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S Dundas

Publications and source records attributed to S Dundas.

15 recordsLinked to original sources
PubMed2000

Silent hydronephrosis/pyonephrosis due to upper urinary tract calculi in spinal cord injury patients.

STUDY DESIGN: A study of four patients with spinal cord injury (SCI) in whom a diagnosis of hydronephrosis or pyonephrosis was delayed since these patients did not manifest the traditional signs and symptoms. OBJECTIVES: To learn from these cases as to what steps should be taken to prevent any delay in the diagnosis and treatment of hydronephrosis/pyonephrosis in SCI patients. SETTING: Regional Spinal Injuries Centre, Southport, UK. METHODS: A retrospective review of cases of hydronephrosis or pyonephrosis due to renal/ ureteric calculus in SCI patients between 1994 and 1999, in whom there was a delay in diagnosis. RESULTS: A T-5 paraplegic patient had two episodes of urinary tract infection (UTI) which were successfully treated with antibiotics. When he developed UTI again, an intravenous urography (IVU) was performed. The IVU revealed a non-visualised kidney and a renal pelvic calculus. In a T-6 paraplegic patient, the classical symptom of flank pain was absent, and the symptoms of sweating and increased spasms were attributed to a syrinx. A routine IVU showed non-visualisation of the left kidney with a stone impacted in the pelviureteric junction. In two tetraplegic patients, an obstructed kidney became infected, and there was a delay in the diagnosis of pyonephrosis. The clinician's attention was focused on a co-existent, serious, infective pathology elsewhere. The primary focus of sepsis was chest infection in one patient and a deep pressure sore in the other. The former patient succumbed to chest infection and autopsy revealed pyonephrosis with an abscess between the left kidney and left hemidiaphragm and xanthogranulomatous inflammation of perinephric fatty tissue. In the latter patient, an abdominal X-ray did not reveal any calculus but computerised axial tomography showed the presence of renal and ureteric calculi. CONCLUSIONS: The symptoms of hydronephrosis may be bizarre and non-specific in SCI patients. The symptoms include feeling unwell, abdominal discomfort, increased spasms, and autonomic dysreflexia. Physicians should be aware of the serious import of these symptoms in SCI patients.

Adult↗
PubMed2000

Clinical presentation, complications and treatment of infection with verocytotoxin-producing Escherichia coli. Challenges for the clinician.

Seventeen years after its recognition, outbreaks and sporadic infections attributed to Escherichia coli O157 continue to increase. Acute gastrointestinal, and the systemic complications haemolytic uraemic syndrome (HUS) and thrombotic thrombocytopenic purpura (TTP), are frequent and severe. Current challenges that face clinicians are the early recognition of infection, identification of risk factors for poor prognosis, determination of appropriate monitoring for the development of complications, establishment of a therapeutic strategy and, finally, advice for patients about their long-term prognosis. Clinical features which, in combination, have been shown to distinguish E. coli O157 infection from other enteric pathogens are a history of bloody diarrhoea, visibly bloody stools, absence of fever, a leucocyte count greater than 10 x 10(9) l(-1) and abdominal tenderness on physical examination. The most consistent risk factors for the development of HUS/TTP are the extremes of age and a raised leucocyte count. Bloody diarrhoea and 'antimotility' drugs are also likely to be important risk factors. Recent evidence from the central Scotland outbreak suggests that individuals who are taking drugs that reduce gastric acidity or antibiotics at the time of infection with E. coli O157, or who have a short incubation period, may also be at increased risk of progression to HUS/TTP. Clinical management, in particular the role of antibiotics in gastrointestinal infection, remains controversial, and retrospective assessment of the 1996 outbreaks from central Scotland and Japan only adds to this controversy. Therapeutic plasma exchange is a promising treatment for adults who develop HUS/TTP, but its role has yet to be determined definitively, either in a randomized controlled trial or by an international register of cases. Significant chronic sequelae of infection occur, particularly irritable bowel syndrome after uncomplicated gastrointestinal infection, and renal failure after HUS/TTP. Their frequency and severity are likely to become evident over the next decade.

Anti-Bacterial Agents↗
PubMed1999

Effectiveness of therapeutic plasma exchange in the 1996 Lanarkshire Escherichia coli O157:H7 outbreak.

