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D Wilson-Storey

Publications and source records attributed to D Wilson-Storey.

At least 19 recordsLinked to original sources
PubMed2004

Early appendicitis--a safe diagnosis?

INTRODUCTION: Serosal inflammation of the appendix in association with a significant peritoneal exudate can be mistaken for early acute appendicitis. We highlight the importance of looking for other sources of intra-abdominal sepsis in this clinical setting. CLINICAL PICTURE: We present 3 cases of so-called "mild" appendicitis with serosal inflammation that was ultimately shown to be caused by Meckel's diverticulitis. TREATMENT: All 3 patients initially underwent an appendicectomy. In 2 of these cases, a further laparotomy and excision of a Meckel's diverticulum was carried out. All 3 made an uneventful recovery. CONCLUSION: Meckel's diverticulitis can mimic acute appendicitis in clinical history, physical findings and operative findings. It is important to always consider this as a possible cause for an acute abdomen.

Abdominal Pain↗
PubMed2003

Troubles with the foreskin: one hundred consecutive referrals to paediatric surgeons.

To assess the reasons for and outcomes of referrals concerning the foreskin, 100 consecutive patients seen in paediatric clinics were followed to discharge. 18 referrals were for circumcision on religious grounds. Of the other 82, the main reason for referral was non-retractability or phimosis. At clinic, 24 (29%) of these were deemed normal for age, 31 (38%) were treated with topical steroid (successfully in 25), 9 (11%) were listed for preputioplasty, 7 (9%) were listed for adhesiolysis, 7 (9%) were listed for circumcision, and 4 were listed for other forms of surgery. 6 patients were identified as having balanitis xerotica obliterans (BXO), a condition that had not been suggested on referral. With the advent of new treatments for foreskin disorders, circumcision is decreasingly necessary. Knowledge of the natural history of the foreskin, and the use of topical steroids, could shift the management of paediatric foreskin problems from the hospital outpatient department to primary care. BXO is not sufficiently recognized as a form of phimosis that requires operation.

Administration, Topical↗
PubMed1996

Ante-natal testicular torsion: only one cause of the testicular regression syndrome?

It has been suggested that the most likely cause of the Testicular Regression Syndrome (TRS) is ante-natal torsion of the testis. As testicular torsion is twice as common on the left this theory cannot explain the incidence of right sided or bilateral cases. From a 5-year retrospective surgical and pathological review, we confirmed that the left testis was the most commonly affected, that boys with TRS tended to be delivered closer to term, and that frequently both testes were present at birth, but one or both subsequently vanished. We also found that direct trauma can produce histological findings indistinguishable from TRS. Close to term, fetal testes are liable to be intrascrotal and therefore susceptible to direct trauma. As the left testis descends into the scrotum at an earlier stage than the right, it is therefore at greater risk of injury. Since the findings of TRS can be produced by direct trauma, we suggest that intra-partum trauma may predispose to the TRS.

Child, Preschool↗
PubMed1996

Just a 'wee prick' with a needle.

Difficulty with vascular access is a common problem in neonatal medicine and surgery. Recent advances in parenteral therapy/nutrition and manufacture of high quality intravenous lines have enabled smaller infants to survive. Thus, in the small surgical neonate, the insertion of an indwelling intravenous long line (either percutaneously or at cut down) is a frequent occurrence. This procedure is not without its complications and it is thus necessary for the clinician inserting these lines to be aware of this and fully understand the regional anatomy of the area being used. I wish to report an unusual complication which posed several diagnostic and management problems.

Catheterization, Central Venous↗
PubMed1995

Children's femoral fractures: the Edinburgh experience.

Femoral fracture is a relatively common cause of trauma admission to the paediatric surgical services in Edinburgh. Our current policy is to use gallows traction for babies and infants under 2 years and external Liston splintage with straight leg balanced skin traction for older children followed by either early mobilization or the application of a hip spica or cast brace. We reviewed the use of this management protocol over a 10-year period (323 cases) in order to assess its value and complications. A prospective study was made of 143-patients between 5 and 10 years after their fracture to assess residual disability. We found our management protocol to be a simple, highly reliable method of treatment with a minimum of complications or long-term disability.

Adolescent↗
PubMed1992

The laparoscope and the undescended testis.

An empty scrotum with an impalpable testis/testes presents a difficult diagnostic and therapeutic problem. Many methods have been used in an attempt at, or as an aid to, the localization of these gonads including venography, ultrasonography, hormone manipulation, and surgical exploration. Laparoscopy has been recommended as an aid to diagnosis. We reviewed our experience with the laparoscope in the diagnosis and management of this problem over a 7-year period. Laparoscopy permitted planning of the approach to orchidopexy, depending on whether the vessels entered the deep inguinal ring. In the latter group 48% of the testes were found to be atrophic. We also found the laparoscope to be of value in performing the first stage of the Fowler-Stephens long loop vas orchidopexy in three cases, with long-term viability of the testes in two of these.

