Vitamin K administration in the newborn: statement by Fetus and Newborn Committee of Paediatric Society of New Zealand.
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Administration, Oral↗
Biomedical subjects
J Doran
Publications and source records attributed to J Doran.
Disruption of the cystic fibrosis transmembrane conductance regulator gene in embryonic stem cells by gene targeting.
We have successfully disrupted the cftr (cystic fibrosis transmembrane conductance regulator) gene at its endogenous locus in embryonic stem cells by gene targeting. We are using a double replacement strategy to introduce subtle mutations into exon 10. We report here the first step of creating a null mutation by insertion of a functional hprt (hypoxanthine phosphoribosyl transferase) mini-gene into exon 10 of the cftr gene. Targeted embryonic stem cell clones were identified by PCR screening and confirmed by Southern blot analysis. One of the cftr targeted clones has been injected into recipient blastocysts and shown to contribute to chimaeras. The targeted clones will now be used as the starting point for a second gene targeting step to remove the hprt gene in exon 10 with the concomitant introduction of the delta F508 mutation or other mutations.
Animals↗
Use of the ultrathin choledochoscope in cholecystectomy.
Use of the ultrathin choledochoscope (2mm) was evaluated in 80 patients undergoing routine cholecystectomy. It was used successfully in 67 (84 per cent) patients. There were eight (12 per cent) explorations of the common bile duct and no negative explorations. The instrument was helpful in determining the nature of an equivocal on-table cholangiogram. The ultrathin choledochoscope may be useful in reducing the rate of negative common bile duct exploration.
Adult↗
First aid and first aiders who work in health food, processing and light engineering in Nottingham.
One hundred and forty nine first aiders working in a health authority, 26 in a light engineering company and 35 in food processing plants completed an anonymous questionnaire about their training and first aid work. Information was also gathered on views about its value, the role of cash bonuses and its promotion amongst other staff. The response rate was 88%. The majority of first aiders were in their 30s and had practised first aid for less than a decade. At least 80% intended to revalidate their certificate and continue to practise. First aid was used most in food processing plants and least in the health authority. Offers of help had seldom been refused. Over 90% of respondents thought first aid was worthwhile.
Data Collection↗
An objective long-term evaluation of the Angelchik antireflux prosthesis.
This paper reports the long-term results of the Angelchik antireflux prosthesis (ACP) in Nottingham from October 1981 to December 1989 in 42 patients with gastrooesophageal reflux disease (GORD). Pre- and postoperative oesophagoscopy, pH monitoring, acid reflux provocation test (ARPT), manometry and symptom evaluation were documented to assess the benefits of the procedure. There were no operative complications, dysphagia was the commonest postoperative problem and necessitated the removal of four ACPs. In most patients, dysphagia resolved within 1 year of surgery. Recurrence of reflux symptoms resulted in revision surgery in two patients. In general, reflux control was good. We believe that the ACP is a good antireflux operation which gives good long-term reflux and symptom control in the majority of patients. The removal rate of 15% in our series is of some concern but may be due in part to operator skills. The long-term objective follow-up has shown a trend towards a return of GOR and this and the unknown long-term effects of implanted silicone may limit the use of this procedure to the more elderly patient.
Adult↗
A survey of the iodide concentration of human milk.
The iodide concentration of human milk from mothers living in the Wellington area and of six prepared infant formulae was measured. A total of 93 human milk samples were assayed, 14 from mothers of infants delivered at less than 35 weeks gestation and collected within 30 days of delivery (group A), 57 samples from mothers of infants delivered at 35 or more weeks gestation and collected within 60 days of delivery (group B) and 22 samples from mothers with infants aged greater than 60 days (group C). There was no significant (p greater than 0.05) difference between the means (SE) of groups A 1.14 mumol/L (0.20) and B 0.98 mumol/L (0.07). The mean for group C 0.39 mumol/L (0.03) was significantly less (p less than 0.05) than the means for both groups A and B. For groups A, B and C combined, there was a correlation (r = 0.44, p less than 0.01) between the milk iodide concentration and the iodide/creatinine ratio of a maternal urine specimen obtained immediately before or after the milk specimen. Formula milk preparations based on cow's milk contained higher concentrations of iodide than human milk.
