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Biomedical subjects

P J Anderson

Publications and source records attributed to P J Anderson.

At least 19 recordsLinked to original sources
PubMed2006

The conservative management of facial fractures: indications and outcomes.

BACKGROUND: With little in the published literature on the conservative management of facial fractures we set out to determine whether our current criteria for treatment are valid. METHOD: Two hundred and thirty adult patients with fractures of the facial skeleton were treated conservatively by our unit between February 1997 and January 2003. Their notes were reviewed retrospectively. RESULTS: Most patients were males (76%), the average age was 38 years, and drugs or alcohol were a significant aspect of the history in 30% of the cases. The most common mechanism of injury was assault (47%), followed by falls and sporting injuries. Fifty percent of the fractures involved the orbital or orbito-zygomatic complex, and 55% had associated injuries. Average follow-up was for six weeks (range 0-44 weeks). Most patients were managed conservatively based on our current criteria of un-displaced/minimally displaced fracture (57%); or minimal/no symptoms (24%). At final review, a number had residual symptoms, but only three required corrective surgery. The other reasons for conservative management included patient non-compliance (11%), and medical contraindications (8%). CONCLUSION: Our results support current indications for the conservative management of facial fractures, but emphasise the need for ongoing follow-up of these patients.

Adolescent↗
PubMed2006

An unusual complication of mandibular distraction.

BACKGROUND: The authors present an unusual complication of mandibular distraction in a child with the curious condition of multiple pterygium syndrome is presented. CASE REPORT: The patient was a Caucasian male with severe pterygia in his neck. As a result of his limited mouth opening and restricted upper airway leading to obstruction, he underwent lengthening of his mandible by distraction, which significantly improved his breathing. During his follow-up, it was observed that an unusually elongated permanent molar was present in an abnormal position. CONCLUSION: This case highlights the need to carefully plan the sites for osteotomy and the potential for damage to the developing permanent dentition in young children.

Child, Preschool↗
PubMed2006

Three-dimensional computed tomography cephalometry of plagiocephaly: asymmetry and shape analysis.

OBJECTIVE: To investigate facial asymmetry associated with both deformational and synostotic plagiocephaly and to identify variables based on skeletal landmarks that distinguish the conditions and quantify severity. DESIGN: Retrospective, cross sectional. SETTING: Australian Craniofacial Unit, Adelaide. MAIN OUTCOME MEASURES: Proportional differences between bilateral distances and principal component (PC) analysis of the skeletal landmarks. PATIENTS: The three-dimensional positions of 78 osseous landmarks were determined from computed tomography (CT) scans of 21 patients with deformational plagiocephaly (DP), 20 patients with unilateral coronal synostosis (UCS), and 2 patients with unilateral lambdoid synostosis (ULS). RESULTS: For both DP and UCS, significant asymmetry was found for the orbital depths, mandibular lengths, maxillary depths, zygomatic arch lengths, lateral base of the parietal bone, and the angle between the anterior and the posterior cranial base projected onto the axial plane. The small sample size for ULS precluded definitive statistical statements but allowed some useful comparisons with the other conditions. The first three PC scores were able to distinguish among the three conditions and which side was affected. CONCLUSIONS: The asymmetry of the cranial base and facial structures, arising from localized abnormality or deformational forces in either the frontal or the occipital regions, can be quantified by a plethora of bilateral features or summarized by PC analysis.

Cephalometry↗
PubMed2005

Neurodevelopmental sequelae of intraventricular haemorrhage at 8 years of age in a regional cohort of ELBW/very preterm infants.

BACKGROUND: Major grades of intraventricular haemorrhage (IVH) are associated with adverse neurodevelopmental sequelae in early childhood but the extent of problems in specific cognitive areas, such as executive function, and the contribution of lesser grades of IVH to neurodevelopmental problems at school age are not well described. AIMS: To determine the neuromotor, cognitive and educational outcome of extremely low birthweight (ELBW, birthweight <1000 g) or very preterm (<28 weeks) infants at 8 years of age related to the severity of IVH diagnosed in the newborn period. DESIGN: Regional cohort study. PATIENTS: Consecutive surviving children of either birthweight <1000 g or gestational age <28 weeks born in the state of Victoria in 1991 or 1992. MAIN OUTCOME MEASURES: Neurological impairments and disabilities, cognitive function and academic progress. RESULTS: Of 298 consecutive ELBW/very preterm survivors 270 (90.6%) with cranial ultrasound data were assessed at 8 years of age. Cerebral palsy, poor motor performance and major neurosensory disability were more prevalent with increasing severity of IVH. Cognitive functioning across domains was worse with increasing severity of IVH. Most of the differences were attributable to the few (n=6) survivors who had grade 4 IVH; there were few substantial differences between survivors with lesser grades of IVH. CONCLUSIONS: Neurodevelopmental dysfunction at school age in ELBW/very preterm survivors varies little with increasing severity of IVH, with the exception of grade 4 IVH.

