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Biomedical subjects

B J Moran

Publications and source records attributed to B J Moran.

66 records · Page 4Linked to original sources
PubMed1990

Through-knee amputation in high-risk patients with vascular disease: indications, complications and rehabilitation.

During a 10-year period 104 patients (mean age 72 years) had 106 through-knee amputations. Indications for surgery were: limb gangrene, 67 (64 per cent); ischaemic ulceration, 22 (21 per cent); rest pain, 9; knee contractures, 6. Thirty patients had had previous unsuccessful vascular reconstructive surgery and five had had a failed femoral embolectomy. The through-knee disarticulation used lateral skin flaps. The mortality was 21 (20 per cent). Of the 83 survivors, 59 (71 per cent) underwent uncomplicated primary wound healing; 36 (43 per cent) of the survivors were unsuitable for rehabilitation on a prosthesis. The remaining 47 (57 per cent) were walking before discharge 30-130 days (mean 68 days) after amputation. Through-knee amputation is a rapid, relatively bloodless, amputation and is a useful debridement procedure. The many surgical and functional advantages, in conjunction with the recent reports of better rehabilitation compared with the above-knee or Gritti-Stokes amputation, suggests that the through-knee amputation deserves greater consideration.

Aged↗
PubMed1990

Metabolism of 15N-labelled urea in the functioning and defunctioned human colon.

1. The luminal metabolism of urea was studied using double-labelled urea ([15N2]urea) which was placed in the lumen of the colon through a colostomy. The recovery of label was measured as [15N2]urea or [14N, 15N]urea in urine and as 15N in stool. 2. Five patients with a loop colostomy allowed a comparison of the right functioning colon with the left defunctioned colon in the same individual. Five subjects with a left end-colostomy enabled a comparison of the right with the left functioning colon. 3. A significantly greater proportion of labelled urea was recovered as [15N2]urea in the urine when the dose was placed in the left defunctioned colon (29%) compared with either the left or the right functioning colon (9 and 4%, respectively). This is interpreted as being a result of a decrease in the bacterial activity and concomitant urea hydrolysis in the defunctioned colon. 4. On average more than half of the label was retained in the body, regardless of whether the urea was placed in the functioning or the defunctioned colon, on the left or on the right. 5. The data confirm that the colon is permeable to the intact urea molecule. Intraluminal urea is readily hydrolysed in the functioning colon. A large proportion of the nitrogen released by urea hydrolysis may be retained within the metabolic nitrogen pool of the host. There are significant differences in the handling of urea nitrogen in the defunctioned colon relative to the functioning colon.

Aged↗
PubMed1990

15N-urea metabolism in the functioning human colon: luminal hydrolysis and mucosal permeability.

The biopsy channel of the colonoscope was used in a novel approach to the study of in vivo colonic nitrogen metabolism in 12 subjects. A tracer dose of 15N15N-urea was placed in the caecum in six and distal to the splenic flexure in six. The urine and stool were collected for 72 hours and isotopic enrichment was measured in a mass spectrometer. A similar proportion of the dose was recovered in the urine as 15N15N-urea from the right colon, 6%, as was recovered from the left, 4%, showing that the urea was absorbed intact. Urinary 15N14N-urea from the right colon was 18% of the dose compared to 13% from the left colon. This represents urea that has been hydrolysed and absorbed as ammonia. Less than 4% of the dose was recovered in the stool. The greatest proportion of the label, 74% from the right and 82% from the left, could not be accounted for in the urine or the stool and is presumed to have entered the metabolic pool of nitrogen. We conclude that; the colon is permeable to urea, intraluminal hydrolysis occurs and that urea nitrogen enters the metabolic pool of nitrogen in functionally significant quantities.

Adult↗
PubMedDate not supplied

Management and imaging of low rectal carcinoma.

Large variations in recurrence rates have been reported with the best results following total mesorectal excision (TME) surgery for low and middle rectal cancers. However, the low rectal cancers still have higher rates of local recurrence (up to 30%) whether operated by low anterior resection or abdominoperineal excision (APE) due to high rates of circumferential margin involvement. The treatment of choice for low rectal cancers that encroach upon the potential circumferential resection margin is surgery combined with preoperative neoadjuvant treatment. Preoperative chemotherapy combined with long-term radiotherapy reduces recurrence rates and preoperative loco-regional staging can help to select the patients more likely to benefit from neo-adjuvant therapy. Surface coil MRI is the most promising modality for patient selection, which can provide good views of the circumferential resection margin especially the presence or absence of tumour encroaching the intersphincteric plane.

Adenocarcinoma↗
PubMedDate not supplied

A cuffed polyurethane catheter for long-term central venous access: a novel technique prevents early displacement.

A new method which provides immediate fixation of a cuffed central venous catheter is described. The cuffed polyurethane catheter has a detachable hub which allows the creation of a second small tunnel distal to the cuff using the wire and the vein dilator. As the catheter exits from a "pinhole," immediate fixation is assured and is independent of tissue healing.

Catheterization, Central Venous↗