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Biomedical subjects

E H Dykes

Publications and source records attributed to E H Dykes.

At least 19 recordsLinked to original sources
PubMed2001

Patterns of management of intussusception outside tertiary centres.

BACKGROUND/PURPOSE: Intussusception is a common problem in young children and should have an excellent outcome in expert hands. Many children are treated in district general hospitals (DGH), which do not have specialist paediatric surgeons. The aim of this study was to clarify current patterns of management for such patients. METHODS: The authors conducted a postal survey of DGH consultant paediatricians, radiologists, and general surgeons in a populous region of England. RESULTS: One hundred forty-one (44%) consultants who responded comprised similar proportions of consultants from each specialty. Most respondents (79%) thought that in their location paediatricians should take responsibility for resuscitation of children with suspected intussusception. Two-thirds indicated that abdominal ultrasound scan, either alone or in combination with another modality, was their investigation of choice for confirming the diagnosis. Preferences for contrast medium for radiologic reduction varied; paediatricians favoured air (46%) or saline (28%), surgeons preferred water-soluble contrast (58%), and radiologists preferred to use barium (49%). Fifty-three percent of consultants indicated they would transfer a child with confirmed intussusception to a tertiary centre before attempting reduction, 42% would attempt reduction locally, and 5% would operate locally without attempting radiologic reduction. After failed reduction, a further 23% of consultants would consider transfer, but the remainder would operate locally. Only 13% of paediatricians thought that their surgeons had appropriate facilities and support to operate on intussusception, but 36% of surgeons claimed to be doing so. Most consultants (84%) admitted seeing fewer than 5 cases per year; 98% of surgeons were in this group. Only 16% of consultants (mostly paediatricians) were aware of any written clinical policy for managing paediatric intussusception in their hospital. CONCLUSION: This study shows that the management of paediatric intussusception outside tertiary centres is not uniform or standardised, and that improvements are necessary. J Pediatr Surg 36:312-315.

Case Management↗
PubMed1996

Prenatal diagnosis and management of abdominal wall defects.

The widespread use of fetal ultrasonography in routine antenatal care now allows the majority of abdominal wall defects to be identified prenatally, with subsequent opportunities for parental counseling, fetal intervention, and optimal perinatal management. Outcome is significantly affected by the presence of additional structural or chromosomal malformations; appropriate multidisciplinary counseling and management is dependent on the early identification of such anomalies in addition to accurate delineation of the abdominal wall defect itself. In cases with associated lethal or multiple severe abnormalities, parents may opt for elective termination of the pregnancy. Serial sonography is of particular value in gastroschisis, but there is little evidence that fetal manipulation or premature delivery confers any significant benefit. For all types of abdominal wall defect, optimal perinatal management is achieved in centers where neonatal medical, surgical, and anesthetic expertise is immediately available; cases diagnosed in units without these services should be considered for in utero transport to the nearest perinatal center.

Abdominal Muscles↗
PubMed1994

A new method of intestinal salvage for severe small bowel ischemia.

The morbidity and mortality in short bowel syndrome are directly related to the length of the remaining small bowel and to the duration of total parenteral nutrition. We describe the successful salvage of an infant with extensive small bowel infarction for whom a new technique was used to preserve all viable mucosal surfaces. The infant, with gastroschisis, was found to have a tight volvulus of the extruded bowel and extensive small bowel ischemia at the time of delivery. Forty-eight hours after reduction of the volvulus and abdominal decompression, a second-look laparotomy was performed. Although only the terminal 13 cm of ileum was completely viable, 25% of the circumference of a further 23 cm of proximal jejunum/ileum was considered salvageable. After debridement of the dead tissue, the remaining gutter of jejunum was divided at its midpoint, and the two halves were anastomosed longitudinally to provide a "neojejunum" of 12 cm in length, which was anastomosed between the duodenum and terminal ileum. Full enteral feeding was tolerated from day 47. Although the neojejunum was excised on day 149, after becoming dilated and atonic, by that time the remaining small bowel had elongated to 30 cm. Because of the early institution of full enteral feeding, there were no long-term complications related to total parenteral nutrition.

Abdominal Muscles↗
PubMed1994

Intrathoracic extra-mediastinal cystic hygroma in infancy.

An infant with intrathoracic extra-mediastinal cystic hygroma is described. Fluid collection within the fetal chest was noted on routine antenatal ultrasound scan and this was subsequently drained. Postnatally, echocardiogram and thoracic CT scan demonstrated a cystic space between the pericardium and right mediastinal pleura. Thoracotomy performed at six weeks of age showed a multiloculated cystic mass adherent to the right pericardium and to the medial aspect of the diaphragm. Histology revealed the tumour to be a cystic hygroma (lymphangioma). Intrathoracic cystic hygroma occurring outside the mediastinum is extremely rare and has never been diagnosed previously in infancy.

Humans↗
PubMed1993

Abnormal aorta and iliac arteries in children with urogenital abnormalities.

