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Biomedical subjects

S J Karran

Publications and source records attributed to S J Karran.

At least 37 records · Page 2Linked to original sources
PubMed1989

An association between parameters of liver blood flow and percentage hepatic replacement with tumour.

The extent of hepatic replacement with tumour is a significant prognostic factor in patients with liver metastases. Measuring the percentage hepatic replacement (PHR) accurately is difficult, but is important for both patient management and clinical trial evaluation. This study correlates haemodynamic indices obtained by dynamic liver scintigraphy (DLS) with estimates of PHR made from isotope scan, ultrasound, CT scan and laparotomy in 45 patients with established colorectal liver metastases and 21 controls who also underwent DLS. There was a significant reduction in the mesenteric fraction (MF) in the group of patients with metastases compared to the controls (P less than 0.001), and also a significant trend for progressive reduction in the MF with increasing PHR. A significant rise in an index of total hepatic arterial blood flow was also demonstrated with increasing PHR. These results are important with current interest in regional hepatic arterial therapy, and may prove of clinical value for prediction or monitoring of response to therapy.

Colorectal Neoplasms↗
PubMed1989

Haemorrhagic effects of sodium heparin and calcium heparin prophylaxis in patients undergoing mastectomy.

In a double-blind prospective clinical trial 75 consecutive patients undergoing mastectomy were randomly allocated to one of three groups. Twenty-five patients received perioperative anti-thromboembolic therapy with sodium heparin and 25 with calcium heparin. The remaining 25 patients were given anti-embolism stockings but no heparin. The total postoperative blood loss and period of drainage did not differ between the two groups given heparin, but a total of 10 of these 50 patients suffered haemorrhagic complications in the form of severe bruising or haematoma postoperatively. Of the patients given no heparin, none suffered haemorrhagic complications and the blood loss following the first 24-hour postoperative period was significantly less than in the groups given heparin.

Adult↗
PubMed1988

The development of hypoprothrombinaemia following antibiotic therapy in malnourished patients with low serum vitamin K1 levels.

A group of nine well-nourished patients, with normal serum vitamin K1 levels (mean 546, range 310-1350 pg/ml), maintained normal prothrombin times (PTs) and factor VII clotting activities throughout a 7 d course of i.v. cefotetan disodium, an N-methyl-thiotetrazole (NMTT) containing cephalosporin antibiotic. However, 11 of 20 patients, with acute intra-abdominal sepsis and initially normal PTs who underwent emergency surgery, developed prolonged PTs (INR 1.4-3.1) associated with reduction in factor VII activities (0.74-0.38 u/ml) after 3-7 d of antibiotic therapy. Nine of these 11 patients had clinical evidence of malnutrition and nine had subnormal serum vitamin K1 levels (mean 119, range 43-354 pg/ml) on admission. Seven received cefotetan but four were treated with a non-NMTT-containing cephalosporin or antibiotics belonging to other groups. The nine patients who maintained normal PTs all had normal nutritional status and normal serum vitamin K1 levels (mean 279, range 103-915 pg/ml) at presentation. The PT is a relatively insensitive indicator of vitamin K stores, and malnourished patients with low serum vitamin K1 levels are at risk of developing hypoprothrombinaemia following intravenous antibiotic therapy.

Adult↗
PubMed1988

The practical management of Fournier's gangrene.

Effective early treatment of this serious condition is necessary to prevent death. Urgent exploration by the most experienced surgeon available should include wide excision of all necrotic or dubious tissue, and adequate drainage of deep fascial planes. Deep and apparently healthy tissues must be exposed and the surgeon must be prepared to proceed to laparotomy, and even diverting colostomy and/or suprapubic cystotomy when necessary. Cross matched blood must be available, and we have found hydrogen peroxide irrigation useful. Pus, tissues, and blood samples for bacteriological culture and sensitivity should always be sent, but broad spectrum antibiotics should be started without delay to prevent systemic complications. In addition to the urgent initial surgery, repeated daily examination of all wounds is necessary, usually under general anaesthesia to allow full inspection, further débridement, irrigation and change of dressings, until the infective process is halted. This is a serious condition with a high mortality which we believe may be reduced by early diagnosis and appropriate aggressive surgery.

