John Macfie

Followers

Following

Co-authors

Public Views

Interests

Uploads

Papers by John Macfie

An investigation into the sensitivities of translocating bacteria to a prophylactic antibiotic regimen

Annals of The Royal College of Surgeons of England, Nov 1, 2002

Introduction: It is well established that bacterial translocation is associated with a significan... more Introduction: It is well established that bacterial translocation is associated with a significant increase in septic morbidity. The purpose of this study was to determine the antibiotic sensitivities of translocating bacteria on the basis that this information may influence antibiotic prophylaxis in surgical patients. Methods: Routine microbiological techniques were used to assess the antibiotic sensitivities of those bacteria cultured from a mesenteric lymph node harvested at laparotomy in a large series of patients. Results: Culture of the mesenteric lymph nodes yielded growth in 51 out of a total of 447 patients studied (11.4%). The isolates from 40 patients, a total of 60 organisms, were available for sensitivity testing. The most common species grown was Escherichia coli (48% of isolates). Thirty-three patients (83%) grew organisms sensitive to the antibiotic prophylaxis used, but there was no significant difference in the incidence of postoperative septic complications between these patients and those in whom resistant bacteria were grown (39% versus 29%, P = 0.64 Fisher's Exact test mid P). Conclusions: The majority of translocating bacteria are sensitive to the prophylactic antibiotics commonly used in patients undergoing laparotomy. However, the occurrence of postoperative septic morbidity is independent of this variable.

Download

Effect of the Energy Source on Changes in Energy Expenditure and Respiratory Quotient During Total Parenteral Nutrition

Journal of Parenteral and Enteral Nutrition, 1983

... Page 2. 1 Original Communications Effect of the Energy Source on Changes in Energy Expenditur... more

A microfluidic chip based model for the study of full thickness human intestinal tissue using dual flow

Biomicrofluidics, Nov 1, 2016

The study of inflammatory bowel disease, including Ulcerative Colitis and Crohn's Disease, has re... more The study of inflammatory bowel disease, including Ulcerative Colitis and Crohn's Disease, has relied largely upon the use of animal or cell culture models; neither of which can represent all aspects of the human pathophysiology. Presented herein is a dual flow microfluidic device which holds full thickness human intestinal tissue in a known orientation. The luminal and serosal sides are independently perfused ex vivo with nutrients with simultaneous waste removal for up to 72 h. The microfluidic device maintains the viability and integrity of the tissue as demonstrated through Haematoxylin & Eosin staining, immunohistochemistry and release of lactate dehydrogenase. In addition, the inflammatory state remains in the tissue after perfusion on the device as determined by measuring calprotectin levels. It is anticipated that this human model will be extremely useful for studying the biology and testing novel interventions in diseased tissue. Published by AIP Publishing.

Download

Quality of life after restorative proctocolectomy with a pelvic ileal reservoir compares favorably with that of patients with medically treated colitis

Diseases of The Colon & Rectum, Jun 1, 1993

There remains some reluctance among physicians to refer patients for restorative proctocolectomy ... more There remains some reluctance among physicians to refer patients for restorative proctocolectomy (RP). They argue that their patients would be worse off with a pouch because of the attendant problems of urgency and frequent bowel actions. The aim of this study was to compare quality of life in patients who had undergone RP with that of patients with ulcerative colitis

Does drainage increase the risk of subhepatic collection following cholecystectomy? a prospective study

