PubMed Health⌕ Search

Biomedical subjects

B W Davies

Publications and source records attributed to B W Davies.

17 recordsLinked to original sources
PubMed2001

Do gastrostomies close spontaneously? A review of the fate of gastrostomies following successful renal transplantation in children.

Previous published data have shown the benefit of nutritional support delivered via a gastrostomy button (GB) for children on chronic dialysis. The use of the GB is suspended following renal transplantation (RT) in most children and it is usually removed 2-3 months later together with the chronic dialysis catheter when the child is on alternate-day steroids. We reviewed the outcome of gastrostomies following successful RT in children. The gastrostomies were created by an open technique (Stamm) with the child under general anaesthesia, usually at the time of insertion of a chronic dialysis catheter. Growth data and complications of the GB were collected in a prospective registry. Following RT, the GB was removed with the expectation that the tract would close spontaneously. Those in whom a gastrocutaneous fistula persisted underwent formal surgical closure. A total of 18 children have had gastrostomy buttons removed: 11 gastrostomies (61%) closed spontaneously, but 7 (39%) required operative closure at a median of 2 months (range 3 weeks-4 years) post-removal. The need for formal closure was significantly related to the duration that the gastrostomy had been in situ pre-transplant (non-parametric statistics, 0.05 > p > 0.01). Although nearly two-thirds of gastrostomies in this study closed spontaneously following RT, less than one-half of those that had been in situ for more than 1 year did so. We thus recommend formal closure of all gastrostomies that have been in situ for more than 1 year. This can be done at the same operation as the removal of the chronic dialysis catheter.

Adolescent↗
PubMed1999

Limited ileal resection in infancy: the long-term consequences.

BACKGROUND/PURPOSE: The longer-term sequelae of short bowel syndrome in infancy are reasonably well documented, but little is known about the long-term nutritional and metabolic effects of limited (less than 50 cm) ileal resection. This makes it difficult to formulate a rational follow-up policy in such children. METHODS: All children who underwent limited ileal resection for either necrotizing enterocolitis (NEC) or intussusception at our institution between 1984 and 1992 were invited to attend a detailed clinical, anthropometric, hematologic, and biochemical assessment, together with a biliary and renal ultrasound scan and measurement of bone mineral density. RESULTS: Twenty-four children (NEC, 17; intussusception, 7) of median age 7.4 years (range, 5.5 to 13.7 years) agreed to participate. Nine previously had undergone an isolated ileal resection, and 15 also had had variable lengths of colon removed. The length of resected ileum ranged from 3 to 44 cm, with a median of 10 cm. Seven control subjects in whom neonatal NEC developed but recovered without surgery were also evaluated. Median height, weight, and body mass index after ileal resection were between the 25th and 50th percentiles; no child was stunted or wasted. After ileal resection, one boy was found to have asymptomatic vitamin B12 deficiency, and three children had low plasma concentrations of vitamin A. Hematologic and biochemical parameters were otherwise normal apart from a few marginally low trace element levels in both subjects and controls. No renal calculi were detected, and bone mineral density measurements were normal in all except one child. Four children had cholelithiasis, all of whom had previously undergone limited ileal resection for NEC (two isolated, two ileocolic). Thus, the prevalence of cholelithasis after limited ileal resection for NEC was 24% at a median age of 7.0 years. CONCLUSIONS: Growth and nutritional status are well preserved after limited ileal resection in infancy. Limited ileal resection for NEC is associated with a subsequent high prevalence of cholelithiasis and a risk of vitamin B12 deficiency. These findings are important when planning strategies for long-term follow-up.

Bone Density↗
PubMed1998

Transperitoneal laparoscopic nephrectomy in children.

Over a 40-month period, 24 consecutive children (1-15 years) underwent laparoscopic nephrectomy. The indication for surgery was a poorly functioning kidney (<6% on DMSA isotope scanning) secondary to a variety of causes, with or without pain or infection. Four cannulas were used in each patient. The kidney was approached through a small incision in the upper paracolic gutter without mobilization of the colon. The procedure was successful in all but one child, who had conversion to open technique because of poor laparoscopic viewing. In 12 children who required nephroureterectomy, the distal ureter was approached by an open technique through either a small extension of the iliac fossa cannula site or a Pfannenstiel incision for combined bladder surgery. The average operating time for laparoscopy was 85 (range 40-160) minutes. The children undergoing nephrectomy or nephroureterectomy alone had an average hospital stay of 2 (range 1-4) days. There were no laparoscopic or surgical complications. Laparoscopy provides a safe and successful approach to pediatric nephrectomy. The technique combines well with an open approach to the distal ureter when nephroureterectomy is indicated.

