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Biomedical subjects

N Couse

Publications and source records attributed to N Couse.

6 recordsLinked to original sources
PubMed1993

Randomized trial of drainage of colorectal anastomosis.

A prospective randomized trial was carried out to determine whether use of a high-pressure closed-suction intraperitoneal drain was associated with a reduction in morbidity rate after colorectal resection and to examine the influence of drainage on postoperative fluid collections. A consecutive series of 148 patients who underwent colonic or colorectal resection were randomized to receive no drain (n = 51) or a high-pressure closed-suction drain for either 3 (n = 47) or 7 (n = 47) days. Three patients were excluded. All patients underwent abdominal ultrasonography on days 3 and 7 and those undergoing left-sided colorectal resection (n = 96) received a water-soluble contrast enema on day 7. The three groups of patients were similar in age, sex, diagnosis and the numbers of sutured and stapled anastomoses. The presence of a drain did not influence the postoperative morbidity or mortality rate. If the anastomosis leaked, neither faeces nor pus emerged from the drain. Ultrasonographic detection of a fluid collection was of no value: such collections bore no relationship to radiological or clinical leaks or the postoperative course. Routine use of a high-pressure suction drain after colorectal resection appears to be unnecessary.

Aged↗
PubMed1993

Total parenteral nutrition by peripheral vein--substitute or supplement to the central venous route? A prospective trial.

51 consecutive gastroenterological patients who required total parenteral nutrition (TPN) were entered into this study. Two patients were withdrawn because of specific nutritional requirements, leaving 49 patients for randomisation. 23 patients were allocated to receive peripheral parenteral nutrition (PPN) and 26 to receive feeding through a central venous line (CPN). There was no significant difference between the groups with respect to the median duration of feeding (9.4 +/- 3.6 days; 12.0 +/- 7.8 days) but significant morbidity occurred more frequently in the CPN group (11%) compared to the PPN group (0%). TPN by the designated route was not possible in 4 patients in the PPN group and in 3 of the CPN group. Of the 19 patients commenced on PPN, 13 continued without complication until resumption of oral feeding (median 10.7 +/- 3.2 days); 6 of these patients had to be converted to central venous feeding for completion of their nutritional requirements. Of the 23 patients commenced on CPN, 21 completed their nutritional course (median 11.8 +/- 5.3 days), 2 patients in the CPN group required conversion to PPN to complete their nutritional course. This study shows that PPN is a feasible, safe alternative to CPN in many patients. It is not necessary to subject all patients who require TPN to the risks and expense of central venous cannulation.

Journal Article↗
PubMed1990

Diagnosis of abdominal masses with percutaneous biopsy guided by ultrasound.

OBJECTIVE: To assess the accuracy and safety of percutaneous biopsy of abdominal masses guided by ultrasound. DESIGN: Prospective study. SETTING: Combined gastroenterology service, Scarborough Hospital. PATIENTS: 108 Consecutive patients identified as having a discrete mass on diagnostic ultrasound examination of the abdomen. INTERVENTION: A sample of tissue was obtained with an aseptic technique under local anaesthesia: an 18 steel wire gauge needle (Tru-Cut) was mounted in a spring loaded firing device (Biopty gun) that was advanced under simultaneous ultrasound scanning, permitting precise localisation of the target organ. MAIN OUTCOME MEASURE: Results of histological examination of tissue specimens. RESULTS: Biopsy failed in four patients. Adequate histological specimens were obtained in 104 patients with masses in the liver (31), pancreas (37), kidney (10), and adrenal glands (six) and in 20 undiagnosed abdominal and retroperitoneal masses. Follow up was until death or confirmation of the diagnosis. Three complications but no deaths occurred. Malignancy was suspected in 84 patients before biopsy. This was confirmed in 70 patients, in 26 of whom confirmation of dissemination obviated the need for further investigation. In 10 patients biopsy indicated a previously unsuspected primary tumour, and in 12 it showed only a benign lesion. Among 24 patients considered to have benign disease biopsy showed an unsuspected neoplasm in seven. Use of biopsy thus had a major effect on clinical management in 55 patients. Four false negative but no false positive diagnoses resulted from the procedure. CONCLUSION: Percutaneous biopsy of abdominal and retroperitoneal masses under ultrasound guidance is a safe and accurate method of obtaining a histological diagnosis. The results obtained have a considerable effect on clinical management.

Abdominal Neoplasms↗