Aged↗
PubMed1987

Noninvasive assessment of portosystemic shunting in extrahepatic portal hypertension in rats.

A simple reproducible animal model of extrahepatic portal hypertension (EHPHT) has been developed in weanling Wistar rats using a two-stage ligation of the portal vein. This model consistently produces substantial collaterals, both portosystemic (hepatofugal) and portoportal (hepatopetal). Using dynamic hepatic scintigraphy (DHS) with 99mTechnetium sulphurcolloid, hepatopetal collateral flow was measured as the mesenteric fraction (MF) of total hepatic blood flow and compared with measurement of hepatofugal collateral flow (portosystemic shunting) following intraportal injection of radiolabeled microspheres. Strong and significant correlation between the two assessments was found with reduction in MF denoting increased portosystemic shunting (PSS). The technique of DHS has been used successfully in adults to assess compromised portal venous flow and is a simple noninvasive test to aid diagnosis, assessment, and follow-up of children with EHPHT.

Animals↗
PubMed1987

Liver tumour blood flow and responses to arterial embolization measured by dynamic hepatic scintigraphy.

Liver and tumour blood flow has been studied in 30 patients with multiple liver metastases and in 14 patients with solitary liver tumours by means of dynamic hepatic scintigraphy. Observations were compared with those of a group of 33 control subjects. Haemodynamic changes were also measured in 10 patients who underwent hepatic arterial embolization (HAE). The mesenteric fraction (MF) to tumour regions in 32 subjects showed a wide range compared with control subjects. In 9 patients the MF to the tumour region was within the normal range suggesting that some tumours may possess a portal venous supply. The MF to the uninvolved liver regions was below the normal range in 25% of patients, indicating that HAE could be hazardous in this group. Following HAE the MF rose in all 4 tumour regions and fell in 4 non-embolized uninvolved liver regions. No increase in colloid clearance rate (k) was seen though a significant decrease occurred in 4 patients. These changes may well represent increased portal venous flow into tumours.

Adult↗
PubMed1987

Non-invasive assessment of absolute values of hepatic haemodynamics using radiocolloid scintigraphy.

A non-invasive technique for the assessment of hepatic haemodynamics using radiocolloid imaging with a computer, in which absolute values of hepatic, mesenteric and splenic arterial effective blood flows were assessed, is described. The technique was carried out on ten volunteers, before and after a standard meal. After eating, total effective liver blood flow rose by 28% and the mesenteric arterial effective flow by 69%. Hepatic and splenic arterial effective flow were reduced.

Adult↗
PubMed1987

Cefotetan in the treatment of serious intra-abdominal sepsis: a controlled clinical trial.

Cefotetan has been compared with two regimens of combination antibiotic therapy in the treatment of peritonitis and serious intra-abdominal sepsis. One hundred predominantly elderly patients (median age 66 years) were entered into a prospective randomized surgical trial. Sixty-two per cent had peritonitis. There were seven non-septic deaths. Side-effects were similar in each group and generally of a minor, self limiting nature. Haematological and biochemical factors were closely monitored, and though there were increases in the prothrombin time, there was no statistical difference between cefotetan and comparators. Cefotetan is as effective as combination therapy in the treatment of surgical patients with serious intra-abdominal sepsis.

Abdomen↗
PubMed1986

Sulbactam/ampicillin compared with cefoxitin for chemoprophylaxis in elective colorectal surgery.

In a prospective, randomized, comparative study, patients undergoing elective major colorectal surgery received four six-hour doses of either sulbactam (a beta-lactamase inhibitor) with ampicillin (1 gm with 1 gm), or cefoxitin (2 gm) commencing at induction of anesthesia. The groups were well matched for age, sex, diagnosis, and surgical procedures. Three patients in the sulbactam group (N = 44), and four in the cefoxitin group (N = 48) developed significant wound sepsis. Minor wound sepsis occurred in an additional four sulbactam patients, and in five cefoxitin patients. There was no difference between the groups in deep sepsis or anastomotic leak rates (sulbactam, four patients; cefoxitin, seven patients). No serious side effects were recorded in either group. These results suggest that sulbactam combined with ampicillin provides a safe, effective alternative to cefoxitin for prophylaxis in colorectal surgery.

