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Biomedical subjects

W Cochran

Publications and source records attributed to W Cochran.

At least 19 recordsLinked to original sources
PubMed1994

Otalgia in infants and children--a manifestation of gastroesophageal reflux.

To investigate if there is a relationship between gastroesophageal reflux and ear pain in the pediatric age group, a series of children presenting with this picture were analyzed. Infants and children are often seen in an emergency room setting because of fretfulness, irritability, and pulling on the ears. A diagnosis of otitis media is usually made, but in some cases the diagnosis may be referred otalgia secondary to gastroesophageal reflux. Six children who presented with the above picture were seen by one of the authors (W.S.G.) the following morning and noted to have a normal ear exam. These children were studied for gastroesophageal reflux by esophageal pH monitoring and in some cases esophagoscopy with biopsy. All children exhibited gastroesophageal reflux and an anti-reflux regimen eliminated the pattern of 'recurring otitis media'. This paper will review the mechanism of referred otalgia along with data supporting the concept of GE reflux as a cause of otalgia in infants and children.

Child↗
PubMed1992

Early diagnosis and management of 5 alpha-reductase deficiency.

Two siblings of Pakistani origin, karyotype 46 XY, were born with predominantly female external genitalia with minute phallus, bifid scrotum, urogenital sinus, and palpable gonads. The older sibling at the age of 8 days showed an adequate testosterone response to human chorionic gonadotrophin (hCG) stimulation. The diagnosis of 5 alpha-reductase deficiency was made at age 6 years when no 5 alpha-reduced glucocorticoid metabolites were detectable in urine even after tetracosactrin (Synacthen) stimulation. In the younger sibling the diagnosis of 5 alpha-reductase deficiency was provisionally made at the early age of 3 days on the basis of high urinary tetrahydrocortisol (THF)/allotetrahydrocortisol (5 alpha-THF) ratio and this ratio increased with age confirming the diagnosis. Plasma testosterone: dihydrotestosterone (DHT) ratio before and after hCG stimulation was within normal limits at age 3 days but was raised at age 9 months. Topical DHT cream application to the external genitalia promoted significant phallic growth in both siblings and in the older sibling corrective surgery was facilitated. In prepubertal male pseudohermaphrodites with normal or raised testosterone concentrations, phallic growth in response to DHT cream treatment could be an indirect confirmation of 5 alpha-reductase deficiency.

Administration, Topical↗
PubMed1988

Assent to ascent of the testis.

We report 13 boys in whom the testis ascended from the normal scrotal position to an undescended position. A patent processus vaginalis was identified in 10 patients at orchidopexy and is believed to have contributed to testicular ascent. The other three patients had retractile testes which were held in the high position by surrounding adhesions.

Child↗
PubMed1987

Unusual finger tip injury in children.

We report two children with finger tip ischaemia resulting from woollen mittens. Ischaemia has progressed to gangrene and required amputation of the affected finger.

Amputation, Surgical↗
PubMed1986

Congenital cystic adenomatoid malformation of the lung. Potential diagnostic pitfall.

Three infants with congenital cystic adenomatoid malformation of the lung were referred to our neonatal surgical unit with the diagnosis of congenital diaphragmatic hernia, and one had an unnecessary laparotomy. The presence of a normal intestinal gas pattern clarifies the diagnosis and, when applicable, ultrasound screening can be used with advantage.

Diagnosis, Differential↗
PubMed1985

Postcatheterization urethral strictures following cardiac surgery in children.

Ten children among 221 with congenital cardiac anomalies developed urinary symptoms after removal of urethral catheters, which were routinely inserted for monitoring purposes during and after cardiac surgery. Six children developed urethral strictures. Poor tissue perfusion concomitant with serious congenital cardiac anomalies, together with secondary urine infection in the presence of a urethral catheter, are proposed as significant factors in the causation of such strictures in children undergoing cardiac surgery.

Child↗
PubMed1985

Wandering distal ends of ventriculo-peritoneal shunts.

Spontaneous migration with extrusion of the distal catheter is an unusual complication of ventriculo-peritoneal shunt for hydrocephalus. Four instances of disconnection migration are reported: one into a patent processus vaginalis and three extruding per rectum.

Anal Canal↗
PubMed1984

Open versus closed diagnostic peritoneal lavage. A multiphasic prospective randomized comparison.

A total of 118 trauma patients were prospectively randomized to receive either open or closed peritoneal lavage. In addition, comparisons were made between using an infraumbilical versus a supraumbilical approach in patients with pelvic fractures. No statistical difference was noted between the open and closed groups, despite the overall accuracy rate of 96.6%. The supraumbilical approach was vastly superior to the infraumbilical approach in patients with pelvic fracture with an accuracy rate of 90.9% versus 57%. In this regard, use of the infraumbilical approach in this setting is to be highly discouraged. Finally, patient body habitus, technique, and physician experience all play a role in the outcome of the lavage.

