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Biomedical subjects

M R Davies

Publications and source records attributed to M R Davies.

At least 19 recordsLinked to original sources
PubMed1992

Facilitating the operative exposure of the portal plate in cases of biliary atresia by dislocating the whole liver onto the abdominal wall.

Obtaining adequate exposure of the portal plate in cases with biliary atresia can tax the ingenuity of the surgeon. The successful completion of a hepatic portoenterostomy depends on it. Mobilising the liver and dislocating it into an ex vivo-like position on the anterior abdominal wall simplifies this step of the operation. It achieves maximal visualisation and access to the anatomy of the liver port. When used correctly by the surgeon this technique is not complicated by hepatic or caval blood flow occlusion. Its use in over 40 clinical cases has not resulted in any major mishap.

Abdominal Muscles↗
PubMed1992

Life-threatening respiratory distress caused by a mediastinal teratoma in a newborn.

Mediastinal teratomas rarely cause symptoms in newborns. Case reports drawing attention to this presentation have appeared in the literature. A 2-day-old baby with respiratory distress treated by intubation and mechanical ventilation underwent an urgent thoracotomy to alleviate tracheal compression that was caused by a teratoma. The clinical, radiological, and surgical features related to this case are reported.

Humans↗
PubMed1990

The use of nasogastric intubation in the radiological diagnosis of oesophageal atresias.

Correctly performed oesophageal intubation determines the presence of atresia. The physical properties of the nasogastric tube used determines the place of radiology in this diagnosis. The appearance of a curled tube (hoop sign) in the proximal oesophagus in the newborn is diagnostic of atresia, as it clearly delineates the oesophageal pouch. The performance of a contrast study to establish this diagnosis is never indicated, since it is impossible to eliminate aspiration completely.

Esophageal Atresia↗
PubMed1988

Intestinal obstruction in the newborn with congenital syphilis.

Four newborn patients with congenital syphilis and intestinal obstruction are discussed in this report. In three cases, the obstruction was due to inspissated meconium, simulating the features of meconium ileus in one, meconium plug in the second, and associated with perforation of the terminal ileum in the third. An exocrine pancreatic insufficiency and a motility disturbance of the intestine due to syphilitic infection during fetal life could be the probable etiologic factor. The fourth patient had multiple ileal stenoses. Ischemia due to the prenatal syphilitic arteritis of the bowel wall can be responsible for this pathology. Attention is drawn to the association between congenital syphilis and neonatal intestinal obstruction.

Female↗
PubMed1987

Congenital hydropericardium associated with the herniation of part of the liver into the pericardial sac.

A congenital pericardial effusion without a clinically obvious cause is rare. The presentation, diagnostic studies, and anatomic findings in three such cases are described. It is postulated that the fluid within the pericardial sac, was a transudate produced by a partially strangulated portion of the liver, trapped in an intrapericardial hernia with sac, which was present in each case. Encroachment with compression by the enlarged pericardium on the developing lung bud structures is the reason given for the pulmonary hypoplasia, associated with this form of diaphragmatic hernia. Severe pulmonary insufficiency was the presenting feature, while cardiac tamponade is noted for its absence, in these cases.

Female↗
PubMed1986

Biliary atresia--surgical management. A 10-year review.

The surgical results in 39 children operated on for biliary atresia at Red Cross War Memorial Children's Hospital between January 1975 and January 1985 are reported. The mean age at operation was 12.8 weeks (range 6 weeks-6 months). In the first 4 years no patient had sustained bile drainage after operation. Since 1979 16 of 32 patients (50%) have had significant bile drainage. Of these, 8 are alive and have been followed up from 6 months to 6 years after operation. Five are jaundice-free and well. The other 3 are mildly jaundiced, have evidence of ongoing liver damage, and have a poor prognosis. The deaths were due to progressive liver damage with liver failure, portal hypertension, and intercurrent infection. Cholangitis after 'successful' porto-enterostomy was the main cause of poor prognosis and can be related to the age at referral and the presence of cirrhosis of the liver at the time of surgery; thus bile drainage does not necessarily equate with cure. Early referral of infants with conjugated hyperbilirubinaemia to a major centre is of paramount importance if we are to improve the prognosis.

Age Factors↗
PubMed1986

Colonic oesophageal replacement in children--functional results.

