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Biomedical subjects

J Drumm

Publications and source records attributed to J Drumm.

At least 19 recordsLinked to original sources
PubMed2001

Absence of germline infection in male mice following intraventricular injection of adenovirus.

The possibility of inadvertent exposure of gonadal tissue to gene therapy vectors has raised safety concerns about germline infection. We show here that the receptor for coxsackie B viruses and adenoviruses 2 and 5 (CXADR) is expressed in mouse germ cells, suggesting the possibility that these viruses could infect germ cells. To directly assess the risk of germline infection in vivo, we injected an adenovirus carrying the germ-cell-specific protamine promoter fused to the bacterial lacZ reporter gene into the left ventricular cavity of mice and then monitored expression of the reporter gene in germ cells. To differentiate between infection of stem cells and differentiating spermatogenic cells, we analyzed expression of the reporter cassette at different times after viral delivery. Under all conditions tested, mice did not express the Escherichia coli beta-galactosidase protein in developing spermatids or in mature epididymal spermatozoa. Primary germ cells cultured in vitro were also refractory to adenoviral infection. Our data suggest that the chance of vertical germline transmission and insertional mutagenesis is highly unlikely following intracoronary adenoviral delivery.

Adenoviridae↗
PubMed2001

Treatment of surgical patients is evidence-based.

OBJECTIVES: To assess the type of evidence that supported our management of surgical patients. DESIGN: Retrospective audit. SETTING: Teaching hospital, Republic of Ireland. PATIENTS: All 222 patients admitted by two surgical teams during one month. Patients admitted for diagnostic procedures were included if they were treated as a result. MAIN OUTCOME MEASURES: Diagnosis and treatment were established from the notes. Evidence for each intervention was then sought in MEDLINE 1986-1999, Best Evidence 1991-1999, and the Cochrane Database of Systematic Reviews Issue 3, 1999, and graded into one of five categories: systematic review, meta-analysis, randomised controlled trial, prospective study, or retrospective study. RESULTS: Treatment was supported by systematic review in 14, by meta-analysis in 12, by randomised controlled trial in 75, by prospective studies in 55, by retrospective studies in 58, and by no evidence in 8. CONCLUSIONS: Everyday surgical practice in our unit is supported by good quality evidence from recent publications.

Adolescent↗
PubMed2001

A prospective evaluation of the efficiency of early postoperative bladder emptying after the Stamey procedure or pubovaginal sling for stress urinary incontinence.

PURPOSE: The pubovaginal sling has been criticized as having a higher incidence of postoperative voiding dysfunction than other surgical approaches for the management of stress urinary incontinence. In 2 similar patient groups we prospectively compared the rates of early postoperative voiding dysfunction after the pubovaginal sling or Stamey procedure. MATERIALS AND METHODS: Between June 1995 and January 1997, 50 consecutive patients underwent the pubovaginal sling or Stamey procedure. Emptying efficiency was measured 48 hours postoperatively by suprapubic catheter in the Stamey group and intermittent catheterization in the pubovaginal sling group. When emptying efficiency was greater than 75%, intermittent catheterization was stopped or the suprapubic catheter was removed. RESULTS: There was no statistically significant difference in emptying efficiency for the first 3 voids using the Dunn multiple comparison method. Median voiding efficiencies were 37%, 43% and 61% with the Stamey procedure in group 1 (mean 43%, 45% and 54%), and 60%, 75% and 75% with the pubovaginal sling in group 2 (mean 49%, 68% and 69%), respectively. The mean number of intermittent catheterizations performed in patients with the pubovaginal sling was 5.7 in less than 1 day. In the Stamey group the suprapubic catheter was removed an average of 6 days postoperatively. The mean duration of hospital stay was similar for the sling and Stamey groups (5.4 versus 6 days, respectively). There were 2 patients in each group who were voiding inefficiently after day 7. Voiding efficiency was restored at 53 and 86 days in the 2 patients with slings and at 18 days in 1 of the 2 who underwent the Stamey procedure, respectively. The second patient who underwent the Stamey procedure was able to void without using the catheter at all, and it was removed 30 days postoperatively when emptying efficiency was confirmed greater than 75%. CONCLUSIONS: These data show that early postoperative voiding dysfunction, measured using bladder emptying efficiency, after the pubovaginal sling is no more common than after the Stamey procedure and help justify the broadened indications for pubovaginal sling for treatment of stress urinary incontinence.

Female↗
PubMed1999

Cardiac-directed adenylyl cyclase expression improves heart function in murine cardiomyopathy.

