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Biomedical subjects

J D Atwell

Publications and source records attributed to J D Atwell.

At least 37 records · Page 2Linked to original sources
PubMed1986

Microproteinuria in children with vesicoureteric reflux.

Microproteinuria was assessed by the measurement of albumin, retinol binding protein (RBP) and creatinine concentrations in random midstream urine samples using a single enzyme linked immunoassay (ELISA) in 36 children with vesicoureteric reflux (VUR) and 36 control patients. Infection was excluded by culture and microscopy of the specimens of urine. No patient was hypertensive. Albumin excretion increased in patients with increasing severity of VUR and with renal scarring. Similar findings were observed with RBP excretion. The results show that glomerular and tubular handling of proteins is altered in VUR. The degree of microproteinuria correlates well with the severity of the VUR and is evidence of tubular dysfunction. The effects of medical management and anti-reflux surgery on microproteinuria require further evaluation.

Adolescent↗
PubMed1985

Nodular lymphoid hyperplasia of the intestinal tract in infancy and childhood.

Over an 18-year period we have diagnosed nodular lymphoid polyposis of the intestinal tract in 6 patients. The site of the polyposis, which was due to prominent lymphoid hyperplasia, was ileal (3), colonic (2), and rectal (1). The diagnosis was made following complications arising from the polyps, which included recurrent intussusception (2), rectal prolapse (1), intestinal or pseudointestinal obstruction (2), and rectal bleeding (1). Immunoglobulin staining was performed on all the bowel specimens and in every case secretory IgA was present on the mucosal surfaces and IgG and IgA were seen in the lamina propria, thus excluding immunodeficiency in these patients. Viral studies were performed in 3 patients and all were positive. In one patient Echovirus II was seen in tissue homogenate from a mesenteric lymph node and in another, adenovirus type II was cultured from lymphoid polyps of the rectum. A further patient had positive serological tests for adenovirus. Thus it appears that nodular lymphoid hyperplasia is part of the generalized lymphoid hyperplasia associated with viral infections in infancy and childhood. Immunodeficiency states as a cause of the lymphoid hyperplasia should always be excluded by estimation of serum immunoglobulins.

Child↗
PubMed1985

Familial pelviureteric junction hydronephrosis and its association with a duplex pelvicaliceal system and vesicoureteric reflux. A family study.

The incidence of pelviureteric junction (PUJ) hydronephrosis and a bifid pelvicaliceal collecting system was determined in the parents and siblings of 19 patients with PUJ hydronephrosis. The high incidence of hydronephrosis in first degree relatives supports the hypothesis that PUJ hydronephrosis is inherited by an autosomal dominant gene of variable penetrance. There is a genetic inter-relationship between PUJ hydronephrosis and a bifid pelvicaliceal system and therefore indirectly between vesico-ureteric reflux and paraureteric diverticula. Ultrasound screening of the children of adults with PUJ hydronephrosis may lead to earlier diagnosis and treatment, thus preventing renal damage.

Adult↗
PubMed1985

Ascent of the testis: fact or fiction.

Ascent of the testis from the normal to an undescended position has been observed in 10 patients. In 9 of them there was a complete hernial sac and it is suggested that the acquired malposition of the testis is due to partial absorption of the processus vaginalis into the parietal peritoneum. Alteration in the length of the inguinal canal with growth may be an additional contributory factor. The mean interval between the original and subsequent observations was 5.2 years, leading to a late orchiopexy at a mean age of 9.4 years.

Adolescent↗
PubMed1985

Family adjustment to the early loss of a baby born with spina bifida.

Sixteen families were contacted two to seven years after the death of their spina-bifida baby following transfer to a specialist unit and the parents' subsequent decision against active treatment. There was little evidence of serious long-term problems of adjustment on any of the measures assessing marital relationships, parental physical and mental health, and decisions about later pregnancies. Parents welcomed the unit's policy of encouraging frequent contact with their baby, and thought that it had facilitated the grieving process.

Adaptation, Psychological↗
PubMed1985

A prospective survey of the indications and morbidity of circumcision in children.

