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Dive into the research topics where Clinton A. Stephens is active.

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Featured researches published by Clinton A. Stephens.


Journal of Pediatric Surgery | 1971

Intussusception: 354 cases in 10 years

Sigmund H. Ein; Clinton A. Stephens

Abstract There are about 35 cases of intussusception treated annually at The Hospital for Sick Children, Toronto. Only cases of intussusception observed by barium enema examination or at operation were included in this 10-year study involving 336 patients. Three fourths of the intussusceptions occurred in children under 2 years. Males predominated in a ratio of 2:1. A peak monthly incidence was noted in May and June; this did not correlate with the hospital incidence of upper respiratory tract infection and/or gastroenteritis. The average duration of signs and symptoms prior to making the correct diagnosis was 24 hours. Pain was the commonest presenting symptom, along with vomiting, a palpable abdominal mass, and blood per rectum. Forty-five per cent of these children who were given barium enemas had their intussusceptions reduced. Attempted hydrostatic reduction was not carried out in 25 per cent of the cases, mainly because the children were too sick. Seventy per cent of the children were operated on. Most of the intussusceptions were of the ileocolic variety. Pathological lead points were not frequently recognized. Postoperative complications were more frequent in those cases where the duration of the presenting signs and symptoms were longer than the average. Five cases of postoperative intussusception were recognized. The total recurrence rate was 4 per cent. Although the incidence of recurrent intussusception after barium enema reduction was 11 per cent, only 3 per cent recurred after operative manual reduction. The mortality in our series was zero.


Journal of Pediatric Surgery | 1978

Nonoperative management of traumatized spleen in children: How and why

Sigmund H. Ein; Barry Shandling; James S. Simpson; Clinton A. Stephens

In the absence of the apleen, overwhelming infection is a real threat. Therefore, there is a trend to try to preserve all spleens. Recognizing this, and realizing that not every damaged spleen must be removed, a nonoperative approach has been advocated and practiced for 35 yr at the Hospital for Sick Children in Toronto. This experience is recorded herein, providing indications and methods of management. The results are considered to be very satisfactory.


Journal of Pediatric Surgery | 1981

Ruptured spleen—When to operate?

David E. Wesson; Robert M. Filler; Sigmund H. Ein; Barry Shandling; James S. Simpson; Clinton A. Stephens

Sixty-three patients with splenic injuries were treated during a 5-yr period from 1974-1979. The decision to operate was based on the patients clinical course, not on the presence of splenic injury alone. Those who were stable on admission or after initial resuscitation were treated nonoperatively. This consisted of strict bed rest, nasogastric suction, and i.v. fluids--including blood--as required. Those who bled massively were operated on promptly. At operation, the spleen was repaired if possible or excised if damaged beyond repair. Forty patients were treated nonoperatively. Sixteen of these required blood transfusions (mean 31.2 +/- 5.3 ml/kg). One patient in this group developed a large defect on spleen scan at 3 wk post injury. There was no other morbidity and no mortality following nonoperative treatment. Nineteen required operation all within 16 hr of admission. Fifteen underwent splenectomy, 2 partial splenectomy, and 1 splenorrhaphy. In 1 the bleeding had stopped. All required blood before operation (mean 80.4 +/- 10.1 ml/kg). Seven in this group died (6 from head injuries and 1 from bleeding). Thus surgery was avoided in 2 out of 3 and the spleen saved in 3 out of 4 patients with documented splenic injuries. We believe that where adequate facilities exist nonoperative treatment of splenic injuries is both safe and effective. When bleeding is massive from the beginning or replacement requirements exceed 40 ml/kg, operation is indicated.


Journal of Pediatric Surgery | 1974

Resistant esophageal stenosis associated with reflux after repair of esophageal atresia: A therapeutic approach+

Raphael Pieretti; Barry Shandling; Clinton A. Stephens

Summary This paper reviews 15 patients with severe, persistent stenosis after repair of tracheoesophageal fistula and esophageal atresia over a 15-yr period 1958–1973. These obstinate stenoses could be secondary to gastroesophageal reflux, which seems to cause inflammation and undue cicatrization at the site of the anastomosis. Attempts at conservative management were not successful. In all 15 patients antireflux operations cured the stenoses.