Since 1961 colonic replacement of the oesophagus has been performed in 38 patients of whom 16 were followed up long-term. The main indication was caustic soda injury to the oesophagus. We prefer a single-stage retrosternal isoperistaltic left colon interposition, based on the ascending branches of the left colic artery, with concomitant pyloroplasty. Oesophagectomy was not performed. The main complications were vascular insufficiency, upper anastomotic leak and subsequent stricture formation. Long-term follow-up (mean 9.5 years) revealed functional acceptance with normal swallowing, absence of pulmonary and gastrointestinal complications and rapid emptying of a passive conduit. Upper cervico-colonic anastomotic stricture of various degrees occurred in 14 per cent of the patients (5 of 35 patients).

Child↗
PubMed1986

Hollow viscus rupture due to blunt trauma.

The results of current pediatric surgical texts suggest that the damage sustained by solid abdominal viscera after blunt trauma is best treated expectantly. Therefore, a child with significant intra-abdominal pathology is managed nonoperatively. For this reason, missed or unexpected pathology may be inappropriately treated. This is the major problem faced by the surgeon caring for these children. A review of 56 patients seen after blunt abdominal trauma is reported; ten of this group had hollow viscus ruptures. It was found that special investigations were of no aid in guiding management policy. This decision remained a clinical one, which stresses the importance of the interpretation of abdominal signs made by the surgeon who is caring for the patient and the role he or she plays in the treatment of children with blunt trauma.

Abdominal Injuries↗
PubMed1984

Prenatal perforation of the extraperitoneal part of the rectum, associated with a developmental defect of the pelvic floor.

Perforation of the extraperitoneal part of the rectum during foetal life is an exceptionally rare event. Two cases are reported where this has been associated with a para-rectal defect in the pelvic floor. It is postulated that in these instances, the rectal lesion is due to this abnormality. As a consequence of the perforation meconium extravasates into the buttock. This has a classic presentation which should be immediately recognised. Urgent rectal decompression, as an emergency measure before surgery, is required if further serious complications are to be prevented.

Extravasation of Diagnostic and Therapeutic Materi↗
PubMed1983

Inadequate pouch emptying following Martin's pull-through procedure for intestinal aganglionosis.

Diarrhea is an expected problem following Martin's operation. Its cause is obvious. With medical management, the phase of intolerance to enteral feeding can be bridged. Adaptation is usually reached within 3-6 mo of surgery. This is confirmed by our experience with five patients treated in this manner. In two further patients, episodic bouts of diarrhea continued to mar their recovery. It was then appreciated that this was related to pouch content stasis. The nonoperative management of this complication proved unsuccessful. A death at 20 mo post-pull-through due to "enterocolitis" and an operation 13 mo post-pull-through to repair an acute pouch perforation followed. Attention is drawn to this complication. The following points aimed at preventing stasis, which in our series has been the most difficult problem to treat, are made: a low anal anastomosis--0.5 cm above dentate line; limit pouch size; and use normally innervated bowel. With the use of these changes, early postoperative diarrhea may be difficult to control. For this reason it is proposed that parenteral feeding be used routinely in the immediate postoperative period, and, as rapid fluid loss is better tolerated, surgery be deferred until the patient is 8 mo or more of age.

Colon↗
PubMed1982

The phreno-pyloric syndrome in symptomatic gastroesophageal reflux.

Pathologic gastroesophageal reflux encountered during the neonatal period can be associated with projectile vomiting often of bile stained gastric content. Between 1960 and 1979, symptomatic gastroesophageal reflux was diagnosed in 36 neonates. Duodenogastroesophageal reflux was present in 16 or 44.4% of this group. This abnormal phenomenon is classically encountered in our experience during the neonatal period. The in-series incompetence of the pyloric and lower esophageal sphincteric mechanisms gives rise to a variant of the so called phreno-pyloric syndrome. The seriousness of this association is emphasized in our series by the high incidence of complications encountered in the patients with this syndrome, i.e., gastroesophageal bleeding in 44% esophagitis with stricture of formation in 12.5%. Conservative management of the cases encountered with this syndrome was successful except in two cases where reflux esophagitis was complicated by severe stricture formation. It is postulated that the pathogenesis of this form of phreno-pyloric syndrome is most probably based upon a motility disturbance of the upper gastrointestinal tract, involving the hormone motilin.

Esophagogastric Junction↗