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Biomedical subjects

K Lakhoo

Publications and source records attributed to K Lakhoo.

17 recordsLinked to original sources
PubMed1997

Thymectomy in black children with juvenile myasthenia gravis

Fifteen black children with juvenile myasthenia gravis presented to our institution over a 10-year period at ages ranging from 18 months to 7 years, 4 males and 11 females. Twelve presented with progressive, generalised weakness and 3 had bulbar manifestations. Ocular signs were absent in 2 patients. All 15 patients were placed on pyridostigmine bromide (Mestinon) and 1 also required steroids and plasmapheresis. Medical therapy only was instituted in 5 patients, of whom 2 came to surgery, 2 died, and 1 was lost to follow-up. Thymectomy was performed in 12 children (including the 2 with failed medical therapy) via a median sternotomy with no mortality or morbidity related to the operation. The timing of surgery was less than 3 months in 75% of the children. Thymic hyperplasia was noted in 10 glands and 2 were reported as normal. Of the children in the operative group, 83% are on minimal medication or in total remission. Better results were noted in young patients with early thymectomy and diseased glands.

Journal Article↗
PubMed1997

Thymectomy in black children with juvenile myasthenia gravis.

Fifteen black children with juvenile myasthenia gravis presented to our institution over a 10-year period at ages ranging from 18 months to 7 years, 4 males and 11 females. Twelve presented with progressive, generalised weakness and 3 had bulbar manifestations. Ocular signs were absent in 2 patients. All 15 patients were placed on pyridostigmine bromide (Mestinon) and 1 also required steroids and plasmapheresis. Medical therapy only was instituted in 5 patients, of whom 2 came to surgery, 2 died, and 1 was lost to follow-up. Thymectomy was performed in 12 children (including the 2 with failed medical therapy) via a median sternotomy with no mortality or morbidity related to the operation. The timing of surgery was less than 3 months in 75% of the children. Thymic hyperplasia was noted in 10 glands and 2 were reported as normal. Of the children in the operative group, 83% are on minimal medication or in total remission. Better results were noted in young patients with early thymectomy and diseased glands.

Black People↗
PubMed1996

Is inguinal exploration for the impalpable testis an outdated operation?

OBJECTIVE: To evaluate the reliability of open inguinal exploration for the investigation of the impalpable testis by reviewing laparoscopic findings after previous negative inguinal exploration. PATIENTS AND METHODS: Laparoscopy was performed in 18 boys (with a total of 22 impalpable testes) in whom previous inguinal exploration in their referring hospitals had yielded negative or inconclusive findings. Subsequent management of the impalpable testes was based on laparoscopic findings. RESULTS: Despite previous negative surgical findings at inguinal exploration, laparoscopy revealed that 13 of the 22 impalpable testes (59%) were present, 12 within the abdomen and one in the inguinal canal. Absence of the remaining nine testes was positively confirmed by visualizing confluent blind ending vas and vessels. CONCLUSION: Inguinal exploration is an unreliable method of investigating the impalpable testis, with an unacceptably high incidence of false-negative or inconclusive findings. Laparoscopy should be undertaken as the initial diagnostic manoeuvre of choice.

Adolescent↗
PubMed1996

Failure of pre-natal ultrasonography to prevent urinary infection associated with underlying urological abnormalities.

OBJECTIVES: To analyse the reasons underlying the failure of routine pre-natal ultrasonography to prevent the subsequent development of urinary tract infection (UTI) in children with predisposing urological abnormalities. PATIENTS AND METHODS: This retrospective study comprised 39 children (22 females and 17 males) who had at least one documented UTI, the presence of an anatomical anomaly of the urinary tract recognized as predisposing to UTI and had undergone ultrasonography of the urinary tract undertaken in fetal life as part of routine maternal ante-natal ultrasonography. Four categories of patients were defined: Group A, those with normal findings on pre-natal ultrasonography and no urological abnormality detected; Group B, those with a urological abnormality detected but where there was a subsequent failure of communication among clinicians; Group C, those with a urological abnormality but who received inappropriate or sub-optimal post-natal management and; Group D, those with a urological abnormality but who had a UTI despite appropriate post-natal management. In each case, the most severe documented episode of UTI was categorized as: Grade I, asymptomatic bacteriuria; Grade II, mild/moderate symptomatic UTI and; Grade III, severe symptomatic UTI necessitating hospital admission. RESULTS: Group A comprised 22 (56%), Group B three (9%), Group C two (5%) and Group D 12 children (31%). Of the 22 children in Group A, nine experienced a UTI of sufficient severity to necessitate hospital admission. Of the 12 children in Group D only one required hospital admission. CONCLUSIONS: The failure of pre-natal ultrasonography to identify the underlying predisposing urological abnormality was the most important factor contributing to subsequent UTI in post-natal life. Failure of communication and inappropriate post-natal management were numerically unimportant. In some children, UTI occurred despite pre-natal detection of their underlying anomaly and appropriate post-natal management. However, in this group the UTI was less severe than in those children whose urological anomalies had not been detected by pre-natal ultrasonography.

