Adaptation of the ruminant digestive tract to diet.
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Adaptation, Physiological↗
Biomedical subjects
R Kay
Publications and source records attributed to R Kay.
Testicular prostheses.
Testicular prosthesis implantation is a generally simple and low-morbidity method of softening the psychological trauma suffered by patients faced with the loss of a testis.
Adolescent↗
Competing risks, interactions and crossing hazards.
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Aged↗
The association of neuroblastoma with myoclonic encephalopathy of infants: the use of magnetic resonance as an imaging modality.
The association of neural crest tumors with myoclonic encephalopathy of infants has been well described. Since these tumors often are clinically occult the diagnostic modalities used to identify these lesions need to be sensitive. We describe a child with neuroblastoma associated with infantile myoclonic encephalopathy in whom magnetic resonance imaging identified the lesion while other techniques were unable to demonstrate a mass clearly. Magnetic resonance imaging should be considered as a diagnostic modality when adrenal lesions are suspected but not apparent with other imaging techniques.
Adrenal Gland Neoplasms↗
Office management of urinary stomas.
The postoperative care of stoma patients is truly life long. With the excellent stoma equipment available, no patient should be a "stoma cripple." New advances in continent reservoirs will improve patient acceptance and lessen the fear associated with stomas. Finally, close follow-up by both the enterostomal therapy nurse and the surgeon is essential for the complete care of the stoma patient.
Ambulatory Care↗
Ureterocalicostomy.
Reconstructive urologic surgery in the upper tract in general is a successful and rewarding procedure. In some settings, however, either complications ensue, or unusual renal anatomy precludes normal procedures. Ureterocalicostomy is an excellent procedure to have available when usual procedures may not be used. In the properly selected patient and with observance of technical details, excellent results may be seen in either primary reconstructive efforts or secondary operations for renal salvage.
Humans↗
Hybrid pUC vectors for addition of new restriction enzyme sites to the ends of DNA fragments.
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Base Sequence↗
Aetiology of growth hormone deficiency.
A retrospective analysis was performed in an attempt to identify perinatal risk factors for the development of growth hormone deficiency. More of the affected children were boys, and their birth weights were significantly lower than those of the national average; there were also considerably more preterm and post-term deliveries among boys.
Adolescent↗
Can histopathologists reliably assess dysplasia in chronic inflammatory bowel disease?
A copy of the standardised classification (SC) proposed for assessing dysplasia in inflammatory bowel disease was circulated to six histopathologists who were asked to apply it to 40 slides from 34 patients with ulcerative colitis to test its reproducibility. The slides were relabelled and recirculated to the pathologists at least one month later. Each was asked to state whether or not key diagnostic features were present before giving a final dysplasia score for the second assessment. Only minor interobserver and intraobserver disagreements were recorded. Pathologists were most consistent at recognising back to back glands, villous mucosal architecture, hyperchromatic nuclei, stratification of nuclei, regenerative nuclei and loss of nuclear polarity. There was poor interobserver agreement in assessing dystrophic goblet cells and columnar mucous cells. Back to back glands, hyperchromatic nuclei, loss of nuclear polarity, stratification of nuclei and columnar mucous cells were considered to be the most important features for determining the severity of dysplasia. As there was poor interobserver agreement in assessing columnar mucous cells and dystrophic goblet cells these features need to be more clearly defined or should be removed from the SC.
Adult↗
EMLA cream reduces the pain of venepuncture in children.
EMLA cream (eutectic mixture of local anaesthetics) was tested in a double-blind clinical trial to examine its effect on the pain of venepuncture at induction of anaesthesia in 40 children (aged 3-13 yrs). Four pain-assessment methods were used and an assessment of the technical ease of venepuncture was made. EMLA was found to reduce significantly the pain and technical difficulty of venepuncture. This study confirms that EMLA is an effective method of reducing the pain and technical difficulty of paediatric venepuncture using 25-gauge needles for induction of anaesthesia in children.
Anesthesia, Intravenous↗
Deception by a casual dental attender.
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Adult↗
Optic neuritis following chickenpox in adults.
Three cases of bilateral optic neuritis, one of which also had transverse myelitis, are described in young adults following chickenpox. Severe bilateral loss of vision developed in all cases and was followed by good visual recovery in the two with isolated optic neuritis, but poor recovery in the patient with concomitant transverse myelitis. The interval between the initial rash and subsequent optic neuritis suggests an immunological pathogenesis for this complication.
Acyclovir↗
Assessment of bone age: a comparison of the Greulich and Pyle, and the Tanner and Whitehouse methods.
