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Abstract
PURPOSE The aim of this study was to review the effectiveness of resecting dilated distal bowel in children suffering unmanageable constipation or soiling who have been operated on previously for anorectal malformations. METHODS A retrospective review was performed of 9 children. Each child underwent excision of dilated bowel to leave normal caliber bowel anastomosed by hand to a rectal reservoir at the peritoneal reflection. The documented follow-up was reviewed. RESULTS The 9 children had primary surgery for the following anomalies: high (n = 1), intermediate (n = 1), low (n = 3), rectal stenosis (n = 3), and anal stenosis (n = 3), Seven children had persistent fecalomas, and 7 had major problems with soiling. All were on large doses of laxatives, with 5 having regular rectal washouts and 4 having regular enemas. In all radiologic studies there was a prompt change from normal caliber bowel to dilated bowel at the upper limit of the dilatation. The mean age at operation for excision was 4 years, 11 months (range, 11 months to 9 years, 11 months). The mean period of follow-up was 4 years, 7 months (range, 2 years, 3 months to 10 years). Follow-up showed that all children improved. None had major complications. All were having between one and 3 bowel actions per day. Three continued to soil but improved. Of the remaining 6, only 2 required occasional laxatives and had regular spontaneous bowel actions without soiling. No child was having enemas or washouts. CONCLUSION Anterior resection for the treatment of megarectosigmoid is a safe and effective procedure.
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Affiliation(s)
- M R Hallows
- Department of Paediatric Surgery, The Birmingham Children's Hospital NHS Trust, and The University of Birmingham, Birmingham, England
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2
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Abstract
The commonest causes of acutely painful scrotum are torsion (of appendix of the testis or the testis itself) and epididymo-orchitis. Exploration is the only way to prove the diagnosis and multiple such procedures are performed in patients with recurrent epididymo-orchitis. The purpose of our study was to investigate the cause of recurrent epididymo-orchitis in pre-pubertal children. Four children, aged three years or less, were investigated for recurrent left epididymo-orchitis. All four had cystic dilatation of the ejaculatory duct in the region of the prostatic utriculus, associated in two children with ectopic opening of the vas in the bladder. Initial ultrasound appeared to be normal in all four patients, a retrospective review of the sonographic films, however, revealed a retrovesical cyst in three of them. The diagnosis was established by a combination of urethroscopy with retrograde contrast study via the utriculus and open vasography. All four cases were treated operatively by a transtrigonal approach. The cyst was excised in each case. In one, a vasovasostomy was performed between the left and the normal right vas; in the other three the left vas was anastomosed to the blind end of the contralateral seminal vesicle. All four are symptom-free at one year follow-up. Cysts of the ejaculatory duct are a treatable cause of recurrent epididymo-orchitis. Pre-pubertal children with recurrent epididymo-orchitis and no obvious underlying cause should have a thorough sonographic examination of the retrovesical region for cystic lesions.
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Affiliation(s)
- A Pimpalwar
- Department of Paediatric Surgery, Birmingham Children Hospital, Birmingham, UK.
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3
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Abstract
BACKGROUND A degree of feed intolerance after neonatal abdominal surgery is common but in an otherwise well baby enteral feeding usually is continued at the highest tolerated level. However, the presence of rectal bleeding, pneumatosis intestinalis, or portal vein gas seen on plain abdominal x-rays suggest the possibility of postoperative necrotising enterocolitis. When this happens feedings usually are stopped for 7 to 10 days, and intravenous antibiotics and total parental nutrition are commenced. METHODS The authors report 12 episodes of rectal bleeding and 11 episodes of pneumatosis intestinalis in 3 infants who previously had undergone neonatal abdominal surgery for intestinal malformations. In 7 of these episodes, feedings were neither stopped nor were antibiotics given. At the time of these 7 episodes, the infants were more than 3 kg in weight, had no significant cardiac or respiratory pathology, were all clinically stable, had no evidence of peritonitis, had no thrombocytopenia, and were greater than 37 weeks postconception. RESULTS The 3 infants were monitored closely. There were no early or late problems observed attributable to this management. CONCLUSION Carefully selected clinically stable patients that have postoperative pneumatosis intestinalis or exhibit rectal bleeding may be successfully managed by reduced enteral feedings with no antibiotics. J Pediatr Surg 36:1820-1823.
