Prolonged foreign body impaction in the oesophagus.
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Aluminum↗
Biomedical subjects
L Spitz
Publications and source records attributed to L Spitz.
Surgical treatment of gastrooesophageal reflux in severely mentally retarded children.
Twenty severely mentally retarded children with significant gastrooesophageal reflux were submitted to surgical treatment. In all patients vomiting was present to a distressing degree in 5 children, 3 of whom required extensive surgery to overcome the obstruction. All had failed to respond to conservative measures. Although the postoperative complication rate was high (50%), the final result in the majority of patients was highly satisfactory.
Adolescent↗
Hirschsprung's disease and malrotation of the mid-gut. An uncommon association.
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Duodenal Obstruction↗
Combined esophageal and duodenal atresia: experience of 18 patients.
An analysis of 18 infants with combined esophageal and duodenal atresia is presented. A total of 50 other associated anomalies were identified in the 18 infants. These predominantly involved the genitourinary (11), cardiac (9), anorectal (8), and gastrointestinal (8) systems. There were 6 early survivors (33% survival rate), 1 of whom died later from an unrelated cause. It is suggested that in an otherwise health infant the primary approach should be towards the esophageal atresia and tracheoesophageal fistula. A wide gastrostomy is mandatory. Repair of the duodenal obstruction may safely be postponed for a few days. In the absence of an associated tracheoesophageal fistula, a primary duodenoduodenostomy and gastrostomy with a transanastomotic feeding tube is the approach of choice.
Esophageal Atresia↗
Denial and minimization in telephone contacts with patients.
This paper defines and demonstrates mechanisms of denial, disavowal, and minimization as they operate in telephone contacts between patient or family member and the physician. The physician needs to be cognizant that such mechanisms, operating in both physicians and patients, distort patient's reports of their observations of their illnesses or those of family members. These distorted diagnoses affect proposed treatment plans and ultimate outcome. Examples of situations in which distortions contribute to dangerous consequences are developed in the paper. Specific techniques are elaborated to deal with patients who deny, including expert questioning, direct confrontation, and/or interpretation of the hidden motives leading to the denial. Physicians need to be alert to their own tendency to deny or block out crucial factors secondary to conflicting personal and professional priorities, fear of loss of self-esteem, and unresolved psychological conflicts regarding particular medical syndromes.
Denial, Psychological↗
Intrathoracic foregut cyst (foregut duplication) associated with esophageal atresia.
Intrathoracic foregut duplication cysts are rare congenital foregut malformations that usually produce respiratory symptoms in early infancy. Surgical resection of this anomaly is usually followed by permanent cure. Two cases of intrathoracic foregut duplication cyst associated with esophageal atresia are reported. The first patient had an associated tracheoesophageal fistula while the second had an isolated atresia. Both patients survived following resection of the cysts.
Cysts↗
The detection of auditory visual desynchrony.
Subjects were presented with a film and its soundtrack through apparatus which enabled asynchrony between picture and sound to be increased. It was found that asynchrony is more easily detected when sound precedes picture, and for a hammer hitting a peg than for someone speaking. These preliminary results suggest that we learn to tolerate the asynchrony between hearing and vision produced by the slower transmission of sound than of light.
Acoustic Stimulation↗
Phimosis in boys.
Phimosis, defined as scarring of the tip of the prepuce, was studied prospectively in a series of 23 boys aged 4 to 11 years. There was little to support the contention that the condition is caused by trauma, or by ammoniacal or bacterial inflammation of the prepuce, nor could any other aetiological factor be identified. Histological examination of the foreskin showed the appearances of Balanitis Xerotica Obliterans in 20 of 21 specimens submitted for study.
Balanitis↗
Primary vesicoureteric reflux in neonates with imperforate anus.
Cystography, performed in 26 out of a total of 33 consecutive neonates with imperforate anus, revealed primary vesicoureteric reflux in 12 cases. The reflux was usually pronounced, and was particularly common in females and in infants with urinary tract infections. The incidence of reflux was unrelated to the severity of the anorectal anomaly, and reflux was often demonstrated in patients in whom an intravenous pyelogram had shown an undilated upper renal tract.
