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Biomedical subjects

B H Harris

Publications and source records attributed to B H Harris.

At least 37 records · Page 2Linked to original sources
PubMed1993

The desmoplastic round cell tumor: a new solid tumor of childhood.

Three patients with a new, pathologically distinct solid tumor of childhood have been treated recently. The disease is characterized by male predominance, adolescent onset, an extensive abdominal primary tumor, and aggressive metastases to regional lymph nodes, liver, and lung. Two patients presented with vague abdominal pain and the third with testicular pain. All three noted fatigue and malaise of less than two months' duration with minimal associated weight loss. Computed tomography (CT) scans of the abdomen and chest were obtained for initial preoperative staging, and then all three underwent surgical exploration. Widespread disease was found in each case. In no instance was complete tumor extirpation possible because of extensive peritoneal spread and lymphatic and hepatic metastases. Histologically, all three tumors consisted of round blue cells with a dense desmoplastic reaction and focal rhabdoid features. Immunohistochemical markers for epithelial, neural, and muscle elements were positive. Aggressive multidrug chemotherapeutic regimens were used in each case, and all three patients are alive and well but with known residual disease. We conclude that in cases of the desmoplastic round cell tumor of childhood, CT scans underestimate the extent of disease, and exploratory laparotomy is necessary for diagnosis and appropriate staging. Surgery is usually palliative because of extensive spread. Awareness of this newly recognized aggressive solid tumor of childhood is essential to define its natural history and guide the development of effective multidisciplinary therapeutic regimens.

Adolescent↗
PubMed1993

Incarceration of inguinal hernia in infants prior to elective repair.

The low morbidity and good results of elective herniorrhaphy in children are adversely affected by incarceration. Since incarceration is a potentially avoidable complication, we reviewed 908 consecutive cases to determine its incidence and consequences in children awaiting elective operation for an inguinal hernia. Eighty-five of the 908 children presented with an incarcerated hernia. Thirty of these 85 patients (35%) were known to have an inguinal hernia prior to incarceration, and 25 of the 30 were awaiting elective hernia repair. The median time from surgical office visit to planned operation was 22 days, but the mean interval from office visit to incarceration was 8 days. Eighty-five percent of the children with incarcerated hernias were infants under 1 year of age. Seventy-one of the 85 patients with an incarcerated hernia (84%) had successful manual reduction. They were all admitted and had a mean hospital stay of 2.5 days. Emergency operation after unsuccessful attempts at reduction was required in the other 14 children, increasing the average length of stay to a mean of 4.0 days. Significant complications, including infarction of the testis or ovary, bowel obstruction, intestinal necrosis, wound infection, and recurrent hernia, occurred in 26 of the 85 children (31%). We conclude that incarceration is a preventable problem. Even patients scheduled for hernia repair are at risk and the operation should be performed soon after the diagnosis is made. Infants are the highest priority group, since 35% of children less than 12 months of age experienced incarceration while awaiting elective surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗
PubMed1993

Scalp and neck masses.

The evaluation of head and neck masses involves an orderly approach based on a careful history and accurate physical examination. Additional information sometimes is necessary using appropriate laboratory and radiologic investigation. In the vast majority of cases, surgery for biopsy or removal of the mass is required. Accurate preoperative diagnosis may require evaluation by appropriate consultants to avoid unnecessary or inappropriate operations.

Child↗
PubMed1993

Experimental volume replacement through lower extremity veins.

Hypovolemic shock was produced in anesthetized pigs by removal of 40% of blood volume over 10 minutes. Following blood loss, the inferior vena cava (IVC) was occluded below the renal veins to simulate the hemodynamics of emergency surgical treatment. Control animals were not treated. Experimental animals received intravenous lactated Ringer's solution equal to three times the blood loss given through catheters either in the IVC or the superior vena cava (SVC) to determine if lower extremity access would be efficacious in this model. To define the path taken by the resuscitation fluids, an additional group of animals received technetium-99m-labelled crystalloid through lower extremity catheters with continuous recording of isotope counts in the IVC and right atrium. The treated animals in all experimental groups had significant improvements in mean arterial pressure, cardiac output, and pH compared with controls. There was no significant difference in hemodynamic response in animals receiving volume replacement through the IVC compared with the SVC. When fluid was infused below a clamped IVC, the arrival of isotope in the right atrium was delayed only 1.5 seconds. We conclude that in a model simulating emergency control of potentially lethal hemorrhage, the beneficial effects of fluid resuscitation are unrelated to the site of venous access. Lower extremity veins provide a valuable site for volume replacement even with IVC occlusion. These findings should have direct application to resuscitation and surgical care of seriously injured patients.

