Biomedical subjects

S G Cox

Publications and source records attributed to S G Cox.

6 recordsLinked to original sources

PubMed2005

Colonic atresia: spectrum of presentation and pitfalls in management. A review of 14 cases.

Fourteen cases of colonic atresia seen over a 38-year period are reviewed with particular reference to clinical presentation and pitfalls in management. Seven had Type I atresia, two Type II and five Type IIIa. Ten had associated gastrointestinal anomalies. Management varied considerably. Six had primary colonic anastomosis. Two of these developed complications due to unrecognized distal hypoganglionosis, two had associated jejunal atresias resulting in short bowel syndrome, and two had primary anastomosis protected by proximal ileostomies. Seven had a staged repair with initial defunctioning enterostomy with only one complication, an unfixed mesentery that later resulted in midgut volvulus. The only mortality was a patient in which a jejunal atresia repair leaked as a result of a missed colonic atresia. Operative strategy should depend on the clinical state of the patients, the level of atresia, associated small bowel pathology and exclusion of distal pathology. Primary anastomosis would only rarely be advised with a circumspect approach. Long-term outlook, as in small bowel atresia is generally excellent.

Colon↗

PubMed2005

Ultrasonography for ilioinguinal/iliohypogastric nerve blocks in children.

BACKGROUND: The ilioinguinal/iliohypogastric nerve block is a popular regional anaesthetic technique for children undergoing inguinal surgery. The success rate is only 70-80% and complications may occur. A prospective randomized double-blinded study was designed to compare the use of ultrasonography with the conventional ilioinguinal/iliohypogastric nerve block technique. METHODS: One hundred children (age range, 1 month-8 years) scheduled for inguinal hernia repair, orchidopexy or hydrocele repair were included in the study. Following induction of general anaesthesia, the children received an ilioinguinal/iliohypogastric block performed either under ultrasound guidance using levobupivacaine 0.25% until both nerves were surrounded by the local anaesthetic or by the conventional 'fascial click' method using levobupivacaine 0.25% (0.3 ml kg(-1)). Additional intra- and postoperative analgesic requirements were recorded. RESULTS: Ultrasonographic visualization of the ilioinguinal/iliohypogastric nerves was possible in all cases. The amount of local anaesthetic used in the ultrasound group was significantly lower than in the 'fascial click' group (0.19 (SD 0.05) ml kg(-1) vs 0.3 ml kg(-1), P<0.0001). During the intraoperative period 4% of the children in the ultrasound group received additional analgesics compared with 26% in the fascial click group (P=0.004). Only three children (6%) in the ultrasound-guided group needed postoperative rectal acetaminophen compared with 20 children (40%) in the fascial click group (P<0.0001). CONCLUSIONS: Ultrasound-guided ilioinguinal/iliohypogastric nerve blocks can be achieved with significantly smaller volumes of local anaesthetics. The intra- and postoperative requirements for additional analgesia are significantly lower than with the conventional method.

Ambulatory Surgical Procedures↗

PubMed2001

Dysphoria: self-devaluative and affective components in recovered depressed patients and never depressed controls.

BACKGROUND: The Interacting Cognitive Subsystems analysis of cognitive vulnerability to depression predicts that subjective experiences of dysphoria in recovered depressed patients will be qualitatively different from those of controls. This study tested this prediction using a new instrument, the Depressed States Checklist. METHODS: Twenty-three recovered recurrently depressed patients and 54 never depressed controls rated the affective and self-devaluative components of a dysphoric experience. RESULTS: Groups reported similar levels of affective component but recovered depressed patients reported higher self-devaluative dysphoric experience. At zero affective component of dysphoria neither group reported any self-devaluative feelings. With increasing affective component of dysphoria, the self-devaluative component increased significantly more in recovered patients than in controls. The ratio of self-devaluative to affective components of dysphoria significantly differentiated recovered depressed patients from controls. CONCLUSIONS: As predicted, dysphoria in recovered depressed patients is qualitatively different from controls in ways that increase vulnerability to major depression. The Depressed States Checklist is a new, brief, measure of cognitive vulnerability to depression that may be particularly useful in large, prospective, epidemiological studies.

