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Biomedical subjects

J MacFie

Publications and source records attributed to J MacFie.

At least 55 records · Page 3Linked to original sources
PubMed1996

Comparison of individual surgeon's performance. Risk-adjusted analysis with POSSUM scoring system.

UNLABELLED: Comparison of outcome after colorectal resection among different surgeons is difficult. Crude rates of morbidity and mortality can be misleading because such rates make no allowance for differences in case mix and fitness of patients. AIM: The aim of this study was to compare outcome among five surgeons by means of the simple, well-validated scoring system POSSUM for risk-adjusted analysis. METHODS: A total of 438 patients were studied prospectively. Each patient underwent colorectal resection by one of the five surgeons. Demographic details, operative procedure, and postoperative course were recorded, and physiologic and operative severity scores were determined. Risk of morbidity and mortality was calculated for each patient. RESULTS: Incidence of morbidity varied sharply among the five surgeons, from 13.6 to 30.6 percent, and the 30-day mortality varied from 4.5 to 6.9 percent. However, application of POSSUM to allow risk-adjusted analysis of the data demonstrated that the incidence of morbidity and mortality predicted by POSSUM based on patients physiologic and operative risks factors was very similar to the observed outcome for each surgeon. CONCLUSION: Direct comparison of individual surgeon's performance based on crude rates of morbidity and mortality can be misleading. Risk-adjusted analysis allows more meaningful comparison.

Aged↗
PubMed1995

Preoperative total parenteral nutrition is not associated with mucosal atrophy or bacterial translocation in humans.

Concerns have recently been expressed at suggestions that postoperative sepsis may be more common in patients who have received preoperative total parenteral nutrition (TPN). The mechanism suggested for this is that TPN causes intestinal mucosal atrophy leading to increased bacterial translocation from the gut as a source of systemic sepsis. This hypothesis was examined in 203 patients who had an elective laparotomy, 28 of whom required at least 10 days of preoperative TPN. Neither mucosal atrophy nor bacterial translocation was more common in parenterally fed patients than in enterally fed controls. In humans theoretical concerns about the adverse effects of TPN on intestinal integrity are unfounded.

Atrophy↗
PubMed1995

Intestinal obstruction promotes gut translocation of bacteria.

PURPOSE: Translocation of enteric organisms has been implicated as a possible source of sepsis in susceptible patients. Animals studies have suggested that intestinal obstruction promotes bacterial translocation from the gut lumen. The aim of this study was to study the prevalence of bacterial translocation in patients with and without intestinal obstruction. METHODS: Serosal scrapings, mesenteric lymph nodes, and peripheral blood cultures were obtained from 254 patients. Scrapings and nodes were homogenized and incubated aerobically and anaerobically. Full-thickness biopsies underwent villous height analysis. The clinical course was followed for at least six weeks. RESULTS: Bacterial translocation to mesenteric nodes occurred more frequently in patients with large bowel obstruction than in patients without obstruction (14 of 36 patients vs. 16 of 218 patients; P < 0.001). Both aerobic and anaerobic bacteria were found to translocate. The more distal the obstruction, the more likely anaerobic bacteria were to be identified. Translocation of bacteria predisposed to postoperative septic complications (P < 0.05). Villous height was not related to bacterial translocation. CONCLUSIONS: Gut translocation of bacteria is more common in patients with intestinal obstruction, and its association with septic complications appears to be of clinical significance.

Adult↗
PubMed1993

Randomized trial of drainage of colorectal anastomosis.

