Control of colostomy prolapse in infants.
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Child, Preschool↗
Biomedical subjects
S Cywes
Publications and source records attributed to S Cywes.
Cystic pulmonary hamartoma simulating posterolateral diaphragmatic hernia.
Posterolateral diaphragmatic hernias and cystic hamartomatous malformations of the lung can cause actue respiratory distress in the immediate postnatal period. The clinical and radiological features of these two conditions can be similar. Owing to misdiagnosis, the surgical approach was inappropriate in 2 of 26 patients diagnosed as having posterolateral diaphragmatic hernias on admission. During the same period, 5 cases of congenital cystic lung disease were treated surgically. Three of these patients were admitted in severe respiratory failure within 48 hours of birth, and in 2 of these cases the wrong diagnosis was made. The clinical features of these two easily confused congenital anomalies are discussed, and the main differentiating points on the chest radiographs are presented.
Cysts↗
Fundamental concepts in the management of congenital anorectal malformations.
Congenital anorectal deformities present a therapeutic challenge to the paediatric surgeon. The anomalies encountered range in complexity from the most simple to the most intricate. It is for this reason that three clear phases in management are defined and applied in every instance, i.e. absolute clarification of the anatomy of the defect, its appropriate operative correction, and, finally, a protracted postoperative period of care during which time voluntary stool control is acquired. Anal continence is the ultimate functional objective. The meticulous treatment required by the unfortunate baby born with this correctable abnormality is emphasized.
Activities of Daily Living↗
Complications and follow-up of gastroschisis.
Twenty-seven patients with gastroschisis were seen at the Red Cross War Memorial Children's Hospital between 1960 and 1977. Twenty-five children were operated on either by primary closure, by skin closure alone, or by the insertion of a reinforced Silastic pouch or patch. The mortality rate has been reduced from 62% to 33% over the past 6 years. Despite better metabolic and respiratory care and intravenous alimentation, serious complications still occur, particularly when prematurity and associated anomalies such as atresia or meconium ileus exist. Other problems were respiratory complications, ileus, perforation, gangrene, intestinal obstruction, enterocolitis and disaccharide intolerance. The long-term follow-up of some of these patients is described.
Abdominal Muscles↗
Colonic intussusceptions in children.
There is a high incidence of primary colonic intussusceptions in infants and children in Africa. The case histories of 37 patients are reviewed. Of the varieties described, the caecocolic intussusception (16 patients) presents as an intestinal upset, often mild, with symptoms of colic and vomiting. In many of these patients there is known to be an intestinal infestation with Ascaris lumbricoides. This often leads to a delay in establishing the correct diagnosis. Colocolic intussusception (13 patients) gives rise to more acute abdominal symptoms. On clinical assessment, signs of intestinal obstruction are found and there is usually an intra-abdominal mass which can be palpated in the left colon. Further confirmatory evidence of intussusception is the finding of occult blood in stools. There is an unusually high incidence of sigmoid intussusceptions in infants (8 patients). The diagnosis of this form of intussusception is often delayed owing to inadequate clinical assessment of prolapsed bowel at the anal orifice. The length of the prolapsed bowel, the curved nature of the prolapse and the possible demonstration of a sulcus between the prolapsed bowel and the anal canal wall, aid in diagnosis.
Cecal Diseases↗
Gastric perforation in the newborn.
Three newborn infants who developed gastric perforation are reported. One infant survived and 2 died. The aetiology of neonatal gastric rupture is discussed, as well as some diagnostic features. The importance of early diagnosis and prompt surgical intervention is stressed.
Female↗
Mandibulo-facial aspects of the cervical cystic lymphangioma (cystic hygroma).
Sixteen cases of cervical cystic lymphangioma are reported; all but two were present at birth. Intra-oral extensions were detected in five and three of these caused macroglossia resulting in partial respiratory obstruction. Mal-development of the jaws and consequent dental malocclusion is a possible complication of the condition. In planning the treatment of such patients, maxillo-facial surgeons and orthodontists should be consulted at an early stage. The treatment of choice is complete excision, but where vital structures are involved repeated sub-total excisions are advocated.
Child↗
The flaccid trachea and tracheoesophageal congenital anomalies.
The patient with an esophageal atresia associated with a distal tracheoesophageal fistula, is often found to have an abnormally soft trachea. The use of contrast material as an aid in the diagnosis of this congenital anomaly demonstrates radiologically the compressive effect that a dilated and hypertrophied proximal esophageal pouch has on the trachea of the newborn. It is postulated that this chronic compressive force plays a part in retarding the development of the trachea during fetal life. The important decompressive effect of a distal tracheoesophageal fistula allowing nonphysiologic escape of lung fluid, supplements this effect. Attention is drawn to the fact that tracheal compression plays an important part in the respiratory distress seen in these patients, both before and after surgical correction of the tracheoesophageal anomaly.
