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Biomedical subjects

N E Dudley

Publications and source records attributed to N E Dudley.

At least 19 recordsLinked to original sources
PubMed1999

Comparison of open posterior versus transperitoneal laparoscopic adrenalectomy.

BACKGROUND: This study reviewed the results of initial experiences of open posterior adrenalectomy and transperitoneal laparoscopic adrenalectomy in 46 patients. METHODS: Twenty-three adrenalectomies were performed using the open posterior approach. Detailed records of the patients' operative and postoperative progress were compared with those of the first 36 laparoscopic adrenalectomies undertaken for a similar range of conditions. RESULTS: Conversion to laparotomy was necessary in one of 23 open posterior adrenalectomies and five of 36 laparoscopic adrenalectomies. The mean operating time for laparoscopic unilateral adrenalectomy was nearly double that for open surgery (158 versus 85 min). Postoperative complications occurred more frequently in the open adrenalectomy series (12 of 23 versus two of 36) but one late unexplained death followed bilateral laparoscopic adrenalectomy. A mean reduction in hospital stay of 5 days was recorded after laparoscopic adrenalectomy (range 2-5 days for laparoscopic versus 6-11 days for open operation). CONCLUSION: Transperitoneal laparoscopic adrenalectomy was attended by a lower morbidity rate than open adrenalectomy and patients were discharged from hospital more quickly.

Adrenal Gland Diseases↗
PubMed1998

Does circumcision alter the periurethral bacterial flora?

A prospective study of 25 boys who underwent circumcision for medical reason was performed. Specimens of periurethral bacterial flora were taken before operation as well as 3 weeks after surgery, so that each boy acted as his own control. Before circumcision, 13 (52%) harboured uropathogenic organisms (Escherichia coli and other coliforms, Enterococcus spp, Proteus spp, Pseudomonas spp, and Klebsiella spp); after circumcision, none of the boys had uropathogens, the only organisms cultured from the periurethral region being skin commensals. We postulate that circumcision converts a 'cul-de-sac' that is a reservoir of organisms capable of causing ascending urinary tract infection into a surface colonised by natural skin organisms. This study provides circumstantial evidence supporting the idea that circumcision in well-selected patients may confer protection from urine infection.

Bacteria↗
PubMed1998

Endoscopic treatment of recurrent tracheo-oesophageal fistulae: long-term results.

Recurrent tracheo-oesophageal fistula (RTOF) occurs in 5%-15% of patients following oesophageal atresia repair. Re-thoracotomy is technically challenging and associated with significant morbidity, including a re-fistulation rate of 10%-22%. Endoscopic occlusion of the RTOF with tissue adhesives (fibrin glue, Histoacryl) is reported to be safe and highly effective. However, long-term results of such therapy are absent from the literature. A postal survey of 13 institutions reporting the use of such treatment regimes for RTOF in the literature between 1974 and 1995 was performed, and data collected concerning the long-term outcomes of their reported patients. Eleven institutions responded to the request for data, providing 22 patients (age range 1 month to 12 years) for review. All had undergone initially successful RTOF closure by endoscopic methods and had been followed up for a median of 107 months (range 3-264 months). There was no morbidity or mortality directly related to the procedure. Overall, only 55% of these endoscopically treated fistulas remained closed long-term. Fistula recurrence invariably occurred within 12 months of successful therapy (median 46 days, range 9-335). Most patients required multiple endoscopic procedures to achieve successful RTOF closure (median 2.0, range 1-4 attempts), although significantly fewer attempts were required with fibrin glue therapy. Surgical re-exploration remains the treatment of choice in the fit child. Endoscopic therapy offers a safe and elegant alternative to high-risk surgery in the sick child, although repeated treatments may be required for successful RTOF closure.

Child↗
PubMed1997

Control of fecal incontinence: continued success with the Malone procedure.

