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Biomedical subjects

D P Fossard

Publications and source records attributed to D P Fossard.

At least 37 records · Page 2Linked to original sources
PubMed1985

Detection of gall stones after acute pancreatitis.

Four methods of gall stone diagnosis after an attack of acute pancreatitis are analysed. Of 128 consecutive patients with acute pancreatitis, 99 patients were discharged from hospital without a definite aetiology. These patients had biochemical tests performed on admission and ultrasonography and oral cholecystography performed six weeks later. The sensitivity for ultrasonography was 87% and the specificity was 93%; the respective figures for oral cholecystography were 83% and 90%. The predictive value of positive ultrasonography was 100% and of negative ultrasonography 75%; the respective values for oral cholecystography were 95% and 68%. A combination of ultrasonography and oral cholecystography failed to detect nine of 70 patients with gall stones (13%). Of 35 patients with normal ultrasonography and oral cholecystography, 33 patients had an endoscopic retrograde cholangiogram (ERCP) which showed gall stones in a further seven patients. All three methods failed to reveal gall stones in two patients, confirmed by laparotomy. The sensitivity of admission biochemical analysis was 73% and the specificity was 94%; the predictive value of a positive result was 97% and of a negative result was 57%. Biochemical analysis predicted gall stones in six of the seven patients shown by ERCP. Only 9% of patients were finally considered to be idiopathic. In conclusion ultrasonography is the investigation of choice and ERCP should be undertaken in all patients who have normal ultrasonography and/or oral cholecystography but have biochemical criteria indicative of gall stones.

Acute Disease↗
PubMed1985

Femoral herniae in children.

A series of 12 femoral herniae in children is presented. Nine were misdiagnosed, eight as inguinal hernia. Nine were reducible. The sex incidence, M:F was 7:5 and nine presented between the ages of 8 and 10 years. One presented as intestinal obstruction due to a Richter's hernia and two had had a previous ipsilateral inguinal hernia repaired. All but one were repaired by herniorrhaphy.

Child↗
PubMed1984

The management of common bile duct calculi by endoscopic sphincterotomy in patients with gallbladders in situ.

Endoscopic sphincterotomy (ES) is widely used in the treatment of patients with common bile duct (CBD) stones following cholecystectomy. The technique has now been extended to patients with gallbladders still present and the results of ES in 100 such patients is reported. Fifty-nine were considered unsuitable for surgery (Group A), in 38 ES was performed as a preliminary to cholecystectomy (Group B) and in 3 ES was performed following emergency cholecystostomy (Group C). ES was achieved in 98 patients and stones completely extracted in 91 patients. In Group A 5 patients required surgery, in 3 because of technical failure and in 2 because of empyema of the gallbladder. One patient who presented in extremis died following failure to extract a large CBD stone. On follow-up (4-50 months), 16 patients have died but in only one from gallbladder sepsis, and one has had a cholecystectomy for pain. In Group B choledochotomy was avoided in 29 of the 37 patients who agreed to cholecystectomy. In Group C no further surgery was required and all patients in Groups B and C remain well. These results indicate that ES is an effective technique for treating patients with CBD stones with the gallbladder in situ, either alone in patients considered unsuitable for surgery or as an adjunct to surgery.

Aged↗
PubMed1984

The urgent diagnosis of gallstones in acute pancreatitis: a prospective study of three methods.

Ultrasonography (US), radionuclide biliary scanning (RBS), and biochemical tests were performed within 72 h of admission in 83 patients with acute pancreatitis in an attempt to define those with gallstones as an aetiological factor. US was 92 per cent accurate in the 80 per cent of patients in whom the gallbladder was demonstrated. There were no false positives. Sixty-seven per cent of patients with gallstones were diagnosed although this improved to 78 per cent when US was repeated following the patients' clinical improvement. The pattern of RBS was completely normal in 46.5 per cent of patients with biliary pancreatitis and 64 per cent of patients with non-biliary pancreatitis. Biochemical tests completely separated 47 per cent of patients with gallstones from those without. Used in combination with US these two methods accurately identified 81 per cent of patients in the biliary group. In conclusion US was found to be a rapid and accurate method of gallstone detection but used alone it has limited usefulness. RBS can be time consuming and was found to be of doubtful value. Biochemical tests were helpful in indicating a proportion of patients who had gallstones which were not detected by US, and therefore have a practical application. Current methods of gallstone detection in patients with acute pancreatitis are far from ideal and further studies are indicated.

Acute Disease↗
PubMed1983

A prospective study of radionuclide biliary scanning in acute pancreatitis.

