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Biomedical subjects

D A Stringer

Publications and source records attributed to D A Stringer.

At least 55 records · Page 3Linked to original sources
PubMed1989

Lavage treatment of distal intestinal obstruction syndrome in children with cystic fibrosis.

The efficacy, adverse reactions, and long-term effects of intestinal lavage treatment with a balanced electrolyte solution (Golytely) was evaluated in patients with cystic fibrosis and distal intestinal obstruction syndrome. Twenty-two patients with cystic fibrosis (mean age 21.8 years, range 14 to 34 years, 15 boys or men) who sought medical attention because of abdominal pain and a mass in the right iliac fossa received Golytely, 5.6 +/- 1.9 L (mean +/- 1 SD), either orally (n = 14) or via nasogastric tube (n = 8) during 5.6 +/- 2.4 hours. No serious side effects occurred. Serum electrolyte values remained within normal limits. Body weight did not change significantly. Minor adverse reactions included bloating (n = 12), nausea (n = 8), vomiting (n = 1), and chills (n = 3). All but one patient reported impressive relief of symptoms and remained pain free for an average of 3 months (range 1 to 19 months). Symptoms of abdominal pain and radiologic signs of fecal impaction assessed before and after lavage both decreased significantly (P less than .0001). During follow-up (mean 15.2 months, range 4 to 26 months), 11 patients required a total of 38 (range one to nine) additional doses of Golytely. Seven patients drank the solution at home (21 treatments); only two patients chose a nasogastric tube. In ten patients with symptoms of recurrent distal intestinal obstruction syndrome prior to institution of therapy, duration of hospitalization was significantly reduced by this treatment (5.1 +/- 7.6 v 2.3 +/- 6.3 hospital days per annum, P less than .02).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1989

Diagnosis of Legionella lung abscess by percutaneous needle aspiration.

Pneumonia is a life-threatening infection of immunocompromised patients, and accurate identification of the causative agent is essential for early initiation of appropriate antibiotic therapy. Percutaneous needle aspiration was used to identify Legionella pneumonia after sputum and bronchoscopy specimens had failed to provide a diagnosis in a 13-year-old leukemic patient with a lung abscess. We believe this is the first report of a child with this disease diagnosed in this way.

Adolescent↗
PubMed1988

Childhood diaphragmatic hernias presenting after the neonatal period.

Twenty-six patients with Bochdalek hernias and 15 with Morgagni hernias were evaluated in a survey of children presenting over the age of 8 weeks during a 20 year period. Ten of the children had previously normal chest radiographs. Radiological assessment at presentation was incorrect with 15 Bochdalek and two Morgagni hernias. These errors were more common in interpretations by general radiologists. Inappropriate thoracocentesis had been performed in four cases misdiagnosed as pneumothoraces. Barium studies, fluoroscopy, erect views and plain radiographs after nasogastric intubation were helpful investigations. Post-operative evidence of lobar collapse and pulmonary hypoplasia was frequently not appreciated at the time of clinical and radiological follow-up. Other congenital anomalies were commonly seen, particularly with Morgagni hernias. Bowel malfixation and malrotation, an important association, was frequently present but was occasionally overlooked at operation, necessitating further surgery for bowel obstruction.

Child↗
PubMed1988

John Caffey Award. Intussusception reduction in children by rectal insufflation of air.

Air was used as the contrast medium for colonic studies in 282 patients with suspected intussusception. Intussusception was documented in 118 of these patients (42%), and reduction was achieved in 89 (75%) of those 118. Twenty-nine patients, in whom the intussusception could not be reduced with air, underwent surgery. Seven of these patients required surgical resection of devitalized bowel. In seven others, the intussusception was reduced by the surgeon with difficulty; in 12, surgical reduction was achieved easily. Three perforations occurred with the use of air. These patients were treated surgically without sequelae. This pilot study of 282 patients suggests that air is a safe substitute for hydrostatic reduction of intussusception.

Administration, Rectal↗
PubMed1988

The association of cystic fibrosis, gastroesophageal reflux, and reduced pulmonary function.

Between 1971 and 1984, 57 patients with cystic fibrosis (CF) and clinically suspected gastroesophageal reflux (GER) underwent a barium-meal examination and routine pulmonary function testing. Reflux was demonstrated in 18 patients; in six of these it was complicated by hiatus hernia, esophagitis, or stricture formation. Compared with 412 CF patients without known GER, the 18 patients with demonstrable reflux had significantly reduced forced expiratory volume and forced vital capacity. GER should be looked for carefully on any barium-meal study in patients with CF; these patients have an increased incidence of reflux, with its implications for lung function, and are not good candidates for surgical intervention.

