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Biomedical subjects

M Davenport

Publications and source records attributed to M Davenport.

At least 37 records · Page 2Linked to original sources
PubMed2000

Anaesthesia, perioperative management and outcome of correction of extrahepatic biliary atresia in the infant: a review of 50 cases in the King's College Hospital series.

Extrahepatic biliary atresia (EHBA) is an uncommon condition presenting in the first few weeks of life. It has an incidence of 0. 5-1 per 10 000 live births and is the end result of a destructive inflammatory process involving the extrahepatic biliary system of unknown aetiology occurring in utero. The net result is neonatal jaundice due to bile stasis, with subsequent hepatocellular damage and cirrhosis. In the untreated, patient death is inevitable within 2 years. Precise diagnosis (or exclusion) of EHBA in the persistently jaundiced infant must be made urgently and major surgery (hepatic portoenterostomy: Kasai procedure) carried out as soon as possible, preferably before 6-8 weeks of age. This review is concerned with anaesthesia for correction of EHBA in 50 consecutive patients and also outlines the experience gained in the largest European centre for correction of EHBA where the number of cases now approaches 500.

Anesthesia↗
PubMed1999

Association of oesophageal atresia and cholecystohepatic duct.

A rare hepatobiliary malformation in which the common hepatic duct drains directly into the gallbladder or the cystic duct (cholecystohepatic duct) is described in two children born with oesophageal atresia. Attention is drawn to the rarity of this combination. A brief review of the literature of cholecystohepatic and accessory hepatic ducts is also presented.

Abnormalities, Multiple↗
PubMed1999

Giant intra-abdominal cyst in a 13-year-old girl.

A case of a massive unilocular intra-abdominal cyst arising in a 13-year-old girl is presented. This appeared to be a foregut duplication cyst of gastric origin, and thus one of the largest recorded in the literature.

Adolescent↗
PubMed1999

Arterioportal hypertension: a rare complication of partial hepatectomy.

An arterioportal fistula (APF) with arterialisation of the portal-venous system is a rare cause of portal hypertension (PH) in children. The condition may be a congenital isolated fistula or occur as part of a more generalised haemangiomatous malformation. We report a case of PH secondary to an APF, which presented with bleeding gastric varices 6 years after partial hepatectomy for hepatoblastoma. The diagnosis was established by angiography and the fistula occluded by embolisation.

Aneurysm, False↗
PubMed1999

Intestinal absorption and permeability in paediatric short-bowel syndrome: a pilot study.

BACKGROUND: Sugar absorption tests are an effective, noninvasive way to assess intestinal permeability. The role of intestinal barrier integrity in complications and outcome of short-bowel syndrome is not known. The purpose of the study was to evaluate whether such tests provide information on the status of intestinal mucosa of these patients. METHODS: Six children with short-bowel syndrome--median age, 12 months, and median small bowel length at birth, 30 cm--had a sugar test with 3-o-methyl-D-glucose, D-xylose, D-rhamnose, and melibiose approximately 2 months after operation. The melibiose/L-rhamnose ratio was used as an index of permeability, and percentages of 3-o-methyl-D-glucose and D-xylose absorbed were used as indices of absorption. Parenteral nutrition requirement, bowel length, liver disease, recent sepsis, and bacterial overgrowth were recorded. RESULTS: Three patients had increased permeability, and all of them had had a recent episode of sepsis and severe liver disease. All subjects had malabsorption of 3-o-methyl-D-glucose, and five of six had malabsorption of D-xylose and L-rhamnose. The absorption of 3-o-methyl-D-glucose correlated with bowel length (r2 = 0.78; P = 0.04), whereas the absorption of D-xylose correlated with parenteral requirement (r2 = 0.66; P = 0.04) at that time. CONCLUSIONS: Increased permeability was observed in three of six patients with short-bowel syndrome associated with a recent episode of sepsis and severe liver disease. Other indices of malabsorption correlated significantly with different clinical features of the disease. A prospective larger scale study in a homogeneous population is indicated to assess at multiple points during the disease course whether the test can be helpful in the management of these patients.

3-O-Methylglucose↗
PubMed1998

Antenatally diagnosed surgical anomalies: the psychological effect of parental antenatal counseling.

BACKGROUND: Increasing numbers of infants have the diagnosis of a surgical malformation made before birth. This allows (1) fetal intervention, (2) in utero transfer and planned delivery in a surgical center, and (3) antenatal counseling of likely prognosis and outcome. The aim of this study was to assess the effectiveness of antenatal counseling in terms of the parental psychological response. METHODS: Antenatal counseling by a pediatric surgeon and neonatal nurse was given after ultrasound diagnosis of a fetal surgical malformation (eg, gastroschisis, diaphragmatic hernia). Anxiety levels were measured using the Spielberger State-Trait Anxiety Inventory, a tool used by psychologists to assess the inherent level of anxiety, or Trait anxiety (STAI-T), and the current level of anxiety, or State anxiety (STAI-S). RESULTS: Fifty six prospective mothers filled out Spielberger questionnaires (subjects, n = 26; controls, n = 30). Nineteen subjects' partners also completed questionnaires. There was no significant difference in Trait anxiety scores between subjects and controls (41 [interquartile range, 30 to 511 v 38.5 [range, 32 to 47]; P = .58). There was no significant correlation between maternal and paternal Trait anxiety (P = .11). There was a significant reduction in State anxiety scores in both subject mothers (49.5 [interquartile range, 27 to 73) v38 [range, 31 to 49]; P = .01) and fathers (47 [interquartile range, 36 to 55] v 37 [interquartile range, 32 to 49]; P = .006) after pediatric surgical consultation. CONCLUSION: Counseling by specialist staff reduced levels of parental anxiety associated with the diagnosis of fetal surgical malformation.

