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Biomedical subjects

M D Stringer

Publications and source records attributed to M D Stringer.

At least 109 records · Page 6Linked to original sources
PubMed1993

Current results of surgery for achalasia of the cardia.

Several treatment options are available in the management of achalasia of the cardia. Of a recent series of 14 children, 12 were treated by a modified Heller's myotomy combined with a floppy Nissen fundoplication. Symptoms were dramatically improved in nine during a mean follow up period of 3.9 years. Recurrent oesophageal pain was the most resistant symptom and continued to be moderately severe in three patients, two of whom obtained temporary relief by oesophageal balloon dilatation. Two patients treated by pneumatic dilatation alone have residual symptoms. These results support a primary surgical approach to the management of achalasia in children.

Adolescent↗
PubMed1992

Childhood deaths from intussusception in England and Wales, 1984-9.

OBJECTIVE: To assess the incidence of potentially avoidable factors contributing to death of children with intussusception. DESIGN: Review of children who died with intussusception in England and Wales between 1984 and 1989 from data of the Office of Population Censuses and Surveys, case notes, coroners' records, and necropsy reports. MAIN OUTCOME MEASURES: Unambiguous objective criteria such as failure to diagnose intussusception within 24 hours of admission. RESULTS: 33 children died of acute intussusception in England and Wales between 1984 and 1989 compared with 67 in the previous six years. Their median age was 7 months (range 2 months to 12 years), and two thirds were boys. Half of the deaths occurred at home or soon after arrival at hospital but 15 patients had surgery. Potentially avoidable factors contributing to death were identified in 20 (61%) children, all but three of whom had ileocolic intussusception. These factors were excessive delay in diagnosis, inadequate intravenous fluid and antibiotic therapy, delay in recognising recurrent or residual intussusception after hydrostatic reduction, and surgical complications. Of the 13 patients in whom no avoidable factors were identified, there were nine of 11 children with isolated small bowel intussusception, who tended to have atypical presentations. CONCLUSION: Although the mortality from intussusception has declined, there remains ample opportunity for improved management.

Child↗
PubMed1992

Paediatric intussusception.

Intussusception is one of the commonest causes of intestinal obstruction in infants and accounts for about 700 hospital admissions each year in England and Wales. Improved results of treatment have followed recent technological developments, which include ultrasonographic imaging and pneumatic reduction techniques. Most intussusceptions can be reduced successfully without the need for operation but close cooperation between surgeon and radiologist is essential. Mortality and morbidity rates from the condition have progressively declined in recent decades but avoidable deaths still occur.

Acute Disease↗
PubMed1992

Abdominal inflammatory myofibroblastic tumours in children.

Inflammatory myofibroblastic tumours (inflammatory pseudotumours) occurring at intra-abdominal sites in children have rarely been described. This paper reports three patients with this tumour, two of whom presented with fever, anaemia and an abdominal mass, the third with chronic duodenal obstruction. All had experienced significant weight loss. At operation, each had a large fibrous tumour (7-18 cm in diameter) originating from the transverse mesocolon, small bowel mesentery and duodenum respectively. Intraoperative frozen section histological examination in one patient was misinterpreted as a sarcoma. All the lesions were judged to have been completely excised, but one was ruptured during operation and the patient subsequently developed recurrent tumour nodules. Abdominal inflammatory myofibroblastic tumours are rare. They may be suspected before operation but their clinical, radiological and pathological features may be confused with those of malignancy. Complete excision is necessary to avoid local recurrence.

Child↗
PubMed1992

Familial intussusception.

We report a father and two sons who each suffered from recurrent acute ileocolic intussusception in childhood, suggesting that there may in some cases be a genetic predisposition to the condition. This might have an anatomical basis.

Adult↗
PubMed1992

Double duodenal atresia/stenosis: a report of four cases.

Four neonates with double duodenal atresia/stenosis are described. Preoperative plain radiographs in two patients demonstrated atypical appearances suggestive of complex pathology. Cystic dilatation of the second part of the duodenum was observed at laparotomy in two patients and in one of these the "cyst" was palpable preoperatively, causing diagnostic confusion. All four patients underwent successful surgery but one infant with Down's syndrome subsequently died of congenital heart disease.

Abnormalities, Multiple↗
PubMed1992

Sonographic detection of the lead point in intussusception.

Using ultrasonography, a caecal duplication cyst was identified as the pathological lead point in a 6 year old boy with acute intussusception. The patient underwent definitive surgery rather than inappropriate treatment by attempted radiological reduction. Various pathological lead points in intussusception can now be defined by ultrasound.

Cecal Diseases↗
PubMed1991

Rationalising the management of swallowed coins in children.

