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Biomedical subjects

D F Thomas

Publications and source records attributed to D F Thomas.

At least 55 records · Page 3Linked to original sources
PubMed1988

Multicystic dysplastic kidney: is nephrectomy still appropriate?

We analyzed 25 cases of multicystic kidney to assess the impact of prenatal diagnosis on the management of this condition. The incidence of unilateral multicystic kidney was 1 in 4,300 live births. Of the 23 children with unilateral multicystic kidneys only 3 (13 per cent) had a readily palpable lesion. These findings suggest that multicystic kidney is a more common renal anomaly than was previously recognized and that the majority of cases remained undiagnosed before the advent of prenatal diagnosis. Ultrasound re-evaluation in 11 children suggests that the natural history of multicystic kidneys is towards spontaneous involution. Two kidneys were not identifiable by followup ultrasound. Hypertension and malignancy complicating multicystic kidney are reported infrequently. The literature on hypertension does not generally support the view that multicystic kidney poses a significant risk of hypertension in later childhood or adult life. We believe that the routine removal of multicystic kidneys in infancy is no longer appropriate.

Evaluation Studies as Topic↗
PubMed1988

Oral vancomycin in prevention of necrotising enterocolitis.

Eighty four very low birthweight babies (considered high risk for developing necrotising enterocolitis) were given vancomycin orally for 48 hours before introduction of oral feeds; one developed necrotising enterocolitis. One hundred and twenty very low birthweight babies (not considered such high risk) were fed without first receiving vancomycin; 17 developed necrotising enterocolitis. Although this was not a randomised control trial, results indicate a role for vancomycin in prophylaxis of necrotising enterocolitis.

Administration, Oral↗
PubMed1987

Percutaneous nephrostomy in paediatrics.

Percutaneous nephrostomy has been performed on 18 kidneys in 16 children with an age range of 1 day old to 14 years. The indications and techniques for percutaneous nephrostomy are described, the results are documented, and the effects of the procedure on the management of these patients are discussed. It is shown that percutaneous nephrostomy in paediatrics is a safe and reliable method for draining renal collecting systems in order to relieve obstruction, to assess renal function and to drain pyonephroses.

Child↗
PubMed1986

Enterocolitis in Hirschsprung's disease: a controlled study of the etiologic role of Clostridium difficile.

Cytopathic toxin neutralized by Clostridium sordellii antiserum was found in the feces of seven out of 13 children with Hirschsprung's disease complicated by enterocolitis (54%). Clostridium difficile was isolated from ten of these 13 children (77%). The frequency of fecal toxin positivity, the magnitude of toxin titers, and the isolation rate of C difficile were all significantly greater in children with Hirschsprung's enterocolitis than in children whose Hirschsprung's disease was not complicated by enterocolitis or in children without Hirschsprung's disease. It is suggested that C difficile may be causally related to enterocolitis in Hirschsprung's disease, but the age distribution of positive results indicates that the major etiologic role is confined to children under three years of age. Vancomycin was found to be an effective form of treatment in the children with enterocolitis in whom it was employed.

Bacteriological Techniques↗
PubMed1986

Pseudomembranous colitis in children and adults.

Pseudomembranous colitis remains a potentially lethal complication of antibiotic usage. Identification of Clostridium difficile as the major pathogen has led to a rational successful approach to therapy and has widened the spectrum of associated disease. The frequent asymptomatic colonization of healthy neonates by C. difficile remains an enigma.

Adult↗
PubMed1985

Pre-natal diagnosis: how useful is it?

Dilatation of the fetal urinary tract can now be detected by ultrasound imaging in pregnancy. Forty-six cases of pre-natally diagnosed dilatation were analysed to assess the contribution of this information to subsequent urological management. Positive pre-natal scans proved accurate. Dilatation was confirmed by neonatal ultrasound imaging or by autopsy in 24 of 25 consecutive inborn neonates and two aborted fetuses. Forty-four live births were studied. Twelve neonates had physical signs at birth which rendered the pre-natal diagnosis unnecessary. In 32 neonates (73%) the urinary tract anomaly was identified solely as a result of pre-natal imaging and would otherwise have remained undetected. However, in seven neonates the information was of doubtful value (mild unilateral dilatation), in 16 it was of probable value (confirmed unilateral PUJ obstruction, multicystic kidney, etc.) and in only nine neonates (20%) was it of definite value (treatable conditions affecting both kidneys or a solitary kidney, e.g. urethral valves, PUJ obstruction in a solitary kidney, etc.). Pre-natally detected bilateral dilatation (18 infants) carried a poor prognosis--33% mortality and 56% incidence of coexistent abnormalities. No infants in our series had undergone intra-uterine drainage, but the numbers of survivors and their renal function was comparable to the published results for fetal intervention.

Dilatation, Pathologic↗
PubMed1984

Clostridial toxins in neonatal necrotising enterocolitis.

Clostridium difficile cytopathic toxin was found in the faeces or gut content of five of 39 neonates with necrotising enterocolitis (NEC). Toxin concentrations were uniformly low and did not differ from those found in healthy neonates. C difficile is unlikely to be involved in the pathogenesis of NEC. Stools from 33 babies with NEC were also tested for C perfringens alpha toxin, with negative results.

Bacterial Proteins↗
PubMed1983

The direct perfusion of surgical wounds with local anaesthetic solution: an approach to postoperative pain?

A simple technique of wound perfusion with bupivacaine (Marcain) which provides sustained postoperative analgesia is described. No complications nor side effects related to toxicity, hypersensitivity, infection, or impaired wound healing were encountered. Postoperative pain was reduced and analgesic requirements were significantly lower in patients undergoing both intermittent (P less than 0.01) and continuous (P = 0.1) wound perfusion (Student t test). Perfusion with isotonic saline was also found to be effective. This may represent a true therapeutic effect attributable to the removal or dilution of pain mediating substances in the wound.

Anesthetics, Local↗
PubMed1982

Pelviureteric obstruction in infancy and childhood. A review of 117 patients.

A series of 135 kidneys with pelviureteric obstruction in 117 children is reviewed (a 16% incidence of bilateral obstruction). The majority (89%) of pyeloplasties or other reconstructive procedures were performed via an anterior transperitoneal approach which afforded excellent surgical exposure with a low (4%) incidence of related post-operative complications. Extra-renal drainage alone was preferred to nephrostomy in the majority of patients. Children presenting with bilateral hydronephrosis were managed by a single, simultaneous bilateral procedure rather than by 2 operations. The total nephrectomy rate of 5% compares favourably with the results reported by authors who favour an extraperitoneal approach and routine nephrostomy drainage.

Child↗