BACKGROUND: We tested the hypothesis that increased cardiac myocyte adenylyl cyclase (AC) content increases cardiac function and response to catecholamines in cardiomyopathy. METHODS AND RESULTS: Transgenic mice with cardiac-directed expression of AC type VI (ACVI) were crossbred with mice with cardiomyopathy induced by cardiac-directed Gq expression. Gq mice had dilated left ventricles, reduced heart function, decreased cardiac responsiveness to catecholamine stimulation, and impaired beta-adrenergic receptor (betaAR)-dependent and AC-dependent cAMP production. Gq/AC mice showed improved basal cardiac function in vivo (P=0.01) and ex vivo (P<0.0005). When stimulated through the betaAR, cardiac responsiveness was increased (P=0.02), and cardiac myocytes showed increased cAMP production in response to isoproterenol (P=0.03) and forskolin (P<0.0001). CONCLUSIONS: Increasing myocardial ACVI content in cardiomyopathy restores cAMP-generating capacity and improves cardiac function and responsiveness to betaAR stimulation.

Adenylyl Cyclases↗
PubMed1997

Experience using the Quinton Permcath for haemodialysis in the Irish Republic.

BACKGROUND: The Quinton Permcath has been widely used for temporary vascular access in patients requiring haemodialysis. Placement under direct vision into the internal jugular vein minimizes the complication rate. This access modality is being used more and more for long-term access in the elderly and in patients where other access modalities are unavailable or have failed. METHODS: We reviewed the results of 50 central venous Permcaths inserted under direct vision in 61 patients, over a 4-year period. The overall survival and complication rates are estimated. A detailed description of the catheter insertion and removal is provided. RESULTS: Seventy-six per cent of patients were successfully managed using the Permcath for a median duration of 105 days. In addition, nine patients (18%) had catheters functioning without complications for over 1 year. Twenty-six (42.6%) catheters were removed for complications. Seven patients had a single and two had second catheter reinsertion during the course of the study. CONCLUSIONS: The Quinton Permcath remains a reliable method for short-term vascular access. When other access modalities are unavailable, it may offer a valuable alternative for long-term haemodialysis.

Adolescent↗
PubMed1991

Identification of bile duct stones in patients undergoing laparoscopic cholecystectomy.

To identify patients with common bile duct stones, all patients considered for laparoscopic cholecystectomy in this unit undergo intravenous cholangiography (IVC) with tomography and, more recently, operative cholangiography. To date 100 consecutive patients with symptomatic gallstones have undergone laparoscopic cholecystectomy with no specific exclusion criteria. Eight patients of 100 were found to have duct stones on IVC with one false-positive. These IVC data were compared with data from 52 patients who also had operative cholangiograms performed. One stone was detected on operative cholangiography that was not identified on IVC. No additional information was gained from operative cholangiography. These data suggest that preoperative IVC is adequate for the detection of duct stones in patients considered for laparoscopic cholecystectomy.

Adolescent↗
PubMed1990

Is intrauterine growth retardation with normal umbilical artery blood flow a benign condition?

OBJECTIVE: To determine whether intrauterine growth retardation associated with normal umbilical artery blood flow is a benign condition. DESIGN: A prospective comparative study of growth retarded fetuses with normal and abnormal umbilical artery blood flow. SETTING: The fetal assessment clinic of a large maternity hospital in Ireland. PATIENTS: 179 Women with singleton pregnancies in which the fetal abdominal circumference, measured by ultrasonography, was below the fifth centile for gestation. MAIN OUTCOME MEASURES: Perinatal deaths, fetal distress requiring caesarean section, preterm delivery, cerebral irritation. RESULTS: Of 124 fetuses with normal flow, all physically normal fetuses survived but one baby had cerebral irritation; there were six preterm deliveries and four caesarean sections for fetal distress. Among 55 women with abnormal flow there were two midtrimester abortions, three perinatal deaths, and one case of cerebral irritation in physically normal fetuses. CONCLUSIONS: Intrauterine growth retardation associated with normal umbilical blood flow is a different entity from that associated with abnormal flow, normal flow being largely benign and abnormal flow carrying a serious risk of adverse outcome.

Cesarean Section↗
PubMed1989

Effect of Roux-en-Y biliary diversion on Campylobacter pylori.

