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Biomedical subjects

N Brewster

Publications and source records attributed to N Brewster.

8 recordsLinked to original sources
PubMed2006

Hand washing rituals in trauma theatre: clean or dirty?

INTRODUCTION: The aim of this study was to investigate the degree of contamination of a surgeon's hand following use of chlorhexidine gluconate or alcohol gel as disinfectants. MATERIALS AND METHODS: In this prospective, randomised trial, orthopaedic surgeons were allocated to one of two different hand-washing protocols using a randomisation table. The hand-washing protocol dictated that all surgeons should wash for 5 min with chlorhexidine for their first case. Thereafter, the surgeon was randomised to wash for 3 min with either alcohol gel or chlorhexidine. At the end of each procedure, the gloves of each surgeon were carefully removed and the fingertips from each hand were placed on an agar plate. The number of bacterial colonies present after 24 h and 48 h of incubation were recorded for each agar plate by a microbiologist blinded to the washing protocol used. RESULTS: Overall, 41 procedures and 82 episodes of hand washings were included in the study. Two episodes were discarded due to contamination at the time of glove removal. Four hands (8%) were contaminated in the chlorhexidine group compared to 19 (34%) in the alcohol group. Fisher's exact test confirmed a significantly higher risk of contamination using alcohol gel compared to chlorhexidine (P = 0.002). In addition, the average bacterial colony count was substantially higher in the alcohol group (20 colony forming units) compared to the chlorhexidine group (5 colony forming units). There was no relationship between the duration of surgery and the degree of contamination (P = 1.12). CONCLUSIONS: Alcohol gel disinfectant is not a suitable alternative to chlorhexidine when hand washing before surgery. This study has identified a higher risk of bacterial contamination of surgeons' hands washed with alcohol. This may lead to higher levels of postoperative infection in the event of glove perforation.

Anti-Infective Agents, Local↗
PubMed2005

Recovery from post-operative anaemia.

Acceptance of lower transfusion thresholds and shorter post-operative stays results in patients leaving hospital after surgery with lower haemoglobin (Hb) than previously. We undertook a prospective observational study to assess the haematological response to post-operative anaemia and to determine the utility of quality of life (QoL) measures in assessing the impact of anaemia on such patients. Thirty patients undergoing unilateral hip arthroplasty had blood samples taken and QoL questionnaires administered pre-operatively and at 7, 28 and 56 days post-operatively. Increased erythropoiesis was evident at day 7 post-operatively. Approximately two-thirds of the post-operative Hb deficit was corrected by day 28. There was evidence of functional iron deficiency in more than one-quarter of patients at day 56. QoL scores used did not show any relationship with Hb in the post-operative period. Red cell 2,3-diphosphoglycerate (2,3DPG) levels increased in proportion to the degree of post-operative anaemia. We concluded that substantial recovery of Hb occurs between day 7 and day 28 post-operatively. Complete recovery of Hb may be delayed beyond day 56 due to development of iron deficiency. Patients are at significant risk of developing post-operative iron deficiency depending on operative blood loss and pre-operative iron stores. Increased red cell 2,3DPG may offset the effect of anaemia on oxygen delivery. We found no evidence that anaemia produces a measurable effect on chosen QoL scores in the post-operative period.

2,3-Diphosphoglycerate↗
PubMed2000

Comparison of novel cannabinoid partial agonists and SR141716A in the guinea-pig small intestine.

The controversial nature of the CB(1) receptor antagonist, SR141716A, in the guinea-pig small intestine was investigated by comparing it with four analogues of Delta(8)-tetrahydrocannabinol (Delta(8)-THC): O-1184, O-1238, O-584 and O-1315. These compounds (10 - 1000 nM) inhibited the electrically-evoked contractions with a rank order of potency of O-1238>O-1184>O-584>O-1315. Log concentration-response curves for O-1238, O-1184 and O-1315 were significantly shifted to the right by SR141716A and the maxima were significantly less than that of the CB(1) agonist, WIN55212-2, an indication of partial agonism. Partial saturation of the triple bond in O-1184 to a cis double bond (O-1238) increased its potency as an agonist (pEC(50) from 6.42 to 7.63) and as an antagonist of WIN55212-2, (pK(B), from 8.36 to 9.49). Substitution of the terminal azide group by an ethyl group (O-584) or removal of the phenolic hydroxyl group (O-1315) had no significant effect on the agonist or antagonist potency. None of these analogues increased the twitch response in a manner resembling that of SR141716A. O-1184 (10 and 100 nM) shifted the log concentration-response curve of WIN55212-2 for inhibition of the twitch responses to the right with pK(B) values of 8.29 and 8.38, respectively. We conclude that these Delta(8)-THC analogues behave as partial agonists rather than silent antagonists at CB(1) binding sites in this tissue. There was no evidence of antagonism of endocannabinoids thus supporting the hypothesis that, in this tissue, SR141716A is an inverse agonist of constitutively active CB(1) receptors.

Animals↗
PubMed1995

Quasi-synchronous patellar tendon rupture.

The case of a 66-year-old male who suffered from rupture of both patellar tendons within a few minutes of each other is reported. The patient was not suffering from any underlying medical problems, and made an uneventful recovery following surgical repair.

Aged↗
PubMed1994

CRP levels as a measure of surgical trauma: a comparison of different general surgical procedures.

Acute phase proteins are released into the circulation as part of the metabolic response to trauma. C reactive protein (CRP) has been shown to be the most specific and sensitive indicator of trauma. We measured pre- and postoperative CRP levels in patients undergoing varicose vein surgery, inguinal herniorrhaphy, laparoscopic cholecystectomy and open cholecystectomy. A significant difference is shown between the levels found in those undergoing varicose vein, hernia surgery or open cholecystectomy; however, there is no significant difference in the CRP levels between open and laparoscopic cholecystectomy.

C-Reactive Protein↗
PubMed1988

Endogenous digoxin-like immunoreactive substance in patients undergoing coronary surgery. Preliminary report.

Perioperative digoxin concentrations were measured in 20 unselected adult patients undergoing coronary surgery. None of the patients were receiving treatment with digoxin. A digoxin-like immunoreactive substance was found in 16 patients postoperatively. This substance, if pharmacologically active, may have important clinical implications in the management of patients after open heart surgery.

Adult↗
PubMedDate not supplied

Joint replacement for arthritis.

BACKGROUND: Joint replacement is most commonly performed at the hip and knee for osteoarthritis. It is also possible to replace joints such as: the shoulder, elbow, metacarpophalangeal joints and ankle, but usually only when the joint has been destroyed by rheumatoid arthritis. While the main benefit of joint replacement is the resolution of arthritic pain, range of movement and function can also be improved and the length of the limb or alignment of the joint may be restored. OBJECTIVE: In this article we address the indications for joint replacement, and how the patient is assessed. The results of joint replacements of varying joints are considered and we discuss some topical current concepts in joint replacement surgery.

Arthritis↗