Regarding internal sphincterotomy for anal fissure.
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Biomedical subjects
Publications and source records attributed to N A Blumberg.
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Thyroid glands were studied during surgery in 17 patients and the records of a further 53 patients who had undergone thyroidectomy were reviewed to establish the incidence of the pyramidal lobe. It was found to be present in 60 - 65% of subjects (usually being situated on the left side), and should therefore be regarded as a normal component of the thyroid gland and not as a congenital abnormality. In patients with diffuse disease of the gland the lobe is always involved.
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A 14-month-old child presented with complete duodenal obstruction due to pressure from a fetus-in-fetu. This was relieved by a subtotal excision of the tumour. The features support the diagnosis of FIF rather than abdominal teratoma. On this premise, future development of malignancy in the remnant is not anticipated. The follow-up period at the time of writing is 12 years.
Two types of hernia appear to exist, a direct, cogenital type and an oblique indirect, acquired type. The congenital type will, in almost all instances, disappear by the age of three years, regardless of its size. It is unlikely that the indirect type of hernia will disappear; on the contrary, it is more likely to progress and become larger. It will, therefore, most probably require surgical repair. It is rarely possible to distinguich the two types at clinical examination, unless the hernia is quite large, but persistence after three years favors the oblique type, as does also marked downward displacement of the umbilicus with a clinical appearance of herniation descending from above. Since strangulation is a rarity in congenital umbilical hernia, operation is not warranted until the age of three years. Thereafer, the hernia is unlikely to disappear on its own. It is postulated that the wide variations in reported incidence, as compared with the figures in this study, may be ascribed to methods of patient selection. There was clear evidence of hernia in all instances in the present series; other workers have used less rigid criteria, for example, a defect admitting the finger was regarded as diagnostic of an umbilical hernia.
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