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Biomedical subjects

S W Beasley

Publications and source records attributed to S W Beasley.

At least 109 records · Page 6Linked to original sources
PubMed1988

The role of the gubernaculum in testicular descent.

The proximal and distal attachments of the gubernaculum were severed in neonatal rats to examine their role in testicular descent and their relationship to transection of the genitofemoral nerve, which prevents descent of the testis. In 34 of 82 animals proximal transection of the gubernaculum resulted in descent of the testis. In 18 animals the testis remained in the abdomen but in both groups the processus vaginalis developed, suggesting that failure of descent was accidental and not caused by scrotal maldevelopment. Distal transection resulted in failure of descent and prevented growth of the processus vaginalis in all 27 rats. These results suggest that distal transection of the gubernaculum is equivalent to division of the genitofemoral nerve, which supplies the gubernaculum through its distal attachment. Because denervation of the gubernaculum prevents the effect of androgens on gubernacular differentiation, the results suggest that testosterone acts via the nerve. The putative effect of androgens on the gubernaculum may be mediated indirectly by the central nervous system, rather than directly on the gubernaculum itself.

Animals↗
PubMed1988

Intussusception: clinical prediction of outcome of barium reduction.

Patients with intussusception who have necrotic bowel requiring bowel resection or who are at major risk of perforation from attempted hydrostatic reduction may be better managed without barium reduction. Ideally, the clinician would like to identify such patients at presentation. Two groups of patients, representing the extreme ends of the intussusception treatment spectrum were investigated in order to highlight the clinical features of patients in whom an attempted barium reduction is not justified. A group of 200 patients who had successful and safe hydrostatic reduction was compared with 104 patients who ultimately required bowel resection. Four features were found to be indicators of an increased likelihood of resection: age 3 months or less, or greater than 2 years, duration of symptoms greater than 24 h, presence of small bowel obstruction on plain radiology, and clinical assessment of dehydration greater than 5%. The validity of these features as prognostic indicators was assessed by applying them to all patients who had attempted barium reduction to see how they predicted patient outcome. In isolation, each feature was found to be compatible with a safe and successful hydrostatic reduction. The rate of resection was increased in patients with multiple adverse features and in these patients the enema technique may require modification. Patients with three or four adverse features had an unacceptably high incidence of gangrenous bowel requiring resection and a low likelihood of successful hydrostatic reduction. It is believed that attempts at reduction are not appropriate in these patients.

Barium Sulfate↗
PubMed1987

Precocious puberty associated with malignant thoracic teratoma and malignant histiocytosis in a child with Klinefelter's syndrome.

A 10-year-old boy with precocious puberty of 2 1/2 years' duration presented with a malignant thoracic teratoma with elevated levels of beta human chorionic gonadotropin (beta-HCG) and alpha fetoprotein (alpha FP). The mediastinal tumor was completely excised and adjuvant chemotherapy commenced. Within 3 weeks of commencing chemotherapy he developed hematologic abnormalities that, with the subsequent clinical illness, led to a diagnosis of malignant histiocytosis. Death occurred a few days after start of therapy for malignant histiocytosis. Cytogenic studies showed the somatic karyotype to be that of Klinefelter's syndrome, while the malignant cells in marrow and lymph node carried an additional marker chromosome. This case, with others reported, suggest that the XXY karyotype may influence the development of mediastinal germ cell tumors, which in themselves appear to be associated with the early onset of a malignancy of the hemopoietic system.

Child↗
PubMed1987

Recurrent intussusception: barium or surgery?

A review was conducted of children with intussusception admitted to the Royal Children's Hospital over a 16 year period: of 630 episodes of intussusception, 28 represented recurrences (4.4%): 10 of these occurred in children aged 2 years or over. Duration of symptoms and the incidence of an incorrect initial diagnosis were markedly reduced with recurrence. The clinical presentation was similar to the first episode apart from rectal bleeding which was less common, reflecting the shorter history. Sixteen barium enemas were performed, of which 10 were successful. There were 18 operations with eight resections; seven for localized lesions and one for failure of manual reduction in a patient with an inverted Meckel's diverticulum. Barium reduction for recurrence should not be attempted in children over 2 years of age in whom no laparotomy was performed for their first episode, for most second recurrences, or in multiple polyposis.

Barium Sulfate↗
PubMed1987

Effect of division of genitofemoral nerve on testicular descent in the rat.