A prospective randomized trial was carried out to determine whether use of a high-pressure closed-suction intraperitoneal drain was associated with a reduction in morbidity rate after colorectal resection and to examine the influence of drainage on postoperative fluid collections. A consecutive series of 148 patients who underwent colonic or colorectal resection were randomized to receive no drain (n = 51) or a high-pressure closed-suction drain for either 3 (n = 47) or 7 (n = 47) days. Three patients were excluded. All patients underwent abdominal ultrasonography on days 3 and 7 and those undergoing left-sided colorectal resection (n = 96) received a water-soluble contrast enema on day 7. The three groups of patients were similar in age, sex, diagnosis and the numbers of sutured and stapled anastomoses. The presence of a drain did not influence the postoperative morbidity or mortality rate. If the anastomosis leaked, neither faeces nor pus emerged from the drain. Ultrasonographic detection of a fluid collection was of no value: such collections bore no relationship to radiological or clinical leaks or the postoperative course. Routine use of a high-pressure suction drain after colorectal resection appears to be unnecessary.

Aged↗
PubMed1993

Quality of life after restorative proctocolectomy with a pelvic ileal reservoir compares favorably with that of patients with medically treated colitis.

There remains some reluctance among physicians to refer patients for restorative proctocolectomy (RP). They argue that their patients would be worse off with a pouch because of the attendant problems of urgency and frequent bowel actions. The aim of this study was to compare quality of life in patients who had undergone RP with that of patients with ulcerative colitis on long-term medical treatment. A detailed questionnaire and the Hospital Anxiety and Depression (HAD) test were completed by 103 patients who had undergone RP and by 95 patients with ulcerative colitis on medical treatment and in remission attending a gastroenterology clinic. Patients with a pouch had a greater frequency of bowel action [five times per 24 hours (range, 4-7) vs. two times per 24 hours (range, 1-3); P < 0.001] but less urgency of defecation [12/103 (11.7 percent) vs. 69/95 (72.6 percent); P < 0.001] than patients with medically treated colitis. Efficiency of evacuation, discrimination between flatus and feces, use of perianal pads, and perianal soreness were similar. Use of antidiarrheal medication was more common in the pouch group [53 of 103 patients (51.5 percent) vs. 3 of 95 patients (3.2 percent); P < 0.05], whereas use of topical steroids was more common in medically treated patients [40 of 95 patients (47.1 percent) vs. 9 of 103 patients (8.7 percent); P < 0.05]. Limitation of social activity and HAD scores were significantly higher in medically treated patients. Quality of life for patients with a pouch appears to be as good as that for patients with medically treated colitis.

Adolescent↗
PubMed1993

Total parenteral nutrition by peripheral vein--substitute or supplement to the central venous route? A prospective trial.

51 consecutive gastroenterological patients who required total parenteral nutrition (TPN) were entered into this study. Two patients were withdrawn because of specific nutritional requirements, leaving 49 patients for randomisation. 23 patients were allocated to receive peripheral parenteral nutrition (PPN) and 26 to receive feeding through a central venous line (CPN). There was no significant difference between the groups with respect to the median duration of feeding (9.4 +/- 3.6 days; 12.0 +/- 7.8 days) but significant morbidity occurred more frequently in the CPN group (11%) compared to the PPN group (0%). TPN by the designated route was not possible in 4 patients in the PPN group and in 3 of the CPN group. Of the 19 patients commenced on PPN, 13 continued without complication until resumption of oral feeding (median 10.7 +/- 3.2 days); 6 of these patients had to be converted to central venous feeding for completion of their nutritional requirements. Of the 23 patients commenced on CPN, 21 completed their nutritional course (median 11.8 +/- 5.3 days), 2 patients in the CPN group required conversion to PPN to complete their nutritional course. This study shows that PPN is a feasible, safe alternative to CPN in many patients. It is not necessary to subject all patients who require TPN to the risks and expense of central venous cannulation.

Journal Article↗
PubMed1992

Nasogastric intubation and elective abdominal surgery.

The use of nasogastric tubes after elective abdominal surgery remains standard practice for many surgeons. Such tubes, however, cause much discomfort and are associated with significant morbidity. This paper reviews the arguments for and against nasogastric intubation, and finds little evidence to support its continued routine use.

Digestive System Surgical Procedures↗
PubMed1990

Diagnosis of abdominal masses with percutaneous biopsy guided by ultrasound.

