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Biomedical subjects

A G Coran

Publications and source records attributed to A G Coran.

At least 163 records · Page 9Linked to original sources
PubMed1983

The quantitative transperitoneal absorption of a fat emulsion: implications for intraperitoneal nutrition.

Intraperitoneal (IP) administration of nutrients would be an attractive alternative to intravenous nutrition since it eliminates intravascular complications. If glucose alone were used as the nonprotein calorie source, associated fluid shifts might not be well tolerated by the patient. A fat emulsion does not have osmotic properties and thus might be incorporated into a program of IP nutrition as a calorie source. Transperitoneal absorption of a commercial fat emulsion (Liposyn 10%, Abbott Laboratories, N Chicago, IL) was studied in 12 beagle puppies divided into two groups. One group received 2.5 gm/kg of fat and the other group received a similar volume of 3.5% crystalline amino acids and 5% glucose in one IP dose. In the first group, the serum triglyceride (TG) increased three fold from 61 +/- 25 mg% to 185 +/- 61 mg% at 15 minutes and then decreased slowly while remaining significantly elevated (p less than 0.05) at 4 hours. 1.94 +/- 0.20 gm/kg of TG were absorbed from the peritoneal cavity over 4 hours. Concommitant IP administration of amino acids and glucose did not affect that absorption. Radiolabeled amino acids and glucose instilled IP were demonstrated in the blood immediately after administration and their absorption was not affected by the presence of a fat emulsion. Plasma free fatty acids showed a small increase at 4 hours (from 0.32 +/- 0.09 mEq/L to 0.59 +/- 0.22 mEq/L). Animals receiving no IP fat showed no change in serum TG. Serum glucose rose in both groups and serum cholesterol showed no changes in either group. Peritoneal fluid accumulation 4 hours after IP fat administration was minimal at 12.7 +/- 6.4 mL/kg. This study shows that a fat emulsion can be quantitatively absorbed from the peritoneal cavity over four hours and that IP nutrition may be feasible.

Absorption↗
PubMed1983

Cervical teratomas in the newborn.

Cervical teratomas are rare neoplasms which have been infrequently reported. During the period of July 1974 to April 1982, six newborns with this lesion were seen at the Mott Children's Hospital. There were three males and three females, all of whom presented at birth with large semicystic neck masses. In four infants, calcifications were seen on x-ray. Four patients required intubation within the first hours of life for respiratory distress. One child of 33 weeks gestation expired prior to operation because of a hypoplastic left ventricle and bilateral hypoplastic lungs. Cord blood T3 and T4 values were normal in three patients; the TSH was elevated 1.5 and 2 times normal in two of these infants. Four neonates were operated upon within 24 hours of birth and suffered no postoperative complications. One baby presented on the third day of life and expired three hours postoperatively from persistent respiratory distress. The tumors were well encapsulated and arose from or were surrounded by a lobe of the thyroid gland. In each case, the tumor was removed by performing a total thyroid lobectomy. The presence of normal thyroid tissue at the resection margin (in the isthmus) was verified by frozen section. One patient presented with cervical node metastases but is currently free of disease one year postoperatively. These six cases bring the total reported cases in the literature to 136. The 80% mortality in cases not operated upon has been reduced to 15% by prompt operation. This series substantiates the significant respiratory distress that can occur in newborns with cervical teratomas and confirms the need for emergency surgery in this group of patients.

Diseases in Twins↗
PubMed1983

The surgical management of terminal ileal and right colon Crohn's disease in children.

During a recent 7-year period, 11 children between the ages of 6 and 15 years underwent intestinal resection for terminal ileal and right colon Crohn's disease. The indications for surgery included: failure of medical therapy in 8 patients, growth retardation in 4, stricture formation in 5, abscess formation in 2, the presence of an enterocutaneous fistula in 2, and intestinal obstruction in 1. All children underwent resection of the grossly involved bowel. The sites of involvement were the terminal ileum and the ileocecal valve in 7 patients and the terminal ileum, cecum, and proximal right colon in 4. There were no postoperative complications or mortality. The follow-up in these patients ranged from 1 to 7 years with a mean of 2.6 years. Thus far, all patients are clinically well and off all medications. Only one questionable recurrence was seen in a teenage girl who was readmitted 3 years after a resection of her terminal ileum and cecum for Crohn's disease. A recent small-bowel series 4 years after the recurrence shows no evidence of Crohn's disease. The initial excellent results with resectional therapy in this small subgroup of children with Crohn's disease has prompted us to consider earlier surgical intervention in these patients.

Adolescent↗
PubMed1983

Radiologic evaluation of gastrostomy complications.

Radiologic examination plays a crucial role in the evaluation of suspected gastrostomy complications. This has not been stressed adequately in the radiologic literature. In a retrospective review of 230 patients who underwent tube gastrostomy for varied clinical conditions, 70 patients who had radiologic examination for evaluation of gastrostomy-related complications were identified. Thirty complications were diagnosed radiologically. There were 11 gastric obstructions, 11 tube displacements, four gastric ulcers, two gastric perforations, one leaking gastrostomy, and one broken gastrostomy tube. Gastric torsion and gastric pneumatosis are reported for the first time as complications of gastrostomy.

