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Biomedical subjects

E T Simpson

Publications and source records attributed to E T Simpson.

11 recordsLinked to original sources
PubMed2002

Vesico-ureteric reflux in the young infant with follow-up direct radionuclide cystograms: the medical and surgical outcome at 5 years old.

OBJECTIVE: To compare the 5-year outcome of 82 infants with vesico-ureteric reflux (VUR) against the initial (< 1 year) and follow-up results of the direct radionuclide cystogram (DRC). PATIENTS AND METHODS: An initial DRC was taken at a mean age of 0.6 years and the follow-up study at 1.7 years. VUR was graded using 'one-third bladder volume' grades (BVG) of 'low', 'moderate', 'high' and 'void', with 'low' considered the most severe. Renal scintigraphy was used to assess renal scarring in 80 of the 82 patients. The outcome at a minimum age of 5 years was defined as resolved reflux, those with corrective surgery or those still being medically followed. RESULTS: Those being followed comprised 29%, corrective reflux surgery 17% and resolved 54% of the patients. Children with VUR grades of 'high' or 'moderate' (as the worst grade either side) were more likely to have resolution than those with 'low' (by four and two times, respectively). Reflux at 'low' bladder volume was 2.6 times more likely to be associated with renal scarring than the other grades combined. 'Low' reflux was present in nine of 14 children needing surgery. There was a linear relationship between VUR grade and the scintigraphic findings. CONCLUSION: The severity of VUR can be assessed from the bladder-volume graded DRC. Continuing VUR at 'low' BVG is associated with increased renal scarring, resistance to natural resolution and corrective reflux surgery.

Child, Preschool↗
PubMed2001

Direct comparison of radiology and nuclear medicine cystograms in young infants with vesico-ureteric reflux.

OBJECTIVE: To determine the sensitivity of the direct radionuclide cystogram (DRC) in detecting vesico-ureteric reflux compared with the micturating cysto-urethrogram (MCU) in the same initial setting, in infants younger than one year. PATIENTS AND METHODS: The results from the dual cystograms of 62 refluxing infants < 1 year old (mean 0.58) were compared. Results from same-day renal scintigraphy with dimercaptosuccinic acid (DMSA) in 60 of the 62 infants were also compared with the reflux grades. RESULTS: Reflux was detected in 105 units, 96 detected on the DRC and 47 on the MCU, representing a sensitivity of 91% and 45%, respectively. The DRC missed half of grade 1, 20% of grade 2 and 6% of grade 3 reflux. Reflux at low bladder filling rates (DRC) represented 40% of all reflux units, and a half (52%) of scarred renal units detected by DMSA scintigraphy. CONCLUSIONS: In young infants the MCU may fail to detect significant reflux and the DRC may fail to detect the lesser grades. The combination of both cystograms in the initial investigation of reflux provides more comprehensive information.

Cystoscopy↗
PubMed1998

The management of the paediatric foreskin.

There are many conflicting opinions among health professionals and parents regarding care of the normal foreskin in young boys as well as the highly controversial subject of circumcision. Minor foreskin related complaints are very common in the first few years of life. Most of these can be managed with advice and reassurance, or with medical treatment alone. Circumcision is very rarely indicated in young boys, particularly under the age of 5 years. The issue of circumcision for non medical reasons, that is, religions, ethnic or personal, remains controversial.

Anti-Bacterial Agents↗
PubMed1996

The management of acute abdominal pain in children.

OBJECTIVE: Acute abdominal pain is a common problem in childhood, and appendicitis is frequently diagnosed by general practitioners and doctors working in emergency departments. The objective of the present report was to determine the frequency of appendicitis in a group of children with acute abdominal pain presenting to the emergency department of a general hospital, as well as attempting to analyse the manner in which these patients were managed. METHODOLOGY: The initial assessment in hospital (by resident hospital staff) of the study group of patients was analysed and their subsequent clinical progress documented. RESULTS: The present report shows that the vast majority of children with acute abdominal pain do not have appendicitis and that appendicitis is significantly over-diagnosed by junior hospital doctors. CONCLUSIONS: Appendicitis is a clinical diagnosis, best made by an experienced member of the paediatric surgical team. Frequent review, with a minimum of investigations, provides the best means of making a rational decision regarding surgery.

Abdomen, Acute↗
PubMed1991

Caecal volvulus in a child: an unusual postoperative complication.

A 2.5 year old dysmorphic child with severe gastro-oesophageal reflux was admitted for elective fundoplication. Three days postoperatively, she developed progressive signs of intestinal obstruction. The diagnosis of caecal volvulus was suggested on the plain radiographic appearance, confirmed at laparotomy and treated by right hemicolectomy. The predisposing factors, diagnosis and approach to surgical management are discussed.

Cecal Diseases↗
PubMed1986

Abdominal muscular deficiency syndrome in a female child.

Abdominal muscular deficiency is a rare syndrome, which affects girls in less than 5% of cases. In addition, urinary tract involvement in females is unusual and these factors may suggest a sexual variation in the pathogenesis of the syndrome.

Abdominal Muscles↗
PubMed1983

Antenatal screening for neural tube defects in South African blacks.

The place of antenatal screening for open neural tube defects is well established throughout the Western world. Alphafetoprotein assay, followed by amniocentesis in selected instances and the option of termination if proved necessary, is accepted as a means of attempting to minimize the many insoluble problems associated with the birth of children afflicted with spina bifida. Nowhere in South Africa is routine screening attempted in Black expectant mothers. The reasons for this are discussed and the feasibility of introducing a screening programme in the Durban area is evaluated.

Black or African American↗
PubMed1982

Gastrocolic fistula complicating benign gastric ulcer. A case report and review of the literature.

Gastrocolic fistula complicating gastric or colonic surgery is a well-recognized entity. It is extremely rare, however, to encounter this condition in patients with benign peptic ulceration who have not undergone previous abdominal surgery. Such a patient was seen recently at Addington Hospital, Durban. The diagnosis was confirmed by means of barium enema examination and subsequent successful surgical resection of the fistula was performed.

Adult↗
PubMed1982

Percutaneous infraclavicular subclavian vein catheterization in shocked patients: a prospective study in 172 patients.

To assess the safety and efficacy of percutaneous infraclavicular subclavian venipuncture in shocked patients 172 consecutive cases were prospectively studied. Catheterization was successful in 163 patients (94.7%); in 119 (69.2%) of these only one attempt was required. Failure was encountered in nine cases (5.2%). There were nine (5.2%) serious complications, four requiring active treatment. Procedure-related mortality was nil. Extrathoracic placement of the catheter tip was detected on routine check chest X-ray in 24 cases (14.8%). Staff relatively inexperienced in the technique contributed eight of the nine complications and six of the nine failures. This study supports the concept that percutaneous infraclavicular subclavian catheterization in shocked patients is a relatively safe technique providing rapid access to a central vein.

Adolescent↗