Adolescent↗
PubMed1988

Real-time sonography of mediastinal and juxtamediastinal masses in infants and children.

Real-time sonography was used to evaluate 10 patients (age range, 2 days to 10 years) with mediastinal and juxtamediastinal masses. Seven of these also had computed tomography (CT). In eight patients sonography provided sufficient information with regard to probable diagnosis and adequate clinical management. CT was more helpful in two older children with postoperative seromas. Sonography is recommended as the imaging method of choice in neonates and in infants whose chest radiographs show mediastinal or juxtamediastinal masses. CT should be reserved for complex cases, and is of more value in older children.

Bronchopulmonary Sequestration↗
PubMed1988

Peptic ulcer disease in children: etiology, clinical findings, and clinical course.

The records of all children with peptic ulcer disease at the Hospital for Sick Children were retrospectively evaluated, excluding neonates, throughout a 5-year period. Only cases with a definite ulcer crater identified either at endoscopy or at surgery were included. There were 36 patients, 20 boys and 16 girls. Duodenal ulcers were more common than gastric ulcers (2.8:1). Ages ranged from 3 months to 17 years, with a mean age of 10 years. Patients were reviewed with respect to etiology of peptic ulcer disease, age when first examined, initial symptoms, and clinical course. Patients were divided into two groups, those with primary (n = 19) and those with secondary (n = 17) peptic ulcer disease. All peptic ulcers in patients younger than 10 years of age were secondary in nature. Secondary ulcers occurred generally in association with a severe underlying illness (11/17), and many ulcers necessitated emergency surgery because of perforation and/or severe hemorrhage (8/17). None of these patients had chronic or recurrent symptoms. In contrast, in children with primary peptic ulcer disease, initial symptoms were more benign. Most patients had abdominal pain and only one required emergency surgery. Children with primary duodenal ulcer disease had a high incidence of recurrent symptoms (67%), however, with surgery for intractable disease necessitated in 40%. Single-contrast barium meals were found to be unreliable in establishing a diagnosis of peptic ulcer disease, particularly cases of gastric ulcer disease.

Acute Disease↗
PubMed1987

Interposition of the gallbladder--or the absent common hepatic duct and cystic duct.

Interposition of the gallbladder is a rare anomaly, but its diagnosis is important since it represents a surgically correctable cause of jaundice. The patients present with jaundice, abdominal pain and sometimes an enlarged gallbladder. Radiological diagnosis may be difficult since the condition may be mistaken for a choledochal cyst, hydrops of the gallbladder or Caroli's disease. The ultrasound, cholangiogram and surgical findings of dilated intrahepatic ducts adjacent to a normal or enlarged gallbladder with no dilatation of the common bile duct are presented in two children with this condition.

Child, Preschool↗
PubMed1987

Velopharyngeal insufficiency due to hypertrophic tonsils. A report of two cases.

Two children in whom idiopathic hypernasality was diagnosed were referred for investigation of velopharyngeal function. Multiview videofluoroscopic assessments showed the tonsils prolapsing posteriorly during speech, preventing the palate from fully approximating the posterior pharyngeal wall. Tonsillectomy was recommended. Postoperative evaluations found that the hypernasal resonance was eliminated in both children.

Child↗
PubMed1987

Abnormal carotid arteries in the velocardiofacial syndrome: a report of three cases.

Internal carotid arteries of unusual size and tortuosity were found before or at the time of pharyngeal flap surgery in three children who had the velocardiofacial syndrome with velopharyngeal insufficiency. In two cases, medial displacement of the arteries prevented surgery, and in the other, hypernasality persisted because only a narrow, asymmetrical flap could be raised. Medial displacement of the internal carotid arteries inhibits surgical treatment of velopharyngeal insufficiency, necessitating treatment with a prosthetic speech device in such children. Since displacement and tortuosity may be associated findings in the velocardiofacial syndrome, the exact location of the internal carotids should be ascertained when pharyngeal flap surgery is planned.

Abnormalities, Multiple↗
PubMed1987

Lymphoid follicular pattern in the colon: an indicator of barium coating.