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Affiliation(s)
- A Abhyankar
- Institute of Child Health, University of Birmingham, Birmingham, England
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4
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Abstract
Ectopic ureters present in childhood with symptoms related to an abnormal site or structure (refluxing, obstructed) of the ureteric orifice. The majority drain duplex kidneys. The diagnosis is relatively easy if the poles are functioning or hydronephrotic. Associated malformations are rarely seen and the results of surgery are gratifying. If an ectopic ureter drains a single kidney, it is called a single-system ectopic ureter (SSEU). We reviewed a 15-year experience (1980-1995) with 127 ectopic ureters from our hospital:11 SSEUs in ten consecutive children were managed during this period. Our data lead us to believe that SSEUs are a special subset of ectopic ureters. Diagnosis is often delayed because the ectopic ureter may be associated with a single small, dysplastic, poorly-functioning, non-visualised kidney and the child may be thought to have a contralateral normal "solitary kidney". Associated systemic malformations are common. Residual symptoms of wetting may persist in the early postoperative period. A high degree of suspicion must be maintained for this entity when a child presents with urinary symptoms of wetting or recurrent infection and a "solitary kidney". Early endoscopic examination of the genitourinary tract will clinch the diagnosis in the majority of cases. Residual symptoms of wetting in the postoperative period generally resolve with passage of time.
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Affiliation(s)
- S K Chowdhary
- Diana, Princess Of Wales Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, UK
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5
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Abstract
Gastroschisis (GS) is the commonest abdominal-wall defect in the Western world. The conventional practice has been reduction of the viscera and closure of the abdominal wall as an emergency procedure. The testis is often a part of the prolapsed viscera along with the bowel loops, stomach, fallopian tube, etc. The primary management of prolapsed (PT) (3) and intra-abdominal (5) testes (IAT) in this condition was studied in 16 consecutive male babies with GS, each was managed by simple reposition of the testes and closure of the abdominal wall. The babies were followed up for spontaneous descent of the testes. At 18-month follow-up, all five IAT had descended into the scrotum spontaneously and were palpably normal. Of the three extra-abdominal PT, two had descended into the scrotum and were normal in size and on palpation. One was palpable in the superficial inguinal pouch. Simple reposition of the testes into the abdomen and closure of the abdominal defect is the correct approach for primary management of PT or IAT in a newborn with GS.
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Affiliation(s)
- S K Chowdhary
- Diana, Princess of Wales Childrens Hospital, Birmingham, UK
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6
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Chowdhary SK, Parashar K, Buick RG, Gornall P, Corkery JJ. Central-venous access through the peripheral route in surgical neonates: an audit of 125 consecutive lines from a regional neonatal centre. Pediatr Surg Int 2001; 17:433-5. [PMID: 11527183 DOI: 10.1007/s003830000550] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A long Percutaneous silastic IV line is frequently used in surgical neonates for infusion of hyperosmolar parenteral nutrition fluid into a central vein for several days without the need for operative insertion of a Broviac catheter or risks of direct puncture of a central vein. Our study was aimed at auditing the performance of 125 consecutive lines over a 2-year period. During this period, insertion was attempted in 125 babies; in 13 cases the line could not be inserted because of technical problems. The gestational ages varied between 25 and 41 weeks and weights between 630 g and 4.2 kg. Success did not appear to be related to the age or weight of the baby. The mean duration of complication-free performance was 22.4 days. There was a significant difference between the complication rate of lines inserted in the operating theatre versus those on the ward (P < 0.05). There was no significant increase in complications in lines used for over 4 weeks. The technique adopted by us for inserting these lines is likely to succeed in the majority of cases, including premature and small-for-dates babies. In our experience, lines inserted in the controlled theatre environment either before or after abdominal surgery performed better. The manufacturer's recommendation to electively change the line every 4 weeks needs further prospective evaluation.