Adolescent↗
PubMed1992

Transitional cell papillary bladder neoplasm in a girl: an unusual presentation.

An 8-year-old girl presented with the clinical features of acute appendicitis. The removed appendix was normal but the abdominal pain persisted. There were no urinary symptoms and bacteriological examination of the urine was negative. An ultrasound scan showed an intravesical tumor that was subsequently excised. Histology showed a grade 1 transitional cell papillary bladder carcinoma of low grade malignancy. All previously reported cases have presented with urinary tract symptoms, usually hematuria.

Acute Disease↗
PubMed1990

Microbiological studies of the enterocolitis of Hirschsprung's disease.

The results of a prospective study of 20 cases of newly diagnosed Hirschsprung's disease (nine of whom developed enterocolitis) and 10 normal controls showed no variations in the bacterial flora (including Clostridium difficile) in the stools of the groups studied. Viral studies showed that rotavirus was present in the stools of seven of the nine cases of enterocolitis during the episode. We suggest that Hirschsprung's enterocolitis may have a complex infective aetiology and that rotavirus plays a part.

Bacteria↗
PubMed1990

Urethral valves--treatment, results and urodynamic assessment.

Posterior urethral valves is an uncommon condition, but it poses many diagnostic and therapeutic problems. Long term follow up of these patients revealed that the majority of these boys have long term problems. In depth assessment of 10 boys with this problem revealed that their upper urinary tracts remained stable whereas urodynamic studies showed gross micturition abnormalities. Most methods of assessing the urinary tracts in these boys are invasive (eg. Intravenous urography, micturating cystography) and may indeed show no change in upper tract radiology despite marked abnormalities of micturition detected by urodynamics and which may require further investigation and treatment. We therefore recommend regular urodynamic assessment of these boys as it is accurate and initially non-invasive. Those boys with a detectable abnormality can progress to further studies.

Child↗
PubMed1990

Orchidopexy: the younger the better?

The optimum age for orchidopexy in childhood remains controversial. Many believe that it should be performed before the child's second birthday, when irreversible changes occur in testicular morphology. Others have shown an increase in the risk of damage to the spermatic cord structures in early operation, resulting in gonadal atrophy. We reviewed 200 patients: 100 had had orchidopexy before and 100 after their second birthday. From the case records and from long-term review, we found that 5% of the testes in each group became atrophic. Some testes, which were 'normal' at the 6-month review, had subsequently failed to increase in size, whereas some which were initially diagnosed as 'atrophic' had grown, by long-term follow-up to a similar, normal size compared with the contralateral organ. In the older group, we also found that 19 testes that had previously been diagnosed as having descended normally had ascended subsequently.

Adolescent↗
PubMed1989

Impaired gastrointestinal mucosal defense in Hirschsprung's disease: a clue to the pathogenesis of enterocolitis?

Twelve patients with Hirschsprung's disease were studied to investigate why some children develop enterocolitis. Previous studies have failed to explain this adequately; they have also failed to explain why enterocolitis can occur many years after definitive surgery. Six of the 12 patients had enterocolitis. By assessing immunological mucosal defense, it was shown that these patients had a marked deficiency in transfer of secretory IgA across the gastrointestinal mucosal cell, and thus were prone to mucosal invasion of both pathogenic and commensal organisms. The abnormalities were detected upon initial investigation (at presentation) prior to the onset of enterocolitis, and persisted into later life. The significance of these findings with reference to predicting which children are prone to develop enterocolitis and their long-term susceptibility to recurrence are discussed.

Digestive System↗
PubMed1989

An unusual 'appendix' testis.

A six-week-old infant was seen with bilateral inguinal herniae. It was noted that the position of the right testis within the scrotum varied with the degree of inguinal herniation. At exploration the appendix was found lying within the patent processus vaginalis with its tip firmly adherent to the upper pole of the right testis. Appendicectomy was performed through the same incision. This unusual finding should be considered by the clinician if presented with a child with easily reducible inguinal herniae and a fluctuating testicular position.

Appendectomy↗
PubMed1987

Scrotal swellings in the under 5s.

Scrotal swelling is a common cause of referral to the paediatric surgical services in Edinburgh, constituting 12% of total admissions. Of these, 2818 (65%) were in boys under the age of 5 years, with a wide variety, including inguinal hernias, hydroceles, testicular torsion, tumours, and some interesting but uncommon conditions. A retrospective study was performed over a 12 year period to assess the incidence, aetiology, mode of presentation, disease, and management of scrotal swellings in boys under 5. Although most of the causes of these swellings were easily elucidated from a history and clinical examination, it was apparent that a high level of suspicion was also necessary to ensure that more serious problems did not go undetected.

Child, Preschool↗