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H V Firor

Publications and source records attributed to H V Firor.

At least 19 recordsLinked to original sources
PubMed1991

The spectrum of eosinophilic gastroenteritis. Report of six pediatric cases and review of the literature.

Eosinophilic gastroenteritis is an inflammatory disease of unknown etiology characterized by infiltration of the gastrointestinal tract with eosinophilic leukocytes, accompanied by varying abdominal symptoms and usually by peripheral blood eosinophilia. We report our experience with six pediatric cases presenting to the Cleveland Clinic Foundation over the past eight years. Unusual findings in our patients included ascitic fluid without eosinophilia and eosinophilic pericarditis (one patient), and eosinophilic cholecystitis (one patient). Endoscopic examination and biopsy helped to establish the diagnosis in all patients. Bone marrow aspiration supported the diagnosis by demonstrating eosinophilia and identifying reactivation of the disease, even in cases without peripheral eosinophilia. All six patients responded promptly to prednisone. Diagnosis is challenging and eosinophilic gastroenteritis may be more common than is recognized. This series of cases significantly expands the spectrum of the disease in children, and documents the usefulness of diagnostic endoscopy in this condition.

Adolescent↗
PubMed1987

Is hemisplenectomy a satisfactory option to total splenectomy in abdominal staging of Hodgkin's disease?

The spleens removed in 76 consecutive staging laparotomies for Hodgkin's disease were studied. The spleens were divided from superior to inferior pole into anterior and posterior halves and each half further divided into superior, mid, and inferior sectors. Sectors were studied grossly and microscopically and involvement by Hodgkin's recorded. Of the 23 positive spleens, all sectors were positive in 12, 5 sectors positive in 1, 4 sectors in 3, 3 sectors in 3, 2 sectors in 1, and 1 sector in 2. In one spleen, four sectors were involved but were not marked properly to allow identification of which four, and one spleen with fairly diffuse disease was not handled according to protocol, remaining an "indeterminate" positive. From the anatomic distribution, a lower pole hemisplenectomy would have removed disease in 22 of 23 spleens and likely would have shown disease in the diffusely involved "indeterminate" spleen. An upper pole hemisplenectomy would have missed disease in one spleen and possibly in the "indeterminate" spleen. Either approach would have missed disease in around 1% of the 76 cases. The addition of a biopsy of the opposite pole that remains is technically feasible and would reduce this small incidence of undetected abdominal disease. With the increasing appreciation of the importance of the immunologic functions of the spleen, alternative techniques for determining splenic involvement have been proposed. From this study, hemisplenectomy appears to be an attractive alternate that preserves the vital functions of the spleen with a minute risk of overlooking the presence of Hodgkin's disease.

Adolescent↗
PubMed1987

Dumping syndrome in children.

Dumping syndrome developed in seven children after gastric surgery, (Nissen fundoplication in six, Whipple procedure in one). The patients ranged from age 10 months to 13 years, and four of the seven were neurologically impaired. The diagnosis was made by demonstrating an abnormal response to an orally administered glucose challenge. The pediatric literature records only eight cases, but we believe that dumping syndrome is more common in children than once believed. Dietary management can often dramatically diminish the associated symptoms.

Child↗
PubMed1985

Pediatric surgical intraoperative consultations.

Six problems that have surgical implications and that may be encountered unexpectedly during urologic procedures in infants and children are discussed. Evolving practice and increased knowledge about these conditions require that the consultant's opinion regarding their management be updated. Discussed are the indications for concomitant appendectomy in young patients and the pros and cons regarding removal of a Meckel's diverticulum encountered unexpectedly. The necessity for and techniques used to preserve the spleen in the face of operative injury, presence of a splenic cyst, or a wandering spleen are discussed. Finally, the implications of finding a rotational abnormality of the gut are reviewed.

Adolescent↗
PubMed1982

Use of high jejunostomy in extensive NEC.

Use of a stoma above involved bowel has been suggested as an option in the infant found to have NEC of an extent which precludes resection. This achieves total decompression and places the involved bowel at rest. A 1-mo-old infant developed NEC after a week of diarrhea. Pneumoperitoneum prompted exploration and involvement of the entire small bowel with a perforation of the ileum was present. The perforation was sutured and a jejunostomy performed within 6 in of the duodenum. Recovery was smooth. After 3 wk of central IV alimentation weight gain was steady and a contrast study ruled out stenosis of the colon. The stoma was resected and bowel continuity restored. Subsequent growth and development have been normal. This approach offers promise in extensive NEC and should be considered early in a patient who fails to improve promptly with intensive medical management.

Enterocolitis, Pseudomembranous↗
PubMed1980

The many faces of Meckel's diverticulum.

Meckel's diverticulum usually presents as a diagnostic problem. Its most common clinical manifestations--lower GI bleeding, small bowel obstruction, and features suggesting acute appendicitis--are fairly well known. Other clinical presentations include a Meckel's diverticulum in an omphalocele, lower GI bleeding followed by perforation, perforation secondary to blunt trauma, and presentation as iron deficiency anemia with and without episodes of overt hemorrhage. Illustrative cases emphasize indications for and usefulness of abdominal scanning as a diagnostic aid.

Adolescent↗
PubMed1979

Pediatric appendicitis. A 20-year study of 1,640 children at Cook County (Illinois) Hospital.

Of 1,640 children with acute appendicitis treated at Cook County (Illinois) Hospital between Jan 1, 1957, and Dec 31, 1976, 35% had appendiceal perforation. Overall morbidity was 12.8% and mortality was 0.24%. Antibiotics, transperitoneal drainage, and delayed wound closure were used routinely in children with appendiceal perforation. Antibiotics and transperitoneal drains did not appreciably alter the incidence of intraabdominal abscess formation. Delayed wound closure in patients with appendiceal perforation reduced the incidence of wound infection by 75%.

Abscess↗
PubMed1978

Mercury poisoning from mercurochrome therapy of an infected omphalocele.

A neonate with an infected omphalocele was treated locally with merbromin (mercurochrome) for five days. Extensive skin peeling with bullous lesions, edema, and fever developed three days after mercurochrome therapy. The infant died on the ninth day. Autopsy revealed evidence of heavy metal poisoning of the kidney, excessive mercury levels in the blood, and in tissues of the brain, kidney, and liver.

Fluoresceins↗
PubMed1975

Technical improvements in the management of omphalocele and gastroschisis.

1. Omphalocele and gastroschisis carried a poor prognosis (50 per cent survival) until the last half decade. 2. The use of a temporary prosthetic covering for the exposed viscera has strikingly altered the outlook in these conditions. 3. Ventilatory assistance, when required, and the ability to monitor blood gases have contributed also to the improved survival rates. 4. In gastroschisis the capability of giving total intravenous nutrition has allowed survival through the long period of bowel dysfunction common in the postoperative period.

Abdominal Muscles↗