Effectiveness of regional trauma systems. Improvements have occurred since study.
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Data Collection↗
Biomedical subjects
R M Kirby
Publications and source records attributed to R M Kirby.
Survey of abdominal ultrasound and diagnostic peritoneal lavage for suspected intra-abdominal injury following blunt trauma.
Over a 3 year period all severely injured blunt trauma patients who were investigated with abdominal ultrasound examinations (AUS) or diagnostic peritoneal lavage (DPL) to exclude intra-abdominal injury were evaluated. The ultrasound examinations were performed by radiologists in 220 severely injured patients (20 of whom also had DPL). The overall sensitivity and specificity of abdominal ultrasound were 82.7% and 99.5%, respectively. The sensitivity increased to 89.1% by repeat scanning. In comparison, 72 DPLs were performed in severely injured patients; the overall sensitivity and specificity of DPL were 82.8% and 97.2%, respectively. DPL resulted in more non-therapeutic laparotomies, 9/25 (36%) compared with 3/23 (13%) with AUS. Abdominal ultrasound is now the first line investigation at this centre for evaluation of possible intra-abdominal injury in injured patients.
Abdominal Injuries↗
10 year experience of splenic injury: an increasing place for conservative management after blunt trauma.
It has been suggested that over 30 per cent of splenic injuries are suitable for conservative management by non-operative treatment and splenorrhaphy; splenic conservation avoids the risk of overwhelming post-splenectomy infection. In this study, injuries of the spleen have been retrospectively analysed for a 10 year period. In the first 5 years the spleen was conserved in only 6/45 (15 per cent) of patients with blunt injury (three non-operative, three splenorrhaphy). In the second 5 years of the study, the spleen was conserved in significantly more patients with blunt trauma, 25 of 61 (41 per cent). This change has been a result of increased non-operative management which has been successful in the majority of cases (20/22). This has been associated with the increased use of abdominal ultrasound. The rate of splenorrhaphy has not changed significantly, five patients compared with three in the previous 5 years. Non-operative management may be increasingly appropriate as less severe splenic injuries are being detected with an increased use of ultrasound. Splenic injury is not a mandatory indication for laparotomy; non-operative management of splenic injuries should be considered in selected patients who are haemodynamically stable and can be closely monitored.
Adolescent↗
Sensorial and microbial effects of gaseous ozone on fresh scad (Trachurus trachurus).
The bactericidal activity of gaseous ozone was investigated using a commercial ozone generator. Five species of fish bacteria, Pseudomonas putida, Shewanella putrefaciens, Brochothrix thermosphacta, Enterobacter sp. and Lactobacillus plantarum, were inoculated on agar surfaces and exposed to different ozonation times in a gas chamber. Results showed ozone in relatively low concentrations (< 0.27 x 10(-3) g l-1) was an effective bactericide of vegetative cells of the five fish bacteria. The age of the cell culture was shown to influence the cell response following exposure. Survival rate was not linearly related to ozonation time, but exhibited biphasic death over an extended period. Similar bactericidal effects were observed on fish skin treated with ozone daily in the laboratory, with decreases of 1.0 log cfu cm-2 for the micro-organisms studied. Whole fish treated daily in the laboratory using a commercial ozone generator showed improved scores for sensory analyses compared with the controls. The results were statistically significant. Fish treated on board ships were also analysed for microbiological and sensory changes. Controls were obtained from a similar vessel without the ozone facility in the hold. Similar trends to those recorded in the laboratory for the microbiological and sensory results on ozonated fish were observed.
Animals↗
Massive arterial bleeding from a single rectal vessel.
We report a case of massive rectal haemorrhage arising from a single ectatic arterial vessel above the haemorrhoidal cushion in normal rectal mucosa. Use of an anal retractor enable identification of the bleeding vessel and avoided a major laparatomy.
Aged↗
Spindle cell stromal tumour of the rectum treated by restorative resection.
