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Biomedical subjects

S J Karran

Publications and source records attributed to S J Karran.

At least 19 recordsLinked to original sources
PubMed1997

Antibiotic prophylaxis and open groin hernia repair.

Antibiotic prophylaxis is not routinely given for nonimplant, clean operations, although this view has recently been challenged. We have conducted a randomized multicenter, double-blind prospective trial to compare co-amoxiclav with placebo in 619 patients undergoing open groin hernia repair. Altogether 563 (91%) patients fulfilled the protocol; 283 received co-amoxiclav and 280 placebo. There was no difference between the groups in the number of patients receiving local or general anesthetic, the type of repair performed, the use of a subcutaneous fat suture, the type of skin closure used, the use of wound analgesia, or the use of a wound drain. Patients were given a card to return to the hospital in the event of their wound discharging or their needing to see their general practitioner. All patients were reviewed at approximately 6 weeks after operation. Fifty (8.9%) patients sustained a wound infection, 25 in the co-amoxiclav group and 25 in the placebo group. We conclude that antibiotic prophylaxis is of no benefit to patients undergoing open groin hernia repair.

Adult↗
PubMed1995

Antibiotic monotherapy with meropenem in the surgical management of intra-abdominal infections.

In an open, multicentre, randomised study, the efficacy and safety of meropenem monotherapy as adjuvant antibiotic therapy in the surgical management of intra-abdominal infection was compared with that of the combination of cefotaxime and metronidazole. A total of 160 hospitalised adult patients with intra-abdominal infection requiring surgery were treated intravenously with either meropenem 1 g every 8 h (by bolus injection or infusion; n = 77) or cefotaxime 2 g and metronidazole 500 mg every 8 h (n = 83). Clinical and bacteriological responses to antibiotic therapy were assessed at the end of treatment and at 2-4 weeks' follow-up after treatment. The clinical response rates at the end of treatment and follow-up were 91% and 96%, respectively, for meropenem and 100% and 97%, respectively, for cefotaxime plus metronidazole. The bacteriological response rates were 90% and 93%, respectively, for meropenem and 92% at both time points for cefotaxime plus metronidazole. Both treatments were well tolerated. In this study, meropenem monotherapy was effective and as well tolerated as cefotaxime plus metronidazole. Meropenem monotherapy should, therefore, prove a useful alternative to standard combination therapy for the empirical treatment of intra-abdominal infections.

Abdomen↗
PubMed1993

Imipenem prophylaxis in elective colorectal surgery.

In a randomized controlled study of 411 patients undergoing elective colorectal surgery, the efficacy and safety of two different regimens of imipenem were compared with those of a control regimen of cefuroxime plus metronidazole. Surgical infections occurred in 92 (26.4 per cent) of 349 evaluable patients. There were no major differences between the three treatment groups. It is concluded that imipenem is as effective as cefuroxime plus metronidazole in the prevention of sepsis after elective colorectal procedures.

Aged↗
PubMed1993

Antimicrobial prophylaxis in 'clean' surgery: hernia repair.

Antimicrobial prophylaxis is not traditionally employed for patients undergoing 'clean' surgery. The true rates of septic complications are grossly under reported for this group of patients, with up to 72% of all complications occurring, undetected by the surgical team, after discharge from hospital. The implied costs of these infections, coupled with the costs to both the patient and the community services, suggest that antimicrobial prophylaxis should be seriously considered for many types of 'clean' surgery. This can now be made both more straightforward and cost-effective by employing the oral route of administration.

Anti-Bacterial Agents↗
PubMed1993

Review of the perceptions of general surgical staff within the Wessex region of the status of quality assurance and surgical audit.

The opinion of surgical staff about the present state and effectiveness of surgical audit within a single regional health authority has been obtained by questionnaire. Seventy-five per cent of registrars/senior registrars and 72 per cent of consultants completed and returned the proforma. The majority of registrars (86 per cent) believe that it is vital or very important to collect clinical outcome information that is relevant, accurate and complete. However, more than half (56 per cent) felt that these objectives were not being met. All consultants also agreed with the statement that meaningful surgical audit and quality assurance must be based on confidential critical peer review of relevant, accurate, ongoing and complete information. None, however, believed that this objective was being met completely, while only 41 per cent felt that they were doing even 'fairly well', with the principle reason for failure being lack of time. These results support the view that most surgeons are keen to achieve meaningful audit, but at present this objective is not being satisfactorily met.

