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Biomedical subjects

A J Mares

Publications and source records attributed to A J Mares.

At least 37 records · Page 2Linked to original sources
PubMed1998

Lymphangioma circumscriptum.

Two children with lymphangioma circumscriptum (LC), a rare cutaneous lymphangioma, are described. One was diagnosed antenatally as having a right axillary cystic hygroma; in addition, postnatally LC was noted on the right forearm. A few years later a mediastinal lymphangioma was diagnosed. This combination of LC associated with additional malformations of the lymphatic system has not been reported previously, and may point to a generalized developmental disorder of the lymphatic system. The pathophysiology of the lesion is discussed with a review of the pertinent literature. It appears that LC primarily affects the subcutaneous tissue in the form of cystic dilatation of lymphatic channels without systemic lymphatic communication. The skin lesions are probably secondary to the increased intraluminal pressure. The typical clinical appearance is manifested by multiple skin vesicles and lymphorrhea. The main treatment modality is surgical excision. Recurrences are not unusual and require re-excision.

Child, Preschool↗
PubMed1998

Thoracoscopic upper thoracic sympathectomy for primary palmar hyperhidrosis--the combined paediatric, adolescents and adult experience.

OBJECTIVE: To present our experience, over the past 4 years, of thoracoscopic upper thoracic sympathectomy in patients with primary palmar hyperhidrosis. DESIGN: Retrospective study. SETTING: University hospital, Israel. SUBJECTS: 402 thoracoscopic upper thoracic sympathectomies in 223 patients over a period of 4 years. INTERVENTIONS: Thoracoscopic ablation of ganglia and severing of the sympathetic chain at the level of T2 and T3. 142 patients underwent bilateral simultaneous sympathectomy, 37 had bilateral non-simultaneous sympathectomy and 44 had unilateral sympathectomy. RESULTS: 220 patients (98.7%) had an uneventful postoperative course and were discharged the following day. Three patients with residual pneumothorax required intercostal drainage and were discharged on the third postoperative day. 219 patients (98.2%) were completely satisfied, having immediate and permanent relief of palmar sweating. Four patients were dissatisfied. CONCLUSION: The thoracoscopic approach to the upper thoracic sympathectomy is at present the procedure of choice. Early operation for severe palmar hyperhidrosis is indicated to save a child many years of frustration and discomfort.

Adolescent↗
PubMed1997

Laparoscopic and thoracoscopic surgery in children and adolescents: a 3-year experience.

Our initial experience over the last 3 years with laparoscopic and thoracoscopic surgery in children and adolescents is reported. Between September 1992 and August 1995, a total of 215 laparoscopic and thoracoscopic procedures were performed: 32 appendectomies for acute appendicitis, 10 cholecystectomies for symptomatic gallstones, 11 procedures for adnexal pathology, 6 laparoscopies in children with nonpalpable testes, 3 diagnostic laparoscopies, and 153 thoracoscopic sympathectomies in children suffering from primary palmar hyperhidrosis. The post-operative course was uneventful in all cases. In 2 children with acute appendicitis we converted to the open technique due to technical difficulties. We are encouraged by the results of our initial experience. There is no doubt that laparoscopic cholecystectomy, laparoscopic surgery of adnexal pathology, and thoracoscopic sympathectomy, because of their numerous benefits - shorter operative time, hospitalization, and convalescence as well as less postoperative pain and improved cosmetic results - are replacing the open techniques. We are not convinced as yet of the advantages of laparoscopic appendectomy in children; we are presently performing both laparoscopic and conventional techniques and studying the various parameters in order to reach a more definite conclusion. Various other endoscopic surgical procedures will be carefully considered in the near future.

Acute Disease↗
PubMed1997

Necrotizing fasciitis and myonecrosis in early childhood: a report of three patients.

Necrotizing fasciitis (NF) is a rare and life-threatening disease. It usually presents as a postoperative complication, but rarely appears following trauma or without apparent cause. Over a period of 2 years we have treated three infants with NF, aged 15, 5, and 30 months, respectively. Two patients developed this complication following minor trauma while the third was post-elective bilateral inguinal hernia repair. The micro-organisms isolated were Staphylococcus aureus with Enterococcus durans in one patient, beta-hemolytic streptococcus in a second, and Staph. aureus in the third. The cornerstone of therapy is prompt, early, aggressive surgical debridement of the massive necrotic tissue and repeated debridement if necessary, with appropriate parenteral antibiotic therapy and hyperalimentation. All three patients survived. Early recognition of this life-threatening situation is mandatory in achieving survival.

Anti-Bacterial Agents↗
PubMed1997

Tracheal rupture after blunt chest trauma in a child.

Blunt traumatic tracheal rupture is a life-threatening injury. The authors report on a 14-year-old boy who suffered such an injury in a road accident, underwent surgery immediately, and survived. The relevant literature is reviewed.

Adolescent↗
PubMed1997

Cyanotic limb in a newborn: a peculiar presentation of septic hip.