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Affiliation(s)
- S K Chowdhary
- Diana, Princess of Wales Children's Hospital, Birmingham, UK
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7
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Charifson PS, Corkery JJ, Murcko MA, Walters WP. Consensus scoring: A method for obtaining improved hit rates from docking databases of three-dimensional structures into proteins. J Med Chem 1999; 42:5100-9. [PMID: 10602695 DOI: 10.1021/jm990352k] [Citation(s) in RCA: 523] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We present the results of an extensive computational study in which we show that combining scoring functions in an intersection-based consensus approach results in an enhancement in the ability to discriminate between active and inactive enzyme inhibitors. This is illustrated in the context of docking collections of three-dimensional structures into three different enzymes of pharmaceutical interest: p38 MAP kinase, inosine monophosphate dehydrogenase, and HIV protease. An analysis of two different docking methods and thirteen scoring functions provides insights into which functions perform well, both singly and in combination. Our data shows that consensus scoring further provides a dramatic reduction in the number of false positives identified by individual scoring functions, thus leading to a significant enhancement in hit-rates.
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Affiliation(s)
- P S Charifson
- Vertex Pharmaceuticals, 130 Waverly Street, Cambridge, Massachusetts 02139-4242, USA.
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8
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Redkar RG, Needham S, Corkery JJ. Colonic metaplasia in prolapsed bladder mucosal grafts. Br J Urol 1998; 82:459. [PMID: 9772896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Affiliation(s)
- R G Redkar
- Department of Paediatric Surgery, Birmingham Children's Hospital, UK
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9
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Lander A, Redkar R, Nicholls G, Lawson A, Choudhury SR, Corkery JJ, Gornall P, Buick RG, Booth IW. Cisapride reduces neonatal postoperative ileus: randomised placebo controlled trial. Arch Dis Child Fetal Neonatal Ed 1997; 77:F119-22. [PMID: 9377133 PMCID: PMC1720698 DOI: 10.1136/fn.77.2.f119] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
AIM To assess the efficacy of cisapride in reducing ileus persisting to the tenth postoperative day after neonatal abdominal surgery. METHODS A prospective, randomised, double blind trial comparing rectal cisapride (1.4-2.3 mg/kg/day) with placebo over seven days was undertaken in 33 neonates. RESULTS Seven of 12 (58%) patients receiving placebo and eight of 11 (73%) receiving cisapride achieved a first sustained feed during treatment. Of those receiving cisapride, the first sustained feed occurred at 2.3 days (SEM 0.6) compared with 4.7 days (SEM 0.8) with placebo. By the seventh day the mean daily net enteral balance was 69 (SEM 18) ml/kg in the cisapride subgroup and 17 (SEM 8) ml/kg for those receiving placebo. Stool was passed on 6.3 (SEM 0.4) treatment days in the cisapride subgroup compared with 4.1 (SEM 1.0) treatment days in the placebo subgroup. CONCLUSION Cisapride is effective in neonates with a prolonged ileus after abdominal surgery.
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Affiliation(s)
- A Lander
- Department of Paediatric Surgery, Children's Hospital, Birmingham.
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10
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Beath SV, Davies P, Papadopoulou A, Khan AR, Buick RG, Corkery JJ, Gornall P, Booth IW. Parenteral nutrition-related cholestasis in postsurgical neonates: multivariate analysis of risk factors. J Pediatr Surg 1996; 31:604-6. [PMID: 8801324 DOI: 10.1016/s0022-3468(96)90507-2] [Citation(s) in RCA: 196] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The medical records of 74 neonates dependent on parenteral nutrition for at least 21 days after emergency abdominal surgery (performed between 1988 and 1992) were reviewed respectively. The role of enteral starvation, prematurity, composition and duration of parenteral nutrition, and sepsis in the evolution of parenteral nutrition-related cholestasis was evaluated by multiple regression analysis. The most important factors for cholestasis were low gestational age (median, 34 weeks), early exposure to parenteral nutrition, and sepsis. Episodes of sepsis were associated with a 30% increase in the bilirubin level. Enteral starvation and composition and the duration of parenteral nutrition solutions did not correlate significantly with the development of cholestasis. Prevention of sepsis should be the priority in minimising cholestasis in postsurgical neonates who are dependent on parenteral nutrition.
