the other centre with 156 patients the 5-year incidence was 10.8 per cent (95 per cent confidence limits, 3-18.6). The minimum predicted annual incidence is 1 per cent. Large thyroid remnants do not protect some patients against early or late postoperative hypothyroidism but do lead to an increased risk of recurrent hyperthyroidism. Hypothyroidism after subtotal thyroidectomy for hyperthyroidism shows a bimodal pattern and this study emphasizes the need to maintain life-long follow-up.

Follow-Up Studies↗
PubMed1981

Single-layer anastomosis in the large bowel: ten years' experience.

Satisfactory experience with single-layer colorectal anastomosis during 1969-74 led to an analysis of the results of single-layer large bowel anastomosis during the subsequent years 1975-79. This technique has continued to be associated with a low incidence of anastomotic failure, but anastomotic integrity also depends on rigorous attitudes to bowel preparation, to bacterial contamination and to the avoidance of anastomosis when the risk of anastomotic failure is high.

Aged↗
PubMed1980

Large-bowel surgery, 1979: self-assessment.

Evidence of wide variability in the immediate results of large-bowel surgery stimulated self-assessment during 1979. The hazards of large-bowel surgery can usually be avoided by good bowel preparation, sound anastomotic technique, primary resection in large bowel emergencies, avoidance of anastomosis when hazardous, and antibiotic lavage for extant or potential peritoneal and wound contamination.

Adult↗
PubMed1978

Peritoneal lavage in appendicular peritonitis.

Peritoneal lavage resulted in a significant reduction in the duration of hospital stay in a retrospective series of 189 children with peritonitis secondary to perforation of the appendix. Antibiotic peritoneal lavage also resulted in a significant reduction in the number of children with septic and adhesive complications compared with antiseptic lavage and no lavage, mainly as a result of fewer wound infections. The overall incidence of residual intraperitoneal infection was low, and although differences in this respect were not significant, none of the children treated with antibiotic peritoneal lavage required reoperation for intraperitoneal sepsis.

Appendicitis↗
PubMed1978

Peritoneal lavage in faecal peritonitis in the rat.

Intraoperative antibiotic peritoneal lavage was significantly better than systemic antibiotic in preventing death from induced faecal peritonitis in the rat. Its efficacy was due to the combined effects of lavage and intraperitoneal antibiotic, each factor alone being significantly inferior to the combined effect of both. Antiseptic lavage was less effective than antibiotic lavage.

Animals↗
PubMed1977

Intestinal obstruction after excision of the rectum.

Over a 5-year period, 33 patients underwent excision of the rectum in the same unit of Aberdeen Royal Infirmary. Six patients in whom the abdominal contents were allowed to fall into the denuded pelvis showed a uniform pattern of delayed intestinal transit. Two of the patients required reoperation and one died. A similar pattern was not seen in patients managed by other methods. Even if leaving the pelvic peritoneum open were to improve the likelihood of primary perineal healing, for which there is no good evidence, the risks are such that the practice must be regarded as unacceptable unless omentum is mobilized to occupy the pelvic cavity.

Aged↗
PubMed1976

Single layer anastomosis in the gastrointestinal tract.

Anastomotic leakage, often followed by serious morbidity or death, is an important complication of resection of the intestine. If surgical technique and judgment are sound, anastomotic leakage seldom occurs. In 205 elective, single layer anastomoses of stomach to duodenum, of small intestine, of colon and of colorectum, clinically apparent leakage did not occur except in one of 52 patients after colorectal anastomosis. After resection of the intestine performed as an emergency procedure, anastomotic leakage occurred but was infrequent and could clearly be attributed to poor judgment or technique. The results are presented to support a conviction that anastomotic leakage need seldom occur if surgical technique and judgment are sound and to draw attention anew to the efficacy and safety of single layer anastomosis.

Adolescent↗
PubMed1975

Single layer anastomosis after rectosigmoid resection.

Anastomosis after resection of the rectosigmoid colon is often followed by leakage at the suture line. When occult leakage discovered on routine contrast study is included incidence rates of over 50 per cent have recently been reported. A single layer interrupted seromuscular inverting technique was used for the anastomosis after elective rectosigmoid resection in 52 consecutive patients. The total incidence of suture line leakage was 6 per cent. Therefore a high incidence of anastomotic dehiscence in the rectum can be avoided and it is concluded that a single layer technique is sound.

Aged↗