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Biomedical subjects

A W Middleton

Publications and source records attributed to A W Middleton.

At least 19 recordsLinked to original sources
PubMed1992

Duplicated urethra: an anomaly best repaired.

Three cases of urethral duplication are described--two complete and one incomplete. The surgical approaches used in 2 of the 3 cases are described, the third not having come to definitive surgery as yet. In the patient with an incomplete urethral duplication the accessory urethra and associated ventral preputial hood were excised. A repair of the complete duplication was devised in which an end-to-side urethrourethrostomy and penile plastic revision were accomplished. The literature is reviewed and a new classification system for urethral duplication is proposed.

Humans↗
PubMed1989

Outcome of surgery for biliary atresia.

Forty-seven infants (26 male, 21 female) with biliary atresia under- went hepatic portoenterostomy during the 16-year period 1971-87. Twenty-six patients (55%) are alive 1-17 years after surgery, with 21 (45%) being jaundice-free. For children who became jaundice-free, the mean age at surgery was 78 days (range: 34-125 days), compared with 97 days (range: 48-224 days) for those who did not. Of 39 patients operated on at less than 120 days of age, 24 (60%) are alive. All four patients operated on after 125 days of life died. Of 31 patients operated on more than 5 years ago, 12 (39%) have survived, the oldest being 17 years. Ten (32%) have normal serum bilirubin concentrations, have non-active cirrhosis on liver biopsy, have had normal growth and development, and lead normal lives. The oldest two patients suffered variceal haemorrhage in their teenage years. In our recent experience, 11 of 16 patients (69%) have had complete clearing of jaundice, lead normal lives and do not currently require assessment for liver transplantation. It is believed that early referral of children with biliary atresia to experienced surgical units for portoenterostomy will lead to long-term survival, without the need for liver transplantation in a majority of cases. Liver transplantation should be offered in infancy only after failed portoenterostomy, except for patients presenting after 120 days in whom transplantation may be considered primary therapy.

Age Factors↗
PubMed1987

Radical prostatectomy for carcinoma in men more than 69 years old.

Between 1974 and 1986, 193 men with prostatic cancer were treated with bilateral pelvic lymphadenectomy and radical retropubic prostatectomy. Of the 193 patients 65 were 70 years or older (5 were 78 years old). Of the 32 men in this series who underwent a potency-sparing modification of the radical prostatectomy 7 were 70 years or older, the oldest being 77 years. A comparison of the morbidity and mortality of the 65 men in the older group with the 128 men in the group less than 70 years old revealed no significant difference. Long-term followup data demonstrated 57 men in the older age group to be well with no evidence of disease, with 10 in that group well with no evidence of disease greater than 5 years after the radical prostatectomy. We recommend radical prostatectomy for patients with clinically localized prostatic carcinoma whose general health suggests a 10-year or greater probable life expectancy, aside from tumor.

Aged↗
PubMed1985

Gastric tube oesophagoplasty--a long-term assessment.

The first gastric tube oesophagoplasty at the Royal Alexandra Hospital for Children was performed in 1968. Over the next 15 years, until 1982, a total of 46 operations were performed. This represents the largest series of gastric tube oesophagoplasty in children yet reported in the literature. Two techniques have been in use and are compared. The main aim of the paper is to present the long-term results of gastric tube oesophagoplasty. In our 15 years' experience with the gastric tube for oesophageal replacement, we have found it to be a very satisfactory procedure, with a very low mortality and failure rate. The vascularity of the stomach gives rise to less anxiety than with colon. Early postoperative complications are readily identified and treated. There is a higher risk of serious chest complications in bringing the gastric tube through the chest with primary anastomosis in the neck. This also predisposes to diaphragmatic herniation and obstruction, complications not seen when the gastric tube is brought up substernally. The long-term results are very encouraging, with virtually all the children leading active and normal lives. The gastric tube functions satisfactorily with no evidence of the late complications often reported with colonic tubes. There is no significant difference in the long-term results of the two techniques of gastric tube oesophagoplasty used in this hospital.

Adolescent↗
PubMed1984

Watery diarrhoea and a vasoactive intestinal peptide secreting ganglioneuroma.

A case of a 12-month-old child with chronic water diarrhoea, weight loss, abdominal distension, hypokalaemia and hypochlorhydria, which were associated with a vasoactive intestinal peptide secreting ganglioneuroma, is reported. Removal of the tumour led to complete clinical and biochemical recovery. Measurement of vasoactive intestinal peptide levels should be included in the evaluation of chronic diarrhoea after the more common causes have been ruled out.

Adenoma, Islet Cell↗
PubMed1984

Eosinophilic cystitis in children: a self-limited process.

We report a case of eosinophilic cystitis in a 7-year-old boy. Bilateral hydronephrosis and a lesion involving most of the bladder were seen initially. Complete resolution of all symptoms occurred within 3 weeks and the x-ray findings returned to normal in 6 weeks without specific therapy. A review of all reported cases of eosinophilic cystitis in children suggests that, unlike in adults, the disease is self-limited.

Child↗
PubMed1984

Recurrent abdominal pain in children.

Recurrent abdominal pain in the child is a common and difficult problem for practitioners. To resolve whether its origin is organic or psychogenic takes time and patience. Investigation is made more difficult by the fact that parents and doctors are happier if the pain has an organic basis; in the great majority of children it is caused by stress.

Abdomen↗
PubMed1983

Biliary atresia: review of experience with twenty-three patients.