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Affiliation(s)
- S V Beath
- Institute of Child Health, University of Birmingham, England
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11
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Abstract
To determine the most successful mode of treatment, 33 consecutive cases of duodenal atresia treated by duodenoduodenostomy and not associated with other gastro-intestinal anomalies were analysed retrospectively. These patients have been placed in a nonrandomised fashion into one of three groups: Group A: Duodenostomy (side to side) with gastrostomy and transanastomotic feeding tube (n = 12); Group B: Duodenoduodenostomy (diamond shape) with jejunostomy feeding tube (n = 12); Group C: Duodenoduodenostomy (diamond shape) only (n = 9). A nasogastric tube was used in all cases. There was no difference between the groups for gestational age, birthweight, and age at operation. The outcome measures used to compare these groups were the time taken to achieve full preanastomotic feeds and the duration of hospital stay. There was no difference in time taken to achieve full pre-anastomotic feeds between Group A and Group B. Patients in Group C took significantly less time to achieve full pre-anastomotic feeds than either of the other two groups (p < 0.05, Mann-Whitney U). The duration of hospital stay was also significantly shorter for patients in Group C (median = 12 days) than for patients in either Group A or B (median = 24, 20 days respectively) (p < 0.05, Mann-Whitney U).
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Affiliation(s)
- V Upadhyay
- Department of Surgery, Children's Hospital, Birmingham, UK
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12
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Abstract
We report on 11 consecutive cases of nesidioblastosis successfully managed, in a 22-year period from 1972-1993 at The Children's Hospital, Birmingham, England. In the pre-operative period all patients were managed by constant glucose administration ( > 10 mg/kg/min) and hyperglycaemic agents such as diazoxide, glucagon, growth hormone and somatostatin either singly or in combination. Seven patients underwent partial pancreatectomy, 2 of whom needed a subsequent near-total resection; 4 others had a near-total pancreatectomy as the primary procedure. The 5 patients who have had partial pancreatectomies are healthy and on no regular medication. Of the 6 patients who had near-total pancreatectomy 3 require insulin for diabetes mellitus and 3 are on pancreatin for pancreatic exocrine deficiency. We recommend partial pancreatectomy as the first operation in the treatment of nesidioblastosis.
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Affiliation(s)
- K Parashar
- Children's Hospital, Ladywood, Birmingham, United Kingdom
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13
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Affiliation(s)
- M Y Hammadeh
- Department of Paediatric Surgery, Children's Hospital, Birmingham, UK
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14
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Hammadeh MY, Nicholls G, Corkery JJ. Recurrent intra-scrotal abscess in an infant: an unusual presentation of ectopic ureter. Br J Urol 1994; 73:592-3. [PMID: 8012790 DOI: 10.1111/j.1464-410x.1994.tb07656.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- M Y Hammadeh
- Department of Paediatric Surgery, Children's Hospital, Birmingham, UK
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15
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Corkery JJ. Infantile hypertrophic pyloric stenosis: where should it be treated? Ann R Coll Surg Engl 1994; 76:70. [PMID: 8117030 PMCID: PMC2502178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
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16
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Hammadeh MY, Nicholls G, Calder CJ, Buick RG, Gornall P, Corkery JJ. Xanthogranulomatous pyelonephritis in childhood: pre-operative diagnosis is possible. Br J Urol 1994; 73:83-6. [PMID: 8298903 DOI: 10.1111/j.1464-410x.1994.tb07461.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To diagnose xanthogranulomatous pyelonephritis (XGP) in childhood pre-operatively. PATIENTS AND METHODS Eleven cases of XGP presenting to Birmingham Children's Hospital over a 10-year-period are reported. Nine (82%) were diagnosed preoperatively on the clinical and radiological findings. RESULTS The characteristic clinical findings were urinary tract infection (9 cases), palpable renal mass (8 cases) and anaemia (8 cases). The most common radiological findings were enlarged kidney (9 cases), renal calculi (7 cases) and non-functioning kidney (6 cases). Renal ultrasound typically demonstrated a central echoic area (6 cases) and multiple hypoechoic areas in the parenchyma (7 cases). A computed tomography (CT) scan was performed in three cases. This showed characteristic multiple, low attenuation, unenhanced areas within the parenchyma with extension of the inflammatory process into peri-nephric fat (two cases). Ten cases (91%) were of the diffuse type. There was extension into the peri-nephric fat in eight cases (73%). Three cases (27%) were associated with congenital urological abnormalities. Nephrectomy was performed in 10 cases and a partial nephrectomy in one. CONCLUSION XGP is uncommon in childhood but should always be considered in the differential diagnosis of renal masses, especially in the presence of anaemia. Nephrectomy usually results in a permanent cure.
