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Biomedical subjects

E Dykes

Publications and source records attributed to E Dykes.

At least 19 recordsLinked to original sources
PubMed2004

Patterns and risks in spinal trauma.

BACKGROUND: Spinal injury in children is rare, and poses many difficulties in management. AIMS: To ascertain the prevalence of spinal injury within the paediatric trauma population, and to assess relative risks of spinal injury according to age, conscious level, injury severity score (ISS), and associated injuries. METHODS: Spine injured children were identified from the UK Trauma Audit & Research Network Database from 1989 to 2000. Relative risks of injury were calculated against the denominator paediatric trauma population. RESULTS: Of 19 538 on the database, 527 (2.7%) suffered spinal column fracture/dislocation without cord injury and 109 had cord injury (0.56% of all children; 16.5% of spine injured children). Thirty children (0.15% of all children; 4.5% of spine injured children) sustained spinal cord injury without radiological abnormality (SCIWORA). Cord injury and SCIWORA occurred more commonly in children aged < or =8. The risk of spine fracture/dislocation without cord injury was increased with an ISS >25 and with chest injuries. The risk of cord injury was increased with reduced GCS, head injury, and chest injury. CONCLUSIONS: Spinal cord injury and SCIWORA occur more frequently in young children. Multiple injuries and chest injuries increase the risk of fracture/dislocation and of cord injury. Reduced GCS and head injuries increase the risk of cord injury.

Age Distribution↗
PubMed2001

Extraluminal migration of a coin in the oesophagus of a child misdiagnosed as asthma.

Ingestion of a foreign body, the commonest being a coin, is a common problem in children. In most cases the coin will pass uneventfully through the gastrointestinal tract. However, on rare occasions it may become lodged in the oesophagus with subsequent extraluminal migration with the potential for serious complications such as vascular fistula or chronic suppurative infection. A case is presented of extraluminal migration of a coin in the oesophageal associated with abscess formation in a 15 month old boy. This case is particularly important because the presenting symptom of wheezing led to the erroneous diagnosis of asthma, which resulted in a three month delay in investigation and treatment. In addition, it raises the issue of whether to perform chest radiography on newly diagnosed asthmatic patients to rule out the presence of a foreign body and thereby prevent serious complications.

Abscess↗
PubMed1998

Bolus intravenous infusion of amino acids or lipids does not stimulate gallbladder contraction in neonates on total parenteral nutrition.

BACKGROUND/PURPOSE: Stimulation of gallbladder contraction in patients receiving total parenteral nutrition (TPN) may be beneficial in preventing cholestatic jaundice associated with TPN. Bolus intravenous administration of either amino acids or fat promotes gallbladder contraction in normal adult volunteers after a period of starvation. This phenomenon has not been investigated in patients receiving continuous TPN. The aim of this study was to test the hypothesis that bolus intravenous infusion of amino acids or fat produces gallbladder contraction in neonates receiving TPN. METHODS: Twenty-eight studies of gallbladder contraction were performed in 18 neonates receiving continuous TPN (median weight, 2.3 kg; range, 1.3 to 7.3; gestational age, 37 weeks; range, 28 to 40; age, 6.5 days; range, 2 to 180). Different types of experiments were performed: (1) bolus intravenous infusion of amino acid or fat for 60 minutes at twice the normal infusion rate; (2) bolus intravenous infusion of amino acid or fat for 15 minutes at four times the normal infusion rate. Gallbladder volume was measured by real-time ultrasonography by a single investigator. Measurements were made before starting the bolus infusion and every 15 minutes for 1 hour. RESULTS: The volume of the gallbladder before bolus intravenous infusion was not significantly different between experiments (median, 985; range, 603 to 1,802 mm3). These volumes are consistent with an enlarged and atonic gallbladder as previously reported in infants receiving parenteral nutrition. In all experiments there was no significant decrease in gallbladder volume after bolus infusion of either amino acids or fat. CONCLUSIONS: Contrary to their effects in adults, bolus infusions of amino acids or fat did not induce gallbladder contraction in neonates on TPN. This may have been because of lack of starvation in the neonates and/or the effect of continuous glucose infusion.

