Biomedical subjects
Publications and source records attributed to M D Stringer.
This case report describes a patient with acute pancreatitis who was found to have inferior vena caval thrombosis. This was diagnosed by CT scan and confirmed by digital subtraction venography. Of the many recognised vascular complications of acute pancreatitis, isolated inferior vena caval thrombosis has not been previously reported.
Explore the source record for details and available documents.
Inflammatory abdominal aortic aneurysms account for 10% of all abdominal aortic aneurysms. They are characterized at operation by their thick fibrotic walls which adhere to adjacent structures; this may present major technical difficulties requiring a modified surgical approach. Because they respond to treatment with corticosteroids, their management is controversial.
Explore the source record for details and available documents.
Cutaneous malignant lymphomas should be considered in the differential diagnosis of unusual swellings or ulcers presenting on the limbs. Four cases on the lower limb are described. They may appear as nodules, plaques or ulcers and it is recommended that cytology is used to supplement histology in diagnosis. Successful treatment with radiotherapy is possible but the overall prognosis is frequently poor.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
The objective of prophylaxis in venous thromboembolism is, first, to prevent fatal pulmonary embolism and, second, to reduce the morbidity associated with deep vein thrombosis (DVT) and the postphlebitic limb. This should now be standard practice for most patients over 40 years of age undergoing major surgery and for younger patients with a history of venous thromboembolism. Particularly high-risk groups include patients over 60 years of age undergoing major surgery, those with malignancy, and those requiring hip operations. Low-dose subcutaneous heparin 5,000 IU commencing 2 hours preoperatively and continuing 12 hourly until the patient is fully mobile is unequivocally effective in preventing DVT in medical and surgical patients and, most importantly, significantly reduces the incidence of fatal postoperative pulmonary embolism and total mortality. Such prophylaxis, in the presence of established DVT, also limits proximal clot propagation, which is the precursor of major pulmonary embolism. Low-dose heparin prophylaxis is associated with a small risk of bleeding complications, evidenced mostly by an increased frequency of wound hematoma rather than major clinical hemorrhage. Low molecular weight heparin fragments (e.g., Fragmin, Choay, Enoxaparine) are emerging as useful alternative agents, having the advantage of once daily administration and yet providing similar efficacy in the prevention of DVT. Mechanical methods of prevention which counteract venous stasis, such as graduated elastic compression stockings, are also useful in protecting against DVT but have not been shown to prevent fatal postoperative pulmonary embolism. They are recommended particularly for patients in whom heparin prophylaxis is best avoided (e.g., neurosurgery) and possibly in combination with heparin in very high-risk patients.
Constipation in the pre-school child is common and causes considerable distress to children and their parents. There is a lack of information regarding prognosis in this group of patients although some are clearly at risk of developing long-term difficulties with defaecation. We have previously reported characteristics of children under 5 years of age referred to hospital over a one-year period with idiopathic constipation. We now report outcome data after 18 months of follow-up in 41 of the original cohort of 42 children. We have also summarised what we regard as good practice in managing constipation in this age group. Eighteen months after initial outpatient assessment, the symptoms of constipation were reported to have resolved in 36 (88%), although seven of these were still needing regular laxative treatment. It was our subjective impression that the five children who apparently did not improve came from families that had a greater degree of psychosocial problems and where compliance with treatment was suspect. This study shows that with simple treatment measures and ongoing support, an optimistic prognosis can be given to families from the outset. The minority of pre-school children who do not improve may benefit from a more intensive psychological approach to management.
Constipation in the pre-school child can cause considerable distress to the individual and to the family. Most cases are idiopathic and with early diagnosis and effective treatment prognosis is good. In a teaching hospital paediatric unit, a year-long prospective study identified 42 new referrals for constipation in children under 5. Before referral for a specialist opinion there appeared to be considerable variation in both duration of symptoms and treatment given. Psychological factors in the family, as well as advice regarding simple behaviour modification and management of common secondary behavioural problems, seemed largely overlooked. Guidelines for for treating constipation in the community could help standardise and improve care. For children with refractory constipation referred to a specialist centre, we recommended a multidisciplinary assessment including paediatrician, paediatric surgeon and member of the child mental health team.