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Biomedical subjects

I MacLennan

Publications and source records attributed to I MacLennan.

At least 19 recordsLinked to original sources
PubMed2004

Long-term results of the antegrade continent enema procedure for constipation in adults.

OBJECTIVE: The aim of this study was to evaluate the long-term results of the Antegrade Continent Enema (ACE) procedure for treating severe constipation in adults. METHODS: Over 10 years 37 ACE conduits were created in 32 patients (median age 35 years, 26 women) with constipation caused by slow transit, obstructed defaecation or both. Conduits were created from the appendix (n = 20, 54%), ileum (n = 10, 27%), neoappendix caecostomy (n = 5, 14%) or colon (n = 2, 5%). Clinical records were retrospectively reviewed to determine outcome. RESULTS: After a median follow up of 36 (range 13-140) months, 28 (88%) required at least one further procedure on a primary conduit, including reversal in 19 (59%). Five patients had a second conduit fashioned, two successfully. Conduit type and constipation cause did not significantly influence the rates of ACE reversal or major revision. Ileal conduits were associated with fewer minor revision procedures for stenosis (1 in 7 patients) than appendix conduits (21 in 20 patients). There was one (3%) serious complication. Satisfactory ACE function was ultimately achieved in 47% of patients, at last follow up. After ACE reversal, 9 (28%) patients underwent formation of an end stoma and 3 patients had a colectomy. CONCLUSIONS: Revision procedures are common, but approximately half of patients can expect satisfactory long-term ACE function. ACE conduit reversal does not preclude subsequent alternative surgical strategies to treat this difficult condition.

Adolescent↗
PubMed2002

Preperitoneal approach to parastomal hernia with coexistent large incisional hernia.

OBJECTIVE: To assess the outcome of preperitoneal mesh repair of complex incisional herniae incorporating a stoma and large parastomal hernia. METHODS: From 1994 to 1998, symptomatic patients who had repair of combined incisional hernia and parastomal hernia were reviewed. Body mass index, co-morbidity, length of hospital stay, patient satisfaction and outcomes were recorded. RESULTS: Ten patients (seven females and three males), mean age 62 (range 48-80) years underwent primary repair. All had significant comorbidities (ASA grade 3) and mean body mass index was 31.1 (range 20-49). Median hospital stay was 15 (range 8-150) days. Complications were of varying clinical significance (seroma, superficial infection, major respiratory tract infection and stomal necrosis). There were no recurrences after a mean follow up of 54 (range 22-69) months. CONCLUSION: The combination of a parastomal hernia and generalised wound dehiscence is an uncommon but difficult problem. The application of the principles of low-tension mesh repair can provide a satisfactory outcome and low recurrence rate. This must be tempered by recognition of the potential for significant major postoperative complication.

Journal Article↗
PubMed1999

Postirradiation sarcoma after external beam radiation therapy for localized adenocarcinoma of the prostate: report of three cases.

We report 3 cases of postirradiation sarcoma that arose in the pelvis 8, 15, and 16 years after completion of external beam radiation therapy (RT) for localized adenocarcinoma of the prostate. Although such cases must be regarded as extremely rare, postirradiation sarcoma should be considered as a potential cause of pelvic pain developing after RT.

Adenocarcinoma↗
PubMed1996

Sequential antigen-specific growth of T cells in the T zones and follicles in response to pigeon cytochrome c.

The sites of accumulation and growth of antigen-specific T cells was assessed during the V alpha 11/V beta 3 T cell receptor-restricted response of IEk+ mice to pigeon cytochrome c. In the T zone, the response was early but transient; V alpha 11/V beta 3+ T cell numbers fell to background levels as germinal centers developed. The follicles were a major site of specific T cell growth, but V alpha 11/V beta 3+ T cells were not obvious in foci of extrafollicular B cell growth in the red pulp. As germinal centers waned, V alpha 11/V beta 3+ T cells in the T zones again rose above background levels and some persisted in the follicles. After the initial stage of T cell priming, specific T cell growth seems to occur where specific interaction can occur with B cells that are presenting processed antigen.

Animals↗
PubMed1994

Antegrade enemas for the treatment of severe idiopathic constipation.

The technique of appendicocaecostomy produces a continent catheterizable channel through which colonic washouts are given. This procedure was performed on six women of mean age 33.5 years with severe idiopathic constipation (mean stool frequency less than 1 per week) resistant to medical therapy. All patients had prolonged colonic transit times, three had evidence of obstructed defaecation and all had reduced or absent voluntary anal squeeze pressure. Patients found the appendicocaecostomy and catheterization acceptable, and symptoms of abdominal distension and pain resolved. All patients were able to initiate defaecation and evacuate the colon within 1 h of irrigation, and no patient had appreciable incontinence. Irrigation was necessary every 48-72 h. Adults with intractable constipation and pelvic floor weakness would be at risk of faecal incontinence after ileorectal anastomosis; it is in these patients that appendicocaecostomy has potential for the greatest benefit.

Adult↗
PubMed1990

Vomiting after Roux-en-Y biliary diversion: relationship to surgical technique.

