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Biomedical subjects

J M Johnstone

Publications and source records attributed to J M Johnstone.

At least 19 recordsLinked to original sources
PubMed1995

Laparoscopic Nissen fundoplication in children.

Laparoscopic surgery for the definitive treatment of gastroesophageal reflux (GOR) has become an accepted alternative to conventional techniques in adults. Although relatively rare, GOR in children represents an important clinical entity with symptoms including failure to thrive, nocturnal dyspnea, and vomiting. This paper details our experience in eight children who have undergone a laparoscopic Nissen fundoplication for failed medical treatment of severe GOR. Particular attention is paid to technical aspects of the procedure and the differences between adult and pediatric techniques are emphasized. The preliminary results suggest that a laparoscopic Nissen fundoplication is a safe procedure which significantly improves reflux symptoms in children and that these results are comparable to those obtained with conventional surgery.

Child↗
PubMed1994

Atypical mycobacterial lymphadenopathy in children--is it underdiagnosed?

Lymphadenitis due to atypical mycobacteria occurs primarily in the neck region of children, the most common organisms isolated are the Mycobacterium avium intracellulare (MAIS) group and M. malmoense. The nodes are unilateral and may be hot or cold. The infection is benign. There is little or no systemic upset and it is usually the preschool child who is affected. Routine haematological investigations are unhelpful, chest X-ray is clear and the Mantoux test may be positive or negative. Cultures are necessary to prove the diagnosis. The ideal treatment is total excision of the affected nodes and antituberculosis chemotherapy is not indicated.

Child↗
PubMed1992

Pancreatic function following partial pancreatectomy and anastomosis of the pancreatic duct to the stomach or duodenum in dogs.

The effects of pancreatic duct anastomosis to stomach (stomach group) or duodenum (duodenal group) on pancreatic function were examined in dogs following two thirds pancreatectomy. Normal fasting blood glucose concentrations were maintained in both groups despite significant reductions in glucose tolerance in the stomach group, and reductions in fasting insulin and insulin peak response in both groups. Pancreatic exocrine function was significantly decreased in both groups, though plasma p-aminobenzoic acid (PABA) concentrations were generally higher in the duodenal group. A correlation was found between plasma trypsin-like immunoreactivity (TLI) and pancreatic weight. These results indicate that anastomosis of the pancreas to bowel can be undertaken with minimal postoperative complications and that the site of the anastomosis influences pancreatic function. They suggest that preservation of more than one third of the pancreas is required for optimal function. The complementary information provided by the PABA and TLI tests suggests their dual application will be clinically useful for the detection and characterisation of naturally occurring pancreatic diseases.

4-Aminobenzoic Acid↗
PubMed1988

Psychological effects of day case surgery compared with inpatient surgery.

Short term psychological disturbance in 70 children undergoing minor surgery was compared in two randomly allocated groups by means of questionnaires answered by their parents. Significantly less psychological disturbance was reported in children undergoing day case surgery compared with children admitted on the day before and discharged on the day after surgery. Children who had day case surgery were less often reported to require extra attention in the first week after discharge home, and at three months after operation these children were less often said to be still affected by their hospital stay. It is concluded that a reduced psychological upset can now be added to the other arguments in favour of day case surgery in children.

Ambulatory Surgical Procedures↗
PubMed1988

Elective splenectomy in haematological disorders.

We report on 106 elective splenectomies performed for haematological disorders between March 1979 and January 1986. The most common indications were immune thrombocytopenic purpura (30 patients) and Hodgkin's disease (19 patients). However, staging laparotomy is no longer performed routinely for patients with Hodgkin's disease and the reasons for this are discussed. Other indications for splenectomy included splenic pain (13 patients), autoimmune haemolytic anaemia (12 patients), hereditary spherocytosis (11 patients) and hypersplenism (9 patients). The overall morbidity and mortality was 48% and 5% respectively. The most common postoperative complication was thrombocytosis (defined as a platelet count greater than 800 X 10(9)/l) and occurred in 26 patients. This review confirms that splenectomy continues to have an important role in the management of certain haematological disorders.

Adolescent↗
PubMed1987

Orchidopexy: the effect of changing patterns of referral and treatment on outcome.

One-hundred and twenty-eight orchidopexies performed between 1979 and 1981 were reviewed in 1985, and the results compared with the results of operations performed in 1972. The age of referral has been determined for 1972, 1979-1981 and 1985. The number of unsatisfactory results has decreased from 35 per cent in 1972 to 9.4 per cent between 1979 and 1981. Five cases of the 'ascending testicle' were discovered, confirming the importance of this phenomenon. We suggest that the optimum age for orchidopexy is during the second year of life; however, during 1985, only 20 per cent of boys referred for orchidopexy were under 3 years of age. Doctors performing neonatal examinations should consider the possibility of cryptorchidism and ensure that affected neonates are reviewed at 1 year. The potential theoretical advantages of orchidopexy at an early age will only be converted into clinical benefit if the operation is performed by an experienced surgeon who has developed an expertise in this area of surgery.