BACKGROUND: Our center has previously reported the use of the Malone antegrade continence enema procedure in children. The procedure involves bringing the appendix to the surface of the abdominal wall to provide a nonrefluxing catheterizable channel that enables antegrade colonic lavage for the control of fecal incontinence. METHODS: This report critically evaluates 23 patients treated for fecal incontinence with up to 6 years of follow-up. After operation, specific scoring criteria were used for assessment. Success in surgical technique, control of fecal soiling, and improvement in quality of life were evaluated. RESULTS: More than 85% of patients achieved maximal or near-maximal scores in all three categories. Postoperative complications remain a relevant concern when this procedure is undertaken, but we have found that significant postoperative complications are few and can be minimized by meticulous follow-up. CONCLUSIONS: Overall, the Malone antegrade continence enema procedure has been shown to be safe and highly effective. There is the potential for wider application in older age groups where sphincter and pelvic floor muscles have been compromised as a result of trauma or cancer surgery.

Adolescent↗
PubMed1995

Diaphragmatic agenesis as a distinct clinical entity.

Anatomically, diaphragmatic agenesis (DA) is the most extreme form of congenital diaphragmatic defect, but clinically it has not been defined separately from Bochdalek's hernia (BH). Between 1986 and 1992, the authors treated 55 neonates who had diaphragmatic defects. Forty-eight of these cases presented within 24 hours of birth. Seventeen of these neonates (35.4%) were found to have DA; the other 31 (64.6%) had BH. There were no significant differences in maternal age, gestational age, gender ratio, birth weight, and incidence of coexisting congenital anomalies between the two groups. However, neonates with DA differed significantly from those with BH with respect to incidence of antenatal diagnosis (76.4% v 12.5%, P = .0004), mean Apgar scores at 1 (4.1 +/- 2.0 v 5.7 +/- 2.3; P = .034) and 5 (5.5 +/- 2.7 v 7.6 +/- 2.2; P = .016) minutes, mean duration of preoperative stabilization (2.8 +/- 2.0 v 2.1 +/- 1.9 days; P = .044), and postoperative respiratory support (27.7 +/- 13.6 v 9.3 +/- 8.0 days; P = .002). Complications occurred in all seven DA survivors (100%) and in only four (19.0%) of the 21 BH survivors (P = .0008). The long-term survival rate was significantly lower for neonates with DA (29.4% v 64.5%; P = .04). Diaphragmatic agenesis is a distinct clinical entity; its unique short- and long-term problems require careful management.

Adult↗
PubMed1995

Pre-operative MRI of anorectal anomalies in the newborn period.

Nine infants (six boys, three girls) with anorectal anomalies were examined in the immediate newborn period, prior to corrective surgery, with MRI. Three high, one intermediate and five low anomalies were found at MRI - one patient with a low lesion was subsequently found at surgery 2 months later to have a high anorectal anomaly. This infant had passed meconium per urethram soon after the MRI study, prompting the need for a protective colostomy and stressing the importance of a thorough clinical examination of babies with anorectal malformations. The MRI results and findings at surgery were in agreement in all other patients (n = 8). Hydronephrosis was evident in two and renal agenesis in one patient. Sacrococcygeal hypoplasia was found in two and two hemivertebrae in one infant. No spinal cord lesion was identified. One fistula was evident on MRI but four were later found at surgery. Uniformly hyperintense T 1 signal meconium was seen in all nine newborns, allowing for easy differentiation of rectal contents from rectal wall and the adjacent musculature. MRI can provide useful information regarding the development of the puborectal and external anal sphincter muscles, can help guide the pull-through procedure and help predict future continence pre-operatively in the newborn period.

Anal Canal↗
PubMed1994

Diaphragmatic agenesis as a distinct clinical entity.