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Affiliation(s)
- M Y Hammadeh
- Department of Paediatric Surgery, Children's Hospital, Birmingham, UK
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17
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Abstract
This study aims to establish the usefulness of delivering neonates with gastroschisis in a regional obstetric and neonatal centre without the facility of on site surgery. A retrospective analysis was performed on the notes of 43 consecutive neonates with gastroschisis referred to Birmingham Children's Hospital over a 10 year period. Two groups were compared: those delivered at the regional obstetric centre (n = 9) and those delivered peripherally (n = 34). Both groups underwent postnatal transfer. There were no significant differences with regard to gestational age, birth weight, caesarean section rate, time to operation, and mortality. Primary closure rates were 89% for the regional centre group and 94% for the peripheral hospital group. Mean time to full enteral feeding was 24 days for the regional centre group and 23 days for those delivered peripherally. These data show that good results can be achieved with postnatal transfer. If on site surgery is not available, neonatal services are adequate peripherally, and the transfer distance is not too great, then delivery in a regional obstetric centre with subsequent postnatal transfer offers no advantage.
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Affiliation(s)
- G Nicholls
- Department of Paediatric Surgery, Birmingham Children's Hospital, Ladywood
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18
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Affiliation(s)
- A Lawson
- Department of Paediatric Surgery, Children's Hospital, Birmingham, UK
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19
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Huddart S, Mann J, Stevens MC, Gornall P, Corkery JJ, Spooner D, Chapman S, Raafat F, Shah K, Worthington D. Neuroblastoma diagnosed antenatally: a treatment dilemma with implications for screening. Med Pediatr Oncol 1992; 20:156-61. [PMID: 1734221 DOI: 10.1002/mpo.2950200212] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- S Huddart
- Department of Oncology, Children's Hospital, Birmingham, England
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20
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Abstract
Between 1984 and 1989, 110 boys with 130 impalpable testes were investigated and treated. One hundred and six boys underwent laparoscopy. Twenty had bilateral impalpable testes and 13 had a palpable, but maldescended, testis on the other side. Forty-nine testes were absent and one atrophic testis was found in the scrotum. Twelve orchidectomies were performed. One child had a microvascular transfer procedure. The remaining 67 testes were treated by orchidopexy: 28 single-stage and 39 two-stage procedures. One of the single-stage and 29 of the two-stage orchidopexies included division of the testicular vessels. Twenty-three testes examined 12 or more months after staged testicular vessel division revealed a good result in 15.
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Affiliation(s)
- A Lawson
- Department of Paediatric Surgery, Children's Hospital, Ladywood Middleway, Birmingham, UK
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21
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Abstract
To investigate the possibility that small intestinal dysmotility is a cause of long-standing and persistent symptoms in patients with malrotation, we retrospectively reviewed 94 patients operated on for intestinal malrotation. In 50 patients operated on during the neonatal period, associated abnormalities were common (24%) and all presented with obstructive symptoms; only three (6%) had continuing mild symptoms the postneonatal period (aged 1 month to 1 year), five of whom (22%) had other abnormalities. Recurrent vomiting was the most common presentation (11/23); only 5 patients (21%) had acute obstruction. Response to operation was good in 18 (78%) and two had persistant symptoms; both died. Twenty-one patients presented beyond infancy (aged greater than 1 year), only 19 of whom had symptoms of less than 2 months' duration. Eight (47%) of those with long-standing symptoms had no relief from operation. Small bowel motility was recorded manometrically in 4 patients with long-standing symptoms. The findings suggest that small intestinal dysmotility may be common in patients with malrotation and persistant symptoms.