OBJECTIVE: To assess the management of swallowed coins in children and identify aspects that could be improved. DESIGN: Study of records of three hospital departments for 1986-90. SETTING: Accident and emergency, radiology, and operating theatre departments in a children's hospital. SUBJECTS: 50 children reported to have ingested coins. MAIN OUTCOME MEASURES: Radiological investigations performed, position of coin, symptoms of child, and surgical intervention. RESULTS: 50 children were recorded to have swallowed coins during 1986-90. Five children had only chest radiography, five only abdominal radiography, and 40 had both. A coin was detected in the oesophagus in 15 children, six of whom had symptoms, and below the cardia in 26, none of whom had symptoms; no coin was seen in nine children. Eleven children had further abdominal radiographs despite the absence of gastrointestinal symptoms; one child had a coin removed from the stomach. CONCLUSIONS: Children are being unnecessarily exposed to radiation and surgical intervention, and a consensus on management of swallowed coins is needed. Most children require only a single chest and neck radiograph.

Algorithms↗
PubMed1991

Paediatric emergencies.

During the last decade neonatal surgical results have improved considerably. Except for infants born with serious congenital heart disease, diaphragmatic hernia or exomphalos, postoperative mortality rates for infants with single anomalies have fallen to the region of 10%. This dramatic success story has been marred by a corresponding increase in the number of individuals with several anomalies entering late childhood with severe chronic handicaps. During the remainder of this century much effort will be expended in devising programmes of investigation which will attempt to predict which individuals will have a poor long-term prognosis. Such programmes will necessitate very close liaison between obstetricians, radiologists, neonatologists, local paediatricians, paediatric surgeons, general practitioners and parents. Very urgent surgery is necessary for the best results in infants with gastroschisis, intestinal volvulus and irreducible inguinal hernia, but for most other conditions there have been recent trends away from very urgent surgery to operation during daylight hours within the ensuing 24 h. Surgery within a few hours of presentation is necessary for intussusception and for early acute appendicitis, but perforated appendicitis should be treated by aggressive fluid replacement and intravenous antibiotics and surgery should be contemplated only in the rare cases of continued deterioration.

Child↗
PubMed1991

Controversies in the management of gastroschisis: a study of 40 patients.

Forty infants with gastroschisis were referred to two paediatric surgeons during a 13 year period. Overall survival was 90%. Nine patients were transferred in utero and 31 were referred postnatally. Birth weights, gestational ages, and Apgar scores were similar for both groups. Primary closure of the defect was successfully achieved in seven (78%) patients in the prenatally transferred group compared with 17 (55%) in the postnatal group. Significantly less postoperative assisted ventilation, and a trend in favour of early discharge home, were noted after prenatal transfer. Problems arising during postnatal transfer may have contributed to these differences. No major differences resulting from the mode of delivery were identified. Patients treated by primary closure fared significantly better than those undergoing staged repairs with prosthetic material. Prospective randomised studies are required to confirm these findings.

Abdominal Muscles↗
PubMed1991

Gastric retention of swallowed coins after pyloromyotomy.

Swallowed coins are a frequent problem in paediatric practice. The majority that reach the stomach will pass unimpeded through the gastrointestinal tract. Prolonged gastric retention of a swallowed penny is reported in three children who had previously undergone pyloromyotomy for infantile hypertrophic pyloric stenosis. The coins were removed after laparotomy in two patients and endoscopically in the third. This abnormal retention may reflect a long-term disturbance of pyloric function after pyloromyotomy.

Child, Preschool↗
PubMed1990

Markers of disease severity in peripheral atherosclerosis.

Many studies have attempted to define haematological markers of disease severity in patients with coronary artery disease but there are few similar analyses in peripheral arterial disease. We have determined haematological correlates of disease severity in 51 patients with angiographically documented occlusive arterial disease. Transfemoral arteriograms performed within the previous 12 months were visually scored for disease severity using a reproducible method. Fasting venous blood samples were withdrawn on two separate occasions from each patient and a complete lipoprotein and haematological profile obtained. These determinations included total cholesterol and triglycerides, lipoproteins with their respective apoproteins, plasma lipid peroxides, fibrinogen, factors VII and VIII and rheological indices (haematocrit, whole blood and plasma viscosity). Mean values for each parameter were correlated with the angiographic score. Of the significant correlations, total cholesterol, triglycerides, low density lipoprotein and apoprotein B were all significantly inversely related to disease severity, in contrast to plasma lipid peroxides which showed a weak positive correlation (r = 0.27, P = 0.06). The best index of disease severity was the lipid peroxide/total lipid ratio (r = 0.41, P less than 0.005). This data strengthens the hypothesis that lipid peroxides are involved in atherogenesis and also suggests that they are the best available plasma marker of disease severity in patients with peripheral arterial disease.

Adult↗