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Biomedical subjects

D M Burge

Publications and source records attributed to D M Burge.

At least 37 records · Page 2Linked to original sources
PubMed1993

Vitamin K coagulation status in surgical newborns and the risk of bleeding.

The vitamin K coagulation status in surgical newborns, who may be at increased risk of developing hypocoagulability and hemorrhage, has not previously been studied. Therefore, we measured the combined activity of the plasma vitamin K-dependent coagulation factors (Thrombotest), total prothrombin, PIVKA II, plasma vitamin K1, fibrinogen, D-Dimer, and platelets in 49 newborns admitted to a neonatal surgical intensive care unit. All infants had significant pathology, and treatment involved surgery in all but two. Twenty-three infants (47%) underwent surgery on two or more occasions. Intravenous or oral antibiotics were used in all patients and many received more than one course. All infants had vitamin K1 prophylaxis at birth. At day 0 (date of birth), the mean Thrombotest and total prothrombin levels were 51% (range, 20% to 100%) and 40% (range, 24% to 59%), respectively. Coagulation activity decreased on day 1 (P > .1) and was followed by a graduate increase in clotting activity, reaching normal adult levels (> 60%) at day 5 for Thrombotest and day 24 for total prothrombin. Only three infants had a Thrombotest less than 20%. PIVKA II was detected in 20 cases (41%). However, levels were within normal limits (< 0.9%) in 17 of these, and between 1.0 and 4.8% in the remaining three infants. There was no relationship between elevated PIVKA levels and coagulation activity in these patients. Plasma vitamin K1 was very high, particularly in the first days of life.(ABSTRACT TRUNCATED AT 250 WORDS)

Birth Weight↗
PubMed1993

Exclusion criteria and outcome in pressure reduction of intussusception.

Experience of 53 episodes of intussusception was examined to compare the observed success rate of pressure reduction with potential outcome had stricter exclusion criteria been applied (history > 24 hours, presence of rectal bleeding, radiological signs of intestinal obstruction). With stricter criteria 25 avoidable laparotomies would have been performed. Most infants can be cured of intussusception by pressure reduction and though some must be excluded this decision should be based on clinical assessment by those experienced in its management. Pressure reduction should not be attempted in the absence of a surgeon with regular experience of intussusception.

Humans↗
PubMed1992

Fetal vesicoureteral reflux: outcome following conservative postnatal management.

Of 222 infants with a urinary tract abnormality detected antenatally 30 male and 9 female patients (64 renal units) were found to have primary vesicoureteral reflux. Grade of reflux was predominantly severe, with grade III or higher noted in 83% of the patients. Prenatal and postnatal ultrasound failed to detect any abnormality in 29 refluxing units (45%) discovered contralateral to the known abnormal system, although 19 had grade III or higher reflux. Of the 64 refluxing units 8 underwent primary ureteral reimplantation, 12 were lost to followup and 44 were managed conservatively for a mean of 3.3 years. Reflux ceased in 61% of the cases, improved in 14% and remained unchanged in 23%. In only 1 unit did the grade of reflux increase. Documented urinary tract infection occurred in 6 of the 39 reflux patients. Dimercaptosuccinic acid renography performed in 21 infection-free patients demonstrated global reduction in renal parenchyma in 4 units, focal parenchymal defects in 3 and normal function in 14. Conservative postnatal management of fetal vesicoureteral reflux is justified. Global and focal parenchymal changes can occur in the kidneys of infants with reflux despite the absence of urinary tract infection.

Child↗
PubMed1991

Long-term assessment of intracranial pressure using the tympanic membrane displacement measurement technique.

The tympanic intracranial pressure (ICP) measurement technique was used to assess intracranial pressure over several months in two patient populations. In the first study, 43 shunted hydrocephalic children, aged 4-17 years, were tested over a period of 18 months when clinically well. Of these 11 (26%) were later admitted with symptoms suggesting acute shunt blockage. The tympanic ICP measurement correlated with clinical and/or operative findings in 10 cases. In the second study, illustrated by a case report, repeated testing over a period of 5 months in children with chronic symptoms suggestive of periods of increased ICP, demonstrated a correlation between symptoms and ICP and helped influence management decisions. Tympanic ICP measurement in shunted children is a valuable tool in the assessment of acute and chronic shunt malfunction. Serial testing was shown to be clinically useful in the long-term management of these patients as a diagnostic indicator of pressure variation and shunt dysfunction.

Adolescent↗
PubMed1991

Outcome of antenatally diagnosed pelviureteric junction hydronephrosis.

