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Biomedical subjects

P Mirilas

Publications and source records attributed to P Mirilas.

10 recordsLinked to original sources
PubMed2005

Retroperitoneal perforation of a duodenal diverticulum with colonic necrosis -- report of a case.

Primary duodenal diverticula are usually asymptomatic. About 115 perforations have been reported, but none with right colon necrosis. We report a 45-year-old woman, with a five days history of high fever along with epigastric and periumbilical pain. Physical examination revealed right upper and lower quadrant tenderness with peritoneal signs. White blood cell count was 11 500/mm (3) while biochemical and hepatic biology tests were normal. Abdominal radiographs showed no pathologic findings. Ultrasound disclosed fluid in the lower pelvis. Computerized tomography revealed fluid collection in the right hepatorenal space. Intraoperative findings included purulent fluid in the lower pelvis, segmental necrotic changes of the right colon, and a perforated diverticulum on the antimesenteric border of the third part of the duodenum. Surgery consisted of right hemicolectomy and ileo-transverse anastomosis, diverticulectomy, and decompressive lateral duodenostomy at the second duodenal portion. The patient had an uneventful postoperative course. A contrast study from the duodenostomy tube on the 6 (th) postoperative day showed no leakage or obstruction. Duodenostomy tube was removed on the 14 (th) postoperative day. Histology confirmed the diagnosis of a primary duodenal diverticulum.

Abdomen, Acute↗
PubMed2004

Sonographic measurement of the abdominal esophagus length in infancy: a diagnostic tool for gastroesophageal reflux.

OBJECTIVE: Our aim was to provide exact sonographic measurements of the abdominal esophagus length in neonates and infants with and without gastroesophageal reflux (GER) and to investigate its diagnostic value. GER severity and hiatal hernia presence were also evaluated and correlated with esophageal length. MATERIALS AND METHODS: This retrospective case-control study comprised 258 neonates and infants (150 without reflux and 108 with reflux). There were 50 children without reflux in each of three age categories: less than 1 month, 1-6 months, and 6-12 months. Of the children with reflux, 42 were less than 1 month old; 34, 1-6 months; and 32, 6-12 months. The abdominal esophagus was measured from its entrance into the diaphragm to the base of gastric folds in fed infants. The number of refluxes during a 10-min period were recorded; GER was categorized as mild, one to three refluxes; moderate, three to six refluxes; and severe, more than six refluxes. Presence of hiatal hernia was recorded. RESULTS: Neonates and infants with reflux had a significantly shorter abdominal esophagus than subjects without reflux: the mean difference in neonates, 4.8 mm; 1-6 months, 4.5 mm; 6-12 months, 3.4 mm. Children with severe reflux had a shorter esophagus compared with those with mild and moderate reflux only in the neonate group. In contrast, children with reflux associated with hiatal hernia had a significantly shorter esophagus compared with children with mild reflux in all three age groups. Sonographic sensitivity was 94%. CONCLUSION: Sonographic measurement of the abdominal esophagus length is highly diagnostic for GER in neonates and infants. In neonates, it can also indicate GER severity. Hiatal hernia is associated with a significantly shorter abdominal esophagus.

Case-Control Studies↗
PubMed2003

Not just an appendix: Sir Frederick Treves.

The history of the anatomy and surgery of the appendix is a beautiful chapter in medical education, and we appreciate the role of Sir Frederick Treves in its development.

Appendectomy↗
PubMed2002

Hemorrhage in the cavum septi pellucidi, and a brief review of the literature.

The aim of this study is to present the cases of four neonates with hemorrhage within the cavum septi pellucidi (CSP). The sonographic findings of this rare location of intracranial hemorrhage, the related pathology and the possible underlying mechanisms are discussed, with a brief review of the literature. Three out of four of the neonates were premature and the fourth was a full-term infant with Down's syndrome. In all the patients the hemorrhage in the CSP was associated with severe intracranial hemorrhage.

Female↗
PubMed2002

Sonographic detection of lymph nodes in the intussusception of infants and young children: clinical evaluation and hydrostatic reduction.

OBJECTIVE: Our aim was to assess the sonographic appearance of enlarged lymph nodes in the intussusception in infants and young children and to investigate whether the enlarged lymph nodes affect the hydrostatic reduction rate of intussusception. MATERIALS AND METHODS: This retrospective case control study included a total of 65 children with intussusception, consisting of two groups: a study group of 28 patients with lymph nodes detected in intussusception and a reference group of 37 patients of similar age without lymph nodes in intussusception. The selection criterion for the study group was the presence of a minimum of two lymph nodes, of which at least one had a long axis of 11 mm or greater. The intussusception patterns, target or doughnut-like, and the presence of trapped fluid in the intussusception were also evaluated. Clinical records were reviewed for associated disease. The reducibility of both study and reference groups was assessed and correlated with all the sonographic features mentioned. RESULTS: Twenty-two of the 28 patients in the study group and none in the reference group had a recent or a current history of gastroenteritis. The overall hydrostatic reduction rate was 46.4% in patients with enlarged lymph nodes in the intussusception and 81.1% (p < 0.005) in patients without enlarged lymph nodes in the intussusception. Larger rather than numerous lymph nodes significantly affected the reducibility rate. Most of the reference group patients had a hydrostatic reduction at first attempt, whereas a second attempt at hydrostatic reduction was required in most of the study group patients. CONCLUSION: Enlarged lymph nodes in the intussusception are mainly found in patients with a current or recent history of gastroenteritis and decrease the overall hydrostatic reduction rate.

