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Biomedical subjects

Z H Krukowski

Publications and source records attributed to Z H Krukowski.

At least 55 records · Page 3Linked to original sources
PubMed1988

Ten-year computerized audit of infection after abdominal surgery.

A prospective audit of the frequency of infective complications after all abdominal operations was carried out between January 1977 and December 1986. A total of 3100 abdominal procedures (2041 elective; 1059 emergency) were performed in 3056 patients. There were 50 (1.6 per cent) in-hospital and 66 (2.1 per cent) late wound infections (overall 3.7 per cent). Fifty-four (1.8 per cent) patients developed postoperative intraperitoneal sepsis. Ninety-eight patients died (overall mortality 3.2 per cent) and intraperitoneal sepsis was a related factor in twelve (0.4 per cent). Wound infection, peritoneal sepsis and mortality were related to the degree of operative contamination and to reoperation. The results support the traditional, although sometimes inadequately stressed, teaching that technique is an important factor in preventing infection. Infection is also reduced by peroperative antibiotic lavage. The limited value and the potential difficulties of the unstructured introduction of computerized audit should be recognized.

Abdomen↗
PubMed1988

Cystic change and neoplasia in isolated thyroid swellings.

During a 6-year prospective study of clinically isolated thyroid swellings (ITS), 148 (37 per cent) of 395 swellings were cystic as defined by the aspiration of fluid during fine needle aspiration cytology (FNAC). In the 106 (72 per cent) patients operated upon, 47 per cent of the cystic swellings were neoplastic and 14 per cent were malignant. In men 29 per cent of cystic swellings were malignant and 11 per cent in women. Only twelve cystic ITS were permanently abolished by aspiration and FNAC was inaccurate in predicting neoplasia. The incidence of malignancy in cystic ITS is higher than generally accepted and most cysts not abolished by aspiration should be removed.

Adenoma↗
PubMed1988

Preventing wound infection after appendicectomy: a review.

An exponential increase in the number of published prospective studies reflects both a continuing interest in, and a lack of consensus on, the optimal prophylaxis of wound sepsis after appendicectomy. Review of the literature over the last 25 years leads us to emphasize both the importance of adequate study size and of stratification of the severity of the sepsis found at operation. For critical comparison of prophylactic regimens the high percentage of wound infections disclosed after discharge from hospital must be taken into account. Antibiotics reduce the frequency of wound sepsis and although low wound sepsis rates have been reported with systemic antibiotics active against only anaerobes, the cumulative evidence favours a spectrum of antibacterial activity against both aerobic and anaerobic organisms. Topical antiseptics have no significant effect but topical antibiotics are beneficial. Wide variations in outcome for similar antibiotic regimens reflect the importance of technical factors in determining the frequency of wound sepsis.

Appendectomy↗
PubMed1987

Effect of topical and systemic antibiotics on bacterial growth kinesis in generalized peritonitis in man.

Quantitative bacteriology in peritoneal exudate was studied in 40 patients with generalized peritonitis of small intestinal, appendicular or colonic origin. Bacterial growth kinesis was measured in 28 of the patients. Systemic antibiotics given before operation resulted in a significant reduction in both the concentration and growth rate of viable bacteria in the peritoneal fluid. Lavage of the peritoneal cavity with saline resulted in a further reduction in growth rate in patients given pre-operative systemic antibiotics by an effect attributable to simple dilution. In contrast, peritoneal lavage with tetracycline (1 mg/ml) resulted in complete inhibition of bacterial growth in the residual peritoneal fluid. These observations support the policy of giving systemic antibiotics to patients with generalized peritonitis as soon as the diagnosis has been made and provide bacteriological evidence for the value of peroperative antibiotic peritoneal lavage.

Anti-Bacterial Agents↗
PubMed1987

Outcome of surgery for Graves' disease re-examined.

The outcome of surgery for Graves' disease in terms of early and late morbidity was studied in 161 patients undergoing subtotal thyroidectomy in the 10-year period 1976-1985. Eighty of these patients had a minimum follow-up of 5 years. There was a low operative morbidity and a zero mortality. The weight of thyroid tissue preserved (in the range 5-10 g) influenced the prevalence of hypothyroidism at one year and at five years. There was a cumulative incidence of hypothyroidism which could not be reliably predicted from biochemical results during the first year. Over 60 per cent of patients with subclinical hypothyroidism at 4 months (63 per cent) or 1 year (70 per cent) did not subsequently need thyroxine replacement within 5 years. Patients remained at risk of developing recurrent toxicity indefinitely and the risk was significantly greater in patients with small goitres (less than 50 g). Our results may be improved by leaving larger remnants (9-10 g) in most patients and smaller remnants (2-4 g) in those with small glands in whom alternative treatment, which is to be preferred, is not acceptable. After subtotal thyroidectomy for Graves' disease lifelong follow-up is necessary.

Adolescent↗
PubMed1987

Polydioxanone or polypropylene for closure of midline abdominal incisions: a prospective comparative clinical trial.

Seven hundred and fifty-seven consecutive patients undergoing a midline abdominal incision were stratified according to age, sex, type of operation and degree of operative contamination and were randomly allocated to mass closure of the abdominal wall with continuous 4 metric polydioxanone (PDX; 374 patients) or continuous 4 metric polypropylene (PPL; 383 patients). Wound infection was less common with PDX (PDX 3.5 per cent; PPL 7.0 per cent; P less than 0.05) and there was one dehiscence in each group. The incidence of defective wounds in patients surviving 1 year was similar (7.7 per cent PDX; 9.7 per cent PPL) but the PPL suture had to be removed because of persisting wound pain or sinus formation in five patients. PDX is the preferred suture material for closure of midline abdominal incisions.