The gubernaculum, which has an important role to play in testicular descent, is richly supplied by the genital branch of the genitofemoral nerve through its scrotal attachment. In neonatal rats the genitofemoral nerve overlying the psoas muscle was divided before inguinal descent would normally occur, and the effect of this procedure on subsequent testicular descent was observed. Denervation of the gubernaculum caused the testes to remain in the abdomen. The significance of this finding in the rat is that an intact genitofemoral nerve is an essential prerequisite for normal descent, perhaps by allowing the gubernaculum to evert.

Animals↗
PubMed1987

Efficacy and safety of continuous morphine infusion for postoperative analgesia in the paediatric surgical ward.

This study determines the efficacy and safety of continuous infusion of morphine following major surgery in non-ventilated children being nursed in general paediatric surgical wards. Pain and analgesia were assessed by a linear analogue scale. Assessment of pain by nursing staff was similar to that made by the patient and parent. Continuous infusions were easy to institute, well accepted by staff and patients alike and resulted in few side effects. The safety and efficacy of morphine infusions allow for wider adoption as a routine method of analgesia for children following major surgery.

Adolescent↗
PubMed1986

Clinical diagnosis of umbilical swellings and discharges in children.

Umbilical swellings and discharges are frequently seen in paediatric practice. Whereas the diagnosis of umbilical hernia and the much rarer conditions of exomphalos and gastroschisis should not be problematic, urachal and vitello-intestinal tract remnants that require surgery may resemble the common umbilical granuloma, which may be treated with silver nitrate. A comparison is made of the features of cases that required admission to the Royal Children's Hospital, Melbourne, for umbilical problems from 1973 to 1985, inclusive. A diagnostic protocol to assist the attending primary care physician is suggested.

Adolescent↗
PubMed1986

Continuous ambulatory peritoneal dialysis and acute appendicitis.

Peritonitis in patients on continuous ambulatory peritoneal dialysis while usually due to contamination of the dialysis line by skin organisms may also be due to intra-abdominal pathology. Three cases are described in whom peritonitis was due to acute appendicitis. The recognition of an intra-abdominal source of infection in patients on CAPD is discussed, and surgical management stressed.

Acute Disease↗
PubMed1986

Inverted Y duplication of the ureter in association with ureterocele and bladder diverticulum.

We report a case of inverted Y duplication of the ureter in association with an obstructing ectopic ureterocele and paraureteral diverticulum. Preoperative radiological studies demonstrated the ureterocele and diverticulum but they failed to show the duplex distal ureter. The duplicated section of ureter was excised and a Cohen reimplantation was performed. The presence of a large ureterocele obstructing the bladder neck, a diverticulum, failure of reflux into the ectopic segment and poor function of the affected kidney all contributed to the difficulties in establishing a preoperative diagnosis.

Diverticulum↗
PubMed1986

Use of mercurochrome in the management of the large exomphalos.

The topical application of solutions containing mercury has remained popular in the conservative management of the large exomphalos, despite recent reports of high organ mercury levels occurring in neonates who have died following this type of treatment. There are few reports of mercury poisoning being recognized in survivors. This report records blood and urine mercury levels in four patients with no apparent sequelae after treatment with Mercurochrome and provides guidelines for the safer use of mercurial solutions in the conservative management of exomphalos: one thin application of 1% Mercurochrome be applied to the intact sac; thereafter, Mercurochrome be applied sparingly only to areas that remain moist; blood and urine levels of mercury be monitored routinely; and applications ceased whenever mercury levels exceed the minimum toxic level. Only with this sparing and judicious use of mercurial solutions is the hazard to the infant kept to a minimum.

Fluoresceins↗
PubMed1986

Influence of age, sex, duration of symptoms and dehydration of serum electrolytes in hypertrophic pyloric stenosis.

A review was conducted of 234 consecutive patients with hypertrophic pyloric stenosis (HPS) proven at operation. The relationship of age, sex, the duration of symptoms and the clinical degree of dehydration to the severity of metabolic derangement as reflected by alterations in serum electrolytes and acid-base status, was analysed statistically. The length of history and the degree of dehydration was found to have predictive value in identifying those likely to have major metabolic disturbances. Where severe vomiting has persisted for more than 1 week, major derangements of the biochemical parameters should be anticipated; and where clinical assessment of dehydration is estimated as being greater than 5%, there is almost always some major biochemical abnormality present. Nevertheless, variation in individual cases necessitates that all patients with suspected HPS should have serum electrolytes and acid-base estimations performed.

Age Factors↗