PubMed Health⌕ Search

Biomedical subjects

C Coren

Publications and source records attributed to C Coren.

9 recordsLinked to original sources
PubMed1997

Pearls and perils in the management of prolonged, peculiar, penetrating esophageal foreign bodies in children.

BACKGROUND/PURPOSE: Most retained esophageal foreign bodies (FB) are identified soon after ingestion and are easily extracted. A minority of FB ingestions are not identified for weeks to years and present significant problems for retrieval. The purpose of this study was to describe the diagnostic and therapeutic strategies needed to care for children who have chronic esophageal FBs. METHODS: Five children were identified as having retained esophageal FBs 2 months to 2 years after ingestion. During the same 3-year period, 100 children who had acute FBs were identified and had their foreign bodies removed endoscopically. The average age of the children was 3 years (range, 2.4 to 3.5). RESULTS: The average age of the five children identified in this study was 3 years. The items ingested included coins, a heart pendant, a clothespin spring, and a toy soldier. Complications from chronically retained foreign bodies were bronchoesophageal fistula, mediastinitis, esophageal diverticulum, and lobar atelectasis. One patient died from an aortoesophageal fistula. In all children, endoscopic removal was attempted. Barium esophagram was then performed, and foreign bodies were eventually removed via right thoracotomy. CONCLUSIONS: Long-retained esophageal FBs are extremely morbid and life threatening. History most often identifies excess salivation, new onset asthma, and/or recurrent upper respiratory infections. Three diagnostic adjuncts are helpful in identifying the presence of a long retained FB: (1) Chest x-ray (PA and lateral), (2) barium swallow, and (3) esophagoscopy. Indications for thoracotomy for removal of foreign body include (1) Poor endoscopic visualization of FB because of inflammatory tissue and (2) Herald bleeding during endoscopy.

Aorta, Thoracic↗
PubMed1995

Neonatal necrotizing enterocolitis. A 12-year review at a county hospital.

PURPOSE: A retrospective, 12-year review of neonatal necrotizing enterocolitis was undertaken at a county hospital, with emphasis on presentation signs and symptoms. METHODS: Eight-two patients with presence of intramural air were included in the study. The following signs and symptoms were studied: evidence of respiratory distress, use of umbilical catheters, white blood cell count and temperature at presentation, time interval from birth to diagnosis and time interval from diagnosis to operative intervention, presence of intramural air, air in biliary tree or free air, changes in abdominal girth, and presence of occult or gross blood in stools. Comparison was done among infants who had surgical or medical treatment, premature and full-term infants, and infants who had neonatal necrotizing enterocolitis less than or more than 20 days after birth. RESULTS: Eleven patients had a fatal outcome, with an overall survival of 87 percent. Sixty-four patients were treated medically and 18 had operative treatment. Mortality of the surgically treated group was 44 percent. Neonates who had surgical intervention had a left shift of the white blood cell count more commonly present, and all had documented abdominal distention. There were 62 premature and 20 full-term neonates in the group. Full-term neonates developed neonatal necrotizing enterocolitis earlier after birth (5.3 days compared with 15.3 days in the premature neonate group). Full-term neonates had a better prognosis in our series. Presentation of symptoms more than 20 days after birth did not change outcome. CONCLUSION: Our results reflect the experience of a community-based hospital. Clinical acumen remains the cornerstone of diagnosis and management.

Abdomen↗
PubMed1987

Neonatal duodenum: fluid-aided US examination.

In 261 infants with vomiting, 11 duodenal abnormalities were diagnosed with fluid-aided ultrasound (US). These abnormalities included duodenal obstruction, malrotation with and without associated volvulus, incomplete rotation, and duodenal stenosis. US was the initial modality used in the evaluation of vomiting in these neonates and young infants. The overall sensitivity and specificity of fluid-aided US evaluation of duodenal abnormalities were 100% and 99%, respectively. (Workup bias limits the reliability of these figures.) Fluid-aided US examination of the stomach and duodenum provided a dynamic view of duodenal rotation and anatomy, and at the very least provided a method of triaging those infants who may require surgery, upper gastrointestinal series, or follow-up US to make a definitive diagnosis.

Duodenal Obstruction↗
PubMed1987

Congenital malignant melanoma.

A 6-week-old girl with congenital melanoma of the skin is reported and the literature is reviewed. We believe this to be the first case of congenital melanoma in a black infant who had no underlying giant melanocytic nevus. Because of the significant relationship between the early treatment and prognosis of malignant melanoma, we wish to alert pediatric clinicians to the existence of this rare congenital neoplasm.

Black or African American↗
PubMed1985

Hemipelvectomy, a lifesaving operation in severe open pelvic injury in childhood.

Near-complete traumatic hemipelvectomy probably carries an extremely high mortality rate. The usual techniques which have been used to control major hemorrhage associated with pelvic fractures such as transperitoneal vascular ligation, intra-arterial embolization, and packing are not applicable (14). Successful management requires prompt recognition of the nature of this injury so that surgical efforts may be directed at resuscitation and expeditious operative completion of the traumatic amputation. When this decision is made appropriately, the dual goals of control of hemorrhage and prevention of sepsis can be achieved. We report the management of a 7-year-old boy who sustained this injury after being struck by a tractor-trailer. In spite of massive resuscitation, hemorrhage could not be controlled and the child remained in shock. When it was recognized that he had sustained an incomplete traumatic left hemipelvectomy, it was surgically completed, permitting prompt control of the hemorrhage and restoration of hemodynamic stability. Intestinal and urinary diversion allowed an uneventful postoperative recovery without significant infection. Although hemipelvectomy appears to be a radical procedure in children with major pelvic injuries, it may be lifesaving and should therefore be considered in those with severe unilateral pelvic injury and uncontrollable hemorrhage. The potential for physical rehabilitation in the group of young, mostly male patients who have survived this injury appears to be unexpectedly good.

Accidents, Traffic↗
PubMedDate not supplied

Oral congenital cystic choristomas: a case report.

Solitary choristomas containing gastrointestinal mucosa occur rarely in the tongue and the oral mucosa and usually present as an asymptomatic mass. This report documents the occurrence of two congenital intraoral cystic choristomas in a 5-month-old male infant. The cysts were located on the dorsum of the base of the tongue and left floor of mouth anterior to the lingual cyst. Both cysts were lined by nonkeratinizing squamous epithelium and gastric, intestinal, and respiratory epithelium. The cysts were excised by an oral approach.

Choristoma↗