PubMed Health⌕ Search

Biomedical subjects

R G Postier

Publications and source records attributed to R G Postier.

29 records · Page 2Linked to original sources
PubMed1983

Consequences of preoperative cholangitis and its treatment on the outcome of operation for choledocholithiasis.

During a 30-month period 73 patients underwent operation for choledocholithiasis. Thirty-three of these patients (45%) had cholangitis preoperatively. When compared to patients with common duct stones who had no preoperative cholangitis, patients with cholangitis were older (P less than 0.001), more likely to present with jaundice (P less than 0.01) and leukocytosis (P less than 0.01), and more likely to have retained or primary common duct stones (P less than 0.01). Cholangitis patients were also more likely to have bactibilia (P less than 0.025), and anaerobes were isolated from the bile of 27% of these patients (P less than 0.01). Twenty-nine of 33 cholangitis patients (88%) received a minimum of 4 days of broad-spectrum antibiotics including an aminoglycoside prior to operation (P less than 0.01). Despite these clear differences, patients with preoperative cholangitis were not more likely to develop infective sequelae or biliary complications. However, cholangitis patients were much more likely (P less than 0.001) to develop an increase in serum creatinine (33% versus 3%) which, in turn, contributed to a longer (P less than 0.01) postoperative hospitalization. Since therapy with aminoglycosides may have contributed to postoperative morbidity and prolonged hospital stay, aminoglycosides should be reserved only for patients with the most severe cholangitis and should be used with great caution.

Adolescent↗
PubMed1982

Biliary bacteria: significance and alterations after antibiotic therapy.

Patients undergoing urgent and complex biliary operations were studied to determine (1) whether bactibilia is associated with postoperative complications amd (2) whether antibiotic therapy influences biliary bacteriology. Aerobic and anaerobic cultures were performed on hepatic bile obtained at surgery in 134 patients. Cultures were repeated four to seven days postoperatively in 111 patients who had indwelling biliary tubes. Positive operative bile cultures were associated with an increased incidence of wound infection and postoperative renal dysfunction. Postoperative bile cultures showed a significant increase in the number of patients having bactibilia, and a significant alteration in the types of organisms isolated. Anaerobes were cultured from 15% of operative and 23% of postoperative cultures. Antibiotic therapy did not sterilize bile, but merely altered biliary bacteriology. Furthermore, prolonged aminoglycoside therapy was associated with a high incidence of renal dysfunction, especially in elderly patients.

Adolescent↗
PubMed1982

Five year experience with pancreatic pseudocysts.

Twenty-six patients with pancreatic pseudocysts underwent surgical intervention from 1975 through 1979. Chronic alcohol use was associated with pancreatic disease in 84.6 percent of these patients. The clinical findings are not specific, and ultrasonographic examination of the abdomen and computed tomographic scanning have been the most reliable diagnostic tests. External drainage is performed for infected or thin-walled cysts, and carries a complication rate of 72.7 percent in this series. Internal drainage was complicated 31 percent of the time. There were no deaths in this series.

Adolescent↗
PubMed1982

The role of topical antibiotics in "high-risk" biliary surgery.

Controlled studies have demonstrated that systemic prophylactic antibiotics significantly reduce the sepsis rate after biliary tract surgery. Other studies have documented the efficacy of topical antibiotic irrigation in decreasing the incidence of wound infection after a wide variety of procedures. Whether systemic antibiotics or the combination of systemic and topical antibiotics provide any advantage over topical antibiotics alone, however, has not been determined. Therefore, a prospective, randomized study was carried out comparing topical intra-abdominal and wound antibiotic irrigation (neomycin and polymyxin) with topical antibiotic irrigation plus parenteral antibiotics (gentamicin and penicillin) in 54 patients undergoing "high-risk" biliary surgery. All patients underwent either an elective common bile duct exploration or a biliary-enteric anastomosis for obstructive jaundice. Twenty-five patients were randomized to the group receiving only topical antibiotics, and 29 received topical plus systemic antibiotics. The two groups were similar with respect to age, sex, presence of common duct stones, incidence of jaundice, positive bile cultures at surgery, and type of surgery performed. There were three wound infections in each group, and no patient developed an intra-abdominal abscess. Other infectious complications occurred with similar frequency in the two study groups. This study suggests that topical antibiotics provide effective prophylaxis in biliary tract surgery and that broad-spectrum systemic antibiotic therapy is of no additional benefit. Topical antibiotics provide an alternative means of prophylaxis for patients discovered intraoperatively to be at "high risk" for infection.