Adolescent↗
PubMed1998

Two-portal endoscopic carpal tunnel release: an outcome analysis of 333 hands.

Outcome data were collected on 239 patients who underwent endoscopic release of the transverse carpal ligament. The procedure was performed on 333 hands in 239 patients. All patients had failed to respond to nonoperative management for carpal tunnel syndrome and had confirmatory electrodiagnostic studies. Patients underwent follow-up evaluations at 21, 28, and 42 days. Numbness and paresthesias were relieved in 98% of the operated hands, and pain was relieved in 90% of the hands. A satisfactory result was achieved in 325 hands, which resulted in a 98% overall satisfaction rate. Eighty-eight percent of the patients required only two or less doses of oral analgesic during the postoperative period. Only 50 hands undergoing endoscopic release exhibited scar tenderness or pillar pain beyond 28 days. Excluding workers' compensation patients, 83% of the patients returned to work in less than 28 days (average, 14.6 days). No operative complications were encountered, although 1 patient experienced postoperative reflex sympathetic dystrophy, which responded to conservative outpatient treatment.

Adult↗
PubMed1998

The impact of vasodilators on random-pattern skin flap survival in the rat following mainstream smoke exposure.

This study demonstrates that acute mainstream cigarette smoke exposure is deleterious to dorsal random-pattern skin flap survival in the rat. Three vasodilators were also studied for their ability to mediate flap survival after smoke exposure. Sprague-Dawley rats (10 per group) were exposed to two cigarettes per day over a 14-day period. This is an exposure equivalent to that of an average cigarette smoker. Dorsal McFarlane caudally based random-pattern skin flaps (4 x 10 cm) were created on day 7 of the smoke exposure. Enteral phenoxybenzamine (0.56 mg per kilogram per day), enteral nifedipine (10 mg per kilogram per day), and topical nitroglycerin (1.3 cm or 7.5 mg per day) were administered after creation of the dorsal skin flaps in two doses daily during smoke exposure. Fluorescein was used to delineate areas of viability accurately. A pad digitizer was utilized to calculate designated skin flap areas to +/-1.0 mm2. Experimental animals demonstrated a 23% decrease (p < 0.01) in skin flap area survival compared with the control animals. The phenoxybenzamine group demonstrated a 5.5% increase in flap area survival (p=0.068), the nifedipine group demonstrated a 4.1% increase in flap area survival (p=0.049), and the nitroglycerin group demonstrated an 8.9% increase in flap area survival (p=0.049). These data suggest that phenoxybenzamine appears to affect skin flap survival marginally after smoke exposure. However, nifedipine and nitroglycerin improve random-pattern skin flap survival significantly after mainstream cigarette smoke exposure in the rat. These results imply that pharmacological intervention with vasodilators may ultimately prove clinically useful for random-pattern skin flap salvage in the cigarette-smoking patient.

Animals↗
PubMed1998

Foot and ankle reconstruction using the radial forearm flap: a review of 25 cases.

