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Biomedical subjects

M J Bell

Publications and source records attributed to M J Bell.

At least 109 records · Page 6Linked to original sources
PubMed1982

Ileal dysgenesis in infants and children.

Ileal dysgenesis describes the segmental dilatation of the terminal ileum treated in seven patients presenting from birth to 15 yr. Manifestations included saccular segmental ileal dilatation adherent to the peritoneal surface of an omphalocele sac in two neonates, a radiographically delineated enterolith in a child studied for an unrelated disorder, and a syndrome including pallor, fatigue, and anemia in four children aged 10 to 15 yr. Literature review uncovered 11 similar patients to 38 yr of age. Other symptoms in that group included intestinal obstruction and recurrent abdominal pain. At laparotomy all patients were found to have segmental saccular or tubular dilatation of the terminal ileum. The dilated segments varied in length from 8 to 25 cm. Meckel's diverticula were present in two patients. Segmental resection and anastomosis was performed in all patients. No lumenal stenosis was present in any specimen to account for the dilatation. Previous reports have referred to this abnormality as "giant Meckel's diverticulum" or "segmental ileal dilatation." Evaluation of these 18 patients suggests that this entity is an intrinsic abnormality of ileal development at the morphologically active site of juncture with the yolk stalk.

Adolescent↗
PubMed1982

Ventilatory support and primary closure of gastroschisis.

Recent clinical reports suggest that the majority of neonates with gastroschisis are best managed with a silon pouch technique. Our results with primary closure and short-term ventilatory assistance show a survival rate equal to that of the silon pouch technique. In addition, multiple operations and the chances of complications related to the pouch are avoided. No complications relating to the ventilatory assistance were encountered. Better pediatric ventilators and improved pediatric respiratory management allow this technique to be used for gastroschisis now, whereas 10 years ago the complications ith neonatal ventilators may have outweighed the morbidity of the silon pouch.

Abdominal Muscles↗
PubMed1981

Controversial aspects of appendicitis management in children.

The areas of controversy in appendicitis management in children include antibiotic usage, drainage of the peritoneal cavity, and closure of contaminated incisions. Our results and bacteriologic data suggest that gentamicin sulfate and clindamycin phosphate should be routinely used in cases of suspected perforation, that only selective and limited use of drains is warranted, and that delayed primary closure should be used in all cases with perforation.

Adolescent↗
PubMed1981

Perforated stress ulcers in infants.

During a 5-yr period, 10 infants less than 1 yr of age developed gastroduodenal perforation during treatment for severe underlying illness. Brisk gastrointestinal hemorrhage preceded perforation in most patients. In contrast to stress ulceration in adults, infants appear to have a higher frequency of single ulcers, perforation, and duodenal (rather than gastric) location. The mortality of 40% in this group, and in those patients reported in the literature who have been treated since 1960, implies that effective preventive and therapeutic measures are not yet available and also emphasizes the serious nature of the underlying disorder.

Duodenal Ulcer↗
PubMed1981

Diagnostic value of the white blood count and neutrophil percentage in the evaluation of abdominal pain in children.

Only 15 of 382 patients with appendicitis had a normal white blood count and neutrophil percentage. Abnormal counts are nonspecific and are elevated in other inflammatory conditions, such as those which are observed in the patients of group 2. A much higher number of patients with negative laparotomy findings had both a normal white blood count and neutrophil percentage. The real value of the white blood count and neutrophil percentage is in selecting patients who can be observed safely rather than undergoing operation. This may decrease the incidence of negative exploratory findings. It is essential to give priority to the physical findings and to use the white blood count and neutrophil percentage only as part of the over-all clinical evaluation.

Abdomen↗
PubMed1980

The microbial flora and antimicrobial therapy of neonatal peritonitis.

Data from 31 infants with gastrointestinal perforation were analyzed to determine the microorganisms usually present in the peritoneum and blood, and the antibiotic susceptibility of those organisms. Multimicrobial contamination of the peritoneal cavity was present in over one-half of the patients and 23% were found to have mixed aerobic-anaerobic peritoneal flora. Most common organisms were E. coli and Bacteroides species. Blood cultures were positive in 32% of patients, most frequently growing E. coli. Among numerous antibiotics tested, only gentamicin was effective against all Enterobacteriaceae isolated. Clindamycin was 99% effective against Bacteroides species isolated and 90% against other anaerobes. Group D streptococcus was the most frequently isolated gram positive aerobe. Based on these findings, empiric therapy with ampicillin, gentamicin and clindamycin is recommended for neonates with gastrointestinal perforation. Adjustments in therapy for individual patients should be based upon culture and sensitivity data.