Abdominal Injuries↗
PubMed1984

Neuropathologic features, including pontine schwannosis, in a four-year survivor of probable Reye's syndrome with secondary Möbius syndrome.

Frequent seizures and loss of motor, language, and intellectual skills necessitated care in an institution for the physically and mentally handicapped for 4 years after diagnosis of presumed Reye's syndrome in a 10-month-old boy. M obius syndrome was diagnosed and bilateral tarsorrhaphy performed for exposure keratitis. Postmortem examination revealed multiple old boundary zone infarcts in the cerebral cortex, small cavitated infarcts in basal ganglia and thalami, diffuse neuronal loss and gliosis, and a focus of old necrosis in the pons; brain stem herniation during the acute phase of Reye's syndrome was responsible for the latter lesion. Irregular congeries of proliferated peripheral nerves, confirmed by ultrastructural study, were ramifying in the gliotic pontine tegmentum. The pathologic substrate for the neurovegetative state in a long-term survivor of probable Reye's syndrome appears to be multifocal cerebral infarction.

Atrophy↗
PubMed1984

Analysis of thyroid carcinoma in patients with cold thyroid nodules: a review.

It is generally accepted that the risk of thyroid carcinoma is more likely when solitary cold nodules are seen on a thyroid scan, while the presence of thyroid carcinoma in hyperfunctioning nodules has been found to be quite rare. This article attempts to establish the incidence of thyroid carcinoma in patients with solitary cold nodules on thyroid scans. The records of 110 consecutive patients who underwent thyroidectomy procedures were reviewed. Of 53 patients with solitary cold nodules, nine had carcinoma, an incidence of 17 percent.

Adolescent↗
PubMed1982

Haemobilia due to ruptured intrahepatic aneurysm in a child.

This report describes a major life-threatening haemorrhage in a 10-year-old child, following an intraduct rupture of an intrahepatic aneurysm of the right hepatic artery. The onset of the gastro-intestinal bleed was preceded by trauma which may have contributed to the rupture of the pre-existing aneurysm, although the documented initial injury was apparently slight. The bleeding was successfully controlled after ligation of the right hepatic artery.

Aneurysm↗
PubMed1977

Protein metabolism in human neonates: nitrogen-balance studies, estimated obligatory losses of nitrogen and whole-body turnover of nitrogen.

1. Aspects of nitrogen metabolism in the human neonate were assessed in one full-term infant and six premature infants by means of nitrogen-balance measurements, estimates of obligatory nitrogen losses and determinations of whole-body nitrogen turnover. 2. Our data indicate that the mean protein requirement for maintenance is 1-1 g of protein day-1 kg-1 and that 3-8 g of protein day-1 kg-1 should be sufficient for adequate growth in healthy premature babies. 3. The mean obligatory urinary, faecal and total nitrogen losses were estimated to be 24, 106, 145 mg day-1 kg-1 respectively. These figures are compared with published values for older infants, and the possible metabolic basis for changes in nitrogen losses during growth and development is discussed. 4. Mean values for whole-body protein synthesis and breakdown were 26-3 +/- 7-0 and 23-8 +/- 7-4 g of protein day-1 kg-1 respectively. Dietary nitrogen intake accounted for 6--18% of the nitrogen flux through the metabolic pool; urea excretion accounted for 2% of the nitrogen flux. 5. The net protein gain, estimated from nitrogen-balanced data, accounted for 9-6% of total daily protein synthesis. 6. These results are discussed in relation to published estimates of whole-body protein synthesis and breakdown at various ages. Their possible significance in the assessment of a "maintenance" requirement for protein and amino acids during the period of rapid growth and development is also considered.

Body Weight↗
PubMed1975

Rubella reinfection during pregnancy. A case of mistaken diagnosis of congenital rubella.

A case of subclinical rubella reinfection during pregnancy with serologic findings in the offspring initially led to an erroneous diagnosis of fetal infection. Laboratory diagnosis of congenital rubella infection, based on finding hemagglutination-inhibition (HI) activity in immunoglobulin M (IgM) fractions of newborn's serum after sucrose gradient fractionation, was questioned when apparent IgM-HI activity was to be probably due to nonspecific inhibitors, which resulted from bacterial action on the beta-lipoprotein in the serum. These findings emphasize some pitfalls encountered in arriving at a diagnosis based soley on serologic data. This case also illustrates the importance of keeping serum samples sterile when performing serologic tests.

Adult↗