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Biomedical subjects

J Macfie

Publications and source records attributed to J Macfie.

At least 37 records · Page 2Linked to original sources
PubMed1994

The prevalence of gut translocation in humans.

BACKGROUND/AIMS: Gut translocation of enteric organisms across the intact intestinal mucosa has been postulated as a potential source of sepsis in susceptible patients. However, little is known of its occurrence or significance in humans. The aim of this study was to determine the prevalence of gut translocation of bacteria in humans and attempt to identify any predisposing factors to its occurrence. METHODS: A consecutive series of 267 general surgical patients were examined for evidence of bacterial translocation by bacterial analysis of intestinal serosa and mesenteric lymph nodes taken at the time of surgery. RESULTS: Translocation occurred in 10.3% of patients overall. Both aerobic and anaerobic bacteria translocated. Excluding patients with distal intestinal obstruction and those with inflammatory bowel disease in whom translocation was more common, the prevalence was 5%. Neither jaundice, nutritional status, nor total parenteral nutrition predisposed to translocation. Similarly, mucosal atrophy did not predispose to this phenomenon. The development of postoperative septic complications was twice as common in patients with translocation as in those without, but mortality was unaffected. CONCLUSIONS: Translocation occurs as a spontaneous event in humans, but its clinical significance remains to be defined.

Bacterial Infections↗
PubMed1994

The effects of major abdominal surgery, enteral and parenteral nutrition on pancreatic function and morphology.

The effects of major abdominal surgery and nutritional support upon pancreatic function and morphology were studied in similar groups of patients who underwent major abdominal surgery (n = 18), received parenteral nutritional support (n = 18) or received enteral nutritional support (n = 16). The exocrine function of the pancreas was measured by means of an oral pancreatic function test (using 1 g of N-benzoyl-L-tyrosyl para-aminobenzoic acid) with measurement of serum para-aminobenzoic acid at 3 h and the Pancreatic Excretion Index. Pancreatic morphology was assessed by real time ultrasound and a pancreatic size index was calculated (maximum diameter of head x body). Serial measurements of function and morphology were carried out in each patient at entry into the study and at 7 and 14 days after operation or start of nutritional support. Serum PABA levels were similar in the 3 groups at the start of the study. Although the levels remained unchanged in the enteral and parenteral groups, a significant and progressive decrease was observed in the surgical group (serum PABA = 27.5 nmol/l (24.0-30.6) before operation, 10.5 nmol/l (5.5-13.4) 14 days after operation, P < 0.01). No significant changes in pancreatic size were seen. Parenteral and enteral nutrition preserves pancreatic exocrine function. A dramatic reduction in pancreatic exocrine function is seen after major abdominal surgery.

Journal Article↗
PubMed1993

Does the addition of pre-operative skin preparation with povidone-iodine reduce groin sepsis following arterial surgery?

Sixty-four consecutive patients undergoing elective vascular surgery involving exposure of the femoral artery at the groin were randomized to one of two groups. Group A (N = 34) received twice-daily skin preparation with 10% aqueous povidone-iodine for 48 h preoperatively, while group B (N = 30) did not. Both groups were examined on a daily basis following surgery and any discharge from the wound was recorded and sent for bacteriological culture. The groups were well matched for age, sex and the type of vascular graft material used. In group A there were six (18.7%) groin wound infections and in group B there were five (17.2%). In this series of patients the addition of preoperative skin preparation with 10% povidone-iodine to standard peri-operative prophylaxis had no effect on the incidence of postoperative groin wound sepsis.

Adult↗
PubMed1991

A prospective and randomised study comparing the incidence of infusion phlebitis during continuous and cyclic peripheral parenteral nutrition.

Phlebitis is a major obstacle to successful and prolonged peripheral parenteral nutrition (PPN). This study evaluated the effects of elective changes of the intravenous cannula and cyclic infusion of PPN on the incidence and the severity of phlebitis. 51 consecutive patients requiring PPN were randomised into three groups. Group 1 received PPN continuously through a line which was changed only on evidence of phlebitis. In Group 2 intravenous lines were changed every 24h. Group 3 patients received PPN as a 12-h infusion after which the intravenous cannula was withdrawn. All patients received 1800 non-protein calories and 9.4g nitrogen daily. Infusion sites were assessed daily for phlebitis and this was scored using a modified Maddox scale. The mean (range) duration of PPN was 7.5 (1-13), 10.0 (2-42) and 8.2 (3-14) days in the three groups respectively. Severe phlebitis occurred more frequently (p < 0.05) in Group 1 compared to Group 2 or Group 3. The overall incidence of phlebitis assessed from the mean value of the Maddox scores for each group was highest in Group 1 and was significantly greater than that observed in either Group 2 (p < 0.05) or Group 3 (p < 0.001). Group 3 patients who received cyclic PPN had the lowest incidence of phlebitis. The results of this study suggest that the incidence of infusion phlebitis is minimised during PPN by the cyclic infusion of nutrient solutions.

