Search PubMed⌕ Search

Biomedical subjects

A E MacKinnon

Publications and source records attributed to A E MacKinnon.

At least 19 recordsLinked to original sources
PubMed2006

Axial fixation of testes for prevention of recurrent testicular torsion.

Testicular torsion is a surgical emergency that requires prompt exploration in order to maintain testicular viability. All testicular fixation techniques, so far in use, are not entirely reliable in preventing recurrences. Although recurrent testicular torsion after previous fixation is rare, in cases that it occurs, it is associated with atrophy of the testis or gangrene leading to loss of the testes. The most common cause for recurrence is improper or inadequate fixation. We describe a simple and effective method using a four point fixation, which is likely to prevent testicular torsion recurrences.

Adolescent↗
PubMed2005

The undescended testis.

Testicular development is determined by the influence of the SRY gene on the Y chromosome of the fetus. This influences the germ cells to produce testosterone and Mullerian inhibiting substance which control descent of the testis. Maldescent of the testis occurs in 0.8% of boys. Current best advice is to perform orchidopexy before the age of two years, therefore a programme for examination by skilled healthcare workers should be established in the first year of life. Indications for surgery include a possible beneficial effect on fertility, malignant potential particularly if intra-abdominal, torsion or trauma and social considerations. Hormonal treatment in the first three months of life is recommended by some. Laparoscopy is the optimum method for evaluating and managing the intra-abdominal testis.

Cryptorchidism↗
PubMed2004

Home-dilatation of the urethral meatus in boys.

OBJECTIVES: To evaluate the efficacy of dilatation of the stenotic urethral meatus in boys at home. PATIENTS AND METHODS: Eighteen boys aged 3-15 years, or their parents, were taught to dilate the urethral meatus at home. The cause of the stricture was balanitis xerotica obliterans (BXO) in five and consequent upon hypospadias surgery in 12, of whom two were complicated by BXO, and one after circumcision for cultural reasons. One boy was re-referred after an interval of 3 years because of apparent deterioration of the stream of urine. Meatal dilatation was taught in the home by one of the authors (J.M.S.). RESULTS: Nine patients were cured by the first course of dilatation, four relapsed early after initial success but responded to further treatment, and three proceeded to meatoplasty because they had no response. Two relapsed late and one responded to further dilatation but the other required surgery. CONCLUSION: Dilatation of the urethral meatus can be taught successfully to boys or their families at home, thus avoiding repeated hospital attendance and often general anaesthesia.

Adolescent↗
PubMed2003

Laparoscopic excision of a prostatic utricle in a child.

Prostatic utricle cysts result from incomplete regression of Mullerian duct structures and occur most frequently in males with perineal or peno-scrotal hypospadias. Utricular cysts may present with various signs and symptoms including urinary tract infection, pain and post-void incontinence, a palpable abdominal mass or recurrent epididymitis. Treatment is reserved for symptomatic cysts and various techniques have been described including transurethral deroofing, endoscopic incision or surgical excision by suprapubic, posterior and midline transvesical approaches. We present a successful minimally invasive approach for excision of a prostatic utricle cyst in a child. Laparoscopic excision is a safe and viable alternative to open procedures in the surgical treatment of symptomatic utricle cysts in childhood. The presence of a cystoscope within the utricle orifice aids identification and safe dissection of the utricular remnant.

Child, Preschool↗
PubMed2003

Endourethral injection of bulking agents for urinary incontinence in children.

OBJECTIVE: To assess the early and late outcome of endourethral injection with bulking agents in children with urinary incontinence (a neuropathic bladder or exstrophy-epispadias complex), by reviewing our experience over a 5-year period. PATIENTS AND METHODS: The records of 15 children (10 boys) were reviewed retrospectively; 10 had spina bifida and a neurogenic bladder, four had a neurogenic bladder from other causes and one had epispadias. All children had a stable low-pressure detrusor and a compliant bladder with sphincteric weakness on preoperative urodynamic testing. Four children had undergone previous enterocystoplasty with a Mitrofanoff stoma, with concomitant urethral lengthening in two and a Goretex trade mark bladder neck sling in two. Three children voided spontaneously while 12 depended on intermittent catheterization. The agent was injected under general anaesthesia in all patients but one, with an endourethral submucosal injection of the bulking agent into four or more points at the junction of the bladder neck and proximal urethra, aiming to obtain visual occlusion of the urethra. The median (range) number of injections was 2 (1-3); five children had one injection, seven had two and three had three. There were no procedure-related complications and most were day-case procedures. Initially PTFE paste was used as the bulking agent, being replaced by bovine collagen or polydimethylsiloxane in the latter half of the series. RESULTS: At a median (range) follow-up of 28 (11-65) months three children were completely dry after a single injection; there was no change in four and a short-term improvement (median 25 months, range 4 days to 37 months) in eight. After this period all children deteriorated to their original incontinence grade; hence the overall cure rate was three of 15. CONCLUSION: This experience with a long-term follow-up differs from previously reported high success rates for the endourethral injection of bulking agents for urinary incontinence in children. Despite a short-term benefit, in the long-term this technique was unreliable and often ineffective. Patients and their carers should be given a realistic and guarded prognosis.

Bladder Exstrophy↗
PubMed2000

Day-care ultrasound avoids urodynamics.

