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Biomedical subjects

J Alexander-Williams

Publications and source records attributed to J Alexander-Williams.

At least 163 records · Page 9Linked to original sources
PubMed1979

Influence of neomycin and metronidazole on colonic microflora of volunteers.

The influence on colonic microflora of neomycin and metronidazole alone, or in combination, was studied in volunteers taking a normal diet. Bacterial counts on daily faecal samples revealed that metronidazole had no influence on anaerobic faecal bacteria. Neomycin on the other hand, was effective against sensitive aerobes. However, the combination of neomycin and metronidazole profoundly reduced both aerobic and bacteria. Assay of faecal antibiotic concentrations showed that neomycin achieved high intraluminal levels while metronidazole was undetectable or present at low concentrations.

Bacteroides fragilis↗
PubMed1979

Comparison between general and local anaesthesia for repair of groin hernias.

A prospective study of 104 cases has been carried out to compare the use of local and general anaesthesia for the elective repair of groin hernias. There were no apparent disadvantages in using a local anaesthetic procedure. Patients having local anaesthetic herniorrhaphy required postoperative analgesics and antiemetics significantly less often and also returned home sooner (3.2 days) than patients having a general anaesthetic (4.1 days). These findings argue strongly in favour of local anaesthesia as a suitable alternative to general anaesthesia for repair of groin hernias.

Adult↗
PubMed1978

Diarrhoea and pseudomembranous colitis after gastrointestinal operations. A prospective study.

241 patients who had gastrointestinal operations were studied prospectively. Postoperative diarrhoea occurred in 58 patients (24%) and was significantly more common after exposure to antibiotics. 9 patients (4%) had high titres of a neutralisable faecal toxin characteristic of pseudomembranous colitis. Toxigenic Clostridium difficile strains were isolated from the stools of all patients with neutralisable faecal toxin. If pseudomembranous colitis is defined as the presence of neutralisable faecal toxin, then the diagnosis is often missed by sigmoidoscopy and rectal biopsy.

Anti-Bacterial Agents↗
PubMed1978

Diagnosis of pseudomembranous colitis.

Twenty-eight patients with histologically proved pseudomembranous colitis have been seen in one hospital since July 1975. All patients with the disease had received antibiotics, six for infections not requiring operations; the other 22 cases all occurred after major surgery. All the patients had diarrhoea; six patients also had fever with clinical signs of sepsis, and three had abdominal pain thought to be due to anastomotic dehiscence after colonic resection. Pseudomembranous colitis was associated with white blood counts over 15 000/mm3 in 17 patients and albumin concentrations of less than 30 g/1 in 18. Pseudomembranous colitis was an incidental finding at necropsy in two of six patients who had not had an operation. Of the 22 patients who had had major surgery, nine died from this complication; in all except two of these cases the diagnosis was made only at necropsy. If pseudomembranous colitis is suspected on clinical grounds or if there is an unexplained complication after colorectal surgery repeat sigmoidoscopy and testing for faecal toxins should be carried out to establish the diagnosis so that prompt supportive treatment can be given.

Adolescent↗
PubMed1978

Prospective randomized multicentre trial of proximal gastric vagotomy or truncal vagotomy and antrectomy for chronic duodenal ulcer: interim results.

In three centres, 222 patients (Birmingham 70, London 87 and Rotterdam 65 patients) with chronic duodenal ulcer were treated by proximal gastrict vagotomy (PGV) (116 patients) or truncal vagotomy and antrectomy (TVA) (106 patients) in a prospective randomized trial. After 1 year 5 recurrent duodenal ulcers (4.3 per cent) have been recorded in the PGV group, compared with 1 (1 per cent) in the TVA group. The reoperation rate was high in both groups-6 after PGV, usually for recurrent ulcer, and 7 after TVA, mostly for gastric retention. PGV showed a marked superiority in the number of patients with a good clinical result Visick I or II) at 1 year after operation, i.e. 82 per cent compared with 56 per cent for TVA.

Chronic Disease↗
PubMed1978

Prediction of wound sepsis following gastric operations.

