Time filter

Source Type

Liverpool, United Kingdom

Gartshore L.,Royal Liverpool Childrens Hospital
British Journal of Oral and Maxillofacial Surgery | Year: 2010

In 1901, René Le Fort conducted some of the most infamous experiments known to maxillofacial surgery. He was an interesting and highly accomplished man with experience in many fields of surgery. We continue to use much of his research today despite many advances in medicine, yet we know little about the man himself.The aim of this short paper is to introduce you to René Le Fort and to describe the highlights of his experiments, which gave rise to a system of classifying facial fractures. © 2009 The British Association of Oral and Maxillofacial Surgeons. Source

Kulkarni A.V.,Hospital for Sick Children | Drake J.M.,Hospital for Sick Children | Kestle J.R.W.,Primary Childrens Medical Center | Mallucci C.L.,Royal Liverpool Childrens Hospital | And 2 more authors.
Neurosurgery | Year: 2010

Background: Endoscopic third ventriculostomy (ETV) has preferentially been offered to patients with more favorable prognostic features compared with shunt. Objective: To use advanced statistical methods to adjust for treatment selection bias to determine whether ETV survival is superior to shunt survival once the bias of patient-related prognostic factors is removed. Methods: An international cohort of children (≤ 19 years of age) with newly diagnosed hydrocephalus treated with ETV (n = 489) or shunt (n = 720) was analyzed. We used propensity score adjustment techniques to account for 2 important patient prognostic factors: age and cause of hydrocephalus. Cox regression survival analysis was performed to compare time-to-treatment failure in an unadjusted model and 3 propensity score-adjusted models, each of which would adjust for the imbalance in prognostic factors. Results: In the unadjusted Cox model, the ETV failure rate was lower than the shunt failure rate from the immediate postoperative phase and became even more favorable with longer duration from surgery. Once patient prognostic factors were corrected for in the 3 adjusted models, however, the early failure rate for ETV was higher than that for shunt. It was only after about 3 months after surgery did the ETV failure rate become lower than the shunt failure rate. CONCLUSIONS: The relative risk of ETV failure is initially higher than that for shunt, but after about 3 months, the relative risk becomes progressively lower for ETV. Therefore, after the early high-risk period of ETV failure, a patient could experience a long-term treatment survival advantage compared with shunt. It might take several years, however, to realize this benefit. © 2010 by the Congress of Neurological Surgeons. Source

Nayagam S.,Royal Liverpool Childrens Hospital | Davis B.,Norfolk and Norwich NHS Foundation Trust | Thevendran G.,Tan Tock Seng Hospital | Roche A.J.,Chelsea and Westminster Hospital NHS Foundation Trust
Bone and Joint Journal | Year: 2014

We describe the technique and results of medial submuscular plating of the femur in paediatric patients and discuss its indications and limitations. Specifically, the technique is used as part of a plate-after-lengthening strategy, where the period of external fixation is reduced and the plate introduced by avoiding direct contact with the lateral entry wounds of the external fixator pins. The technique emphasises that vastus medialis is interposed between the plate and the vascular structures. A total of 16 patients (11 male and five female, mean age 9.6 years (5 to 17)), had medial submuscular plating of the femur. All underwent distraction osteogenesis of the femur with a mean lengthening of 4.99 cm (3.2 to 12) prior to plating. All patients achieved consolidation of the regenerate without deformity. The mean follow-up was 10.5 months (7 to 15) after plating for those with plates still in situ, and 16.3 months (1 to 39) for those who subsequently had their plates removed. None developed a deep infection. In two patients a proximal screw fractured without loss of alignment; one patient sustained a traumatic fracture six months after removal of the plate. Placing the plate on the medial side is advantageous when the external fixator is present on the lateral side, and is biomechanically optimal in the presence of a femoral defect. We conclude that medial femoral submuscular plating is a useful technique for specific indications and can be performed safely with a prior understanding of the regional anatomy. © 2014 The British Editorial Society of Bone & Joint Surgery. Source

Gladman G.,Royal Liverpool Childrens Hospital
Paediatrics and Child Health (United Kingdom) | Year: 2013

Asymptomatic cardiac murmurs are a common finding in paediatric patients with some estimates suggesting that 90% of children have a murmur detected at some stage. Most are benign 'innocent' noises or reflect minor structural heart disease of no haemodynamic significance. The degree of parental anxiety invoked by the detection of a murmur in their child is considerable and although in virtually all cases their concerns of significant underlying cardiac disease are unjustified, providing adequate reassurance is a challenge for the health professionals involved. The aim of this article is to guide practitioners in determining which babies or children need urgent referral for a specialist opinion and to provide management suggestions for when a murmur is noted coincidentally during a routine examination. © 2012. Source

Chai P.F.,University of Malaya | Lee W.S.,University of Malaya | Brown R.M.,Birmingham Childrens Hospital | McPartland J.L.,Royal Liverpool Childrens Hospital | And 2 more authors.
Journal of Pediatric Gastroenterology and Nutrition | Year: 2010

Background: Graft rejection and disease recurrence are well-recognized complications of liver transplantation (LT) for autoimmune hepatitis (AIH) and autoimmune sclerosing cholangitis (AISC). We describe indications and outcome of LT for childhood AIH and AISC. Patients and Methods: Twenty-year retrospective review of a cohort of children (n = 101) with AIH, AISC, or AIH/sclerosing cholangitis overlap syndrome from a single center. Results: AIH type 1 (AIH1, n = 67) was more common than AIH type 2 (AIH2, n = 18), AISC (n = 8), or overlap syndrome (n = 8). Overall, 18 patients (18%) required LT, the indications being failure of medical therapy (n = 16) and fulminant liver failure (n = 2). Patients with AIH who required LT had a more prolonged prothrombin time at presentation compared with those who did not undergo transplantation (P = 0.01). Patients with AIH1 who received LT had a lower aspartate transaminase (P = 0.009) and alanine transaminase (P = 0.02) levels at initial diagnosis compared with those with AIH1 who did not undergo transplantation. Post-LT, 11 patients (61%) had 18 episodes of rejection, most were steroid sensitive. Disease recurrence was observed in 7 patients (39%, median duration post-LT 33 months), more common in AIH2 (80% recurrence rate), and those taking cyclosporine (71%, 5/7 patients) compared with those taking tacrolimus (18%, 2/11 patients; P < 0.05) and in 3 of 3 children who did not have maintenance steroids post-LT. The overall 5- and 7-year post-LT survival rate was 94% and 88%, respectively. Conclusions: LT is a good therapeutic option for progressive AIH and AISC, although recurrence of the primary autoimmune process limits the outcome. Copyright © 2010 by Lippincott Williams & Wilkins. Source

Discover hidden collaborations