BACKGROUND: The largest number of adult cases of haemolytic uraemic syndrome (HUS)/thrombotic thrombocytopenic purpura (TTP) during an Escherichia coli O157 outbreak occurred in 1996 in central Scotland. Adults who develop HUS/TTP induced by E. coli O157 tend to be elderly and have a historical mortality rate of almost 90% when treated conservatively. Therefore the decision was made to treat adults who developed HUS/TTP during this outbreak with therapeutic plasma exchange (TPE). We report our outcome with this controversial treatment. METHODS: A case definition for HUS/TTP was developed at the beginning of the outbreak. All cases meeting this definition were considered for TPE. Information on demographics, clinical features, treatment and outcome of patients was obtained by retrospective case note review. FINDINGS: 22 adults developed HUS/TTP. They had a mean age of 71 years. 16 cases received TPE. Six cases had contraindications to TPE or died before the procedure could be done. Ten of the 22 (45%) adults with HUS/TTP died. Five of the 16 (31%) TPE-treated cases died, four of eight aged over 70 years compared with one of eight aged less than 70 years. Premorbid illness, neurological features, treatment with ciprofloxacin or prostacyclin, and the laboratory severity of HUS/TTP were not associated with death; the number of cases, however, was too small to allow statistical conclusion. INTERPRETATION: The mortality rate is high in adults who develop HUS/TTP induced by E. coli O157. TPE appears to be a promising treatment that was well tolerated in our elderly patients. A national register of adult cases of HUS/TTP induced by E. coli O157 should be established.

Adolescent↗
PubMed1994

Urethral cytology in spinal cord injury patients performing intermittent catheterisation.

Local reactions of the urethral wall are known to occur by repeated introduction of a catheter in the urethra. Urethritis was found in 2-19% of patients practising intermittent catheterisation. Although the use of catheters of smaller size and the liberal use of lubricants may prevent urethral irritation and trauma, it was postulated that hydrophilic catheters (LoFric, Astra Tech Ltd, Stroud, England) induce significantly less trauma than PVC catheters because of the binding of the water molecules to the catheter surface which consists of polyvinylpyrrolidone and sodium chloride. Although urethritis and urethral stricture may represent one end of the spectrum of repeated urethral trauma, minor degrees of inflammation need to be quantitatively determined while assessing two different catheters for intermittent catheterisation. The degree of urethral inflammation in patients practising intermittent catheterisation was studied by urethral cytology and staining the smear by Papanicolaou's method. The number of neutrophil polymorphs and epithelial cells in three random high power fields in the urethral smear was counted and the percentage ratio of polymorphs to epithelial cells was calculated. Group 1 comprised 14 patients practising intermittent catheterisation with a PVC catheter and group 2 comprised 17 patients performing intermittent catheterisation with a LoFric catheter. There was no significant difference between the two groups as regards the age, diagnosis, size of the catheter used for intermittent catheterisation and the number of times that they performed catheterisation during a 24 hour period. Urethral cytology revealed a percentage (mean ratio) ratio of polymorphs to epithelial cells of 66 in group 1 and 0.04 in group 2. (< 0.0005).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

Carcinoma cuniculatum of the hand.

Carcinoma (epithelioma) cuniculatum is an uncommon variety of squamous cell carcinoma formerly considered to be limited to the foot. It has recently been reported in other parts of the body. We report a case in the hand and describe its management.

Carcinoma, Squamous Cell↗
PubMed1987

Intestinal lymphangiectasia secondary to radiotherapy and chemotherapy.

We report a case of intestinal lymphangiectasia secondary to radiotherapy and chemotherapy. The patient also had small bowel bacterial overgrowth and pancreatic insufficiency. Lymphatic ectasia as a histological feature has been described previously in association with postradiotherapy malabsorption, but radiation-induced lymphangiectasia producing clinical manifestations has hitherto not been reported. Replacement of dietary long-chain fats with medium-chain triglycerides, pancreatic enzyme supplements, and a short course of oxytetracycline, resulted in dramatic clinical improvement. The possibility of intestinal lymphangiectasia should be borne in mind in patients with postradiotherapy malabsorption. A low serum albumin and lymphocyte count should draw attention to this possibility.

Adult↗
PubMed1986

Incidence and clinical significance of colonic cytomegalovirus infection in idiopathic inflammatory bowel disease requiring colectomy.

Evidence of cytomegalovirus infection has been sought in a consecutive series of patients requiring colonic resection for idiopathic inflammatory bowel disease confined to the colon. Colonic tissue was examined by light and electron microscopy for cytomegalovirus inclusion bodies and cytomegalovirus antigen was sought using an immunoperoxidase technique. Cytomegalovirus infection was identified in three of 26 patients studied, but the infection did not appear to influence the course of the colitis. Although all three patients with cytomegalovirus infection needed urgent surgery, none had toxic megacolon. No evidence of cytomegalovirus infection was found in three other patients with toxic megacolon. One patient, who had a rising titre of IgG to cytomegalovirus received treatment with acyclovir which eradicated cytomegalovirus from the colon without altering the course of the colitis.

Colectomy↗