Biomedical subjects

C MacFarlane

Publications and source records attributed to C MacFarlane.

10 recordsLinked to original sources

PubMed2002

Battle injuries of the rectum: options for the field surgeon.

Historically, battle wounds of the rectum have had high mortality and morbidity. This has improved greatly over several decades as a result of battle experience. This article highlights the value of civilian gunshot experience and its possible use in the military setting. The standard principles of rectal examination, followed by proctosigmoidoscopy after initial resuscitation, remain unchanged. Thereafter, the surgical decisions are made at laparotomy. Rectal injuries commonly have other injuries in association which must also be dealt with. In the stable patient rectal repair may be possible. Where repair is hazardous due to extensive injury (rectum or adjacent structures), the well-proven protective colostomy is used. A loop colostomy with or without distal closure is effective and is used to protect most injuries; possible exceptions being injuries dealt with early, in which there is minimal contamination and repair is easy. Presacral drainage can generally be reserved for severely destructive wounds or those in which repair has not been done. Rectal washout remains an option in patients with inspissated faeces. The basic military surgical principles remain valid, their extent and degree of implementation depending on the anatomical location of injury, degree of damage and any delay in presentation to surgery.

Colostomy↗

PubMed2002

Aide memoire for the management of gunshot wounds.

The hospitals in Johannesburg deal with about 4,000 gunshot wounds a year. Although most are from hand guns, a number are from high velocity, military-type weapons. Extensive experience has been built up and many lessons learned. Attention is directed to the actual damage inflicted rather than on theoretical predictions based on presumed velocity of the bullets involved, as this can often be misleading. Some patients are delayed in their presentation to emergency departments, in other cases several gunshot wound patients arrive at the same time, requiring appropriate triage and urgent management.

Decision Making↗

PubMed2001

Primary closure of battle wounds of the colon: is it an option for the military surgeon?

The management of battle wounds of the colon has been safely established for many years, with primary closure of the wounds being discouraged. More recent work, involving large numbers of patients from civilian trauma centres, has challenged this. The appropriateness of these conclusions for the battle situation is discussed, including the nature of injury, the medical logistics and the combat scenario. Parameters are indicated and guide lines given, incorporating battle-proven military surgical principles and modern trauma experience. This includes damage control and possible primary closure of selected wounds. In this way the military surgeon can take an informed decision in providing optimal care for patients with battle wounds of the colon.

Anastomosis, Surgical↗

PubMed2001

Hyperbaric oxygen and surgery.

Hyperbaric oxygen (HBO) therapy, that is the administration of 100% oxygen delivered under pressure, has a beneficial effect in several surgical conditions. Its use has been assessed and audited and its pharmacological effects demonstrated. It is appropriate for use in several surgical conditions as evidence-based therapy. These are: (i) gas gangrene; (ii) crush injuries, compartment syndromes and acute traumatic ischemias; (iii) enhancement of healing in selected problem wounds; (iv) exceptional blood loss anaemia; (v) necrotising soft-tissue infections; (vi) refractory osteomyelitis; (vii) radionecrosis; (viii) compromised skin grafts and flaps; (ix) thermal burns; (x) intracranial abscess. HBO therapy has been used inappropriately in the past; there is also lack of knowledge regarding its application, and scarce hyperbaric facilities. Hyperbaric therapy, when properly supervised by a physician trained in its use, working closely with a surgeon, and ethically used for appropriate indications, can be a useful adjunct to surgical practice.

Combined Modality Therapy↗

PubMed2000

Hyperbaric oxygen in trauma and surgical emergencies.

Hyperbaric oxygen therapy (HBO), that is the administration of 100% oxygen delivered under pressure, has a beneficial effect in several surgical conditions. Its use has been assessed and audited and its pharmacological effects demonstrated. It is appropriate for use in several acute surgical conditions as evidence-based therapy. These are: Gas Gangrene Crush Injuries, Compartment Syndromes & Acute Traumatic Ischaemias Enhancement of Healing in Selected Problem Wounds Exceptional Blood loss Anaemia Necrotising Soft Tissue Infections Compromised Skin Grafts & Flaps Thermal Burns HBO therapy suffers from previous inappropriate use, lack of knowledge, and scarce hyperbaric facilities. Hyperbaric therapy, when properly supervised by a physician trained in its use, working closely with a surgeon, and ethically used for appropriate indications, can be a useful adjunct to surgical practice. Military surgeons may be in a situation in which they can utilize HBO in acute surgical conditions and trauma. They are urged to identify HBO facilities, both fixed and portable, and to establish communication with hyperbaric therapy colleagues.

Combined Modality Therapy↗

PubMed1999

A rapid and simple method for processing wood to crude cellulose for analysis of stable carbon isotopes in tree rings.