Child↗
PubMed2005

Improved neurosensory outcome at 8 years of age of extremely low birthweight children born in Victoria over three distinct eras.

AIM: To determine neurosensory outcome at 8 years of age of extremely low birthweight (ELBW) children born in the 1990s, how it varies with birth weight, and how it compares with ELBW children born in the 1980s and 1970s. METHODS: Subjects were born in the state of Victoria during 1991-92 and comprised 224 of 241 consecutive survivors with a birth weight of 500-999 g, and 223 of 262 normal birthweight (NBW) controls who had been randomly selected at birth. The comparison cohorts from earlier eras comprised 87 of 89 consecutive ELBW survivors born in 1979-80, 206 of 212 consecutive ELBW survivors born in 1985-87, and 51 of 60 randomly selected NBW survivors born in 1981-82. Survivors were assessed for neurological impairments (cerebral palsy, blindness, deafness, intellectual impairment) and disabilities at 8 years of age by paediatricians and psychologists blinded to perinatal details. RESULTS: For the 1991-92 cohorts, the rate of neurosensory disability was substantially higher in ELBW children compared with NBW controls (p<0.0001). Within the ELBW group, neurosensory disability was more prevalent in children with a birth weight of <750 g compared with a birth weight of 750-999 g (p = 0.024). Disability rates were lower in the 1991-92 ELBW cohort compared with the ELBW cohort born in 1979-80 (p = 0.046). CONCLUSIONS: Neurosensory disability rates at school age were more common in ELBW children born in the 1990s compared with NBW controls, and were significantly more common in the 500-749 g birthweight subgroup, but have improved compared with ELBW children born in earlier eras.

Birth Weight↗
PubMed2005

Multidisciplinary management of Opitz G BBB syndrome.

Opitz G BBB syndrome is a rare condition characterized by the 3 major anomalies of hypertelorism, cleft lip and palate, and hypospadias, although there may be other associated anomalies. The underlying genetic causes are complex and consist of both X-linked recessive and autosomal dominant forms of the disorder. Previously, there have been publications on the underlying genetics and case reports, but there have been few reports regarding the long-term outcome. The aim in this study was to review the range of clinical presentation and evaluate outcomes of the multidisciplinary management of a cohort of patients with Opitz G BBB syndrome. In a 25-year period, 7 patients with Opitz G BBB syndrome were managed by the Australian Craniofacial Unit (ACFU), 5 male and 2 female. Most of the patients are now reaching skeletal maturity. Each one presented with a range of severity in the triad of hypertelorism, cleft lip and palate, and hypospadias anomalies. The males all exhibited the triad of anomalies, while the females both had hypertelorism, only 1 had isolated cleft palate, and neither had any genitourinary anomalies. Each patient underwent multidisciplinary assessment to make a treatment plan for staged management of different anomalies. Plan for surgical corrections of facial anomalies were performed according to the unit's protocol management of both hypertelorism and cleft lip and palate, but the presence of these coexisting anomalies required adjustment of the standard protocol of management of cleft lip and palate. In conclusion, we recommend that patients with Opitz G BBB syndrome require careful evaluation, and management of the anomalies should be in a coordinated manner by a multidisciplinary team.

Abnormalities, Multiple↗
PubMed2005

Differences in the single-oral-dose pharmacokinetics and urinary excretion of paracetamol and its conjugates between Hong Kong Chinese and Caucasian subjects.

