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Biomedical subjects

C M Allan

Publications and source records attributed to C M Allan.

27 records · Page 2Linked to original sources
PubMed1982

The conduct of cholecystectomy: incision, drainage, bacteriology and postoperative complications.

The benefits of some ancillary techniques of cholecystectomy are exaggerated by retrospective study of selected patients. Therefore, the authors performed a prospective, randomized study of 100 consecutive patients who underwent simple elective cholecystectomy for chronic cholecystitis and cholelithiasis. No patient was excluded because of incomplete hemostasis or fear of bile leakage. The frequency of pulmonary complications and wound infections was independent of the type of incision--vertical or subcostal. Peritoneal drainage was found to be unnecessary. Short-term drainage may increase the frequency of postoperative fever, but did not increase pulmonary complications or wound infections. In these patients, intra-abdominal sepsis is rare; wound infections were uncommon and the gallbladder bile was usually sterile and not the cause of postoperative infection.

Bile↗
PubMed1981

Preventing anaerobic infection in surgery of the colon.

A randomized prospective study of antibiotic prophylaxis was carried out in patients who underwent elective surgery of the colon. The wound infection rate in 70 patients who received cephradine intravenously in the perioperative period (group 1) was 25%, compared with 8% in 60 patients who received metronidazole and erythromycin base orally before operation (group 2). Both Bacteroides fragilis and Escherichia coli were cultured from the majority of wound infections in group 1, but B. fragilis was not found in any group 2 patients. Wound contamination indicated by wound class or by culture of the subcutaneous tissue of the wound before closure was the best predictor of subsequent wound infections. These results suggest a dominant role for intestinal anaerobes in the genesis of wound infections after colonic surgery and show that antibiotics specifically directed against these organisms can substantially reduce the rate of wound infection.

Administration, Oral↗
PubMed1979

Discriminate use of antibiotic prophylaxis in gastroduodenal surgery.

In a prospective study of 107 patients undergoing surgery for gastroduodenal disease, antibiotics were withheld from a group of 24 patients defined preoperatively to be at low risk of developing postoperative infections; no wound infection occurred in this group. Perioperative cephaloridine was randomized among the remaining patients (high risk). Wound infections developed in 11 of 42 patients who did not receive cephaloridine, but in none of the 41 patients who were given cephaloridine (p less than 0.02). Coliform bacteria were grown only from swabs of the stomach mucosa of patients in the high risk group and were the main cause of wound infections. Severe preoperative lymphocytopenia was frequently associated with the development of serious postoperative sepsis. The results validate a policy of restricting antibiotic prophylaxis in gastroduodenal operations to patients at high risk of postoperative infection and suggest a new risk factor--the preoperative blood lymphocyte count.

Adult↗
PubMed1979

Spontaneous aortoduodenal fistula: successful treatment by extra-anatomic vascular bypass.

A 77-year-old woman was admitted to hospital with massive upper gastrointestinal bleeding of obscure etiology and a palpable abdominal aortic aneurysm. A spontaneous aortoduodenal fistula, discovered at operation, was treated successfully by resection of the aneurysm, aortic closure, lateral duodenal repair and axillobilateral femoral grafting. The three clues to the correct diagnosis were: a palpable, pulsatile abdominal mass, recurrent abrupt cardiovascular collapse and significant upper gastrointestinal bleeding with no obvious source. The conventional method of treatment--aortic resection, duodenal repair, and intra-abdominal aortic grafting--is followed by secondary infection and aortic anastomotic bleeding, and by death in nearly 50% of the patients. The method of treatment used by the authors in this patient may be safer and deserves further consideration.

Aged↗
PubMed1978

Antibiotics in surgery of the colon.

In a randomized prospective study of patients undergoing elective colonic surgery the postoperative wound infection rate was 13% (early, 10%) in patients receiving systemic cephaloridine perioperatively and 12% (early, 7.3%) in those given oral neomycin and erythromycin base preoperatively. Wound infections were more frequent in patients with severe lymphopenia or hypoalbuminemia preoperatively, but the potential degree of wound contamination was the main determinant of postoperative infection.

Aged↗
PubMed1974

Abdominal splenosis.

Abdominal splenosis was an incidental finding at laparotomy for acute appendicitis in a 39-year-old man who had had splenectomy for traumatic rupture of the spleen nine years previously. Similar cases of abdominal and intrathoracic splenosis are reviewed.

Adult↗