Cryptorchidism↗
PubMed1985

Luteinising hormone releasing hormone for incomplete descent of the testis.

Forty boys with 54 incompletely descended testes took part in a double blind, controlled trial of intranasal luteinising hormone releasing hormone. In the control (placebo) group of 18 boys there was no significant change in testicular descent and all required orchidopexy; in the 22 treated boys, however, 12 of 29 testes (42%) were found in a lower position. This study supports the idea that a trial of intranasal luteinising hormone releasing hormone (1200 micrograms/day for 28 days) will help clarify the need for orchidopexy in at least 30% of boys with incomplete descent of the testis, particularly those in whom the testes have emerged from the inguinal canal.

Administration, Intranasal↗
PubMed1978

Eosinophilic gastroenteritis.

Eosinophilic gastroenteritis is an uncommon condition affecting one or more segments of the gastrointestinal tract, mainly the stomach and small bowell, the principal changes being a variable degree of both oedema and eosinophilic infiltration. Occurring at any age it is commonest in the third decade, is often associated with abdominal pain and peripheral blood eosinophilia, and responds to steroids: allergy or asthma occurs in some 25% of patients. The oedema and eosinophilia involve the submucosa generally but any layer of the gut may be affected. The aetiology is discussed: no allergic or other cause has been determined and it is probable that further knowledge of the role of the eosinophil may be necessary before the precise nature of the lesion can be understood. An association of eosinophilic gastroenteritis with malabsorptive or protein-losing enteropathies is noted.

Adult↗
PubMed1978

Inflammatory fibroid polyp of the gastrointestinal tract.

Details of 13 new cases of inflammatory fibroid polyp of the gastrointestinal tract and of 76 patients recorded in the literature (total 89) are described and analysed. The lesion is always benign, may occur at any age but is commonest in the sixth and seventh decades, and involves the stomach most frequently. Abdominal pain, often related to obstruction, is the principal symptom. Eosinophilia of the peripheral blood does not occur. The lesions are sessile or polypoidal, originate in the gut submucosa, vary greatly in cellularity, and have a wide range of tissue eosinophilia. Some are very vascular, many of the larger vessels having a notably broad zone of connective tissue about them. The aetiology of the condition is discussed and reasons for distinguishing it from eosinophilic gastroenteritis, with which it is frequently confused, are given. The precise nature and aetiology of the inflammatory fibroid polyp remains undetermined.

Adult↗
PubMed1977

A preliminary assessment of bladder distension in the treatment of enuretic children.

Urodynamic studies were performed in 22 enuretic children. Each child had previously been investigated to exclude gross psychological disturbance and organic disease and had been treated unsuccessfully in the past by conventional means. 16 of the 22 children showed evidence of bladder instability and were subjected to bladder distension. At follow-up, 4 children were in complete remission of symptoms, 6 had improved and 6 showed no change; the girls responded better than the boys. The interpretation of urodynamic studies, the significance of the results of bladder distension and the possible role of detrusor instability in the aetiology of enuresis are discussed.

Adolescent↗
PubMed1976

A quantitative assessment of the structural changes the rat's liver following obstruction of the common bile duct.

A study has been made of sequential changes in the rat's liver from 1 to 40 days after obstruction of the common bile duct. The qualitative changes have been described and illustrated. The volume proportions of hepatocytes, bile duct epithelium and biliary stroma have been quantified by histological analysis using a point counting technique. The proliferation of hepatocytes and bile duct cells have been measured by labelling with tritiated thymidine. The absolute quantity of hepatocytes in each liver has been estimated and expressed as a percentage of body weight. Over 40 days there is a relative fall in the volume proportion of hepatocytes and an increase in bile duct cells and biliary stroma. These changes in volume proportions are related directly to the period of jaundice. Biliary stroma increases in support of new bile duct tissue and there is no excessive fibrosis. Hepatocytes proliferate at a greater rate than normal after obstruction of the common bile duct and the degree of proliferation reaches a maximum of 24 times that of normal 4 days after obstruction. Similarly, the proliferation of bile duct epithelium is increased in obstructive jaundice but in this instance it reaches a maximum of 50 times that of normal 24 h after ligation of the common bile duct. The absolute quantity of hepatocytes in the liver probably falls during the period of jaundice. However, the fall is less than anticipated from the volume proportion of hepatocytes because of the overall increase in liver size.

Animals↗