Anatomically, diaphragmatic agenesis (DA) represents the most extreme form of congenital diaphragmatic defects, but clinically it has not been defined separately from Bochalek's hernia (BH). Between 1986 and 1992, the authors treated 55 neonates who had diaphragmatic defects. Forty-eight of them presented within 24 hours of birth and comprised the study group. Seventeen neonates (35.4%) were found to have DA; the other 31 (64.6%) had BH. There were no differences in the maternal age, gestation course, gender ratio, birth weight, or incidence of co-existing congenital anomalies between the two groups. However, there were significant differences with respect to the incidence of antenatal diagnosis (76.4% for DA patients v 12.5% for BH patients; P = .0004), mean (+/- SD) Apgar scores at 1 (4.1 +/- 2.0 v 5.7 +/- 2.3; P = .034) and 5 minutes (5.5 +/- 2.7 v 7.6 +/- 2.2; P = .016), mean duration of preoperative stabilization (2.8 +/- 2.0 v 2.1 +/- 1.9 days; P = .044) and mean duration of postoperative respiratory support (27.7 +/- 13.6 v 9.3 +/- 8.0 days; P = .002). Complications occurred in all seven survivors of DA and in only four (19.0%) of 21 survivors of BH (P = .0008). The neonates with DA had a significantly poorer long-term survival rates (29.4% v 64.5%; P = .04). Diaphragmatic agenesis is a distinct clinical entity; its unique short-term and long-term problems require careful management.

Diaphragm↗
PubMed1991

Pentavalent Tc-99m DMSA scintigraphy. Prospective evaluation of its role in the management of patients with medullary carcinoma of the thyroid.

Ten patients with suspected primary, recurrent or metastatic medullary carcinoma of the thyroid (MCT) were studied prospectively with Tc-99m(V) DMSA. Of these, two patients had primary disease, seven patients were asymptomatic but had persistent and serial elevations in serum calcitonin following previous thyroid resections for MCT, and one asymptomatic patient with normal serum calcitonin was studied because of suspected hilar nodes metastases. The serial calcitonin peak in the patients was 0.04-43ng/ml (normal less than 0.08ng/ml). Scintigraphy was considered positive in seven of the asymptomatic patients and equivocal in one. The two patients with primary disease had increased uptake before but not after thyroidectomy. Primary disease, localized recurrence and distant metastases in soft tissue (nine patients) and bone (one patient) were detected in these patients, and this resulted in early surgical resection (five patients) and radiotherapy (one patient). We conclude that Tc-99m(V) DMSA is a useful imaging agent in the evaluation of asymptomatic MCT patients with hypercalcitonemia.

Adult↗
PubMed1989

Medullary carcinoma of the thyroid: management of persistent hypercalcitonaemia utilizing [99mTc] (v) dimercaptosuccinic acid scintigraphy.

Whole body scintigraphy with [99mTc] (v)dimercaptosuccinic acid (pentavalent DMSA) was performed in seven patients with histologically confirmed medullary carcinoma of the thyroid (MCT). Six of these patients had undergone previous thyroid resections for MCT and, although asymptomatic at the time of pentavalent DMSA scintigraphy, had persistent and serial elevations in their plasma calcitonin levels. One additional patient was scanned before and after total thyroidectomy for MCT. The pentavalent DMSA scintigram demonstrated either local neck recurrence (three patients) or distant metastases (two patients) in five of the six asymptomatic patients. In one asymptomatic patient only equivocal neck uptake was demonstrated. Since he had only minimal calcitonin elevations, repeat neck exploration was not performed. The one patient studied before thyroid resection for MCT demonstrated neck uptake before, but not after, total thyroidectomy. The results of the scintigrams had significant impact on patient care and resulted in neck re-exploration (three patients), neck biopsy (one patient), and lumbar spine biopsy and subsequent radiotherapy (one patient). These data demonstrate pentavalent DMSA to be a sensitive localizing agent in the evaluation of asymptomatic MCT patients with hypercalcitonaemia. Accurate targeting of treatment may be shown in due course to have a beneficial impact on survival.

Adult↗
PubMed1988

Relative concentration of astatine-211 and iodine-125 by human fetal thyroid and carcinoma of the thyroid in nude mice.

The concentrations of 211At and 125I were measured in various tissues in nude mice bearing xenografts of human thyroid tissue (fetal and malignant). The relative concentration of the two halogens was obtained at 4 and 24 h after injection. Samples were taken of the host blood, muscle and thyroid gland and the grafted tissues. The mouse thyroid concentrated 125I more efficiently than 211At but the human grafts concentrated both halogens about equally.