Child, Preschool↗
PubMed1994

Left-sided liver abscess in childhood.

Abscesses occur less frequently on the left side of the liver than on the right, and are implicated in a higher incidence of complications. Of a total of 124 children with liver abscesses seen at Red Cross War Memorial Children's Hospital from 1974 to 1990, 26 had left-sided and 98 right-sided lesions. A similar spectrum of organisms was cultured, and 20 (77%) of the left-sided abscesses were found to be caused by pyogenic organisms as opposed to 78 (79%) of those on the right. The remainder were of amoebic origin. In 5 patients with multiple abscesses involving predominantly the left side of the liver, the right side was also involved. These were excluded from further comparison of left and right liver abscesses. Of the remainder, 16 (62%) left-sided and 77 (83%) right-sided abscesses were solitary. Clinical features were similar in both groups but epigastric mass was more frequent in left-sided lesions. After an initially conservative management policy, surgical drainage was necessary in 87.5% of solitary left-sided liver abscesses as opposed to 64% of solitary right-sided abscesses. No intrapericardial ruptures were noted, but 2 pericardial effusions required drainage. There was no mortality but 3 patients with solitary left-sided abscesses ruptured. The important role of ultrasound in the diagnosis and follow-up period is stressed. Patients with solitary left-sided abscesses are identified as being at risk. Abscess drainage is recommended in this group.

Child↗
PubMed1993

Mediastinal teratomas: review of 15 pediatric cases.

One hundred fifty-three children with a teratoma presented to one hospital between 1970 and March 1992. The clinical and pathological features of 15 patients with mediastinal teratomas are reviewed; six were newborn and nine aged from infancy to 13 years. Thirteen patients including the six newborns presented with respiratory distress and all 15 patients had a mass on chest radiograph. A definite diagnosis of teratoma was not made preoperatively in any of these patients. At operation, a median sternotomy was used to approach seven anterior tumors and a lateral thoracotomy performed in the other eight patients. Histologically two were mature, 10 had immature elements, and three were malignant teratomas. The patients with malignant tumors were all over 12 years of age and died within 6 months of treatment. All six neonates had immature teratomas. Raised serum alpha-fetoprotein levels provided useful markers in two patients with recurrent tumors. Three conclusions can be drawn: (1) mediastinal teratomas are rare in children and frequently are not diagnosed before operation; (2) in newborns these tumors may be immature and present with respiratory distress; and (3) a median sternotomy gives excellent exposure for anterior mediastinal tumors.

Biomarkers, Tumor↗
PubMed1993

Caustic ingestion.

Explore the source record for details and available documents.

Burns, Chemical↗
PubMed1993

Bowel stomas in infants and children. A 5-year audit of 203 patients.

A 5-year audit of the formation, management and closure of small-bowel stomas and colostomies at Red Cross War Memorial Children's Hospital, Cape Town, is described. Of the 203 patients, 128 (63%) required the stroma in the neonatal period. Anorectal malformations (80), Hirschsprung's disease (65), necrotising enterocolitis (33), trauma (11) and neoplasm (5) comprised most of the indications. One hundred and thirty large-bowel stomas were sited in the proximal sigmoid and 37 in the transverse colon, all but 11 being divided with each end brought out through a short muscle cutting incision or through the laparotomy wound. Thirty-six ileostomies were performed and in 30 of these the stoma was sited in the wound. Complications, which included necrosis, bleeding, prolapse and wound sepsis, occurred in 31%. The colostomies sited in the transverse colon had the highest incidence of prolapse (38%). Neonatal stomas brought out in the wound had an acceptably low incidence of complications. Most stomas were temporary in nature. One hundred and eighty-eight were closed, all with excision and end-to-end intraperitoneal anastomosis. There was a 4% incidence of complications (5 would sepsis, 2 leaks, 1 stenosis). The formation, management and closure of bowel stomas represents a considerable section of the work of the paediatric surgeon. Correct meticulous technique is essential in keeping complications to a minimum.

Colostomy↗
PubMed1992

Gastric acid secretion and gastrin release in the baboon.