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Affiliation(s)
- R C Coombs
- Institute of Child Health, University of Birmingham, England
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22
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Newell SJ, Morgan ME, McHugo JM, White RH, Taylor CM, Chapman S, Shah KJ, Gornall P, Corkery JJ. Clinical significance of antenatal calyceal dilatation detected by ultrasound. Lancet 1990; 336:372. [PMID: 1975348 DOI: 10.1016/0140-6736(90)91910-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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23
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Abstract
Fifty infants with infantile hypertrophic pyloric stenosis were studied prospectively to evaluate the reliability of plasma chloride estimation in the assessment of the acid-base status on admission and during correction of alkalaemia. Four cases were subsequently excluded because of a breach of the study protocol, leaving 46 cases in the study. Seventeen (37 per cent) were normoacidaemic on admission; 13 had plasma chloride concentrations of greater than or equal to 106 mmol/l and four had chloride concentrations of 100-105 mmol/l on admission. Twenty-nine (63 per cent) were alkalaemic on admission; six cases had chloride concentrations of 100-105 mmol/l and 23 cases had concentrations of less than 100 mmol/l. Of those 29 cases requiring correction of alkalaemia, normoacidaemia was achieved at a plasma chloride concentration of greater than or equal to 106 mmol/l in 21 cases (72 per cent) and at a concentration of 100-105 mmol/l in eight cases (28 per cent). Plasma chloride is a reliable parameter in the assessment and correction of alkalaemia in infantile hypertrophic pyloric stenosis provided that a concentration of at least 106 mmol/l is the goal.
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Affiliation(s)
- D W Goh
- Department of Paediatric Surgery, Birmingham Children's Hospital, UK
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24
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Abstract
The long-term effects of ileocolic anastomosis in children are not known. We therefore carried out a survey of all such patients treated at our hospital between 1971 and 1985. Thirty-seven patients were identified and invited to attend for follow-up. Twenty-seven (73 per cent) were examined and included in the survey. Mean age at survey was 7.8 years (range 1.6-17.6 years) and mean duration since operation was 6.3 years. Necrotizing enterocolitis and intussusception were the commonest indications for operation. As judged by height, weight and skin fold thickness, all patients were well nourished. Seven (26 per cent) had loose stools, five had chronic folic acid deficiency and one was vitamin B12 deficient. We conclude that resection of the ileocaecal region is well tolerated in childhood and does not affect growth. Loose stools are directly related to the length of ileal resection.
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25
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Abstract
The long-term complications of loose stools and failure to thrive following resection of the ileocecal region with end-to-end ileocolic or jejunocolic anastomosis are well recognized. We report four cases of a previously undescribed insidious complication that has developed in 8% of our patients after a latent period of many years following the primary operation; that of perianastomotic ulceration leading to severe iron deficiency anemia.
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Affiliation(s)
- K Parashar
- Children's Hospital, Birmingham, United Kingdom
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26
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Abstract
This is a case report of a previously asymptomatic 11-year-old boy who developed chronic intestinal pseudo-obstruction. Barium studies revealed grossly disordered motility of the proximal small bowel, and ganglion cells in a gastric biopsy were mildly abnormal. Treatment with conventional prokinetic agents and gastrojejunostomy were ineffective. Intravenous cisapride induced an immediate remission, which has been maintained subsequently by rectal administration of the drug.
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Affiliation(s)
- N P Cohen
- Children's Hospital, Birmingham, United Kingdom
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27
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Brearly S, Armstrong GR, Nairn R, Gornall P, Currie AB, Buick RG, Corkery JJ. Pseudomembranous colitis: a lethal complication of Hirschsprung's disease unrelated to antibiotic usage. J Pediatr Surg 1987; 22:257-9. [PMID: 3559870 DOI: 10.1016/s0022-3468(87)80341-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Seventy-two new cases of Hirschsprung's disease were seen between 1980 and 1985. Twenty-six patients (36%) developed the clinical features of enterocolitis and, of nine patients who died, colitis was the immediate cause of death in six. Histologic material was available from 20 patients with colitis; this showed nonspecific inflammation typical of Hirschsprung's colitis in 13 cases but seven had pseudomembranous colitis (PMC). Five of the patients with PMC had not recently been exposed to antibiotics. PMC was responsible for three of the six deaths from colitis. All patients with Hirschsprung's disease who develop signs of colitis should have stool testing for Clostridium difficile toxin and should be treated with an antibiotic active against Clostridium difficile.
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28
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el Haddad M, Corkery JJ. The anus in the newborn. Pediatrics 1985; 76:927-8. [PMID: 4069862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The size of the anus is defined in newborns of varying weights. A plea is made for proper examination of the anus at birth.
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29
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Abstract
In a four-year period 46 boys have been laparoscoped in the search for 55 impalpable testes. Thirty-three per cent of the testes were located intrabdominally. Another 53 per cent were absent. This could be diagnosed by laparoscopy alone in 35 per cent. Laparotomy was needed in only 3 boys to locate the testes.
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30
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Abstract
Hemangiopericytoma has never previously been reported as a cause of hematemesis in the newborn. We now report one such case.
