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Biomedical subjects

S W Beasley

Publications and source records attributed to S W Beasley.

At least 73 records · Page 4Linked to original sources
PubMed1996

Factors affecting the development of the processus vaginalis in the rat.

PURPOSE: We examined the factors that influence development of the processus vaginalis in the rat. MATERIALS AND METHODS: Neonatal Sprague-Dawley rats 0 to 3 days old underwent distal or proximal gubernaculotomy, unilateral orchiectomy or proximal genitofemoral nerve transection. At ages 28 to 60 days the rats were sacrificed, position of the testis was noted and length of the processus vaginalis was measured. RESULTS: There was no development of the processus vaginalis after distal gubernaculotomy. Proximal gubernaculotomy enabled the processus vaginalis to achieve a mean length similar to that of controls (p = 0.06) when the testis descended into the scrotum. Mean length of the processus after proximal gubernaculotomy with an abdominal testis, surgical orchiectomy and torsion of the testis after proximal gubernaculotomy was similar (p = 0.9) but less than that of controls (p < 0.05). Proximal division of the genitofemoral nerve produced variable results depending on how and when the surgical procedure was performed, and whether the psoas muscle was divided. CONCLUSIONS: Distal attachment of the gubernaculum is essential for normal development of the processus vaginalis. Distal gubernaculotomy prevents development of the processus vaginalis because of mechanical disruption of the gubernaculum. Proximal attachment is not essential for normal development of the processus vaginalis but it serves to anchor the testis to the region of the internal inguinal ring, allowing intra-abdominal pressure to facilitate descent of the testis. In the presence of an innervated gubernaculum the processus vaginalis achieves greater length when the testis descends into the scrotum, suggesting that its complete development demands the presence of a testis in the sac. The timing of genitofemoral nerve division may be crucial in determining the subsequent effect on the development of the processus vaginalis and testicular descent, since programming of the gubernaculum by calcitonin gene-related peptide released from the genitofemoral nerve appears to occur just before birth in the rat.

Animals↗
PubMed1995

How to avoid complications during percutaneous endoscopic gastrostomy.

Percutaneous endoscopic gastrostomy (PEG) has advantages over open gastrostomy, and is an accepted technique for children. However, a number of technical problems may be encountered during insertion. This report identifies those problems and proposes precautions that can be taken to reduce their likelihood. Recognized major complications include esophageal injury, colonic perforation, wound infection, gastric erosion by the gastrostomy tube, and later symptomatic gastroesophageal reflux requiring correction by fundoplication.

Adolescent↗
PubMed1995

Trends in the use of fundoplication in children with gastro-oesophageal reflux.

OBJECTIVE: To document changing trends in the indications for fundoplication in children with gastro-oesophageal reflux and to identify the main shortcomings and complications of the procedure. METHODOLOGY: Retrospective review of 405 consecutive children undergoing fundoplication between 1978 and 1992 inclusive. RESULTS: Trends in the indications for fundoplication related to broadening of its use in those with severe neurological impairment and uncontrolled reflux, and to changes in the management of patients in the neonatal period. Complications included unwrapping with recurrence of reflux, hiatal hernia, adhesive small bowel obstruction, dumping syndrome, post-operative persistence of oesophageal stricture, excessively tight wrap and poor oesophageal clearance (mostly in oesophageal atresia patients). CONCLUSIONS: This study identified those patients most likely to develop complications following fundoplication. This may assist in the pre-operative assessment of the likely benefit of fundoplication in children who often have other complex problems.

Adolescent↗
PubMed1995

Technique and complications of percutaneous endoscopic gastrostomy in children.

Percutaneous endoscopic gastrostomy (PEG) is now a well-established technique in children. In this study of 63 children (mean age 7.8 years, youngest 2.4 months), technical problems associated with insertion of the gastrostomy tube, and complications related to the procedure, were analysed. Complications included wound infection, oesophageal injury (probably sustained during extraction of the guide wire) and symptomatic gastro-oesophageal reflux (GOR) occurring after PEG insertion. Many of these complications can be avoided or reduced in likelihood by refinements to the technique of insertion.

