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Biomedical subjects

J D Ireland

Publications and source records attributed to J D Ireland.

At least 19 recordsLinked to original sources
PubMed2003

Percutaneous endoscopic gastrostomy in children--a 5-year experience.

INTRODUCTION: Percutaneous endoscopic gastrostomy (PEG) has been performed on children since 1979. The indications for a PEG are wide ranging and while there are well-established benefits, it remains a procedure with recognised complications. GOALS AND OBJECTIVES: The goal of this study was to review our experience with this procedure at a South African paediatric tertiary referral hospital over a 5-year period. The objectives were to review PEGs with regard to patient characteristics, indications, anaesthesia time required and complications. METHODS: The study was a retrospective case record review. RESULTS: A total of 70 PEGs were performed. Patients had a mean age of 4 years and 3 months, and a mean weight of 12.2 kg at the time of performing the procedure. The mean anaesthetic time required for performing a PEG was 27 minutes. Fifty-four PEGs (77%) were performed for inability to swallow, 15 (21%) to improve caloric intake, and 1 (1%) for continuous enteral feeding. There were no deaths, 5 patients had major complications (6%), and 12 patients (17%) needed antireflux surgery subsequent to the placement of a PEG. DISCUSSION: There is an increasing demand for PEGs at our institution. The indications for a PEG in this series are similar to those reported in other series, although we may be underutilising PEGs to improve caloric intake. Our complication rates compare favourably with those reported in other series. We have, however, identified post-PEG gastrooesophageal reflux disease as a complication we would like to reduce, and suggest a practical approach to do so.

Adolescent↗
PubMed2000

Children with cystic fibrosis in South Africa: an improving nutritional picture.

Nutritional status and growth play an important part in determining the prognosis in cystic fibrosis (CF). In South Africa, the median survival of patients with CF is 18 years. Using chart review, we studied the pattern of growth over time of a South African CF population. The percentages of expected weight-for-age, height-for-age and weight-for-height were determined for each patient in 1986 (n = 49) and 1996 (n = 63). Mean indices were the same in the two years. In 1996, mean weight-for-age of children aged 5-10 years was 94.2 per cent (SD 20.4), 14.3 per cent higher (p < 0.05, 95 per cent confidence intervals 3-25 per cent) than children of the same age in 1986. Improved growth of young children with CF has been achieved in a resource-poor country setting the scene for improved prognosis.

Adolescent↗
PubMed1997

Surgery in cystic fibrosis--a 20-year review.

The surgical histories of 111 patients with cystic fibrosis (CF) seen between 1972 and 1991 were examined. Fifty-seven of these children underwent 154 operations; in 34 the surgery was directly related to CF and accounted for 84 operations. Meconium ileus and its complications were responsible for 26 of the 32 major abdominal CF-related procedures and there were 3 major CF-related thoracic operations. Only 1 child died within a month of operation. Complications occurred in 11.9% of general anaesthetics and post-operative complications in 9.2% of operations. Patients with CF are likely to need operative intervention and, when indicated, surgery should have a low morbidity and mortality.

Child↗
PubMed1990

Cholestatic disorders of infancy--aetiology and outcome.

The relative frequency of causes of cholestatic disorders of infancy in a developing area was established in a prospective study. During a 10-year period, 145 infants with conjugated hyperbilirubinaemia were investigated. Intrahepatic disorders accounted for 68 per cent with no identifiable cause (idiopathic hepatitis) in the majority. Syphilis, urinary tract infection and septicaemia together made up 30 per cent of intrahepatic causes with metabolic disorders accounting for 12 per cent. Outcome in those with idiopathic hepatitis, and those treated for syphilis and UTI was relatively good. Complete recovery from syphilitic hepatitis on average took 11 months. Extrahepatic disorders occurred in 32 per cent and were almost entirely due to biliary atresia. Results of hepatic portoenterostomy for biliary atresia were poor because of late referral in many instances. Compared to developed countries, infantile cholestasis in developing areas is more commonly associated with treatable bacterial infection. Referring agencies should be aware of this fact and the need for early referral of cases with possible biliary atresia.

Cholestasis↗
PubMed1988

Cystic fibrosis in Cape Town.

A retrospective study of all patients with cystic fibrosis (CF) seen at the Red Cross War Memorial Children's Hospital was undertaken. A total of 106 patients were identified and of these 64 still attend the CF clinic regularly. By 1 year of age 95% had symptoms but only 63% had been correctly diagnosed. In 27% the diagnosis was only made after 5 years of age. Chronic lung disease, failure to thrive, and diarrhoea or steatorrhoea were the most common presenting symptoms. Clinical scores of those still attending the clinic show that 79% are in the mild or better categories. The overall mortality rate was 21% and death was due to severe chest disease in the vast majority of cases. On the basis of the number of new patients with CF born during a 4-year period and the total number of live births recorded in this time, the calculated incidence of CF in Cape Town was 1/2,000 for whites and 1/12,000 for coloureds. Calculated prevalence rates for both whites and coloureds were much higher in urban Cape Town than in the rural areas of the western Cape. This suggests that many cases remain undiagnosed in the rural areas.

Adolescent↗
PubMed1980

Hodgkin's lymphoma presenting as a protein-losing enteropathy: a case report.

A 10-year-old boy presented with oedema. Panhypoproteinaemia due to excessive enteric protein loss was demonstrated, and further investigation revealed the cause to be lymphocyte-depleted Hodgkin's lymphoma. Appropriate chemotherapy resulted in a dramatic improvement in the serum protein level and resolution of the proptosis and lymphadenopathy.

Child↗
PubMed1978

Clubbing and whipworm infestation.

The association of clubbing, growth retardation, pallor, abdominal distension, and prolonged bloody diarrhoea with whipworm (Trichuris trichiura) infestation is described and discussed. Failure to recognise this association leads to misdiagnosis and unnecessary investigation.

Child↗