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Biomedical subjects

B Gill

Publications and source records attributed to B Gill.

At least 37 records · Page 2Linked to original sources
PubMed1994

Distribution and variability of resistive index values in undilated kidneys in children.

OBJECTIVES: To assess better the utility of duplex Doppler sonography in the diagnosis of obstructive hydronephrosis in children, we specifically studied undilated urinary tracts with the intention of establishing a nomogram of resistive index (RI) values and determining if the RI value of 0.7 reliably precludes an undilated collecting system. METHODS: Renal duplex Doppler ultrasound was performed in a standard fashion on 47 children more than 12 months of age (93 renal units) where there was no suspicion of upper urinary tract dilation. RI and RI ratio (RIR) were calculated and statistical analysis performed. RESULTS: There were 27 males and 20 females 12 to 180 months old (mean, 63.9 months). Kidney size ranged from 5.0 to 9.8 cm (mean, 7.28 cm), RI ranged from 0.34 to 0.94 (mean, 0.65), and RIR ranged from 1.00 to 1.76 (mean, 1.14). There was no statistically significant relationship between the RI and renal size or laterality, gender, or age (p > 0.05). However, between the ages of 24 and 108 months, the RI was significantly higher in females compared with males (p = 0.002). If one were to use 0.7 and 1.10 as discriminatory values for RI, 37% of renal units had values above 0.7, and 41% of RIR values were above 1.10. CONCLUSIONS: We believe that RI values in undilated kidneys of children vary significantly and its routine use and reliability need to be evaluated further in the pediatric population.

Adolescent↗
PubMed1994

Optimal renal preservation with timely percutaneous intervention: a changing concept in the management of blunt renal trauma in children in the 1990s.

OBJECTIVE: To report the results of treatment of 132 children with blunt renal trauma and indicate our treatment recommendations. RESULTS: Between 1971 and 1991 132 children presented with blunt renal trauma. Grade I injuries (renal contusion) were seen in 97 children, grade II injuries (renal laceration) in 32 and grade III (shattered kidney and pedicle injury) in three. Twenty-six children with grade II injuries were treated non-surgically. Urinomas developed in three, which were drained percutaneously with complete resolution. Prior to 1985 six patients with grade II injuries underwent total or partial nephrectomy for major renal lacerations. Repair of shattered kidneys resulted in significant morbidity. Conservative management of major blunt injuries with judicious percutaneous intervention resulted in no renal loss. CONCLUSION: We believe that conservative therapy with timely percutaneous drainage of urinomas in children with major blunt renal injury, other than shattered kidney or pedicle injuries, optimizes renal preservation and minimizes secondary complications.

Adolescent↗
PubMed1993

Urolithiasis in children following augmentation cystoplasty.

Until recently urolithiasis in children following augmentation cystoplasty was an infrequently noted problem. We examined our 10-year experience and found urinary calculi to form in 52% of children and young adults undergoing augmentation cystoplasty. Calculi formed at a median interval of 24.5 months after surgery, predominantly in the lower tract. Urinary tract infection was a statistically significant risk factor, while the use of absorbable staples, intestinal mucus and hypocitraturia were also implicated. Calculus composition was primarily a mixture of apatite, struvite and ammonium urate. Bladder calculi were effectively managed endoscopically in the majority of cases without complication. Upper tract calculi presented an endourological challenge.

Adolescent↗
PubMed1993

Intrathecal baclofen for intractable spasticity of spinal origin: results of a long-term multicenter study.

A total of 93 patients with intractable spasticity due to either spinal cord injury (59 cases), multiple sclerosis (31 cases), or other spinal pathology (three cases) were entered into a randomized double-blind placebo-controlled screening protocol of intrathecal baclofen test injections. Of the 88 patients who responded to an intrathecal bolus of 50, 75, or 100 micrograms of baclofen, 75 underwent implantation of a programmable pump system for chronic therapy. Patients were followed for 5 to 41 months after surgery (mean 19 months). No deaths or new permanent neurological deficits occurred as a result of surgery or chronic intrathecal baclofen administration. Rigidity was reduced from a mean preoperative Ashworth scale score of 3.9 to a mean postoperative score of 1.7. Muscle spasms were reduced from a mean preoperative score of 3.1 (on a four-point scale) to a mean postoperative score of 1.0. Although the dose of intrathecal baclofen required to control spasticity increased with time, drug tolerance was not a limiting factor in this study. Only one patient withdrew from the study because of a late surgical complication (pump pocket infection). Another patient received an intrathecal baclofen overdose because of a human error in programming the pump. The results of this study indicate that intrathecal baclofen infusion can be safe and effective for the long-term treatment of intractable spasticity in patients with spinal cord injury or multiple sclerosis.

