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Biomedical subjects

S W Moore

Publications and source records attributed to S W Moore.

At least 55 records · Page 3Linked to original sources
PubMed1994

Fenestrated duodenal membranes: an analysis of symptoms, signs, diagnosis, and treatment.

Duodenal obstruction typically occurs in the ampullary region and presents in the early neonatal period. If the obstruction is incomplete, as with a fenestrated duodenal membrane, the presentation may be delayed and the diagnosis overlooked. Sixteen patients with fenestrated duodenal membranes presented over a 23-year period. Six presented in the neonatal period, with vomiting; an abdominal x-ray was diagnostic in four. Ten presented later (5 weeks to 14 years) with nonspecific symptoms, ie, failure to thrive, postprandial epigastric distension, and recurrent chest infections. Vomiting occurred in all, but was of short duration (< 1 week). Two patients in the delayed group had Down's syndrome. Diagnosis was confirmed on barium meal, and optimal surgical treatment was a bypass duodeno-duodenostomy. The diagnosis of fenestrated duodenal membrane must be considered in all cases with symptoms and signs suggestive of upper gastrointestinal tract obstruction, and excluded by contrast radiology.

Adolescent↗
PubMed1994

A histological grading system for the evaluation of co-existing NID with Hirschsprung's disease.

The significance of dysplastic features in the surgical pullthrough segment of bowel in patients with Hirschsprung's disease (HD) has not yet been clarified. The aim of this study was to evaluate prospectively the ganglionated proximal bowel in 26 patients with HD (January 1988 through January 1991). The significance of dysplastic features and their influence on post operative outcome were evaluated by means of a newly devised histological scoring system based on the morphological features. Functional outcome was assessed clinically at follow-up interview. Comparison was with control specimens from 22 patients undergoing unrelated bowel surgery and a further 5 patients with neuronal intestinal dysplasia (NID). Results indicated a wide spectrum of histologically identified dysplastic features in patients with NID, the ganglionated bowel of HD and controls. Although individual abnormal features were noted in the control group, significant degrees of dysplasia were absent. The overall degree of dysplasia was less striking than that observed in NID and in the 5 patients in whom NID co-existed with HD. Dysplasia of the ENS in residual bowel could be correlated with postoperative dysfunction in 4 out of 5 patients (80%) with HD and features of co-existing NID. In addition, milder symptoms were noted in 50% of patients having a borderline score (5-6/12). This study emphasizes the relationship between clinical obstructive symptoms and a high degree of dysplasia within the ENS. A histological grading system is of value in evaluating the spectrum of abnormal findings and prospectively identifying those with functional significance in patients with NID co-existing with HD.

Acetylcholinesterase↗
PubMed1994

A fiber optic system for measuring dynamic mechanical properties of embryonic tissues.

Dynamic mechanical properties of embryonic tissues, including viscoelasticity and active motility, play a major role in morphogenesis. Mechanical abnormalities resulting from altered cytoskeletal chemistry presumably contribute to spina bifida and other birth defects, but research in this area has been limited by inadequate mechanical measurement techniques. This paper discusses aspects of embryo tissues that make them difficult to measure and describes a versatile new system developed and used to study the biomechanics of morphogenesis in amphibian embryos. It incorporates a flexible optical-fiber probe driven by piezoceramic elements to impose and measure feedback-controlled, two-dimensional, time-varying patterns of stress or strain in the tissue. Compression, tension, and shear geometries are possible. Capacitive displacement sensors provide the precision and low drift rates required for these measurements. Software control permits the system to perform both standard and customized rheological tests, including interactive ones in which test parameters change in response to measured tissue behavior. Sample size range is 50 microns to 5 mm. Displacement range is 60 microns with a resolution of 0.1 microns. Force range is 10 microN with a resolution of 0.02 microN. Frequency range is DC to 20 Hz.

Amphibians↗
PubMed1994

Left-sided liver abscess in childhood.