BACKGROUND AND OBJECTIVES: The present study was conducted to determine if ethnic differences exist for single oral dose pharmacokinetics of paracetamol and its conjugates between Hong Kong Chinese and Caucasian subjects. METHODS: Twenty healthy Chinese (n = 11) and Caucasian (n = 9) subjects, aged 21-44 years, 11 male and nine female, were given oral paracetamol syrup 20 mg/kg, following an overnight fast. Paracetamol and its metabolites (glucuronide, sulphate, cysteine and mercapturic acid conjugates) were measured in serial plasma samples (0.25, 0.5, 0.75, 1.0, 1.5, 2, 3,...,12, 24 h) and urine collections (0-24 h) by high-performance liquid chromatography. RESULTS: In Chinese subjects, the (mean range) peak plasma concentration of paracetamol was 23.8 mug/mL (17.9-32.3) and time to attain this peak 0.66 h (0.5-0.75). This was lower (P < 0.015) at 18.7 microg/mL (14.4-22.9) and achieved later (P < 0.033) at 1.06 h (0.5-2.0) in Caucasians. In Chinese subjects, plasma levels of glucuronide were lower, sulphate higher and cysteine conjugates significantly lower than in Caucasians (P < 0.05). Chinese subjects excreted 6% more sulphate and 5% less glucuronide. They also excreted significantly less mercapturic acid conjugates (P < 0.001). DISCUSSION AND CONCLUSION: Chinese subjects show more rapid absorption of paracetamol, a tendency to produce less glucuronide but more sulphate conjugates and reduced production of cysteine and mercapturic acid conjugates. The latter may help to protect against hepatotoxicity following paracetamol overdose.

Acetaminophen↗
PubMed2005

Psychiatric morbidity and health outcome in Type 1 diabetes--perspectives from a prospective longitudinal study.

AIMS: To describe psychiatric status and relationship to metabolic control in adolescents with Type 1 diabetes studied prospectively from diagnosis. METHODS: Adolescents (n = 41) completed a self-report measure of psychiatric status 10 years after disease onset. Metabolic control information was recorded prospectively from diagnosis. The rate and type of psychiatric disorder were determined and the relationship between mental health status and metabolic control history examined. RESULTS: Thirty-seven per cent of the adolescents met criteria for a DSM-IV psychiatric disorder, two to three times higher than community levels of psychiatric morbidity. Females were significantly more likely to receive a diagnoses (chi2 = 4.98, P < 0.05). Two thirds of participants had experienced at least one serious hypoglycaemic episode and one third had a history of chronic poor metabolic control. DSM-IV diagnoses were present in half of those with a history of chronic poor control, one third of the hypoglycaemia group and one quarter of well controlled participants. Adolescents with a current Mood (t = -2.83, P < 0. 01), Anxiety (t = -3.77, P = 0.001) or Behaviour (t = 2.56, P < 0.05) disorder and those with a history of poorly controlled diabetes (F (2,29) = 5.4, P = 0.01) had higher externalizing behaviour problem scores at diagnosis than those without current disorder. CONCLUSIONS: Adolescents with Type 1 diabetes are at high risk for psychiatric disorder. Poorly controlled diabetes over the first 10 years of illness was associated with pre-existing behaviour problems at diagnosis and there was a trend for an association with current psychiatric status.

Adolescent↗
PubMed2004

Mucinous adenocarcinoma of the face. A case report.

Cutaneous mucinous adenocarcinoma is a rare neoplasm. It occurs most commonly on the facial skin. We present a case of an apparently recurrent primary mucinous adenocarcinoma of the facial skin and highlight the necessary diagnostic work up and management of this tumour.

Adenocarcinoma, Mucinous↗
PubMed2004

Prenatally diagnosed unilateral renal pelvic dilatation: a dynamic condition on ultrasound and diuretic renography.

PURPOSE: Imaging characteristics obtained from serial scintigraphic and ultrasonographic studies in children with the prenatal diagnosis of unilateral pelvic dilatation are presented. MATERIALS AND METHODS: Serial ultrasonographic and scintigraphic findings in 101 children with unilateral pelvic dilatation collected during followup were reviewed. Changes in hydronephrotic kidney in terms of renal pelvis diameter, kidney size, differential renal function and drainage were noted. A total of 42 children underwent surgery at a mean age of 15.6 months (range 3.1 to 69.2, median 8.2), while 59 were treated nonsurgically. RESULTS: Mean age at presentation was 5.6 months (range 0.8 to 36.4, median 3.5). Mean followup was 35.5 months (range 6.4 to 78.4, median 29.6). Differential renal function remained stable (46.4% vs 47.3%) but improved drainage (68.4% vs 81.2%) and decreased renal pelvis size (22.2 vs 18.3 mm) was noted in the 2 groups. With age drainage function improved, especially between the younger than 12-month and 12-month or older groups. The mean affected-to-unaffected kidney length ratio at presentation was significantly greater than the ratio at the final followup (paired t test p <0.05). CONCLUSIONS: In this retrospective review drainage function was prolonged in infants. During followup drainage, dilatation and relative renal size improved in the surgery and nonsurgery groups. There was no change in renal function in either groups during followup. These data support the benign nature of prenatal unilateral hydronephrosis.

