Lead colic: report of a case.
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Adolescent↗
Biomedical subjects
F Lennon
Publications and source records attributed to F Lennon.
Cryptorchidism: a general surgical perspective.
BACKGROUND: The treatment of cryptorchidism has changed, with surgery now advocated before the age of two years. Delayed treatment affects fertility, malignant potential and psychological stress. AIMS: To assess the pattern of referral of cryptorchid patients to a surgical clinic, management and follow-up. METHODS: A four-year review of 114 cryptorchid patients examined age at presentation, waiting time, timing of surgery and length of follow-up. RESULTS: The mean age at presentation to the surgical clinic was 6.7 years (neonatal to 71). The mean age at orchidopexy was 5.6 years. Seventy per cent had a surgical procedure within eight weeks of presentation to a surgeon. Seven per cent were kept under surveillance until a maximum age of three years before orchidopexy was considered. Only 29% proceeded to surgery before the age of two. Seventeen were referred to a paediatric urology unit for further management. CONCLUSIONS: Orchidopexy seems prudent between one and two years of age. Only one-quarter of patients underwent early orchidopexy. It is vital that it is detected early, by paediatricians at birth or the general practitioners (GPs) at the six-week check up. Prompt referral to a surgeon with a paediatric interest is essential in order to permit surveillance or surgery.
Adolescent↗
Metastatic tumour in the parotid gland.
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Adenoma, Pleomorphic↗
Changing trends in acute peptic ulcer surgery in a district surgical unit.
Despite changes in management and the advances in therapeutics, surgeons are still required to treat the complications of peptic ulceration. A retrospective review of all open surgical interventions for complications of peptic ulcer disease between January 1983 and December 1993 was carried out. There were no exclusion criteria. Open gastric surgery accounted for 3% of all inpatient surgical procedures and 13% of all the major operations. There were 341 adult and 132 paediatric procedures performed in the 11 year period. Acute gastric procedures accounted for 34% of major gastric surgery in this district unit. 76 perforated ulcers and 39 bleeding ulcers required surgery. 38% of the patients were over 70 years. The perioperative mortality was 13.9% (4% for those under 70 years). The overall morbidity rate was 71% and procedure-related morbidity rate was 17%. Acute gastric surgery has a very high inpatient morbidity and is associated with a significant mortality particularly in elderly patients.
Acute Disease↗
Non-operative management of perforated duodenal ulcer.
We describe the selective non-operative management of 34 patients who had an initial diagnosis of perforated duodenal ulcer made on acute presentation between 1984-1994 in our district surgical unit. Diagnosis of the condition was made on clinical grounds with the aid of an erect chest X-ray which demonstrated pneumoperitoneum in 28 patients (82 per cent). Six patients (18 per cent) who did not respond to non-operative treatment required surgical intervention; 3 patients had an unsealed duodenal ulcer perforation; 2 had a perforated benign gastric ulcer and 1 patient had acute gangrenous cholecystitis. The overall mortality and morbidity rate was 3 per cent and 35 per cent respectively. There were no documented reperforations over a mean follow-up period of 27 months. While these figures are acceptable and comparable with operative intervention for this condition, we do however stress the labour intensive methods and close clinical monitoring that is required to avoid morbid sequelae.
Adult↗
Evidence for genetic heterogeneity supports clinical differences in congenital myasthenic syndromes.
Congenital myasthenic syndromes (CMS) define a diverse group of disorders, all of which compromise neuromuscular transmission. Symptoms can be present at birth or appear during childhood, and can range in severity. Both autosomal dominant and recessive forms exist, and a number of clinical subtypes have been described. The cause of many cases of CMS has been traced to mutations in the genes for the acetylcholine receptor (AChR) subunits, previously mapped to chromosomes 2 and 17. Recently, an additional form of CMS known as familial infantile myasthenia (FIM) was linked to chromosome 17p. The gene for FIM has not yet been identified. We examined the DNA from 5 families of Iranian Jewish origin (6 affected individuals) who have been diagnosed with a phenotypically unique form of CMS. Four of the families are consanguinous, and all families originate from the same geographical region, thus it is highly likely that they would carry the same ancestral CMS mutation. We examined these families for linkage to the regions on chromosomes 2 and 17 containing the AChR subunit genes, and to the region on 17p to which FIM was localized. Our data excludes linkage to these regions, suggesting that the clinical differences seen among patients with CMS correlate with locus heterogeneity, and that a defect in a different gene is responsible for the CMS in these patients.
Female↗
Non-specialist paediatric surgery--where should it be performed?
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Child↗
149 consecutive thyroid operations--indications, technique and outcome.
One hundred and forty nine patients underwent thyroid and parathyroid surgery over a nine year period. The most common indications for surgery were the presence of a solitary thyroid nodule (56%) or the onset of pressure symptoms (30%). Carcinoma was found in 7.4% of cases. Wound complications occurred in 5%. The permanent nerve injury rate was 0.67%. The incidence of permanent hypothyroidism after surgery was 4%. No patients developed permanent hypoparathyroidism.
Adolescent↗