Gut, Dec 17, 1985

Randomized trial of pelvic drainage after rectal resection

Diseases of The Colon & Rectum, Mar 1, 1995

Most surgeons continue to advocate routine use of drains after pelvic anastomoses. Several recent... more Most surgeons continue to advocate routine use of drains after pelvic anastomoses. Several recent studies have, however, demonstrated that patients gain little or no benefit from such drainage and that drains may indeed be a source of morbidity to some. PURPOSE: The aim of this trial was twofold: 1) to determine whether use of a high pressure, closed suction pelvic drain was associated with reduced morbidity; 2) to investigate the influence of drainage on postoperative fluid collections after rectal resection. METHODS: A consecutive series of 100 patients was randomized to receive either no drain (n = 48) or a high pressure, closed suction intraperitoneal drain for seven days (n = 52). The two groups were similar in terms of age, sex, diagnosis, and type of anastomosis. Patients underwent postoperative pelvic ultrasound and water-soluble contrast studies on day 7. RESULTS: There were six deaths (three drain, three no drain). Clinically significant anastomotic leak occurred in seven patients (five drain, two no drain), and a radiologic leak was demonstrated in another five patients (two drain, three no drain), each of whom remained well. Presence or absence of a drain did not influence rate of morbidity and mortality. Pelvic fluid collections were more likely to be demonstrated if a drain was used; however, this did not reach statistical significance. Neither pus nor feces emerged from the drain in any patients in whom a leak occurred. CONCLUSION: Use of a pelvic drain after rectal resection did not confer any benefit to the patient.

Download

Authors' reply: Randomized clinical trial of multimodal optimization of surgical care in patients undergoing major colonic resection (Br J Surg 2005; 92: 1354-1362)

British Journal of Surgery, Jun 14, 2006

The Editors welcome topical correspondence from readers relating to articles published in the Jou... more The Editors welcome topical correspondence from readers relating to articles published in the Journal. Responses should be sent electronically via the BJS website (www.bjs.co.uk). All letters will be reviewed and, if approved, appear on the website. A selection of these will be edited and published in the Journal. Letters must be no more than 250 words in length.

Download

Randomized clinical trial of the impact of early enteral feeding on postoperative ileus and recovery (Br J Surg 2007; 94: 555–561)

British Journal of Surgery, Jul 16, 2007

Download

Total parenteral nutrition by peripheral vein — Substitute or supplement to the central venous route? A prospective trial

Clinical Nutrition, Aug 1, 1993

consecutive gastroenterological patients who required total parenteral, nutrition (TPN) were ente... more consecutive gastroenterological patients who required total parenteral, nutrition (TPN) were entered into this study. Two patients were withdrawn because of specific nutritional requirements, leaving 49 patients for randomisation. 23 patients were allocated to receive peripheral parenteral nutrition (PPN) and 26 to receive feeding through a central venous line (CPN). There was no significant difference between the groups with respect'to the median duration of feeding (9.4 + 3.6 days; 12.0 + 7.8 days) but significant morbidity occurred more frequently in the CPN group (11%) compared to the PPN group (0%). TPN by the designated route was not possible in 4 patients in the PPN group and in 3 of the CPN group. Of the 19 patients commenced on PPN, 13 continued without complication until resumption of oral feeding (median 10.7 f 3.2 days); 6 of these patients had to be converted to central venous feeding for completion of their nutritional requirements. Of the 23 patients commenced on CPN, 21 completed their nutritional course (median 11.8 f 5.3 days), 2 patients in the CPN group required conversion to PPN to complete their nutritional course. This study shows that PPN is a feasible, safe alternative to CPN in many patients. It is not necessary to subject all patients who require TPN to the risks and expense of central venous cannulation.

Download

Energy Substrate Utilisation in Trauma

S. Karger AG eBooks, Apr 20, 2015

Activities of Hexokinase, Phosphofructokinase, Fructose Bisphosphatase and 2-Oxoglutarate Dehydrogenase in Muscle of Normal Subjects and Very Ill Surgical Patients

Clinical Science, Apr 1, 1981

1. The activities of hexokinase, phosphofructokinase, fructose bisphosphatase and 2-oxoglutarate ... more 1. The activities of hexokinase, phosphofructokinase, fructose bisphosphatase and 2-oxoglutarate dehydrogenase have been measured in the vastus lateralis and rectus abdominus muscle .of normal human subjects and in very ill surgical patients. 2. The activities of these enzymes in the muscle of control subjects were similar to the pattern seen in the skeletal muscle of other mammals and lower vertebrates. 3. Fructose bisphosphatase and phosphofructokinase activities were significantly lower in the muscle of ill patients although the depression of the activity of fructose bisphosphatase was much greater than that of phosphofructokinase in both muscle types of ill patients. 4. The maximum rate of cycling in the fructose 6-phosphate-fructose 1,6-diphosphate cycle may be altered in the ill. 5. This decreased cycling may have a direct influence on the sensitivity of glycolysis to regulators such as the adenine nucleotides and may reduce the ability to maintain body temperature. 6. Increased glycogen synthesis in these muscles may indicate that the role of fructose bisphosphatase is unlikely to be solely in glycogen resynthesis.