Twenty-five patients underwent soft-tissue reconstruction of the different anatomic regions of the foot and ankle using the microvascular radial forearm free flap. The patients, 19 men and 6 women, ranged in age from 3 to 80 years (mean, 48.4 years). Indications for the surgery included diabetes and/or vascular insufficiency (10 patients), trauma (9 patients), tumor (3 patients), gunshot wound (2 patients), and burn (1 patient). Osteomyelitis occurred in patients with traumatic (3 patients) and diabetic (3 patients) wounds. The weight-bearing surface of the foot was involved in eight patients. Defects ranged in size from 45 to 210 cm2 (mean, 100.4 cm2). The radial forearm flap was successful in 23 of 25 cases (92 percent). Flap complications included flap loss (two patients), infection (three patients), and minor wound dehiscence at the flap-leg skin interface (two patients). Recurrent ulceration occurred in two patients; both were diabetics with weight-bearing flaps. Donor site complications included partial skin graft loss with tendon exposure in two patients; both healed with conservative management. Recurrent or persistent osteomyelitis was not seen in any of the patients. Of the eight patients with weight-bearing flaps, four were ambulatory, one had limited ambulation, one was nonambulatory, one had too short a follow-up, and one suffered flap loss. Two patients required modified shoes. Debulking was performed in one patient. Follow-up ranged from 2 to 72 months (mean, 24.9 months). The radial forearm flap meets most of the anatomic prerequisites for the ideal foot flap. It facilitates the restoration of normal foot contour by replacing "like-with-like," allowing patients to use normal shoes without the need for debulking (except in one patient); it provides a durable and stable weight-bearing plantar surface during ambulation; it achieves excellent aesthetic results without the dryness or cracking of the hypertrophied skin-grafted muscle; and it permits sensory reinnervation. We have found it especially useful for resurfacing the dorsum, ankle, and forefoot, moderate-sized defects, weight-bearing surfaces, and osteomyelitic wounds.

Adolescent↗
PubMed1997

The survivors of gastroschisis.

AIMS: To assess the long term morbidity and quality of life in survivors of gastroschisis. DESIGN: All babies born with gastroschisis between 1972 and 1984 and who survived more than one year were identified. Those who could be traced were questioned about their general health, growth, abdominal symptoms, cosmetic concerns, education, employment, and fertility. RESULTS: Of the 35 patients, two have died, seven could not be traced, and three declined to be interviewed. Twenty three subjects (70% of survivors) with a median age of 16 years (range 12-23 years) responded. Twenty two (96%) were in good health and overall growth was within normal limits. Eight subjects (35%) have had further surgery related to gastroschisis, including two for adhesive small bowel obstruction and three for scar complications. In 13 (57%), absence of an umbilicus caused distress during childhood. CONCLUSION: Most gastroschisis survivors can eventually expect normal growth and good health. Adhesive bowel obstruction is an uncommon, but potentially late, complication. The umbilicus should be conserved during gastroschisis repair.

Abdominal Muscles↗
PubMed1997

Prenatally detected posterior urethral valves: qualitative assessment of second trimester scans and prediction of outcome.

PURPOSE: We attempted to determine if the degree of second trimester dilatation and/or other qualitative sonographic features of the fetal urinary tract are predictive of postnatal outcome in male neonates with posterior urethral valves. MATERIALS AND METHODS: We reviewed ultrasound reports and/or hard copy imaging in 17 cases of posterior urethral valves initially detected on second trimester scans (median gestation 18 weeks, range 15 to 23.5). Ultrasound appearance was categorized according to the pattern and severity of dilatation, cystic change or echogenicity of the renal cortex and presence of oligohydramnios. Outcome was reviewed at a median followup of 5.7 years (range 4.4 to 10). RESULTS: Of the 17 cases there was a poor outcome in 10, including death in 4 and chronic renal failure in 6. Seven patients were alive and well with normal renal function at followup. The prognosis in cases of moderate or severe upper tract dilatation was poor. Of the 9 patients with marked prenatal hydroureteronephrosis 8 (89%) were dead or had chronic renal failure at followup. In contrast, only 2 of the 8 patients (25%) with mild upper tract dilatation or dilatation limited to the bladder had chronic renal failure at review (p = 0.05). Three cases of prenatal renal parenchymal change and 3 of subsequent oligohydramnios had a poor outcome postnatally. CONCLUSIONS: The prognosis for boys with prenatally detected posterior urethral valves is closely associated with qualitative aspects of second trimester scan findings. This information may be of clinical value in the prenatal counseling of parents.

Female↗
PubMed1996

Reduction mammaplasty: a comparison of outpatient and inpatient procedures.

A review of the procedure, postoperative outcome, and expense of outpatient inferior pedicle reduction mammaplasty was compared with inpatient hospital treatment. Twenty outpatient procedures were compared with an equal number of inpatient procedures. Medical and social backgrounds of the two patient populations were similar. The findings indicate that bilateral breast reduction can be performed safely and cost-effectively as an outpatient procedure.

Adolescent↗
PubMed1995

Inguinal hernia repair: see one, do one, teach one?