Anti-Bacterial Agents↗
PubMed1980

Circular esophageal myotomy simulating a pulmonary or mediastinal pseudocyst.

Circular esophageal myotomy of the upper pouch in infants with esophageal atresia is an effective means of reducing anastomotic tension. This report describes two patients who developed marked postoperative dilatation of the proximal esophagus at the myotomy site. On radiographs, the dilated, air-filled esophagus simulated a pneumomediastinum or intrathoracic cyst-like structure.

Cysts↗
PubMed1980

Low velocity vehicular injuries in children--"run-over" accidents.

Fourteen children, mostly in the toddler to preschool age group, were treated for injuries resultant from low velocity vehicular accidents in which the child was literally run over. Multiple system injury and visceral injury to brain, lungs, liver, and kidneys were noted. One death and several permanent disabilities resulted in this small group. Most of the accidents could have been prevented by closer supervision of the children. Devices such as childproof door handles, which are currently available, and audible backing signals, currently available on industrial vehicles, might further reduce the incidence of this type of accident.

Accidents, Traffic↗
PubMed1979

Changes in the incidence of necrotizing enterocolitis associated with variation of the gastrointestinal microflora in neonates.

The incidence of necrotizing enterocolitis was noted to vary in association with significant variation in the gastrointestinal microflora cultured from infants in the neonatal intensive care unit. Increased colonization with E. coli and K. pneumoniae was associated with an increased incidence of necrotizing enterocolitis, which suggests that these organisms are related to the pathogenesis of necrotizing enterocolitis.

Digestive System↗
PubMed1979

Epidemiologic and bacteriologic evaluation of neonatal necrotizing enterocolitis.

The incidence of necrotizing enterocolitis (NEC) in our neonatal unit has varied from 4.7% to zero to 4.4% during three time periods. Simultaneously, significant changes have occurred in the spectrum of bacterial species in the gastrointestinal tract of unaffected infants in the same unit. During the first period of increased attack rate, 82% of gastric and 88% of fecal Enterobacteriaceae were E. coli and K. pneumoniae. When the attack rate decreased the frequencies were 11% (gastric) and 47% (fecal), and P. mirabilis was retrieved with increased frequency. The return of E. coli and K. pneumoniae as the dominant organisms was associated with an increase in NEC. Infants with NEC, compared with controls, had a statistically significant increased frequency of retrieval of E. coli and K. pneumoniae from gastric and fecal samplings. The data suggest an active role for certain enteric bacteria in the pathogenesis of NEC.

Enterocolitis, Pseudomembranous↗
PubMed1979

Alterations in gastrointestinal microflora during antimicrobial therapy for necrotizing enterocolitis.

Changes in the gastrointestinal microflora were noted in 22 infants during combined topical and parenteral antimicrobial therapy for necrotizing enterocolitis (NEC). Gastric and fecal cultures obtained during therapy showed significantly decreased Gram-negative aerobic organisms, most of which were Enterobacteriaceae, when compared with pretreatment cultures. Members of this bacterial family have been implicated in the pathogenesis of NEC in many reports. The data presented here show that the number of organisms retrieved can be reduced with this method of antimicrobial therapy.

Clindamycin↗
PubMed1978

Evaluation of a method for transportation and preservation of anaerobic microorganisms.

Fecal samples from sixty patients were utilized to evaluate a method for the preservation of anaerobic organisms. Comparison was made with a method commonly employed in the collection of specimens from the operating room and bedside. Analysis of the numbers ae preservation of anaerobic fecal flora in a reliable manner during a 24 hour delay between specimen collection and plating.

Bacteriological Techniques↗
PubMed1978

Prepyloric gastric antral web: a puzzling epidemic.

Antral webs and diaphragms are considered a rare cause of gastric outlet obstruction in infants and children. A radiographic diagnosis of antral web was made in 28 children during a 26-mo period. Nonbilious, often projectile vomiting was the predominant presenting symptom in 24 infants who were less than 6 mo of age. The older children complained of pain, vomiting, fullness after eating, and eructation. The characteristic radiologic finging was a wirelike transverse septum 1--2 cm proximal to the pylorus. Poor antral filling was an important early clue in the radiographic search for the webs. Pyloroplasty was performed in 20 patients, frequently after failure of medical management of symptoms. Coexistent congenital abnormalities were present in 28% of patients. A search for environmental and familial factors has failed to elucidate any teratogenic influences in this population.

Abnormalities, Multiple↗