Adolescent↗
PubMed1995

A continuing quality improvement (CQI) approach to improving the results of treatment in intussusception.

There is little incentive to change existing protocols or clinical practices of medical conditions in which the results of treatment are considered already to be satisfactory. Our approach to continuing quality improvement (CQI) demands that, even in these conditions, attempts should be made to improve performance further. This report shows how the management of childhood intussusception has been refined at our institution, producing a measurable reduction in the operation rate and thus reducing the overall morbidity to the child. At each step, audit was followed by an intervention, the effect of which was documented. It is our belief that this approach can be applied to any number of medical conditions, and it is a responsibility of CQI personnel to encourage such processes.

Barium↗
PubMed1994

Intussusception: a repeat delayed gas enema increases the nonoperative reduction rate.

The operative rate in intussusception has been significantly reduced by (1) expansion of the indications for attempted enema reduction of intussusception to include all children except those with peritonitis or septicaemia and (2) use of the gas (oxygen) enema rather than barium. This prospective study looked at the value of performing a delayed repeat gas enema in children in whom only partial reduction was achieved during the first enema, and who remained clinically stable. Twenty-one patients (of 156 with proven intussusception) had a repeat delayed gas enema, 30 minutes or more after the first attempt at reduction. This was successful in over 50%, reducing the number of patients requiring surgery at our institution by 24% and saving approximately five children a year from surgery.

Child↗
PubMed1993

Oesophageal duplication cyst: another cause of neonatal respiratory distress.

Oesophageal duplication cysts in infants (usually males) should be recognized as a cause of respiratory distress which worsens during the neonatal period, and which is associated with feeding difficulties. Their radiological appearance is that of a right-sided posterior mediastinal mass, which is shown to be cystic on ultrasound. Excision is curative.

Deglutition Disorders↗
PubMed1993

Accessory diaphragm contributing to respiratory insufficiency in a child with progressive thoracolumbar spinal scoliosis.

A patient with an accessory right diaphragm discovered during thoracotomy for correction of severe thoracolumbar scoliosis is presented to illustrate the diagnostic difficulties that may occur in children with accessory diaphragm. The patient had presented at an early age with respiratory symptoms which were assumed to be asthmatic in aetiology and complicated by progressive chest deformity. The respiratory symptoms in accessory diaphragm can be improved by surgery.

Child↗
PubMed1993

Gas enema for the reduction of intussusception: relationship between clinical signs and symptoms and outcome.

OBJECTIVE: The aim of this study was to establish the extent to which the clinical features of intussusception can be used to predict successful outcome of gas enema and to determine whether the nonsurgical management of intussusception in children can be improved by refining the criteria used to select patients for gas enema. SUBJECTS AND METHODS: Clinical data on 282 consecutive episodes of intussusception (255 patients) were collected prospectively from January 1987 to July 1991. Gas enema was performed in 273 episodes, in which the clinical signs and symptoms were studied by using logistic regression. Nine patients had primary surgery. RESULTS: Gas enema was successful in 216 (79%) of 273 enemas attempted. Fifty-seven patients had surgery after unsuccessful enema. Univariate analysis showed significant associations between successful enema and duration of signs and symptoms less than 12 hr, no rectal bleeding, absence of small-bowel obstruction, presence of a palpable mass, and normal hydration. Multivariate analysis showed that dehydration, small-bowel obstruction, and duration of signs and symptoms longer than 12 hr were significant predictors of unsuccessful enema; yet, in these groups the rate of success still justified attempted enema. Even in severe dehydration, the successful enema reduction rate was 31%. CONCLUSION: Our data suggest that although the factors identified had some predictive value in determining the outcome of attempted enema reduction, they could not be used to indicate patients in whom enema reduction should not be attempted. All patients with intussusception should have a gas enema if the absolute contraindications to enema (i.e., peritonitis or perforation) are absent.