Adolescent↗
PubMed1983

Noncirrhotic portal hypertension: differing patterns of disease in children and adults.

Of 440 patients who underwent operative portal decompression to control variceal hemorrhage, 25 (6%) had histologically verified noncirrhotic portal hypertension (NCPH). A review of these patients identified two distinct patterns of disease. Fourteen children with an average age of 8.5 years were treated with no deaths at operation. Occlusion of the portal vein (PV) was demonstrated preoperatively or intraoperatively in 10 children (71%). Follow-up for 12 to 207 months showed that no children died of a liver-related illness and only one child (7%) developed portal-systemic encephalopathy (PSE). In contrast, 11 adults with an average age of 56 years were treated with an operative mortality rate of 18%. Occlusion of the PV was demonstrated angiographically in four adults (35%). Of nine surviving adults who were followed for 12 to 164 months, five adults (56%) manifested PSE. Intraoperative liver biopsy specimens were analyzed by light microscopy in all cases. With the possible exception of sinusoidal fibrosis and dilatation of intrahepatic portal venous radicles, no histologic discriminators of adult forms versus childhood forms were identified regardless of the status of the PV. We conclude that age stratification in patients with NCPH may provide important prognostic data regarding survival rates and the incidence of PSE after portal-systemic shunting.

Adolescent↗
PubMed1983

Liver fibrosis (cardiac cirrhosis) five years after modified Fontan operation for tricuspid atresia.

A 15-year-old girl was found to have severe liver fibrosis on liver biopsy at the time of cholecystectomy, 5 1/2 years following a modified Fontan procedure (right atrial-right ventricular conduit) for tricuspid atresia. Postoperative right atrial pressures were consistently elevated above 13 mm Hg and this, in part, may have been due to progressive mild conduit stenosis. Because of increasing symptoms, the patient underwent successful revision of the conduit at the age of 15 years. It is suggested that sustained systemic venous hypertension caused the striking morphologic changes in the liver and that this serious complication may significantly affect the long-term prognosis of patients surviving the Fontan procedure.

Adolescent↗
PubMed1983

The endorectal pull-through for the management of ulcerative colitis in children and adults.

Between June 1977 and November 1981, 26 children and adults with ulcerative colitis have undergone a total colectomy, an endorectal dissection of the rectal mucosa, and an ileoanostomy. A combined abdominoperineal approach was used to perform the operation, and the mucosal-submucosal rectal tube was dissected out intact from the abdominal approach. Every patient survived the operation and showed marked clinical improvement presumably due to resection of the diseased colon. Three patients developed intestinal obstruction that was successfully treated with an enterolysis. A rectal cuff abscess and a retroperitoneal abscess were the only other complications. The postoperative stooling pattern of each patient was obtained through detailed interviews. All the patients were continent during the day and at night one month after surgery. Twenty-two patients had a median stool frequency of seven per 24 hours one month after surgery. At one year, the average number of stools was seven per day. Six patients experienced a stool frequency of seven per 24 hours two years after surgery. The results with this series of patients had encouraged the authors to continue to recommend this approach to children and adults with ulcerative colitis, since it offers an alternative lifestyle that is more attractive to certain patients than the presence of an abdominal stoma.

Adolescent↗
PubMed1982

Modification of the serum bromide assay for the measurement of extracellular fluid volume in small subjects.

Serum bromide has been used in the past to measure extracellular fluid volume in infants. In this report, a modification and refinement of a previously described spectrophotometric assay suitable for determining bromide levels in blood is presented. The assay involves sample deproteinization with perchloric acid followed by spectrophotometric analysis of the complexes formed by the reaction between sodium bromide and gold chloride. Linear standard curves were obtained by diluting 1:2 with pooled serum at the following bromide concentrations: 10, 20, 30 and 40 mg%. Intra- and interassay variation using this technique was extremely small (n = 6, correlation coefficient, 0.995, and n = 5, correlation coefficient, 0.988, respectively). For toxicological analysis, a linear standard curve was derived from sodium bromide standards at the following concentrations: 40, 60, 80, and 100 mg%. The reproducibility and reliability of this assay have been excellent and the correlation with neutron activation analysis was excellent. The assay is easily adapted for the analysis of large numbers of samples, is easy to perform, and requires only small sample volumes.

Age Factors↗
PubMed1982

The impact of pediatric surgery training on the attitudes and practice patterns of general surgeons.