A 12-day-old infant presented with marked cyanosis of the right lower limb, mimicking vascular compromise. Physical examination, plain radiography, and laboratory evidence of systemic infection suggested septic arthritis of the hip. Pyoarthrosis was verified by needle aspiration and open drainage. Streptococcus pneumoniae was isolated. A cyanotic limb may be an atypical presentation for septic arthritis in the newborn.

Arthritis, Infectious↗
PubMed1996

[Psoas abscess: diagnostic dilemma in childhood].

A series of 16 children diagnosed as having a psoas abscess or deep iliac lymphadenitis seen over a 25-year period (1970-1994) is presented. 10 were treated conservatively while 5 were drained surgically and 1 percutaneously under imaging guidance. The presenting signs and symptoms may mimic the frequently seen entities, acute appendicitis and acute hip arthritis. Lower abdominal and inguinal pain, limp, fever and increased white count are common in all of these conditions. Accurate differential diagnosis is necessary to avoid unnecessary surgery due to a wrong diagnosis. Ultrasonography is preferred for diagnosis. Antibiotic therapy should be instituted immediately, aimed primarily at Staphylococcus aureus, the most common causative agent, although other organisms may be implicated. When a psoas abscess has been diagnosed, surgery and drainage are indicated. One of the preferred approaches is percutaneous drainage under imaging guidance. Convalescence is usually rapid and without late sequelae.

Anti-Bacterial Agents↗
PubMed1996

[Thoracoscopic upper thoracic sympathectomy for primary palmar hyperhidrosis].

We report our initial experience, over the past 3 years, with thoracoscopic sympathectomy for severe, primary, palmar hyperhidrosis in children and adolescents. From 1992-1995, 179 thoracoscopic sympathectomies were performed in 61 girls and 35 boys, 5.5 to 18 years old (mean 14.8). During the first 2 years the procedures were performed bilaterally but not simultaneously. During the past years, 65 underwent bilateral, simultaneous sympathectomy, using a single 10 mm subaxillary port of entry. 94 (98%) had immediate and permanent relief of palmar sweating. The immediate postoperative course was uneventful in all except 2 who had residual pneumothorax that required 24-hour intercostal drainage. These results compare favorably with the open method and are actually better in terms of less pain, early discharge, quicker return to normal activity and a smaller and less conspicuous scar. We emphasize the benefits of early surgery in children with severe, palmer hyperhidrosis, to avoid the many years of psychological, social and physical discomfort during adolescent growth and development.

Adolescent↗
PubMed1996

[Conservative approach to blunt hepatic and splenic trauma in childhood--experiences in the Pediatric Surgery Department, Soroka Hospital in the years 1980-1994].

42 children with blunt hepatic and splenic trauma, seen from 1980-1994, were treated conservatively, but 15 with splenic and 2 with hepatic trauma underwent surgery (7 had splenic preservation procedures: partial splenectomy or splenorrhaphy). Boys predominated, the mean age was 8.6 years and the main cause of injury was road accidents. In most cases hemodynamic instability within the first 24 hours was the most significant factor in determining the appropriate approach. Those who were hemodynamically stable after this period could be safely managed without operation. No complications were attributed to either operative or conservative treatment. In 5 cases there were mild respiratory or urinary tract infections unrelated to the initial trauma; there were no deaths. The overall results support the prevailing conservative approach to the treatment of blunt splenic and hepatic trauma in the hemodynamically stable child. CAT is our preferred diagnostic imaging modality in the acute phase, and ultrasonography in the follow-up period.

Accidents, Traffic↗
PubMed1996

The laparoscopic approach to uterine adnexal torsion in childhood.

Seven girls with adnexal torsion (of varying degrees) were treated laparoscopically during a 6-month period. All had associated adnexal pathology. Six had simple follicular cysts (> 4 cm in diameter), and one had a 10-cm dermoid cyst. Detorsion with resection of the cyst and preservation of ovarian tissue was performed in all cases. No intraoperative or postoperative complications were encountered. Video-assisted minimally invasive surgery is suitable for the treatment of adnexal pathology in children; the hospitalization period is short, the cosmetic results are excellent, and the return to normal activity is rapid.

Adnexal Diseases↗
PubMed1995

Thoracoscopic upper thoracic sympathectomy for primary palmar hyperhidrosis in children and adolescents.

After 20 years of experience with the "open" transaxillary approach, the authors are presently performing the thoracoscopic technique for upper thoracic sympathectomy in severe primary hyperhidrosis. During a period of 14 months, 23 operations were performed and 22 patients had immediate and permanent relief of palmar sweating. The immediate postoperative course was uneventful in all cases. Hospitalization was short, and all patients returned to school and full activity 3 to 5 days after operation. These initial results compare favorably to the "open" method and, pending further experience, are actually better in terms of less pain, early discharge, quicker return to normal activity, and a smaller, less conspicuous scar.

Adolescent↗
PubMed1994

[Laparoscopic and thoracoscopic surgery in children and adolescents].