Administration, Topical↗
PubMed1981

Factors affecting mortality in biliary tract surgery.

Fifteen clinical and laboratory parameters in 155 consecutive patients having bile duct surgery over a 3 year period were analyzed in an effort to define the factors associated with a poor outcome and to define the subpopulation of patients at greatest risk. Ten of the 15 parameters evaluated were found to correlate significantly (p < 0.05) with hospital mortality. Five or more risk factors correlated significantly with mortality (p < 0.0001) and with postoperative renal failure, bacteremia and upper gastrointestinal hemorrhage (p < 0.005). This risk-factor analysis has the advantages of providing information rapidly and employing only clinical observations and readily available laboratory tests. Patients with five or more risk factors should be considered for preoperative percutaneous transhepatic decompression.

Adolescent↗
PubMed1980

Postoperative T-tube cholangiography. Is antibiotic coverage necessary.

One hundred patients undergoing postoperative cholangiography had blood cultures drawn prior to and 15 minutes and six hours after cholangiography. Bile cultures obtained prior to cholangiography grew organisms in 92 of 100 patients with E. coli, Klebsiella pneumoniae and enterococcus being the bacteria most frequently isolated. Anaerobes were isolated from the bile in 21% of the patients. Nine of 83 patients (11%) not receiving antibiotics developed a bacteremia after cholangiography with organisms identical to those in the bile. All nine patients recovered without further complications of cholangiography. Those who developed a bactermia could not be distinguished from the group as a whole on the basis of age, sex, laboratory data, type of surgery or cholangiographic findings. None of the eight patients with negative bile cultures and none of 17 patients on antibiotics at the time of cholangiography experienced a bacteremia. Ninety to 93% of 304 organisms isolated from the bile were sensitive to a combination of a penicillin and an aminoglycoside. Most patients undergoing postoperative tube cholangiography do not develop a bacteremia and do not require antibiotics. Only patients with positive bile cultures who might tolerate a bacteremia poorly, and those who are febrile from cholangitis immediately prior to cholangiography should be covered with a short course of systemic antibiotics.

Adolescent↗
PubMed1980

Prophylactic antibiotics in vascular surgery. Topical, systemic, or both?

A prospective, randomized, blinded study was performed to determine whether prophylactic antibiotics would reduce the incidence of infection in peripheral vascular surgery and whether the route of antibiotic administration was important. Patients undergoing a vascular procedure with a groin incision were allocated to one of four groups with respect to prophylactic antibiotics. Group I received no antibiotic. Group II had topical cephradine instilled in their incisions prior to closure. Group III received a 24-hour perioperative course of intravenous cephradine, and Group IV received both topical and intravenous cephradine. Groin and abdominal incisional infections were significantly reduced (p < 0.01) among patients who received prophylactic antibiotics by either the topical, systemic, or combined routes of administration. No significant differences were noted among the three antibiotic groups. Profundoplasty, femoral embolectomy, and femoral aneurysm repair were each associated with an increased incidence of infection (p < 0.01). Other risk factors were only important in patients not receiving antibiotics. Either intraoperative topical antibiotics or perioperative systemic antibiotics prevent infection in peripheral vascular surgery, but antibiotic administration by both routes is unnecessary.

Anti-Bacterial Agents↗