Over a 6-year period, in a series of 107 consecutive patients with antenatally detected urological anomalies, 45 had pelviureteric junction (PUJ) hydronephrosis (66 units). Of these, 24 units (36%) had obstructive (group I) and 42 (64%) non-obstructive hydronephrosis (group II). Significantly compromised renal function was found only in group I. Treatment in group I was by an early pyeloplasty; in group II the patients were kept under close review. During the 6-year period, 2 units (5%) in group II, deteriorated, 13 (31%) improved and 27 (64%) were unchanged. These results suggest that early in life, antenatally diagnosed PUJ hydronephrosis without obstruction may be a relatively benign condition but will require long-term follow-up in order to determine the natural history of the condition.

Female↗
PubMed1990

Feeding regimens after pyloromyotomy.

In a prospective randomized study three different feeding regimens after operation were compared in 74 babies with infantile hypertrophic pyloric stenosis: gradual regarding of feeds over 48 h (regimen 1), rapid regarding of feeds over 16 h (regimen 2), and initial starvation followed by full normal feeds at 24 h (regimen 3). No significant difference between the treatment groups was found either in episodes of vomiting after operation (regimen 1, 2.9 episodes in 21 patients; regimen 2, 3.6 episodes in 28 patients; regimen 3, 3.6 episodes in 25 patients) or in the mean duration of postoperative hospital stay (regimen 1, 59.3 h; regimen 2, 47.8 h; regimen 3, 56.7 h). We conclude that vomiting following pyloromyotomy is self-limiting and independent of the timetable or composition of the postoperative dietary regimen.

Enteral Nutrition↗
PubMed1990

Surgical presentation of Kawasaki disease (mucocutaneous lymph node syndrome).

Five patients with Kawasaki disease (mucocutaneous lymph node syndrome) are reported whose varied presentations included acute abdominal pain, peripheral arterial aneurysms, digital gangrene and sterile pyuria and whose presenting pathology ranged from hydrops of the gallbladder to enteric pseudo-obstruction. As the complications of the disease can usually be managed without resort to surgery, which is associated with a mortality rate of up to 25 per cent, the recognition of Kawasaki disease will prevent hazardous and unnecessary laparotomy.

Abdominal Pain↗
PubMed1990

Irreducible inguinal hernia in children below two years of age.

Eighty-five cases of irreducible inguinal hernia in children below 2 years of age were reviewed. Non-operative treatment was successful in 71 (84 per cent); 14 children required emergency surgery. The younger the child and the longer the duration of symptoms at presentation, the worse was the outcome of non-operative treatment. In 35 (41 per cent) children the diagnosis of inguinal hernia had been made before irreducibility. There is an increased incidence of postoperative complication associated with irreducibility, especially in preterm infants. Early diagnosis of inguinal hernia in young children and prompt referral for surgery is recommended.

Emergencies↗
PubMed1990

Reflux nephropathy secondary to intrauterine vesicoureteric reflux.

In 107 infants with 182 antenatally diagnosed urinary tract anomalies, 24 had either unilateral (12) or bilateral (12) vesicoureteric reflux (VUR). The VUR was more common in boys (male to female ratio, 16:8) and usually severe (grades IV [16], III [10], II [4], and I [6]). Intravenous pyelography showed the changes of atrophic pyelonephritis in 10 refluxing units, and in another two with an associated pelviureteric junctional hydronephrosis. Lateral ectopia of the ureteric orifices was noted in six of these 10 refluxing renal units. Isotopic renography showed a reduction in function in nine of the 14 patients examined, ranging between 9% and 41%. (45% and above was considered within the normal range). Only two patients developed a urinary infection before intravenous pyelography or isotopic renography was performed, suggesting that renal changes noted were primary rather than secondary. Findings support the hypothesis that foetal VUR may be a contributing factor in the causation of atrophic pyelonephritis (foetal reflux nephropathy) observed in these patients.

Atrophy↗
PubMed1990

Non-invasive assessment of ventricular shunt function using tympanic membrane displacement measurement technique.

