ORCID Profile
0000-0003-0856-783X
Current Organisations
University of Western Australia
,
University of Sydney
,
Royal Australasian College of Surgeons
,
Curtin University
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Publisher: Springer Science and Business Media LLC
Date: 08-05-2007
DOI: 10.1007/S00383-007-1928-4
Abstract: Integra has been shown to be very useful in accelerating the growth of neodermis. It has found extensive use in case of burns as a primary dressing immediately after a burn, after release of contractures and following scar revision. It has been used to achieve cover after the debridement of extensive infective processes involving the skin. Encouraged by these results we have assessed the application of Integra to augment and/or patch defects of the urinary bladder, diaphragm and the abdominal wall in the rat model. This was a pilot study and involved the incorporation of Integra in the diaphragm, the urinary bladder (extramucosal) and the muscle layer of the abdominal wall. Eight adult Wistar rats were given general anaesthesia and Integra was implanted with absorbable sutures at the sites mentioned. The omentum was hitched to the collagen matrix surface to revascularise the graft. The silicone was left in situ. The operative period was covered with antibiotics. The anaesthesia was then reversed. Postoperatively the rats were given analgesia and feeds started immediately. The rats were sacrificed after 3 weeks. The abdominal cavity was examined for adhesions. The Integra implant along with adjacent tissue was harvested and examined histologically. There were no visible intra-abdominal adhesions. The histology revealed good degree of neovascularisation and fibrosis in and adjacent to the implant. This was comparable to the changes seen in the skin. This pilot study has shown that implanting Integra invokes a similar response in deeper tissues and it can develop neovascularisation from the omentum. Hence, this could find some application in treating congenital conditions such as diaphragmatic hernias, abdominal wall defects and for bladders requiring augmentation. Our initial results are quite encouraging and we feel that this field should be further explored.
Publisher: Georg Thieme Verlag KG
Date: 19-02-2010
Abstract: Foetal dilated or echogenic bowel have been described as markers for a variety of conditions including bowel obstruction, chromosomal and infectious disorders and cystic fibrosis. We aim to describe possible surgical interventions and outcomes. A 5-year review was performed of the clinical course of infants with antenatally diagnosed isolated echogenic bowel and/or dilated bowel or intraabdominal echogenic foci presenting at Princess Margaret Hospital for Children, Perth, Western Australia. Abnormal antenatal findings were present in 35 foetuses. Twelve babies underwent surgery for intestinal atresia, meconium ileus and duplication cysts. Postoperative courses and outcomes were good. Echogenic bowel on antenatal ultrasound is a non-specific marker for a variety of disorders. Although associated with higher rates of foetal loss, the majority of neonates are normal at delivery. Bowel dilatation with or without echogenicity is often predictive of bowel obstruction requiring surgery. Surgical outcomes are, however, very good. Echogenic foci elsewhere in the abdomen have little postnatal significance.
Publisher: Elsevier BV
Date: 10-2005
DOI: 10.1016/J.JPEDSURG.2005.06.019
Abstract: Primary sternal osteomyelitis is rare in the pediatric population. We present 4 recent cases that demonstrate a wide range in age, presenting features, and clinical course, and we performed a literature review. A combination of diagnostic aspiration with prolonged appropriate antibiotic therapy led to successful resolution in all cases. Surgical debridement should be reserved for cases that do not respond to medical therapy. Sternal osteomyelitis is a rare condition in children that usually resolves with aspiration and prolonged antibiotic therapy.
Publisher: Elsevier BV
Date: 09-1995
DOI: 10.1016/0022-3468(95)90485-9
Abstract: Intralesional bleomycin injection was used as sclerosant therapy for sixteen patients with cystic hygroma. An excellent (complete clinical resolution) response was obtained in seven (44%) patients, a good (> 50% response) result in seven (44%), and a poor or no response in two (12%). Minor transient side effects (fever, vomiting, cellulitis, skin discoloration) were seen in six patients, and there were no serious side effects. The results suggest that bleomycin intralesional sclerosant is effective therapy for cystic hygroma, with response rates comparable to those of surgical removal, but with the advantage of avoiding inadvertent nerve damage and scarring.
