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Biomedical subjects

G Stringel

Publications and source records attributed to G Stringel.

31 records · Page 2Linked to original sources
PubMed1985

Delay in diagnosing gastrointestinal injury after blunt abdominal trauma in children.

Intestinal perforation after blunt abdominal trauma in children is rare and thus the diagnosis may be delayed. For this reason the authors reviewed their experience with 12 children to recommend a protocol for investigation that would reduce the delay in diagnosis. Of the 12 perforations, 2 were gastric, 2 duodenal, 7 jejunal and 1 colonic. The diagnosis of jejunal perforation, in particular, was usually delayed because free air was not seen radiologically in the first few hours after injury. This may be because of delayed rupture or spasm of the injured intestine. Serial films were valuable in aiding the diagnosis and are recommended, together with assessment of solid organ injury by radionuclide scanning. In this series peritoneal lavage was not used. No child died.

Abdominal Injuries↗
PubMed1985

Catheterization of the umbilical artery in neonates: surgical implications.

Catheterization of the umbilical artery is a common procedure in neonatal intensive care units. The authors studied the records of 100 consecutive newborns who underwent this procedure to review the indications for and complications of umbilical artery catheterization and to discuss preventive measures and alternative techniques. Only polyvinylchloride barium-impregnated catheters were used (nos. 3.5 and 5.0 French). The commonest indications were respiratory distress syndrome, asphyxia and congenital heart disease. Of the 100 infants, 75 weighed less than 2500 g. Ampicillin and calcium were the commonest medications infused (70 and 65 babies respectively). There were three major complications, two of which were gangrene of the lower extremity. Amputation of the foot was necessary in one and amputation of the toes in the other. The third complication was the development of gluteal necrosis. In all three cases, catheter placement was low and the infusion was ampicillin. In two of the babies, calcium was also administered. Minor complications were seen in 32 cases, with vascular spasm in the lower limb being the most common. All catheter tips were cultured; there was bacterial colonization in 13%, Staphylococcus epidermidis being the commonest organism. Proven necrotizing enterocolitis was seen in eight infants and was suspected in eight others. Blanching is a serious sign and was seen in the three infants with major complications. The infusion should be stopped immediately. When necrotizing enterocolitis is suspected, the catheter should be removed.

Amputation, Surgical↗
PubMed1984

Giant hemangioma in the newborn and infant. Complications and management.

Most hemangiomas do not cause major problems but they may be functionally or emotionally unacceptable. In uncomplicated cases spontaneous involution is frequent and treatment consists of expectant care. We report three newborn babies and two infants with giant hemangiomas in whom acute life-threatening complications required immediate treatment. Complications included cardiac failure, hemorrhage, platelet trapping, and disseminated intravascular coagulation (DIC). Modes of therapy employed were surgical excision, steroids, embolization, radiotherapy, intermittent pneumatic compression (Jobst), and continuous compression treatment (Jobst). Our five cases show that several modalities of treatment may be necessary to control the life-threatening complications of giant hemangiomas.

Adrenal Cortex Hormones↗
PubMed1984

Surgical management of persistent postoperative chylothorax in children.

Chylothorax occurring postoperatively in children is found most commonly after cardiovascular operations, but may occur after almost any thoracic procedure. Seven cases of postoperative chylothorax seen at the Children's Hospital of Eastern Ontario in Ottawa from 1976 to 1983 are reported. Two resolved with nonoperative management and five required surgical intervention. The authors discuss the clinical presentation, treatment and outcome. They describe a simple, safe and effective method of ligation of the thoracic duct just above the diaphragm.

Child↗
PubMed1984

Eosinophilic gastroenteritis.

Eosinophilic gastroenteritis is a rare condition, characterized by diffuse infiltration of the gastrointestinal tract by eosinophils. This involves mainly the stomach, duodenum and small bowel and rarely the esophagus, colon, pancreas, gallbladder, prostate and urinary bladder. Most reported cases have occurred in adults in the third decade of life. The authors report on a 15-day-old infant who initially presented with rectal bleeding and a scan that indicated a Meckel's diverticulum was present. At laparotomy, however, a Meckel's diverticulum was not found. The appendix was slightly distended and there was a mild inflammatory reaction. Appendectomy was performed. Microscopically the appendix showed diffuse eosinophilic infiltration. The blood eosinophil count was elevated. The patient recovered well, but had several minor episodes of rectal bleeding following ingestion of milk. He remained asymptomatic on a milk-free diet. The etiology of eosinophilic gastroenteritis is unknown and there is no specific treatment. In uncomplicated cases, diet, corticosteroids and adrenocorticotropic hormone are used. Operation is reserved for cases of obstruction and hemorrhage.

Age Factors↗
PubMed1983

Idiopathic perforation of the biliary tract in infancy.

