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Biomedical subjects

A V Pollock

Publications and source records attributed to A V Pollock.

At least 55 records · Page 3Linked to original sources
PubMed1985

Does mass closure of midline laparotomies stand the test of time? A random control clinical trial.

We compared the incidence of wound failure (burst abdomen and incisional herniation up to 4 years after operation) in a consecutive series of 282 major laparotomies closed with continuous monofilament nylon, and randomly allocated to mass (all layers except skin) or layered (anterior and posterior aponeuroses separately sutured) techniques. Surgeons were free to choose the site and direction of incision which resulted in a preponderance of midline incisions in the mass, and of paramedian incisions in the layered, group. One patient in the former, and two in the latter, burst their abdomens during early convalescence, and 17 incisional hernias were discovered within four years in the mass group compared with four in the layered group (log rank X2 7.16, P less than 0.01). Seven hernias in the former, and one in the latter, group were not detected within eight months of operation. We conclude that layered closure of a paramedian incision results in a lower incidence of incisional hernias than mass closure of a midline incision and that many hernias are not discovered until years after operation.

Abdomen↗
PubMed1984

Trials on trial. A review of trials of antibiotic prophylaxis.

The ability of a small-scale random-control clinical trial comprising less than 500 patients to disclose clinically important differences between treatment groups depends on the event rate in the control group. The high rate of wound infection after abdominal operations has attracted many trials of methods of antibiotic prophylaxis. We reviewed all of the pertinent English literature recorded in Index Medicus in 1980 and 1981. We examined 45 articles for defects in design, analysis, and presentation. Of the 45 articles, 25 reported statistically significant differences between treatment groups and 20, no significant differences. Unsatisfactory methods of randomization were used in four trials, ethics were questionable in 22, statistical methods were incorrect in 31, and presentation was inadequate in 40. We concluded that there is room for improvement in the conduct of clinical trials.

Anti-Bacterial Agents↗
PubMed1983

Two methods of skin closure in abdominal operations: a controlled clinical trial.

Operative bacterial contamination of surgical wounds is common. The ability of the host to eradicate these bacteria and prevent subsequent wound infection is affected by a number of factors; one of these has been shown experimentally to be the presence of suture material in the subcutaneous tissues. In a prospective randomized controlled clinical trial in 341 abdominal operations we compared the primary infection rates after two methods of skin closure: either vertical mattress monofilament nylon sutures (182 patients) or steel clips which penetrated only the dermis (159 patients). All patients received a single dose of a cephalosporin intravenously at induction of anaesthesia and neither sutures nor drains were placed in the subcutaneous plane. The overall wound infection rate in the sutured wounds was 17.0 per cent, compared with 6.3 per cent in those closed by clips (X2 = 9.26, P less than 0.01). We conclude that skin closure with clips reduces the incidence of wound infection in patients in whom operative parietal contamination has occurred.

Abdomen↗
PubMed1983

Latamoxef for the prophylaxis of abdominal surgical wound infection: a controlled clinical trial.

In a series of 236 abdominal operations, patients were allocated at random to receive a single intravenous dose of either 1 g cephaloridine or 1 g latamoxef (at induction of anesthesia) for the prophylaxis of postoperative wound infection. Of the 116 patients given latamoxef, one developed major and seven minor wound infections, whereas five major and 21 minor infections occurred in the cephaloridine group (P less than 0.01). Latamoxef has now replaced cephaloridine as our prophylactic antibiotic of choice in potentially contaminated abdominal operations.

Abdomen↗
PubMed1982

Delayed hypersensitivity testing for the prediction of postoperative complications.

One hundred and sixty-six patients undergoing elective major laparotomy were skin tested preoperatively with four common recall antigens in an attempt to correlate preoperative cell-mediated immune status with postoperative septic complications. Nineteen patients were anergic, 22 relatively anergic and the remaining 125 reacted to two or more of the antigens and were regarded as normally reactive. No significant differences in morbidity or mortality were found between patients who had depressed delayed cutaneous hypersensitivity reactions and those who reacted normally. We conclude that identification of those patients with depressed cell-mediated immunity preoperatively does not help in predicting postoperative problems.

Adult↗
PubMed1982

Levamisole and postoperative complications: a controlled clinical trial.

We studied the relationship between cell-mediated immunity (assessed by preoperative skin reactions to four recall antigens) and postoperative infective complications in 166 patients undergoing major laparotomies. They were randomly allocated to receive 150 mg of levamisole or placebo on the day of operation and for the following 2 days; their course was followed for at least 1 month. Neither the degree of preoperative anergy nor the administration of levamisole resulted in any significant differences in numbers of postoperative deaths or infective complications, but the levamisole group had significantly less postoperative pyrexia than the control group.

Adolescent↗
PubMed1982

Staples or sutures for colonic anastomoses--a controlled clinical trial.

We randomly allocated 100 patients undergoing colonic or rectal resections to have their anastomoses made either by a single layer of braided polyester interrupted sutures, or by the SPTU circular stapling instrument. Twelve anastomoses leaked, 4 being detected only by contrast enema. There was no difference in leak rate between the two anastomotic methods, but patients in the stapled group had a significantly higher incidence of minor wound infection, and spent significantly more days in hospital after operation. The stapling instrument is no safer than sutures for colonic and rectal anastomoses, but considerably facilities the performance of a low anterior resection.

Adult↗
PubMed1982

The role of peritoneal lavage in the prediction and treatment of severe acute pancreatitis.

Four practice criteria of severity were assessed on admission in 87 patients with acute pancreatitis. The value of hypotension and hypocalcaemia was limited by their lack of sensitivity (14-32%). Hypoxaemia and a positive peritoneal tap had greater sensitivity (47-55%) without losing diagnostic accuracy (83-84%). The presence of one or more positive criteria discriminated between a 'severe' group of patients with a mortality of 43% and a 'mild' group with a majority of 3% (p less than 0.001). Twenty-three patients with predicted 'severe' disease were randomised to receive peritoneal lavage for 72 h (9) or no lavage (14), but no statistically significant benefit has yet been shown from this treatment.

Acute Disease↗