Adult↗
PubMed1993

The changing incidence of chronic lung disease.

This paper reports an examination of the incidence of chronic lung disease in premature infants admitted to the neonatal intensive care unit at Liverpool Maternity Hospital. From January 1980 to December 1989 details were obtained for these infants such as gestation, weight, sex, survival to discharge and ventilatory support received. The findings show that a total of 242 infants had developed chronic lung disease; one-third of these were born in 1988 or 1989. Logistic regression suggests that chronic lung disease was significantly associated with being male, low birthweight, low gestation, surviving to discharge, and being born in 1988 or 1989. Among infants at 'high risk' of this condition, mortality had significantly decreased and the incidence had significantly increased. This increase is not fully explained by changes in the population admitted during the last decade. A rising workload should be anticipated in terms of the specialised follow-up and care required by these babies.

England↗
PubMed1992

Electrical stimulation and multichannel EMG recording for identification of functional neural tissue during cauda equina surgery.

Electrical stimulation of structures within the surgical field was used to identify functional neural elements during 25 cauda equina operations. EMG responses from anterior thigh, posterior thigh, and anal sphincter muscles were recorded simultaneously using a multichannel signal averager. During nine operations, stimulation of a presumed filum terminale or other tissue produced clear EMG responses, prompting modification of surgical procedures. In one patient, this resulted in preservation of a flattened spinal cord which resembled a band of scar tissue. Some EMG responses were restricted to a single muscle group; these neural structures would probably not have been identified if only a single-channel EMG recording was used. Visual examination alone was not adequate for identifying functional neural elements, or for determining whether atretic-appearing nerve roots were functional. Electrical stimulation with multichannel EMG recording facilitates the preservation of functional neural elements and the optimization of surgical results in cauda equina surgery.

Adolescent↗
PubMed1992

Significance of accessory ductal structures in hernia sacs.

The finding of ductal structures resembling a vas deferens during pathological examination of a hernia sac specimen has significant medical and legal implications. A method of distinguishing these accessory structures from an inadvertently transected vas has been lacking and is needed. Between July 1989 and January 1990 we examined 147 hernia sacs from 105 consecutive prepubertal and adolescent boys to determine the incidence and salient histological features distinguishing these ductal structures from a true vas deferens. Luminal diameters of the ductal structures were compared with published normal age-related established vas deferens diameters and with those measured during hernia repair in 10 of our youngest patients. Among the 147 specimens 6 hernia sacs (4.1%) contained ductal structures. We found that the mean ductal diameter (0.263 mm.) was significantly smaller than that of a normal vas deferens (0.69 to 1.5 mm.). Furthermore, the surrounding mantle of tissue of these ductal structures lacked muscle tissue when studied with Masson trichrome stain. We conclude that duct diameter and trichrome staining are simple ways of differentiating these structures from a true vas deferens.

Adolescent↗
PubMed1991

Ethics and the allocation of health resources to the elderly.

This paper examines some of the ethical issues confronting the allocation of scarce health resources in the context of an ageing society with increasing levels of chronic disease. The allocation of resources at both the micro and macro level is explored, utilising the ethical principles of patient-centred beneficence, autonomy, full beneficence and justice. The implications of the dominance of science and technology within health care are analysed along with the paternalistic and individualistic nature of traditional medical ethics. The possible variations in value systems between patients and health professionals are examined and a greater emphasis on patient autonomy is advocated. Such a change, it is argued, may well result in an actual decrease in demand for expensive high technology treatment.

Aged↗
PubMed1990

Significance of intraoperative venographic patterns on the postoperative recurrence and surgical incision placement of pediatric varicoceles.