Amino Acids↗
PubMed1997

Prenatal ultrasound diagnosis of gastrointestinal malformations.

Prenatal ultrasonography is commonly used to detect fetal structural abnormalities. The aim of this study was to evaluate the reliability of fetal sonography in the detection of congenital gastrointestinal malformations (GIM). From a prospective database of all major structural fetal anomalies detected by ultrasound over 3 years in a region with a population of 3.5 million and an annual birth rate of 52,000, 294 reports of GIM were identified and reviewed. There were 220 confirmed cases of GIM, of which only 35 (16%) had been correctly identified prenatally. Of 84 prenatal diagnoses of GIM, only 35 (42%) were confirmed postnatally. Prenatal ultrasound was most reliable in the detection of duodenal obstruction (55% confirmed cases identified prenatally) and least reliable in malformations of the hindgut. Of 44 cases of nonspecific sonographic bowel abnormality (eg, echogenic bowel) with adequate follow-up, only 12 (27%) had a confirmed GIM after delivery. This study demonstrates that the prenatal ultrasound scan is still unreliable in the detection or exclusion of fetal GIM, and consequently clinicians involved in prenatal sonography or counselling should exercise caution in making such diagnoses.

Digestive System Abnormalities↗
PubMed1997

A pilot study to determine the order of emergence of permanent central incisors and permanent first molars of children in the Colchester area of the U.K.

Over the period of one calendar month, 505 children in the Colchester area of England were examined. The data gathered from the 12 non-Caucasian children was not used, leaving 493 Caucasian children (255 boys and 238 girls). Their mean age was 6.48 years, with a range of 4.49-8.75 years and 164 children had no permanent teeth leaving 329 children with a total of 2,238 permanent teeth present. A permanent tooth was deemed to have emerged if any part of it was visible in the mouth. The forensic significance of the results of this pilot study are that there is no significant difference (t = 0.407, P > 0.2) between the age of emergence of permanent central incisors (mean age 6.23 years) and permanent first molars (mean age 6.29 years). On the whole, lower central incisors emerge before upper central incisors and there is no significant difference (t = 0.899, P > 0.2) in the emergence times of upper and lower permanent first molars. There is no significant difference (t = 0.876, P > 0.2) in the emergence times of permanent central incisors for boys and girls (6.22 and 6.25 years respectively) and there is no significant difference (t = 1.413, P > 0.1) in the emergence times of permanent first molars for boys and girls (6.40 and 6.08 years respectively).

Age Factors↗
PubMed1996

Cystic hygroma: comparison between prenatal and postnatal diagnosis.

Antenatal diagnosis of congenital malformation often leads to opportunities for intervention in the pregnancy that may have a profound effect on the outcome of the fetus. The accuracy of the diagnostic technique is a critical factor in judging the appropriateness of such interventions. This article reports the current accuracy of prenatal ultrasound diagnosis of cystic hygroma (CH) in a region with a population of 3.5 million and an annual birth rate of 52,000. During a 32-month period (to December 1994), 113 diagnoses of CH were reported to the South East Thames Regional Congenital Malformation Registry. Eighty-nine diagnoses were made prenatally and 24 were made postnatally (at delivery or postmortem). The number of confirmed cases of CH was 52 (46% total diagnoses). The prenatal diagnoses were established at a mean gestational age of 19 weeks. Fifty-six (63%) pregnancies with a prenatal diagnosis of fetal CH were terminated; in only 25% of these was the presence of CH confirmed after termination. Overall, of the 89 prenatal diagnoses, 28 (32%) were confirmed, 45 (50%) were incorrect, and 16 (18%) could not be confirmed or refuted. Only 24% of fetuses with a prenatal diagnosis of CH were live born. The survival rate at 1 year for the live-born infants with CH in this series was 88%. The diagnosis of fetal CH has a recognised association with chromosomal abnormalities, and consequently may lead to termination of the pregnancy. A potential error rate of almost 70% in the prenatal ultrasound diagnosis of this condition requires clinicians to adopt a more cautious approach to the management of the fetus with "cystic hygroma."

