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Biomedical subjects

J Duckett

Publications and source records attributed to J Duckett.

At least 19 recordsLinked to original sources
PubMed1996

Paediatric rectal prolapse in Rwanda.

During the 1994 crisis in Rwanda, a high incidence of full-thickness rectal prolapse was noted among the refugee children in the south-west of the country. The prolapses arose as a result of acute diarrhoeal illness superimposed on malnutrition and worm infestation. We used a modification of the Thiersch wire technique in 40 of these cases during two months working in a refugee camp. A catgut pursestring was tied around the anal margin under local, regional or general anaesthesia. This was effective in achieving short-term control of full-thickness prolapse until the underlying illness was corrected. Under the circumstances, no formal follow-up could be arranged; however, no complications were reported and only one patient presented with recurrence.

Anal Canal↗
PubMed1992

Results of a randomized clinical trial of medical versus surgical management of infants and children with grades III and IV primary vesicoureteral reflux (United States). The International Reflux Study in Children.

A total of 132 infants and children with grades III and IV primary vesicoureteral reflux was entered into a prospective trial comparing medical to surgical management. Inclusion criteria were an age not exceeding 10 years and a glomerular filtration rate of at least 70 ml. per minute per 1.73 m.2. Children with significant urinary tract malformations and clinical signs/symptoms of dysfunctional voiding were not accepted into the trial. Medical therapy consisted of continuous low dose antibiotic prophylaxis until vesicoureteral reflux resolved. The type of surgical procedure used for the correction of reflux was left to the discretion of the surgeon. Outcome variables included the appearance or progression of renal lesions, rate of renal growth, recurrence rate of urinary tract infection or pyelonephritis, changes in total kidney glomerular filtration rate, development of hypertension and resolution rate of vesicoureteral reflux. Followup at 6, 18, 36 and 54 months after entry included, in addition to history and physical examination, voiding cystourethrography, excretory urography and a urine culture. Of the patients 68 were allocated to the medical group and 64 to the surgical group. They were stratified for age, sex and preexisting renal scarring. Of the patients 10% were boys, 47% were between 2 and 6 years old at entry, 93% had a history of pyelonephritis, 67% had either scarring or thinning of the parenchyma at entry, 87% had grade IV vesicoureteral reflux in at least 1 unit and 56% had bilateral reflux. There were no significant differences in the frequency distribution of entry characteristics between the patients allocated to either group. New renal scarring developed in 22% of medical and 31% of surgical patients (p < 0.4). Growth of kidneys with grade IV vesicoureteral reflux was slightly less than normal in the medical (-0.67 +/- 0.15 standard deviation) and surgical (-0.42 +/- 0.11 standard deviation) groups (p < 0.7). Pyelonephritis occurred in 15 medical patients versus 5 surgical patients (p < 0.05). There was no significant change in glomerular filtration rate within each treatment group and no difference in glomerular filtration rate between groups. No patient had hypertension during the followup period. The disappearance rate of vesicoureteral reflux in patients with grade IV reflux was approximately 8% per year. Of the medical patients 75% still had vesicoureteral reflux after 3 years of observation.(ABSTRACT TRUNCATED AT 400 WORDS)

Child↗
PubMed1987

Treatment of cryptorchidism with low doses of buserelin over a 6-months period.

In a collaborative study, 48 prepubertal boys with undescended testes ranging in age from 15 months to 11 years were treated with low-dose intranasal buserelin following an every-other-day programme for a period of 6 months. Urinary LH, FSH, and testosterone were not altered during the treatment period. Boys over 7 years of age experienced a slight but significant rise in testosterone at the end of treatment. Testicular descent was achieved in only 17% of boys. In the remainder, bilateral testicular biopsies were obtained during orchiopexy. Grouped analysis showed a significant increase in the number of germ cells per tubule in both unilateral and bilateral cryptorchid boys, suggesting that buserelin treatment of the testis in a cryptorchid position is capable of improving fertility potential. If time-matched controls are compared to treated boys of the same age, again a significant difference is observed indicating that buserelin treatment does increase the germ cell count.

Administration, Intranasal↗
PubMed1987

Long-term effect of luteinizing hormone-releasing hormone analogue (buserelin) on cryptorchid testes.

