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Biomedical subjects

V E Boston

Publications and source records attributed to V E Boston.

At least 55 records · Page 3Linked to original sources
PubMed1987

Assessment of hindgut function in premature newborns.

Anorectal manometry was performed on 32 small for dates and or preterm infants, using a micro-tip pressure transducer. A normal rectoanal reflex was observed in otherwise normal infants on the first day of life. During the neonatal period, hindgut function in these infants was studied longitudinally using the minimum excitation energy (MER) to elicit a rectoanal reflex. Data suggest that hindgut dysfunction (indicated by a significant increase in MER) develops prior to the onset of abdominal distension or necrotizing enterocolitis (NEC), rather than being present from birth. Consequently, this abnormality of function probably does not initiate the process that leads to NEC. This increase in MER may be a warning that the infant is about to develop abdominal distension or NEC.

Anal Canal↗
PubMed1987

The role of intraluminal tension and pH in the development of necrotizing enterocolitis: an animal model.

Presented is an in vivo animal model of necrotizing enterocolitis (NEC) in which we used an isolated loop of rabbit colon. Changes in mucosal perfusion and macroscopic and microscopic appearances were studied after exposure of the mucosa to different intraluminal tensions and pHs. Mucosal perfusion was reduced with increasing intraluminal tension and decreasing pH. Histologic changes consistent with NEC were identified after five hours when the mucosa had been exposed to both increased intraluminal tension and decreased pH. Factors affecting intraluminal tension and pH could influence the development of NEC in the neonate.

Animals↗
PubMed1987

Sequential assay of expired breath hydrogen as a means of predicting necrotizing enterocolitis in susceptible infants.

Breath hydrogen levels were investigated prospectively from birth, in a population of neonates at risk of developing NEC. This was standardized to the quantity of carbohydrate in the feed. Children who developed NEC, confirmed radiologically, were compared with matched controls. There was a significant increase in breath hydrogen, in the 24 hours prior to the onset of disease, in index cases as compared with controls. This test may be effective in discriminating between those children who are going to develop NEC and those in whom feeding can be continued safely.

Breath Tests↗
PubMed1987

The natural history of vesicoureteric reflux in children with neuropathic bladder and open neural tube defects.

Vesicoureteric reflux in children with neuropathic bladder and open neural tube defects has been reviewed to determine its natural history. In 78%, reflux was identified during the first 2 years, emphasising the importance of investigation in the neonatal period and at regular intervals thereafter. Deterioration occurred in 67%. Those most likely to deteriorate had a flaccid detrusor and bilateral reflux, which was grade 4 or greater at the time of diagnosis. Only 24% remained unchanged and in only 9% did reflux resolve spontaneously. Many patients were treated by continuous or intermittent catheterisation, or by surgical procedures to reduce outflow obstruction, but with disappointing results. Surgical intervention for deteriorating upper tracts was usually late and involved extensive procedures such as nephroureterectomy or urinary diversion. The results suggest that treatment should be aimed primarily at restoration of the anti-reflux function of the vesicoureteric junction. Using endoscopic subureteric Teflon injection (STING) at an early stage, especially in the at risk group, it should be possible to avoid ongoing renal damage and more extensive, salvage surgery at a later date.

Adolescent↗
PubMed1987

Parental attitudes to the unclosed open neural tube defect.

Recent years have seen a trend away from the immediate closure to delayed or nonclosure of the back lesion in open neural tube defects (ONTD). Parental attitudes towards this more conservative surgical policy have not been investigated. We therefore surveyed 70 families in Northern Ireland of children who are still alive, over six months of age who had an ONTD which was not surgically closed immediately after birth. Fifty-eight parents (84%) responded. Most parents (84%) had no difficulty in handling or dressing the back, but three-quarters felt that the lesion was painful and 41% felt that its appearance was disturbing to other members of the family. In those who had delayed closure (n = 15) all parents confirmed that the child was more comfortable and easier to handle afterwards. Eleven of them (73%) felt that the child was more acceptable to the rest of the family and that surgery should have been carried out earlier. A third preferred immediate closure "to make the child more comfortable" and to "improve the general quality of life". However, 46% did not want surgery for fear of upsetting the status quo. This survey suggested that parental attitudes towards the open back lesion differ greatly and that these views should play a greater role in the decisions which influence the timing of closure of ONTD.