Intraoperative post-ligation spermatic venography has proved to be a reliable adjunct in pediatric varicocele surgery. In a previous study we described the technique and initial results. In this series of 60 consecutive patients with pediatric varicoceles having intraoperative venography, we specifically studied the collateral venous circulation and crossover veins to characterize the venographic patterns associated with varicocelectomy failure. The relationship of incision site and number of venograms necessary to ensure complete interruption of the internal spermatic system was evaluated to determine if an optimum incision placement exists, minimizing the number of venograms necessary. Our data indicate that the most common etiology of recurrent varicocele in children seems to be residual proximal (central) collateral veins, pelvic collateral veins (that is cremasteric, deferential and crossover veins) rarely seem to contribute to varicocelectomy failure and there is an inherent but low risk of varicocelectomy failure despite radiological evidence of complete internal spermatic vein interruption.

Adolescent↗
PubMed1990

Efficacy of orchiopexy by patient age 1 year for cryptorchidism.

We evaluated 77 male patients with true cryptorchidism ranging from 2 to 46 months old to determine whether orchiopexy could be performed safely and efficiently, and whether treatment was helpful in patients less than 1 year old. Our results indicate that orchiopexy in patients younger than 1 year is safe, effective and beneficial, and optimizes treatment of this condition.

Age Factors↗
PubMed1989

Significance of epididymal and ductal anomalies associated with testicular maldescent.

Epididymal abnormalities have long been found in conjunction with cryptorchid testicles. The aim of this study was to document the different types of epididymal and ductal anomalies in relation to the position of the cryptorchid testis and to determine their clinical significance. Exploration was performed on 187 cryptorchid testes in 174 boys. The position of the testis and the epididymal and ductal anomalies were documented at operation. A biopsy was taken from the testis or atretic spermatic cord structures for light microscopy. Epididymal, ductal and/or testicular anomalies were detected in 43 per cent of the 187 testes, including anomalies of ductal fusion, anomalies of ductal suspension and anomalies associated with absent or vanishing testes. Biopsy of the testes with severe anomalies of ductal fusion showed preservation of germ cells in 69 per cent and diminished germ cells in 31 per cent. The higher the arrest of testicular descent, the more grossly abnormal was the associated ductal system. Early successful orchiopexy alone may not ensure subsequent fertility despite the presence of normal germ cells.

Biopsy↗
PubMed1989

Needle biopsy in the diagnosis of testicular leukemia in children.

Aggressive chemotherapy in patients with acute lymphoblastic leukemia has resulted in a marked upsurge in patient survival. In the course of their management, testicular biopsy and rebiopsy have an important role. We evaluated the histological findings in 50 sets of open wedge and simultaneous needle core biopsy specimens from 44 testes of children with acute lymphoblastic leukemia to determine the accuracy of the needle biopsy technique in the evaluation of testis involvement in acute lymphoblastic leukemia. We conclude that needle biopsy of the testis in acute lymphoblastic leukemia is highly accurate and correlates well with the conventional open wedge biopsy, and it may have a role in the management of children with acute lymphoblastic leukemia.

Biopsy, Needle↗
PubMed1988

Fibroepithelial polyp in a child.

Only 15 cases of fibroepithelial polyp in children have been reported in the world medical literature. Clinical differentiation between this tumor and a malignant ureteral tumor is difficult and often results in unnecessary nephrectomy. We report the sixteenth case of a child with fibroepithelial polyp of the ureter. The lesion was resected, and the kidney was preserved. Optimum treatment of this lesion mandates renal preservation in children. The rationale for this recommendation is explored.

Child↗
PubMed1988

The dilated urinary tract in children. Prospective analysis with correlation of radiological, isotope, pressure perfusion and surgical findings.

Moderate and even severe dilatation of the urinary tract in the absence of vesicoureteric reflux may remain stable or show spontaneous resolution. Two such cases are described. Twenty-five children with dilated urinary systems were studied to correlate the radiological, isotope, pressure perfusion and surgical findings. A positive Whitaker test correlated well with the surgical findings and post-operative improvement in renal function in all patients with pelviureteric junction (PUJ) and vesicoureteric junction (VUJ) obstruction. High flow rates of 8.6 and 12 ml are required even in neonates and infants in order to demonstrate obstruction by Whitaker testing.

Adolescent↗