Biomedical subjects
Publications and source records attributed to B Gill.
We report on a child with xanthogranulomatous pyelonephritis--an uncommon entity in children. A review of the literature revealed that in only 18 per cent was the diagnosis made correctly preoperatively. In children the disease is of a focal nature rather than a diffuse one, suggesting that possibly radical surgery would be less necessary for adequate treatment.
Varicocelectomy in the adult is followed by a relatively low recurrence rate but children treated by conventional techniques seem prone to have more frequent recurrences. We believe that the higher recurrence rate observed in children after routine varicocelectomy actually represents residual varicose communications that had been missed at the primary operation. Routine post-ligation intraoperative venography has been used to detect these occult communications in 26 children undergoing varicocelectomy. Our results indicate a low recurrence rate (3.6 per cent), suggesting that routine use of this procedure with childhood varicocelectomy is beneficial.
This report deals with 10 female patients with urethral diverticula, 8 of whom were also found to have findings of stress incontinence. This association was proved by urodynamic studies. Three patients were seen with incontinence postdiverticulectomy. Seven patients were evaluated prior to diverticulectomy, and of these 5 had anatomic changes of stress urinary incontinence. Those patients in whom the preoperative evaluation considered them to be at risk for development of stress incontinence postdiverticulectomy were treated with a prophylactic urethropexy. Patients so treated were continent and voided well and were probably spared having a postoperative problem with incontinence. The role of urodynamic techniques in the detection of any association between the diverticulum and a possible risk of postdiverticulectomy incontinence, and how to recognize the problem and its correction before it becomes clinically manifest are the stated purposes of this report.
We reviewed the medical records of 65 boys with surgically and pathologically proved monorchism. A striking laterality to the left side was identified. In 83 per cent of the patients wolffian structures were present and in 20 per cent microscopic evidence of a terminal nubbin of hyalinized, calcified or hemosiderin-containing tissue was noted. These findings strongly suggest that in most instances of monorchism a testis had been present and had undergone subsequent in utero degeneration. Characterization of the hormonal changes associated with unilateral absent testes was done by determining fasting morning levels of luteinizing hormone and follicle-stimulating hormone. In a subgroup of monorchid boys and age-matched prepubertal unilateral cryptorchid boys luteinizing hormone release factor stimulation also was performed to determine if endocrine analysis could predict the absence of 1 testis.
We investigated the mechanisms of injury involved in unilateral testis torsion as well as the interventional effects of orchiectomy at 48 h and immunosuppression with corticosteroids in rats. Torsion was associated with abnormal contralateral testis histology and raised antilymphocytes and antisperm antibody titers. Both orchiectomy and steroid administration lessened these findings, suggesting that an immunological process underlies the abnormality seen in this experiment model.
The comparative anti-arrhythmic effect of equivalent daily doses of conventional propranolol ('Inderal') and long-acting propranolol ('Inderal' LA) was assessed in a double-blind, crossover study lasting 6 weeks in 13 patients with cardiac arrhythmias. Patients were investigated using 24-hour ambulatory monitoring. Both formulations of propranolol significantly reduced the heart rate, together with the number of ventricular premature beats and ventricular couplets, with no significant difference between treatments. The two formulations also produced similar plasma concentrations of propranolol. The long-acting formulation of propranolol proved an effective anti-arrhythmic treatment which, with once-daily dosage, may improve patient compliance with treatment.
Deep hypothermia with cold cardioplegia is a technique that increases the chances for successful palliative or reparative cardiac surgery for the critically ill infant or child with complex or severe cardiac anomalies. Perioperative nursing care is of vital importance to the child, family, and operative team. Nursing care measures include perioperative teaching as well as preoperative and postoperative physical assessment of the child and psychosocial assessment of the child and family unit. An understanding of the advantages and the potential complications of hypothermic techniques enhances the nurse's ability to carry out these nursing interventions.
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This study examines some of the biophysical properties of mixtures of whole blood with 3 different hydroxyethyl starch-hemoglobin (HES-Hgb) polymer blood substitutes. The polymers have about a 3-fold range of number average molecular weight and intrinsic viscosity range. The range dependent rheologic studies with a 60 g/L of polymer solution showed that all 3 blood substitutes were very effective hemodiluents paralleling the hemorheologic properties of the starting HES polymers. The 2 higher molecular weight polymers enhanced the erythrocyte sedimentation rates (ESR) at an 8:1 blood to polymer dilution; however, the lowest molecular weight sample actually retarded the settling. The kinetics of malonamide-induced hemolysis indicated that these new polymers do not increase the rate of hemolysis but rather, offer some protection in a manner similar to stroma-free Hgb (SFH) solutions. The oxygen transport properties determined by biotonometry during an exchange transfusion showed that the P50 values decreased and were dependent upon the Hct. However, these samples were able to maintain rats at an Hct level of 10%.
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Twenty-eight cases of ectopic ureters are reviewed. Two groups consisting of single ectopic ureters and ectopia associated with duplex systems are considered. The former is associated with a high incidence of congenital anomalies. A dilated ectopic ureter remains completely extravesical but can produce features closely resembling those of an ectopic ureterocele. The use of 99mTc-DMSA renal scan has proved helpful in the diagnosis of the condition because it can demonstrate the existence of a poorly functioning kidney not evident on excretion urography.
Forty-six cases of neonatal necrotizing enterocolitis are reported, with a 46% mortality rate. Unlike most other series, low birth weight children accounted for only half the cases. The recognized initiating factors of hypoxia and hemodynamic changes were not always present. A high index of suspicion in the child with non-specific malaise and earlier positive diagnosis provide the most likely means of improving results.
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Three cases are presented which demonstrate the significance of faecoliths in the diagnosis of acute appendicitis in infants. A wide spectrum of symptoms is noteworthy. The usefulness of a plain X-ray of the abdomen in infants with acute abdomen is stressed.
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There have been a number of national surveys of psychiatric morbidity which have included questions on drugs, alcohol and tobacco. These surveys have helped delineate the overlap between substance use and dependence and other psychological morbidity. There is a strong association reported between high substance consumption and other measures of psychological problems. This article provides an overview of a national household survey, a survey of institutional residents with psychiatric disorders and a national survey of a homeless population. All three surveys used comprehensive and complex sampling strategies and lay interviewers to conduct structured diagnostic interviews. The household survey included over 10,000 households, the institutional survey interviewed 755 individuals and the homeless survey of hostels, night-shelters, day centres and private-sector leased accommodation interviewed 1,061 individuals. This overview looks at patterns of nicotine, alcohol and other drug use in the different samples and examines interactions with other psychiatric morbidity. The survey reports that substance-related disorders are some of the commonest disorders in the community, with 5% of the household sample alcohol dependent, 7% alcohol dependent in the institutional sample and over 21% in the homeless sample recorded as alcohol dependent. Tobacco, alcohol and other drug use and dependence were dramatically higher in the homeless sample than in either of the other two samples. Substance use was significantly associated with higher rates of psychological morbidity as measured by the Clinical Interview Schedule Revised. Future service planning needs to take account of the striking disparity of prevalence of psychiatric disorders in different subsections of the population.