Biomedical subjects
Publications and source records attributed to H H Nixon.
The intestinal obstruction of duodenal atresia needs urgent differential diagnosis from malrotation with its risk of midgut volvulus and gangrene. There is an uncommon variant with a high incidence of familial recurrence, and a significant association with Down's syndrome, although the majority of the babies are otherwise normal. Oblique end-to-end anastomosis around the atresia is the preferred treatment and has a high success rate.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Cytopathic toxin neutralized by Clostridium sordellii antiserum was found in the feces of seven out of 13 children with Hirschsprung's disease complicated by enterocolitis (54%). Clostridium difficile was isolated from ten of these 13 children (77%). The frequency of fecal toxin positivity, the magnitude of toxin titers, and the isolation rate of C difficile were all significantly greater in children with Hirschsprung's enterocolitis than in children whose Hirschsprung's disease was not complicated by enterocolitis or in children without Hirschsprung's disease. It is suggested that C difficile may be causally related to enterocolitis in Hirschsprung's disease, but the age distribution of positive results indicates that the major etiologic role is confined to children under three years of age. Vancomycin was found to be an effective form of treatment in the children with enterocolitis in whom it was employed.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
This study is based on 150 patients whose first symptoms of inflammatory bowel disease (IBD) appeared before puberty between 1955 and 1979. Recurrence of disease after improvement on medical treatment occurred within a shorter time in Crohn's disease than in ulcerative colitis. In this series it was twice as probable for surgery to be required within the first five years of illness for a child with Crohn's disease than for a child with ulcerative colitis. Median relapse time after medical treatment was 11 months for ulcerative colitis and 15 months for Crohn's disease, and the median relapse time after surgical treatment (including "incomplete" procedures) was over seven years for ulcerative colitis and just under five years for Crohn's disease. In ulcerative colitis it is suggested that earlier surgery might save the patient a period of distressing symptoms and reduce the risk of recurrence.
Continence depends on many factors; hence, management varies depending on individual deficiencies be they motor, sensory, anatomic, psychological, local or general. As would be expected, correctly performed primary operation has produced better results than secondary salvage surgery. The high (supralevator) anomalies lack an internal sphincter. This is believed to be the reason that the best results do not approach those of low (infralevator) anomalies. Continence in patients with high anomalies is slowly learned, as opposed to the natural development of continence at the normal time in individuals with low anomalies. Although the puborectalis sling is accepted as the most important muscle in continence, true normal as opposed to socially satisfactory continence requires an internal sphincter as a persistently tonic "anti-leak" device. The orthodox pull-through operations add to problems with continence by removing specific rectal sensation and, hence, the reflex between the rectal distension and the striated muscle of the pelvic floor. Early operation on high anomalies to allow of "minimal mobilisation" before disuse retraction of the rectal ampulla is, therefore, being reassessed. Many neuropathic patients, e.g. those with spina bifida, acquire satisfactory learned continence by voluntary efforts with or without a regimen of aperients or enemas. A minority have an automatic rectum responding to a small volume of stool and/or an active colon producing a loose stool. These patients may benefit by the recently available drug Loperamide. Our incontinent patients are assessed by anorectal manometry, barium defaecogram, as well as by examination and pelvic floor stimulation under general anaesthesia. Treatment may include: 1) a training regimen with or without drugs, e.g., Loperamide; 2) local anoplasty for stenosis or redundant mucosa; 3) levator plasty if the levator is active though not effecting closure of the lumen; 4) bilateral gracilis sling (not the original ring technique) if the levator is not active due to iatrogenic damage or neuropathy. In assessing the results, it is important to recognise the frequent spontaneous improvement in continence around puberty. Although present techniques have seemed unreliable, use of gluteus maximus, a natural synergist, should have therapeutic potential. A satisfactory technique for an internal sphincter substitute appears to be the most urgent present need.
Explore the source record for details and available documents.
An operative technique is described for the management of babies with esophageal atresia, where primary anastomosis is either impossible or unsuccessful. The procedure has been performed on six patients. One infant subsequently required resection of a resultant stricture, and one developed a recurrent tracheoesophageal fistula. All six infants required several esophageal dilatations. No patient required dilatation beyond the age of 5 months and all are now swallowing normally and thriving.
Two newborn infants with megacystis-microcolon-intestinal hypoperistalsis syndrome are described. Review of the literature revealed twenty previously reported cases of this syndrome. Electron microscopic examination of the ileum and urinary bladder showed vacuolar degenerative changes in the smooth muscle cells with abundant amount of connective tissue between the muscle cells. These ultrastructural findings suggest that a degenerative disease of smooth muscle may be the cause of megacystis microcolon intestinal hypoperistalsis syndrome.
150 patients whose first symptoms of inflammatory bowel disease (IBD) presented before puberty were seen at this hospital between 1955 and 1979. Ulcerative colitis with the rectum less severely involved than the colon was commoner than usually reported in adults. Colectomy with ileorectal anastomosis allowed these children to go through school life and adolescence without an ileostomy. Failure of medical treatment was much commoner in those presenting with already total colonic involvement. Children with Crohn's disease were twice as likely to come to surgery within the first five years of illness than those with ulcerative colitis. Delayed diagnosis (mean 2.6 years) was much greater in Crohn's disease, especially in the 25% presenting initially with failure to thrive and no specifically alimentary symptoms.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.