Adolescent↗

PubMed2000

Breastfeeding--a gradual return to mother's autonomy.

The aim of this study, the final in a series, was to assess mothers' perceptions of some aspects of midwifery care in relation to breastfeeding. These included conflicting advice and its possible effect on breastfeeding outcomes; whether information considered crucial to the maintenance of breastfeeding was provided by health professionals; and whether mother's autonomy was encouraged following the implementation of antenatal breastfeeding workshops. A structured, self-administered questionnaire was mailed to 550 women who delivered in 1994 approximately one year after the birth of their child. The results obtained were compared to those achieved in a 1991 survey of a similar population. Of the 247 respondents, 33.5% considered they had received conflicting advice, with 18.6% commenting they felt this had negatively influenced how successfully they had breastfed. Three quarters of the women surveyed indicated they received information on the factors considered crucial for the maintenance of lactation. Seventy-eight percent (78%) said they usually or always attached the baby for themselves. Fifty-three percent (53%) of the mothers breastfed for more than six months, and 37.7% were still breastfeeding at 12 months.

Breast Feeding↗

PubMed1999

Functional MRI study of the cognitive generation of affect.

OBJECTIVE: The authors investigated, by whole brain functional magnetic resonance imaging (MRI), the neural substrate underlying processing of emotion-related meanings. METHOD: Six healthy subjects underwent functional MRI while viewing 1) alternating blocks of pairs of pictures and captions evoking negative feelings and the same materials irrelevantly paired to produce less emotion (reference pairs); 2) alternating blocks of picture-caption pairs evoking positive feelings and the same materials irrelevantly paired to produce less emotion; and 3) alternating blocks of picture-caption pairs evoking positive feelings and picture-caption pairs evoking negative feelings. RESULTS: Compared with the reference picture-caption pairs, negative pairs activated the right medial and middle frontal gyri, right anterior cingulate gyrus, and right thalamus. Compared with the reference picture-caption pairs, positive pairs activated the right and left insula, right inferior frontal gyrus, left splenium, and left precuneus. Compared with the negative picture-caption pairs, positive pairs activated the right and left medial frontal gyri, right anterior cingulate gyrus, right precentral gyrus, and left caudate. CONCLUSIONS: Contrasts of both 1) negative and reference picture-caption pairs and 2) positive and negative picture-caption pairs activated networks involving similar areas in the medial frontal gyrus (Brodmann's area 9) and right anterior cingu-late gyrus (areas 24 and 32). The area 9 sites activated are strikingly similar to sites activated in related positron emission tomography experiments. Activation of these same sites by a range of evoked affects, elicited by different methods, is consistent with areas within the medial prefrontal cortex mediating the processing of affect-related meanings, a process common to many forms of emotion production.

Adult↗

PubMed1998

Developing effective interactions to improve breastfeeding outcomes.

The objective of this replicated research was to assess the effectiveness of antenatal Breastfeeding Workshops (Jamieson 1990) in improving breastfeeding outcomes. It was a longitudinal study using a pre-test/post-test design to evaluate any increase in the confidence, skill and knowledge of women and midwives. The research was carried out in the maternity section of a large Tasmanian teaching hospital. Fifty-six midwives who attended the workshops became the research group with 49 non-attendees as the control. Of the 159 women who indicated an interest in attending, 107 who attended formed the research group, and the remaining 52 were used as the control. The paper is in two parts. The first describes responses from midwives. The results show those midwives who attended a workshop perceived an increase in their confidence level in supporting mothers to breastfeed, altered their perception of those factors most important in successful breastfeeding, and acknowledged that updating of breastfeeding knowledge is necessary on an annual basis. The second part analyses breastfeeding outcomes in respondent women. The results show that women who attended the workshops had a significant increase in confidence levels associated with breastfeeding, and were more likely (p < 0.01) to breastfeed for an extended time even though they experienced difficulties.

Breast Feeding↗