Abortion, Eugenic↗
PubMed1996

Impact of antenatal diagnosis on incidence and prognosis in abdominal wall defects.

The authors review data from the Congenital Malformation Registry in South East Thames regarding fetal abdominal wall defects. Over 24 months, 80 cases were observed (40 gastroschisis, 40 exomphalos). Live-born infants with gastroschisis had few associated anomalies and an excellent prognosis (83% survival rate). Exomphalos is associated with an increased rate of life-threatening anomalies and chromosomal defects. The latter cases often are terminated prenatally. If these cases are excluded, the 1-year survival rate for liveborn infants with exomphalos is favorable (close to 80%). Fetuses in whom gastroschisis and exomphalos are identified by ultrasonography but who have no associated life-threatening chromosomal anomalies should have a favorable prognosis.

Abdominal Muscles↗
PubMed1995

Scattered radiation in a neonatal surgical unit.

We studied the doses of "scattered" received by neonates in a Neonatal Surgical Unit by placing thermoluminescent dosemeters in various positions expect the direct beam. Doses of "scattered" radiation received by neonates as a results of exposure of their neighbours to X-ray examinations were found to be negligible. Sick neonates need not be moved from their neighbours undergoing exposure to X-rays.

Humans↗
PubMed1994

Cystic mesothelioma of the peritoneum: a rare cause of 'ascites' in children.

A 2-year-old girl presented with a 3-month history of progressive painless abdominal distension. Results of the clinical examination suggested massive ascites, but no other symptoms or signs could be elicited. There was no history of any other illness preceding the onset of distension. Ultrasonography and a computed tomography scan confirmed gross ascites, with multiple thin-walled loculi throughout the abdomen, from the diaphragm to the pelvis. The preoperative diagnosis was intraabdominal lymphangioma. During laparotomy, multiple transparent cysts were found throughout the peritoneum. There was no evidence of malignancy in any organ, and the cysts appeared almost completely avascular. Histological and ultrastructural appearances were those of benign cystic mesothelioma of the peritoneum, a condition that hitherto has been recognized only in adults. It is thought to represent a borderline variant between a truly benign adenomatoid lesion and the better-known malignant mesothelioma. The experience with adult cases suggests a high potential for recurrence but no progression to malignancy. It is possible that some cases of intraabdominal lymphangioma may have been misdiagnosed in the past; future cases should be fully evaluated, both immunohistochemically and ultrastructurally, to establish the true incidence of mesothelial proliferative disease in children.

Ascites↗
PubMed1994

Accuracy of prenatal diagnosis of congenital cystic adenomatoid malformation.

A series of 13 consecutive patients with a prenatal diagnosis of congenital cystic adenomatoid malformation (CCAM) were reviewed with respect to prenatal ultrasound findings, clinical features at birth, and postnatal outcome. In two cases (15%) the abnormality regressed in utero. Only three infants (23%) showed any respiratory distress at birth. After a mean of 25 months postnatal follow up, 11 patients (85%) were found to have a definite pulmonary abnormality. In seven patients (54%) the specific prenatal diagnosis of CCAM has been confirmed (five histologically, two radiologically). Four infants (31%) were found to have other types of pulmonary abnormality and in two (15%) the lungs remain apparently normal. Prenatal ultrasound appears reliable in the detection of pulmonary abnormalities but the variety of conditions identified postnatally suggests that specific prenatal diagnoses and prognoses should be avoided; prenatal counselling and perinatal management should be adapted accordingly.

Cystic Adenomatoid Malformation of Lung, Congenita↗
PubMed1993

Impaired respiratory function in infants with anterior abdominal wall defects.

Respiratory function at follow-up was assessed in 13 infants who had undergone surgical repair of an anterior abdominal wall defect. Six infants had exomphalos and seven had gastroschisis. The infants were delivered at a median gestational age of 36 weeks (range, 32 to 38 weeks). Respiratory function was assessed by measurement of functional residual capacity (FRC) at a median postnatal age of 5 months (range, 1 to 10 months). Although there was no significant difference in the FRC of the infants with gastroschisis compared with those with exomphalos, the study group's mean FRC (25 mL/kg) was significantly lower than that of 50 healthy control infants (mean, 30 mL/kg; 95% CI, +/- 6 mL/kg). Five infants had an FRC below the 95% confidence limit of the normal range. These data suggest that infants with anterior abdominal wall defects may have impaired antenatal lung growth.