Attitude of Health Personnel↗
PubMed1992

Community surveillance of complications after hernia surgery.

OBJECTIVE: To assess the effect of a programme of postoperative community surveillance on the rate of detection of wound complications after operation for inguinal hernia. DESIGN: Prospective audit of wound complications including complications recorded in case notes and those discovered by community surveillance. SETTING: Academic surgical unit of three consultant surgeons. PATIENTS: 510 patients undergoing elective inguinal hernia repair between June 1985 and August 1989. RESULTS: The wound infection rate recorded in the hospital notes was 3% compared with 9% when additional information was obtained from community surveillance. Wound complications were detected in 143 (28%) patients by community surveillance compared with a complication rate of 7% in the case records for the same patients. CONCLUSIONS: Wound complications are common after clean surgery in patients discharged home early. Complication rates are a reflection not only of the standards of surgical practice but also the rigour with which they are sought. Before national comparative audit data are published the method of collection must be standardised. For short stay surgery this should include meaningful community surveillance.

Anti-Bacterial Agents↗
PubMed1992

Timing and method of reversal of Hartmann's procedure.

The outcome of 145 patients undergoing Hartmann's resection between 1973 and 1989 has been reviewed. The mortality rate of the primary procedure was 8 per cent. Eighty patients proceeded to reanastomosis. Multifactorial analysis of these patients was undertaken to determine the risk involved. The interval between the primary and secondary procedures was found to be the most important factor. Six of 12 patients had clinical evidence of a leak when this interval was < 3 months, compared with seven of 28 for 3-6 months, and none of 40 when the second operation was delayed for > 6 months. All deaths (three patients) and clinical septicaemia (four) occurred in the two 'early' groups. All colovaginal fistulae (three patients) and strictures (three) were associated with stapled anastomoses. No association was found between the complication rate following reanastomosis and the initial pathology or grade of surgeon undertaking the secondary operation.

Adult↗
PubMed1992

A randomized prospective study to compare cefotetan with cefuroxime plus metronidazole as prophylaxis in elective colorectal surgery.

This study compares the efficacy of cefotetan with the combination of cefuroxime plus metronidazole as antibiotic prophylaxis in elective colorectal surgery when given over the first 24 h postoperatively. There was no significant difference in wound infection rates between the two groups (14.7% for cefotetan and 13.9% for cefuroxime plus metronidazole), or the rates of other infective complications. Adverse reactions occurred with equal frequency in both treatment groups and no serious side effects occurred. Cefotetan is a safe and effective antibiotic for use as prophylaxis in elective colorectal surgery. Its advantages are that it is a single agent with a spectrum covering both aerobic Gram-negative rods and anaerobic organisms and, because of its long half-life, needs only to be given at 12-hourly intervals.

Cefotetan↗
PubMed1992

Antibiotic prophylaxis in clean surgical cases and the role of community surveillance.

In an ongoing prospective study of clean surgical procedures, patients have been examined by specialist research nurses on a minimum of three occasions during the postoperative period to determine the incidence of wound complications. Whereas a previous retrospective audit suggested a wound infection rate of 2%, this community surveillance programme revealed the true rate as at least fourfold greater (p less than 0.001). Of these complications, more than 70% were detected only by the surveillance programme. Immediate benefit was obtained by a reduction in all complications. Despite these improvements, a core of postoperative sepsis remained, particularly in high-risk cases. Thus, a prospective, controlled, prophylactic antibiotic trial has been undertaken, in an attempt to reduce the infection rate still further. An antibiotic regimen of teicoplanin, 400 mg i.v., given as a single dose, was chosen because of the excellent activity of this agent against staphylococci and streptococci, and also because of the long half-life which renders it suitable for single-dose administration.

Anti-Bacterial Agents↗
PubMed1992

Clinical evaluation of percutaneous insertion and long-term usage of a new cuffed polyurethane catheter for central venous access.