Gastric aspirates were obtained from 12 healthy volunteers, 49 patients with duodenal ulcer, 14 with gastric ulcer and 35 with gastric carcinoma. The mean total viable bacterial counts in these groups were as follows: volunteers 0, duodenal ulcer 3.8 X 10(1), gastric ulcer 6.95 X 10(4), carcinoma 1.9 X 10(7) organisms/ml. The incidence of wound sepsis in patients without antibiotic cover was; duodenal ulcer 17 per cent, gastric ulcer 38 per cent, carcinoma 56 per cent. Regardless of the underlying pathology, patients with counts greater than 5 X 10(6) organisms/ml in the gastric aspirate had a 93 per cent incidence of wound sepsis, compared with 16 per cent in patients with counts of less than 5 X 10(6) organisms/ml (P less than 0.001). In the group with high counts all except one of the wound infections were caused by organisms present in the stomach at the time of operation. There was a good correlation in the bacteriology of apirates obtained during preoperative endoscopy compared with operative nasogastric samples (n = 31) both for viable counts (r = 0.93) and for the counts of individual organisms. Therefore, preoperative endoscopy can be used to identify patients who are at risk of developing wound sepsis after gastric surgery.

Duodenal Ulcer↗
PubMed1978

Influence of bowel preparation and antimicrobials on colonic microflora.

The influence of three types of preoperative mechanical bowel preparation on colonic microflora has been studied in 88 patients undergoing elective bowel resection and compared with 21 controls. Neither conventional bowel preparation (CBP) using oral magnesium sulphate, enemas and rectal washouts nor whole bowel irrigation (WBI) via a nasogastric tube influenced the type or number of organisms in the colon at the time of operation. The administration of an elemental diet (ED) was associated with only a small reduction the numbers of Escherichia coli (P less than 0.02). The addition of oral neomycin and metronidazole for 48 h before operation to all three methods of bowel preparation was associated with a highly significant reduction in the counts per ml of E. coli (P less than 0.001) and Bacteroides fragilis (P less than 0.001) in the colon. There was no correlation between the diameter of the lesion being resected with the numbers of bacteria in the colon even when oral neomycin and metronidazole were added to the bowel preparation.

Adult↗
PubMed1978

Randomized multicentre trial of oral bowel preparation and antimicrobials for elective colorectal operations.

A study of 120 patients undergoing elective colorectal operations has investigated the effect of adding oral neomycin and metronidazole to bowel preparation in a double-blind randomized controlled trial. Comparisons have also been made between a standard mechanical preparation and the use of an elemental diet. The addition of neomycin and metronidazole to bowel preparation significantly reduced the rate of wound sepsis (P less than 0.01), septicaemia (P less than 0.02) and anastomotic dehiscence (P less than 0.02); anaerobic infections were abolished and there was a significant reduction in the incidence of aerobic Gram-negative infections. Elemental diets were shown to have no advantage over mechanical preparation.

Administration, Oral↗
PubMed1978

Influence of inflammatory bowel disease on intestinal microflora.

The microflora of the jejunum, ileum, and colon has been studied from operative samples in Crohn's disease (n = 30), ulcerative colitis (n = 15), and controls (n = 40). There was no significant difference in the flora of patients with ulcerative colitis compared with controls. In Crohn's disease there was a significant increase in E. coli (P less than 0.001) and B. fragilis (P less than 0.001) in the ileum and of E. coli (P less than 0.001) and lactobacilli (P less than 0.01) in the colon. The abnormal ileal flora in Crohn's disease was unrelated to serological evidence of disease activity (indices: ESR, serum albumin, serum seromucoids), diameter of the ileum, or excision of the ileocaecal valve. The abnormal colonic flora in Crohn's disease was not related to presence of macroscopic colitis.

Bacteroides fragilis↗
PubMed1978

Selection of patients for bile diversion surgery: use of bile acid measurement in fasting gastric aspirates.

Eighteen patients with dyspepsia and vomiting which followed surgery for peptic ulcer have completed a study to examine the role of diverting bile from the stomach by a Roux-en-Y procedure. Bile regurgitation and mild epigastric pain relieved by vomiting were abolished. Measurements of bile acids in the fasting gastric aspirate were useful in predicting the outcome of surgery; good results were obtained when initially there was reflex into the stomach of more than 120 mumol/hour of bile acids. A wider group of patients than those selected in previous series may benefit from this operation, as good results can be obtained in patients with dyspepsia relieved by alkali and without achlorhydria or gastritis. Endoscopy was repeated one year after Roux-en-Y operation. Erythema of the mucosa was improved, but gastritis did not improve.

Adult↗