Abscesses occur less frequently on the left side of the liver than on the right, and are implicated in a higher incidence of complications. Of a total of 124 children with liver abscesses seen at Red Cross War Memorial Children's Hospital from 1974 to 1990, 26 had left-sided and 98 right-sided lesions. A similar spectrum of organisms was cultured, and 20 (77%) of the left-sided abscesses were found to be caused by pyogenic organisms as opposed to 78 (79%) of those on the right. The remainder were of amoebic origin. In 5 patients with multiple abscesses involving predominantly the left side of the liver, the right side was also involved. These were excluded from further comparison of left and right liver abscesses. Of the remainder, 16 (62%) left-sided and 77 (83%) right-sided abscesses were solitary. Clinical features were similar in both groups but epigastric mass was more frequent in left-sided lesions. After an initially conservative management policy, surgical drainage was necessary in 87.5% of solitary left-sided liver abscesses as opposed to 64% of solitary right-sided abscesses. No intrapericardial ruptures were noted, but 2 pericardial effusions required drainage. There was no mortality but 3 patients with solitary left-sided abscesses ruptured. The important role of ultrasound in the diagnosis and follow-up period is stressed. Patients with solitary left-sided abscesses are identified as being at risk. Abscess drainage is recommended in this group.

Child↗
PubMed1993

Secondary effects of prolonged intestinal obstruction on the enteric nervous system in the rat.

Motility disturbances following prolonged intestinal obstruction have been attributed to secondary effects. This study aimed to demonstrate the effects of incomplete obstruction on the enteric nervous system (ENS) of a rat model. Surgical placement of a nonstrangulating ligature encircling the distal bowel was performed in 41 freshly weaned rats. Anesthetic protocol included Ketamine, ether, or Xylazine (an alpha 2-adrenergic agonist). Histological evaluation was by ganglion cell morphology, histochemical staining for acetylcholinesterase (AChE) and tyrosine hydroxylase (TOH) immunocytochemistry. Forty-one freshly weaned LE rats were divided into controls (8), sham procedures (8), intestinal obstruction (16), and a group of rats with colonic biopsy performed prior to and following experimental obstruction (9). The rats were sacrificed at periods varying between 14 and 45 days post experimental obstruction (median survival, 27 days). Histological changes included elongation of ganglion cells and a decrease in the number per 5-mm slide in obstructed animals. No other obstruction specific differences were detected. A significant (P < .01) increase in AChE in the submucous plexus was recorded in Xylazine-anesthetized animals. No obstruction-specific effects could be demonstrated in the ENS, suggesting that prolonged obstruction without ischemia does not result in any significant alterations in the ENS. Pharmacological stimulation of the alpha 2-adrenergic receptor appeared to result in an increase in AChE. This mechanism may help to explain a possible role for the adrenergic system in the increased AChE levels in affected bowel in patients with Hirschsprung's disease.

Acetylcholinesterase↗
PubMed1993

Acquired aganglionosis following surgery for Hirschsprung's disease: a report of five cases during a 33-year experience with pull-through procedures.

Acquired Hirschsprung's disease is a rare and controversial form of colonic aganglionosis. Little is known about its aetiology and pathogenesis. We report five cases encountered amongst 173 long-term follow-up patients treated for classical Hirschsprung's disease between 1957 and 1990 at the Red Cross Children's Hospital, Cape Town, and review the current literature. The clinical and pathological findings of the cases have been studied to explore possible aetiological mechanisms. Our cases, like most of those previously reported, developed obstructive symptoms and acquired aganglionosis in pulled-through bowel which had been previously confirmed as ganglionated. Two patients had histological evidence of hyaline fibrosis of blood vessels in the segment of bowel with acquired aganglionosis. Such fibrosis and other features attributable to regional hypoxia were not found in the other three cases. It is suggested that ischaemia with fibrosis may have a pathogenetic role in some, but not all, cases of acquired Hirschsprung's disease. A plea is made for patients developing recurrent symptoms of Hirschsprung's disease, after adequate surgical correction, to be fully studied with repeated sequential biopsies in order to gain a better understanding of the entity.

Child, Preschool↗
PubMed1993

Degenerative leiomyopathy in African children: a review of current perspectives.