Clinical management of inguinal hernias has been the subject of recent debate, and guidelines have been produced by The Royal College of Surgeons of England. There is evidence that the results of hernia repair by trainees are inferior to those of more experienced surgeons, but there are no published data on the amount of training and supervision currently experienced by junior surgeons. Thirty-two questionnaires were returned by trainees (21 senior house officers and 11 registrars) from hospitals in the south of England, giving details of teaching and supervision for 3,013 hernia repairs recorded in their log books. Trainees had assisted at 2-90 (median 8) repairs before operating themselves, and had then been supervised during 2-46 (median 9) repairs before being allowed to operate unsupervised. They had assisted subsequently at a further 0-100 (median 9) repairs, and had received supervision during a further 0-42 (median 6) repairs after their first unsupervised repair. The majority (79 per cent) felt adequately trained at the time of their first unsupervised repair. Senior house officers had significantly more experience than registrars in the Shouldice and Lichtenstein techniques, suggesting that these methods have gained ground recently in surgical training. These results show substantial variation in the amount of training and supervision given for inguinal hernia repair. In general, however, trainees experienced a good progression through assisting, supervision, and subsequent reinforcement by further work with senior surgeons after being allowed to operate unsupervised.

Adult↗
PubMed1994

Oromandibular reconstruction using a keel-shaped modification of the radial forearm osteocutaneous flap.

The keel-shaped modification for harvest of the radial forearm osteocutaneous flap has been used to reconstruct 19 oromandibular defects in 18 patients. Fourteen men and 4 women ranging in age from 22 to 72 years have undergone composite mandibular reconstruction, with follow-up ranging from 3 to 36 months. Sixteen patients (17 reconstructions) had resection of advanced malignancies, and 2 patients sustained shotgun wounds. Twelve symphyseal and 7 lateral or posterior defects were reconstructed with donor radius bone ranging in length from 5 to 13.5 cm. Double osteotomies were performed in 7 patients. Two skin paddles were used in 4 patients to provide simultaneous intraoral lining and external skin coverage. The radial forearm osteocutaneous flap is still an excellent choice for oromandibular reconstruction. Anterior and lateral composite mandibular defects were satisfactorily reconstructed both aesthetically and functionally using the keel-shaped modification of the radial forearm flap. Donor-site problems were uncommon and minor, and long-term forearm function was minimally affected. Radius fracture occurred in only 1 patient.

Adult↗
PubMed1993

Clinical office anesthesia: the use of propofol for the induction and maintenance of general anesthesia.

Ambulatory surgery has become routine for many plastic surgery procedures. Anesthesia techniques including general anesthesia by inhalation and intravenous infusion and the dissociative technique have all been used successfully for outpatient anesthesia. Propofol (Diprivan), a relatively new agent, has proven to be a safe and effective general anesthesia agent for outpatient surgery. We report on our experience with propofol as an induction agent and continuous drip for general anesthesia maintenance in 100 consecutive outpatient, plastic surgery procedures performed in an office facility. Assessment factors were recovery-room time, nausea and vomiting in the recovery room and at home, hallucinations, patients' recollection of anesthesia experience, and overall patient satisfaction.

Ambulatory Surgical Procedures↗
PubMed1992

Noncompression unicortical miniplate osteosynthesis of mandibular fractures.

The use of transoral noncompression unicortical miniplates in treating 42 consecutive patients with 64 displaced mandibular fractures (excluding subcondylar) was reviewed. Titanium miniplates (Wurzburg) were used for fixation. The principles set forth by Champy and colleagues, with two plates for body and symphyseal fracture fixation and one plate superiorly along the oblique ridge for angle fractures, were performed. Intermaxillary fixation was not used postoperatively. Results compared favorably with other forms of treatment with no evidence of postoperative malocclusion, with an overall complication rate of 3%. The advantage of no external incision, avoidance of intermaxillary fixation, and normal postoperative incisal opening and occlusion make this technique our treatment of choice.

Adolescent↗
PubMed1990

Total abdominal wall reconstruction.

Total abdominal wall loss results in a difficult reconstructive problem. To obtain stable, durable soft-tissue coverage and restore fascial integrity, a number of reconstructive techniques are frequently required. Use of these techniques can achieve a functional and cosmetically acceptable reconstruction.

Abdominal Muscles↗