Prior to the Kasai procedure of hepatic porto-enterostomy in 1959, biliary atresia was a bleak chapter in paediatric surgery. It was only after many years, however, that the procedure became widely accepted. During the past 8 years 23 cases of biliary atresia have been treated at the Royal Alexandra Hospital for Children (RAHC). Twenty-one had the noncorrectable type of atresia. Sustained drainage was obtained in ten patients, all of whom had the noncorrectable type anomaly. Nine are still alive, eight having survived more than one year after operation and all are free from jaundice. Cholangitis has been a problem in six of these patients and six have evidence of fibrosis or cirrhosis on subsequent liver biopsy. Two patients have shown improvement in liver histology since operation. Sustained biliary drainage is related to age at operation, the size of biliary ductules at the porta and the subsequent development of cholangitis. Long term prognosis still remains uncertain.

Bile Ducts↗
PubMed1980

Indications for and results of nephrectomy for metastatic renal cell carcinoma.

We find that, when metastases are present, a nephrectomy for renal cell carcinoma is not justified in the vast majority of cases. The only noncontroversial indication is for palliative nephrectomy which is performed to relieve intractable symptoms in the properly chosen patient. However, it is unusual to see a patient with tumor-related symptoms that cannot be conservatively managed. A relative indication for nephrectomy is found in the patient with osseous metastases only, as some studies have demonstrated a prolongation of survival by adjunctive nephrectomy in this setting. Another relative indication is in the patient with limited metastases that are amenable to surgical or radiation ablation coupled with nephrectomy; patients in whom the metastasis appears years after the nephrectomy have the best chance for a successful outcome. When therapy that is effective against metastatic tumor is eventually found, adjunctive nephrectomy as a debulking procedure may become indicated; until then, surgery is not justified. On the basis of data presently available, adjunctive nephrectomy in the hope of inducing spontaneous regression of metastases is never indicated.

Adenocarcinoma↗
PubMed1979

The prognostic value of cell surface antigens in low grade, non-invasive, transitional cell carcinoma of the bladder.

Tumors in 23 patients who presented with a low grade, non-invasive transitional cell carcinoma of the bladder were studied for blood group antigens A, B or O on the cell surface. Of 14 patients without cell surface antigens initially 13 suffered an invasive tumor subsequently and 1 had diffuse carcinoma in situ. Of 9 patients with cell surface antigens initially 8 did not have an invasive recurrence during a 5 or more-year followup and 1 did. The presence or absence of blood group cell surface antigen on a low grade, non-invasive transitional cell carcinoma of the bladder would seem to have value in predicting future recurrence with muscle invasion.

ABO Blood-Group System↗
PubMed1978

Radiographic findings in children surveyed for enuresis.

Over a one-year period 216 children had a radiographic survey of their urinary tracts performed for the evaluation of enuresis with many of these having a precedent history of urinary infection as well. Significant urinary tract abnormalities were found in 27 per cent of the children. Clinical correlation was obtained in 135 of these children with 19.3 per cent requiring surgery. The groups of children with a history of diurnal enuresis or urinary infection were quite different from the group with nocturnal enuresis alone. These differences are discussed.

Age Factors↗
PubMed1977

Tapered ileum as ureter substitute in severe renal damage: antireflux technique for bladder implantation.

Three cases are reported in which ileum has been used to replace irreparably damaged ureters despite preexisting moderate to severe pyelocaliectasis. Two cases have had satisfactory results while one had increasing pyelocaliectasis and azotemia requiring subsequent cutaneous diversion. The rationale for using ileum to replace ureter is presented with a discussion of objectives to be achieved surgically to assure the success of the procedure.

Adolescent↗
PubMed1977

A comparison of the morbidity associated with radical retropubic prostatectomy with and without pubectomy.

Radical retropubic prostatectomy with bilateral pelvic lymphadenectomy for prostatic carcinoma was done with pubectomy in 8 patients and without pubectomy in 8 other patients. A comparison of the postoperative courses reveals an excess morbidity in patients who had pubectomy, with severe protracted pelvic girdle pain in 75 per cent, lower extremity thrombophlebitis in 37 per cent (one of which resulted in a non-fatal pulmonary embolus) and varying degrees of urinary incontinence persisting for 6 months or more in 75 per cent. In contrast, in patients who did not have a pubectomy mild transient pelvic girdle pain was noted in only 25 per cent of the cases, late lower extremity thrombophlebitis in 12 per cent and no late urinary incontinence. Pubectomy should not be used routinely with radical retropubic prostatectomy.

Aged↗
PubMed1976

Ileal conduits in children at the Massachusetts General Hospital from 1955 to 1970.

The 45 ileal conduits performed on children at the Massachusetts General Hospital from 1955 to 1963 are reviewed and compared to the 45 ileal conduits performed from 1964 to 1970. Late complications involving the conduits occurred in 60 per cent of the early group and in 51 per cent of the late group. Of the renal units judged normal pyelographically preoperatively in the early group 77 per cent went on to at least some deterioration, while 62 per cent of the late group judged normal later deteriorated. Combining all renal units, 34 per cent remained unchanged, 26 per cent improved and 41 per cent showed some degree of deterioration after ileal conduit urinary diversion. The late complication and renal deterioration rates seem to increase progressively with time. There was no apparent urinary obstruction in 13 per cent of the renal units that deteriorated. Theoretical and experimental considerations indicate the reflux of infected urine as the etiology of the renal deterioration. Because of the late complications and the unacceptably high rate of renal deterioration we no longer perform ileal conduits in children. Instead every effort is made to reconstruct the urinary tract or if urinary diversion is necessary, a colon conduit with non-refluxing ureterocolonic anastomoses is performed.

Adolescent↗