The syndrome of degenerative leiomyopathy causing intestinal obstruction clinically manifests in young indigenous African children as massive megacolon without aganglionosis. Eighteen children have been seen over a 16 year period from a localized geographic area. There were 10 males and 8 females having a mean age of 9.5 years at presentation and a mean duration of symptoms of 4.3 years. The youngest was 6 months old. All had progressive abdominal distension and infrequent stooling but 11 had intermittent diarrhoea and 9 had colicky abdominal pain. Gross gaseous distension of the large bowel with extension into small intestine occurred in 9 and this extended into stomach and oesophagus in 4. Biopsy of the dilated, thin walled bowel showed smooth muscle degeneration and necrosis with replacement by fibrous tissue. Neuronal cells of Auerbach's plexus tend to be displaced into the circular layer of smooth muscle with mild inflammatory changes. Some small arteries show medial fibrosis with subintimal fibroblastic proliferation. Acetylcholinesterase and immunohistochemical staining with neural and muscle markers are within normal limits. One child died while 14 have been maintained on prokinetic agents, low residue diets, laxatives and enemas. Nine children have required surgical intervention of whom 4 had volvulus and 3 adhesive bowel obstruction. Degenerative leiomyopathy is a distinctive entity with classical clinical and histological features. The aetiology is still obscure.

Biopsy↗
PubMed1992

Is tube cecostomy safe in the surgery of Hirschsprung's disease?

The use of concomitant tube cecostomy remains an option for decompression after distal large-bowel surgery but has been criticised because of a reported high complication rate. Two hundred and three patients who underwent a Soave endorectal pull-through procedure for Hirschsprung's disease (1974-1990) were evaluated. Operative technique included a modified sutured Soave endorectal pull-through procedure and a Stamm tube cecostomy utilising a large-lumen catheter. One hundred and twenty patients who had a modified two-stage procedure plus concomitant tube cecostomy were compared with 83 patients who underwent a three-stage procedure with colostomy cover. Early postoperative complications occurred in 8 patients (6.6%) in whom cecostomies were performed. A distal cuff abscess developed in 1 patient (0.8%), an anastomotic leak in 1 (0.8%) and 3 patients (2.5%) had colo-anal stenosis. The cecostomy tube dislodged in 2 patients and 1 required operative closure of a faecal fistula at the cecostomy site. Colonic venting was adequate and little nursing care was required. In 2 instances colonic distension developed after cecostomy clamping. Decompression was achieved by opening the cecostomy tube; this resulted in relief of symptoms and a good subsequent recovery. In contrast, there were 11 postoperative complications in the 83 patients undergoing a three-stage procedure (13.2%). In 2 patients (2.4%) an anastomotic leak occurred and 5 distal cuff abscesses (6%), 3 (3.6%) early strictures and 1 (1.2%) neorectal retraction developed. The use of a concomitant tube cecostomy with a two-stage Soave procedure is an effective and safe means of providing proximal colonic venting and did not add to mortality or morbidity.(ABSTRACT TRUNCATED AT 250 WORDS)

Cecostomy↗
PubMed1991

Familial aspects of Hirschsprung's disease.

Twenty-eight of 370 patients (14 families) treated for Hirschsprung's disease (HD) over a 34 year period had a family member with histologically proven HD. These 14 represented 4% of the 351 families: more than one affected child per family in 10 (2.8%) and both parent and child in 2 families. Neuronal intestinal dysplasia (NID) in a parent was associated with total colonic aganglionosis in two siblings of one family which suggests a similar genetic inheritance pattern to HD. Aganglionosis extended beyond the rectosigmoid in 61% of the familial group as opposed to 27% of the non-familial group. A significantly higher number of total colonic aganglionosis (TCA) was noted in those with a family history; 11 out of 28 (39%) as opposed to 19 out of 342 (5.6%) without a family history (p less than 0.001). Fifty percent of males with TCA had a family history but in only 2 cases was this transmitted through a female sibling. Although no significant difference was noted between male and female probands, a three times higher incidence of familial occurrence was noted in females with rectosigmoid disease than in males. Progression of length of segment in succeeding generations was noted in two families. Associated anomalies occurred in 16% without familial occurrence and 11% of the familial group.

Adult↗
PubMed1989

Ultrasonic features of pyogenic and amoebic hepatic abscesses.

Pyogenic liver abscesses are not infrequent in some developing countries. Amoebic abscesses may also occur in endemic areas and differentiation may be difficult. The ultrasonic data of proven cases of both conditions were compared and we are now more more confident in predicting the aetiology of these lesions.