Both the British Medical Association and the American Academy of Pediatrics recommend that circumcision should only be performed for medical reasons. No one has ever described which reasons are actually used, nor measured the morbidity of the procedure. Of 140 boys coming to day-case elective circumcision between the ages of 3 months and 14 years (mean 4.3 years), the commonest cause was a congenital phimosis (42.8%). Four (2.8%) patients required acute readmission postoperatively, and a further 4 developed meatal stenosis, requiring a formal meatotomy. Of 99 patients followed up in detail, 46% vomited, 36% oozed, 19% did not pass urine for more than 12 h and 26% could not wear pants for more than 7 days. Childhood circumcision has an appreciable morbidity, and should not be recommended without a medical reason.

Adolescent↗
PubMed1983

Posterior urethral valves in the British Isles: a multicenter B.A.P.S. review.

The management of 108 patients with posterior urethral valves from 7 pediatric surgical centers has been reviewed. All the patients have been treated in the 10 year period since 1970. 53 were under 3 mo of age at presentation (Group I), 8 between 3 mo and 1 yr (Group II), 22 between 1 and 5 yr (Group III), and 25 over 5 yr of age (Group IV). Under 5 yr of age urinary infection (37) and renal failure (22) were the commonest methods of presentation. Over 5 yr of age diurnal and nocturnal enuresis were the commonest symptoms. Endoscopic fulguration of the valves with or without preliminary catheter drainage has been the treatment of choice. Repeated fulguration of residual valve cusps was often required. The incidence of urethral stricture (2 patients) was highest after the use of the resectoscope. Refashioning and reimplantation of the ureters is associated with a high complication rate and is not recommended. Secondary operations on the bladder neck have been avoided in this series due to the risk of incontinence. 8 patients died (7.4%) and 7 of these deaths occurred in patients presenting under 3 mo of age. One patient died from renal failure 7 yr after the diagnosis of posterior urethral valves at 2 yr of age. It is suggested that the high mortality from renal failure in the group presenting early is related to renal dysplasia.

Child, Preschool↗
PubMed1983

Changes in the mucosa of colon conduits with particular reference to the risk of malignant change.

Intestinal suction biopsies were obtained in 15 infants and children with cutaneous colo-ureterostomies. The patients were subdivided into groups according to the length of time the conduit had been established, i.e. less than 5 years, 5 to 10 years, 10 to 15 years and over 15 years. The histological changes found were chronic inflammation with a dense infiltration of plasma cells and eosinophils. The changes were progressive and correlated with the length of time the conduit had been established. As persistent chronic inflammation is a precursor of malignancy, it seems likely that there is a risk of malignant change in these conduits. Regular follow-up of such patients is recommended and should include flexible fibreoptic endoscopy of the conduit.

Adolescent↗
PubMed1983

Renal dysplasia and duplex kidneys.

34 children with double ureters (n = 26), bifid ureters (n = 7) or bifid renal pelvis (n = 1) had heminephrectomy, leaving a normal portion of kidney. Patients with ectopic ureteroceles and ectopic ureters had upper pole lesions (18 of 18) whilst the lower pole was more often involved in those with vesico-ureteric reflux (9 of 11). Histological changes of renal dysplasia were present in both upper and lower pole lesions, being generally less severe at the lower pole. These findings suggest that prolonged urinary obstruction plays a major role in the formation of dysplasia in developing kidneys.

Child↗
PubMed1982

Vesico-ureteric reflux in the neuropathic bladder with particular reference to the development of renal scarring.

96 unselected and consecutive patients with myeloceles (n = 75), meningomyeloceles (n = 17) and lipomatous meningomyeloceles (n = 4) were admitted to the Wessex Regional Paediatric Surgical Centre between 1st July, 1969, and 31st December, 1971, for early closure of the spinal defect. Intravenous pyelography and cystography were performed in the first month following closure of the back and repeated at 1, 3 and 5 years of age and at 4 months in patients with upper tract dilatation or vesico-ureteric reflux at the initial examination. The mortality was 30.2% in the first year of life. Primary associated renal anomalies were found in 10.4%. Vesico-ureteric reflux was present in 18 patients by 1 month of age (28%) and in 29 patients by 5 years of age (45%). New renal cortical scars developed in 9 patients. Urinary infection, intrarenal reflux and a bladder with a high urethral resistance were factors of aetiological significance.

