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Biomedical subjects

S R Thomson

Publications and source records attributed to S R Thomson.

At least 19 recordsLinked to original sources
PubMed2001

Penetrating chest injuries in the firearm era.

BACKGROUND: firearm wounds of the chest are now common at our institution. The management algorithm for firearm wounds has not been evaluated for this mode of injury. METHODS: records of all patients with penetrating chest injuries admitted to an urban tertiary hospital over 1 year were retrieved and analysed. RESULTS: there were 473 stab and 116 firearm wounds. In comparison to stab injuries firearm wounds had significantly more normal X-rays (14 vs. 5%), fewer pneumothoraces (15 vs. 37%), and more contusions (43 vs. 2%). The frequency of haemothoraces (34 vs. 23%) and haemopneumothoraces (36 vs. 35%) was similar in both groups. Stabbing caused all the 18 cardiac injuries. Associated abdominal injuries occurred in 8% of stab and 34% of firearm injuries. Pneumothoraces due to firearms were uncommon and rarely required drainage. More pneumothoraces were treated nonoperatively among firearm injuries in contrast to stabbing injuries where the opposite applied. The management of haemothorax and haemopneumothorax was similar in both groups that fulfilled the criteria for drainage. The rate of ICU admission was higher and the hospital-stay longer following firearm injuries. Fifty-nine patients died (10% of the total), 33 (28%) from the firearm injuries and 26 (6%) from stab-wounds. Early deaths were 1 and 3% for stabs and firearms, respectively. CONCLUSIONS: patients with firearm injuries reaching hospital suffered three times higher mortality and a longer ICU and hospital stay than those with stab injuries. However, early mortality was similar for both modes of injury and validates the continued application of the stab wound derived management algorithm to all modes of injury.

Adolescent↗
PubMed2000

Control of follicular development and luteal function in the mare: effects of a GnRH antagonist.

Control of the equine estrous cycle was studied by suppressing gonadotropin secretion by administration of a GnRH antagonist to cyclic pony mares. Four mares received vehicle (control cycle) or a GnRH antagonist, Antarelix (100 microg/kg) on Day 8 of diestrus, and blood samples were collected at 15-min intervals from 0 to 16 h, 24 to 36 h, and daily until the next ovulation. Ovarian activity was monitored by transrectal ultrasonography, and measurement of plasma concentrations of progesterone and estradiol. Antagonist treatment eliminated large diestrous pulses of LH. Progesterone concentrations had fallen significantly in all mares by the day after treatment and, in three of the four mares, remained low until luteolysis. However timing of luteolysis (ie., progesterone concentrations <1 ng/mL) was not affected by antagonist treatment. The preovulatory surges of estradiol and LH were significantly delayed in the treatment cycle, as was the appearance of a preovulatory follicle >30 mm. Cycle length was significantly longer during the treatment than the control cycle. These results show that treatment of diestrous mares with a GnRH antagonist attenuated progesterone secretion, indicating a role for LH in control of CL function in the mare, and delayed ovulation presumably because of lack of gonadotropic support.

Animals↗
PubMed2000

Abdominal content containment: practicalities and outcome.

BACKGROUND: Alternatives to fascial closure of the abdominal wall are increasingly used in critically ill patients. They pose practical and logistical problems in management which are described in this single-institution study. METHODS: Between January 1994 and December 1997, 157 predominantly young male patients (100 trauma and 57 non-trauma) underwent temporary abdominal content containment (t-ACC) using plastic bags or polyglactin mesh. Indications for t-ACC were severe sepsis requiring reoperation, abdominal compartment syndrome, abdominal wall tissue loss or a combination of these. A total of 385 laparotomies were performed. RESULTS: Two t-ACC procedures failed owing to technical error and two were complicated by enteric fistulas. Six patients underwent early definitive abdominal closure within 15 days. The remaining survivors had a protracted hospital stay (mean(s.d.) 44.6(26.6) days) and all developed incisional hernias which were challenging to repair. The overall mortality rate was 44 per cent. CONCLUSION: Plastic bags were cheaper and as effective as polyglactin mesh for t-ACC. Survivors require a multidisciplinary approach in management, undergo a protracted hospital stay and later need complex incisional hernia repairs.

Abdominal Injuries↗
PubMed2000

The management of sigmoid volvulus.

The epidemiology and clinical pattern of sigmoid volvulus are well defined. Although clinical manifestations of acute volvulus are often clear-cut, diagnostic doubt is not uncommon and, if gangrene supervenes, mortality rises appreciably. While gangrene requires resectional surgery, the management of the viable colon related to a volvulus episode has a variety of options. These, particularly non-resectional alternatives, require more critical reappraisal in the light of advances in minimally invasive techniques.

Acute Disease↗
PubMed2000

Detection of steroidogenic acute regulatory protein in equine ovaries.