Clinical Trials as Topic↗
PubMed1985

Fine needle aspiration cytology in isolated thyroid swellings: a prospective two year evaluation.

During 1 September 1981 to August 1982 aspiration cytology was carried out in all isolated thyroid swellings referred to the Aberdeen Thyroid Clinic: cytological findings were not disclosed, did not influence management, and were compared retrospectively with the histological diagnosis. In a total of 70 swellings sensitivity for the detection of neoplasia was 86% and overall accuracy 92%; the positive predictive value was 80% and negative predictive value 96%. During the second year (1 September 1982 to 31 August 1983), when cytological findings were used to influence management, the frequency of operation for isolated thyroid swellings decreased by 25% and the proportion of operations for neoplasia increased from 31% to 50%. In terms of bed occupancy the potentially avoidable surgical workload for benign disease was reduced by 34%. Aspiration cytology, carried out at the first clinic attendance, makes a sound basis for selective surgery and leads to economy in the management of isolated thyroid swellings.

Adult↗
PubMed1985

Treatment of acute abscesses by incision, curettage and primary suture without antibiotics: a controlled clinical trial.

One hundred and thirty-seven consecutive acute superficial abscesses were randomly allocated to incision, curettage and primary suture without parenteral antibiotics (64 cases) or to conventional treatment with incision, drainage and dressings (73 cases). Wound healing was faster; 7.0 days: 25.1 days (P less than 0.01, Wilcoxon's rank sum test), the number of hospital visits was smaller; 3.8 visits: 11.1 visits (P less than 0.01) and the time off work was shorter; 4.0 days: 14.1 days (P less than 0.01) in the group treated by primary closure compared with those managed conventionally. In this study no complications attributable to the withholding of antibiotics occurred. Incision and primary closure of abscesses is safe and more economic than conventional drainage. Routine antibiotic cover is not necessary.

Abscess↗
PubMed1985

Immediate resection in emergency large bowel surgery: a 7 year audit.

In a consecutive series of 153 emergency admissions with large bowel disease during a 7 year period, 49 per cent were for colonic obstruction, 46 per cent for peritonitis and 5 per cent for miscellaneous conditions. Urgent operation was performed on 104 (68 per cent) patients. Of those operated upon, 82 (79 per cent) had a primary resection with a mortality rate of 12.2 per cent, intraperitoneal sepsis rate of 2.4 per cent and wound sepsis rate of 7.3 per cent. The median postoperative hospital stay was 21 days. An immediate anastomosis was performed in 46 (56 per cent) patients with a mortality rate of 8.7 per cent, anastomotic leak rate of 2.2 per cent, and wound sepsis rate of 8.7 per cent. The median postoperative hospital stay was 19 days. The mortality in patients presenting with large bowel emergencies is related to age and advanced malignant disease. Immediate resection is applicable in over 80 per cent of patients requiring urgent operation and morbidity can be low and treatment economical. Immediate anastomosis after proximal colonic resection is safe and the use of intra-operative colonic irrigation permits a primary anastomosis in selected patients after emergency resection of the distal colon.

Adult↗
PubMed1985

Intra-operative colonic irrigation in the management of left-sided large bowel emergencies.

In a consecutive series of 93 patients who required emergency surgery for distal colonic lesions, 61 had primary bowel resection with immediate anastomosis after intra-operative antegrade colonic irrigation. The operative mortality was 8 per cent, anastomotic leakage rate 7 per cent and superficial wound infection occurred in 3 per cent of patients. The mean hospital stay was 13 days. Of the remaining 32 patients, 3 did not have a resection and 29 had a primary resection and end colostomy without anastomosis: bowel continuity was later restored in 17 of 28 survivors (61 per cent) but 11 (39 per cent) were left with a permanent colostomy. The hospital mortality in this group was 6 per cent, superficial wound infection rate 14 per cent and the mean hospital stay 26 days. The results of this study suggest that intra-operative colonic irrigation is an effective method enabling the surgeon to perform a primary anastomosis with reasonable safety after emergency resection of selected distal colonic lesions.

Adolescent↗
PubMed1985

Pyloric reconstruction.

Fourteen patients with persistent and severe postcibal symptoms following vagotomy and pyloroplasty for duodenal ulcer had the pylorus reconstructed. A dumping provocation test was useful in patient selection and evaluation of results. When assessed between 6 months and 3 years after operation, nine patients had an excellent or good result and three were improved. Surgical technique is relatively simple and the operation should be considered and practised more often than it seems to be from documented experience.

Adult↗
PubMed1985

Continuing experience with single layer appositional anastomosis in the large bowel.

Results of continuing experience with single layer appositional anastomosis of the large bowel during 8 years (1977-84) were extracted from a prospective computerized audit of all abdominal operations under one consultant. After 204 elective operations mortality rate was 1.5 per cent: there were no deaths from anastomotic leakage. The total incidence of wound infection (including late infections) was 2.0 percent. The median duration of postoperative stay was 9.7 days and the mode 8 days. Three clinical anastomotic leaks (total incidence 1.5 per cent) occurred in 140 patients (2.1 per cent) after elective colorectal anastomoses. A restorative anastomosis was made in 86 per cent of patients with rectal carcinoma 6-12 cm from the anus and in 29 per cent with tumours below 6 cm. The overall incidence of a permanent stoma for rectosigmoid carcinoma was 19 per cent. 'Protective colostomy' and anastomotic drains were not used. The safety and applicability of single layer anastomosis in the rectum are compared with those of stapling.

Adult↗