In order to evaluate how experience in pediatric surgery during residency training affects attitudes and practice patterns of general surgeons, questionnaires were sent to the 51 residents who graduated from our general surgical residency program since the establishment of a Section of Pediatric Surgery in 1974. There were 51 respondents (100%) of whom 50 were male and 1 female. Three were pediatric surgeons and their responses to the questionnaire were not included in the analysis. During the past year, 29 of the respondents had performed from 2 to 55 pediatric operations, with a mean of 23.7. Most of these were herniorrhaphies, appendectomies, and sub-specialty cases. Thirty-two of the 48 respondents referred most pediatric cases to a board certified pediatric surgeon nearby. Ninety-two percent of the respondents indicated that pediatric surgery rotations were of great value in their training (6.3 mean response on a scale of 7) and 92% felt that pediatric surgery was a necessary part of a general surgery training program. Respondents had a mean exposure of 1.8 mo to pediatric surgery as junior residents, and 2.1 mo as senior residents; 90% felt that their operative experience was good to excellent (5.5 mean on a scale of 7). Most respondents felt qualified to do many more pediatric procedures than they actually performed; however, their perception was that these cases were best done by fully trained pediatric surgeons. The 51 graduates of our general surgical residency program considered pediatric surgery an important factor in the development of their technical skills and surgical judgment.

Attitude of Health Personnel↗
PubMed1982

The successful management of chronic constipation in infants and children.

During a 3 yr period, 77 patients with functional constipation and 34 patients with constipation related to organic lesions of the anorectal area were managed with a strict regimen employing the long-term use of daily enemas. Seventy-four percent of the patients with functional constipation had excellent results and the rest had good results. In children with associated anorectal anomalies, 52% had excellent results, 35% had good results and only 13% had a poor result. A detailed flow chart of the workup and treatment regimen is presented.

Adolescent↗
PubMed1982

Complete resolution of life-threatening hemangioma by embolization and corticosteroids.

A case is presented in which congestive heart failure and thrombocytopenia were complications of an inoperable hemangioma in a neonate. Selective embolization of the hemangioma in the patient achieved significant diminution in the congestive failure and tided this infant through the first few days of life while awaiting positive effects from the steroids and external compression. The combined treatment modalities of selective embolization, external compression, and short course of low-dose systemic steroids resulted in a rapid and complete resolution of this life-threatening problem.

Adrenal Cortex Hormones↗
PubMed1982

Surgical management of ulcerative colitis.

Most patients with universal ulcerative colitis ultimately require a colectomy either to treat the inflammatory process or to prevent the subsequent development of a malignant tumour. Since the introduction of total proctocolectomy and ileostomy for the definitive surgical management of ulcerative colitis, this procedure has become the standard operative therapy for this disease. The description of the eversion technique of ileostomy in 1952 improved the life-style of patients with an ileostomy and made the total proctocolectomy a more attractive procedure. Nevertheless, many patients are emotionally disturbed by having an incontinent ileostomy and often will delay their surgery because of the associated psychologic trauma. Because of this, the Kock pouch or continent ileostomy has been introduced and advocated during the past decade. This procedure has met with notable success but has found less application in the younger patient. However, even the continent ileostomy is associated with a certain amount of psychologic trauma because of the abdominal stoma. Therefore, the endorectal pull-through has recently been used for the management of ulcerative colitis. First introduced in 1948, this procedure allows total removal of the diseased bowel, maintains continence and eliminates the need for an ileostomy. During the last 3 1/2 years, the author has used the endorectal pull-through to treat 24 patients with ulcerative colitis and 1 with familial polyposis. The results are encouraging in that all patients are continent and the average daily stool frequency is 6 to 10. These results and those of others support the continued use of this new surgical approach to the management of ulcerative colitis.

Adolescent↗
PubMed1981

Intragastric pressure measurement: a guide for reduction and closure of the silastic chimney in omphalocele and gastroschisis.

In newborn infants with omphalocele or gastroschisis, traditional criteria for reduction of the herniated viscera either primarily or after application of a Silastic chimney have been the baby's color, respiratory rate, and lower extremity turgor. These are not always accurate or immediately apparent. In order to define more objective guidelines for reduction, measurements of intragastric pressure through a gastrostomy tube using a water manometer were carried out. The validity of this pressure measurement was demonstrated in five puppies where intra-abdominal pressure correlated well with inferior vena cava pressure and intragastric pressure measured through a gastrostomy tube (R = .98 and .99, respectively). Over a 3.5-yr period, 25 newborn infants with omphalocele (9) or gastroschisis (16) were treated. Ten underwent primary closure, and 15 were treated by placement of a Silastic chimney with serial reduction and closure. Manual reductions were performed once or twice daily to a maximum intragastric pressure of 20 cm water. Greater pressures demonstrated cardiovascular and respiratory comprise both experimentally and clinically. The mean time required for removal of the Silastic chimney was 4.7 days. There were no infections related to the chimney. There were 2 early and 5 late deaths, a 28% mortality rate. The remaining patients are alive and well. Intragastric pressure measurement in patients with omphalocele or gastroschisis provides objective criteria for safe primary closure and Silastic chimney reduction, shortens the time of reduction, and reduces the number of associated circulatory, respiratory, and septic complications.

Abdominal Muscles↗