Biomedical subjects
Publications and source records attributed to H Saing.
An 8-month-old girl with a right-sided hemihypertrophy was found to have a large abdominal mass. At exploration, the mass, arising from the antero-inferior edge of the right lobe of the liver, was pedunculated and measured 17 cm x 12.5 cm x 12.5 cm. This was excised and histology confirmed it to be a benign single cyst of the liver.
A parapharyngeal teratoma in a newborn was the cause of acute respiratory distress, which was relieved by tracheostomy. Subsequent investigations by soft tissue x-rays of the neck, computed tomography, and examination under anesthesia defined the anatomic location of the tumor, its extent, and its likely nature. The tumor was removed completely by the transcervical approach. Mandibulotomy was not required. Histological examination showed the presence of a large amount of mature brain tissue, a moderate amount of collagenous fibers and smooth muscle cells, and a minute amount of cartilage and epithelial structures. The postoperative course was satisfactory. No recurrence was seen 6 years after surgery. The computed tomography scan was found to be the most useful investigative method. To the authors' knowledge, this is the first comprehensive report of a teratoma occupying the parapharyngeal space in a newborn.
A previously healthy 2-year-old boy was admitted because of shortness of breath, cough, and fever; there was minimal abdominal pain. He had recurrent right, followed by left pleural effusions, which contained markedly elevated amylase levels and high protein content. The pleural fluid amylase levels were disproportionately higher than the serum amylase levels. His abdominal signs were minimal. Surgical exploration showed a disruption of the proximal pancreatic duct. Distal pancreatectomy and Roux-en-Y pancreatico-jejunostomy were performed. After a complicated postoperative course he was discharged well and has remained so for more than 2 years.
Neuronal intestinal dysplasia (NID) usually mimics Hirschsprung's disease, but rarely presents as neonatal enterocolitis. The authors report a case of colonic hyperganglionosis, which is a form of NID, presenting with postenterocolitis intestinal strictures. NID should be considered as a possible (although rare) cause of neonatal enterocolitis and may present with intestinal strictures.
In the past 3 years, three children (ages 2, 4, and 8 years) suffering from peptic pyloric stenosis and repeated vomiting were treated in our department with balloon dilatation followed by H2-receptor antagonist therapy. After the dilatation, all three patients could take solid food without vomiting. There were no complications as a result of the procedures. During a mean follow-up of 17 months (range, 5-30) there was no recurrence of symptoms. The method of dilatation is described, and we recommend it as an option for the initial nonoperative treatment of pediatric peptic pyloric stenosis. The long-term results of balloon dilatation of peptic pyloric stenosis will, however, require further evaluation.
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Over a five-year period, 125 newborns with necrotizing enterocolitis (NEC) were managed by us. Their mean birthweight was 1700 g and mean maturity was 32 weeks. Before commencement of antibiotics, routine septic work-up was done in order to define the bacterial spectrum and antibiotic sensitivity. The study includes aerobic and anaerobic cultures of gastric and pharyngeal aspirates, blood cultures, umbilical swabs and culture of umbilical catheter tips in relevant cases. Peritoneal swab results were also analyzed if laparatomy was performed. Positive cultures were present in 45 patients (36%) with 55 positive specimens. Fifteen types of organism were isolated: the commonest was Enterobacter (29%), followed by E. coli (14.5%) and Klebsiella (13%). They were resistant to ampicillin and first-generation cephalosporin. These organisms were usually opportunistic pathogens. Overgrowth of them may be the cause of NEC. Regular review of the antibiotic sensitivity of these organisms allows prompt and appropriate choice of antibiotics. At the same time, antibiotic sensitivity for these organisms was analyzed to guide us in the choice of antibiotic therapy.
Stridor implies partial airway obstruction, resulting from intrinsic or extrinsic abnormalities of the upper respiratory tract. In a neonate whose airway is small, soft and easily occluded this may be potentially life threatening. Its immediate diagnosis with prompt therapy is a rewarding challenge. When stridor occurs in a neonate with congenital hypothyroidism, surgically amenable cause of obstruction due to an ectopic thyroid or thyroglossal cyst has to be seriously considered. We report a case of neonatal stridor caused by a lingual thyroid, and discuss the imaging approach.
