Biomedical subjects
Publications and source records attributed to G Gillespie.
A combination of kanamycin and metronidazole administered for 3 days by mouth preoperatively, significantly suppresses both the aerobic and anaerobic colonic microflora, and significantly reduces the incidence of postoperative wound infection. During 6 years experience with this regimen, no toxic or untoward effects have been observed.
By means of a new thin needle (Chiba), percutaneous transhepatic cholangiography was carried out in 60 jaundiced patients admitted to a general surgical unit over a period of 12 months. In patients in whom the technique was technically unsuccessful, or in whom inadequate information was obtained, a liver biopsy was performed. Our results indicate that this is a safe and reliable method of achieving an early and accurate diagnosis in the majority (91%) of jaundiced patients.
Selected microbial components in dental plaque were determined for children in Biddeford, Maine and Colombia, South America. Using cultural methods, Streptococcus mutans was detected in 51.4% of the Colombian children and 63.3% of the Maine children. Serotype c was predominant in both populations. The greatest difference between the two groups occurred with serotypes d and g which were present in 25% of the Colombian children with S. mutans and were not detected in the Maine children. In the specimens examined with specific FA conjugates. Actinomyces was the predominant genus, present in all individuals and comprising an average of 52% of all cells.
A series of 102 patients with presumptive acute appendicitis entered a prospective, randomized, clinical trial of intrarectal metronidazole given over a 48-h period commencing before surgery. Adequate levels of circulating metronidazole were achieved. A significant reduction in the incidence of anaerobic wound infection was observed in the treated group (P less than 0.02). The convenience and short duration of the prophylactic regimen allowed early discharge from hospital. No untoward effects were observed.
Three cases of pyloric diaphragm in elderly patients are reported. The finding of these patients within a 2-year period (1976-8) suggests that the condition is not as rare as previously thought. Diagnosis was achieved endoscopically and the condition managed surgically. While there has been controversy in the past over whether the disorder is acquired or congenital, the histological evidence of the cases presented here tends to suggest that it is a late presentation of a congenital abnormality.
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Sixty patients who had been referred for elective ulcer surgery, and in whom a remission had been induced, entered a prospective double blind controlled trial of a single daily dose of 400 mg of cimetidine given at bedtime, or placebo. Eighty per cent of patients receiving placebo suffered symptomatic relapse and recurrence of duodenal ulceration at endoscopy within 6 months. The mean interval to relapse was 10 weeks. On the other hand, only 27 percent of patients had a recurrence during the 6-month period on low dose cimetidine therapy. No significant toxic or other side effects which could be attributed to the drug were observed.
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40 adult outpatients with active endoscopically proven duodenal ulceration, who would otherwise have merited elective ulcer surgery, entered a double-blind trial of either cimetidine (1g/day) or placebo. After twenty-eight days, 17 of 20 (85%) patients receiving cimetidine showed ulcer healing, compared with 5 of 20 patients receiving placebo (p less than 0.0005). Patients receiving cimetidine had significantly more pain-free days and pain-free nights than those receiving placebo. There was good correlation between ulcer healing and symptomatic relief (p less than 0.0005).
Pneumatosis cystoides intestinalis is an uncommon condition characterized by the presence of gas within the wall of the bowel. In most cases the clinical course is benign and may well be self-limiting, while in others the appearance of pneumatosis may indicate the presence of bowel ischaemia and necessitate emergency laparotomy. This paper describes 5 cases which demonstrate some of the difficulties in diagnosis and management and the improvement which can result from clinical awareness of the condition.
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A patient is described with recurrent peptic ulceration, evidence of hypersecretion of gastric acid and excess circulating gastrin. The preoperative differentiation between extragastric "gastrinoma" and G-cell hyperplasia of the pyloric antrum as a source for the hypergastrinaemia can be made by immunofluorescent staining of an antral biopsy for "gastrin cells", and by measuring the response of the gastric antrum to an amino acid meal or secretion infusion stimulus. The site of excessive gastrin production determines the nature of the surgery required. A classification of recurrent peptic ulceration types is suggested.