Adenocarcinoma↗
PubMed1987

Anatomical findings at orchiopexy.

The anatomical findings at orchidopexy for cryptorchid testis were recorded for 60 boys aged between 6 months and 18 years. In 11 patients (18.3%) bilateral cryptorchidism was present. At operation, atrophied testicular tissue was found in two patients and one testis was found to be absent; 69.1% (47/68) of the remaining testes were found in the superficial inguinal pouch at operation, 27.9% (19/68) were in the inguinal canal, one was in the femoral triangle and one was high in the scrotum. In 35 testes (51.5%) there was an associated hernial sac. In 54 testes (79.4%) the gubernaculum testis was attached to an anatomical site other than the lower scrotum. In 26 (38.2%) there was a fascial block to descent into the scrotum and one or other of these findings was present in 64 testes (94.1%). These findings suggest that failure to establish a patent route from the superficial inguinal region to the scrotum and the passage of the gubernaculum along this route are the abnormalities responsible for failure of testicular descent.

Child↗
PubMed1986

Undescended testis: the effect of treatment on subsequent risk of subfertility and malignancy.

The literature was reviewed for information on the long-term effects of cryptorchidism on fertility and cancer incidence. In unilateral cryptorchidism, treatment policies of orchidopexy alone, or of human chorionic gonadotrophin (hCG) therapy followed, if necessary, by orchidopexy, have resulted in similar levels of reduced fertility (15% azoospermia, and an additional 30% oligospermia, ie, sperm count less than 20 X 10(6)/mL). Very similar results were observed in unilateral cryptorchid men who had had no treatment (and were still cryptorchid at semen examination). In contrast, no untreated bilaterally cryptorchid men have normal fertility (sperm count greater than 20 X 10(6)/mL), whereas of those treated, a quarter have normal fertility. In some series, as many as half of the bilateral cryptorchid testes descended following hormonal treatment; a finding that could be attributed, at least in part, to the frequent difficulty in deciding on clinical examination, whether these testes are truly cryptorchid. There is little evidence that operation early rather than late within the age range of 4 to 14 years has any effect on subsequent fertility. Histologic studies suggest that orchidopexy should be carried out before age 2, but there are almost no follow-up data with which to evaluate the results of early operation. Since there is evidence that orchidopexy may result in testicular atrophy in a small proportion of cases, a trial of luteinizing hormone-releasing hormone (LHRH) may be advisable. There is little information available concerning the effect of age at orchidopexy on the subsequent risk of testicular cancer. Testes that cannot be brought into the scrotum should be excised.

Age Factors↗
PubMed1986

A comparison between gap-length and Waterston classification as guides to mortality and morbidity after surgery for esophageal atresia.

In a retrospective study of tracheoesophageal fistula repairs in the Oxford Region, 1968 to 1982, 64 consecutive cases were classified according to Waterston group and gap length (less than 2 cm or greater than 2 cm); where possible their current status was assessed by interview or questionnaire. Waterston group and gap length varied independently. Both affected the course of the first admission but thereafter, Waterston classification was a poor prognostic guide. However, those with a long gap were significantly more likely to have respiratory and swallowing difficulties and stunted growth.

Esophageal Atresia↗
PubMed1985

Parathyroid carcinoma: pointers to successful management.

Five patients with parathyroid carcinoma are reported. In the first case the clinical and histological features of malignancy at initial surgery were not recognised and recurrence of the tumour occurred within two years. Referring to previously published series this sequence appeared to be typical and underlined the likely reasons for the poor prognosis of this rare tumour. A review of the diagnostic criteria to improve early diagnosis was undertaken and a treatment protocol drawn up. It was based on a more radical surgical extirpation to include the tumour bed together with postoperative radiotherapy. Four further cases have subsequently been identified, treated according to the protocol and at 16 to 49 months' follow up, show no sign of recurrence and have a normal serum calcium.

Aged↗