Journal of Pediatric Surgery | 1970

Cystic and solid ovarian tumors in children: A 44-year review

Sigmund H. Ein; J.M.M. Darte; Clinton A. Stephens

Abstract Cystic and solid ovarian tumors in children are not common, but should be considered in the differential diagnosis of acute abdominal pain in girls. They frequently undergo torsion of their pedicles and in such circumstances must be differentiated from acute appendicitis or other abdominal emergencies. They may also be the cause of chronic abdominal pain or of an abdominal mass. Hormonal changes may occur with ovarian tumors but are not commonly seen. The treatment is prompt surgical removal and, in benign tumors, is accompanied by an excellent prognosis. Malignant tumors vary greatly in their degree or malignancy but when removed before spread has taken place, they may be accompanied by a relatively good prognosis. Radiotherapy may be used if removal has been incomplete.


Journal of Pediatric Surgery | 1980

Nonsurgical management of appendiceal mass in late presenting children.

Joseph S. Janik; Sigmund H. Ein; Barry Shandling; James S. Simpson; Clinton A. Stephens

Thirty-seven late presenting children with appendiceal mass were treated between 1965 and 1975 with i.v. fluids, alimentation according to the state of gastrointestinal function, and no antibiotics. They ranged in age from 18 mo to 16 yr and all had had symptoms for at least 5 days (mean 8.7), an abnormal WBC (mean 19.9), and a fixed palpable mass without rebound tenderness. Children were discharged when clinical findings resolved. All returned for interval appendectomy. Eighty-one percent (31 children) had clinical improvement within 5-22 days (mean 10.9). Nineteen percent (7 children) had recurrence or worsening of symptoms and required abscess drainage within 2-10 days after observation began. No child in either group received antibiotics nor did any die. Only one recurrence of symptoms after discharge was recorded before interval appendectomy. Pathologic specimens revealed fibrosis in 46%, subacute inflammation in 35%, and acute inflammation in 19%. Nonoperative management of the appendiceal mass without antibiotics in children is safe as long as diligent observation is maintained. Interval appendectomy can be performed as late as 20 wk after symptom resolution or drainage, however, over 50% of the interval appendectomy specimens reveal acute and subacute inflammation.


Journal of Pediatric Surgery | 1981

An assessment of the surgical treatment of adhesive small bowel obstruction in infants and children

Joseph S. Janik; Sigmund H. Ein; Robert M. Filler; Barry Shandling; James S. Simpson; Clinton A. Stephens

At The Hospital for Sick Children, Toronto, Canada, adhesive small bowel obstruction (SBO) ranks seventh as a cause of pediatric bowel obstruction. Between January 1968 and December 1979, 131 infants and children had adhesive SBO proven at laparotomy or autopsy: 123 had 1; 7 had 16 adhesiotomies; 1 died without surgery; 100 had 1 prior operation; and 31 had multiple operations. Over 80% of the SBOs developed within 2 yr of the prior operations. Appendectomy and subtotal colectomy were the most common prior operation. Postoperative morbidity occurred in 29 children; 20 were observed longer than 24 hr before laparotomy. The rate of wound infection ranged from 4% to 50%; it was lowest for those children who had lysis of adhesions only, and highest for those who had lysis and decompressive enterotomy or perforation repair. Results indicate that delaying adhesiotomy and entering the GI tract during adhesiotomy are associated with increased morbidity (p less than 0.01), and therefore should be avoided. Prophylactic antibiotics may have a protective role during anterolysis.