Publisher: Springer Science and Business Media LLC
Date: 24-11-2000
Abstract: The twin incidence is higher in infants with oesophageal atresia (OA) than in the general population. The purpose of this study was to review the twin OA information from five institutions and evaluate possible links between the development of OA and the twinning process. Data were compared, combined, and analysed. There was a total of 1,215 infants with OA, of whom 50 were from a twin pregnancy and 1 from a triplet pregnancy. Two sets of twins were concordant for OA. Mean birth weights and gestational ages were lower in the twin infants (P < 0.0005) and survival was lower in twins (65%, P < 0.005) than singletons. The anatomical variant of pure OA without fistula was seen in proportionally fewer twins (4%) than in singletons (7%). Multiple anomalies were present in 40% of twins compared with 33% of singletons, although this did not reach statistical significance. OA in our multicentre population was more common in twins. Several possible mechanisms are put forward to explain the apparent link between twinning and OA. Further analysis of this aspect of OA may aid in understanding the aetiology of this congenital anomaly.
Publisher: Elsevier BV
Date: 08-2006
DOI: 10.1016/J.JPUROL.2006.05.007
Abstract: Posterior urethral valves are the main cause of bladder outflow obstruction in human fetuses. Thirty per cent of boys with valves develop end-stage renal disease, despite intervention in the postnatal period. The timing and mechanisms of renal damage in bladder outflow obstruction are unknown. We investigated the timing of changes in morphology and apoptosis in the fetal sheep kidney in response to obstruction. Thirty-three fetal lambs at day 70 of gestation underwent surgical creation of bladder outflow obstruction. Twenty-nine fetal lambs had sham surgery. Fetal kidneys were collected 2, 5, 10, 20 and 30 days after surgery. Renal histology was examined. Real-time PCR was used to quantify the renal cortical expression of the pro-apoptotic gene Bax and anti-apoptotic gene Bcl-X. The TUNEL technique was used to assess regional renal apoptosis in response to obstruction. Changes in renal morphology were evident as early as 2 days after surgery in fetuses with bladder outflow obstruction, and progressed over 20-30 days to cystic renal dysplasia. Bladder outflow obstruction increased the renal cortical expression of Bax relative to Bcl-X. Tubular apoptosis peaked after 2 days of obstruction. Blastemal apoptosis peaked after 5 days of obstruction. Changes in pro- and anti-apoptotic gene expression in the fetal renal cortex, and alterations in the number of apoptotic cells and renal morphology are evident soon after the onset of bladder outflow obstruction. These findings suggest that damage to the developing fetal kidney begins to occur at the onset of obstruction. Attempts to preserve renal function by antenatal interventions may best be achieved by early treatment.
Publisher: Springer Science and Business Media LLC
Date: 09-2003
DOI: 10.1007/S00383-002-0936-7
Abstract: Since the human appendix testis is a Mullerian duct derivative it has been theorised that rising oestrogen levels in puberty result in enlargement of this organ and consequent predisposition to torsion. This study sought to establish the presence or absence of both androgen and oestrogen receptors in the human appendix testis. Bilateral appendix testis specimens surgically excised from ten patients undergoing scrotal exploration for acute scrotum were stained immunohistochemically for androgen and oestrogen receptors. These were examined by light microscopy. The human appendix testis was found to express both oestrogen and androgen receptors. Marked regional variation of androgen and oestrogen receptor positivity was demonstrated. The surface epithelium and some stromal cells were androgen receptor positive, whereas oestrogen receptors were confined to ductular invaginations, gland-like structures and some stromal cells. Rising levels of androgens and oestrogens in pubertal boys may account for enlargement and the predisposition of the human appendix testis for torsion since this structure contains receptors for both.
Publisher: Oxford University Press (OUP)
Date: 08-1993
Abstract: A study of surgery for breast cancer was performed to examine the influence of haematoma formation and radiotherapy on the development of mammographically detected scars. Fifty-nine women undergoing lumpectomy and radiotherapy were studied. Sixteen had mammographic scars 12 months after surgery. There was a correlation between postoperative haematoma formation and scarring (P = 0·03) but not between tumour size and scarring. The type of radiation therapy did not influence scar formation.
