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Biomedical subjects

A E Mackinnon

Publications and source records attributed to A E Mackinnon.

14 recordsLinked to original sources
PubMed2004

Expanded PTFE bladder neck slings for incontinence in children: the long-term outcome.

OBJECTIVE: To assess the long-term outcome of circumferential expanded PTFE (Gore-tex, WL Gore Associates, Scotland) bladder neck slings for achieving urethral continence in children with a neuropathic bladder. PATIENTS AND METHODS: The records were reviewed of 19 children undergoing bladder reconstruction (most with a neuropathic bladder) who had a Gore-tex sling placed circumferentially at the bladder neck, over a 5-year period. Of these, seven had spina bifida; two each spinal dysraphism, surgery for anorectal anomalies and an idiopathic neuropathic bladder; five who developed a neuropathic bladder from other causes, and one born with bladder exstrophy. All children had an uncompliant bladder with a low urethral leak-point pressure on preoperative urodynamics. In all children conventional clean intermittent catheterization and pharmacotherapy had failed. Four had had previous augmentation surgery while 15 had concomitant bladder augmentation and formation of a Mitrofanoff stoma. The main outcome measure was achieving dryness. The original intention of the procedure was also to maintain urethral catheterization. RESULTS: Full details of the follow-up were available in 17 patients. Despite initial good short-term results, at a median follow up of 7 years, in 14 patients the sling had to be removed because of erosion, often with transient urethral leakage before the bladder neck subsequently closed. A bladder calculus was associated with each case of erosion except one. CONCLUSION: Although in the short term this technique had favourable results, it was not a useful technique in the long term.

Child↗
PubMed2003

Hyperammonemia with complex urinary tract anomaly: a case report.

Hyperammonemia has been reported rarely in the pediatric age group in systemically ill patients. All cases resulted from infections with urea splitting organisms, which are more common among patients who have undergone surgical procedures on the urinary tract. The authors report for the first time in the pediatric literature, one patient who presented with hyperammonemic encephalopathy that resulted from urinary tract infection with Staphylococcus epidermidis and Corynebacterium sp.

Bacterial Proteins↗
PubMed2003

Long-term outcome in bladder detrusorectomy augmentation.

BACKGROUND AND OBJECTIVES: Bladder augmentation in children can have significant benefits in terms of continence and social function. In an attempt to overcome the problems associated with using foreign mucosa in the urinary tract, techniques to increase to bladder volume and improve compliance by resecting the detrusor muscle alone have been described. Here we describe our experience using an omental-backed detrusorectomy augmentation and examine possible reasons for a poor outcome observed in some patients in the longer term. METHODS: This was a retrospective review covering an eight-year period with a minimum follow-up of 2 years. Pre- and post-operative urodynamics were performed in every case. RESULTS: 11 patients were included in the study. There were 7 male and 4 female patients with a median age of 10 years (range 4 - 16). The underlying pathology in 6 patients was myelodysplasia and in the remaining cases there was one each of ano-rectal malformation with neuropathic bladder, Guillain-Barré syndrome, a myopathy of unknown cause, transverse myelitis and one case of a non-neuropathic neuropathic bladder. Detrusorectomy provided a modest increase in bladder capacity (median 26 %) and decrease in maximum bladder pressure (median 12 %). Long-term follow-up has revealed treatment failure in 6 patients, resulting in revision augmentation surgery in 3 (with surgery planned in a further 2), and one patient developing end-stage renal failure. Notable complications were bladder stone formation in 4 patients and troublesome lower abdominal pain related to bladder drainage in 2. There appeared to be no correlation between initial diagnosis, age at operation, pre-operative urodynamics, peri- or post-operative factors, and long-term outcome. CONCLUSIONS: In our series, omental-backed detrusorectomy for a neuropathic bladder in children resulted in a poor outcome in 55 % of cases. We were unable to identify factors that would allow this result to be predicted pre-operatively.

Adolescent↗
PubMed1997

Laparoscopy for the impalpable testis.

BACKGROUND: Use of laparoscopy in the management of the impalpable testis remains controversial. Localization of the testis may help plan or obviate the need for groin exploration. This study reviews the need for inguinal exploration with respect to laparoscopic findings, particularly of vas and vessels entering a closed deep inguinal ring. METHOD: Case notes of boys undergoing laparoscopy for undescended testes were reviewed retrospectively. RESULTS: Of 86 impalpable testes, 32 were intra-abdominal and ten were absent with intra-abdominal blind ending vas and vessels. In 17 instances the vas and vessels entered an open internal ring and in 26 a closed internal ring. In one boy neither vas, vessels nor testis were visualized. Of the 26 impalpable testes with a closed internal ring, excision of testicular remnants in 18 revealed no histological testicular parenchyma, one boy had bilateral perineal ectopic testes missed clinically and six were not explored. CONCLUSION: The laparoscopic finding of vas and vessels entering a closed deep inguinal ring should prompt a careful examination for an ectopic testis. If a palpable testis can be ruled out, inguinal exploration is not necessary, as viable testicular parenchyma is rarely found. Laparoscopy would have avoided negative exploration in 42 per cent of impalpable testes in this series.

Adolescent↗
PubMed1984

Teratoid Wilms' tumor.

A child with bilateral Wilms' tumors is reported. The left renal tumor showed nephroblastoma with several tissues of apparent mesenchymal derivation and tubules with diverse epithelial differentiation. The right-sided tumor showed the more familiar triphasic pattern of nephroblastoma. Initial percutaneous renal biopsy of the left tumor did not reveal nephroblastoma but showed tubules with various epithelia and mesenchymal elements, and led to a diagnosis of teratoma. The pathogenesis of this complex neoplasm is discussed, and argument is presented that primitive renal blastema may be capable of more diverse differentiation than has previously been realized. A comparison is drawn between this neoplasm and some cases of hepatoblastoma. Certain cases reported as renal teratoma may be similar in nature.

Adipose Tissue↗
PubMed1979

The scrotal pouch operation for undescended testis.

Patients who had undergone a total of 167 orchidopexies by the scrotal pouch technique were followed up for 1-3 years. The technique is described in detail. At follow-up 6 testes were found to have retracted out of the scrotum and these were successfully dealt with at a second operation. One testis was hypoplastic in the scrotal pouch and another infarcted in the groin after the first stage of a planned two-stage procedure. The remaining 159 tests were entirely satisfactory, giving an overall success rate of 95.2%. This technique compares favourably with other methods of orchidopexy, both in achieving a satisfactory anatomical position and in avoiding damage to the testis.

Child↗
PubMed1978

Archenteronoma (yolk sac tumors).

Ten cases of archenteronoma are reviewed with a follow-up between 2 mo and 7 yr. Their presentation was similar to that of rhabdomyosarcoma except for testicular tumors that may present as a hydrocele. A good prognosis was found with tumors amenable to primary resection and chemotherapy. Other tumors are best treated initially with chemotherapy before relatively conservative surgery, radiotherapy being used either pre- or postoperatively.

Abdominal Neoplasms↗
PubMed1977

Treatment of pneumatosis cystoides coli by oxygen inhalation.

Endotracheal intubation and intermittent positive pressure ventilation were used to overcome the difficulties of oxygen therapy for pneumatosis cystoides coli in a 9-year-old child with Down's syndrome and a congenital heart defect. As compared to previously reported cases, a shorter duration of treatment and a lower arterial oxygen tension proved successful.

Child↗