A lymphoid follicular pattern was noted more frequently when high-density (100% w/v) replaced low-density (58% w/v) barium in children undergoing double-contrast barium enema examinations. Therefore, a retrospective study was undertaken to compare the presence of follicles seen in 24 consecutive patients under 10 years old given low-density barium with that of 50 patients given high-density barium. The high-density studies revealed follicles in 90% of the children compared with 46% of the children having low-density studies. All follicles were less than 2 mm in diameter. An aphthoid appearance was present in nine of these 50 children. The most common indications for the high-density examination were rectal bleeding and abdominal pain. The final diagnosis was normal bowel in more than two thirds; no child under six years old given high-density barium had inflammatory bowel disease. There was no correlation between final clinical diagnosis and the presence, extent, or severity of the lymphoid follicular pattern.

Barium Sulfate↗
PubMed1987

Imaging inflammatory bowel disease in the pediatric patient.

Idiopathic inflammatory bowel disease in childhood was once considered rare but is now being increasingly recognized. Although ulcerative colitis and Crohn's disease, the two most common types, have some features in common with the adult form, in all of these diseases the differential diagnoses, presentation, and therapy differ in many important ways from those in adults. Infants are also susceptible to diseases not seen in older children. These differences and the often extremely young age of the patient markedly affect the choice and performance of diagnostic imaging techniques. These techniques have to be modeled more to the individual's requirements than in adults, and infants need a different approach even from older children.

Adolescent↗
PubMed1986

Treatment of distal intestinal obstruction syndrome in cystic fibrosis with a balanced intestinal lavage solution.

Conventional treatment of distal intestinal obstruction syndrome (DIOS) with high doses of pancreatic enzymes, mucolytic agents, and enemas is neither predictably effective nor rapid in action. In 6 cystic fibrosis patients with DIOS a balanced, non-absorbable intestinal lavage solution produced clinical and radiological improvement and striking improvement in DIOS scores. It is suggested that a balanced intestinal lavage solution should be considered as an alternative treatment for DIOS in patients with cystic fibrosis.

Adolescent↗
PubMed1986

Behçet's syndrome involving the gastrointestinal tract--a diagnostic dilemma in childhood.

Behçet's syndrome is very rare in children, especially those under 10 years of age. Clinical and radiological features are described in 4 children, including 2 under the age of 5 years, with the syndrome. As in other pediatric cases reported, the incomplete form of Behçet's syndrome was present in each case. All 4 patients had oral and genital mucosal effects, arthritis and gastrointestinal and dermatological manifestations. Ophthalmological symptoms occurred in only 1 patient. Radiologically, the 4 cases demonstrated the spectrum of gastrointestinal involvement, from minimal irregularity and thickening of the terminal ileum to gross irregularity and deformity of the terminal ileum and cecum. Because of the difficulty in differentiating Behçet's syndrome from other forms of inflammatory bowel disease it is suggested that in children with gastrointestinal involvement, 3 major criteria be present before the diagnosis of Behçet's syndrome is made.

Adult↗
PubMed1986

Correlation of double-contrast high-density barium enema, colonoscopy, and histology in children with special attention to disparities.

Colonoscopic and double-contrast high-density barium enema (DCBE) findings were correlated in 68 patients (39 boys and 29 girls) aged 6 months to 18 years (mean 11.6 years) evaluated over a 24-month period. There was excellent correlation in 53 patients (78.0%) and good correlation in another 3 (4.4%) who had identical diagnoses and only slightly differing extent of disease reported. In 2 of these, DCBE showed more extensive disease, confirmed histologically in 1. Distal colitis seen on colonoscopy as reddening and neovascularity was missed on DCBE in 6 patients. Colonoscopy and DCBE failed to show a polyp in 1 patient each. One patient who had a normal DCBE and colonoscopy demonstrated a histological abnormality, and 1 patient with an abnormality on histology and DCBE was normal on colonoscopy. A disparity resulted from the time between procedures in 1 patient and observer error in another. This high correlation is far better than any previously reported in children, supporting the use of high-density barium sulfate and double-contrast barium enemas in pediatric patients.

Adolescent↗
PubMed1986

Congenital hepatic fibrosis with saccular dilatation of intrahepatic bile ducts and infantile polycystic kidneys.

A case report is presented of a child who died in the neonatal period and who had the sonographic findings of multiple, tubular, fluid-filled spaces in the liver characteristic of Caroli's disease. There was an echodense renal cortex and pyramids. Necropsy findings were consistent with Caroli's disease but the liver also showed evidence of congenital hepatic fibrosis and there was infantile type polycystic disease of the kidneys.

Bile Duct Diseases↗