Child, Preschool↗
PubMed1981

Congenital hypertrophic pyloric stenosis and associated anomalies in the genitourinary tract.

Genitourinary anomalies were looked for in patients with congenital hypertrophic pyloric stenosis. In a prospective series of 64 patients investigated by intravenous pyelography, 13 were abnormal (20.6%). In a retrospective series of 232 patients, 6 had anomalies of the upper urinary tract (2.7%). In this latter series the incidence of inguinal hernia (3.4%), undescended testes (3.0%), and hypospadias (0.9%) was determined. In another 10 patients urinary tract anomalies (5), urinary infection (2), and a significant family history (3) were found associated with congenital pyloric stenosis. As the incidence of these anomalies is greater than expected, which suggests an interrelationship, a hypothesis has been proposed linking genetic factors and the metabolism of gastrin with the etiology of congenital hypertrophic pyloric stenosis.

Female↗
PubMed1981

Growth of the kidney following unilateral antireflux surgery.

Measurements of the mean renal lengths pre-operatively, 3 months, 1, 3 and 5 years post-operatively in patients with unilateral reflux showed that renal growth accelerates unilateral antireflux surgery. The growth spurt was confined to the first post-operative year and was maximal in the first 3 months following operation and was identical in both kidneys. The cause of these alterations in renal growth are obscure but freedom from infection, increased dietary intake and improved concentrating ability of the kidney are significant factors.

Child↗
PubMed1980

Observations on the role of esophagogastrostomy in infancy and childhood with particular reference to the long-term results and operative mortality.

Esophagogastrostomy is a satisfactory method of restoring continuity of the esophagus with minimal long-term effects on growth and development. Anemia or reflux oesophagitis is not a complication of the operation provided the anastomosis is high in the thoracic cage, i.e., above the level of the aortic arch. Postural gastritis secondary to regurgitation of bile was not seen in our patients. The mortality of the operation is high (33%) but this is due to the small number of patients in whom it is indicated. This contrasts markedly with the results in adults where the mortality in large series has fallen to low levels (13%). Thus, esophagogastrostomy should retain a place in selected patients for the primary treatment of esophageal atresia and the high esophageal stricture.

Child↗
PubMed1980

The paraureteric diverticulum in childhood.

The clinical features and the results of surgical treatment in 27 children with a paraureteric diverticulum treated between 1969 and 1979 were reviewed. The condition is commoner in males. Vesicoureteric reflux and double ureters were associated findings and together with the diverticulum accounted for the high incidence of urinary infection as a presenting feature. In only 2 patients with the diverticulum seen on excretion urography, but micturating cystography confirmed the diagnosis in 24 patients. Conservative treatment with continuous chemotherapy is satisfactory when the diverticulum is small and prior to the development of vesicoureteric reflux. In the later stages, excision of the diverticulum and reimplantation of the contiguous ureter is the surgical treatment of choice.

Child↗
PubMed1980

The interrelationship between paraureteric diverticula, vesicoureteric reflux and duplication of the pelvicaliceal collecting system: a family study.

The incidence of a bifid pelvicaliceal system, vesicoureteric reflux, its sequelae and paraureteric diverticulum was determined in the patients and siblings of 22 patients with a paraureteric diverticulum. The results support the hypothesis that there is a direct genetic relationship between a paraureteric diverticulum, duplication of the pelvicaliceal system and vesicoureteric reflux. This suggests that the vesicoureteric reflux associated with a parauretic diverticulum is primary and related to lateral ectopia of the ureteric orifice. This syndrome complex may be inherited by multiple genes producing a cumulative effect, thus determining the length of the intravesical ureter, or by an autosomal dominant gene of variable penetrance.

Diverticulum↗