Age Factors↗
PubMed2003

Modified costochondral graft osteotomy in hemifacial microsomia.

Hemifacial microsomia is the second most common facial clefting condition after cleft lip and palate. The deformity affects the skeleton and soft tissues in the temporal region of the affected side, although the degree of involvement is markedly variable. We describe a modification of surgical technique in a skeletally mature case who had previously undergone mandibular reconstruction with a costochondral graft.

Facial Asymmetry↗
PubMed2003

The use of sentinel node biopsy in the management of epitheloid haemangioendothelioma of the lip.

This report describes a rare tumour, an epitheloid haemangioendothelioma affecting the lower lip. This tumour has a predilection for the head and neck region in young adults. Its potential to metastasise is well recognised, but the likelihood of this is currently uncertain. Current management is usually to locally excise the tumour and follow up, although there is a recognised risk that subsequent presentation with metastatic nodal disease can occur. We present a case occurring in the lip of an 18-year-old girl who had a sentinel node biopsy performed as a staging tool in conjunction with excision of a local recurrence. Although clinical examination and CT imaging of the head and neck found no evidence of metastatic disease, the sentinel node was found to contain metastatic tumour. The result of this unexpected finding was that she was investigated further with additional CT scanning of her chest and abdomen. Subsequently, a therapeutic modified radical neck dissection preserving the accessory cranial nerve was undertaken. After 3 years she remains well with no evidence of recurrent tumour. We believe that the consequence of undergoing sentinel node biopsy, which detected early metastatic tumour and her subsequent treatment, suggests a role for sentinel node biopsy in the management of epitheloid haemangioendothelioma.

Adolescent↗
PubMed2003

Impaired drainage on diuretic renography using half-time or pelvic excretion efficiency is not a sign of obstruction in children with a prenatal diagnosis of unilateral renal pelvic dilatation.

PURPOSE: Delayed drainage on diuretic renography is an accepted sign of obstruction in adults and symptomatic children. We investigated how to analyze the diuretic challenge as well as assess the significance of impaired drainage. MATERIALS AND METHODS: We followed 24 children with a unilateral prenatal diagnosis of pelvic dilatation up to a minimum of 2 years. A total of 91 diuretic renograms were performed. All children had stable differential renal function and renal pelvic diameter did not change by greater than 9 mm. on sequential ultrasound. Kidneys with stable differential function and no increase in dilatation were considered not obstructed. Analysis of the diuretic challenge included half-time, a post-void image with a change in posture, that is the child erect for 5 to 7 minutes, and drainage considering renal function using the pelvic excretion efficiency. Prolonged drainage was defined as a half-time of greater than 20 minutes or a post-void pelvic excretion efficiency of less than 71%. RESULTS: Median patient age at presentation was 0.32 years and median followup was 3.07 years. The affected nonobstructed hydronephrotic kidney showed impaired drainage in 68% of the children using the half-time parameter, and in 80% and 44% using pelvic excretion efficiency before and after voiding, respectively. Variability in drainage was documented on sequential diuretic renography. CONCLUSIONS: Using the guidelines for data acquisition and processing of diuretic renograms we nevertheless noted impaired drainage in 44% of this young group with nonobstructed kidneys. The half-time parameter was an inappropriate parameter. The diagnosis of obstruction cannot be simply based on delayed drainage in this group of asymptomatic children with a prenatal diagnosis of unilateral renal pelvic dilatation.

Age Factors↗
PubMed2002

Assessment of regional kidney function may provide new clinical understanding and assist in treatment of children with prenatal hydronephrosis.

