Biomedical subjects
Publications and source records attributed to Reyazuddin.
Respiratory distress caused by a giant mediastinal teratoma is hitherto unreported. This communication presents the case history of an 8-year-old boy who presented with this serious problem, along with perforation of the chest wall.
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Two children with gastric outlet obstruction without oesophageal involvement secondary to acid ingestion are described. They presented with frequent vomiting along with pain in the epigastrium. The diagnosis was made by barium swallow and barium meal examination. Treatment consisted of gastrojejunostomy. The literature on this subject is briefly reviewed.
A 3.5-year-old girl sustained compression injury leading to isolated bilateral diaphragmatic rupture with extensive herniation of abdominal viscera into the pleuropericardial cavities. Reduction of the hernia and repair of the defects were readily accomplished through a thoraco-abdominal approach with excellent outcome.
A total of 100 cases of flail chest were studied to find out the efficiency of the anti-lung contusion regimen containing a diuretic, a steroid and an enzyme preparation for some 10 days, along with pad and strapping. There were 80 males and 20 females. Majority (71%) of patients were between 16 and 45 years. Road side accident was the commonest cause, present in 65% cases followed by bull horn injuries (25%), fall from a height (8%) and gun shot injuries to chest (2%). Associated intrathoracic and extrathoracic injuries were recorded in 45% and 30% cases respectively and they were treated according to their merits. There were 11 deaths with an overall success rate of 89%.
Closed mitral valvotomy was performed in 45 subjects with rheumatic mitral stenosis. There were 22 males and 23 females with an age range from 4.5 to 20 years. The majority of the patients presented with dyspnoea and palpitations, and 79.92% were in the New York Heart Association functional class IV. Fairly good results were noted in almost all the patients in the immediate post-operative period and on follow-up. There were two deaths, one immediately after the operation and the other after 6 months. Surviving patients are receiving rheumatic fever prophylaxis.
Penetrating injuries of the chest with emphasis on the policy of selective management in 150 cases, 145 males and 5 females, with age ranging from 5-60 years were reviewed. Chest pain and breathlessness were the commonest presenting features. Haemorrhagic shock and haemoptysis were noted in 30% and 20% cases respectively. Fire arms injury was the leading cause of chest trauma, being present in 80 (53.33%) cases. Except for 6 (3 cases had superficial stab wounds and 3 died on way to operation theatre), all patients (144) needed surgical intervention (tube thoracostomy drainage in 110 and major operation in 34 patients). There were 7 deaths in this study; massive haemorrhage was the cause of death in 4 and septic shock in 3 cases. An overall success rate of 95.34% was observed in this series.
We reviewed the records of 95 consecutive patients with spontaneous pneumothorax. The children, 75 boys and 20 girls, ranged in age from newborn to 12 years. The average duration of symptoms, cough, chest pain and breathlessness, was 5 days. Pyogenic lung infection (74.8%) and pulmonary tuberculosis (21%) were the commonest underlying causes of pneumothorax. All children underwent tube thoracostomy drainage along with supportive treatment. Five died owing to sever infection present at the time of admission. Except for the five (5.21%) who died, all children (94.79%) had full relief of pneumothorax. We conclude that pyogenic pulmonary infection and pulmonary tuberculosis are still the commonest causes of pneumothorax in the tropics. Tube thoracostomy drainage is very successful and thoracotomy in selected patients is safe.
A total of 60 cases of thoracic trauma in children, treated over a period of 4.5 years (January 1983 to June 1987), were analysed. Blunt-impact trauma was the major cause in 58.33% cases, stressing that bullock-cart accidents and bull-horn and buffalo-hoof injuries are still a continuing cause of chest injury in developing countries. Haemo- and/or pneumothorax were the main injuries (78.33%), but cardiac and oesophageal involvement were seen, in two cases each. Isolated first rib fracture was another surprising finding. Except for three, all the cases presented within 24 h of injury. Cyanosis and profound shock were found in five patients each. The majority of the patients (60%) were treated with intercostal tube drainage and major surgical operations were needed in 30%. In the remaining 10%, observation was sufficient. There were two deaths (3.33%), with a success rate of 96.67%.
A tension pneumomediastinum production features of cardiac tamponade developed in a 6 year old girl as a result of trauma. She improved dramatically when the air was released by cervical mediastinotomy.
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Sixty-five cases of pleural empyema (50 boys and 15 girls) were seen between January 1983 and June 1986. Fifty-three of these 65 children were below 10 years of age. Pulmonary infection was the commonest underlying cause. Cough with or without expectoration (98%) and fever (95%) were the commonest symptoms followed by breathlessness (85%) and chest pain (83%). Staphylococcus aureus was isolated from pus and blood in 61% and 18% of cases, respectively, while pseudomonas was grown in 8% and 3%. Most of the children (88%) were treated with antibiotics and tube thoracostomy drainage. Decortication was needed in 12% of cases. There were four deaths in this study. The overall success rate was 94%.
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Successful removal of unusual intrapleural foreign bodies (surgical blades) by means of a bronchofibrescope (BFS) passed through the thoracostomy tube tract is reported. The potential role for the use of the fibreoptic bronchoscope for this purpose is emphasized.