Biomedical subjects
J C McGregor
Publications and source records attributed to J C McGregor.
The dynamic activity work profile (DAWP): a simple way to illustrate waiting-list numbers, work load and clinic priorities for the disbelievers or the uninformed.
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Further comment on Trilucent breast implants.
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Waiting times--what are they and can these be prioritised? A personal opinion.
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Incomplete excision of rodent ulcers--management decisions.
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A three year review of injuries to professional footballers (1995-98) and comparison with previous observations (1990-93).
A prospective study over a three year period (1995-8) of footballers' injuries in first team players was undertaken in a similar fashion to a previous study (1990-3). During the present study the Club had a major cup success and appeared to have a younger squad with less major injury and subsequent time out of action. As a result of the earlier paper it would appear that some lessons and observations may have been put into action and helped produce a more consistent standard for the club. Increasing recognition of the need to reduce and monitor the levels and types of injuries seems now to be established.
Can assessment of a surgeon's performance ever be made in a meaningful and fair way? A plastic surgeon's personal view.
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Skin cancer referrals--could prioritization be a reasonable approach in the new millennium?
With the increasing and ageing population and concomitant increased referral of skin lesions and skin cancer in particular, problems with regard to waiting times to be seen as well as waiting lists currently face us. While several other specialties including radiotherapists, dermatologists, general surgeons, general practitioners may perform surgical and other treatments, there may be some confusion as well as some inefficiencies in the services provided. With a better understanding of the different grades and types of skin cancer, it should be possible to provide a more efficient and fairer service even without a major increase in resources. The question is whether or not the general practitioners and their patients are ready for prioritization?
Trilucent breast implants--a personal review of the current controversies (May 1999).
Trilucent ("Soya Bean") breast implants were marketed as a safe alternative to silicon implants. Following their use in the UK for the past four years, a reassessment of this has currently been announced (March 1999) and further implantation has been suspended by the Trilucent company in conjunction with the MDA (Medical Devices Agency). This has been the result of some reports of adverse reactions to the triglyceride filling material when the implant ruptures. All patients with trilucent implants were advised to return to their respective surgeons for review and advice. A personal review has been undertaken by the author of this paper. The results obtained are discussed. The majority of patients were concerned, but were happy with cosmetic results, and did not at present wish their implants removed. None appeared as yet to have had serious complications that could be attributed to the implants.
Colonic perforation following prolonged hypovolaemia in a major burns injury.
Perforation of the lower gastrointestinal tract is rare in burns patients. A 41-year-old male, who sustained 40% total body surface area burns and subsequently developed an acute abdomen on day 15 postburn, is presented. Emergency management included a subtotal colectomy and ileostomy formation performed to repair a perforated transverse colon found at laparotomy. The burns were debrided and grafted and the patient required cardiac, renal and respiratory support initially in the ITU setting before making a complete recovery. It is suggested that ischaemia caused the perforated transverse colon due to a prolonged low flow state. This was not detected until invasive cardiovascular catheterisation was performed and revealed a hypovolaemic state, which was corrected by fluids and noradrenaline. Both the previous cardiac history of the patient (Fallot's Tetralogy repair) and the noradrenaline may have exacerbated the low flow state within the mesenteric circulation leading to ultimate perforation. This case highlights the difficulties that may arise in resuscitating a patient who has previously had a cardiac defect repaired. Despite repair, abnormal physiology may persist resulting in misleading observations that produce undetected hypovolaemia with subsequent adverse events, as in this case. In such patients, early invasive cardiovascular monitoring should be considered.
Breast reduction--rationed or rational?
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Trilucent breast implants--a personal review of the current controversies (May 1999)
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Polaroid photographic referral for skin cancer--a potentially useful method of reducing time to surgery.
A prospective trial was conducted on twenty-five patients referred by dermatologists during 1998 using a referral letter and an accompanying polaroid photograph for prospective plastic surgical management of skin cancers. Using the description and the photograph, suitable patients were given dates for operation without requiring a plastic surgery out-patient clinic appointment. This enabled, not only a saving in the cost of an out-patient appointment, but a significant reduction in waiting time to surgery.
Plastic surgery waiting list--the numbers game fact or fiction?
Previous studies have indicated the importance of work load and operating time in helping to manage a waiting list. While analysis of a waiting list based solely on numbers cannot give an accurate assessment it is only this and "the waiting time" to surgery (apparently irrespective of clinical priorities) that seem to matter to the government, the Trust Hospitals, and to the public. This study examines case numbers on a waiting list over a two year period and links this to the preceding six months elective operations. Further insight into a waiting list construction can be obtained because of the clinical need for some degree of prioritisation, particularly because of malignancies, it is obvious why the bare waiting list numbers and composition can give a false impression of the true situation. The secondary effect on waiting time for less urgent cases can thus be more readily explained. Some form of rationing may be the answer.
Bodily disfigurement and its relevance in the care of patients in the NHS.
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Profile of the first four years of the Regional Burn Unit based at St. John's Hospital, West Lothian (1992-1996).
In March 1992, the Regional Adult Burn Unit for the South East of Scotland in Bangour was transferred to the new District General Hospital in West Lothian. With the change in site and with changes in NHS policies and staff, it was expected that some difficulties would occur. An analysis of the initial situation was considered to be educational as well as of practical value. Parameters of mortality and infection were looked at in particular. The number of admissions of patients with burns (and notably those of 15% total body surface area or more) appears to be reducing annually; the mortality of 4.7% is comparable with Bangour, but the 42% mortality of patients with burns of 15% or more of the total body surface area is a cause for concern. Although the most common infectious organism in the Burn Unit remains Staphylococcus aureus, the advent of MRSA is worrying. The new unit has been closed twice because of bacterial infection. It is concluded that it is essential that patients with burns are managed in a separate Burn Unit within the District General Hospital and not amalgamated with other areas such as Intensive Care.
Microcystic adnexal carcinoma: a report of three cases.
Microcystic adnexal carcinoma is an uncommon adnexal neoplasm. It is highly aggressive locally and its importance lies in the fact that it can be easily confused with benign adnexal tumours, particularly desmoplastic trichoepithelioma, trichoadenoma and syringoma. We report three cases of microcystic adnexal carcinoma of the skin, all three being on the face: two on the lips and one on the left eyebrow. Clinically, the neoplasms were slow growing indurated nodules or plaques. Two of the cases displayed benign features on initial biopsy and their malignant potential could not be established at that stage. On subsequent review, the three neoplasms showed all the characteristic features of microcystic adnexal carcinoma as described by Goldstein et al. and the University of Virginia study. All three patients were treated by surgery in the form of wide excision. They behaved in a highly locally malignant manner with excisions being incomplete in two of the lesions, in spite of taking an adequate margin around the clinically assessable margins. The other recurred after three years in spite of a histologically proven complete excision. Two of the tumours showed infiltration into the underlying muscle with perineural spread. Wider excision in the next stage with frozen section control achieved good clearance and after a five year follow-up period all are symptom free. None of these tumours showed any evidence of distant spread.
Polaroid photography as an alternative method of recording clinical material in plastic surgery.
Polaroid photography has been used as a method for assessing and recording certain plastic surgery cases. It has the advantage of being easily and immediately available. Photocopies, in black and white or in colour, can be obtained and can be enlarged. Either the originals or photocopies can be sent to clinicians for rapid appraisal or for their own records. This technique is useful whether silhouette or contrast changes are important, and it allows immediate presentation to the patient for discussion and illustration. Several clinical pre- and post-operative examples demonstrating these facts are given in photographic form. The possible advantages of using Polaroid cameras, which rival the quality and cost of conventional photography, are raised.