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Biomedical subjects

B Jaffray

Publications and source records attributed to B Jaffray.

At least 19 recordsLinked to original sources
PubMed2006

Birth prevalence of cryptorchidism and hypospadias in northern England, 1993-2000.

AIM: There is much debate as to whether the prevalence rates of cryptorchidism and hypospadias are increasing. To address this issue we investigated the birth prevalence of cryptorchidism and hypospadias in the northern region of England during the period 1993-2000. METHODS: Cases of cryptorchidism and hypospadias were identified from northern region hospital episodes statistics (HES). Trends in birth prevalence, based on the number of male live births, were assessed using linear regression. RESULTS: Prevalence was 7.6 per 1000 male live births for cryptorchidism and 3.1 per 1000 male live births for hypospadias. The orchidopexy rates for 0-4 year olds and 5-14 year olds were 1.8 and 0.8 per 1000 male population, respectively. The rates for hypospadias repair for 0-4 year olds and 5-14 year olds were 0.6 and 0.1 per 1000 male population, respectively. There was a statistically significant decreasing temporal trend for the corrective procedure in cryptorchidism of 0.1 per 1000 male population aged under 5 years per annum (95% confidence interval: -0.01 to -0.05, p<0.001), but no temporal change for the corrective procedure in hypospadias (p = 0.60). CONCLUSION: HES data were of high quality for the study period. There was no significant change in the prevalence of surgically corrected hypospadias. However, there was an apparent decline in the prevalence of surgically corrected cryptorchidism that may reflect a decrease in the prevalence of the condition or may be due to a decrease in the rate of surgical intervention.

Adolescent↗
PubMed2005

Minimally invasive surgery.

In 1987 Mouret performed the first laparoscopic cholecystectomy, starting a revolution in surgery. For paediatricians it is difficult to appreciate the magnitude of what has occurred in this short period. The development of minimal access techniques represents the most significant change in surgical practice since the introduction of aseptic technique or safe anaesthesia. As with many innovations, rapid change, technical language, and the evangelism of pioneers has left confusion in its wake.

Biliary Tract Diseases↗
PubMed2004

MACE or caecostomy button for idiopathic constipation in children: a comparison of complications and outcomes.

The Malone antegrade enema (MACE) and the caecostomy button (CB) are two methods of achieving colonic lavage in constipated children with faecal soiling. We reviewed our experience with the MACE and CB, aiming to compare results, complications, and outcomes. Between June 1998 and August 2002, 37 children (15 boys) underwent MACE and 12 children (9 boys) underwent CB for idiopathic constipation that had failed conventional treatment. Rectal biopsy was ganglionic in all cases. Mean age at surgery was 9.9 years for the MACE patients and 9.8 years for the CB patients. All children are under continuous review, and mean follow-up is 18 months. Statistical analysis of proportions used Fisher's exact test. Soiling stopped completely in 30 children with MACE and in 9 with CB. Occasional soiling is still present in two children with a CB and in one with MACE. One child with a CB had resumed regular bowel activity, and the CB was removed. MACE failed in 5 (14%) patients because of ineffective colonic lavage, and in one patient (3%) the appendix was replaced by a CB because of perforation of the appendicostomy. CB failed in one patient (8%) because of faecal leak around the button; the child was subsequently converted to MACE (P = >0.5). Complications requiring operative intervention were seen in 9 (24%) of the 37 patients who underwent MACE and none of the 12 patients who underwent CB (P = 0.09). The main complication requiring surgical intervention was stoma stenosis (11%). Complications not requiring operative intervention were seen in 7 (19%) patients after MACE and 11 (92%) of the 12 patients who underwent CB (P < 0.001). The MACE and CB procedures are reliable and effective with high success rates. The MACE has a higher incidence of complications requiring operative intervention. Conversely, complications not requiring operative intervention are more frequent with CB. CB is a safe and effective alternative to MACE in children with faecal soiling.

Adolescent↗
PubMed2003

Childhood constipation is not associated with characteristic fingerprint patterns.

BACKGROUND: It has been suggested that there is an association between simple arch fingerprint patterns and severe childhood constipation. If real, this association might be useful to predict which children have a poor prognosis. AIM: To see how many severely constipated children have simple arches, compared to non-constipated controls and their first degree relatives. METHODS: Fingerprints were classified by two blinded assessors in 30 children requiring surgery for refractory constipation, and 30 children with appendicitis, and the first degree relatives of both groups. Colonic transit times and clinical outcomes were also evaluated among constipated children. RESULTS: At least one simple arch was found in similar numbers of constipated children (13%) and their families (16%), and control children (7%) and their families (13%). Arch positivity was commoner among relatives of arch positive (6/6) than arch negative children (14/54), regardless of bowel history. Arch positivity did not identify children with prolonged transit times, nor those who required colectomy. CONCLUSIONS: Fingerprint patterns are not associated with severe childhood constipation, do not aid their management, and do not support a genetic aetiology for this problem.

