Biomedical subjects
Publications and source records attributed to J D Orr.
A case of progressive extrahepatic biliary obstruction due to chronic midgut volvulus secondary to malrotation in a 5-month-old girl is presented. The obstruction to the bile duct was relieved after correction of the malrotation and division of the obstructing bands.
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During a 10-year period 217 cases of acute haematogenous osteitis were treated. In 131 patients the diagnosis was confirmed either radiologically or bacteriologically, but in the other 86 the diagnosis was based on clinical examination. Either cloxacillin or lincomycin proved to be effective if given before bacteriological diagnosis. Frequent clinical examination, assessing both local signs and the child's general state, will decide which child requires surgery (which should be reserved for the toxic child, the child with concomitant medical disorders lowering host resistance, and the child who does not respond to, or has a lesion which flares up after, initial conservative treatment). Constant vigilance is required by clinicians looking after children with this disease in order to reduce the disabling long-term sequelae.
During the period October 1974 to November 1977, six children with Hirschsprung's disease have undergone anorectal myectomy followed by anterior resection. The procedure was carried out in a group of older children who presented late, where the aganglionic segment was thought to be confined to the rectum alone. In these cases, when the initial myectomy specimen revealed total aganglionosis and serial biopsies revealed that the aganglionic segment extended beyond the reach of myectomy, it was decided to carry out anterior resection. The rationale, methods, and results are discussed. It is suggested that this type of procedure is most suitable to those older patients who are diagnosed late, with disease located in the rectum.
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Seven general surgical units co-operated in a clinical trial of dextran 70 and pneumatic calf compression alone and in combination in the preventing of 125I-fibrinogen-detectable deep vein thrombosis in 305 patients. Both dextran regimens were significantly more effective than pneumatic compression alone. Pulmonary embolism was diagnosed in 14 patients, but there was no significant difference in incidence among the three treatment groups. In patients receiving dextran there was no greater median operative blood loss but there was a significantly greater incidence of postoperative bleeding complications.
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Four of 12 unlinked polymorphic marker systems were identified as predictors of normal serum cholesterol levels. Consistent effects between males and females and with other studies suggest that these marker loci are themselves involved in cholesterol determination or are closely linked to the involved loci. Two-locus combinations suggest that an 8-9 mg/100 ml difference in nonfasting serum cholesterol may be predicted between phenotypic classes which are not rare in frequency.
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Factors affecting outcome after pediatric forearm fracture include fracture angulation and fracture position. A new index, axis deviation, combines these factors. Two review studies were performed to determine if axis deviation correlated with outcome. In the first study, 35 subjects were reviewed 2.7 years after fracture without radiographs. In the second study, 152 fractures were reviewed a mean of 4 years after fracture, with 124 patients consenting to undergo radiographs. In both studies, the new index, axis deviation, correlated better with restricted forearm movement than either degree of angulation or fracture position. Midshaft and distal remodeling occurred and could be predicted in terms of axis deviation. We propose that an axis deviation of < 5 at the time of union be the reduction criteria of pediatric forearm-shaft fracture regardless of fracture position.
A 13-year-old boy presented with right-sided gynecomastia. Histological examination of the excised specimen revealed distention of ducts by papillary configurations of proliferating epithelium. The boy had no known family history of breast disease and physical examination revealed minor dysmorphic features, but a karyotype was normal. The possible relationship of this lesion to other proliferative lesions described in the pubertal male breast is discussed.