Cough↗
Serum and erythrocyte acetylcholinesterase activity in Hirschsprung's disease.
Acetylcholinesterase activity was measured in the serum and erythrocytes from 22 children. The 12 patients in whom the diagnosis of Hirschsprung's disease was confirmed, had a significantly higher concentration of enzyme in both serum and erythrocytes than the 10 children in whom the diagnosis was excluded. This systemic manifestation, may prove of value in the diagnosis of Hirschsprung's disease.
Acetylcholinesterase↗
Amoebic liver abscesses in infancy and childhood.
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Child↗
[Causes of burn injuries in children].
In this article the causes of burn injuries in a series of 236 children admitted to the burns unit of Red Cross War Memorial Children's Hospital are investigated. Special reference is made to housing conditions as a contributing factor. The findings suggest that overcrowding and inadequate bathing and cooking facilities are conditions permeating almost all other contributory factors. More pertinent preventative measures are recommended.
Baths↗
Children with thyroid carcinomas.
The presenting symptoms and the clinical findings in 4 children with histologically proven thyroid carcinomas are described. The child with a single nodule in the thyroid gland, the child with a dyshormonogenetic goitre, the child with a thyroglossal duct remnant and the child with thyroid carcinoma and metastatic cervical lymph node involvement are discussed separately.
Adenocarcinoma↗
"Thoracoschisis" associated with an ipsilateral distal phocomelia and an anterolateral diaphragmatic hernia--a case report.
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Abnormalities, Multiple↗
Qualitative and quantitative evaluation of internal anal sphincter function in the newborn.
One-hundred-and-one normal neonates were examined manometrically in the first day of life to assess anorectal function. In order to overcome some of the difficulties in subjective interpretation of results, the stimuli used and the response pattern seen in the anal canal were measured. In the unstimulated state, all subjects demonstrated rhythmical changes in anal canal tone. Mean maximal intraluminal pressure in the anal canal decreased significantly after 10 hours of age and after the first meconium stool. Only five out of the 101 examined on the first day of life had an abnormal manometric response. It is significant that none of these had passed meconium at the time of examination, and that all had a normal response pattern at the age of 28 hours. In 20 of these babies the sensitivity of the rectoanal reflex was measured and found to be significantly increased on the third day of life compared with the first. The quantitative changes in anorectal reflex function in the newborn, are thought to be related to the state of physiological ;constipation' which exists in utero and in the early neonatal period. The results indicate that a normal response pattern can be obtained in healthy babies after the first day of life. Consequently, anorectal manometry will be meaningful as a diagnostic method thereafter in the neonatal period. Further, it is suggested that measurement of the stimulus and the response will add useful information and reduce subjective error in interpretation of results.
Age Factors↗
A review of deaths in a paediatric burns unit.
During a 5-year period, 1970 to 1974, a total of 2 118 new patients were admitted to the Burns Unit of the Red Cross War Memorial Children's Hospital in Cape Town. There were 35 deaths. The main complications and causes of death in these 35 patients are critically analysed and standard management methods are reviewed to highlight mistakes in the management of burns.
Bacterial Infections↗
Stomas in children.
During a 2-year period 176 stoma operations were performed at the Red Cross War Memorial Children's Hospital, for various conditions. About 50% were performed on neonates and a further 30% on infants under 1 year of age. The majority of stoma operations in this age group are performed as emergencies and the stomas are temporary. Only 10% are permanent. The specific stomas, the indications for these, some special points in technique, and the complications are considered and discussed. The management of an infant or child with a stoma is reviewed and the value of a stomatherapist in a surgical unit is stressed.
Cecum↗
Oesophageal atresia and tracheo-oesophageal fistula.
The operative management of oesophageal atresia is reviewed. The operative technique and the approach to management, based on antomical classification of oesophageal atresia and classification into 3 different risk groups, are stressed. The embryology, aetiology, clinical features, symptoms and signs and radiological diagnosis of this condition are also briefly discussed.
Esophageal Atresia↗
Portacaval shunt in two patients with homozygous type II hyperlipoproteinaemia.
We report the clinical and biochemical course of 2 patients who underwent portacaval shunting for the relief of homozygous type II hyperlipoproteinaemia. In our first patient, the initial favourable clinical and biochemical response subsequently deteriorated and a splenoportogram revealed the presence of a blocked splenic vein with a large collateral blood supply to the liver. The second patient has responded quite dramatically; there has been relief of her preoperative anginal attacks and a significant fall in her plasma cholesterol concentration. The present role of portacaval shunts in the management of this conditions is discussed.
Child, Preschool↗