A technique which was originally developed for measuring cochlear fluid pressure, has been under trial for the past two years as a means of assessing ventricular shunt function. The principle of the technique has been reported in previous papers (1, 2, 3) and has been shown to provide a reliable measure of intracranial pressure (ICP) in terms of induced displacement of the tympanic membrane. This study concentrates on the assessment of shunt blockage in spina bifida patients who subsequently underwent shunt revision. The tympanic displacement technique is shown to be of value to this patient group in three respects. Firstly as a research technique to study group-averaged ICP measurements where the ICP needs to be known but invasive measurements cannot be justified. Secondly for assessing shunt dysfunction in individual patients and, finally, in determining the success of shunt revision surgery. The technique was found to be extremely sensitive to relative changes in ICP with shunt revision or any subsequent blockage. The technique is more reliable diagnostically in instances where the patients act as their own controls and a comparison with baseline measurements can be made. Three case reports are illustrated which were selected from those patients tested to emphasise the importance of serial measurements of ICP over period of several days post-revision. The tympanic displacement technique is shown to provide a practical and acceptable method by which this can be undertaken.

Acoustic Impedance Tests↗
PubMed1990

Fetal vesicoureteric reflux.

We present an analysis of 30 patients with fetal vesicoureteric reflux (VUR) from a series of 107 patients with prenatally diagnosed urinary tract anomalies. In 13 patients (Group 1) the fetal VUR was the only urinary tract abnormality. In 17 patients (Group 2) the fetal VUR was combined with other urinary tract problems. In 14 of 46 refluxing renal units there was no evidence of upper tract dilatation on a pre- and post-natal ultrasound examination. Any infant with postnatal urinary tract dilatation needs full urological investigations, including a micturating cystogram. A normal postnatal ultrasound examination does not exclude fetal VUR.

Female↗
PubMed1990

Antenatal diagnosis of abdominal wall defects: a missed opportunity?

A review of six years' experience with antenatal diagnosis of abdominal wall defects by ultrasound showed its impact to be limited by poor detection rates. Twenty infants with exomphalos and 20 with gastroschisis were recorded but only 25 (63%) were diagnosed antenatally. The ultrasound false negative rate was higher for exomphalos (35%) than for gastroschisis (22%). No difference was detected in the incidence of associated abnormalities, premature gestation, primary closure rate, or mortality between the antenatally and postnatally diagnosed groups for either exomphalos or gastroschisis. Antenatal diagnosis of gastroschisis has little effect on management but allows parental counselling and in utero transfer. The frequency of concomitant abnormalities in exomphalos profoundly affects prognosis and the detection of these is the major role of antenatal diagnosis in this condition. Failure to detect abdominal wall defects by ultrasound may be a reflection of technique or equipment, but some gastroschisis may be of perinatal onset and not detectable antenatally.

Abdominal Muscles↗
PubMed1990

The relationship between intracranial pressure and tympanic membrane displacement.

Transmission of intracranial pressure (ICP) to the perilymph of the cochlea may occur via the cochlear aqueduct and possibly other routes. Indirect measurement of perilymphatic pressure may be investigated by observing tympanic membrane (TM) displacement during stapedial reflex contraction. In a previous study we investigated the effects of changes in ICP on perilymphatic fluid pressure in three patients who underwent ventriculo/lumbar-peritoneal shunt operations. The TM displacement technique proved extremely sensitive and revealed marked changes in cochlear fluid pressure brought about by changes in ICP (Marchbanks et al., 1987). The study has been extended to 58 patients with hydrocephalus, intracranial tumours and other neurological conditions associated with abnormal ICP. Significant differences in the TM displacement were found between patients with raised and normal ICP. We have shown that changes in ICP can affect the hydrostatic pressure of the cochlea and influence the peripheral auditory system. The finding that ICP can be correlated with TM displacement strengthens the association between an abnormal TM displacement and abnormal cochlear hydrostatic status, irrespective of cochlear aqueduct patency. We suggest that the TM displacement technique provides a useful non-invasive method for the assessment of perilymphatic fluid pressure.

Acoustic Stimulation↗
PubMed1989

Could the stomach site help predict outcome in babies with left sided congenital diaphragmatic hernia diagnosed antenatally?

The site of the stomach in 36 babies presenting postnatally with left sided congenital diaphragmatic hernia (CDH) was assessed as a predictor of outcome. Babies with a thoracic stomach had a higher mortality (P less than .0005), and more frequently developed significant persistent foetal circulation (PFC) (P less than .001), than babies in whom the stomach was normally sited. Normal stomach site was associated with 100% survival and only a 20% incidence of significant PFC. It is possible that stomach site may be the most accurate predictor of outcome in left-sided CDH diagnosed antenatally, and may thus help in planning perinatal and postnatal management. It may also open the door for prenatal surgical correction of CDH by predicting a poor prognostic group or, perhaps more importantly, by predicting those babies with a good prognosis in whom antenatal surgery should not be attempted.

Female↗