Stromal tumours of the rectum and anal canal are rare, representing 0.02-0.03% of malignant neoplasms in the region. Current advice in their management is treatment by abdomino-perineal resection. We report a case of malignant spindle cell stromal tumour in which adequate clearance was obtained whilst preserving the anal sphincter, using a posterior parasacral approach.
Adult↗
Role of the general surgeon in a British trauma centre.
A prospective audit of trauma patients seen or treated by the Department of General Surgery at the North Staffordshire Hospital Trauma Centre has been carried out, examining both the effect of a newly established trauma centre on overall workload and the outcome of patients admitted with severe injury. Trauma comprised approximately 2 per cent of the overall general surgical emergency workload. General surgeons were involved in the assessment of 25 per cent of severely injured patients but overall operated on fewer than 10 per cent of patients in this group. No patient died during the study period as a consequence of missed or inadequately treated intra-abdominal injury. These data suggest that there is insufficient work to justify specialist general surgical trauma surgeons in the UK. When general surgical intervention is required, however, it is usually vital and potentially life-saving.
General Surgery↗
A method and medium for the electrical detection of Listeria spp. from food.
The development of a liquid medium for the detection of Listeria spp. by capacitance monitoring of food samples previously enriched in UVM 1 broth is described. Rapid growth of Listeria monocytogenes was shown to occur in liquid media with selectivity based on antibiotics found in Oxford agar. The final capacitance medium contained higher concentrations of the Oxford selective agents than Oxford agar and did not require the esculin/ferric ammonium citrate reaction to be observed. The medium relied upon the ability of Listeria spp. to induce a greater than 30% change in capacitance within 30 h. When run in parallel with the Listeria spp. test samples of a large food company, the method gave far fewer false-positive results than Fraser broth.
Bacteriological Techniques↗
Early endoscopic sphincterotomy for retained bile duct stones after gallbladder surgery.
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Cholecystectomy↗
Day-case surgery.
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Ambulatory Surgical Procedures↗
Prospective randomized trial of Nissen fundoplication and Angelchik prosthesis in the surgical treatment of medically refractory gastro-oesophageal reflux disease.
Fifty patients with gastro-oesophageal reflux disease refractory to multiple courses of medical therapy were entered into a prospective randomized trial comparing Nissen fundoplication with the Angelchick prosthesis as a primary surgical procedure. The two groups were matched for age, sex, duration of symptoms before surgery, type of medical therapy, pattern of symptom presentation, endoscopic grade of oesophageal inflammation, manometric lower oesophageal pressure and 24-h pH profile. Twenty-five patients were randomized to each of the Nissen fundoplication and Angelchik prosthesis groups. Operation time and hospital stay were similar in both groups. Persistent dysphagia was reported in five of the patients with an Angelchik prosthesis compared with none in the Nissen fundoplication group. Three prostheses were removed because of severe dysphagia while no Nissen fundoplication required revision. No patient with preoperative dysphagia because of stricture reported swallowing difficulties after operation. At clinical assessment at 3, 6, 12 and 24 months after operation, 85-88 per cent of the patients having a Nissen fundoplication were graded Visick 1 or 2 compared with 60-72 per cent of patients in the Angelchik group.
Adult↗
A new breast screening programme--an audit of the first year.
The experience of a new breast screening unit is reported. In the first 12 months there was a 72.1% response rate with 9890 women being screened. After the initial screen 598 (5.8%) were referred to the Assessment clinic. Following repeated mammography and clinical examination 166 patients were referred for a surgical opinion; 105 (1.06% of the total screened) were considered to be possibly malignant; 61 further patients with clinical and mammographically benign disease were kept under review by a single surgeon; 101 patients had excision biopsies; 28 of 32 palpable breast lumps and 36 of 69 non-palpable lesions proved to be malignant.
Biopsy↗
A retractor for cholecystectomy.
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Cholecystectomy↗
Vertical Silastic ring gastroplasty: a 6-year experience.