Significant species differences have been demonstrated in gastric physiology, a factor that limits extrapolation of animal data to man. Primate physiology is thought to be similar to that of man; however, gastric function has not been adequately documented in the primate. In the present study six baboons (body weight 25.5 +/- 1.8 kg) were trained to sit in a chair and gastric acid secretion and gastrin release was studied in conscious animals. Mean basal acid secretion was 1.3 +/- 0.1 mmol (H+)/hr. Maximum output after pentagastrin (12 micrograms/kg/hr) was 9.5 +/- 0.9 mmol (H+)/hr and 11.0 +/- 0.4 mmol (H+)/hr after histamine (40 micrograms/kg/hr). A statistically significant (by cosinor analysis) circadian rhythm was demonstrated for intragastric pH over 24 hr in fasted baboons (P less than 0.001). Mean basal serum gastrin level was 37.7 +/- 8.3 pg/ml. The integrated gastrin response after administration of a protein rich meal was 2.52 +/- 0.07 ng x min/ml and this increased to 5.17 +/- 0.18 ng x min/ml (P less than 0.05) following simultaneous administration of a meal with atropine (0.2 mg/kg) (P less than 0.05). Our results suggest that there is significant basal and stimulated acid secretion in the baboon; the amount of acid secreted is similar to that reported in man. Gastric pH demonstrated a circadian rhythm. Postprandial gastrin release was significantly enhanced by cotreatment with atropine. As the present findings are similar to those previously reported in man, the baboon may be a useful model for further studies in gastric physiology and experimental peptic ulceration.

Animals↗
PubMed1991

Pancreatic injuries in children.

Pancreatic injuries over an 11-year period were reviewed. Pedestrian motor vehicle accidents accounted for 45% of the injuries. Diagnosis was made clinically and on raised serial serum amylase levels. Eighty per cent of the patients were managed conservatively. Two patients required emergency surgery for pancreatic trauma. There were no deaths. It is concluded that a conservative approach is successful in most paediatric patients with pancreatic trauma.

Child↗
PubMed1991

Pancreatic leiomyosarcoma. A case report.

The pancreas is an unusual site for leiomyosarcoma. Only 12 such cases have previously been reported. A case of pancreatic leiomyosarcoma in a 68-year-old man is presented and the diagnostic dilemma and management of such a tumour are discussed.

Aged↗
PubMed1991

Blunt splenic trauma in children.

Splenic trauma in 96 patients over an 11-year period is reviewed. Almost 80% of injuries resulted from motor vehicle accidents in which the patients was a pedestrian, and over 80% of patients sustained multiple injuries. Splenic injury was confirmed by isotope scanning at laparotomy. Non-operative management was feasible in 87.5% of the children, with no mortality or morbidity. In patients requiring surgery, splenic salvage was possible in 75%.

Child↗
PubMed1991

Risk factors for complications after thyroid surgery.

Data on 60 patients who underwent thyroid surgery were retrospectively reviewed. The clinicopathological data were compared with the occurrence of the complications of recurrent laryngeal nerve palsy, hypocalcaemia and laryngeal oedema. Age, pressure symptoms and types of pathology were not associated with complications. Large glands and radiological evidence of a compressed trachea were statistically significant risk factors for postoperative complications.

Adult↗
PubMed1989

Giant submandibular calculus. A case report.

A case of giant mandibular calculus, 6.5 X 5.5 cm, is presented. The management of this condition is reviewed and an explanation offered for the occurrence of these calculi.

Adult↗
PubMed1989

Parotid tumours in black patients. The Baragwanath Hospital experience, 1981-1986.

Parotid tumours are rare, but their diagnosis and management continue to be a surgical challenge. In a retrospective review of 60 patients over a 6-year period, the value of clinical features in distinguishing malignant from benign parotid tumours was examined. The sex of patients, the consistency, size and site of tumour, smoking, length of history and rate of growth were not helpful in differentiation. However, the association of pain, facial nerve paralysis, skin infiltration and enlarged ipsilateral cervical nodes with a final diagnosis of cancer was significant (P less than 0.005). Fixity of tumour and old age were also significant indicators of malignancy (P less than 0.05). When these symptoms and signs suggestive of malignant disease are associated with a parotid tumour, the patient should be prepared for the possibility of a radical operation. The surgeon should make extra efforts to obtain a histological diagnosis before proceeding to definitive surgery.

Adolescent↗
PubMedDate not supplied

Galactocele in a male infant: case report and review of literature.

An 11-month-old male developed painless enlargement of the left breast over 1 month. The lesion was mobile, fluctuant, and nontender. Surgical excision was performed and histological examination revealed a galactocele. A galactocele is a very rare cause of breast enlargement in male infants and children.

Breast Diseases↗