To assess the effect of biliary diversion on gastric colonization by Campylobacter pylori, we undertook a retrospective histologic study of 24 patients with symptomatic bile reflux after peptic ulcer surgery, who had endoscopic gastric biopsies performed before and after a Roux-en-Y operation. The time interval between the preoperative and postoperative endoscopic examinations ranged from 0.8 to 9.8 yr (mean 4.7 yr). The partial gastrectomy specimen, which had been resected at the initial operation, was available for assessment in 12 patients (50%). Biopsy specimens were assessed for the presence of C. pylori and scored for severity of reflux gastritis by the use of a histologic grading system. Ten of the 12 partial gastrectomy specimens (83%) were C. pylori-positive. Only 13 of the 24 patients (54%) were C. pylori-positive before the Roux-en-Y operation, rising to 22 (92%) after biliary diversion (p = 0.008). The median reflux score was 6 in the partial gastrectomy specimens; it rose to 11 before the Roux-en-Y operation and fell again to 6 after biliary diversion (p less than 0.001). These results suggest that C. pylori may recolonize the gastric remnant after biliary diversion.

Adult↗
PubMed1987

Effect of Roux-en-Y reconstruction on the gastric emptying of a solid meal.

The gastric emptying of a solid meal was measured in 39 patients after Roux-en-Y reconstruction and compared with that in 27 patients after truncal vagotomy and pyloroplasty and that in 22 patients after Polya gastrectomy. There were no significant differences among the groups. It is concluded that despite the disruption of the normal motor pathway produced by the Roux-en-Y reconstruction it does not lead to clinically significant delay in gastric emptying.

Duodenogastric Reflux↗
PubMed1986

Emergency presentation and mortality from colorectal cancer in the elderly.

We have assessed the influence of age on the mode of presentation and perioperative mortality in 1033 patients with colorectal cancer. There were 522 patients (51 per cent) over 70 years (group I) and 511 patients (49 per cent) under 70 (group II). In group I, 301 patients (58 per cent) were admitted as emergencies compared with only 222 (43 per cent) in group II (P less than 0.001). Perioperative mortality was especially high in the elderly emergencies, 38 per cent, compared with 18 per cent for elective operations. Of the patients presenting as emergencies in either age group 66 per cent had localized "potentially curable' disease. The incidence of colorectal cancer is highest in the elderly. A larger number of these elderly patients present as emergencies and die from the consequences of complications of localized disease. Earlier diagnosis by pre-symptomatic screening is therefore especially desirable in these old patients.

Age Factors↗
PubMed1986

The pharmacokinetics and tissue penetration of imipenem.

Two studies were performed to investigate the penetration of imipenem into chemically induced inflammatory exudate and into peritoneal fluid. In the first study six volunteers received 500 mg of imipenem, alone and with 500 mg cilastatin. Little difference was noted in the pharmacokinetics or inflammatory fluid penetration of imipenem when given with or without cilastatin. The only significant alteration was the urine recovery (an increase from a mean of 14.7% to 55.6% in the presence of the enzyme inhibitor). The mean inflammatory fluid level of imipenem at 30 min was 6.2 mg/l (or 35% of the plasma level). The inflammatory fluid levels exceeded the plasma levels after 2 h. The overall penetration of imipenem/cilastatin into inflammatory fluid was 67.8% (+/- 13.8) and imipenem alone 73.2% (+/- 13.9). The mean elimination half-life of imipenem from plasma was 1.1 h and from inflammatory fluid 1.4 h (with or without cilastatin). In the second study, 29 patients received 1 g imipenem plus cilastatin before elective surgery and plasma and peritoneal levels were measured over 4 h. There was considerable penetration of the peritoneum, imipenem levels in excess of 30 mg/l being found 15 min after administration declining to 5-7 mg/l by 3-4 h. The mean percentage penetration was 73.4% (+/- 22.1). A brief review of the literature on imipenem tissue penetration is included.

Adult↗
PubMed1985

Metronidazole and Augmentin in the prevention of sepsis after appendicectomy.

Two hundred and fifty patients were admitted to a prospective randomized trial to compare the efficacy of Augmentin with metronidazole in the prevention of sepsis after appendicectomy. Pre-operatively they received either 500 mg metronidazole or 1.2g Augmentin intravenously. Those patients with gangrenous or perforated appendices received eight additional doses of the trial drug at 8 hourly intervals. Overall there were 13 wound infections in the Augmentin group (11 per cent) and 21 in the metronidazole group (18 per cent). The 90 per cent confidence limits for the overall 7 per cent difference in infection rates were +/- 8.5 per cent. There were high rates of wound infection in the gangrenous group (Augmentin 8 per cent versus metronidazole 19 per cent) and especially in the perforated group (Augmentin 33 per cent versus metronidazole 63 per cent). There was no statistically significant difference between the infection rates with the two antibiotics but our study suggests that Augmentin, which is active against both aerobes and anaerobes, may be more effective than metronidazole in reducing wound sepsis after appendicectomy.

Adult↗