We studied 48 prepubertal boys with cryptorchidism between 1 year 3 months and 11 years old who were treated with buserelin every other day for 6 months. Urinary luteinizing and follicle-stimulating hormones, and testosterone remained unchanged during the entire treatment period. In boys older than 7 years a slight but significant increase in testosterone was noted in the first morning voided urine at the end of treatment. Testicular biopsies were obtained at orchiopexy in all patients in whom testicular descent was not complete (83 per cent). A significant increase in the number of germ cells was observed in patients with unilateral and those with bilateral cryptorchidism, indicating that 6 months of buserelin therapy improved the fertility status even when testes were in an undescended position during treatment.

Administration, Intranasal↗
PubMed1987

Yolk sac carcinoma of the testis in children.

We reviewed the records of 11 patients with yolk sac carcinoma of the testis seen at the Children's Hospital of Philadelphia from 1971 through 1983. Each child was less than 2 years old at diagnosis, and each had stage I disease (localized to the testicle). Initial management consisted of radical inguinal orchiectomy in all 11 patients. Four patients then underwent retroperitoneal node dissection and none had pathological evidence of retroperitoneal tumor spread. After primary surgical management 5 patients received no further initial treatment. Of these 5 patients 3 are alive with no evidence of disease at 1.5, 2.7 and 4.5 years after diagnosis. The tumor recurred in 2 patients, 1 of whom was salvaged with pulmonary radiation therapy and chemotherapy. The other 6 patients received chemotherapy postoperatively and only 1 has suffered relapse. Over-all, of 3 patients in whom pulmonary metastases developed 1 died of tumor and 1 died of treatment-related pneumonopathy. Our experience and that of others have led us to conclude that patients with localized disease and normal postoperative serum alpha-fetoprotein levels do not benefit from retroperitoneal node dissection, postoperative abdominal irradiation or chemotherapy. Patients with retroperitoneal nodal involvement, widely metastatic disease or recurrent disease can be treated successfully with chemotherapy and in some cases with radiation therapy.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1986

Testicular histology in children with unilateral testicular torsion.

Testicular biopsies from 38 boys at the time of unilateral testicular torsion were studied retrospectively. Of the patients 30 were adolescent and 8 were prepubertal. In 18 boys biopsy of the torsed testis only was performed, while in another 18 bilateral testis biopsy was obtained. The remaining 2 patients had biopsy of the contralateral testis only because the torsed testis was infarcted completely. After allowances were made for the acute testicular changes associated with the torsion itself, significant pre-existing testicular abnormalities could be identified in 20 of the 38 patients (53 per cent), including the Sertoli-cell-only syndrome (7), partial Sertoli-cell-only syndrome (4), defective spermatogenesis (8) and mucous plugs caused by cystic fibrosis inducing tubular changes (1). In 70 per cent of the biopsies from prepubertal boys the number of spermatogonia per tubule was diminished. In adolescent boys the mean number of late spermatids also was diminished severely in the contralateral and torsed testes. Pronounced atrophy of Leydig cells was found in all but 1 testis examined. The presence or absence of a morphological blood-testis barrier did not appear to be related to pathological changes in the contralateral testis. These observations suggest that infertility in patients with unilateral testicular torsion may be a consequence of a pre-existing testicular pathological condition.

Adolescent↗
PubMed1984

Ureteroceles in children: clinical study and report of 58 cases.

Fifty-eight children with ureteroceles are the subject of this study. The lesions occurred more commonly in females and affected the left urinary transport system predominantly. Ectopic ureterocele was the most common type and virtually always developed on the ureter originating from the upper renal unit of a duplex kidney. There was a high incidence of associated urinary tract obstruction or vesico-ureteral reflux. The most common presenting symptoms were those of urinary infection followed by discovery of an abdominal mass. A characteristic filling defect in the bladder was seen on excretory urogram, and voiding cystourethrography revealed vesicoureteric reflux in 50% of the patients. Management of an infant or child with a ureterocele should begin with appropriate antibiotic treatment if infection is present, followed by excision or drainage of the involved renal segment(s). A pus filled upper pole and ureter may need to be removed or drained urgently in some ill patients. Ureteroceles are often complicated anatomic problems, which should be treated by surgeons who are familiar with the various facets of this congenital malformation.

Age Factors↗
PubMed1977

Adaptive and maladaptive behavior of idiots savants.

A comparison was made of 25 institutionalized idiots savants and a control group of institutionalized retarded persons matched for age, sex, IQ, and length of institutionalization. As a group, idiots savants were found to be somewhat more disturbed and disturbing than their peers, although they did not show extreme emotional disturbance nor reflect a clear behavioral profile.

Achievement↗