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Biomedical subjects

D A Macleod

Publications and source records attributed to D A Macleod.

At least 37 records · Page 2Linked to original sources
PubMed1993

Open biliary surgery and the use of routine inpatient audit.

'Morbidity profiles' offer a practicable and effective method of assessing overall surgical performance. In this study they have been used to document the results of elective and emergency open biliary surgery carried out on 246 consecutive patients over a 2-year period. The results demonstrate that such surgery for the treatment of cholelithiasis and its complications is extremely safe. There was one postoperative death (0.4%) and an in-hospital major morbidity rate of 4.6%. Minor morbidity was common, especially in the elderly and following emergency surgery. The data presented here will be of particular interest to the increasing number of surgeons advocating laparoscopic biliary surgery.

Adult↗
PubMed1991

Rectal examination in patients with pain in the right lower quadrant of the abdomen.

OBJECTIVE: To determine whether rectal examination provides any diagnostic information in patients admitted to hospital with pain in the right lower quadrant of the abdomen. DESIGN: Casualty officer or surgical registrar recorded symptoms and signs on admission on detailed forms. Final diagnosis was noted on discharge from hospital. SETTING: District general hospital. PATIENTS: 1204 Consecutive patients admitted to hospital with pain in the right lower quadrant of the abdomen as their major complaint; 1028 had a rectal examination on admission. MAIN OUTCOME MEASURES: Odds ratio for each symptom and sign related to final diagnosis. Results of multiple logistic regression analysis for acute appendicitis. RESULTS: Right sided rectal tenderness, present in 309 of those examined, was more common in patients with acute appendicitis (odds ratio 1.34, p less than 0.05). This odds ratio was considerably less than that for other clinical signs--namely, tenderness in the right lower quadrant (odds ratio 5.09), rebound tenderness (3.34), guarding (3.07), and muscular rigidity in the abdomen (5.03). In the logistic regression analysis of patients with acute appendicitis, when allowance was made for the presence or absence of rebound tenderness, rectal tenderness on the right lost its significance. Six patients had masses palpable rectally, of which three were palpable on abdominal examination; the other three patients had acute appendicitis. No other unexpected diagnoses were established, and no useful additional diagnostic information was obtained by routine rectal examination. CONCLUSION: If patients presenting with pain in the right lower quadrant of the abdomen are tested for rebound tenderness then rectal examination does not give any further diagnostic information.

Abdominal Pain↗
PubMed1991

Practical surgical audit: a morbidity profile.

A prospective study of 248 patients admitted consecutively under the care of a single surgeon was performed and data on a variety of patient details were collected daily during the period of their hospitalization. Analysis of the data identified four quantifiable indices of morbidity, namely duration of hospitalization, duration of intravenous infusion, analgesic requirement and antibiotic administration, which can be combined arithmetically and used to produce a morbidity profile. The use of such a profile may allow comparisons to be made between different units if applied to specific conditions and permit a more accurate assessment of overall patient morbidity than can be presently done using mortality rates.

Adult↗
PubMed1990

Oro-facial and dental injuries in club rugby union players.

Oro-facial and dental injuries are of particular importance as dental tissues have a low potential for recovery when damaged and such injuries can give rise to functional, aesthetic and psychological disfigurement. Also their repair can be costly, distressing and time consuming. This study sought to clarify the nature and severity of oro-facial injuries amongst rugby players in a first division club in Scotland. A secondary aim of the study was to examine the influence of position and standard of play on injury rates. The results show that oro-facial injuries are common amongst rugby players, and that players in the first fifteen were at the greatest risk. Although injuries may still occur when mouthguards are used, their severity will be reduced by use of such protective devices.

Adolescent↗
PubMed1990

Bacterial colonization of the skin after chemical depilation.

A study of the effects of preoperative skin depilation on skin microflora has been performed. Areas of skin were prepared with a chemical depilatory agent and compared with areas of unprepared skin. Preparation of skin with a chemical depilatory agent causes no increase in skin microflora, in contrast to the effects of shaving as demonstrated by earlier studies.

Bacteria↗
PubMed1989

Skin stapling of wounds in the accident department.

In a randomized prospective study of 100 consecutive patients presenting to the accident and emergency department with superficial lacerations, staples and sutures were compared for skin closure. Acceptability of the methods by staff and patients, and end results were similar. Staples were more expensive than sutures, but were significantly quicker, simpler to use and safer. They are, therefore, particularly suitable for use in a busy accident and emergency department.

Attitude of Health Personnel↗
PubMed1989

Team doctor.

Explore the source record for details and available documents.

Football↗
PubMed1986

Clinical factors in the prediction of further haemorrhage or mortality in acute upper gastrointestinal haemorrhage.

Data collected prospectively from 326 admissions for acute upper gastrointestinal haemorrhage were examined to identify factors predicting further haemorrhage or mortality. Seven predictive factors were identified by univariate analysis for both further haemorrhage and/or mortality, but only age over 60 years, an admission haemoglobin less than 8 g/dl and the presence of endoscopic stigmata of recent haemorrhage were shown by stepwise logistic regression to have independent significance for further haemorrhage. An age over 60 years, the presence of clinical shock on admission and an episode of further haemorrhage following admission emerged as independently significant in the prediction of mortality.

Gastrointestinal Hemorrhage↗
PubMed1982

Anterior lesser curve seromyotomy and posterior truncal vagotomy in the treatment of chronic duodenal ulcer.

The value of anterior lesser curve seromyotomy with posterior truncal vagotomy as a simple and safe method of denervating the parietal cell mass without the need for a drainage procedure was assessed in 143 patients with chronic duodenal ulcer at two different centres. There were no early complications directly attributable to the gastric surgery and the operation took less time than truncal vagotomy and pyloroplasty. Postoperative diarrhoea and dumping were not significant difficulties. Basal acid output was reduced by 84.4% and an early positive insulin response within the first three months occurred in 8.75% of patients tested. Satisfactory Visick grades (I and II) were recorded in 93.8% of patients during the early postoperative period.

Adolescent↗
PubMed1976

Persistent gastrointestinal bleeding due to angiodysplasia of the gut in von Willebrand's disease.

Gastronintestinal vascular dysplasia as a cause of persistently recurring melaena is reported in two patients with von Willebrand's disease. Colonic wall vasculature was affected in one patient, the abnormality being demonstrated both radiologically and at operative hemicolectomy undertaken to control bleeding. Abnormalities in the vasculature of the duodenal and jejunal walls were found in the second patient at operation and necropsy, though not demonstrated by angiography.

Adult↗
PubMed1976

Anterior urethral injuries.

Seventeen patients are reviewed who presented at the Birmingham Accident Hospital over a 20-year period with injuries to the anterior urethra. Fourteen of the injuries resulted from isolated direct blows to the perineum, while 3 were associated with multiple injuries. The clinical features and management of these patients are discussed in conjunction with a review of the relevant literature. A protocol for the management of this type of injury is outlined.

Accidents, Traffic↗