Retroiliac ureters have been found in association with a variety of urogenital abnormalities but the iliac artery usually retains a retroperitoneal position. We report 7 children with various urogenital abnormalities (cloacal malformation 4, bladder agenesis 1, urogenital sinus 1, neuropathic bladder 1) in whom the lower aorta and iliac arteries were so distorted as to pose a significant operative hazard. In all cases the distal aorta and/or iliac arteries lay within the peritoneal cavity, often anterior to the bladder. In 3 cases the aorta was fixed by a short ligament to the umbilicus, and in 3 patients one of the iliac arteries ran across the pelvis behind the pubic bones before entering the leg. In one patient an anomalous iliac artery was inadvertently divided during reconstruction of a cloaca; when recognized, the vessel was rejoined. Recognition of an association between urogenital or cloacal malformations and a major vascular anomaly is of great importance to reconstructive surgeons who, if not forewarned, could unintentionally compromise the arterial supply to one or both lower limbs.

Abnormalities, Multiple↗
PubMed1993

Fatal bicycle accidents in children: a plea for prevention.

We reviewed the coroner's records of all fatal bicycle accidents occurring in children (aged 0 to 15 years) in Ontario (pediatric population, 2,007,230) between January 1, 1985 and December 31, 1989. The injuries sustained were documented and scored with anatomical injury scores (Abbreviated Injury Score 1985 and Injury Severity Score) and categorized as unsurvivable or survivable. The causes and circumstances were documented from police accident reports. Eighty-one deaths resulted from bicycle accidents, an annual mortality rate of 1.44 deaths per 100,000 children per year. In 74 (91%) of these cases the injuries were deemed unsurvivable, 89% of which were head injuries. Seventy-eight (96%) of the deaths resulted from collisions with motor vehicles. No victim was wearing a helmet at the time of injury. In 70% of the deaths, the cyclist was considered to have caused the collision, either because of a violation of a road traffic law or poor road sense. These findings suggest that more emphasis should be placed on primary and secondary injury prevention by such methods as bicycle safety education for children and the promotion of bike helmet use. In addition, in view of the high incidence of unsurvivable head injury, the introduction of legislation requiring the use of protective helmets should be considered.

Abbreviated Injury Scale↗
PubMed1993

Prenatal diagnosis of gastroschisis: development of objective sonographic criteria for predicting outcome.

OBJECTIVE: To determine which sonographic findings predict intestinal damage in fetuses with gastroschisis, and to develop objective criteria that may be useful in selecting candidates for preterm delivery. METHODS: Twenty-four consecutive fetuses at two perinatal centers were assessed retrospectively or prospectively. Maternal, perinatal, and sonographic data were recorded and correlated with postnatal outcome. RESULTS: Bowel diameter of at least 18 mm was associated with a significantly longer time to oral feeding and with significantly greater need for bowel resection. When gestational age was plotted against bowel diameter, a threshold curve was generated, above which all patients had prolonged hypoperistalsis and below which only 30% had prolonged hypoperistalsis. Two infants were delivered at 33 weeks' gestation, both of whom had complications potentially related to prematurity. Only one of 22 patients who delivered later than 33 weeks had similar complications. CONCLUSIONS: Bowel dilatation may be a marker of prenatal bowel damage in fetuses with gastroschisis, especially when it presents late in gestation. Prenatal sonography may be useful in selecting appropriate fetuses for preterm delivery.

Abdominal Muscles↗
PubMed1992

Gastrocystoplasty in children.

We report our experience of gastrocystoplasty in 8 children (mean age 10.1 years) with compromised renal function (mean creatinine 186 mmol/l, mean glomerular filtration rate 39 ml/min/1.73 m2). Current follow-up ranges from 11 to 35 months (mean 21). The physiological outcome of the procedure has been excellent, with improved biochemical and urodynamic parameters in all cases. Six patients are off H2-receptor blockers and are asymptomatic. In 2 children we have encountered significant symptoms related to acid secretion in the bladder. Detailed investigations suggest that the excess aciduria is related to the size of the gastric patch in 1 patient. The second child underwent renal transplantation 5 months after gastrocystoplasty and it is postulated that his immunosuppressive regimen (which includes prednisolone) may be responsible for the increased acid secretion. It is concluded that gastrocystoplasty is a very satisfactory alternative to intestinal segment bladder enhancement in children with compromised renal function, but the size of the gastric patch is critical in determining the resultant acid secretion. Post-transplantation immunosuppressive therapy may increase acid production from the gastric patch; since the children most suitable for gastrocystoplasty are also those likley to require transplantation, this aspect requires further study.

Adolescent↗
PubMed1991

Fetal renal artery blood velocimetry in multicystic kidney disease.

Color flow mapping and Doppler velocimetry were used to measure impedance to flow in both renal arteries of 11 fetuses with unilateral multicystic kidney disease at 19-34 (mean = 26) weeks' gestation. In all cases, the pulsatility index in the renal artery of the multicystic kidney was higher than that of the contralateral normal kidney; the mean pulsatility index in the arteries of the affected kidneys was significantly higher than the normal mean for gestation.

Journal Article↗
PubMed1991

The use of the Mitrofanoff principle in achieving clean intermittent catheterisation and urinary continence in children.

