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Biomedical subjects

P Chetcuti

Publications and source records attributed to P Chetcuti.

12 recordsLinked to original sources
PubMed1993

Gastrointestinal morbidity and growth after repair of oesophageal atresia and tracheo-oesophageal fistula.

Upper gastrointestinal morbidity and anthropometric data in 334 patients aged 1 to 37 years with repaired oesophageal atresia and tracheo-oesophageal fistula are reported. Two thirds were subsequently hospitalised with oesophageal complications and half underwent one or more surgical procedures. Thirteen percent were hospitalised for more than 50 days. Anastomotic strictures were present in one third and just under half had gastro-oesophageal reflux. Dysphagia was present in about 65% in all age groups but symptom severity and surgical intervention decreased significantly after 5 years of age. Gastro-oesophageal reflux symptoms were commoner in the older patients increasing from 18% in the group under 5 years of age to 52% in those over 15 years. Height centile distribution was normal, but the median weight centile was the 25th. Weight for height values greater than 2 SD below the mean were present in 13%, and two thirds of these patients were under 5 years of age. The majority of adults enjoyed a normal lifestyle and were comparable with their peers.

Adolescent↗
PubMed1993

Respiratory morbidity after repair of oesophageal atresia and tracheo-oesophageal fistula.

Respiratory morbidity in 334 patients aged 1 to 37 years with repaired oesophageal atresia and tracheo-oesophageal fistula is reported. Just under half the patients were subsequently hospitalised with respiratory illness. Two thirds of admissions were before 5 years of age. Five percent were admitted on more than five occasions. Patients with gastro-oesophageal reflux and low birth weight were more likely to be admitted. Thirty one percent of patients had one or more episodes of pneumonia in the first five years of life and 5% after 15 years. The prevalence of annual bouts of bronchitis in these age groups was 74% and 41% respectively. The prevalence of wheeze was about 40% in all age groups. Patients with symptoms persisting after 15 years were more likely to have had lower respiratory tract illness in early childhood and a history of atopy. In the 12 months before review, weekly episodes of wheezing were present in one third under 5 years and 15% over 15 years. Thirty two percent of patients aged 5-10 years and 8% over 15 years missed two or more weeks of school or work in the previous year with respiratory illness.

Adolescent↗
PubMed1992

Lung function abnormalities in repaired oesophageal atresia and tracheo-oesophageal fistula.

BACKGROUND: Respiratory complications are common after neonatal repair of oesophageal atresia and tracheo-oesophageal fistula. The prevalence of lung function abnormalities and the relation between gastrointestinal complications and lung function has not been studied in a large number of patients. METHODS: Lung volumes and flow-volume loops were measured in 155 patients without spinal curvature aged 6-37 years who had undergone surgery for oesophageal atresia and tracheo-oesophageal fistula. RESULTS: Sixty four of the 155 patients had evidence of mild lower airways disease, with values for FEV1 more than two standardised scores below the predicted value in 39 (25%) and above 2 standardised scores for the residual volume (RV)/total lung capacity (TLC) ratio in 64 (41%). Restrictive lung disease (TLC more than 2 standardised scores below predicted) was present in 28 (18%). Severe lung function abnormalities were present in under 10% of the 155. Half the subjects had some evidence of extra-thoracic tracheal obstruction, with a high ratio of expiratory to inspiratory flow for peak flow in 76 (50%) and at 50% of vital capacity in 59 (38%). Patients with radiological gastro-oesophageal reflux in early childhood had more airways obstruction and smaller lung volumes. Patients with current gastrointestinal symptoms were similar in their lung function to symptom free patients. CONCLUSIONS: Minor lung function abnormalities are common in patients after repair of oesophageal atresia. Early diagnosis and management of gastro-oesophageal reflux may help to minimise these lung function abnormalities.

Adolescent↗
PubMed1990

Kinetic and equilibrium binding studies of amsacrine-4-carboxamides: a class of asymmetrical DNA-intercalating agents which bind by threading through the DNA helix.

