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Biomedical subjects

J A Coil

Publications and source records attributed to J A Coil.

27 records · Page 2Linked to original sources
PubMed1980

The continuing challenge of perforating appendicitis.

A series of 335 consecutive patients treated for acute appendicitis is presented. The incidence of perforation in the series was 32.2 per cent. The mortality was 0.3 per cent for the total series and 0.9 per cent for those patients with perforating appendicitis. When perforation occurs, a twofold increase in the hospital stay and a threefold increase in hospital costs result. A complication rate of 47.2 per cent in instances of perforation was significantly greater than that noted in instances of nonperforation. A 40 per cent incidence of perforation was noted during the first decade of life, after which the frequency of perforation declines. Beginning with the fifth decade, a progressive increase in the incidence of perforation was noted. Prior to hospital admission, a significant delay was noted among patients with perforation. In addition, those with perforating appendicitis were far more likely to have been seen previously by a physician who failed to advise hospital admission. Finally, a significant inhospital delay, from admission to operation, was noted in patients with perforating appendicitis. While geographic access to health care did influence the incidence of perforation, insurance status and possession of a telephone did not.

Adolescent↗
PubMed1980

Appendicitis: factors that influence the frequency of perforation.

The mortality from perforating appendicitis has decreased, but the incidence of perforation has not changed in 30 years. We found that among 335 consecutive patients treated for acute appendicitis, 108 (32%) had evidence of perforation. No significant differences between the groups were noted with respect to race, sex, educational level, family income, health insurance coverage, availability of transportation, and possession of a telephone. Perforation was more likely in patients who lived more than 20 miles from the hospital and in patients under age 10 years or over age 60. Patients with perforation were ill for a mean of 2.5 days before seeking medical attention, compared to a mean of 1.5 days for those without perforation (P < .001). Yet, approximately 75% of patients in each group stated that they had a "family doctor." Patients with perforation had significantly more physician visits before hospital admission (mean 1.61 vs 1.33, P < .005); 54.3% of patients with perforation had previous contact with a physician who failed to make the correct diagnosis.

Adolescent↗
PubMed1979

The protective effect of intraperitoneal splenic autotransplants in mice exposed to an aerosolized suspension of type III Streptococcus pneumoniae.

Splenosis has been shown to occur after traumatic injury to the spleen. It is postulated that this is the mechanism for the low incidence of bacterial infection in this group of patients when compared to those who undergo splenectomy for other reasons. Therefore, we studied the effect of exposure to an aerosolized suspension of type III Streptococcus pneumoniae on splenectomized mice who had either all or half of their splenic tissue cut up and reimplanted into the abdominal cavity 8 wk prior to bacterial exposure. It was determined that the mortality experience of these two groups of mice was similar to each other and no different from the sham control group, although all three groups had a statistically significant lower mortality experience than the splenectomized control group. This study demonstrates that splenosis in mice can protect against aerosolized bacterial infection.

Animals↗
PubMed1979

Protective effect of prophylactic penicillin on splenectomized mice exposed to an aerosolized suspension of type III Streptococcus pneumoniae.

Prophylactic penicillin has been recommended for use in asplenic patients and postsplenectomy patients. A laboratory model using aerosolized pneumococci has been devised to test the effectiveness of prophylactic penicillin in a manner analogous to human experience. There is increased mortality, over time, in asplenic mice exposed to aerosolized type III Streptococcus pneumoniae. One hundred twenty-one male Swiss mice (mean weight 26 g) were divided into four groups: splenectomized, sham-operated, splenectomized + penicillin, and sham-operated + penicillin. After 2 wk the four groups were exposed for 30 min to an aerosolized atmosphere of 2.4 x 10(9) colony-forming units of type III S. pneumoniae using a Tri-R model A-42 airborne infection apparatus. Penicillin was given at a daily intramuscular dosage of 40,000 units procaine penicillin G beginning 2 days prior to exposure and continuing through the third day after exposure. The splenectomized and sham-operated mice given penicillin showed significantly lower mortality (p less than 0.001) than mice not given penicillin.

Aerosols↗
PubMed1978

Increased susceptibility of splenectomized mice to infection after exposure to an aerosolized suspension of type III Streptococcus pneumoniae.

Most reported experimental studies concerning the effect of splenectomy in animals have shown enhanced mortality from pneumococci injected either intravenously or intraperitoneally. We have developed a laboratory model in which mice are exposed to type III Streptococcus pneumoniae via an aerosolized atmosphere, thus closely approximating the route of human infection with this organism. Ninety-one male Swiss mice (mean weight 26 g) were divided into three approximately equal groups of control, sham-operated, and splenectomized animals. Two weeks later they were exposed for 30 min in individualized compartments within a confined chamber to an aerosolized atmosphere producing a uniform challenge of 5.9 X 10(9) colony-forming units per ml of pneumococci. A statistically significant increase (P less than 0.01) in mortality was demonstrated in the splenectomized group over the pooled sham-operated and control groups. The animal model used in these investigations can be applied to the study of infections acquired by the respiratory route in numerous experimental designs.

Aerosols↗