OBJECTIVE: To assess the accuracy and safety of percutaneous biopsy of abdominal masses guided by ultrasound. DESIGN: Prospective study. SETTING: Combined gastroenterology service, Scarborough Hospital. PATIENTS: 108 Consecutive patients identified as having a discrete mass on diagnostic ultrasound examination of the abdomen. INTERVENTION: A sample of tissue was obtained with an aseptic technique under local anaesthesia: an 18 steel wire gauge needle (Tru-Cut) was mounted in a spring loaded firing device (Biopty gun) that was advanced under simultaneous ultrasound scanning, permitting precise localisation of the target organ. MAIN OUTCOME MEASURE: Results of histological examination of tissue specimens. RESULTS: Biopsy failed in four patients. Adequate histological specimens were obtained in 104 patients with masses in the liver (31), pancreas (37), kidney (10), and adrenal glands (six) and in 20 undiagnosed abdominal and retroperitoneal masses. Follow up was until death or confirmation of the diagnosis. Three complications but no deaths occurred. Malignancy was suspected in 84 patients before biopsy. This was confirmed in 70 patients, in 26 of whom confirmation of dissemination obviated the need for further investigation. In 10 patients biopsy indicated a previously unsuspected primary tumour, and in 12 it showed only a benign lesion. Among 24 patients considered to have benign disease biopsy showed an unsuspected neoplasm in seven. Use of biopsy thus had a major effect on clinical management in 55 patients. Four false negative but no false positive diagnoses resulted from the procedure. CONCLUSION: Percutaneous biopsy of abdominal and retroperitoneal masses under ultrasound guidance is a safe and accurate method of obtaining a histological diagnosis. The results obtained have a considerable effect on clinical management.

Abdominal Neoplasms↗
PubMed1987

Body composition in malignant disease.

It has been suggested that adaptation to starvation may be impaired in patients with malignant disease and that this may contribute to the development of cancer cachexia. We have investigated this by comparing the body composition, as well as the tissue composition of weight loss, of a group of 49 patients with gastrointestinal carcinomas and 91 patients with benign gastrointestinal disease all of whom had sustained a weight loss greater than 10% of their recalled pre-illness weight. Total body protein was calculated from total body nitrogen measured by in vivo neutron activation analysis which also provided absolute values of sodium, chlorine, phosphorus, and calcium. The masses of muscle and nonmuscle protein were estimated using a validated compartmental analysis. Total body fat was derived using anthropometry. Total body water was estimated from the difference between body weight and the sum of body protein, fat, and minerals. The loss of body weight incurred by patients with both benign and malignant disease was primarily muscle mass and body fat. Both groups of patients retained nonmuscle protein. All patients manifested, with increasing weight loss, a progressive loss of muscle protein, fat, and water, which must represent the tissue composition of weight loss. No significant differences between patients with benign or malignant disease were demonstrated for any of the body composition parameters measured. The results of this study do not support the hypothesis that adaptation to starvation in patients with cancer is in anyway different from that which occurs in patients with benign disease.

Adult↗
PubMed1986

Immunorestorative effect of lipid emulsions during total parenteral nutrition.

This prospective in vivo cross-over study investigated the effect of Intralipid on immune responses. Twenty-three patients were randomly allocated to receive one of two alternative total parenteral nutrition (TPN) regimens for the first 7 days and the other regimen for the second 7 days. Only one of the regimens included a fat emulsion to provide 50 per cent of the calorific requirement. Immunological studies were performed on days 0, 7 and 14. These included peripheral blood T cell subsets, antibody dependent cellular cytotoxicity and basal and maximal Interleukin 2 production. All immunological parameters were significantly augmented during total parenteral nutrition using the lipid based regimen. No such change was seen during intravenous feeding with carbohydrate based TPN. It is concluded that, far from being immunosuppressive, the incorporation of a fat emulsion into a TPN regimen has immunostimulatory properties.

Adult↗