PURPOSE: As calculated from a (99m)technetium (Tc)-mercaptoacetyltriglycine (MAG3) renogram, differential renal function is an important parameter affecting the clinical treatment of children with prenatal unilateral hydronephrosis. We determined whether value is potentially added by calculating a functional image from MAG3 renograms that represents proximal tubule ability to clear tracer from the blood, that is the MAG3 clearance image. MATERIALS AND METHODS: MAG3 clearance image findings and differential renal function at presentation and followup in 59 nonsurgically and 42 surgically treated children with prenatally diagnosed unilateral hydronephrosis were retrospectively reviewed. All patients underwent at least 3 99mTc-MAG3 renograms. RESULTS: In the surgical and nonsurgical groups there was no significant difference in followup (p = 0.11), age at presentation (p = 0.98) or age at last visit (p = 0.97), whereas differential renal function was significantly different (p = 0.01). A large affected kidney with focal defects was the most frequent finding in each group, including kidneys with a normal differential renal function of 45% to 55%. In the nonsurgical group the most common observation was improvement in the MAG3 clearance image in 26 of 59 cases (44%) and stabilized differential renal function in 41 (70%). Postoperatively the MAG3 clearance image improved in 31 of 42 cases (74%) and differential renal function remained stable in 25 (60%), while no significant increase in differential renal function was noted at the last visit (p = 0.74). CONCLUSIONS: This study shows that it is possible to assess regional parenchymal function using the MAG3 clearance image in children with unilateral hydronephrosis. This information is available in addition to 99mTc-MAG3 information on the whole kidney, that is differential renal function. The majority of affected kidneys with normal differential renal function showed parenchymal defects, suggesting regional renal dysfunction. However, functional improvement on a regional basis occurred in each group of children during followup.

Child, Preschool↗
PubMed2002

Obesity and cardiovascular risk factors in Hong Kong Chinese.

The purpose of this cross-sectional study was to examine the risk associations between obesity indexes [body mass index (BMI) and waist circumference (WC)], cardiovascular risk factors [plasma glucose and lipids, blood pressure and urinary albumin excretion (UAE)] and morbidity conditions (Type 2 diabetes mellitus, hypertension, dyslipidaemia and/or albuminuria) in Hong Kong Chinese. Seven-hundred and two Hong Kong Chinese subjects (18-65 years of age, 59.4% of whom had at least one morbidity condition) were recruited from the Prince of Wales Hospital, Hong Kong SAR. The measurements taken of the subjects included: height; weight; waist and hip circumferences; blood pressure; fasting plasma glucose and lipids; and 24-h UAE. The mean BMI was 22.4 and 25.7 kg m(-2) in healthy subjects and patients, respectively. The mean WC measurements of healthy subjects and patients were 77.1 and 86.4 cm in males and 71.0 and 81.8 cm in females, respectively. There were increasing trends between obesity indexes and the severity of cardiovascular risk factors and the prevalence of morbidity conditions (all P-values for trend <0.05). Using 19.0-20.9 kg m(-2) and <70 cm as a referent, subjects with a BMI of > or =25.0 kg m(-2) (in both sexes) and/or a WC of > or =85 cm in males and > or =75 cm in females had an age-adjusted odds ratio between 3.2 and 4.4 for the occurrence of at least one morbidity condition. Patients with a greater number of comorbidities also had higher BMI and WC measurements (all P-values for the trend were <0.05 with adjustment for age and gender). Hence, despite Hong Kong Chinese being less obese than Caucasians, the intimate relationships among obesity, cardiovascular risk factors and morbidity conditions remain. Our data support using lower BMI and WC levels to define obesity and its associated health risks rather than using the criteria established from Caucasians who generally have larger body frames.

Adolescent↗
PubMed2001

A gene, cobA + hemD, from Selenomonas ruminantium encodes a bifunctional enzyme involved in the synthesis of vitamin B12.

Coenzymes derived from vitamin B12 (cyanocobalamin) are particularly important for core metabolism in ruminant animals. Selenomonas ruminantium, a Gram-positive obligate anaerobe isolated from cattle, is the main contributor of vitamin B12 to such ruminant animals. In nature, there are both aerobic and anaerobic pathways for B12 synthesis - the latter is only partly elucidated. Until now, there has been no investigation of B12 synthesis in S. ruminantium, which must use an anaerobic pathway. This paper reports the cloning of the chromosomal operon from S. ruminantium which is responsible for the first committed steps in corrinoid synthesis. Five open reading frames were found in the cloned fragment. All deduced amino acid sequences had similarity to defined proteins in the databases that are involved in porphyrin and corrin synthesis. Of particular interest is the gene designated cobA + hemD, which encodes a single polypeptide possessing two catalytic functions - uroporphyrinogen III synthase and uroporphyrinogen III 2,7-methyltransferase. This enzyme converts hydroxymethylbilane to precorrin-2. The functions of the protein coded by cobA + hemD were established by heterologous expression in Escherichia coli. The CobA activity has been demonstrated for three distinct types of proteins - monofunctional, bifunctional with siroheme formation and, this report, bifunctional with uroporphyrinogen III synthesis. The type found in S. ruminantium (cobA + hemD) is probably restricted to obligately anaerobic fermentative bacteria.

Alkyl and Aryl Transferases↗