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Biomedical subjects

J Lari

Publications and source records attributed to J Lari.

At least 19 recordsLinked to original sources
PubMed1998

Pancreatic inflammatory pseudotumour: an uncommon childhood lesion mimicking a malignant tumour.

We describe a rare case of pancreatic inflammatory pseudotumour that clinically presented as a malignant tumour in an 11-year-old boy. We also review all six previously described cases, including three that occurred in children. Complete surgical removal is regarded as the best choice of therapy, and follow-up in our case showed no evidence of disease after 3 years. It is important to be aware of this lesion, since it can be confused with a malignant tumour both radiologically and clinically.

Child↗
PubMed1998

Esophageal replacement with colon in children.

Between 1974 and 1994, 25 colonic interposition procedures were performed for esophageal replacement in 23 cases of esophageal atresia (EA) and 2 corrosive strictures. Nine patients had one-stage and 16 had two-stage reconstructions. The transthoracic route was used in 16 cases (64%) and the retrosternal route in 9 (36%). Average age at the time of operation in EA patients was 17 months (range 12-33), and the children with corrosive injuries were 3 and 6 years old. Mean age at follow-up was 11.8 years (2.3-20.5 years). There was no mortality in the series. One patient developed full-graft necrosis and had a gastric pull-up procedure later. One child had partial graft necrosis (3 cm at the cervical end), however, enough colon was available for reconstruction. Ten patients developed a leak from the cervical anastomosis (40%) and 7 developed a stricture at the cervical esophago-colonic anastomosis (28%). The strictures were treated by repeated esophageal dilatation, and 3 patients required revision of the anastomosis (12%). Other complications included acid reflux in 2 cases (8%), small-intestinal obstruction in 1 (4%), redundancy of the colon in 1 (4%), and chest infections in 2 (8%). Follow-up included assessment of the patient's symptoms, serial growth measurements (height and weight), and where relevant, endoscopy and a contrast swallow or meal. There was a 52% improvement in weight and height percentiles post-operatively. Each of the 19 patients who had barium swallows showed rapid transit and emptying without any significant delay or hold-up. Overall long-term results were excellent in 13 patients (52%), good in 7 (28%), and fair in 5 (20%). The colon conduit thus provides an excellent substitute esophagus in pediatric patients.

Child, Preschool↗
PubMed1998

Gastroschisis and total intestinal atresia.

Gastroschisis is an uncommon condition which is now being detected at an earlier stage due to the use of routine antenatal ultrasound scanning. The presence of intestinal atresia secondary to impairment of the vascular supply is well recognised and is associated with a poorer outcome because of the potential for loss of bowel length. We report a case of gastroschisis in which there was resorption of the bowel and closure of the abdominal wall defect. At laparotomy there was total intestinal atresia.

Adult↗
PubMed1997

Long-term results of surgery for childhood achalasia.

Childhood achalasia is an uncommon condition characterised by the absence of oesophageal peristalsis together with increased resting pressure and failure of relaxation of the lower oesophageal sphincter. The currently accepted management is a modified Heller's cardiomyotomy with Nissen fundoplication; however, the long-term results are uncertain. A retrospective review of the notes of 10 children undergoing surgical treatment of achalasia at our institution over a 23-year period were reviewed. There were six boys and four girls. The median age at onset of symptoms was 123 months and at diagnosis was 133 months. Five children were below average weight at the time of presentation. All underwent a modified Heller's operation and Nissen fundoplication. The follow-up ranged from 12 to 277 months with a mean of nearly 10 years. The results were excellent in terms of symptomatic improvement in eight of ten with one good and one moderate outcome. All children below average weight have shown improvement postoperatively. We would conclude that the management of achalasia in childhood should consist of an extended Heller's cardiomyotomy performed by the abdominal approach with the addition of an antireflux procedure such as Nissen fundoplication.

Adolescent↗
PubMed1996

Corrosive injuries of the oesophagus and stomach: experience in management at a regional paediatric centre.

In a 21-year period between June 1974 and May 1995, eight children required surgery for the treatment of complications after ingestion of corrosive substances. There were six oesophageal injuries due to alkali ingestion and two gastric injuries secondary to acid ingestion. Of those ingesting alkali, diagnosis of stricture was made at a mean of 28 days and all children underwent endoscopic dilatation with a mean of six treatments (range 2-13). Two children subsequently required oesophageal replacement and colonic interposition. One of the children ingesting acid presented as an emergency with peritonitis and required laparotomy at which partial gastrectomy and pyloroplasty were performed. The second child presented 3 weeks after ingestion with a gastric stricture and required gastrostomy. All children are currently alive and well and are asymptomatic. The details of management are discussed, together with a review of the literature.

Acids↗
PubMed1995

Management of infantile polyposis syndrome.