Initial experience with laparoscopic and thoracoscopic surgery in children during the year Sept. 1992-Sept. 1993 is presented. The 36 procedures included 20 appendectomies, 3 cholecystectomies, 10 upper thoracic sympathectomies, 1 bilateral oophorectomy and 2 diagnostic laparoscopies. Indications were appendicitis, symptomatic gallstones, idiopathic primary palmar hyperhidrosis, and gonadal dysgenesis (xo/xy mosaicism) in a 13-year-old girl. 2 diagnostic laparoscopies were performed for chronic abdominal pain and for a possible retroperitoneal lesion, respectively. All procedures were successfully managed without complications. In 2 cases of acute appendicitis it was necessary to change to the open conventional technique because of technical difficulties. Duration of hospitalization for cholecystectomy and sympathectomy was significantly shorter than with the conventional surgical approach and convalescence was excellent, with less postoperative pain. As for the surgical approach in acute appendicitis, we cannot as yet decide whether or not laparoscopy is superior to the conventional technique.

Abdominal Pain↗
PubMed1994

[Plasma cell granuloma of the chest and lung in childhood].

Plasma cell granuloma is a benign, non-neoplastic lesion rarely found in children. It occurs mainly in the chest and lungs, the right lung mostly. Most cases are asymptomatic and are discovered incidentally on routine chest X-ray, although there may have been atypical upper respiratory symptoms. The X-ray findings, as well as those of other imaging modalities, are nonspecific, making the exact localization and diagnosis of the lesion difficult, as demonstrated in the cases of 2 boys aged 8 and 9 years, respectively. Locating the right diaphragm and its relation to the large lesion by various imaging modalities was unreliable in 1 of the cases. The large, dense, firm, adherent lesions were carefully and completely resected in both cases. In 1 case it was located in the right lung, pulmonary hilum and mediastinum. In the other, in the right pleural space in the supradiaphragmatic region, adherent to the posterolateral aspect of the lower ribs. Biopsies for frozen section should always be taken before deciding on the extent of surgery. Radical resection of normal surrounding tissue should be avoided. Our cases have been followed for 2 and 3 years respectively, with no evidence of recurrence. Prognosis is excellent when lesions are completely removed.

Child↗
PubMed1994

Isolated torsion of the fallopian tube in premenarcheal girls.

The authors report on two premenarcheal girls, ages 4 and 13 years, with isolated torsion of the fallopian tube, an extremely rare condition. The fallopian tube was salvaged by detorsion in the younger girl, the first salvage described in the English literature on children. The mechanism of the isolated torsion and the clinical implications are discussed.

Adolescent↗
PubMed1994

Transaxillary upper thoracic sympathectomy for primary palmar hyperhidrosis in children and adolescents.

Primary palmar hyperhidrosis is part of a triad of palmar, plantar, and axillary hyperhidrosis of unknown etiology, affecting children, adolescents, and young adults. Sixty-seven children and young adolescents were operated on during a 10-year period. A total of 103 transaxillary upper thoracic sympathectomies (36 bilateral) were performed, with no mortality. The immediate postoperative course was uneventful in 90%; the other 10% had mostly minor problems. The average hospitalization period was 3 to 4 days. Total abolition of palmar sweating was achieved in all but two patients in whom some residual moisture remained. Long-term extreme satisfaction was reported by 64 of 67 patients (94%). One was moderately satisfied, and two were not satisfied because of excessive "compensatory" sweating elsewhere. Compensatory sweating of some degree was reported by 45% of patients but did not alter satisfaction. By further limiting ganglionectomy to just one ganglion (T2 or T3), compensatory sweating possibly may be reduced further. Early surgery for severe palmar hyperhidrosis will save a child many years of agony and social discomfort because all types of conservative therapy are ineffective and cause unnecessary delay. A limited transaxillary upper thoracic sympathectomy is presently the authors' preferred approach, although ablation via thoracoscopy should not be excluded as further experience is gained with this modality.

Adolescent↗
PubMed1993

Bridging of esophageal defects with lyophilized dura mater: an experimental study.

The aim of this study was to investigate the use of a prosthetic biologic material-lyophilized dura mater (Lyodura) in patching esophageal defects in dogs, having in view its potential use in bridging long gap congenital esophageal atresia and patching acquired esophageal defects. To follow the incorporation process, 20 mongrel dogs had full-thickness, 6 cm2 cervical esophageal defects, patched with Lyodura. The dogs were sacrificed at different postoperative periods and the patched esophagus removed for gross and microscopic examination. In a second group of 10 dogs, a segment of the esophagus was excised and replaced by 3 cm in length and 2 cm in diameter, Lyodura tubes. In this group, prolonged follow-up was undertaken including radiologic, endoscopic, and histological assessment. Special attention was given to the swallowing function and to growth and development. This study shows that: (1) the area of prosthetic replacement was characterized by a narrowing of the esophageal wall and the histopathologic study showed that the epithelialization process was complete in about 2 months; and (2) muscle reconstruction did not take place at the patched areas. We conclude that, pending further studies and improvement, lyophilized dura mater can be considered as a successful alternative for bridging esophageal defects.

Age Factors↗