Detailed equilibrium and kinetic studies of the DNA interaction of the amsacrine-4-carboxamide class of compounds suggest that they bind by intercalating the acridine chromophore at near-maximal overlap with the base pairs, locating their two dissimilar side chains in specific grooves of the double helix. The first step is a fast bimolecular association to form an outside-bound complex (probably in the major groove). Insertion of the less bulky carboxamide side chain then occurs in a process governed largely by the rate of transient opening of the double helix by natural "breathing" motions and is followed by further monomolecular rearrangements to allow the carboxamide side chain to find its highest affinity binding sites in the minor groove. Dissociation of the complexes are much more ligand structure dependent, but also involve opening of the double helix to allow disengagement. Compounds of this type, which locate their two distinguishable side chains one in each DNA groove, form a unique class of DNA-binding ligand, with considerable potential for regiospecific delivery of reactive functionality to DNA. Although natural products which also have such specific binding modes are known (e.g. nogalamycin), the amsacrine-4-carboxamides discussed here are the first class of readily modified synthetic compounds with this property.

Amides↗
PubMed1989

Chest wall deformity in patients with repaired esophageal atresia.

Chest wall deformities developed after thoracotomy for esophageal atresia, in 77 of 232 patients (33%) who did not have a congenital vertebral anomaly. Anterior chest wall asymmetry was present in 47, scoliosis in 18 and a combination of both in 12 patients. Scoliosis was convex away from the incision in two thirds of those affected. Anterior chest wall deformity was more common in patients greater than 25 years of age, and scoliosis was more common in patients who had had multiple thoracotomies. Breast surgery to minimize inequality was required in three female patients, and spinal surgery in one patient. Twenty-two of 53 patients with a congenital vertebral anomaly developed scoliosis, eight of whom required surgery. The scoliosis was probably the result of the vertebral anomaly in these patients, who are particularly at risk for progressive deformity.

Adolescent↗
PubMed1989

Spinal deformity in patients born with oesophageal atresia and tracheo-oesophageal fistula.

Spinal deformity was present in 58 (19%) of 302 patients born with oesophageal atresia and fistula when examined at review. This was present in 24 (47%) of 51 patients with vertebral anomalies and 34 (14%) of 251 patients with normal vertebrae. Scoliosis was present in 21 patients with vertebral anomalies, torticollis in two, and lordosis in one. Two thirds of the patients with congenital scoliosis have had or are likely to require operation, compared with five patients with non-congenital scoliosis. Scoliosis associated with mixed vertebral anomalies in the lower thoracic spine had the worst prognosis. The medical records of a further 64 patients who had survived operation but who could not be traced were reviewed, and indicated that four had had congenital vertebral anomalies but none had a spinal deformity. We recommend early detection of vertebral anomalies in this group and careful follow up of patients with these abnormalities.

Abnormalities, Multiple↗
PubMed1988

Adults who survived repair of congenital oesophageal atresia and tracheo-oesophageal fistula.

One hundred and twenty five adults who were born before 1969 with oesophageal atresia or tracheo-oesophageal fistula or both and were managed at the Royal Children's Hospital, Melbourne, were reviewed. Most enjoyed a normal life. Though over half had difficulties in swallowing and symptoms of gastro-oesophageal reflux, the symptoms occurred only occasionally and were regarded as inconsequential by most. One third of the patients had wheeze and a quarter had at least one episode of bronchitis a year, but these interfered little with daily activities. Overall, these results are encouraging for young patients with oesophageal atresia and their families.

Activities of Daily Living↗
PubMed1987

Seat belts: a potential hazard to the fetus.

The widespread introduction of seat belts for front seat passengers has undoubtedly reduced injury and death during impact but the effects on the fetus of belt restraint has been little reported. We report here a fetus whose mother was involved in a low speed head-on collision and who rapidly developed abdominal tenderness. The fetus was bradycardic and emergency cesarean section delivered an infant who was shocked due to placental abruption and who required immediate resuscitation. The baby subsequently developed renal failure and convulsions but on follow-up is entirely normal. We draw attention to the fact that maternal seat belt trauma may cause placental abruption with severe fetal compromise. Careful assessment of fetal cardiotocography should be performed in all pregnancies where a deceleration collision in the presence of a maternal seat belt restraint makes fetal injury a possibility.

Acute Kidney Injury↗
PubMed1985

Birth size in Indian ethnic subgroups born in Britain.

Comparison in size at birth was made among Indian mothers of Hindu, Sikh, and Moslem origin living in Leicester and their infants, and white mothers and their infants. White infants were significantly heavier than infants from all Asian subgroups studied and had larger heads. Sikh babies were significantly longer and heavier than Moslem and Hindu babies, and in some respects were more comparable to white infants than their Indian peers. There were no important differences between the Moslem and Hindu babies.

Adolescent↗