A steroidogenic acute regulatory (StAR) protein has been identified in several species as a probable important rate-limiting step in steroidogenesis. This protein is believed to be responsible for transporting cholesterol from the outer to the inner mitochondrial membrane. It is known that equine chorionic gonadotrophin (eCG) stimulates steroidogenesis in the corpora lutea of early pregnant mares and that eCG also upregulates StAR mRNA in bovine ovaries. In the present study, ovarian tissue from cyclic and early pregnant mares was immunostained to detect the distribution of the StAR protein. Western blot analysis was performed, followed by phosphor imaging to establish whether the onset of eCG secretion in pregnancy was associated with increased expression of the StAR protein. Immunostaining for StAR was confined to the theca interna of growing and preovulatory follicles, but 24 h after treatment with hCG, some granulosa cells were positively stained. Positive staining was confined to the large luteal cells of the equine corpus luteum. There was no difference in the distribution of immunostaining before or after onset of eCG secretion in pregnant mares, but increased amounts of StAR were detected in corpora lutea from mares at day 40 or day 41 of pregnancy compared with non-pregnant mares and mares at days 20-30 of pregnancy.

Animals↗
PubMed1999

Universal primary colonic repair in the firearm era.

All patients with colonic trauma treated at King Edward VIII Hospital, Durban, from August 1993 to May 1994 underwent primary repair of the colonic wound. They were evaluated prospectively to assess the mode of injury and outcome variables. Colonic injuries were sustained by 102 patients. These were inflicted by gunshots (62), stabs (22), shotguns (14), and blunt trauma (4). The transverse colon was injured most frequently (53). All shotgun injuries were multiple. Average time from admission to theatre was similar for shocked and non-shocked patients. Eighty-seven patients had simple closure (18 deaths) and 15 required resection and anastomosis (eight deaths). Ten patients died in the first 48 h, and 16 died subsequently owing to multiple-organ systems dysfunction. The mortality rates were stabs 9% (2), gunshots 27% (17), shotguns 50% (7), and 0% for blunt trauma. Septic morbidity was seen in 16 but was not related to breakdown of the colonic repair. Implementation of strategies to reduce preoperative time delays and use damage control principles for the management of massive trauma should be evaluated as methods of reducing mortality.

Adolescent↗
PubMed1998

Sequelae of cholecystojejunostomy for benign intrapancreatic biliary strictures.

The case histories of 5 patients who presented with recurrent jaundice following cholecystojejunostomy for biliary decompression of benign intrapancreatic strictures were studied. Four developed episodes of severe cholangitis 2-9 years after their initial operation. A subsequent surgical intervention was undertaken in 3 patients, 2 of whom died from cholangitis. The fourth patient experienced 3 episodes of cholangitis, declined surgical intervention and died. The fifth patient presented 4 months after the first procedure with a transient cholangitis. Cholelithiasis and cholangitis may take several years to develop but seem inevitable when cholecystojejunostomy is used to decompress benign biliary obstruction. Its use in suspected benign biliary obstruction should be abandoned.

Adult↗
PubMed1997

Review of 1198 cases of penetrating cardiac trauma.

BACKGROUND: This study was a clinicoforensic analysis of the prevalence and outcome of traumatic cardiac injuries in Durban. METHODS: Between 1990 and 1992, 1198 patients sustained cardiac trauma. Seventy (6 per cent) reached hospital alive and 1128 (94 per cent) were taken directly to the mortuary. Seven hundred victims had suffered stab wounds, 494 gunshot wounds and four blast injuries. Gunshot injuries increased from 34 per cent in 1990 to 50 per cent in 1992. The mean (s.d.) age was 30.5 (5.4) years and the majority (91 per cent) were men. RESULTS: Thirty-five (50 per cent) of those who reached hospital alive died, including all four gunshot victims. Significant factors associated with survival were isolated injury, the presence of cardiac tamponade (univariate and multivariate analysis), right ventricular injury, single cardiac chamber injury and absence of pleural breach (univariate analysis alone). Delay in operative intervention was associated with a higher mortality rate. When analysing the patients who did not reach hospital alive, 202 (18 per cent) with tamponade due to an isolated stab wound were identified as a subset who might have been saved with prompt treatment. CONCLUSION: An increasing number of gunshot injuries in combination with delays in reaching hospital and in receiving treatment accounted for the high mortality rate in this unselected series.

Adolescent↗
PubMed1996

Lymphocyte subsets in the endometrium of genitally normal mares and mares susceptible to endometritis.

The density and distribution of MHC Class II positive cells and subpopulations of lymphocytes were studied in the endometrium of genitally normal mares and mares susceptible to endometritis. In genitally normal mares, more MHC Class II positive cells were present in the epithelium and stratum compactum during oestrus than dioestrus. Significantly more CD4+ and CD8+ lymphocytes were present in the stratum compactum than in the stratum spongiosum. CD4+ lymphocytes were present in greater numbers than CD8+ lymphocytes in the stratum compactum but approximately equal numbers were present in the stratum spongiosum and in lymphoid aggregates. Occasional CD4+ and CD8+ cells were seen in the luminal and glandular epithelium. Infrequently, B cells were present in the endometrium and were not observed in the epithelium. Numbers of T and B cells did not appear to be affected by cycle stage. In mares with endometritis, the densities of CD4+, CD8+ and B cells were significantly increased. Large aggregates of lymphoid cells which contained approximately twice as many CD4+ cells as CD8+ cells were present in the endometrium of these mares and all 3 subclasses of lymphocyte were seen occasionally in luminal and glandular epithelium.