In a 3-year period, 63 consecutive patients with advanced perforated (n=53) and gangrenous (n=10) appendicitis were allocated to undergo either immediate wound closure or delayed primary wound closure after emergency appendectomy. The incidence of wound infection between delayed primary wound closure and immediate wound closure was similar (24.0% and 21.1%, respectively). The duration for complete healing of infected wounds was slightly shorter in the group undergoing delayed primary wound closure (mean +/- SD, 24.3 +/- 9.2 days) than in the group undergoing immediate wound closure (mean +/- SD, 32.6 +/- 16.5 days), but the difference was not significant. However, healing of noninfected wounds was significantly prolonged in the group undergoing delayed primary wound closure (mean +/- SD, 19.3 +/- 10.1 days) compared with the group undergoing immediate wound closure (mean +/- SD, 7.0 +/- 0 days). The latter had been shown to associate with more nonseptic wound complications and therefore required longer rehabilitation. Our study showed that delayed primary closure did not offer additional advantage over immediate closure in the treatment of wounds associated with advanced appendicitis in children.
Thirty-six children aged 2-10 years, the majority of whom were males admitted for urogenital surgery, were observed for level and frequency of distress and type of social interaction over the duration of hospitalization. The results indicate that high levels of observed distress were associated with longer post-operative hospital stays. Staff interactions were associated with higher levels of distress while peer caretaking interactions were associated with lower levels of distress. We tested the hypothesis that social interaction lowered distress, leading to a briefer hospital stay. Using path analysis, we found peer caretaking interactions accounted for a small but significant percentage of the observed variance in duration of post-operative hospital stay. These data illustrate the potential importance of social environments in the maintenance of reduction of distress before and after paediatric surgery. This raises the expectation that certain types of social environments could facilitate recovery from surgery.
In a 3-year study, 103 children with acute non-perforated appendicitis who underwent appendicectomy were randomized for either a single preoperative dose of gentamicin and metronidazole or three doses of gentamicin and metronidazole given before and after the operation. The overall wound infection rate was 1.9%. There was no significant difference between wound infection rates of the single-dose group (2.1%) and the three-dose group (1.8%). The mean(s.d.) hospital stays of the single-dose and three-dose groups were similar: 6.6(2.2) days and 6.4(2.7) days. This study shows that a single preoperative dose of gentamicin and metronidazole is as effective as three doses of gentamicin and metronidazole in the control of post-appendicectomy wound sepsis.
From January 1983 to April 1989, 39 children were diagnosed as suffering from primary peptic ulcer. Of these ulcers, 30 were duodenal, seven prepyloric, and two patients had a combination of both. Among 36 patients with H2-blocker therapy, 33 had treatment completed with ulcer healing assessed by endoscopic examinations. Sixteen patients (49%) had ulcer healing within a single 6-week course of treatment, whereas 17 patients (51%) required multiple 6-week courses. The latter group had a mean basal acid output (BAO) of 0.13 +/- 0.06 mmol/kg/h and a mean maximal acid output (MAO) of 0.48 +/- 0.12 mmol/kg/h, which is significantly higher (P less than .05 and P less than .005, respectively) than the mean BAO (0.08 +/- 0.06 mmol/kg/h) and mean MAO (0.31 +/- 0.11 mmol/kg/h) in patients whose ulcers healed within 6 weeks of treatment. Subsequent follow-up with endoscopy over a mean period of 1.8 years (range, 3 months to 6 years) showed 10 patients with recurrent ulcers. Life-table analysis showed a recurrence rate of 35% within 1 year after ulcer healing. Five patients required surgery for ulcer complications--obstruction (2), perforation (2), and bleeding (1). In two of these patients initial H2-blocker therapy was unsuccessful.
A modified urease broth test was used in 109 gastric biopsy specimens of children that yielded a 96% sensitivity and a 100% specificity rate for Campylobacter pylori infection. The longest reaction time was less than or equal to 4 min. The correlation between the degree of C. pylori infection and the reaction time was found to be highly significant (gamma = 0.78, p less than 0.001). Patients were examined as outpatients, and immediate medications were prescribed for eradication of the bacteria on the basis of the urease broth test results. This is the first report on the use of this modified rapid urease test for the diagnosis of C. pylori infection in children.
A 3 year old child with a tight and angulated stricture at the cervical oesophagogastric anastomosis developed marked dysphagia. Initial attempt at Savary-Gilliard bougienage failed because the bougies tended to coil up in the proximal oesophageal pouch. He was subsequently managed successfully by serial Gruntzig balloon catheter dilatation guided by flexible endoscope, with complete amelioration of dysphagia. The methodology of balloon catheter dilatation is described and its advantages for use in high cervical oesophageal stricture discussed.