For analysis of carbon isotope discrimination in wood, cellulose or holocellulose is often preferred to whole tissue because of the variability in isotopic composition of different wood components and the relative immobility of cellulose. Most currently used methods for the preparation of wood components for stable isotope analysis (e.g., the Jayme-Wise method) produce a residue of holocellulose. The Jayme-Wise method was initially developed to extract holocellulose from small (~1 g) samples of wood, and, despite subsequent modifications, the method requires specialized glassware, considerable time and entails the risk of sample loss. For carbon isotope analysis, we adapted an acid-catalyzed solvolytic method for preparing crude cellulose by treating wood meal with acidified di-glycol methyl ether (diglyme). The one-step process requires no special glassware, is complete within 24 hours and enables over 100 samples to be processed in a day. This method gives similar delta(13)C values to the Jayme-Wise method for wood of Eucalyptus globulus Labill., Pinus radiata D. Don and Pinus pinaster Ait. The relationship between delta(13)C of wood and crude cellulose is as strong as that observed between wood and alpha-cellulose and stronger than that observed between wood and holocellulose in other species. These relationships suggest that variation in delta(13)C of wood may result from hemicellulose and that analysis of stable carbon isotopes in crude cellulose is preferable. If the consistent -0.3 bias in the value of delta(13)C of cellulose resulting from residual lignin is corrected for, then the relationship between delta(13)C of wood and crude cellulose may be used to predict delta(13)C of cellulose from a small sub-sample. The method is well suited to species with low concentrations of extractives, but further testing is needed to assess its general applicability.

Journal Article↗

PubMed1993

Urban bomb blast injuries: patterns of injury and treatment.

A review of many series reporting injuries following blasts, data allows certain conclusions to be made: 1. Most patients sustain minor injuries, which may be treated on an outpatient basis. 2. Injuries predominantly affect the head and neck and the periphery, which suggests that clothing plays a major role in protection from secondary injuries. 3. Injuries to the chest and abdomen are relatively uncommon but have a high mortality, also associated with head injury. 4. Primary blast injuries are uncommonly seen in a hospital setting, because they usually result in immediate death.

Blast Injuries↗

PubMed1990

Gut barrier function and the surgeon.

There is accumulating evidence that multiple organ failure is not always the result of an established septic focus. Increasing attention has centred on the gut as a reservoir of bacteria (and bacterial endotoxins) that can traverse the intestinal mucosal barrier (a process called 'bacterial translocation') and initiate the septic state. Although the link between haemorrhagic shock and sepsis was recognized decades ago, the full experimental demonstration of this phenomenon is more recent. It was shown to occur in three main settings: physical disruption of the gut mucosa, impaired defence mechanisms and altered gut microbial ecology. Conditions such as haemorrhagic shock, burns, protein malnutrition and sepsis are seen in the severely ill surgical patient or the multiply injured, and are known to cause various combinations of circumstances favourable to bacterial translocation and endotoxin absorption. These may play an important role in the mortality of the critically ill.

Animals↗

PubMed1989

Emergency room arteriography: a useful technique in the assessment of peripheral vascular injuries.

Emergency room arteriography is a useful aid in the assessment of limbs for possible vascular injury. It can be performed quickly by junior staff in the emergency room, using simple equipment, thereby avoiding the delays commonly associated with formal radiology suite arteriography. It can also be performed in units which lack formal arteriographic facilities, and resuscitation procedures need not be interrupted while this procedure is being performed. The resulting pictures are adequate for immediate diagnosis of vascular lesions and are of great value to the trauma surgeon. This pilot study of 50 cases confirms that emergency room arteriography is a safe and effective means of diagnosis in the resuscitation area and that the films are as useful as formal angiography for immediate diagnosis of vascular lesions of a traumatic nature.

Angiography↗

PubMedDate not supplied

Management of gunshot wounds: the Johannesburg experience.

The Johannesburg hospitals see large numbers of gunshot wounds and there is, therefore, considerable experience in their management. Historically, management has been dictated by experimental theories of wounding mechanisms. More modern work has indicated that some of these theories have been somewhat misleading, and some traditional means of management have changed. The basic military surgical lessons of the excision of dead tissue, delayed primary suture remain valid, it is the understanding of tissue damage and the more logical response which has changed. It is the wound as encountered which is managed, irrespective or the theoretical velocity of the bullet. The Johannesburg practice is outlined with regard to regions of the body, with discussion of, among others, the conservative management of gunshot wounds of the abdomen, primary repair of the colon, non operative management of certain limb wounds. The practice is summarised, based on considerable experience and the logistic implications of large numbers and may be useful to surgeons less experienced in gunshot wound management.

Abdominal Injuries↗