BACKGROUND: Post-voiding residual urine is a common problem underlying urinary symptoms in many children often associated with infection. Tertiary referral is often made to exclude a neurological aetiology. This review reports the experience of clinician-performed ultrasound examinations in the Day-Care Unit on 50 children during a 9-month period, with various aetiologies of urinary incontinence avoiding urodynamic studies in 34. METHODS: From March 1999 tertiary referral patients with urinary incontinence with or without infection and secondary referrals not responding to 'standard' management regimes, underwent clinician-performed bladder ultrasound scans in the day-care ward. A standard renal tract ultrasound examination had been reported as normal in 19 patients. In general referral had been made to exclude a neuropathic aetiology. In addition 5 patients were studied who were known to have a neurogenic bladder, 3 with an anorectal anomaly, 3 were post cystoplasty and 2 had undergone surgery for ureteric reflux. RESULTS: In 34 patients it was considered that a urodynamic study had been avoided, while in one results from a urodynamic study were refuted. By means of directly visualising the bladder on real time scanning, 12 children and families achieved a significantly better understanding of the relevance of residual urine in relation to symptoms, or were shown to have normal detrusor function (7), excluding a neuropathic aetiology. The three who had undergone cystoplasty were shown to have adequate bladder volumes in spite of persisting wetness. CONCLUSION: Real-time ultrasound examination of the bladder performed by a clinician in a patient-friendly environment (day-care ward) can provide significant information regarding detrusor function, often avoiding urodynamic studies. The test does not replace formal scanning for anomalies but may provide information that is masked by the more rigid environment of a radiology department, sometimes correcting results from standard urodynamic studies.

Adolescent↗
PubMed1999

Periurethral Goretex sling in lower urinary reconstruction.

Urethral incontinence in patients with neuropathic bladders remains a management problem not only to urologists but also to the primary carers of these patients. It impairs quality of life and encourages social withdrawal, but also leads to perineal soreness and inflammation. A number of surgical techniques have been described to increase bladder outlet resistance in order to render patients with neuropathic bladders perineally dry. We report our experience in achieving dryness with a periurethral Goretex sling in 17 patients.

Adolescent↗
PubMed1998

Overnight shunt pressure monitoring in children.

We audited the value of overnight shunt pressure monitoring in 17 children with symptoms of possible shunt dysfunction but no other supportive evidence. The shunt was accessed by a 25G butterfly connected to a disposable arterial pressure monitor positioned on the ipsilateral shoulder whose output was recorded continuously, while noting posture, sleep state and symptoms. Initially traces were analysed only for the portion spent both asleep and supine or prone. Six showed pressure peaks while asleep: of these four underwent shunt revision with remission of their symptoms and two resolved spontaneously, one with a simultaneous resolution of a peritoneal CSF collection, but the other had a recurrence of symptoms after six months. Two more subsequently shown to have blocked shunts had normal traces while asleep but abnormal pressure peaks when awake and upright. Two showed pressure troughs: one responded to insertion of an antisyphon device and one resolved spontaneously. Five had normal traces while asleep and awake: symptoms resolved in three and persisted in two in whom later prolonged extradural monitoring with a fibre-optic transducer was also normal. Studies failed in two. We conclude that prolonged overnight shunt pressure monitoring with this technique is useful in diagnosing shunt dysfunction and that abnormalities detected while awake and upright are as significant as those detected asleep and supine or prone.

Adolescent↗
PubMed1996

Detrusorectomy with Mitrofanoff stoma.

The clinical and social benefits derived from bladder augmentation are well known. Most procedures involve the implantation of gastric or intestinal segments into the bladder. These have problems of the acid-haematuria syndrome, mucous production, urinary infection, stone formation and metabolic disturbances. Lang and colleagues presented their experiences in 1994 with detrusorectomy alone as an alternative procedure. We have performed detrusorectomy with Mitrofanoff stoma on 9 patients, protecting the denuded bladder mucosa with omentum. This represents 50% of the bladder reconstructions managed over an 18-month period. Follow-up urodynamics studies have demonstrated a compliant low-pressure system of good capacity in all but one case. Apart from this failure, all the rest are continent. One boy suffered a ruptured bladder due to rough play and another suffered excruciating bladder pain on drainage. He was managed by the instillation of bupivicaine (4 mg/kg) twice daily. Successful management of cases depends on intensive support of the outreach nursing service.

Adolescent↗
PubMed1996

Antibiotic prophylaxis for infantile pyloromyotomy.

A retrospective study of 50 patients with infantile hypertrophic pyloric stenosis (IHPS) showed wound infection in six patients. In an attempt to assess the value of antibiotic prophylaxis in infantile pyloromyotomy 150 patients with infantile hypertrophic pyloric stenosis were entered in a prospective randomized controlled study. The infants were allocated to receive a dose of Cefuroxime (30 mg/kg) at induction of anaesthesia or no antibiotic. Eight infants developed wound infection, five in the control group and three in the antibiotic prophylaxis group. Although the difference between the two groups was not statistically significant there was an overall reduction of wound infection (6.5%) compared with pre-trial figures (12%). In order to study the bacterial flora in the umbilicus in these infants, culture swabs were taken from the umbilicus on admission, immediately prior to surgery and from the wound prior to skin closure. It was shown that the umbilicus was not the source of infection.

Antibiotic Prophylaxis↗
PubMed1995

Mitrofanoff stoma--an iceberg of problems?

The advent of a self-catheterisable continent abdominal wall urinary stoma has provided an enormous improvement in the quality of life for many patients. Successful results of surgery have been presented from many centres. However, these reports concentrate on the technical aspect of patient care. In this paper we review the work of the outreach nursing sister in supporting thirty patients operated upon during a four-year period, and their families.

Adaptation, Psychological↗