The Mitrofanoff principle has been used to achieve clean intermittent catheterisation (CIC) and urinary continence in 28 children. The mean age at operation was 10.1 years (range, 1 to 19 years). A catheterisable conduit was created using the appendix (19), ureter (8), or vas deferens (1). CIC was commenced 10 to 28 days postoperatively (median, 15 days). After a mean follow-up of 13 months (range, 2 to 45 months), 24 children (86%) have achieved successful CIC and urinary continence. Use of the Mitrofanoff principle is a valuable adjunct to the treatment of urinary incontinence in children and may allow successful CIC in patients who are unable to catheterise urethrally.

Adolescent↗
PubMed1991

Risks and benefits of percutaneous biopsy and primary chemotherapy in advanced Wilms' tumour.

Between 1982 and 1988, 36 children with advanced Wilms' tumour underwent percutaneous trucut needle biopsy followed by chemotherapy before definitive surgery. Nephrectomy was performed after a median of 14 weeks of chemotherapy. Substantial reduction in tumour bulk was achieved in 94% of patients. Biopsy morbidity was low and complete concordance between the histological assessment of the tumour in the biopsy specimen and at subsequent nephrectomy was confirmed in 26 of 28 (93%) patients. The overall clinical value of trucut biopsy was 83% (30/36 patients). Survival rates in this high-risk group were comparable to those of children with less advanced disease. Chemotherapy may be the primary treatment of choice for patients with Wilms' tumour. Percutaneous biopsy allows definition of histology in most patients without increasing morbidity.

Adolescent↗
PubMed1990

Reduced tracheal growth after reconstruction with pericardium.

Four groups of piglets were used to test the use of pericardium and periosteum as free grafts in the repair of full thickness cervical tracheal defects. Pericardium provided an airtight, rapidly healing graft, but did not give sufficient structural rigidity to prevent narrowing and growth failure at the graft site. Composite grafts of pericardium and periosteum were also unsatisfactory, in that the periosteum failed to produce enough bone to prevent collapse of the graft. Since previous studies have shown that periosteal grafts result in good bone formation when applied alone or as an extramucosal support, it is concluded that the osteogenic potential is dependent on the available blood supply and speed of revascularization. It appears that the presence of pericardium in the composite grafts may have inhibited this property.

Animals↗
PubMed1989

Surgery for neonatal necrotising enterocolitis in Ireland 1980-1985.

Forty-seven infants were operated on for necrotising enterocolitis (NEC) in Ireland in a 6-year-period from 1980 to 1985. Incidence for surgical NEC in Ireland is 1/8733 live births. 44/47 patients were operated on during the acute phase and 3 patients had elective resection of strictures following conservative management. Indication for surgery in the acute phase was pneumoperitoneum in 37 infants. The initial procedure was: drainage alone in 10 patients, laparotomy and defunctioning enterostomy in 18, resection of the necrotic segment and proximal enterostomy in 15. 27/44 acute patients survived giving an overall mortality of 38.6% for acute NEC but mortality directly related to NEC was 31.8%. There was an inverse relationship between mortality and age at surgery. Medical treatment included total parenteral nutrition (TPN) in all patients for a mean time of 20.5 days.

Cohort Studies↗
PubMed1989

Preventable pediatric trauma deaths in a metropolitan region.

All pediatric trauma deaths occurring in metropolitan Toronto (population, 2.2 million) in 1986 were analyzed from the regional coroner's records. Injuries sustained were scored using the Abbreviated Injury Scale (1985; AIS) and Injury Severity Score (ISS). Victims with injuries graded AIS 6 (any region), AIS 5 head/neck (excluding acute epidural hematoma), or ISS greater than 59 were deemed unsalvageable. All other injuries were considered survivable and the deaths from them preventable. Use of these objective criteria indicated that 8/38 of the children (21%) who died from trauma had survivable injuries. Since in three cases medical aid was not sought because of social circumstances, 5/38 (13%) was considered a realistic estimate of preventable death rate (PDR). These results suggest that when objective criteria are used, the PDR in pediatric trauma may be less than that reported in adult trauma victims. Defining the PDR on the basis of objective criteria may prove useful in the conduct of further studies of this kind and permit valid comparisons to be made.

Adolescent↗
PubMed1989

Total colonic aganglionosis.

All cases of total colonic aganglionosis (TCA) diagnosed in Dublin, Ireland, from 1978 to 1986 are reviewed. Nine patients were found to have TCA, and eight have undergone definitive surgery. There have been no deaths, and all patients are continuing to thrive. The diagnostic and operative features of the disease are described.

Female↗
PubMed1989

Evaluation of pediatric trauma care in Ontario.

Three hundred sixty-seven consecutive pediatric trauma deaths which occurred in Ontario between 1985 and 1987 were analyzed from the coroners' records. Injuries were classified as survivable or unsurvivable, and a preventable death rate of 20% was identified. Rural preventable deaths occurred mainly before arrival at hospital, but 55% of urban preventable deaths occurred in hospitals. The causes of death in children with survivable injury suggest that the institution of prehospital resuscitation and improvement in trauma care education for physicians might reduce mortality. The high incidence of unsurvivable injury suggests that injury prevention will be more cost effective in the long term.

Adolescent↗