Biomedical subjects
Publications and source records attributed to M J Mayell.
Traumatic pneumatocele is a recognized but uncommon complication of blunt thoracic trauma. Its clinical relevance lies in the difficulty the attending surgeon encounters in differentiating the x-ray appearances from more serious pathology requiring urgent surgical intervention. We document this case because it is important that surgeons be aware of this condition and of its benign course so as to avoid unnecessary diagnostic or operative procedures.
Acquired gastric outlet obstruction occurred in a neonate following gastrostomy, after surgery to salvage a dehisced primary repair of an esophageal atresia. Despite free drainage of the gastrostomy and total support of the neonate, the gastric outlet obstruction persisted and required a further operation. An anterograde gastric mucosal intussusception was found to be the cause.
Over a five year period 55 fetuses had abnormalities of the urinary tract detected by antenatal ultrasound scan. The incidence was 1:935 total births during a one year prospective study. Intrauterine intervention was undertaken in five for suspected obstructive uropathy, which was confirmed in only two. Of 51 live born infants, five died (two with renal failure), and only 18 (35%) had a clinically detectable abnormality at birth. Twenty seven patients underwent postnatal operations, the remainder being treated conservatively. Antenatal counseling was seldom undertaken by those responsible for the postnatal care. There were many instances of prospective parents receiving little or inappropriate information. Greater cooperation is required between all the staff concerned particularly as the natural history and appropriate postnatal management of some urinary tract abnormalities are still not known.
One hundred and twenty nine children under the age of 15 years were diagnosed as having achalasia in Britain and Ireland between 1976 and 1985 by 175 surgeons with an interest in paediatrics or oesophageal disease. The incidence in Eire was 0.31 cases/10(5) population/year and this was significantly higher than in England and Wales (0.1/10(5)/year), Scotland (0.06/10(5)/year/or Northern Ireland (0.02/10(5)/year). Details of age at diagnosis were only obtained for 36 of the 129 patients. The disease appeared to become commoner with increasing age but there is no evidence of a delay in diagnosis until early adulthood. Such a delay would not account for the apparent regional variations in incidence, as they have also been reported in adults. Southern Irish children are at greater risk of the disease than other children in the British Isles.
The surgical management of posterior urethral valves remains controversial. To examine the effects and results of operative treatment in boys with proven posterior urethral valves, a retrospective study was undertaken. The case records of 33 male children who presented with posterior urethral valves over a 10-year period were reviewed. Two patients died prior to definitive treatment and one died postoperatively. Following resuscitation and diagnostic procedures, the remaining patients had eradication of the posterior urethral valves by electrothermic fulguration. In 14 patients this was performed using the Innes-Williams diathermy hook under control of contrast enhanced radiography. In 16 patients the valves were fulgurated under direct cystoscopic visualization. All surviving patients had an uneventful postoperative recovery. However, of those undergoing cystoscopic fulguration, four developed symptomatic urethral strictures necessitating repeat cystoscopy and urethral dilatation. No cases developed strictures following the use of the diathermy hook. One patient from each treatment group developed dribbling. The Innes-Williams diathermy hook has been proven to be a safe, simple, and inexpensive technique. This has specific application in the neonate and small infant where cystoscopy poses technical problems because of anatomic size and where potentially traumatic urethral instrumentation should be avoided.
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