A new, long-term venous access catheter was evaluated in clinical practice and the insertion time, complication rate and prospective follow-up recorded. Fifty novel polyurethane catheters (Cuff-Cath) were inserted in 48 patients, for cytotoxic chemotherapy in 36, long-term total parenteral nutrition in five and miscellaneous indications in seven. All catheters were inserted by a percutaneous technique under local anaesthesia. The mean insertion time was 18 min. There were three insertion complications; failure to cannulate, pneumothorax and malposition. Seven catheters required removal (sepsis in five, subclavian vein thrombosis in two) and one catheter fell out. Total catheter days to date has been 6607 (mean 132, range 18-831 days). Eleven catheters are still in use a mean of 154 days (range 38-490 days) after insertion. Furthermore, a new technique has been described which prevents inadvertent displacement. This new catheter combines the mechanical advantages of polyurethane, together with those of a Dacron cuff. Early results suggest that this catheter may be a useful alternative to silicone catheters of the Hickman/Broviac type for long-term central venous access.

Antineoplastic Agents↗
PubMed1991

A randomized prospective study to compare ceftizoxime with cephradine as single dose prophylaxis in elective cholecystectomy.

This study compares the efficacy of ceftizoxime with that of cephradine as single agent prophylaxis in elective cholecystectomy. The incidence of purulent wound infection was low in both groups (ceftizoxime 1/99; cephradine 2/92). No adverse reactions to the trial antibiotics occurred in either group. Ceftizoxime is a safe, effective, convenient and well-tolerated antibiotic for use as single agent prophylaxis in elective cholecystectomy. However, because it has no demonstrable advantage over cephradine and is three times as expensive, its routine use is not justified.

Ceftizoxime↗
PubMed1991

Mortality in a university surgical unit: what is an avoidable death?

Between January 1978 and December 1987 there were 23,557 surgical admissions to the University Surgical Unit in Southampton. During this period there were 543 deaths, an overall death per admission rate of 2.3%. During the 10-year period the number of admissions per year had risen from 1884 in 1978 (death per admission = 3.6%) to 3467 in 1987 (death per admission rate = 1.7%). At the monthly audit meeting an attempt was made to classify each death as 'avoidable' or 'unavoidable'. During this 10-year period it was considered that there were 89 'avoidable' deaths. This represents an avoidable mortality rate (AMR) of 0.38%. These 'avoidable' deaths were due to a wide variety of causes and this paper discusses the lessons learnt from a review of surgical mortality and outlines how units might compare results.

Adolescent↗
PubMed1990

A comparison of three indices of relative hepatic perfusion derived from dynamic liver scintigraphy.

Data from dynamic radiocolloid liver scintigraphy (DLS) have been analysed to calculate three indices of relative arterial to total hepatic perfusion. Ninety subjects have been studied, comprising 21 normals, 62 patients with metastatic liver disease and 7 patients with cirrhosis. Correlation coefficients above 0.81 were found in all patient groups between an index based on rates of liver uptake (the hepatic perfusion index, HPI) and a method based on quantitative liver uptake (the mesenteric fraction, MF). A further method employing the spleen to model arterial inflow (hepatic arterial ratio, HAR) had less agreement with both HPI and MF, with correlation coefficients below 0.76. Posterior images have previously been used to calculate HAR, and greater errors are expected in HAR from the anterior images acquired in this study. Receiver operating characteristic analysis showed that the diagnostic performance of HPI and MF indices in metastatic disease were not significantly different. For anterior image data analysis both HPI and MF were superior to HAR.

Humans↗
PubMed1990

Regional indices of relative hepatic arterial perfusion from dynamic liver scintigraphy: the variability of indices and the use of parametric imaging.

Regional indices of relative arterial hepatic perfusion have been studied in 21 control subjects following dynamic radiocolloid scintigraphy of the liver (DLS). Three different indices have been calculated: the hepatic perfusion index (HPI); the hepatic arterial ratio (HAR) and the mesenteric fraction (MF). Three regions were defined in the upper, mid and lower right hepatic lobes and the three indices were calculated for each region. There was reasonable agreement between regional values of the same index with inter-regional correlation coefficients above 0.7 and standard errors in straight line fits of less than 0.093. There were significant regional differences for (1-MF) and HPI indices, but not for HAR. The index (1-MF) was calculated for each pixel and presented as a parametric image in 16 control subjects. The parametric images indicated the raised regional arterial indices due to overlying lung, right kidney and aorta. Parametric images may be of value to show the hepatic area free of significant overlying tissue and therefore available for analysis by DLS. However, the results suggest that the observed variability of single pixel indices limit the potential of parametric imaging for the localization of small focal lesions.

Humans↗