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Biomedical subjects

R A Mustard

Publications and source records attributed to R A Mustard.

At least 37 records · Page 2Linked to original sources
PubMed1988

Antibiotic efficacy in intraabdominal sepsis: a clinically relevant model.

We present preliminary data on the role of antibiotics in intraabdominal sepsis using a new, clinically relevant animal model. Peritoneal cavity infection was induced by ligation and perforation of the cecum in adult rats. Surviving rats were randomized to receive either saline or cefoxitin at the time of cecal excision and peritoneal lavage, 18 h after the onset of infection. This is different from previous models of abdominal sepsis (in which antibiotics are given within 4 h of peritoneal contamination) and mimics the clinical setting in which antibiotics are initiated much later, at the time of operation. Antibiotic-treated rats received 20 mg cefoxitin i.m. every 8 h for 7 days; controls received saline at similar times. Thirty-nine of 67 control rats died (58%) versus 20 of 64 (31%) that received cefoxitin (p less than 0.005). We conclude that even with delayed administration, antibiotics appear to improve the outcome of intraabdominal sepsis. With further characterization of this model we plan to use it as an in vivo assay to compare the efficacy of different antimicrobial agents in intraabdominal sepsis.

Animals↗
PubMed1988

Multiorgan failure in critically ill patients.

Of 1136 patients admitted consecutively to two medical-surgical intensive care units, 100 were found to have multiorgan failure, defined as failure of more than two organ systems. The average duration of stay in the intensive care units was 13.4 days. The overall death rate was 78% compared with 12.8% for patients without multiorgan failure. The most common initiating illnesses or insults were sepsis, surgery, accidental trauma and cardiogenic shock. Of potential risk factors studied, shock, sepsis, surgery, pre-existing organ disease and age over 65 years were the most common. Although sepsis occurred before or during the course of multiorgan failure in 78 patients, in only 34 was sepsis judged to be the prime insult leading to multiorgan failure. Surgery during the course of multiorgan failure had neither an adverse nor beneficial effect on outcome. The mean number of organ systems failing was 4.36 for survivors and 5.03 for nonsurvivors. The most common systems to fail were central nervous, cardiovascular and respiratory.

Adolescent↗
PubMed1987

C-reactive protein levels predict postoperative septic complications.

We studied 108 patients undergoing clean-contaminated and dirty surgical procedures to determine whether daily C-reactive protein (CRP) measurements for 14 days postoperatively could predict the occurrence of septic complications prior to clinical diagnosis. Diagnostic criteria for septic complications and positive CRP response were defined in advance of the study. The CRP assays were carried out using an automated laser nephelometer system after the patient's discharge from the hospital. Forty-six septic complications were diagnosed in 40 patients. These complications consisted of wound infection (23), urinary tract infection (11), pneumonia (six), upper respiratory tract infection (three), intra-abdominal abscess (one), and other (two). The CRP testing was found to have a positive predictive value of 69% and a negative predictive value of 78%. We conclude that serial CRP measurements may be a valuable adjunct to surgical care in patients at high risk of postoperative septic complications.

Adult↗
PubMed1986

A simplified method for metabolic studies in conscious swine.

Reliable short-term blood access in conscious swine was provided by implanting multiple silastic catheters. Catheters were inserted into the aorta, hepatic vein, portal vein, and inferior vena cava through a midline laparotomy incision. Multiple catheters also were placed into the external jugular vein through a separate cervical incision. Catheter patency rates for blood withdrawal on the sixth post-operative day were: arterial 100%, hepatic 91%, portal 86%, inferior vena cava 71%. No animal had major wound or catheter infection on the seventh post-operative day. The methods described allow metabolic studies, including measurements of splanchnic blood flow, to be carried out either acutely or for up to at least 7 days post-operatively.

Animals↗
PubMed1986

Percutaneous drainage of a tuberculous liver abscess.

The authors describe the management by percutaneous drainage of a rare solitary tuberculous liver abscess in a 37-year-old woman. Open surgical drainage of such abscesses can be avoided using percutaneous drainage combined with transcatheter infusions of antituberculous agents. For the safe and successful use of this method three criteria must be met: the abscess should be unilocular, there must be a safe access route and a previously sterile compartment must not be contaminated. In addition a small (22 or 23 gauge) needle should be used for the initial puncture.

Adult↗
PubMed1985

2,3-Dihydroxybenzoic acid. Effect on mortality rate in a septic rat model.

Neutrophil-derived oxygen-free radicals may play a role in organ dysfunction associated with generalized sepsis. A rat model was used to test the effects of two free radical scavengers, dimethyl sulfoxide (DMSO) and 2,3-dihydroxybenzoic acid (2,3-DHB), on mortality from intra-abdominal sepsis produced by cecal ligation and perforation. Being an iron-chelating agent, 2,3-DHB may have an additional bacteriostatic effect. Therapeutic regimens included no treatment; gentamicin sulfate (2 mg given intraperitoneally [IP] every eight hours); DMSO (2 g/24 hr given IP every eight hours in divided doses); 2,3-DHB (35 mg/kg given IP every eight hours); and combinations of gentamicin with each free radical scavenger. No statistically significant improvement in survival was obtained by therapeutic intervention with gentamicin alone, DMSO alone, 2,3-DHB alone, or gentamicin in combination with DMSO. When used in combination with gentamicin, 2,3-DHB yielded a statistically significant improvement in survival when compared with gentamicin alone or with no treatment. These results show that 2,3-DHB when used in combination with gentamicin has a beneficial effect on mortality following intra-abdominal sepsis in this model.

Abdomen↗
PubMed1984

Blunt splenic trauma: diagnosis and management.