Download

Bacterial translocation and immunohistochemical measurement of gut immune function

Journal of Clinical Pathology, Aug 1, 2001

Aims-The local immune response in the small bowel mucosa might play a role in bacterial transloca... more Aims-The local immune response in the small bowel mucosa might play a role in bacterial translocation (BT). The aim of this study was to quantify immune cells and secretory antibodies in the small bowel mucosa, and relate this to BT as assessed by culture of a mesenteric lymph node. Methods-Immunohistochemical techniques were used to measure the frequency of plasma cells and IgA and IgM positive cells in the lamina propria and semiquantitatively to assess mucosal surface IgA and IgM values in small bowel specimens obtained from 11 patients in whom positive evidence of BT had been identified in a mesenteric lymph node harvested at the time of laparotomy. These were compared with similar specimens obtained from 11 patients in whom a similar lymph node had yielded no growth. Results-BT was associated with a significantly increased median frequency of plasma cells (p < 0.01) and IgA positive cells (p < 0.05) in the lamina propria. The frequency of IgM positive cells was also higher in these patients, although this difference was not significant. In addition, semiquantitatively scored IgA and IgM concentrations at the mucosal surface were both significantly higher in the patients in whom BT had been identified (p = 0.006 and 0.016, respectively). Conclusion-Higher numbers of plasma cells and higher IgA and IgM values are present in the small bowel mucosa of patients in whom BT has been shown to occur, suggesting an increased local immune response.

Download

Intestinal obstruction promotes gut translocation of bacteria

Diseases of The Colon & Rectum, Jun 1, 1995

Transl0cation of enteric organisms has been implicated as a possible source of sepsis in suscepti... more Transl0cation of enteric organisms has been implicated as a possible source of sepsis in susceptible patients. Animal studies have suggested that intestinal obstruction promotes bacterial translocation from the gut lumen. The aim of this study was to study the prevalence of bacterial translocation in patients with and without intestinal obstruction. METHODS: Serosal scrapings, mescnteric lymph nodes, and peripheral blood cultures were obtained from 254 patients. Scrapings and nodes were homogenized and incubated aerobically and anaerobically. Full-thickness biopsies underwent villous height analysis. The clinical course was followed for at least six weeks. RESULTS: Bacterial translocation to mesenteric nodes occurred more frequently in patients with large bowel obstruction than in patients without obstruction (14 of 36 patients vs. 16 of 218 patients; P < 0.001). Both aerobic and anaerobic bacteria were found to translocate. The more distal the obstruction, the more likely anaerobic bacteria were to be identified. Translocation of bacteria predisposed to postoperative septic complications (P < 0.05). Villous height was not related to bacterial translocation. CONCLUSIONS: Gut translocation of bacteria is more common in patients with intestinal obstruction, and its association with septic complications appears to be of clinical significance.

Download

The ethics of artificial nutrition

Medicine, 2011

ABSTRACT

Ethics and Nutrition

Whilst much has been written on the implications of withholding or withdrawing nutritional suppor... more Whilst much has been written on the implications of withholding or withdrawing nutritional support therapy from the terminally ill, the comatose or vegetative patients relatively little has been published on the ethical implications of nutritional therapy in other groups. This article outlines a surgeon's view of ethical issues as they apply to nutrition and concludes that failure to provide nutritional support in one form or another for patients who have or who are expected to have seven days or more of inadequate oral intake should now be considered unethical.

