Biomedical subjects
Publications and source records attributed to S W Beasley.
A 9 year old girl presenting with multiple glomus tumours is reported. Multiple glomus tumours are rare, often asymptomatic lesions, with a familial tendency and found in a more proximal location than their solitary counterparts. In our report four close relatives had similar lesions. Indications for surgical excision are discussed.
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Crossed testicular ectopia is a rare condition which usually presents as a hernia on the side of a fully descended testis and an impalpable testis on the contralateral side. At operation two testes are found on the side of the hernia. A case of crossed testicular ectopia where both testes had failed to reach the scrotum is described. The criteria for diagnosis of crossed testicular ectopia are listed and the appropriate management of the disorder is discussed.
The management of splenic trauma at the Royal Children's Hospital from January 1973 to January 1984 is reviewed. During the period studied there was a trend toward non-operative management in uncomplicated cases, and where laparotomy was required splenic repair rather than splenectomy was performed. Guidelines are given for the selection of patients who can be treated in safety without operation.
The EEA stapler has been used at Wellington Hospital in 83 patients. The use of the instrument in 72 patients with colorectal disease is described. Fifty-one patients had malignant disease. Prior bowel preparation and perioperative antibiotics were used routinely. A 'low' anastomosis was performed in 26 patients. Complications relating to the integrity of the anastomosis occurred most frequently in low rectal cases and did not appear to be influenced by the presence or absence of a diverting colostomy. Tumour clearance was compromised (less than two centimetres) in 10 out of 23 patients with 'low' tumours. Two staple line recurrences occurred in this group.
Oesophageal atresia in which there is a long gap between the ends of the oesophagus remains one of the most difficult problems confronting the pediatric surgeon. While it is generally accepted that the best results are obtained if oesophageal continuity is established, this may be difficult to achieve. Various manoeuvres have been advocated to mobilise and lengthen the oesophagus, and if these measures fail, cervical oesophagostomy and oesophageal replacement may become necessary. This paper outlines the situations in which long gap oesophageal atresia might be expected, how infants should be investigated to determine the most appropriate type and time of procedure, and provides a basis for surgical decision-making during the operative procedure itself. These guidelines should enable oesophageal continuity to be obtained in the vast majority of infants with long gap oesophageal atresia.
Associated congenital abnormalities occur in over 50% of infants with oesophageal atresia. Many of them influence the way in which the oesophageal atresia is managed and therefore should be detected as soon as possible after birth. Early recognition of those with no prospect of long-term survival (e.g. Trisomy 18, bilateral renal agenesis) will avoid unnecessary surgery to the oesophagus. About 12% of oesophageal atresia infants will have no surgery performed. This paper presents a protocol for the initial investigation and management of associated anomalies in oesophageal atresia, based on an experience of 670 infants treated at the Royal Children's Hospital, Melbourne, Pre-operative detection of associated anomalies of oesophageal atresia requires clinical examination, pre-operative renal ultrasound (if the child has not passed urine), and an echocardiograph of the heart to exclude duct-dependent lesions. If there is clinical suspicion of a major chromosomal abnormality, surgery should be deferred until chromosomal analysis has been completed.
A 3-month-old infant died following a 3-week illness that commenced with diarrhoea and vomiting, and produced progressive infarction of his small bowel. Post-mortem identified multiorgan arteritis of uncertain aetiology, giving rise to coronary artery occlusion and myocardial infarction as well as necrosis of the entire small bowel and other organs. Kawasaki disease and polyarteritis nodosa of infancy are proposed as possible aetiologies in this case.