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Mann JR, Corkery JJ, Fisher HJ, Cameron AH, Mayerová A, Wolf U, Kennaugh AA, Woolley V. The X linked recessive form of XY gonadal dysgenesis with a high incidence of gonadal germ cell tumours: clinical and genetic studies. J Med Genet 1983; 20:264-70. [PMID: 6620326 PMCID: PMC1049117 DOI: 10.1136/jmg.20.4.264] [Citation(s) in RCA: 36] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Five phenotypic females in one family had the genotype 46,XY and all had gonadal germ cell tumours. Studies of the family pedigree suggest that this form of XY gonadal dysgenesis is inherited in an X linked recessive manner. G banding of elongated metaphase chromosomes from two subjects with XY gonadal dysgenesis and a female carrier showed no aberrations of the X chromosome. The titres of H-Y antigen in three girls with XY gonadal dysgenesis were in the male control range. Thus it appears that, in the X linked form, XY gonadal dysgenesis may be caused by a point deletion or mutation of a gene on the X chromosome, which controls the gonad specific receptor for the H-Y antigen. Studies of Xg blood groups were uninformative about linkage of Xg with the X borne gene causing the XY gonadal dysgenesis. Dermatoglyphic studies in the girls with XY gonadal dysgenesis and female carriers revealed high a-b palmar ridge counts and a tendency for the A mainline to terminate in the thenar area. Both of these features have been described in patients with Turner's syndrome.
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Abstract
A series of 37 girls with primary vesicoureteric reflux of grade II and greater severity underwent urodynamic investigations. Twenty-eight (75%) were found to have unstable bladder activity. Disordered micturition patterns were common and persisted after urinary tract infections had been eradicated. Twenty-six girls had urgency of micturition and 19 urge incontinence occurring once per week or more. The correlation between these symptoms and unstable bladder activity was significant (P less than 0.01), but there was no correlation between bladder instability and the incidence of renal scarring.
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Abstract
Retrospective analysis of the records of a children's hospital shows an increased incidence of Meckel's diverticulum in children born with major malformation of the umbilicus, alimentary tract, nervous system or cardiovascular system in descending order. A consideration of the risks associated with Meckel's diverticulum suggests that elective resection is indicated only for diverticula that are atypical on inspection or palpation.
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Abstract
Twenty-two patients with rhabdomyosarcoma have presented in the years 1970--1977. Of 8 patients who had inadequate postoperative chemotherapy and radiotherapy, or none at all, only 2 patients with small completely resectable tumors are alive and well at 6 and 4 yr after surgery. Fourteen patients had intensive combination chemotherapy in addition to appropriate surgery and radiotherapy. Five have died and the remaining nine are well and free of disease at follow up ranging from 9 mo to over 5 yr. A continued place in the treatment regime is advocated for early surgery aimed at total excision of the primary tumor where this is feasible.
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Abstract
The consequences of a delayed diagnosis of congenital anal stenosis in 11 children are described. A plea is made for proper anal examination in the newborn, the technique for which is described.
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Abstract
Fifteen cases of neonatal necrotising entero-colitis (NEC) following umbilical vein catheterisation are reported. Their clinical and radiological features are briefly described and the proper course of a catheter through the umbilical vein--ductus venosus--inferior vena cava segment is demonstrated. The significance of mal-position of the catheter and its association with NEC is discussed. It is suggested that the abdominal radiographs be taken in the antero-posterior and lateral projections with a portable X-ray machine to check the position of the radio-opaque catheter prior to the commencement of transfusion of infusion.
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Mann JR, Lakin GE, Leonard JC, Rawlinson HA, Richardson SG, Corkery JJ, Cameron AH, Shah KJ. Clinical applications of serum carcinoembryonic antigen and alpha-fetoprotein levels in children with solid tumours. Arch Dis Child 1978; 53:366-74. [PMID: 78685 PMCID: PMC1544917 DOI: 10.1136/adc.53.5.366] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
A study was carried out on serum carcinoembryonic antigen (CEA) and alpha-feto-protein (AFP) levels, both measured by radioimmunoassay, in 88 children with malignant solid tumours and in 26 children with nonmalignant disorders, who presented during the years 1973-77. Slightly or moderately raised CEA levels were found at presentation in 11 of 66 children with malignant tumours, in 2 others with recurrent tumours, and in 4 children with nonmalignant disorders. Raised CEA levels generally indicated advanced malignant disease, often affecting the liver, or other hepatic disorders, but were not associated with a specific tumour type. Except in the first months of life, significantly raised AFP levels were detected only in 11 patients with yolk sac-derived tumours, or hepatomas, and in one child with tyrosinosis who later developed a malignant hepatoma. Serial measurements of AFP accurately reflected the clinical response to treatment and in 2 patients indicated recurrence before this could be detected clinically.