Case-Control Studies↗
PubMed2001

Sonographic features indicative of hydrostatic reducibility of intestinal intussusception in infancy and early childhood.

The aim of the study was to investigate the various sonographic patterns of intussusception, which may be indicative of its reducibility by hydrostatic reduction. Seventy-one infants and children clinically suspected of having intussusception were studied sonographically and given barium enemas. Sonographic patterns of intussusception were correlated with its reducibility. When the head of intussusception appeared as a target-like mass the hydrostatic reduction rate was 100%. When demonstrated as a doughnut-like mass, the intussusception reducibility depended on the thickness of the hypoechoic external ring of the "doughnut". With a thickness equal to, or less than, 7.2 mm the reduction rate was 100%, with a thickness ranged between 7.5 and 11.2 mm the reduction rate was 68.9% and with a thickness measured 14 to 14.2 mm a surgical resection of bowel was required. When a small amount of fluid appeared within the head of intussusception, like a crescent hypoechoic area, the hydrostatic reduction was unsuccessful, regardless of the sonographic pattern of intussusception (target- or doughnut-like mass). The presence of a small amount of free peritoneal fluid did not affect the reducibility of intussusception. In conclusion, sonographic patterns of intussusception identify good and poor prognostic features for the success of hydrostatic reduction.

Barium Sulfate↗
PubMed1999

Natural antibodies in childhood: development, individual stability, and injury effect indicate a contribution to immune memory.

Natural, often autoreactive antibodies are present in normal sera in large quantity and show alterations in specificity in diverse pathological situations. They have, however, usually not been studied longitudinally. Here we investigated some representative serum reactivities of natural antibodies in 67 normal children and 10 with injury during childhood, followed up for 3 years. Normal children showed an individually characteristic and relatively stable level of most IgM, IgG, and IgA reactivities when measured with ELISA by reference to a standard. Injured children showed some very rapidly enhanced reactivities within 3 days after trauma, which thereafter slowly diminished over years before coming back to a normal level. This period exceeds by far the lifetime of antibodies and plasma cells. We conclude that natural antibodies contribute to the establishment and maintenance of immune memory in a manner that is distinct from classical immune reactions.

Adolescent↗
PubMed1999

Ovarian cavernous hemangioma in an 8-year-old girl.

The case of an ovarian cavernous hemangioma with torsion in an 8-year-old girl is described. Current literature records less than 50 cases of which only 8 are in children. The presenting symptoms of acute abdomen and the ultrasonographic study led to the preoperative diagnosis of torsion of an ovarian tumor. Salpingo-oophorectomy and appendicectomy were performed with an uneventful postoperative course. The histological pattern of the tumor was that of an entirely cavernous hemangioma. The case is reported in view of its rarity.

Abdomen, Acute↗
PubMed1999

Absence of antisperm surface antibodies in prepubertal boys with cryptorchidism and other anomalies of the inguinoscrotal region before and after surgery.

PURPOSE: Although the prepubertal immune system cannot recognize postmeiotic germ cell antigens, an overall 21 to 28% incidence of antisperm antibodies directed at these antigens has been reported preoperatively in prepubertal children with cryptorchidism and other inguinoscrotal anomalies. We investigated the prevalence of antisperm antibodies in these prepubertal patients before and after surgery. MATERIALS AND METHODS: We examined 82 prepubertal boys 0.6 to 13.2 years old, including 33 with unilateral cryptorchidism, 21 with inguinoscrotal anomalies and 28 who were normal. IgG, IgM and IgA antisperm antibodies were determined by the indirect Immunobead test. Serum testing was repeated 1 and 2 years postoperatively and annually for 2 more years in the normal children. Also sera from 183 infertile men 21 to 47 years old with a history of cryptorchidism and/or inguinal hernia operated on in childhood were similarly studied. RESULTS: Of the adults 70 (39%) tested IgG positive, including 12 (7%) who were also IgA positive, and all tested IgM negative. Repeat measurements were negative for all IgG, IgA and IgM isotypes in all children, patients and controls. CONCLUSIONS: We conclude that there are no antibodies to sperm surface antigens in prepubertal children with cryptorchidism and inguinoscrotal anomalies before and within 2 years after surgery. Autoimmunity against postmeiotic sperm membrane antigens is apparent in adults only.

Adolescent↗