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Biomedical subjects

J M Duggan

Publications and source records attributed to J M Duggan.

At least 37 records · Page 2Linked to original sources
PubMed1996

Achromobacter xylosoxidans bacteremia: report of four cases and review of the literature.

Seventy-seven cases of bacteremia due to Achromobacter xylosoxidans were reviewed, and susceptibility studies were performed on 11 clinical isolates of A. xylosoxidans. Nosocomial bacteremia was noted in 54 of 77 patients (70%), and 28 (36%) had infection associated with an outbreak or acquired from a discrete point source. The most common underlying illnesses were malignancies (30%) and cardiac disease (21%); immunosuppression affected 27%. The most common clinical syndromes were primary and catheter-associated bacteremia (19% each) and pneumonia (16%). The case-fatality rate was 30%; only 3% of patients with primary or catheter-associated bacteremia died, but 65% of patients with meningitis, endocarditis, and pneumonia died. The case-fatality rate in neonates was 80%. Susceptibility studies showed that all strains were resistant to aminoglycosides, most were resistant to quinolones, and all were susceptible to broad-spectrum penicillins, imipenem, ceftazidime, and trimethoprim-sulfamethoxazole. Two-disk approximation and time-kill studies showed synergy or additive effects for the combination of gentamicin and piperacillin against most strains.

Adolescent↗
PubMed1995

Pneumococcal vertebral osteomyelitis.

Vertebral osteomyelitis is an unusual complication of pneumococcal infection. This report describes a patient who presented with back pain and lower extremity weakness after bacteremic pneumococcal pneumonia. Magnetic resonance imaging showed destruction of the L-4-L-5 vertebral bodies and thecal sac compression, and Streptococcus pneumoniae was isolated from an aspirate of the disk space. We found only 10 other cases of pneumococcal vertebral osteomyelitis in a review of the literature. In these 11 cases the presentations were usually subacute, and the onset of back pain was insidious. Elevated erythrocyte sedimentation rates were commonly noted. Computed tomography and magnetic resonance imaging were most helpful in delineating the extent of involvement in patients seen in the last decade. Successful treatment included surgery alone in 2 cases that occurred before the antibiotic era, surgery plus 6 weeks of antibiotic therapy in 1, and antibiotics alone for 4 weeks to 7 months in 5. Two patients seen in the preantibiotic era died.

Aged↗
PubMed1994

Quality of care under casemix.

The introduction of casemix funding in some States has led to concerns that hospitals, faced with budgetary problems, may be tempted to discharge patients prematurely after inadequate treatment--the "quicker and sicker syndrome". There are no significant Australian data on quality of care before and after casemix funding, but a large study in the United States found that, in general, there was no evidence of a deterioration in care. Contrary to expectation, readmission rates were unaltered. There was, however, some evidence of an increase in discharge of patients in an unstable state and more were transferred to nursing homes. There are significant reasons why these conclusions can not be readily transported to the Australian environment, and there is a need to monitor the discharge status of patients, particularly the frail elderly, with casemix funding in Australia.

Aged↗
PubMed1993

Is the aggressive management of peptic ulcer justified by the data?

Sophisticated and very effective means of diagnosing and treating peptic ulcers are now available. This entails considerable resource utilization in affluent western societies, all with resource limitations, which mean that the costs need to be balanced by the outcomes achieved--the benefits. Little attention has been paid to the risk to life and well-being posed by ulcer and the effect, if any, of the intervention on such risks. I present an analysis of the natural history of peptic ulcer including studies of the natural history of peptic ulcer including studies incorporating life-table analysis and a population comparison. The conclusions are clear. The possessors of a peptic ulcer have, in general, a normal life expectancy. A major cause of ulcer-related death in the past was postoperative. Symptoms and workloss have diminished after the introduction of H2 antagonists, but no evidence is yet available of any change in the rates of bleeding, perforation or death from ulcer related to modern methods of diagnosis and management. The risk of major complication is approximately 0.025/year over the next 10 years. The risk of death is greatest in elderly women with gastric ulcer and in those on corticosteroids. The data suggest to me that the costs of aggressive investigation and treatment of peptic ulcer need to be justified by the dangers averted.

Aged↗
PubMed1992

Aluminium beverage cans as a dietary source of aluminium.

OBJECTIVE: To examine the possibility that aluminium beverage cans contribute to the dietary level of aluminium. METHOD: The aluminium content of a variety of beverages from aluminium cans and glass containers was measured. RESULTS: The contents of 106 aluminium cans and bottles representing 52 different beverages all had a higher aluminium content than Newcastle tap water at 1.4 mumol/L, ranging as high as 385 mumol/L. Non-cola soft drinks averaged 33.4 mumol/L from cans and 5.6 mumol/L from bottles. Cola drinks averaged 24.4 mumol/L from cans and 8.9 mumol/L from bottles, whereas beer in cans or bottles averaged about 6 mumol/L. CONCLUSIONS: In general, the aluminium content of beverages from aluminium cans was higher than that from glass containers, and it rose with decreasing pH. Within a given category there was a wide variation in aluminium content. If the speculative link between aluminium intake and Alzheimer's disease is established then beverages from aluminium cans, particularly soft drinks, may be a risk factor.

Aluminum↗
PubMed1992

Changing trends in perforated peptic ulcer during the past 45 years.

Since 1944 there has been a dramatic change in the pattern of admissions for perforated peptic ulcer (PPU) to the Royal Newcastle Hospital, the main teaching hospital of the Hunter Region, Australia. Between 1944 and 1950, females accounted for 6% of all perforations; since then the proportion of females admitted with this complication has risen to 32%. Simultaneously, the modal age for PPU has shifted from the fifth to the seventh decade and the ratio of gastric to pyloroduodenal perforations has fallen from 1.1:1 to 0.6:1. No good explanation for this change in the natural history of PPU, also noted elsewhere, is evident.

Adult↗
PubMed1992

Perforated peptic ulcer in the Hunter region: a review of 174 cases.

A review of 174 consecutive patients admitted with a diagnosis of perforated peptic ulcer to eight Hunter Region hospitals during 1979-86 is presented. Among the female admissions, the proportion of patients greater than 70 years of age was twice that in males. One-third of all perforations were in females who accounted for two-thirds of all perforated gastric ulcers. Multivariate analysis revealed that perforations located in the stomach and older age were both significant independent variables adversely affecting outcome following surgery. In contrast, shock at presentation and delay in operating were not statistically significant independent risk factors.

Adolescent↗