Guidelines for Perioperative Care in Elective Colonic Surgery: Enhanced Recovery After Surgery (ERAS®) Society Recommendations

World Journal of Surgery, Oct 6, 2012

Background This review aims to present a consensus for optimal perioperative care in colonic surg... more Background This review aims to present a consensus for optimal perioperative care in colonic surgery and to provide graded recommendations for items for an evidencedbased enhanced perioperative protocol. Methods Studies were selected with particular attention paid to meta-analyses, randomised controlled trials and large prospective cohorts. For each item of the perioperative treatment pathway, available English-language literature was examined, reviewed and graded. A consensus recommendation was reached after critical appraisal of the literature by the group. Results For most of the protocol items, recommendations are based on good-quality trials or meta-analyses of goodquality trials (quality of evidence and recommendations according to the GRADE system). Conclusions Based on the evidence available for each item of the multimodal perioperative care pathway, the Enhanced Recovery After Surgery (ERAS) Society, International Association for Surgical Metabolism and Nutrition (IASMEN) and European Society for Clinical Nutrition and Metabolism (ESPEN) present a comprehensive evidence-based consensus review of perioperative care for colonic surgery. This study was conducted on behalf of the ERAS Ò Society, the European Society for Clinical Nutrition and Metabolism and the International Association for Surgical Nutrition and Metabolism The guidelines are published as a joint effort between the Enhanced Recovery After Surgery (ERAS) Society, for Perioperative Care, The European Society for Clinical Nutrition and Metabolism (ESPEN) and The International Association for Surgical Metabolism and Nutrition (IASMEN) and copyrights for this publication is shared between the three societies. The guidelines are published jointly in World Journal of Surgery (IASMEN) and Clinical Nutrition (ESPEN), and will also be available on the ESPEN (http://www.espen.org), IASMEN (http://www.iasmen.org) and ERAS Society website (http://www.erassociety.org).

Download

Feasibility of a novel exercise prehabilitation programme in patients scheduled for elective colorectal surgery: a feasibility randomised controlled trial

Supportive Care in Cancer, 2019

Background and objectives To investigate the feasibility of delivering a functional exercise-base... more Background and objectives To investigate the feasibility of delivering a functional exercise-based prehabilitation intervention and its effects on postoperative length of hospital stay, preoperative physical functioning and health-related quality of life in elective colorectal surgery. Materials and methods In this randomised controlled feasibility trial, 22 elective colorectal surgery patients were randomly assigned to exercise prehabilitation (n = 11) or standard care (n = 11). Feasibility of delivering the intervention was assessed based on recruitment and compliance to the intervention. Impact on postoperative length of hospital stay and complications, preoperative physical functioning (timed up and go test, five times sit to stand, stair climb test, handgrip dynamometry and 6-min walk test) and health-related quality of life were also assessed. Results Over 42% of patients (84/198) screened were deemed ineligible for prehabilitation due to insufficient time existing prior to sc...

Download

Long-Term Parenteral Nutrition: Problems with Venous Access

Journal of the Royal Society of Medicine, 1990

Long-term parenteral nutrition requires central venous access, often difficult in patients who ha... more Long-term parenteral nutrition requires central venous access, often difficult in patients who have had several central venous catheterizations. Therapy may be complicated by thrombosis and sepsis which may further compromise central access. We report five cases illustrating such difficulties and suggest that these patients be referred early to specialist centres where experienced catheter insertion and management results in a greatly reduced incidence of complications.

Download

Towards cheaper intravenous nutrition

BMJ, Jan 11, 1986

Download

Influence of intraperitoneal drains on subhepatic collections following cholecystectomy: A prospective clinical trial

British Journal of Surgery, Dec 1, 1986

Influence of intraperitoneal drains on subhepatic collections following cholecystectomy : a prosp... more Influence of intraperitoneal drains on subhepatic collections following cholecystectomy : a prospective clinical trial In this prospective randomized study, the influence of an intraperitoneal drain on the incidence and clinical significance of subhepatic collections occurring in patients after acute or elective cholecystectomy WQS assessed by ultrasound examination. A total of 112 patients entered the study, of whom 54 received a drain. There was no significant difference between the drainage and the non-drainage groups with respect to mean age or sex distribution, the number of patients in whom the gallbladder bed was formally closed (27 versus 21) nor in the number of acute cholecystectomies performed in either group (12 versus 13). Ultrasound detected 10 (18 per cent) collections in the drainage group and only one (1.8 per cent) in the non-drainage group (P < 0.01, x2 test). None of the collections required any further treatment and no morbidity occurred that was directly attributable to the presence of the retained fluid. These results suggest that rather than preventingfluid collections, suction drains may predispose to the development of subhepatic collections after cholec ystectomy.

Download

John Macfie

Uploads

Papers by John Macfie

Log In