Abdominal Muscles↗
PubMed1993

Accurate measurement of surface areas of anatomical structures by computer-assisted triangulation of computed tomography images.

There is a need for accurate surface area measurement of internal irregular anatomical structures in order to define light dosimetry in adjunctive intraoperative photodynamic therapy (AIOPDT). No satisfactory preoperative method exists of measuring this parameter. We have investigated whether computer-assisted triangulation of serial sections generated by computed tomography (CT) scanning can give an accurate assessment of the surface area of the walls of the true pelvis after anterior resection and before colorectal anastomosis. We have shown that the technique of paper density tessellation is an acceptable method of measuring the surface areas of phantom objects, with a maximum error of 0.5%, and is used as the gold standard. Computer-assisted triangulation of CT images of standard geometric objects and accurately-constructed pelvic phantoms gives a surface area assessment with a maximum error of 2.5% compared with the gold standard. The CT images of 20 patients' pelves have been analysed by computer-assisted triangulation and this shows that the surface area of the walls varies from 143 cm2 to 392 cm2. Simple step-like analysis of images and approximation to geometric shapes with subsequent calculation give unacceptably high errors. The surface area of an internal, rigid, irregular surface area for illumination in AIOPDT can be accurately measured preoperatively by computer-assisted triangulation of CT images.

Anthropometry↗
PubMed1993

Three-dimensional reconstruction: methods of improving image registration and interpretation.

(i) Image registration. The use of serial images for computerised three-dimensional reconstruction necessitates the inclusion of three separate sources of information at the stage of data input. These are (i) artificial registration points or fiducials, (ii) a calibration scale and (iii) an outline of each slab of the section to be included in the reconstruction. Most traditional methods rely on the production of drawings of the contours of the structure under investigation which also include both registration points and a calibration scale. We report on a method which considerably reduces the time involved at this labour intensive stage of reconstruction and in addition allows subsequent reconstructions of different structures to be performed without new drawings. Use is made of computerised alignment of tissue sections and the production of composite photomicrographs of both the tissue under investigation and an accurately registered stage micrometer scale. (ii) Improving image interpretation. Images derived from computerised three-dimensional reconstruction can be affected by the number of coordinates used to form the contour of each slice of a structure and by the number of slices that are used to construct the final model. Too little or too much data can considerably reduce the ability of the observer to interpret accurately the image generated by the computer. We report on a feature-based method which enables the experimenter to assess objectively the amount of data required in the two-dimensional plane, i.e. the number of data points per slice, and the three-dimensional plane, i.e. number of slices per structure, so that optimal reconstructions are generated.

Computer Graphics↗
PubMed1990

Thoracic vascular injuries: a post mortem study.

We reviewed the coroner's records for all pediatric (less than 16 years of age) trauma fatalities in Ontario (population, 9.5 million) for the period January 1, 1985, through December 31, 1987. Twenty-six (8%) of the 322 cases for which complete autopsy data were available had major thoracic vascular injuries. Twenty-five deaths occurred within 6 hours of injury. The majority of patients had at least one AIS 6 injury. The aorta was the most frequently injured vessel. Major thoracic vascular injuries are more common among children than previous reports suggest, probably because they are rapidly fatal. Many deaths occur in the field, at local hospitals, or in transit before the patient can reach a trauma center. Efforts to reduce the number of total thoracic vascular injuries should focus on primary and secondary prevention.

Adolescent↗
PubMed1984

Computer-generated three-dimensional visualization of the trigeminal nuclear complex.

The spatial configuration of the trigeminal nuclear complex has been determined using new computer techniques aided by color graphic display facilities. Precise, statistical computer-generated drawings are provided of the three-dimensional anatomy of the nuclear complex and spinal tract of the fifth cranial nerve, as well as adjacent structures. Techniques for viewing these structures from variable directions and producing stereopairs are presented.

Computers↗