Animals↗
PubMed1996

Immunolocalization of aromatase P-450 in ovarian tissue from pregnant and nonpregnant mares and in ovarian tumours.

Aromatase P-450 (P-450arom) is a crucial regulatory enzyme that is necessary for conversion of androgens to oestrogens. Corpora lutea and follicles were obtained from the ovaries of cyclic mares and from mares at day 20 and days 40-70 of pregnancy. The presence of P-450arom within specific cell types was investigated by immunostaining to determine potential sites of oestrogen synthesis. Immunoreactivity for P-450arom was confined to the granulosa layer of non-atretic follicles > 5 mm in diameter and to corpora lutea at all stages of the oestrous cycle and during pregnancy. These findings confirm that aromatization of androgens occurs within the granulosa cells of the preovulatory follicle of the mare and that the corpus luteum of the mare has the capacity for oestrogen production if adequate androgen substrate is available. Granulosa cells in ovarian tissue from three mares with granulosa cell tumours showed little staining for P-450arom which suggests that these tumours have little aromatizing capacity.

Animals↗
PubMed1996

Prospective audit of multiple penetrating injuries to the colon: further support for primary closure.

Solitary colon injuries are being increasingly managed by intraperitoneal primary closure. The optimal management of the colon wound in multiple injuries of the colon, which have a high mortality, has not been determined. From 1983-1989, 668 patients sustained colonic injuries. In 71 of these patients the colon was injured at more than one site. Of the 597 single injuries to the colon, 472 (79%) were due to stabs and 102 (17%) to gunshot wounds. Sixty-eight men and three women sustained injuries at more than one site in the large intestine. The median age of patients was 26 years (range 13-66). In 61 patients the colon was injured at two sites and in seven patients at three sites. Three patients had more than three sites injured. The injuries were inflicted by: gunshots 35 (49%); stabs, 30 (42%); shotguns, three; and blunt trauma, three. Forty-one patients were treated by intraperitoneal primary closure (IPC) and 30 by a colostomy procedure or exteriorization of the primarily sutured colon (EPSC). Penetrating Abdominal Trauma Index (PATI) scores were high at 32 +/- 6, and were similar for all methods of colon wound management. Twenty-four patients were suffering from shock on admission, 13 of those patients were treated by primary repair and 11 were treated by an exteriorization procedure. Individuals treated by an exteriorization procedure stayed in hospital significantly longer, 45 days versus 21 days (P < 0.004) and had a higher mortality rate, five deaths versus one death (P < 0.04) than those patients who were primarily repaired. Intraperitoneal primary closure of all wounds is the method of choice for the majority of multiple injuries. Colostomy procedures or EPSC contribute to morbidity and mortality.

Adult↗
PubMed1995

Restoration of continuity following pancreaticoduodenectomy.

Current controversies surrounding restoration of gastrointestinal continuity after pancreaticoduodenectomy are reviewed. The optimum method of reconstruction following this procedure remains debatable, particularly with regard to the pancreatic anastomosis. Pylorus-preserving pancreaticoduodenectomy is increasing in popularity. Pancreaticogastrostomy is associated with at least as low a morbidity rate as pancreaticojejunostomy and is a safe alternative.

Anastomosis, Roux-en-Y↗
PubMed1995

Morphological aspects of microarterial anastomoses: a comparison of nylon with polydioxanone.

The morphological appearance of longitudinally sectioned rat femoral arteries was determined in intact arteries and from 3 to 435 days after vessel division and anastomosis with either 9/0 gauge nylon or polydioxanone (PDS) in 26 animals. The purpose of the study was to establish the mechanisms and compare the quality of healing after microarterial anastomosis and to determine whether PDS was degraded before sufficient anastomotic healing had taken place. The results revealed that there was no difference in the process of healing or quality of anastomosis with either suture material. From 3 to 21 days post anastomosis, there was a progressive separation of the ends of vessels within the developing scar. Anastomotic patency was established and maintained at first by an adventitial overgrowth of fibroblasts and undifferentiated adventitial cells and later by the growth of a smooth myocyte scar that stretched between the cut ends of the vessel and over the intima in the form of elongated circumferential plaques. The vessel was morphologically healed by the 21st day. The sutures served little or no purpose in maintaining anastomotic integrity after the 5th day, being situated in the scar forming between the separating vessel ends. PDS was present within the vessel wall up to 120 days post anastomosis and was certainly intact at the time of morphological healing, suggesting that this material is safe as a microvascular suture.

Anastomosis, Surgical↗