Adult↗
PubMed1998

Serial lung volume measurements during the perinatal period in infants with abdominal wall defects.

METHODS: Daily measurements of lung volume (functional residual capacity, FRC) were made during the perinatal period in eight infants (median gestational age, 37 weeks; range, 34 to 38 weeks) with abdominal wall defects. RESULTS: On the first day of life and before surgical intervention, four infants had FRCs below the reference range; the occurrence of low lung volumes was not significantly related to gestational age or diagnosis. Lung volume was further, but only temporarily, impaired by surgical closure of the abdominal wall defect, with a reduction in the median FRC from 25 mL/kg (range, 18 to 36) preoperatively to 12 mL/kg (range, 5 to 19) on the first postoperative day (P < .02). CONCLUSION: These data are consistent with abnormal antenatal lung growth in certain infants with abdominal wall defects.

Abdominal Muscles↗
PubMed1998

Chylothorax after repair of congenital diaphragmatic hernia--risk factors and morbidity.

BACKGROUND/PURPOSE: Chylothoraces have been reported rarely after congenital diaphragmatic hernia (CDH) repair, but that is contrary to the authors' experience. The aim of this study was to audit the outcome of antenatally diagnosed CDH cases to determine the incidence, possible risk factors, and morbidity associated with chylothorax in CDH patents. METHODS: Twenty-four of 35 consecutive infants with CDH (69%) underwent surgical repair and survived the immediate postoperative period. RESULTS: Effusions developed in all 22 for whom chest radiographs were available. Six of the eight infants whose effusions required drainage had a chylothorax. Those six infants required a mean of 8 days of thoracentesis, during which a mean total volume of 358 mL/kg of fluid was removed. The infants remained on a medium-chain triglyceride (MCT) formula for a mean of 81 days. The six infants with a chylothorax differed from the rest with respect to their duration of oxygen dependence (a median of 28.5 versus 15 days, P < .05) and hospital stay (a median of 5.5 versus 4 weeks, P < .05), but no significant risk factors for the development of a chylothorax were identified. CONCLUSION: Chylothorax is a relatively common cause of effusion after CDH repair and is associated with increased morbidity.

Chylothorax↗
PubMed1998

Antenatal diagnosis of congenital anomalies of the biliary tract.

BACKGROUND: The accuracy of the technique of antenatal ultrasonography in the diagnosis of congenital bile duct lesions is unknown. METHODS: Thirteen patients with proven biliary disease who had abnormal antenatal scans were reviewed. Two infants had type I cystic biliary atresia and one had a noncommunicating segmental dilatation of the bile duct in a type 3 biliary atresia. The remainder had choledochal cysts and included two patients with intrahepatic cysts. The correct diagnosis was made antenatally in only two (15%) cases. Of the remaining patients, seven received a diagnosis of intraabdominal cysts of unknown etiology, three of duodenal atresia, and one ovarian cyst. The median gestational age at the antenatal diagnosis was 20 weeks. RESULTS: Jaundice developed in 11 infants, and dilatation of intrahepatic biliary radicals was noted in four of the choledochal cysts. Obstructive jaundice and increasing cyst size were indications for early surgery, and twelve infants underwent a laparotomy at a median age of 4 weeks. During the median follow-up period of 2 years, 12 of the 13 patients have lost their jaundice or remained anicteric. Antenatal diagnosis offers the possibility of early definitive surgery for uncomplicated choledochal dilatation and the chance of improved outcome for surgically treated biliary atresia. An algorithm is suggested for the management of antenatally detected cystic biliary lesions.

Biliary Atresia↗
PubMed1998

Intra-abdominal pulmonary sequestration associated with congenital cystic adenomatoid malformation of the lung: just an unusual combination of rare pathologies?

A case of intra-abdominal pulmonary sequestration associated with histological features of congenital cystic adenomatoid malformation (CCAM) of the lung is reported. The lesion consisted of a Stocker type II CCAM in which numerous striated muscle cells were present. A review of the literature of this rare combination of congenital pulmonary anomalies is presented.

Adult↗
PubMed1998

Six unrelated HLA-DR-matched adults recognize identical CD4+ T cell epitopes from influenza A haemagglutinin that are not simply peptides with high HLA-DR binding affinities.

Influenza A/Beijing/32/92 (H3N2) haemagglutinin (HA)-specific short-term CD4+ T cell lines were generated from six unrelated HLA-DR0701, 1501 positive adults (aged 27-60 years) 3 months following administration of an influenza subunit vaccine containing HA A/Beijing/32/92. Epitope recognition was examined using 118 HA A/Beijing/32/92-specific 16mer peptides which overlapped by 11 residues and which spanned the entire molecule. Following influenza vaccination the donors recognized identical HA peptides. The selected peptides represented HA regions which have been free from extensive drift mutation since the emergence of human H3N2 influenza A strains. Using DAP DR7.0701 cells (a murine cell line expressing HLA-DR0701) as antigen-presenting cells the majority of CD4+ T cell responses were shown to be HLA-DR0701 restricted. The relationship between HA peptide recognition and relative strength of HA peptide-HLA-DR0701 binding was then explored in a competition assay with biotinylated CLIP peptide. Although peptides representing dominant HA epitopes bound to DR0701, the relationship between relative strength of binding and immunodominance was complex, and many strongly binding peptides, particularly those with glycosylation sites and showing inter-strain variation, were not recognized. These results illustrate the control HLA class II exerts over CD4+ T cell HA epitope selection in unrelated adult humans. Immunodominance appears not to be directly related to the relative strength of HA peptide-HLA class II binding, and thus reflects complex interactions between antigen processing, intracellular competition for HLA binding, TCR repertoires and repeated exposure to different strains of influenza A viruses.

Adult↗