Journal of Pediatric Surgery | 1984

Thirty years of experience with pediatric primary malignant liver tumors

M. Giacomantonio; Sigmund H. Ein; Kent Mancer; Clinton A. Stephens

Since 1950, 48 infants and children from 10 weeks to 16 years of age presented with primary hepatic malignancy. Signs and symptoms ranged from asymptomatic to those of malignant disease. All patients had a palpable abdominal mass. Jaundice was seen in five patients, four of whom had preexisting cirrhosis. Three male children had evidence of precocious puberty. Whereas liver function tests were usually normal, alpha-fetoprotein levels, when elevated, proved useful diagnostically and as a tumor marker in follow-up. Hepatic angiography and computed tomography (CT) scans have provided the most valuable preoperative assessment of hepatic architecture. Sixteen infants and children underwent resection for cure. Eleven of these patients are alive and disease free 6 months to 23 years later. Six additional patients had incomplete resection with subsequent radiotherapy and/or chemotherapy; only one such patient is disease-free past 3 years. Twenty-six tumors could only be biopsied; most of these patients died within 12 months regardless of what treatment they received. The histology was hepatoblastoma in 39 patients, hepatocellular carcinoma in 4, fibrolamellar carcinoma in 4, and malignant mesenchymal tumor (mesenchymoma) in 1. The patients with hepatocellular carcinoma and mesenchymoma all died. Three of four patients with fibrolamellar carcinoma are alive and disease-free following resection up to 3 years; this histology seems favorable. The other survivors had hepatoblastoma. The role of adjunctive chemotherapy and/or radiotherapy has not yet been determined.


Journal of Pediatric Surgery | 1983

Recurrent tracheoesophageal fistulas seventeen-year review

Sigmund H. Ein; David A. Stringer; Clinton A. Stephens; Barry Shandling; James S. Simpson; Robert M. Filler

Twenty-three pediatric patients had recurrent tracheoesophageal fistulas during the 17-year period from 1965 to 1982 after 250 repairs of esophageal atresia and TEF. There were 13 males and 10 females. Four babies had their newborn repair at other hospitals. Sixteen atresias had end-to-end repairs (none under tension) while there were seven Duhamel repairs (six under tension). There were 9 postoperative leaks and 10 strictures; 8 babies had neither. The recurrent fistulas were diagnosed from 7 days to 9 years after newborn operation and more than 50% within two months. All but three had some coughing, choking, gagging, cyanosis, apnes, dying spells, wheezing, and recurrent chest infection. Each fistula was diagnosed by barium swallow, although in four patients as many as six x-rays were needed before it was identified. Not one bronchoscopy in seven infants was diagnostic. All fistulas but one were repaired. No fistula closed spontaneously. They were repaired between 1 day and 14 months after diagnosis, most within 7 months. Recovery in the majority of cases was uneventful. However, 5 of the 22 repairs had a second recurrent TEF presenting in similar fashion between 2 weeks and 2 years; all but one within 11 months. All were repaired within 9 months of discovery. The DuHamel anastomosis was more prone to recurrent fistulization than the more common end-to-end type. More of our own patients had their original anastomosis done without any tension. Under these circumstances the esophageal anastomosis is in close proximity to the tracheal closure and a leak or local abscess could easily result in a reconnection between the esophagus and trachea. Any TEF baby who has signs and symptoms related to feeding and/or chest infections must be considered to have a recurrent TEF and a persistent and diligent search should be made for it.


Journal of Pediatric Surgery | 1968

Esophageal replacement with a gastric tube in infants and children

John D. Burrington; Clinton A. Stephens

Abstract 1.1. Esophageal replacement or by-pass with a tube created from the greater curvature of the stomach has proved successful in 8 children ranging in age from 212 months to 16 years. Four of these replacements were performed for congenital esophageal atresia, three for lye stricture and one for peptic esophagitis. 2.2. When possible, the upper anastomosis should be performed at the initial operation if there is no pre-existing cervical esophagostomy. Using this technique we have had no anastomatic leaks. Angulation of the tube in the neck was minimal. 3.3. The tube serves as a relatively inert conduit and seems to retain its tone and empty quickly. There has been no problem with stasis. 4.4. Reflux can be demonstrated radiographically, but has not caused symptoms. None of the patients regurgitate and all can lie down after eating. 5.5. This type of esophagoplasty is ideally suited to the infant with associated colon or anal malformations and to those with a colonic blood supply unsuitable for support of a colon transplant.

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David E. Wesson

Baylor College of Medicine

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