Vertical Silastic ring gastroplasty was carried out in 71 patients as treatment for morbid obesity. The mean excess weight loss at 6 months (59 patients) and 2 years (43 patients) was 48 per cent and 65 per cent respectively. Subsequently the weight stabilized around this level with 58 per cent of the excess weight lost at 5 years (14 patients) postgastroplasty. Five patients (7 per cent) failed to lose weight. Sixteen patients (23 per cent) required revision for technical complications but continued to lose weight or to maintain a satisfactory weight. Vertical Silastic ring gastroplasty is an effective surgical method of achieving sustained weight loss.
Adolescent↗
Survival of dehydrated cells of Salmonella typhimurium LT2 at high temperatures.
Cells of Salmonella typhimurium LT2 were dehydrated on hydrophobic membranes (Millipore FGLP2500) placed in a controlled atmosphere chamber held at 57% equilibrium relative humidity (ERH) and 37 degrees C. Dehydration for 48 h under the above conditions increased the heat resistance of Salm. typhimurium LT2 when measured as the surviving fraction after a heat challenge of 135 degrees C for 30 min. Results also showed that little or no death occurred during heat challenges of 1 h at temperatures of up to 100 degrees C. The survival of Salm. typhimurium LT2 was measured as the ability to form colonies on solid media tryptone soy broth plus 1.2% agar (TSBA) after 24 h at 37 degrees C. Incorporation of sodium pyruvate, at a concentration of (TSBA) after 24 h at 37 degrees C. Incorporation of sodium pyruvate, at a concentration of 0.2% into the recovery medium, did not enhance the recovery of heated Salm. typhimurium LT2. Dehydrated cells of S. typhimurium LT2 showed a triphasic death curve. Increasing the period of dehydration from 48 h to 34 d, reduced initial numbers due to die off but did not alter the shape of the subsequent survival curve.
Colony Count, Microbial↗
Gastric banding in the treatment of morbid obesity.
Gastric banding was carried out in 30 patients as a treatment for morbid obesity. The mean excess weight lost at 3 months was 32.6 per cent (27 patients) and 69.7 per cent at 2 years (eight patients). Fifteen patients required 22 reoperations for technical complications. Two patients underwent removal of the band and seven patients were converted to a stapled vertical Silastic ring gastroplasty. Although gastric banding appears to be a satisfactory method of achieving weight loss, the complication and reoperation rates are unacceptable in our hands. It is recommended that this operation should no longer be used as a treatment for morbid obesity.
Adult↗
The accuracy of aspiration cytology in the diagnosis of rejection following orthotopic liver transplantation.
The role of aspiration cytology (AC) and the total corrected increment (TCI) in the diagnosis of hepatic rejection was assessed in 30 patients following 36 liver transplants. A total of 174 AC specimens were "blindly" evaluated. Patients underwent protocol AC twice weekly and when biochemical or clinical parameters suggested rejection. Hepatic rejection was only confirmed when clinical and biochemical changes were accompanied by positive histological diagnosis. In all, 103 specimens were matched against histology, the remainder assessed against retrospective clinical and biochemical diagnoses. There were 80 cytological diagnoses of rejection, confirmed in 69 specimens, and 94 diagnoses of no rejection, confirmed in 73 specimens. These figures give a sensitivity of 76.7%, a specificity of 86.9% and a positive predictive value of 86.3%. Overall, 39.7% of specimens taken more than 2 months after grafting proved to be incorrectly diagnosed. However, the accuracy was higher in 145 specimens taken within 8 weeks of transplantation, with a sensitivity of 81.3%, a specificity of 90%, a positive predictive value of 89.7% and an accuracy of 85.5%. Although histology remains the gold standard in the diagnosis of acute rejection after hepatic grafting, AC using a TCI with a positive predictive value of 86.3% may prove to be of value in monitoring liver transplant patients in the first 2 months after grafting.
Adolescent↗
The total corrected increment in the diagnosis of hepatic dysfunction after orthotopic liver transplantation.
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Biopsy, Needle↗