Creatinine↗
Carcinoid tumour of the common bile duct--a novel complication of von Hippel-Lindau syndrome.
A 30 year old man with von Hippel-Lindau syndrome presented with obstructive jaundice caused by a carcinoid tumour of the mid- and upper common bile duct. This association is probably causally related in view of the propensity for patients with von Hippel-Lindau syndrome to develop neuroendocrine tumours.
Adult↗
Cryotherapy for liver metastases: a new approach.
A new system designed for cryosurgery of liver metastases is described. The cryoprobe, which utilizes circulating liquid nitrogen and produces a spherical iceball around each metastasis, is controlled by operative ultrasound. There was nor mortality and all patients left hospital within 10 days. Cryotherapy produced an area of destruction within the liver substance which decreased in size by 6 weeks as shown on serial computed tomographic scanning.
Cryosurgery↗
Choledochoscopy via the cystic duct: evaluation of a new ultrathin disposable choledochoscope.
A 2 mm fibreoptic choledochoscope with a disposable (resterilisable) flexible section was evaluated in 25 cadavers and 13 patients undergoing cholecystectomy. It was possible to pass the instrument via the cystic duct (CD) into the common bile duct (CBD) in 23 out of 25 cadavers and in 12 out of 13 patients. The CD diameter in cadavers was 2.4 mm (SD 0.5). Optical clarity was excellent and it was easy to pass into the duodenum, but proximal passage required mobilisation of the CD/CBD junction. This instrument may be a useful adjunct or even an alternative to intraoperative cholangiography.
Common Bile Duct↗
[10 years' experience using a modified Shouldice surgical technic for inguinal hernia in adults. II. Which factors modify the recurrence of inguinal hernia?].
Many factors seem to influence the recurrence rate after adult inguinal hernia repair. A statistical analysis of data derived from 726 transversalis fascia repairs examined by the authors (with a follow-up rate of 82.5% and a mean follow-up time of 5.5 years) revealed a significantly higher recurrence rate in patients with chronic bronchitis (p less than 0.05) or with postoperative complications (p less than 0.001). Lower recurrence rates were found after resection of lipomas of the cord (p less than 0.01) or cremasteric muscle resection (p less than 0.05). No significant difference of recurrence rate could be established for following parameters: Sex, side, age distribution, profession, prostatism, obesity, type of hernia (direct, indirect, combined, sliding), suture material (silk, polyglycolic acid), surgeon, anesthesia (local, spinal, full), elective or emergency operation, and whether the repair was unilateral or simultaneously bilateral. Recurrent repairs showed no significantly higher recurrence rate than primary repairs.
Adult↗
[10 years' experience using a modified Shouldice surgical technic for inguinal hernia in adults. I. Method and results in 726 operations with follow-up].
Since 1973 we have used a modified Shouldice repair to treat inguinal hernias in adults. The repair was performed on unselected patients. The procedure was performed by both senior surgeons and surgeons in training. Over a 10-years period, 880 transversalis fascia repairs were done and 726 (82.5%) were examined by the authors 12-142 months after the operation (mean time 66.1 months). In 94.2% of the 726 repairs the patients were satisfied with the result. Follow-up studies revealed testicular atrophy in 0.6%, deep wound infection in 0.8% and an overall recurrence rate of 5.8%. The recurrence rate was not significantly different after direct, indirect, combined or sliding hernias. In 25% of recurrences the patients were asymptomatic and unaware of the recurrence.
Adult↗
Coronary vascular occlusion mediated via thromboxane A2-prostaglandin endoperoxide receptor activation in vivo.