A boy with generalised infantile polyposis syndrome is reported to highlight the difficulties in management. Despite attempts to reduce polyp mass by regular endoscopic polypectomy, daily transfusions of blood products, and a trial of the non-steroidal anti-inflammatory agent sulindac, his condition gradually deteriorated and he died of septicaemia.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1991

Neonatal colorectal spindle cell sarcoma.

Intestinal spindle cell sarcomas occur very rarely in the neonatal period. There have been 10 previous reported cases. A neonate with colorectal spindle cell sarcoma is reported. The clinical features of the 11 cases and the prognosis of the tumor are discussed.

Colorectal Neoplasms↗
PubMed1990

Maternal response to anomalies detected by antenatal ultrasonography.

OBJECTIVE: To determine the effect of an atypical antenatal scan on the expectant mother. DESIGN: Postnatal postal questionnaire. SETTING: Questionnaires completed at home after the infants had been investigated at a regional paediatric surgical unit. SUBJECTS: Twenty-nine mothers. RESULTS: The mothers had a very positive attitude to antenatal ultrasonography. The information that the scan was atypical resulted in a high level of parental anxiety which sometimes persisted into the postnatal period. CONCLUSION: A multidisciplinary approach is required for the management of the expectant mother who has an atypical scan.

Attitude to Health↗
PubMed1989

Unilateral biorchism associated with contralateral rudimentary uterus.

A healthy 5-year-old boy presented with two palpable masses in the right hemiscrotum. An examination also showed a palpable mass in the left groin. During surgery, he was found to have right-sided biorchism and a left groin nodule attached to the left vas deferens and spermatic cord. The nodule was excised and histologic examination showed the presence of persistent Mullerian structures. A chromosome analysis showed the normal male karyotype. Both conditions have been previously reported, but this is the first report of both conditions occurring in the same patient.

Child, Preschool↗
PubMed1988

Clinical outcome of fetal uropathy.

Thirty seven infants (27 boys and 10 girls) whose uropathy had been diagnosed antenatally were reviewed at a mean age of 24.4 months. Antenatal ultrasonography was found to be an accurate detector of renal disease, as uropathy was subsequently confirmed in 33 of the 37 infants (89%). A smaller proportion of patients required operations than in other series reported. Shortly after birth the kidney undergoes physiological adjustments and investigation may be carried out too soon. It should be delayed, especially if the infant is well. The timing of postnatal ultrasonography is important and the advice of a paediatric urologist should be sought before investigations are carried out.

Female↗
PubMed1983

Duodenal bile acids in diagnosis of congenital biliary atresia.

This diagnostic study was useful in distinguishing between complete and partial biliary obstruction in a small number of cases. It has been used widely in Japan and is published here to bring it to the attention of other investigators.

Bile Acids and Salts↗
PubMed1983

Infantile hypertrophic pyloric stenosis in South Glamorgan 1970-9. Effects of changes in feeding practice.

In a retrospective analysis of cases of surgically confirmed infantile hypertrophic pyloric stenosis (IHPS) in South Glamorgan in the decade 1970-9 the incidence rose sharply in 1976 reflecting a general increase reported throughout Wales and from other parts of the United Kingdom. The increase was mainly among boys and although it occurred at a time when breast feeding had become more popular, it affected bottle fed infants more than breast fed infants. The apparent correlation between incidence of IHPS and incidence of breast feeding may coincidental and changes in infant milk formulae that became general in 1976 may be more important. An appreciable excess of first born infants with IHPS was noted but there was no correlation between birthweight and IHPS. Variations according to month of birth did not coincide with true seasonal variation.

Birth Order↗
PubMed1976

Chronic intussusception in children.

Three children with chronic intussusception are reported together with a review of the literature. Neither the palpation of a mass nor the passage of blood per rectum was necessary for the diagnosis. Weight loss was seen in each case and 1 child was investigated for malabsorption. In all 3 children there was a delay in diagnosis, and it is suggested that a chronic intussusception should be considered more frequently in children with persistent abdominal symptoms for which no cause can be found. Although a barium enema was helpful diagnostically, it did not result in the reduction of the intussusception. The problem of a recurrence after a reduction and its subsequent management is discussed.

Child, Preschool↗
PubMed1976

Bacteriological survey of acute appendicitis in children.

A bacteriological study of 110 emergency appendicectomies is reported. In two-thirds of these the appendix was inflamed or gangrenous, and in 45 cases positive cultures were obtained from swabs taken at operation. Bacteroides were found frequently in these swabs and also in those taken from wound infections. Although this study is too small to draw any definite conclusions, it is felt that bacteroides should be considered an important pathogen in appendicitis and should be taken into account in the few ill patients where antibiotic treatment is contemplated. It was also noted that swabs taken from the surface of the appendix itself were more often positive than those from the peritoneal cavity, and this difference apperars to be significant.

Adolescent↗