Child↗
PubMed1986

Variable speech control vs Varispeech: does newer mean better?

Normal-hearing volunteers (N:30, aged 19-28 yrs) yielded intelligibility scores for W-22 word lists and CID sentences at 40 db re each S's SRT, and judgments on a 7-pt scale ("very pleasant"----"very unpleasant") for Sentence 3 of Fairbanks' "Rainbow Passage". Normal and time-altered speeds (60%: compression; 140%: expansion) were compared between the widely-used but obsolescent Lexicon Varispeech (VSp) unit vs the commercially available Variable Speech Control Model A-7 which incorporates a time-sampling technique similar to the VSp. With both VSp and VSC, intelligibility was nearly perfect at all three speeds, and thus both appear equally suitable for intelligibility studies, but at the 60% and 140% speeds the signal clarity was significantly preferable for the VSp system (p less than .01 in both cases), by .6 of a scale interval at 60% and 1.8 interval at 140%. Furthermore, the VSC does not operate beyond the 60-140% range, as occasionally may be desirable in research on the effects of time alteration on speech reception.

Adolescent↗
PubMed1980

Blunt abdominal trauma with jejunal injury: a review.

Jejunal perforation is relatively common following focal blunt abdominal trauma. The mortality rate remains in the region of 30%. Significant factors affecting mortality are therapeutic delay of 24 hours or more, and multiple injuries. The commonest clinical features are abdominal pain, tenderness, and guarding, diminished or absent bowel sounds and signs of hypovolemia. Diagnostic difficulty is presented by the patient with an impaired level of consciousness and/or associated remote injuries which may distract the clinician from the abdomen. Delayed rupture may also occur, and observation should continue for at least 48 to 72 hours with a warning to return immediately if pain recurs. Straight abdominal and chest radiography are of limited diagnostic value, but nevertheless may prove helpful in 50% of cases. All patients with multiple injuries, particularly in the presence of a head injury with an impaired level of consciousness should be submitted to diagnostic abdominal paracentesis. A negative result should prompt diagnostic peritoneal lavage. Early diagnosis and aggressive therapy are essential if the mortality is to be reduced. To this end careful, frequent abdominal assessment should be practiced, with immediate laparotomy if clinical parameters deteriorate, or do not improve over a 12 to 18-hour period.

Abdominal Injuries↗
PubMed1977

Role of surface mucin in primary antibacterial defense of bladder.

Histochemical staining of bladder tissue has demonstrated a discrete layer of mucopolysaccharide (mucin) at the surface of rabbit and human bladders. This mucin is disrupted by acid treatment and is probably resynthesized by the transitional cells in less than twenty-four hours and replaced by forty-eight hours. Physiologic data indicate that bladder mucose can resist bacterial attachment, a function that is also disrupted by acid and recovers in less than twenty-four hours. These findings suggest that the surface mucopolysaccharide inhibits bacterial binding and may be the primary antibacterial defense of the urinary tract.

Adsorption↗
PubMed1975

Epitheloid sarcoma masquerading as Peyronie's disease.

A 23-year-old man presented witha firm plague-like penile mass with pain and deviationon erection, suggesting Peyronie's disease. Biopsy was erroneously interpreted asconformatory. Irradiation was the one mode of therapy which gave temporary subjective relief. Extension of the mass and focal gangrene led to rebiopsy 6 years later. Epithelioid sarcoma was present microscopically, and was also found on re-examination of theoriginal biopsy. Partial penectomy was performed, but pulmonary metastasis had alreadyoccurred. He was treated with chemotherapy and radiotherapy and is now alive with disease 2 years later. The diagnosis of possible penile sarcoma, although rare, must be considered in patients with symptons suggesting Peyronie's disease, especially if the lesion continues to enlarge.

Biopsy↗
PubMed1975

Significance of proliferative epithelial lesions of the uterine tube.

Proliferative epithelial lesions of the oviduct have been called adenomatous hyperplasia or carcinoma in situ. In order to assess the incidence and significance of these lesions, we sectioned entire oviducts from 124 nonselected hysterectomies. We found 23 cases (18.5%) with lesions corresponding to those described in the literature. We have found no justification for diagnosing and treating these lesions as carcinoma in situ. There appears to be an association with salpingitis.

Adult↗