The use of enzyme inhibitors to clarify the role of thromboxane A2 in vasoocclusive disease has been complicated by their non-specific action. To address this problem we have examined the effects of thromboxane A2/prostaglandin endoperoxide receptor antagonism in a canine model of platelet-dependent coronary occlusion. Two structurally distinct thromboxane A2/prostaglandin endoperoxide receptor antagonists, 3-carboxyl-dibenzo (b, f) thiepin-5,5-dioxide (L636,499) and (IS-(1 alpha,2 beta(5Z),3 beta,4 alpha))-7-(3-((2-((phenylamino)-carbonyl)hydrazino)methyl)-7- oxabicy-clo(2.2.1)-hept-2-yl)-5-heptenoic acid (SQ 29,548), were studied to ensure that the effects seen in vivo were mediated by receptor antagonism and did not reflect a nonspecific drug effect. Both compounds specifically inhibited platelet aggregation induced by arachidonic acid and by the prostaglandin endoperoxide analogue, U46619, in vitro and ex vivo, and increased the time to thrombotic vascular occlusion in vivo. When an antagonist (L636,499) was administered at the time of occlusion in vehicle-treated dogs, coronary blood flow was restored. In vitro L636,499 and a third antagonist, 13-azaprostanoic acid, specifically reversed endoperoxide-induced platelet aggregation and vascular smooth muscle contraction. Neither compound altered cyclic AMP in platelet-rich plasma before or during disaggregation. Therefore, reversal of coronary occlusion may reflect disaggregation of platelets and/or relaxation of vascular smooth muscle at the site of thrombus formation through specific antagonism of the thromboxane A2/prostaglandin endoperoxide receptor. Thromboxane A2/prostaglandin endoperoxide receptor antagonists are compounds with therapeutic potential which represent a novel approach to defining the importance of thromboxane A2 and/or endoperoxide formation in vivo.
Animals↗
Palliation for carcinoma of head of pancreas.
Ninety eight consecutive patients with an operative diagnosis of carcinoma of the head of the pancreas are discussed. Recent advances in the preoperative diagnosis and management appear to have failed to make a significant impact in non-specialised units, with 82 patients undergoing palliative procedures with an operative mortality of 25.6% rising to 36% when jaundice was present. Overall median survival was 202 days (range 35-967). Recurrence of jaundice developed in 42 patients and was more common with cholecysto-enteric bypass than in choledocho-enteric bypass. Forty four per cent of patients undergoing biliary bypass alone subsequently had signs of gastric outlet obstruction.
Adult↗
Obstruction of the colon by a giant gallstone.
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Cholelithiasis↗
Measurement of urinary 2,3-dinor-thromboxane B2 and thromboxane B2 using bonded-phase phenylboronic acid columns and capillary gas chromatography--negative-ion chemical ionization mass spectrometry.
The use of bonded-phase phenylboronic acid columns to selectively extract 2,3-dinor-thromboxane B2 and thromboxane B2 from urine is reported. The compounds were first derivatized as the methoxime and then applied to the phenylboronic acid columns. Subsequent purification by thin-layer chromatography and derivatization to the pentafluorobenzyl ester, trimethylsilyl ether followed by capillary gas chromatography-negative-ion chemical ionization mass spectrometry, monitoring specific ions, allows quantitation in the low-picogram/milliliter range. In healthy male volunteers, the median excretions of 2,3-dinor-thromboxane B2 and thromboxane B2 were 10.3 ng/h (range, 4.5-24 ng/h) and 2.8 ng/h (range, 0.5-7.3 ng/h), respectively. The method offers a noninvasive, specific approach to the study of thromboxane synthesis and platelet function in man. It is much less labor intensive than currently available methods employing electron-impact chromatography-mass spectrometry.
Boronic Acids↗
Reflux versus dysphagia: an objective evaluation of the Angelchik prosthesis.
Twenty-seven patients with proven longstanding gastro-oesophageal reflux underwent insertion of an Angelchik anti-reflux prosthesis. Preoperative studies included oesophageal manometry, endoscopy, acid reflux provocation test (ARPT) and 24 h oesophageal pH recording (24 h pH). Following operation mean lower oesophageal sphincter pressure was increased from 11 to 20 cmH2O. ARPT revealed significant pre-prandial reflux before operation in 16/24 compared with only 1/20 postoperatively; 24 h pH also showed an improvement in that 21/22 patients refluxed before operation compared with no significant reflux after. Dysphagia for solids of some degree was seen postoperatively in 26 patients and this was also demonstrated by delay in transit of a marsh-mallow swallow test. Severe dysphagia was seen in 4 patients and in 3 of these was related to rotation and displacement of the prosthesis necessitating removal.
Deglutition Disorders↗