Publisher: Elsevier BV
Date: 07-2001
Abstract: There is no universally accepted theory to explain esophageal embryology and the abnormal development that produces esophageal atresia. The impact of Adriamycin administration on the pathogenesis of esophageal atresia was studied in the rat model of VATER association, from embryonic day (ED) 10 to ED 13. Tissues in the ED10 Adriamycin-exposed embryos displayed less cell proliferation as shown by the reduced population of MIB-5-labelled cells. Cell apoptosis that is characteristic of the normal ED 12 lateral epithelial folds of the foregut (the prospective site of tracheoesophageal septation) was absent in the foregut of the Adriamycin-exposed embryo. Histologic examination of the ED 11-exposed embryo showed the presence of abnormal notochord that was stretched, split, or tethered to the foregut. This contrasts with the normal embryo in which the notochord was localized in close vicinity of the ventral part of the neural tube and separated from the foregut by le amount of mesenchyme. The abnormal localization of the notochord was accompanied by the lack of down-regulation of the sonic hedgehog (Shh) activity in the prospective site of future tracheoesophageal separation in the exposed ED 12 embryo. The authors proposed that the ectopic location of the notochord leads to the disruption in Shh signalling that may underpin the development of esophageal atresia.
Publisher: Georg Thieme Verlag KG
Date: 11-02-2009
Publisher: Springer Science and Business Media LLC
Date: 03-11-2009
DOI: 10.1007/S00383-009-2521-9
Abstract: We present our experience with an experimental urinary bladder auto augmentation model using SURGISIS and INTEGRA (collagen layer) in comparison with seromuscular enterocystoplasty. The aim of the study was to evaluate the change in compliance and elasticity of the urinary bladder. Eighteen lambs were ided into three different groups. Auto augmentation was performed using the seromuscular layer of small bowel, SURGISIS or the collagen layer of INTEGRA. After 3 months of the initial procedure, the lambs were re-operated, the bladder compliance was measured and the urinary bladder was submitted for histological examination and assessment of elasticity. The lambs were euthanized. The postoperative period was uneventful in 17 lambs except for intestinal obstruction in one lamb from the seromuscular enterocystoplasty group. A statistically significant difference in compliance was observed with SURGISIS and the INTEGRA. Histologically, there was neovascularization in all the specimens from the SURGISIS and INTEGRA groups with the presence of fibrosis in the SURGISIS group. The INTEGRA group showed better elastic properties than the SURGISIS. Urinary bladder auto augmentation using the collagen layer of INTEGRA showed better functional and histological results when compared with SURGISIS and demucosalized enterocystoplasty in the present model.
Publisher: Springer Science and Business Media LLC
Date: 18-05-2004
DOI: 10.1007/S00383-004-1163-1
Abstract: Oesophageal atresia management has evolved alongside the development of paediatric surgery. An analysis of a 30-year prospective collection of oesophageal atresia cases treated at the Royal Alexandra Hospital for Children, NSW, Australia is presented. There has been a dramatic change in the surgical approach. Fewer infants are undergoing operations of cervical oesophagostomy, gastrostomy and oesophageal replacement. More, including fragile infants, are surviving with a repaired native oesophagus. Fewer infants are suffering morbidity secondary to anastomotic leak. The progression in treatment has been enabled by improved neonatal support due to advances in neonatology, neonatal anaesthesia, nutritional support and antimicrobial therapy. Oesophageal atresia treatment and outcome has changed markedly over three decades. Cooperative multi-centre database development is now required to provide data in order to further refine treatment for clinical challenges that remain.
Publisher: Elsevier BV
Date: 03-1999
DOI: 10.1016/S0022-3468(99)90484-0
Abstract: The aim of this study was to reproduce the animal model of esophageal atresia and the VATER association. The purpose was a dose response analysis of Adriamycin teratogenicity in the rat and comparison of these anomalies with the human VATER association. Twenty time-mated Sprague-Dawley rats received intraperitoneal Adriamycin (dose range, 0 to 2.5 mg/kg/d) for 4 consecutive gestational days E6 to E9. The embryos were harvested on day E21, inspected, weighed, and dissected with a binocular dissecting microscope. Statistical analysis was performed with exact chi2. Threshold doses of 1.25 and 1.5 mg/kg/d Adriamycin produced renal and gastrointestinal anomalies, respectively (exact chi2, P < .00001). In doses below 1.25 mg/kg/d Adriamycin, no anomalies were seen, and in above-threshold doses, the frequency of anomalies rose sharply as the dose increased. At 2.25 mg/kg/d of Adriamycin all embryos were abnormal, and Adriamycin at 2.5 mg/kg/d led to resorption of all embryos. Adriamycin induced esophageal atresia, and VATER in the rat is a reproducible model that has many similarities to the VATER anomalies in the human. There is a relationship between dose and the frequency as well as severity of anomalies. Further studies of this model are likely to provide information relevant to the understanding of this human congenital disease.
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