To examine the morbidity and mortality associated with blunt splenic injuries, the authors reviewed the results in 106 such patients treated in the Sunnybrook Regional Trauma Unit between June 1, 1976 and June 30, 1983. Initial assessment included peritoneal lavage in 86 patients. No patient with known or suspected splenic injury was treated nonoperatively nor were any patients found to have had splenic injuries missed at the initial assessment. Seventy-one splenectomies and 35 splenorrhaphies were performed. The overall mortality was 25% and 10 surviving patients had serious complications. The splenic injury itself was never the cause of death. Only one patient who initially underwent splenorrhaphy later required splenectomy. It is concluded that blunt splenic injury is rarely the cause of death or serious morbidity when a policy of immediate diagnosis and operative treatment is carried out. Furthermore, in selected patients, splenorrhaphy is a safe and effective treatment.

Abdominal Injuries↗
PubMed1982

Management of medullary carcinoma of the thyroid.

Total thyroidectomy is universally advised for the familial variety of MCT. Although total thyroidectomy is also recommended for sporadic cases, partial thyroidectomy may be adequate. Cervical and upper mediastinal nodes should be sampled for microscopic study, even when they are small and appear to be normal. Appropriate neck or mediastinal nodes should be sampled for microscopic study, even when they are small and appear to be normal. Appropriate neck or mediastinal dissection is done if metastasis is present. External radiation is a valuable adjuvant to surgical excision following the apparent complete resection of the tumor, and is beneficial in the management of unresectable disease. Despite local control, patients continue to die from disseminated disease; therefore, there must be a continued search for an effective chemotherapeutic program. Much remains to be learned from calcitonin monitoring of MCT patients.

Adult↗
PubMed1982

Gastric variceal bleeding due to occlusion of splenic vein in pancreatic disease.

Nine patients with gastric varices secondary to occlusion of the splenic vein, which resulted from pancreatic disease, were treated by the authors between 1973 and 1981. Profuse hemorrhage, recurrent bleeding and hypochromic anemia were investigated by endoscopy, gastrointestinal roentgenography and selective angiography. Pancreatic disease was defined by ultrasonography, endoscopic retrograde pancreatography and operation. There were three cases of chronic pancreatitis, three of pancreatic abscess, two of pseudocyst and one of carcinoma of the pancreas. Definitive control of upper gastrointestinal bleeding from gastric varices was achieved by combining splenectomy with selective pancreatic surgical procedures. Two patients did not undergo operation. One death resulted from an unresectable carcinoma. Bleeding did not recur in six patients followed for up to 8 years after operation.

Adult↗
PubMed1981

Vascular problems associated with carotid body tumors.

In the last 25 years at the University of Toronto, 27 patients with carotid body tumors were encountered. All patient problems appeared to be related to delay in treatment, size of the tumor, and previous operations. To minimize hazard in this procedure, one should avoid operating on elderly and unfit patients, and otherwise operate early to avoid the problem of a bulky tumor, using a simple subadventitial approach while reserving complete carotid excision and vascular replacement for complicated adherent lesions. Preoperative angiography is mandatory for definitive diagnosis, which permits proper planning of available operating room time, blood replacement, and availability of workers with expertise in vascular surgery. Adequate surgery is effective in tumor clearance, preventing malignant transformation and the lethal effects of local growth.

Adult↗
PubMed1980

Irradiation as an etiologic factor in tumours of the thyroid, parathyroid and salivary glands.

Irradiation to the head and neck region, usually of low dosage, results in an increased frequency of thyroid, parathyroid and salivary gland tumours. The authors have reviewed their experience with these tumours. Fifty of 475 patients with carcinoma of the thyroid had received previous irradiation. Papillary or mixed papillar-follicular carcinoma occurred most commonly. Eleven of 100 patients with primary hyperparathyroidism had been irradiated and had a parathyroid adenoma. Twenty of 662 patients with salivary gland tumours had previously been irradiated. Mucoepidermoid carcinoma was the most common tumour. Patients who have been irradiated and have a palpable abnormality of the thyroid or the salivary glands should be treated surgically. The various noninvasive tests are of little value in distinguishing between a benign and a malignant tumour. Those with hypercalcemia, considered to be due to primary hyperparathyroidism, should be treated by exploration of the neck, identification of the four parathyroid glands and excision of an adenoma with biopsy of the three remaining glands. If more than one gland is abnormal, a subtotal parathyroidectomy is recommended.

Acne Vulgaris↗
PubMed1975

The role of surgery in the management of thyroid cancer.

This is a review of one surgeon's personal experience with 85 patients with thyroid cancer treated over a 20-year period. The data confirm that for papillary thyroid tumours, with rare exceptions, the prognosis is excellent. Anaplastic lesions, however, are consistently lethal. Follicular carcinoma and medullary carcinoma fall between these extremes. A simple clinical classification is offered as a guide to operative management and a reliable index of prognosis. Patients with clinically apparent, "manifest cancer" have serious, life-threatening disease; many such patients die of their disease. Patients with "neck lumps not yet diagnosed" usually have papillary carcinoma; their prognosis is excellent. Patients whose thyroid tumours fall into the category of "malignant nodule" or "pathologist's cancer" are particularly fortunate: in this series no such patient has died. The importance of age in relation to thyroid cancer is also confirmed: non of the patients first treated before the age of 40 years has died of cancer. For young patients with favourable disease the author recommends conservative surgical treatment, which avoids cosmetic deformity or functional disability, to be followed by administration of levothyroxine to suppress production of thyroid=stimulating hormone. For patients with "unfavourable" thyroid cancer valuable palliation can often be achieved by a combination of surgery and irradiation. Survival rates for the total series are 76% at 5 years and 60% at 10 years.

Adenocarcinoma↗