Idiopathic perforation of the bile duct is rare in children. Sixty-seven cases were reported in the English literature to 1980. It is, nevertheless, the second commonest surgical cause of jaundice in the neonate. The etiology is unknown though distal obstruction and weakness in the bile duct wall have been postulated. Limited surgical treatment with external drainage is the preferred therapy. In isolated cases internal drainage procedures or repeated aspiration have been successful. The diagnosis should be suspected in the presence of jaundice and ascites with or without abdominal pain and signs of peritoneal irritation. We describe a 3-month-old girl presenting with anemia, vomiting, jaundice, and ascites. This was initially diagnosed as hepatitis but bilious fluid was found on paracentesis. Computerized tomography with cholangiography and 99 MTC Diisopropyl IDA cholescintigraphy confirmed the diagnosis. The latter seems to be more accurate than I-131 Rose Bengal. The perforation was at the junction of the hepatic and cystic ducts. It was treated successfully by external drainage and a cholecystostomy. Direct attempts to close the perforation, or more complicated surgical procedures, are unnecessary while nonoperative treatment carries a high mortality. At follow-up after 1 year the IV cholangiogram and liver-function tests are normal. Cholecystostomy provided good drainage of the biliary ducts as well as easy access for follow-up cholangiography.

Ascites↗
PubMed1983

Isolation of Campylobacter jejuni from an appendix.

Campylobacter jejuni Skirrow biotype 1, Lior serotype 8 was isolated from the appendix of an 11-year-old boy who had a 6-h history of acute abdominal pain. Histological diagnosis on the appendix section was early acute appendicitis. Dilute carbol fuchsin stain and indirect fluorescent antibody test performed on the appendix section also revealed the presence of Campylobacter sp. The patient developed a significant bactericidal antibody titer of 1,024, providing substantial clinical evidence of the pathogenicity of the isolate. This case indicated that not only may abdominal pain caused by Campylobacter enteritis mimic appendicitis, but the organism may actually be recovered from the infected appendix.

Antibodies, Bacterial↗
PubMed1982

Fictitious pancreatitis in choledochal cyst.

The classical presentation of choledocal cyst has been regarded as a triad of abdominal pain, jaundice and a palpable abdominal mass; unusual presentations include rupture of the choledocal cyst with bile peritonitis, pancreatitis and bleeding esophageal varices. We are reporting 3 children presenting clinically as recurrent acute pancreatitis with elevated serum amylase and found to have type I choledocal cyst. Despite elevated serum amylase there was no evidence of pancreatic inflammation at laparotomy. High amylase concentration was found in fluid contained within the cyst. This was probably responsible for the elevated serum amylase and also the inflammatory reaction seen in the wall of the choledocal cyst. These cases support the hypothesis that pancreatic reflux into the bile ducts is the etiological factor in the development of choledocal cyst. Our 3 cases were treated by cyst excision and have remained asymptomatic. The presence of hyperamylasemia should not delay appropriate surgical management. The treatment of choice is cyst excision, since it will eliminate factors contributing to the development of cholangitis and hyperamylasemia.

Adolescent↗
PubMed1981

Balloon embolization of a bleeding gastroduodenal artery in a 1-year-old child.

Severe stress can produce ulceration and uncontrollable hemorrhage in the pediatric age group. Modern angiographic techniques, using embolization of a Silastic balloon to occlude a visualized bleeding vessel, can successfully control hemorrhage and avoid surgical intervention and its resultant disordered gastric physiology. Recently this technique was used to control hemorrhage from the gastroduodenal artery in a 1-year-old child with severe respiratory sepsis. This is the youngest reported child in whom the technique has been used to control bleeding from this vessel.

Aneurysm↗
PubMed1979

Prognostic factors in omphalocele and gastroschisis.

Size of the abdominal wall defect, viscera exposed or herniated, birth weight, associated medical conditions and congenital anomalies, mode and complications of treatment, and the use of total parenteral alimentation was reviewed in 79 cases of omphalocele and 44 cases of gastroschisis treated in the past 10 yr. Sixty-seven percent of infants with omphalocele and 73% of those with gastroschisis survived. In omphalocele, the most important factors affecting mortality were the presence of other associated abnormalities and low birth weight. The size of the abdominal wall defect, the viscera herniated, and the mode of treatment did not appear to affect mortality. In gastroschisis, the size of the abdominal defect, birth weight, viscera exposed or herniated, and associated anomalies were not significant factors affecting mortality. Mortality was usually secondary to intestinal or wound complications. Statistical analysis could not prove that primary repair resulted in greater survival than the use of a silon pouch, but analysis of complications clearly indicates that the former method is preferable and that silon pouch should be reserved for cases in which primary repair is not possible.

Abdominal Muscles↗
PubMedDate not supplied

Idiopathic post-operative pulmonary hypertension in the newborn.

A case of severe pulmonary hypertension following the primary repair of an omphalocele in a term infant is reported. There were no pre-disposing factors known to contribute to the postoperative pulmonary hypertension (PPH). Therapy was successful first by using hyperventilation, and then subsequently with tolazoline. Upper gastrointestinal bleeding limited the use of tolazoline after the first fourty-eight hours. Complete recovery ensued. The occurrence of PPH and the current therapy of this unpredictable condition is discussed.

Carbon Dioxide↗