Biomedical subjects
Publications and source records attributed to R E Cudmore.
Ultrasound of a patent urachus has been well described. However, ultrasound of the other congenital abnormalities affecting the umbilicus has not. Two cases are described, one of a vitelline (omphalomesenteric) duct and one of an umbilical granuloma, in which the ultrasound findings guided the child's management, preventing a minilaparotomy.
The case notes of all newborn infants with posthemorrhagic hydrocephalus (PHH) operated over the past 10 years at our institution were reviewed to establish the incidence and the effect of necrotizing enterocolitis (NEC) on morbidity and mortality following cerebrospinal fluid (CSF) shunting. Thirteen neonates had both PHH and NEC (group A); 7 of these patients were initially treated by ventriculoatrial (VA) shunt and six by ventriculoperitoneal (VP) shunt. Seventy-five patients had PHH alone (group B); all were treated by VP shunt. Eight patients in group A required an abdominal operation for NEC. The two groups were comparable for birth weight, gestational age, and other complications of prematurity. Episodes of shunt malfunction (infection and/or obstruction) and deaths occurring within 12 months from shunt insertion, in the two groups were compared. Shunt malfunction was more frequent in group A (72%) than in group B (27%) (P < .001). Shunt infection was observed in 39% of group A patients versus 14% in group B (P = .03). Distal shunt obstructions occurred in 28% of group A patients and only 3% of group B patients (P = .001). There were more deaths in group A (62% v 9%; P < .001). Thirty-one percent of group A patients and 4% of group B patients died following shunt complications (P = .006). In group A, there was no significant difference in mortality and shunt malfunction between patients with VA or VP shunts. The method of treatment and the stage of NEC did not influence morbidity and mortality after internal drainage for PHH.(ABSTRACT TRUNCATED AT 250 WORDS)
This study evaluates the safety, efficacy, and technical problems of the new technique of endoscopy-guided balloon dilation (EGBD) in the treatment of strictures of the esophagus and its replacement. Between 1986 and 1990, the authors treated 33 children (aged 3 weeks to 20 years) with EGBD; 18 had esophageal strictures (primary esophageal atresia repair, 13; reflux esophagitis, 5), 13 had anastomotic strictures after esophageal replacement (colon, 12; stomach, 1), and 2 had caustic strictures. The majority (23 of 33) had previously failed to respond to conventional bouginage (mean, 11.2 sessions; range, 1 to 32 sessions). EGBD was performed using flexible endoscopy and flouroscopic screening under general anesthesia. Endoscopy identified and resolved the errors or uncertainties of preoperative contrast studies in 7 patients, 5 of whom had colon interposition. EGBD was achieved in all 31 patients with esophageal or replacement strictures; the mean number of EGDB procedures per patient was 2.1 (range 1 to 7). Symptomatic relief was excellent in 24 and moderate in 7 patients. Both patients with caustic strictures had esophageal perforation from EGBD (excessive inflation, 1; false passage of guide wire, 1). Patients who had experienced both conventional bouginage and EGBD noticed less pain with EGBD and resumed eating sooner. The authors conclude that EGBD is safe and effective for treating esophageal and replacement strictures but not caustic strictures.
Two neonates presented with benign scalp tumours that mimicked encephaloceles. In the more recent case ultrasonography confirmed that the tumour was extracranial.
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Experience in our hospital and figures from the Home Accident Surveillance System indicate that the number of accidents involving baby walkers is increasing. Safety specifications issued by the British Standards Institution are rarely, if ever, met in full by manufacturers. Home accident prevention measures have been shown to be of limited benefit. We advocate more stringent implementation of safety features in the design of baby walkers.
Two unusual intestinal duplications are described. In each case the mesenteric duplication had a separate muscular coat from the normal bowel permitting complete excision of the duplication without interference with the blood supply to the normal intestine.
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Chest wall mesenchymoma is a rare benign tumour arising from the ribs and occurring in infants, being usually present from birth. The few previously documented cases have been of solitary tumours. A 6-week-old infant presented with two separate lesions demonstrating specific radiological signs, and on isotope scanning with Technetium MDP a high uptake of the agent was demonstrated.
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Two patients with raised intracranial pressure responding to ventriculoperitoneal shunting are described in whom ultrasound failed to show dilated ventricles. The importance of not equating absence of ventricular dilatation with normal pressure and ventricular dilatation with high pressure is emphasised.
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Ten cases of shunt-associated ventriculitis treated with intraventricular vancomycin are described. Eight were cured of their infection, one of these without shunt removal, though this failed in another instance. There were no toxic or untoward effects except in one case, where intravenous administration of vancomycin produced a histamine-like reaction. Intraventricular vancomycin, preferably combined with oral rifampicin, should be considered in cases of intractable or problematic shunt-associated ventriculitis due to Gram-positive organisms.
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Children with a history of exposure to smoke in a confined space or showing soot or burns, however minimal, on the face should be admitted to hospital. Respiratory distress may be delayed, but if it is progressive the patient should be curarized, intubated, and mechanically ventilated. Ventilation should be continued for a minimum of 48 hours, followed by 24 hours of spontaneous respiration against a positive airway pressure. It treatment is stopped sooner, a recurrence of stridor and pulmonary oedema is likely. It is mandatory to pass an endotracheal tube small enough to allow a leak between it and the oedematous mucosa, in order that laryngeal damage and subsequent subglottic stenosis may be avoided. It is important tu use high humidity of inspired gases to keep secretions fluid and the endotracheal tube patent. Dexamethasone should be given to minimise cerebral oedema and antibiotics to reduce the incidence of chest infections.
Of 95 boys treated for acute lymphoblastic leukaemia 25 have developed leukaemic infiltration of the testes. In 15 children relapse was apparently confined to the testes, and since treatment 7 of these boys remain in remission. The median duration of remission after testicular relapse was 72 weeks, considerably longer than that reported after other forms of leukaemic relapse.
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