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Biomedical subjects

N V Freeman

Publications and source records attributed to N V Freeman.

At least 37 records · Page 2Linked to original sources
PubMed1986

"High" anorectal anomalies treated by early (neonatal) operation.

Between 1973 and 1983, 18 patients with "high" anorectal anomalies were treated by one of the authors (N.V.F.) by immediate sigmoid loop-colostomy, followed by a sacroperineal or abdominosacroperineal pull-through operation as soon as possible thereafter. This was performed in seven patients between 1 and 14 days, in seven patients between 15 and 40 days, and in four patients between 60 and 120 days. Daily anal dilatations were started 7 to 10 days postoperatively and continued until the anus was soft and supple. The colostomy was then closed, the aim being to complete all treatment by the age of 3 to 4 months. Continence was assessed using Kiesewetter's criteria. Results in 70% were "good", 18% "fair", and 12% "poor". The clinical results are discussed together with the possible advantages of definitive surgery in the neonatal period for "high" anorectal anomalies.

Abnormalities, Multiple↗
PubMed1985

Purpura fulminans in neonates and childhood.

Three cases of purpura fulminans are reported. A five-year-old boy was successfully treated for purpura fulminans but had autoamputation of both legs and autolysis of bladder and urethra. He did not show any sign of shock at the onset of the disease. However, before an irreversible change of the skin lesion and organ involvement occurred, prompt diagnosis was effected, and aggressive treatment was given. An eight-day-old girl suffered from purpura fulminans at her four extremities, skull, bladder, ovary and vagina. Interesting findings were obtained in case 2, who had a positive family history. Several black spots in the extremities had disappeared spontaneously before admission, whereas the other lesions got progressively worse, with subsequent severe attack. Her general condition was not parallel to the severity of the disease. A 20-day-old boy had purpura fulminans after severe aspiration pneumonia, and showed a typical clinical course of the disease. In all patients, sudden drop of Hb and leukocytosis occurred after the skin lesion appeared. The diagnosis was unequivocal in these cases. Clotting time and FDP were good indicators of the progress of the disease in conjunction with the clinical features. Prompt diagnosis and aggressive therapy are necessary, not according to the patient's condition, but according to the laboratory findings and the serious nature of the disease. Internal haemorrhage must be considered as well as the skin lesion, this being a fatal complication.

Child, Preschool↗
PubMed1985

A prospective survey of the indications and morbidity of circumcision in children.

Both the British Medical Association and the American Academy of Pediatrics recommend that circumcision should only be performed for medical reasons. No one has ever described which reasons are actually used, nor measured the morbidity of the procedure. Of 140 boys coming to day-case elective circumcision between the ages of 3 months and 14 years (mean 4.3 years), the commonest cause was a congenital phimosis (42.8%). Four (2.8%) patients required acute readmission postoperatively, and a further 4 developed meatal stenosis, requiring a formal meatotomy. Of 99 patients followed up in detail, 46% vomited, 36% oozed, 19% did not pass urine for more than 12 h and 26% could not wear pants for more than 7 days. Childhood circumcision has an appreciable morbidity, and should not be recommended without a medical reason.

Adolescent↗
PubMed1984

The foreskin anoplasty.

The role of anal sensation in fecal control is well established. A new operative method of creating a skin-lined anal canal using the patient's foreskin, as a secondary procedure, in patients with anal (colonic) prolapse following surgery for high anorectal anomalies, is described. The results in five patients treated between 1967 and 1979 are presented. A sixth patient, treated in 1983, is not included due to the short follow-up period.

Anal Canal↗
PubMed1984

Intractable constipation in children treated by forceful anal stretch or anorectal myectomy: preliminary communication.

Sixty-one children with intractable constipation admitted between 1978-1981 under the care of the author were studied retrospectively. Ten of these patients were also studied prospectively by means of defaecating proctograms, and pre- and postoperative evoked anal potentials. It was found that 85.7% of the children who had anorectal myectomies benefited from the procedure. The possible mechanism by which the improvement is achieved is discussed.

Anal Canal↗
PubMed1984

Rectal prolapse in children.

Some of the factors thought to be responsible for rectal prolapse in children are reviewed. In the United Kingdom management has in the past been conservative. It is suggested that children should be treated at an early stage by means of an injection of phenol in almond oil, in order to reduce the discomfort of recurrent manipulative reductions of the prolapse in the child and alleviate the anxiety of the parents. In 18 cases treated during the past 3 years a single injection performed under general anaesthesia, as a day case, was successful in preventing further prolapse of the rectum.

Child↗
PubMed1982

Colon interposition: a modification of the Waterston technique using the normal esophageal route.

Intrathoracic colon interposition in children with esophageal atresia has been available for 30 yr. The retrosternal and left pleural cavity have been the preferred routes. The posterior mediastinal route does not appear to have been tried in children. Sixteen cases treated by the principle author (N.V.F.) using this route are presented. The mortality, anastomotic leakage and stricture rate (at each anastomosis) were 12.5%, respectively. The posterior mediastinal route is suggested as an alternative route for interposition of the colon or any other conduit.

Body Weight↗
PubMed1981

Cecal fecalith mimicking intussusception.

The rare finding of a cecal fecalith in an 8-year-old child is described together with a review of similar cases. These indicate not only the difficulty of diagnosis, but the dilemma faced by the surgeon at the operation.

Cecal Diseases↗