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Biomedical subjects

R D MacMillan

Publications and source records attributed to R D MacMillan.

7 recordsLinked to original sources
PubMed2003

Intraductal injection of the breast: a potential pitfall of radioisotope occult lesion localization.

The use of radioisotope for the localization of occult breast lesions (ROLL) has been advocated in preference to wire guided excision as it allows reduced excision volume and better lesion centering. However, as this technique is new, potential complications are unknown. In 2 out of 38 ROLL procedures performed at our institution, intraductal injection of isotope has occurred. This was diagnosed on check mammography as non-ionic iodinated contrast was mixed with the isotope. In one of these cases conversion to wire localization was required.

Breast Diseases↗
PubMed2001

Complicated urinary tract infections in patients with voiding dysfunction.

Complicated urinary tract infections (UTIs) occur in patients who have structurally or functionally abnormal urinary tracts -- in contrast to simple cystitis, which usually occurs in young, healthy females who have normal anatomy. Because of their abnormal anatomy, patients with complicated UTIs can be exceedingly difficult to treat. Successful treatment usually requires correction of the underlying anatomical problem, but this may not possible, so relapse of the infection is the general rule. Although most infections are still caused by Escherichia coli, many are caused by more exotic and highly resistant coliforms, such as citrobacter and pseudomonas. As well, gram-positive bacteria such as staphylococcus and enterococcus can be found. In patients with spinal cord injuries, high bladder pressure due to obstruction at the sphincter level can cause obstruction and/or reflux. In these patients, as well as in patients with benign prostatic hypertrophy, and in geriatric women, high residual bacteria levels prevent washout of bacteria. Other possibly significant risk factors include poor fluid intake, poor hygiene, and poor nutrition that results in decreased immunity. Finally, the unavoidable use of catheters actively introduces bacteria into the urinary tracts of these patients. Prevention by modifying as many of these risk factors as possible is essential to reduce attack rates of UTIs. Treatment must be guided by the results of urine cultures. Broad-spectrum coverage including anti-pseudomonal activity is preferable, and the fluoroquinolones, eg. ciprofloxacin or levofloxacin, seem to fit this bill perfectly. If possible, physicians should start by prescribing oral antibiotics for a minimum of 10 days and maybe for a lot longer, as indicated. There is no role for short-course therapy. Other options include oral, second-generation cephalosporins, or intravenous therapy with aminoglycosides and piperacillin. Physicians must be prepared to treat aggressively for prolonged periods. Unfortunately, reinvestigation, reculturing, and retreatment are usually required.

Female↗
PubMed1995

Predicting local recurrence by correlating pre-operative mammographic findings with pathological risk factors in patients with breast cancer.

The pre-operative mammograms for 231 patients undergoing conservation surgery for breast cancer between March 1988 and September 1992 were analysed for features that may predict the presence of pathological risk factors of local recurrence (residual microscopic disease, extensive intraduct carcinoma (EIC) and lymphatic/vascular invasion). Residual microscopic disease was detected in 40% of patients and was associated with a DY mammographic pattern (p = 0.03), casting calcification (p = 0.0002) and absence of mammographic nidus (p = 0.0006). Residual microscopic disease was found in 75-88.9% of patients when two of these preoperative mammographic features were present in combination. The mean lumpectomy diameter was significantly smaller for patients with DY compared to N1 mammographic pattern on Wolfe grade (p = 0.039). Both residual disease and Wolfe grade were related to age (p = 0.0032 and p < 0.0001). EIC was found in 22% of patients and was associated with casting (p < 0.0001) and non-casting (p = 0.04) calcification, absence of mammographic nidus (p < 0.0001) and stellate mammographic nidus (p = 0.02). No significant association was found between mammographic features and lymphatic/vascular invasion. Pre-operative mammographic features can predict patients likely to have residual microscopic disease or EIC following conservation surgery for breast cancer. These patients should be selected for wider primary excision.

Adult↗
PubMed1988

Simultaneous aortic and renal artery reconstruction for acute arterial occlusion in solitary kidney.

A case is described of the onset of acute renal failure due to renal artery occlusion in a solitary kidney of a sixty-six-year-old woman. She had been treated for severe hypertension due to renal artery stenosis. An aortorenal bypass to revascularized the kidney was combined with repair of an abdominal aortic aneurysm. There was early and full recovery of renal function in the single kidney, and the patient was completely rehabilitated. Review of the literature shows that an aggressive surgical approach to the management of renal artery occlusion is usually followed by excellent results. The pre-existence of renal artery stenosis encourages the formation of a collateral arterial supply which maintains the nutrition of the kidney almost indefinitely, after renal artery occlusion. Revascularization will result in prompt recovery of renal function.

Acute Kidney Injury↗
PubMed1985

Assessment of urinary stream after repair of anterior hypospadias by meatoplasty and glanuloplasty.

Voiding function was studied after repair of anterior hypospadias in 44 boys using Duckett's technique of meatoplasty and glanuloplasty. Assessment of the urinary stream was done in 2 ways. At least 6 weeks postoperatively a uroflow measurement using a DISA rotating disk machine was done. Peak flow was compared to previously prepared normal values in a large group of normal boys. Then, a high speed picture of the stream was taken using electronic video photography at the time of peak flow. Of the boys 42 had normal flow rates and 40 had acceptable stream patterns. The only complication was meatal stenosis in 2 cases. There were no fistulas. Although the primary indication for correction of anterior hypospadias is cosmetic, it is essential that function not be sacrificed to achieve this end. This study indicates that voiding function is maintained after hypospadias repair with meatoplasty and glanuloplasty.

Adolescent↗