Attitude↗
PubMed1987

Henoch-Schönlein purpura: problems in surgical diagnosis and management.

The clinico-pathological features of 133 consecutive cases of Henoch-Schönlein purpura are presented, with emphasis on the gastrointestinal manifestations. The potential pitfalls of contrast radiography are underlined with respect to management of intussusception and a plea is made to re-establish clinical assessment of the abdomen as the prime indicator in deciding to undertake laparotomy.

Abdomen↗
PubMed1983

The influence of metronidazole prophylaxis and the method of closure on wound infection in non-perforating appendicitis in childhood.

Prospective investigation of consecutive children suffering from non-perforating appendicitis indicated that metronidazole prophylaxis significantly reduces the risk of postoperative wound sepsis regardless of the method of closure. However, in view of the advantages of subcuticular polyglycolic acid this must be regarded as the method of closure of choice in non-perforating appendicitis in children.

Appendectomy↗
PubMed1979

A retrospective analysis of conservative versus active management in severe open myelomeningocele.

88 patients with thoraco-lumbar myelomeningocele not operated upon in the 1976-1977 period were compared with 76 patients with the same condition operated upon in the 1964-1971 period. There was no significant difference in sex and hydrocephalus at birth in the two groups. Mortality was less in the surgically treated group only after the age of three months. Ventriculitis appeared to be related to the incidence of hydrocephalus in the surgically treated group. There was a reduced risk of developing progressive hydrocephalus after birth in the untreated group, and the neurological status of the survivors at one year was the same in both groups. Interpreting the results as indicating that early surgery increased the incidence of progressive hydrocephalus and ventriculitis, and might increase survival of more disabled infants, then non-surgical treatment is justified since survivors are no worse as a result of this non-active approach.

Cerebral Ventricles↗
PubMed1978

Serum and erythrocyte acetylcholinesterase activity in Hirschsprung's disease.

Acetylcholinesterase activity was measured in the serum and erythrocytes from 22 children. The 12 patients in whom the diagnosis of Hirschsprung's disease was confirmed, had a significantly higher concentration of enzyme in both serum and erythrocytes than the 10 children in whom the diagnosis was excluded. This systemic manifestation, may prove of value in the diagnosis of Hirschsprung's disease.

Acetylcholinesterase↗
PubMed1977

Qualitative and quantitative evaluation of internal anal sphincter function in the newborn.

One-hundred-and-one normal neonates were examined manometrically in the first day of life to assess anorectal function. In order to overcome some of the difficulties in subjective interpretation of results, the stimuli used and the response pattern seen in the anal canal were measured. In the unstimulated state, all subjects demonstrated rhythmical changes in anal canal tone. Mean maximal intraluminal pressure in the anal canal decreased significantly after 10 hours of age and after the first meconium stool. Only five out of the 101 examined on the first day of life had an abnormal manometric response. It is significant that none of these had passed meconium at the time of examination, and that all had a normal response pattern at the age of 28 hours. In 20 of these babies the sensitivity of the rectoanal reflex was measured and found to be significantly increased on the third day of life compared with the first. The quantitative changes in anorectal reflex function in the newborn, are thought to be related to the state of physiological ;constipation' which exists in utero and in the early neonatal period. The results indicate that a normal response pattern can be obtained in healthy babies after the first day of life. Consequently, anorectal manometry will be meaningful as a diagnostic method thereafter in the neonatal period. Further, it is suggested that measurement of the stimulus and the response will add useful information and reduce subjective error in interpretation of results.

Age Factors↗