Anus, Imperforate↗
Ligation of the common bile duct in the fetal lamb: an experimental model for the study of biliary atresia.
Intrauterine ligation of the common bile duct was carried out in ten fetal lambs at approximately 80 days gestational age. Six of the fetal lambs survived until term and were sacrificed at varying periods until the 36th day of life. The lesion which developed resembled a "correctable" type of extrahepatic biliary atresia [Kasai type I (b)]. The lining epithelium was either totally or incompletely denuded in the blind end of the common duct proximal to the obstruction.
Animals↗
Congenital H-type fistulae of the anorectal region.
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Adult↗
Haematemesis in infantile hypertrophic pyloric stenosis: the source of the bleeding.
Thirteen infants with haematemesis associated with hypertrophic pyloric stenosis were investigated in order to elucidate the source of bleeding. All 13 patients showed endoscopic evidence of oesophagitis, moderate in 4 and severe in 9. No significant gastric mucosal lesion was found. It was concluded that the site of the haemorrhage was the oesophageal mucosa in all 13 infants. Eleven of the patients experienced troublesome postoperative vomiting.
Esophagitis↗
The development of the glands of the common bile duct.
The number of glands at a constant level within the wall of the common bile duct was measured in the foetus, infant, child and adult. The number of glandular acini increases from foetal life to reach a maximum within the 1st year of life. Thereafter it remains remarkably constant. This is in contrast to the lumen and wall of the common bile duct which only reaches adult proportions in adult life. Conversely, the density of acini within the wall of the common bile duct is at a peak in early foetal life and decreases progressively throughout infancy and childhood.
Adolescent↗
Dipygus (caudal duplication).
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Abnormalities, Severe Teratoid↗
Vomiting after pyloromyotomy for infantile hypertrophic pyloric stenosis.
An analysis of the factors which may predispose towards postoperative vomiting after pyloromyotomy for hypertrophic pyloric stenosis was carried out in 72 infants at this hospital. 26 (36%) infants experienced moderate to severe postoperative vomiting of sufficient intensity to cause the postoperative feeding regimen to be modified or interrupted. Only two parameters were found to be of statistical significance. These were the state of the oesophageal mucous membrane on endoscopical examination and the presence of haematemesis in the preoperative period. No evidence for a gastric mucosal lesion could be found. An advanced oesophageal mucosal lesion was found in 30% of patients, and this was the source of the haemorrhage in all 11 in whom haematemesis was noted postoperatively. The stay in hospital was prolonged (8 days) in those infants with troublesome vomiting postoperatively compared with those with lesser problems (3 days).
Female↗
A histopathological study of gastric mucosal biopsies in infantile hypertrophic pyloric stenosis.
Gastric biopsies from 35 infants with hypertrophic pyloric stenosis have been assessed for histological features of gastritis. No erosions were found, and there was no excess cellular infiltration of the lamina propria compared with a control group. Fresh haemorrhage into the lamina propria was frequent in both pyloric stenosis and control sections.
Age Factors↗
Neonatal appendicitis.
Another example of neonatal appendicitis is presented, and the clinical details of 33 cases previously documented in the literature are reviewed. This rare condition is characterized by an inordinate delay in diagnosis, a high incidence of perforation of the appendix and a high mortality.
Appendicitis↗
Preventable death in oesophageal atresia.
We report on experience gained in the treatment of 158 cases of oesophageal atresia presenting during a period of 10 years. The factors influencing mortality were analysed. During the period studied there was a slight improvement in survival, and this was probably due mainly to improved preoperative preparation of those babies undergoing primary repair. At best, 'staging' was thought to have had little influence on the survival of poor risk cases. Midwives, obstetricians, paediatricians, surgeons, and general practitioners did not do all that they could have done to prevent morbidity and mortality in these babies. At least one-third of the 79 deaths could have been prevented, and several deaths were caused solely by lack of awareness of the possible complications and associated abnormalities.
Community Health Services↗