Aged↗
PubMed1986

Effects of N-methyl-thiotetrazole cephalosporin on haemostasis in patients with reduced serum vitamin K1 concentrations.

Two patients with low random serum vitamin K1 concentrations but with normal prothrombin times and normal biological assays of the vitamin K dependent coagulation proteins were treated with an N-methyl-thiotetrazole cephalosporin (cefotetan) postoperatively. Four to six days later both patients developed a prolonged prothrombin time and a noticeable and specific lowering of the clotting activities of factors II, VII, IX and X, though the serum vitamin K1 concentrations remained unchanged. Crossed immunoelectrophoresis of prothrombin showed the appearance of a second peak corresponding to descarboxyprothrombin (PIVKA II). These abnormalities corrected after vitamin K administration. These data are consistent with the hypothesis that cephalosporins with an N-methyl-thiotetrazole side chain inhibit the hepatic utilisation of vitamin K but that this only causes hypoprothrombinaemia when liver reserves of vitamin K are low.

Aged↗
PubMed1986

Alterations in liver blood flow and reticuloendothelial function in progressive cirrhosis in the rat.

Cirrhosis of the liver was induced in rats by twice weekly inhalation of carbon tetrachloride in conjunction with sodium phenobarbitone administration. At sequential time intervals during induction, liver blood flow and extraction efficiency of colloid were assessed in order to elucidate changes in these parameters which occur with cirrhosis. Liver samples were also taken for histologic examination and graded for extent of disease. Initially there was a fall in extraction efficiency (and thus reticuloendothelial function), associated with early histologic change. Subsequently extraction efficiency recovered, as regeneration was observed on histologic specimens. From 4 wk and onward, blood flow gradually fell, as did extraction efficiency. These changes were associated with increasing severity of disease as demonstrated by histologic sections.

Animals↗
PubMed1986

Postoperative complications: how much do they cost?

Complications following major abdominal surgery incur considerable expense. The aims of this study were to analyse prospectively the costs of complications following major abdominal surgery and to compare such costs with those of elective distal large bowel resection. Six patients undergoing elective resection for large bowel cancer were studied at the Royal South Hants Hospital between January and March 1983. The mean cost of resection and primary anastomosis, without postoperative complications, was pounds 1,364 (n = 4). Indirect costs accounted for 38%, nursing 25%, medical staff 13%, investigations 8% and consumables 16%. The operation itself accounted for 12% of the total. Complications following major abdominal surgery were studied in a further ten patients. The costs of complications not prolonging hospital stay were: wound infection pounds 64-146; chest infection pounds 21-27; urinary infection pounds 3-6. Complications prolonging hospital stay resulted in considerably greater cost: pelvic abscess pounds 1245; myocardial infarction pounds 476; subphrenic abscess pounds 857; colostomy retraction pounds 764; wound dehiscence pounds 599; incisional hernia pounds 1723, and major chest infection pounds 258. Owing to high fixed costs, the main factor in determining cost for bowel resection and complications was length of hospital stay.

Abdomen↗
PubMed1985

Dynamic liver scanning in cirrhosis.

Dynamic liver scanning using 99mTc sulphur colloid has been used in assessing 41 patients with cirrhosis and the data compared with 33 control subjects. The mesenteric fraction (MF) was significantly reduced in cirrhotics (0.30 +/- 0.17) compared with controls (0.58 +/- 0.09), P less than 0.001. The liver: spleen ratio (L:S) was also significantly different (1.6 +/- 0.95 compared with 4.9 +/- 1.4), P less than 0.001. Those patients who had undergone a recent variceal bleed had values less than patients who had not bled. Dynamic scintigraphy may be of value in monitoring the progress of disease and response to treatment.

Adult↗
PubMed1985

Studies of hepatic tolerance of polyvinylpyrrolidone in the rat.

Intraperitoneal polyvinylpyrrolidone in amounts much larger than used in povidone-iodine for peritonitis or for adhesion prophylaxis was administered to rats. No adverse effects on hepatic reticulo-endothelial function could be detected using dynamic hepatic scintigraphy and fewer histochemical changes occurred than expected.

Animals↗