By the London post: Evidence for the Royal Commission -- ethical responsibilities for doctors -- alcohol abuse.
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Biomedical subjects
Publications and source records attributed to J Lister.
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Three new cases of congenital segmental dilatation of the ileum are presented and added to 12 cases of segmental dilatation found in the literature. The aspect of the condition which is of particular interest is the presence in 3 of the dilated segments of heteroplastic foregut derivatives of unusual varieties. The etiology of the condition is discussed; it does not appear to be a single distinct pathological entity.
Paediatric surgery is a young specialty whose rapid growth in the United Kingdom has largely been as a result of the development of neonatal surgery in the past 20 years. A decreasing birth rate, and pre-natal diagnosis of some major congenital anormalies with the possibility of termination of pregnancy, are likely to prevent further increases to neonatal surgical units. Expansion of case material is likely to come from earlier attacks on congenital heart disease, and improvement in results is more likely to come from improved respiratory management than from the development of new surgical techniques.
A double-blind, placebo controlled, crossover trial of 20 and 40 mg of xipamid once daily in the treatment of mild to moderate hypertension is reported and some of the difficulties and pitfalls of multicentre trials of this type are described. 2 Both doses were significantly more effective in reducing the blood pressure than the placebo and neither was superior to the other. Both produced some potassium loss. Xipamid acted for at least 22 h and was effective in up to 83% of the patients. 3 Further trials are suggested to investigate the activity of a lower dose than 20 mg.
In a consecutive series of 200 neonates having undergone surgery for open myelomeningocele, 24 of the 106 survivors at 10 to 12 years of age proved to be continent of urine. These figures included 11 children who had considerable neurological involvement. 4 children did not acquire urinary control until after the age of 5 years. Therefore, we consider early urinary diversion in children with myelomeningocele, even in the presence of neurological deficit, to be indicated only for the prevention of progressive deterioration in renal function. Incontinence of urine itself is not an indication for urinary diversion in the first decade of life.
An unselected series of 200 consecutive closures of open myelomeningocele is reported with reviews of the survivors at 5 and 10 years. Assessment of the child's ability to fit into society can be made reasonably accurately at 5 years. Urinary tract problems in older children have not been so prominent as expected. Twenty-six out of 106 10-year-olds had normal micturition. Social problems seem likely to outweigh surgical ones in the teenage survivors.
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