Twenty three children with coexistent duodenal ulcer and Helicobacter pylori infection were treated with either two weeks of amoxycillin (25 mg/kg/day) in addition to six weeks of cimetidine, or cimetidine alone. Endoscopy with antral and duodenal biopsies for urease test, microaerophilic culture, and histological studies were performed at entry, six weeks, 12 weeks, and at six months. Children with persistent H pylori infection at six weeks were given a further two weeks' course of amoxycillin. H pylori persisted in all children not receiving amoxycillin treatment but cleared in six of the 13 children (46%) treated with amoxycillin. With failure of H pylori clearance at six months, only two out of six (33%) ulcers had healed and 50% of patients had experienced ulcer recurrence. In contrast, when H pylori remained cleared all ulcers healed and no ulcer recurred. Persistent H pylori infection was associated with persistent gastritis and duodenitis despite endoscopic evidence of ulcer healing. Detection and eradication of H pylori deserves particular attention in the routine management of duodenal ulceration in children.
A report of 59 hydronephrotic kidneys due to pelviureteric junction (PUJ) obstruction in 50 children less than 12 years of age is presented. Thirty-two percent of the patients were less than 1 year of age, with their main presenting feature being an abdominal mass (88%). For older children, loin or abdominal pain was the chief presenting symptom (68%). During infancy, the left and right sides were equally affected, followed closely by bilateral involvement. On the other hand, in older children, the left side was predominantly affected, being twice as common as the right, and the latter again was twice as common as bilateral involvement. Dismembered pyeloplasty was the procedure used in most cases (88%); the nephrectomy rate was 8% for grossly dilated or dysplastic kidneys. During follow-up (of 6 months to 10 years) of 54 pyeloplasties, improvement was seen in 36 (67%), 12 were unchanged (22%), and one reverted to normal (2%) after the initial operation. Two (4%) worsened initially but achieved stabilization after reoperation; the remaining 3 patients (6%) showed unsatisfactory results. Stents were used in 65% of the cases and nephrostomies in 53%.
This report describes a series of 553 flexible upper gastrointestinal (GI) endoscopies performed on 382 children in two surgical centers between 1975 and 1987. Indications included abdominal pain (180), reassessment of known disease (149), upper GI bleeding (99), foreign body ingestion (77), vomiting (14), dysphagia (10), and miscellaneous (24). Findings were chronic peptic ulcer (47), gastritis/duodenitis (63), healing disease (92), nonhealing disease (22), recurrent disease (32), foreign body impaction (22), stricture (9), esophagitis (7), varices (7), mass (6 [3 polyp, 1 lymphoma, 1 fungus ball, 1 inflammation]), normal (209), and miscellaneous (37). Endoscopic diagnosis was uniformly correct except on two occasions, when the presence of recurrent tracheoesophageal fistula in small infants was missed due to use of an inadequate instrument. A pathologic lesion is likely to be identifiable in GI bleeding (84.8%). Endoscopic surveillance for progress of known disease was found to be valuable, particularly in peptic ulcer management, as both incomplete healing after standard therapy as well as recurrence are frequent. The recent practice of routine antral biopsy in children with severe "nonspecific abdominable pain" enabled four cases of Campylobacter pylori colonization in the stomach to be diagnosed, thus allowing appropriate treatment. Endoscopy was therapeutic on 61 occasions: injection sclerotherapy (32), foreign body removal (20), polypectomy (3), and stricture dilatation (6). Endoscopy-guided bougienage, in particular, represents a recent major advance. There was no morbidity or mortality in the entire series. It is concluded that pediatric upper GI endoscopy performed by experienced surgeons is safe and effective. As a result of better understanding and technological advances, a changing trend of wider and more rational applications of the procedure is now evident.
We report our 20 years' experience on the management of 78 children with primary chronic peptic ulcer, giving special emphasis to the recent 32 patients (29 duodenal ulcer, 3 gastric ulcer) who received H2-antagonist therapy guided by endoscopic surveillance. The most striking observation was the marked decrease in the incidence of "failed medical treatment necessitating surgery" from 34.8% (16/46) in the pre-H2-antagonist era to 3.1% (1/32) in the H2-antagonist era. H2 antagonist was uniformly well tolerated and without side-effects. In 29 patients with duodenal ulcer, a 6-week therapeutic course resulted in complete ulcer healing in 22 (75.9%). Further therapeutic courses resulted in complete ulcer healing in four additional patients (13.8%). There was only partial ulcer healing in two patients (6.9%) and nonhealing in one patient (3.49%). There were 11 episodes of recurrence in nine patients (symptomatic 5, asymptomatic 6). Recurrence was more frequent when nocturnal-dose maintenance was not given (8/11 recurrences). All recurrences responded satisfactorily to further H2-antagonist therapy. Patients with gastric ulcer responded even more favorably, all three healing completely with a single therapeutic course and not requiring maintenance therapy. We conclude that H2-antagonist is safe and highly effective for healing peptic ulcer in children. For duodenal ulcer, maintenance therapy ensures a satisfactory remission rate.