Early surgery for biliary pancreatitis has resulted in a need for an accurate method of gallstone detection in acute pancreatitis. Fifty patients with acute pancreatitis were studied prospectively to assess the diagnostic value of Radionuclide Biliary Scanning (RBS) performed within 72 hours of an attack. To assess the general accuracy of RBS a further 154 patients with suspected acute cholecystitis or biliary colic were similarly studied. There were 34 patients with biliary pancreatitis and 18 (53%) had a positive scan (no gallbladder seen). There were 16 patients with non-biliary pancreatitis and 5 (31%) had a positive scan. All 51 patients with acute cholecystitis had a positive scan, as did 82% of the 51 patients with biliary colic. There were 52 patients with no biliary or pancreatic disease and none of these had a positive scan. RBS is highly accurate in confirming a diagnosis of acute cholecystitis or biliary colic. However, it cannot be relied on to differentiate between biliary and non-biliary pancreatitis and should certainly not be used as the basis for biliary surgery in these patients.

Acute Disease↗
PubMed1982

Pyogenic liver abscess: a study of forty-four cases in two centres.

44 patients with pyogenic liver abscess, 22 each from Leicester, UK, and Göteborg, Sweden, presenting between 1972 and 1980 have been reviewed. 29 patients were diagnosed prior to specific treatment with 3 deaths (10%); 15 patients were first discovered at autopsy resulting in an overall mortality of 41%. The presentation, pathogenesis, and treatment are discussed in detail. It is concluded that the continuing high mortality of this condition largely relates to the difficulty in establishing the diagnosis. Reduced morbidity (and perhaps mortality) might be achieved with wider use of percutaneous methods of drainage.

Adolescent↗
PubMed1980

Fibrinolysis and the prediction of postoperative deep vein thrombosis.

Fibrinolytic activity was measured in 28 patients undergoing elective abdominal surgery in order to assess the value of fibrinolytic activity as a predictive indicator of deep vein thrombosis. Eighty-nine non-smoking adults acted as controls. Fibrinolytic activity was estimated before and during operation, immediately postoperatively and 24 h and 48 h after operation. The onset of deep vein thrombosis was assessed daily for 5 days using 125I-fibrinogen uptake scans. Fibrinolytic activity in 9 patients changed significantly and 7 of these developed deep vein thrombosis. Preoperative assessment of fibrinolytic activity cannot alone predict deep vein thrombosis but changes in the pattern of activity may be of help in defining those at risk.

Abdomen↗
PubMed1977

Prevention of Fatal Postoperative pulmonary embolism by low doses of heparin. Reappraisal of results of international multicentre trial.

The results of a multicentre trial, designed to assess the efficacy of low-dose heparin in preventing fatal postoperative pulmonary embolism, were published in July 1975. In view of inconsistencies which have now become apparent in the data from one of the twenty-eight centres which took part in the trial, the results of the trial have been re-examined, excluding the data from this centre. Of 4031 patients remaining after exclusion of these data, 2033 were in the control group and 1998 in the heparin group. 170 (4-2%) patients died during the postoperative period, 94 in the control group and 76 in the heparin group; 70-2% of deaths in the control group and 65-7% in the heparin group had necropsy examination. 15 patients in the control group and none in the heparin group were found at necropsy to have died due to acute massive fatal pulmonary embolism (P less than 0-001). Exclusion of data from the one centre did not alter already published significant differences in the total incidence of deep-vein thrombosis, nor in the frequency of operative and post-operative bleeding complications observed in the control group and the heparin group.

Clinical Trials as Topic↗
PubMed1977

Wound infection following appendicectomy: the effect of extraperitoneal wound drainage and systemic antibiotic prophylaxis.

The value of extraperitoneal wound drainage and a 3-day course of prophylactic systemic cephaloridine used both separately and together have been assessed in a prospective controlled randomized trial involving 246 patients undergoing appendicectomy at the Leicester Royal Infirmary. Extraperitoneal wound drainage was shown to reduce significantly the incidence of postoperative wound infection in patients with a gangrenous or perforated appendix (P less than 0-025). Prophylactic cephaloridine significantly reduced the overall incidence of wound infection (P less than 0-02) and was also effective when the appendix was gangrenous or perforated (P less than 0-01). A highly significant reduction in wound infection was achieved when the appendix was gangrenous or perforated by the addition of wound drainage to the antibiotic regimen (P less than 0-001).

Adolescent↗
PubMed1974

Assessment of limulus test for detecting endotoxaemia.

The occurrence of endotoxaemia in 46 surgical patients has been investigated using a sensitive preparation of limulus lysate. Altogether 23 patients with local and systemic Gram-negative infections were shown to have endotoxaemia. An overt infection is not a prerequisite for a positive limulus test result, since endotoxin can be absorbed via the peritoneal cavity in patients with "chemical" peritonitis. Over 70% of the tests performed during episodes of Gram-negative infection or peritonitis gave positive results. In 23 patients without clinical evidence of infection or peritonitis only 15% of the limulus test results were positive. The implications of these findings and the use of the test in clinical practice are discussed.

Adult↗