Vomiting is a frequent complaint after revisional gastric surgery using a Roux-en-Y biliary diversion. This is believed to be due to gastric stasis or stasis in the jejunal component of the Roux-en-Y. Thirty-three patients, ten with a satisfactory outcome following Roux-en-Y diversion and 23 with an unsatisfactory outcome, were studied using a semisolid, radiolabelled meal and compared with 12 normal subjects. Outcome was assessed by modified Visick grading. Seven patients with an unsatisfactory outcome because of frequent vomiting had gastric stasis and two had delay in emptying of the jejunal component of the Roux-en-Y. Vomiting was more likely in patients with a dependent sump (P less than 0.006) and emptying was significantly prolonged where a sump was present (P = 0.0009). Surgical technique contributed to the dependent sump.

Adult↗
PubMed1990

Outcome of revisional gastric surgery using a Roux-en-Y biliary diversion.

One hundred and seven patients with postoperative reflux gastritis treated by Roux-en-Y biliary diversion were reviewed. Three patients died in the postoperative period, and 16 others have since died; cardiorespiratory disease was the most frequent cause of death. Seventy-nine patients were interviewed at a median of 5.5 years (range 0.5-26 years) following Roux-en-Y diversion. At review, a satisfactory result by modified Visick grading was present in 47 per cent of patients. Bilious vomiting (P less than 0.001), food vomiting (P less than 0.01), the severity of upper abdominal pain (P less than 0.001) and heartburn (P less than 0.025) were significantly improved by Roux-en-Y diversion. Weight, haemoglobin levels and employment status were not significantly altered by the procedure. Outcome was related to the surgery preceding Roux-en-Y diversion with significantly better results after partial gastrectomy compared with truncal vagotomy and drainage (P less than 0.01), cholecystectomy (P less than 0.05), or combinations of these procedures (P less than 0.01). Outcome was not predicted by sex, preoperative symptoms, smoking status, consultant surgeon, length of Roux-en-Y or 99Tc-Sn-2,6-di-ethylacetanilidoiminodiacetate (HIDA) scanning results.

Adult↗
PubMed1989

Sequential hemibody radiotherapy in poor prognosis localized adenocarcinoma of the prostate gland: a preliminary study of the RTOG.

Ten patients with poor prognosis localized adenocarcinoma of the prostate gland received local regional radiotherapy to the prostate gland followed by sequential radiation therapy to the lower hemibody and the upper hemibody. The treatment technique is presented and its feasibility demonstrated. Five patients are alive, free of disease, with a minimum of 20 months follow-up. The most common adverse effect was prolonged reversible bone marrow suppression.

Adenocarcinoma↗
PubMed1984

External radiation in the management of superior sulcus tumor.

Thirty-one patients with superior sulcus tumor (Pancoast's syndrome) treated with radiation between 1967 and 1980 were reviewed. Doses ranged from 2000 to 7000 cGy delivered with a continuous schedule (23 patients) and a split course regimen (8 patients). The overall survival at 5 years was 18% (median, 17 months). Patients without bone erosion or scalene lymph node involvement (13 patients) had the best 5-year survival rate of 40%. Local control tended to correlate with the total dose and tumor extent; doses below 5000 cGy or bone invasion were associated with a higher rate of local failure. Primary external radiation is not only useful for palliation but can also cure some patients with superior sulcus tumor.

Adenocarcinoma↗
PubMed1984

Usefulness of postoperative hip irradiation in the prevention of heterotopic bone formation in a high risk group of patients.

Heterotopic ossification is a complication of total hip arthroplasty in 14 to 30% of patients. Significant functional impairment will occur in up to 28% of patients with ectopic bone. The high risk group includes those with preexisting heterotopic bone in either hip, those suffering from hypertrophic osteoarthritis or ankylosing spondylitis and patients who have had multiple procedures on the hip. Fifty-eight patients (67 hips) were irradiated after surgical removal of ectopic bone (53 hips) or received radiation prophylaxis of heterotopic ossification (14 hips). Ninety-five percent of patients had either no bone visible or insignificant amounts of ectopic bone visible on postoperative hip X-rays. Only 5% of patients showed significant persistence of ectopic bone. Postoperative hip function was dramatically improved compared to preoperative function in all patients treated. The importance of early commencement of irradiation is emphasized.

Adult↗
PubMed1983

Entamoeba histolytica in male homosexuals.

The mobility patterns of four enzymes using cultured trophozoites of Entamoeba histolytica were examined by electrophoresis. By this means the stocks of amoebae isolated from male homosexuals were characterised into zymodemes. No amoebic stock isolated corresponded to a pathogenic zymodeme.

Animals↗
PubMed1982

Anterior lesser curve seromyotomy and posterior truncal vagotomy in the treatment of chronic duodenal ulcer.

The value of anterior lesser curve seromyotomy with posterior truncal vagotomy as a simple and safe method of denervating the parietal cell mass without the need for a drainage procedure was assessed in 143 patients with chronic duodenal ulcer at two different centres. There were no early complications directly attributable to the gastric surgery and the operation took less time than truncal vagotomy and pyloroplasty. Postoperative diarrhoea and dumping were not significant difficulties. Basal acid output was reduced by 84.4% and an early positive insulin response within the first three months occurred in 8.75% of patients tested. Satisfactory Visick grades (I and II) were recorded in 93.8% of patients during the early postoperative period.

Adolescent↗