Child↗
PubMed1993

Pyloromyotomy: why make an easy operation difficult?

Recently Ohri et al. advocated a modification to the standard pyloromyotomy for pyloric stenosis which they believed reduced postoperative vomiting. Their study had no control group to support their contention. We therefore compared 37 infants with hypertrophic pyloric stenosis who underwent a conventional longitudinal pyloromyotomy with the 37 infants reported by Ohri et al. who underwent a modified Ramstedt's pyloromyotomy. Data were recorded prospectively and the postoperative vomiting was assessed using the same scale as in the previous report. The incidence of vomiting was significantly less in the children undergoing the conventional operation (P = 0.03), suggesting that there is no justification for performing a double V-shaped pyloric incision in pyloric stenosis.

Female↗
PubMed1992

Management of the premature infant with esophageal atresia and hyaline membrane disease.

Prematurity of 34 weeks' gestation or less occurs in 12% of infants born with esophageal atresia and distal tracheoesophageal fistula, and is likely to result in moderate or severe hyaline membrane disease. In the past, these infants have often had their surgical treatment delayed or staged. Based on our experience of 24 such patients since 1977, we propose that optimal treatment involves early division of the distal tracheoesophageal fistula via a thoracotomy and simultaneous repair of the esophagus where the patient's condition permits. This should be in the first 12 hours of life, before the hyaline membrane disease becomes fully established. Gastrostomy is not required and may be contraindicated.

Contraindications↗
PubMed1992

Intussusception: prediction of outcome of gas enema.

Gas has replaced barium as the preferred medium for enema reduction of intussusception in tertiary pediatric institutions. Previously, adverse clinical features that in combination predicted a low likelihood of successful reduction using barium had been identified and used to select patients suitable for attempted enema reduction. This study examines whether these adverse features are equally applicable to gas reduction of intussusception. For any given number of adverse features, gas enema reduction was found more likely to be successful than barium reduction and, in the absence of clinical evidence of peritonitis, multiple adverse features probably do not represent a contraindication to attempted gas enema reduction.

Child, Preschool↗
PubMed1992

Familial occurrence of complete agenesis of the diaphragm.

The tenth occurrence of complete unilateral agenesis of the diaphragm (McKusick 22240) in siblings is reported in this study. It is likely that parents of children with this type of congenital diaphragmatic hernia have a significantly increased recurrence risk for future offspring. Genetic counselling and antenatal ultrasound should be considered for subsequent pregnancies in families with a previous child with complete agenesis of the diaphragm.

Abnormalities, Multiple↗
PubMed1991

Influence of anatomy and physiology on the management of oesophageal atresia.

Anatomical and physiological considerations specific to newborn infants with congenital thoracic abnormalities directly affect the timing and nature of surgical intervention during the neonatal period. This paper uses oesophageal atresia as an example of a common neonatal thoracic condition to highlight the way in which these considerations have influenced the approach to their surgical management. The type of surgical approach employed during thoracotomy determines the likelihood of subsequent chest wall deformity: an intercostal approach is preferable to rib resection. Multiple thoracotomies adversely affect the chest wall appearance and lung function. In premature infants with respiratory distress syndrome early surgical closure of the tracheo-oesophageal fistula is advantageous, and gastrostomy alone often prolongs the ventilatory difficulties. The upper oesophagus can be extensively mobilized with little danger to its blood supply, whereas the lower oesophagus, because it receives a segmental supply, is more vulnerable to ischaemia. The severity and distribution of tracheomalacia is reflected in its symptomatology. Tracheomalacia often coexists with gastro-oesophageal reflux, which should be corrected by a fundoplication if respiratory symptoms persist or an oesophageal stricture develops. The numerous factors producing heat loss in the newborn during thoracotomy are discussed. It is clear that an understanding of the anatomy and physiological changes which occur in the neonate is required if these infants are to be treated effectively and safely.

Esophageal Atresia↗