A comparison of two methods of bone-age estimation has been made using the hand and wrist radiographs of 66 boys and 58 girls. An estimate made using the specialist auxological technique of Tanner and Whitehouse was compared with three separate estimates obtained by the atlas matching method of Greulich and Pyle (1971). Two of the latter estimates were carried out by two dedicated radiologists whose results showed close agreement. The third estimate made using the Greulich and Pyle method was derived from the routine reports of a number of radiologists at initial presentation. Only in one narrow age-range for girls was there a significant inter-observer difference, and the reasons for this are discussed. Estimates made using the method of Greulich and Pyle were younger than those made using that of Tanner and Whitehouse. There was a linear relationship between the two methods for the boys but not for the girls. It is suggested that atlas matching methods still have a valuable place in non-specialist hospitals concerned with initial diagnosis rather than with the long-term care of growth problems.
Adolescent↗
Ureterosigmoidostomy and bladder exstrophy: a long-term followup.
Of 158 patients who underwent ureterosigmoidostomy for exstrophy of the bladder from 1925 to 1970, 52 were available for followup by telephone interview. Of these patients 34 still had a functioning ureterosigmoidostomy (30 had complete continence day and night) but 18 required diversion by other methods. All of the patients were believed to be socially well adjusted and leading productive lives. Of the patients surviving 15 or more years after ureterosigmoidostomy 11 per cent had colon cancer. Most of the remaining patients were unaware of the risk of adenocarcinoma engendered by the ureterosigmoidostomy. Patients undergoing ureterosigmoidostomy must be fully informed of all health risks and adequate surveillance programs should be arranged. In selected patients ureterosigmoidostomy remains a useful form of urinary diversion, with excellent continence and good social adaptation.
Adolescent↗
The spectrum of urinary tract fibroepithelial polyps in children.
A fibroepithelial polyp is a benign neoplasm that occurs throughout the urinary tract. In children less than 18 years old only 12 cases of upper tract polyps have been reported. We report 2 additional pediatric cases of upper tract fibroepithelial polyps and a rare case of a fibroepithelial polyp in the bladder. At 2 to 7-year followup there has been no recurrence or further development of the polyps. A benign natural history and conservative therapy should be emphasized when fibroepithelial polyps of the upper or lower urinary tracts are encountered in children.
Adolescent↗
Noninvasive testicular screening in childhood leukemia.
To evaluate the potential of transscrotal ultrasound and magnetic resonance imaging as noninvasive screening methods we studied 8 boys with acute lymphocytic leukemia before testicular biopsy. Ultrasonic images of the testes were performed in 4 patients, including 2 with negative and 2 with positive biopsies, and all images were interpreted as normal. Magnetic resonance images of the testes also were interpreted as normal in 4 patients, including 2 with negative and 2 with positive biopsies, and they were technically inadequate in the remaining 4. The results suggest that neither transscrotal ultrasonography nor magnetic resonance imaging as currently applied may substitute reliably for testicular biopsy as a screen for occult testicular leukemia.
Adolescent↗
Jejunal conduit urinary diversion.
The clinical course of 14 patients undergoing jejunal conduit urinary diversion between 1971 and 1985 is reviewed. Indications for use of jejunum rather than ileum or colon for diversion included radiation changes of the ileum, concurrent colonic neoplasms or injury, concerns about collateral blood supply of the colon and multiple adhesions. There were 2 operative deaths. Followup in the remaining 12 patients was 1 to 116 months (mean 34 months). All of the patients had satisfactory postoperative renal function. Eight patients (67 per cent) experienced a total of 13 complications. Only 3 patients (25 per cent) suffered the electrolyte imbalance characteristic of jejunal conduit syndrome, representing the only complication directly attributable to the use of jejunum. The jejunal conduit is a viable alternative form of urinary diversion in patients in whom the use of other intestinal segments is undesirable because of previous irradiation, surgery or concurrent disease processes. Although jejunal conduits carry an increased risk of electrolyte imbalance, the use of short jejunal loops and prophylactic oral electrolyte replacement therapy can minimize the occurrence of this complication.
Adult↗
Renal transplantation in end stage renal disease patients with existing urinary diversion.
From 1971 to 1984 renal transplantation was performed in 20 patients with end stage renal disease who presented with an existing form of urinary diversion. These patients were evaluated with a cystometrogram, voiding cystourethrogram and cystoscopy. In some cases bladder function was studied further by cycling through a suprapubically placed catheter. The bladder was considered unstable in 13 patients and undiversion was done at transplantation. The period of prior diversion ranged from 3 to 20 years (mean 12.7 years). There were no surgical complications postoperatively and normal bladder function returned in all patients. Currently, 8 patients have a functioning renal allograft 16 months to 9 years after transplantation (mean 4.2 years). Seven patients were considered to have a nonusable bladder owing to severe neurogenic disease or refractory contracture. In these patients transplantation was done into a pre-fashioned intestinal conduit (5) or cutaneous ureterostomy (2). Currently, 4 patients have a functioning renal allograft 16 months to 6.2 years after transplantation (mean 3.8 years). Transplantation candidates who present with an existing form of urinary diversion should be evaluated carefully, since many will have a usable bladder. Regardless of whether the bladder is usable, transplantation can be performed safely with no increased surgical or immunological risk.
Adult↗