Biomedical subjects
Publications and source records attributed to A F Azmy.
Ten infants presented with choanal atresia. Four showed 4 or more components of CHARGE association, 3 of whom died before the age of 2 months while infants with choanal atresia but not having other features of CHARGE association survived. The combination of choanal atresia and heart disease carries a very high risk.
We report two children with finger tip ischaemia resulting from woollen mittens. Ischaemia has progressed to gangrene and required amputation of the affected finger.
One hundred and fifty children with proven urinary tract infection who were assessed by renal ultrasound (U/S), intravenous urography (IVU) and dimercaptosuccinic acid (99mTc DMSA) scan, were studied to identify the sensitivity of each examination and the pick-up rate of renal scarring secondary to vesicoureteric reflux. Sixty-three of these children who had the examinations carried out within a 6-month period were assessed in detail. A DMSA scan is the most accurate method of detecting early renal scars in the young age group (0-2 and 2-5 years), followed by ultrasound. The examinations are equally sensitive over the age of 5. A new grading system of the severity of renal scarring is presented.
Sixteen neonates with suspected necrotising enterocolitis (N.E.C.) underwent a contrast enema examination as part of their initial assessment. It confirmed the presence of N.E.C. in 12 patients, and showed more extensive disease than suggested by plain x-ray in 4 patients. This has resulted in an alteration of their management. Two neonates showed colonic perforation, the contrast confirmed the presence of an established perforation with absence of free intraperitoneal gas in one and initiated a perforation in the other. Both underwent immediate laparotomy and colostomy. Restorative surgery was performed a month later with no subsequent intestinal problems. The use of a contrast enema examination in neonates with suspected N.E.C. has generally been discouraged (1). The role of this examination in the acute phase of N.E.C. is discussed.
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.
Twenty children with horseshoe kidney have been reviewed. Fifteen were symptomatic and nine required surgery. Associated renal and other abnormalities were common. The surgery of horseshoe kidney is discussed.
Five children under 11 years of age with traumatic rupture of the spleen were treated conservatively (non-operatively) and showed recovery of the injured spleen after an initial period of instability. The progress was monitored clinically, ultrasonically and with radionuclide scans.
Renacidin is a urinary stone dissolving agent composed primarily of gluconic and citric acids and their magnesium salts, buffered to a pH of 4. We describe its use in a child with oxalosis, disabling renal colic and deteriorating renal function in whom its use was associated with hypermagnesemia and rapid progression of the renal failure. Possible mechanisms for the deterioration in renal function are discussed.
Retrospective analysis of 27 factors in 80 neonates with necrotizing enterocolitis has enabled us to identify three factors that appear to be of prognostic statistical significance, namely blood pH, platelet count, and the presence of congenital defects. All three factors may be assessed objectively at the time of admission of the patient. Using these factors we have estimated a "probability of death" score for each patient and a high-risk group of neonates has been identified.
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.
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.
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One hundred barium meal examinations performed on infants of less than 4 months of age are reviewed. All the infants presented with vomiting as a major symptom and the diagnosis remained in doubt following the initial clinical assessment. Fifty seven per cent of the examinations showed an abnormality of which 45% were thought to be significant. Hypertrophic pyloric stenosis was demonstrated in 23 infants. Other abnormalities included hiatus hernia, gastro-oesophageal reflux, and duodenal abnormalities. The value of barium meal examinations in this group of infants is emphasised.
Fifty-four neonates transferred to the neonatal surgical unit because of acute necrotising enterocolitis (N.E.C.) are presented. Eleven died (20.4%), of whom seven were treated conservatively and four by operation. Ten patients required surgical exploration because of intestinal perforation, obstruction or suspected perforation. Another five neonates presented with intestinal perforation and were treated by percutaneous catheter drainage of the peritoneal cavity because of their extreme prematurity. Nine patients developed a colonic stricture diagnosed between six weeks and a year after the onset of the disease. Another six patients showed a segment of colonic narrowing detected on barium enema radiography without clinical evidence of bowel obstruction. They were treated conservatively and showed complete resolution at follow up studies.
Children with cystic fibrosis may develop intestinal obstruction later in life due to inspissation of small bowel content. Two children with cystic fibrosis who developed intestinal obstruction at the age of 5 and 14 years respectively are reported. The condition may be precipitated by reduction or stopping pancreatic supplement, dehydration or intercurrent chest infection. The intensive therapy of chest complications has improved the survival of children with cystic fibrosis, so that it is likely that in future more cases of meconium ileus equivalent will present in later childhood and in adulthood.
Of 114 children with oesophageal atresia, 6 had cleft palate and other craniofacial anomalies present included cleft lip, micrognathia, hypertelorism, microcephaly, and hydrocephalus. The difficulties encountered in the management of patients in whom these conditions present together are emphasised with special reference to swallowing problems and recurrent chest aspiration.
Eleven cases of simple renal cysts occurring in childhood, including three cases presenting in the neonatal period are reported.
Thirty four neonates presented with acute duodenal obstruction due to malrotation during a 9 year period between 1973 and the end of 1981. Of these, 20 patients (58.8%) presented in the first week of life, and 24 (70.5%) had an associated midgut volvulus. This frequent association is stressed as bowel necrosis occurs very rapidly. Massive gangrene of small bowel was present in 5 patients, extensive resection was necessary in 3 patients, of whom 2 died postoperatively (5.8%). Five patients required reoperation and 10 had additional G.I. malformations (29.4%).