Journal Article↗
PubMed1986

Post-mastectomy breast reconstruction using the inflatable tissue expander.

Breast reconstruction following mastectomy has previously relied on the insertion of a silicone gel implant or the use of a myocutaneous flap. We report the use of an innovation, the inflatable tissue expander, for both immediate and delayed breast reconstruction in 26 patients where soft tissue cover was inadequate to permit the use of the silicone implant. By serial inflation of the tissue expander with saline, sufficient tissue cover was achieved for a second operative placement of a silicone prosthesis of appropriate volume to match the normal breast. To date, 10 patients undergoing delayed reconstruction and 5 of 16 patients with immediate reconstruction have had their final prosthesis inserted, while 3 women are satisfied with the result of the expandable implant and desire no further surgery. Only two technical complications have arisen with loss of the expander in one patient who had had recent radiotherapy and in another the tissue expander was placed much too high on the chest wall. Mechanical failure occurred in three cases where disruption of the seam led to sudden deflation in two and a slow leak from the injection port developed in one. One patient also attempted self-inflation leading to deflation of the tissue expander. The cosmetic results were subjectively and objectively very good with capsular distortion present in only one case. We feel that the inflatable tissue expander is simple and safe to use, may be used for immediate reconstruction without compromising the ablative surgery and should be a choice available to general surgeons for providing safe and cosmetically acceptable reconstructive surgery.

Adult↗
PubMed1985

Immediate colectomy and primary anastomosis for acute obstruction due to carcinoma of the left colon and rectum.

A consecutive series of 35 patients with acute obstruction due to carcinoma of the left colon (29) or rectum (six) were treated by primary resection with anastomosis. The operation usually took the form of a left hemicolectomy or sigmoid resection without a proximal colostomy. There were three operative deaths (8.5 percent) due to anastomotic dehiscence, bronchopneumonia, and pulmonary embolism, respectively. Nonlethal complications occurred in ten patients (anastomotic leakage in three, a ureteric fistula in one, and wound infection in six). The mean duration of hospital stay in patients without complications was 18 days (range, 12 to 35). The morbidity and mortality in this series did not exceed the cumulative morbidity and mortality that would be expected after staged surgery. Compared with staged surgery, immediate resection and anastomosis, by avoiding the problems of colostomy and reducing the length of hospital stay, have significant advantages for the patient.

Aged↗
PubMed1984

Energy requirements of surgical patients during intravenous nutrition.

The energy requirements of surgical patients during intravenous nutrition have been estimated from separate measurements of resting metabolic expenditure, active metabolic expenditure and the increase in energy expenditure that occurs in response to feeding--the specific dynamic action. The results suggest that very few surgical patients will require more than 2000 kcals/day.

Adipose Tissue↗
PubMed1981

Activities of hexokinase, phosphofructokinase, fructose bisphosphatase and 2-oxoglutarate dehydrogenase in muscle of normal subjects and very ill surgical patients.

1. The activities of hexokinase, phosphofructokinase, fructose bisphosphatase and 2-oxoglutarate dehydrogenase have been measured in the vastus lateralis and rectus abdominus muscle of normal human subjects and in very ill surgical patients. 2. The activities of these enzymes in the muscle of control subjects were similar to the pattern seen in the skeletal muscle of other mammals and lower vertebrates. 3. Fructose bisphosphatase and phosphofructokinase activities were significantly lower in the muscle of ill patients although the depression of the activity of fructose bisphosphatase was much greater than that of phosphofructokinase in both muscle types of ill patients. 4. The maximum rate of cycling in the fructose 6-phosphate--fructose, 1,6-diphosphate cycle may be altered in the ill. 5. This decreased cycling may have a direct influence on the sensitivity of glycolysis to regulators such as the adenine nucleotides and may reduce the ability to maintain body temperature. 6. Increased glycogen synthesis in these muscles may indicate that the role of fructose bisphosphatase is unlikely to be solely in glycogen resynthesis.