Child↗
PubMed2002

Gastric tonometry after gastroschisis repair.

Gastric tonometry and intravesical pressure measurement were performed on eight babies born with gastroschisis for 72 hours after abdominal closure. Intravesical pressure was not high. The gastric mucosal pCO2 and gastric mucosal pH remained stable and closely matched arterial values. Tonometry may be a useful technique to monitor these babies.

Carbon Dioxide↗
PubMed1999

Necrotizing enterocolitis in omphalopagus conjoined twins.

Female omphalopagus twins underwent laparotomy on the second day of life after an antenatally diagnosed high jejunal bowel obstruction. Bowel resection and choldocho-enterostomies were performed. Despite recovery from laparotomy, the development of severe necrotizing enterocolitis (NEC) in one twin led to rapid deterioration and the death of both infants on day 34. The elucidation of the combined biliary tree, the dilemma of NEC in conjoined twins, and the possibilities of emergency separation are discussed. Consideration should be given to emergency separation of conjoined twins in the event of potentially lethal complications.

Enterocolitis, Necrotizing↗
PubMed1998

A patient's perspective on the management of peptic esophageal stricture: experience and results in 113 consecutive cases.

A retrospective analysis of 113 consecutive cases of benign esophageal stricture, all secondary to gastroesophageal reflux, 100 treated conservatively, 13 treated surgically, has been carried out in conjunction with a postal questionnaire of patients. Patients were requested to grade both their swallowing ability and the acceptability of their treatment. Of those responding to questionnaire, 88% of patients treated conservatively found their treatment acceptable or better, and 72% were left with either no or minimal restriction of diet. There was no correlation between either the total number or frequency of dilatations and the result achieved. Similarly, patient satisfaction appears largely independent of these variables. Doctors should be wary of taking recurrence of a stricture after initial dilatation as indicating a poor eventual outcome or a dissatisfied patient. There was no difference in terms of either the result or patient satisfaction between conservatively treated and surgically treated patients.

Adult↗
PubMed1996

Real and apparent mortality from congenital diaphragmatic hernia.

Some 50 cases of congenital diaphragmatic hernia (CDH) born in the authors' regional referral area over the 14 years from 1980 to 1993 were reviewed, contrasting 7 years when management included preoperative ventilatory stabilization with the preceding 7 when urgent surgery was performed. Six children experienced no respiratory distress and suffered no mortality. For infants with respiratory distress in the first 6 h of life, ventilatory stabilization improved survival rates of those who reached the surgical centre from 45 per cent between 1980 and 1986 to 59 per cent between 1987 and 1993. A larger proportion of the total number of patients, however, continued to die without reaching the surgical centre. The improvement in survival rate based on the true incidence of CDH was from 28 per cent in the first period to 38 per cent in the second. The apparent poor survival rate of patients born in central obstetric units compared with those born in peripheral units (37 versus 75 per cent) can be attributed to patient selection; a larger number of children born in central units were transferred for surgery (70 versus 57 per cent). There is no evidence that paediatricians have altered their referral practice to include prolonged ventilation outside the surgical unit since delayed surgery was advocated. Assessment of the impact of altering the management of CDH cannot be made without knowing the number of patients who die before transfer to a neonatal surgical unit. Any serious attempt to reduce the mortality rate of CDH must be directed to neonates who are not presently referred to the surgical service.

Child↗
PubMed1996

Transhiatal oesophagectomy: a comparison of alternative techniques in 68 patients.

Over a 7-year period 68 patients with oesophageal carcinoma underwent transhiatal oesophagectomy, utilizing blunt dissection in 42 cases and eversion stripping in 26. The effects of the alternative techniques on mortality and morbidity have been analysed. There was no significant difference between the two techniques in terms of operative blood loss or time or the number of patients requiring post-operative ventilatory support. Stripping of the oesophagus was associated with significantly fewer cardiorespiratory complications and a shorter hospital stay. There was no significant difference in either 30-day or 3-month survival. Eversion stripping should become the preferred method of oesophageal resection once the primary tumour has been mobilized.

Bronchopneumonia↗
PubMed1991

Efficiency of blood use and prospects for autologous transfusion in general surgery.

A 6-month retrospective audit of crossmatch and transfusion practice in a general surgical unit has been performed. Inefficiencies in blood ordering practices have been demonstrated and the value of performing a local audit to allow estimation of blood needs has been proven. Using criteria based on the suggested tariff for operations derived from this audit, only a small number of general surgical patients would be considered as potential autologous blood donors.

Blood Donors↗
PubMed1990

Bacterial colonization of the skin after chemical depilation.

A study of the effects of preoperative skin depilation on skin microflora has been performed. Areas of skin were prepared with a chemical depilatory agent and compared with areas of unprepared skin. Preparation of skin with a chemical depilatory agent causes no increase in skin microflora, in contrast to the effects of shaving as demonstrated by earlier studies.

Bacteria↗