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Biomedical subjects

S J Karran

Publications and source records attributed to S J Karran.

12 recordsLinked to original sources
PubMed1992

Community surveillance of complications after hernia surgery.

OBJECTIVE: To assess the effect of a programme of postoperative community surveillance on the rate of detection of wound complications after operation for inguinal hernia. DESIGN: Prospective audit of wound complications including complications recorded in case notes and those discovered by community surveillance. SETTING: Academic surgical unit of three consultant surgeons. PATIENTS: 510 patients undergoing elective inguinal hernia repair between June 1985 and August 1989. RESULTS: The wound infection rate recorded in the hospital notes was 3% compared with 9% when additional information was obtained from community surveillance. Wound complications were detected in 143 (28%) patients by community surveillance compared with a complication rate of 7% in the case records for the same patients. CONCLUSIONS: Wound complications are common after clean surgery in patients discharged home early. Complication rates are a reflection not only of the standards of surgical practice but also the rigour with which they are sought. Before national comparative audit data are published the method of collection must be standardised. For short stay surgery this should include meaningful community surveillance.

Anti-Bacterial Agents↗
PubMed1992

Timing and method of reversal of Hartmann's procedure.

The outcome of 145 patients undergoing Hartmann's resection between 1973 and 1989 has been reviewed. The mortality rate of the primary procedure was 8 per cent. Eighty patients proceeded to reanastomosis. Multifactorial analysis of these patients was undertaken to determine the risk involved. The interval between the primary and secondary procedures was found to be the most important factor. Six of 12 patients had clinical evidence of a leak when this interval was < 3 months, compared with seven of 28 for 3-6 months, and none of 40 when the second operation was delayed for > 6 months. All deaths (three patients) and clinical septicaemia (four) occurred in the two 'early' groups. All colovaginal fistulae (three patients) and strictures (three) were associated with stapled anastomoses. No association was found between the complication rate following reanastomosis and the initial pathology or grade of surgeon undertaking the secondary operation.

Adult↗
PubMed1992

A randomized prospective study to compare cefotetan with cefuroxime plus metronidazole as prophylaxis in elective colorectal surgery.

This study compares the efficacy of cefotetan with the combination of cefuroxime plus metronidazole as antibiotic prophylaxis in elective colorectal surgery when given over the first 24 h postoperatively. There was no significant difference in wound infection rates between the two groups (14.7% for cefotetan and 13.9% for cefuroxime plus metronidazole), or the rates of other infective complications. Adverse reactions occurred with equal frequency in both treatment groups and no serious side effects occurred. Cefotetan is a safe and effective antibiotic for use as prophylaxis in elective colorectal surgery. Its advantages are that it is a single agent with a spectrum covering both aerobic Gram-negative rods and anaerobic organisms and, because of its long half-life, needs only to be given at 12-hourly intervals.

Cefotetan↗
PubMed1992

Antibiotic prophylaxis in clean surgical cases and the role of community surveillance.

In an ongoing prospective study of clean surgical procedures, patients have been examined by specialist research nurses on a minimum of three occasions during the postoperative period to determine the incidence of wound complications. Whereas a previous retrospective audit suggested a wound infection rate of 2%, this community surveillance programme revealed the true rate as at least fourfold greater (p less than 0.001). Of these complications, more than 70% were detected only by the surveillance programme. Immediate benefit was obtained by a reduction in all complications. Despite these improvements, a core of postoperative sepsis remained, particularly in high-risk cases. Thus, a prospective, controlled, prophylactic antibiotic trial has been undertaken, in an attempt to reduce the infection rate still further. An antibiotic regimen of teicoplanin, 400 mg i.v., given as a single dose, was chosen because of the excellent activity of this agent against staphylococci and streptococci, and also because of the long half-life which renders it suitable for single-dose administration.

Anti-Bacterial Agents↗
PubMed1992

Clinical evaluation of percutaneous insertion and long-term usage of a new cuffed polyurethane catheter for central venous access.

A new, long-term venous access catheter was evaluated in clinical practice and the insertion time, complication rate and prospective follow-up recorded. Fifty novel polyurethane catheters (Cuff-Cath) were inserted in 48 patients, for cytotoxic chemotherapy in 36, long-term total parenteral nutrition in five and miscellaneous indications in seven. All catheters were inserted by a percutaneous technique under local anaesthesia. The mean insertion time was 18 min. There were three insertion complications; failure to cannulate, pneumothorax and malposition. Seven catheters required removal (sepsis in five, subclavian vein thrombosis in two) and one catheter fell out. Total catheter days to date has been 6607 (mean 132, range 18-831 days). Eleven catheters are still in use a mean of 154 days (range 38-490 days) after insertion. Furthermore, a new technique has been described which prevents inadvertent displacement. This new catheter combines the mechanical advantages of polyurethane, together with those of a Dacron cuff. Early results suggest that this catheter may be a useful alternative to silicone catheters of the Hickman/Broviac type for long-term central venous access.

Antineoplastic Agents↗
PubMed1979

In vivo measurement of liver perfusion in the normal and partially hepatectomized rat using Tc-99m sulfur colloid.

A nonsacrificial technique for measurement of liver perfusion in rats using Tc-99m sulfur colloid and gamma camera with computer system is described. The results of measurement in normal rats and at various stages after partial hepatectomy are presented and are compared with results obtained by workers using other techniques. The method reported here is simpler to perform than those previously reported and has the additional advantage that frequent sequential determinations of liver perfusion can be made.

Animals↗
PubMed1975

Uptake of a colloid in rat liver following intravenous intrasplenic and intramesenteric injection.

Intramesenteric and intrasplenic injections of 99mTc-sulfur colloid in the rat resulted in significant differences between the mean uptakes in only some of the liver lobes. More important were the wider interlobular variations seen in the intrasplenic and intramesenteric routes of injection compared with the intravenous route. It is suggested that these differences result from laminar blood flow in the portal vein. In the light of our findings, previous evidence must be considered inconclusive. Laminar flow appears to vary between individual animals and may also vary from time to time in the same animal. Caution is therefore advised when other than systemic routes of injection are used.

Animals↗
PubMed1975

In vivo assessment of liver size in the rat.

In vivo assessment of liver mass in the rat was achieved using several parameters obtained by scintigraphy, including one computed using a Nuclear Data 50:50 analysis system. All correlated well with the directly measured liver weight. The simplest parameter, the area of the anterior view measured from the Polaroid scintigraph, was therefore the one preferred. The results so obtained were compared with those derived from the relationship between liver and body weights. It is suggested that this accurate in vivo measurement of liver mass is of value in the study of the pathophysiology of this organ.

Animals↗