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Abstract
Diarrhoea and perianal excoriation occur frequently after the endorectal pull-through operation for Hirschsprung's disease. A new method of faecal analysis was performed on 3-day stool collections in 17 postoperative Hirschsprung patients and in 14 normal children, in order to define the faecal abnormality and to establish the cause of perianal excoriation in these patients. Loose stools in postoperative patients were deficient in dry solid content and contained an excess of extractable faecal water. This also had a raised electrolyte concentration, particularly with respect to sodium. Total daily output of faecal water was normal. Formed stools from postoperative patients were also deficient in drysolids but had a normal extractable water content. Excess extractable faecal water, the main abnormality of loose stools in these patients, is the result of abnormal water absorption from the distal colon. Perianal excoriation in these patients is most closely associated with the concentration of sodium in faecal water.
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Abstract
234 punch biopsy specimens of rectal tissue were taken from 112 children. In 94% of the patients the diagnosis of Hirschsprung's disease was confirmed or refuted by the first biopsy. There were no false-positive or false-negative results. One patient developed a serious complication, a pelvic haematoma.
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Corkery JJ. Hirschsprung's disease. Clin Gastroenterol 1975; 4:531-44. [PMID: 1183060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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42
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43
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Abrams LD, Ashton F, Barnes AD, Barrow MEH, Black J, Bland EP, Brookes V, Campkin V, Clarke DB, Collis JL, Corkery JJ, Cort F, Dalton G, Dawson-Edwards P, Deacon AL, Edwards JM, Gourevitch A, Hamer J, Hopkinson R, Inglis JM, Jones SEF, Lee RE, Mathews ET, Mills M, Mills W, Mitchell RG, Mortell A, Mucklow R, Nicholson H, Oates GD, Price C, Pusey R, Reid D, Smith BH, Tomlin P, Watts GT, Williams JA. Consultant Negotiations. West J Med 1975. [DOI: 10.1136/bmj.2.5969.504-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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44
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Abstract
Four children with chronic diarrhoea and perianal excoriation after a pull-through operation for Hirschsprung's disease have been shown to have increased but not markedly raised levels of faecal bile acids. Bile acid analysis of the 'bile-rich' duodenal fluid obtained after pancreozymin stimulation in 3 of the patients indicated a marked reduction in the proportion of deoxycholic acid conjugates. These findings are compatible with colonic malabsorption of secondary bile acids in these patients which is related in some way to the pull-through operation, but which is not likely to be the cause of the diarrhoea and the anal excoriation.
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Corkery JJ. Some social aspects of day-case surgery. Arch Dis Child 1974; 49:826. [PMID: 21032518 PMCID: PMC1649163 DOI: 10.1136/adc.49.10.826-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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46
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Obeid ML, Corkery JJ. Importance of the urinary tract in imperforate anus. Proc R Soc Med 1974; 67:203-4. [PMID: 4856564 PMCID: PMC1645352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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47
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Obeid ML, Corkery JJ. Importance of the Urinary Tract in Imperforate Anus. Proc R Soc Med 1974. [DOI: 10.1177/003591577406700313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- M L Obeid
- The Children's Hospital, Ladywood Middleway, Birmingham, B16 8ET
| | - J J Corkery
- The Children's Hospital, Ladywood Middleway, Birmingham, B16 8ET
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Abstract
Four patients are reported in whom perforation of the colon followed exchange transfusion for haemolytic disease of the newborn. This association seems to be more than coincidental, and possibly the perforation is due to a vascular accident occurring as a mechanical result of the exchange transfusion. The insidious onset of colonic perforation may be recognized early by the passage of blood per rectum. There is no place for conservative treatment, and once the diagnosis has been made treatment must include broad-spectrum antibiotics and laparotomy.
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