Fructose-Bisphosphatase↗
PubMed1981

The effect of an anabolic steroid on body composition in patients receiving intravenous nutrition.

In this controlled trial we investigated the effect of an anabolic steroid, in terms of the changes in body composition that occurred in ill surgical patients requiring intravenous nutrition. Glucose was the sole non-protein energy source. The study was conducted over a 14-day study period in two comparable groups of 13 patients. The changes in body weight, fat, protein and water were measured. The control group received a nutrient solution of hypertonic dextrose and amino acids (44.8 +/- 8.2 kcal/kg/day), and the comparative group received the same solution (44.3 +/- 5.2 kcal/kg/day) and 100 mg of an intramuscular injection of nandrolone decanoate at the commencement of the study and again one week later. Over the two-week study period both groups gained body weight. In the controls this was composed of fat (0.4 kg) and water 1.5 kg). In the anabolic steroid group, weight gain was mainly water, and fat gain did not occur. Neither group gained body protein. Diuretic therapy was required more often (21 patient days compared with 5 patients days; p less than 0.001) in the anabolic steroid group to control excessive water retention. Our study has shown no benefit from an anabolic steroid when given in combination with a 14-day course of intravenous nutrition. Water retention was more of a problem with this therapy.

Aged↗
PubMed1981

Glucose or fat as a nonprotein energy source? A controlled clinical trial in gastroenterological patients requiring intravenous nutrition.

The best nonprotein energy source for routine use in patients receiving intravenous nutrition (IVN) for short periods of time is not known. In particular the relative merits of glucose and fat remain controversial. The present study was undertaken to determine if a quantitative difference in the ability to retain nitrogen could be documented between these two energy sources. In a prospective study of two comparable groups of 16 gastroenterologic patients who received IVN for 2 wk the changes in body weight, fat, water, and protein that occurred were measured. The only difference in the IVN between the groups was the nonprotein energy source. Group I received hypertonic glucose alone (49.2 +/- 7.9 kcal/kg day), and group II received an intravenous fat emulsion (60% of the nonprotein energy) in addition to hypertonic glucose (51.5 +/- 5.0 kcal/kg/day). Significant weight gain occurred in both groups (p < 0.001). In group I this was acounted for by gains of water (p < 0.02) and fat (p < 0.01) but not of protein. Patients receiving glucose together with fat (group II) gained protein (p < 0.02), but the gains of fat and water were not significant. Our study shows that protein repletion was achieved with an intravenous fat emulsion over a 2-wk period and the problems of water retention which occurred in the patients fed with glucose alone was not present. The results suggest that the fat in conjunction with glucose may be more effective as an energy source than equicaloric amounts of glucose alone in the type of patients we have studied.

Adult↗
PubMed1980

The management of the open perineal wound using a foam elastomer dressing: a prospective clinical trial.

In an attempt to improve the management of the perineal wound after abdominoperineal excision of the rectum we have assessed the value of foam elastomer, a catalysed silicone polymer dressing. The substance has already been used successfully in the treatment of open, granulating wounds at other sites (1). On the fourteenth postoperative day 50 patients with open perineal wounds were randomized to receive either conventional gauze packing or treatment with a foam elastomer dressing. Patients were received weekly until healing occurred. When no cavity remained, a dry dressing alone was used. Initial wound volume was calculated in all patients by forming a foam dressing the volume of which was measured by displacement of water. Healing times were shorter in patients who received foam elastomer, but not significantly so. However, less analgesia (P less than 0.01) and fewer district nurse visits (P less than 0.001) were required by patients in the foam elastomer group. This study suggests that foam elastomer dressing is a more comfortable alternative to a gauze pack in the management of the perineal wound and substantially reduces the amount of nursing supervision which is required. We recommend its routine use in the management of the open perineal wound particularly in the young and cooperative patient.

Adult↗
PubMed1979

A double-blind trial of a single intravenous dose of metronidazole as prophylaxis against wound infection following appendicectomy.

One hundred patients undergoing appendicectomy through a right iliac fossa incision were randomized to receive normal saline or 500 mg metronidazole as an intravenous infusion during the operation. One patient in the saline group developed an erythematous rash. There were 13 wound infections (as defined by the discharge of pus), 12 (out of 51) in the saline group and 1 (out of 49) in the metronidazole group. Bacteroides spp. were frequently cultured from the lumen of removed appendices and from pus obtained from infected wounds. This work supports the value of metronidazole but suggests that a single-dose regimen is adequate for prophylaxis.

Adolescent↗