Animals↗
PubMed1991

Sutureless hemisplenectomy.

Splenic salvage following blunt injury can fail when parenchymal bleeding is uncontrollable. To define the usefulness of an argon beam coagulator for hemostasis, we used the instrument in a laboratory trial of partial splenic resection. New Zealand white rabbits, weighing 4 to 5 kg, had sharp excision of the lower half of the spleen. No sutures were used to control hemorrhage from the cut splenic surface or the hilar vessels. Hemostasis was achieved with 2 to 4 seconds of electrocoagulation delivered by a beam of argon gas. All animals survived the procedure and were in good health when killed between the fourth and sixth week following the procedure. At necropsy, the spleen was viable in all animals with no abscess or hematoma. Minimal adhesions from the treated splenic surface to the omentum were found. The scar at the cut surface was 1 mm in depth, and the histology of the remainder of the spleen was normal. In this simulated splenic injury model, argon beam coagulation was uniformly successful in achieving hemostasis. Minimal tissue destruction and lack of infection were noted. The argon beam coagulator may be useful in patients with severe splenic injuries and other situations requiring partial splenectomy.

Animals↗
PubMed1991

Surgical restraint in Burkitt's lymphoma in children.

Burkitt's lymphoma is a disease of unique cytokinetics that account for the bulky tumors, variety of presenting symptoms, and sensitivity to chemotherapy. A need to ascertain the role of surgery in the treatment of this illness prompted this review. Of nine children 5 to 12 years of age with Burkitt's lymphoma, eight had abdominal involvement. Two of the eight patients also had oral lesions and staging was done by biopsy of the oral lesion and noninvasive imaging of the abdominal tumors. The other six patients presented with abdominal complaints. One of these had diagnostic paracentesis, another had only gastroscopy, and four underwent exploratory laparotomy. The four children in whom the diagnosis was established either by biopsy of an oral lesion, biopsy of an abdominal mass, or resection of an abdominal tumor are alive without evidence of disease 6 months to 6 years after treatment. Each of these children had rapid initiation of chemotherapy. Of the other four who died, two had delayed induction of drug therapy following cytoreduction or gastroscopic biopsy. The best outcomes were associated with prompt chemotherapy. We conclude that except in rare instances in which a solitary lesion lends itself to total or near-total resection, the proper role of surgery is a simple, safe procedure to obtain enough viable tumor for accurate diagnosis and prompt chemotherapy.

Biopsy↗
PubMed1991

Femorofemoral artery bypass for blunt iliac artery occlusion in a child.

Vascular injuries from blunt trauma are rare in children. This report concerns traumatic occlusion of the common iliac artery with limb-threatening ischemia in a 6-year-old boy sustained while wearing a lap belt. Associated injuries included fracture of the third lumbar vertebra, perforation of the sigmoid colon, and disruption of the anterior abdominal wall musculature. Because of fecal contamination from the colon perforation, revascularization using a subcutaneous prosthetic femorofemoral artery bypass was performed and proved successful in limb salvage. As improved prosthetic vascular conduits of smaller caliber are developed, applications in small children with vascular injuries may increase.

Accidents, Traffic↗
PubMed1991

Experimental hemorrhage and blunt trauma do not increase circulating tumor necrosis factor.

Tumor necrosis factor (TNF) is a potent cytokine mediator of the shock states associated with sepsis and burn injury. This experimental study was done to determine whether circulating TNF plays a major role in the vasomotor collapse seen following experimental hemorrhage and blunt injury. Twenty anesthetized pigs were divided into two groups. Ten animals were bled 60% of their calculated blood volume in 15 minutes. Animals in Group IA (n = 5) had no treatment, and Group IB animals (n = 5) were given twice the shed volume as crystalloid 30 minutes after hemorrhage. The other animals, groups IIa and IIb (n = 5 each), were first subjected to a blunt injury to the thigh sufficient to cause a midshaft femur fracture, then bled and similarly treated. In both groups, mean arterial pressure (MAP), cardiac output (CO), and serum TNF activity by L929 bioassay were measured at 15-minute intervals for 120 minutes after hemorrhage or hemorrhage and blunt injury. An additional three animals were infused with 4 x 10(8)/kg heat-killed E. coli to validate the TNF assay. All bled animals sustained a fall in MAP and CO to a mean of 33% of baseline values, with or without fracture. Group IB and IIB animals responded to fluid resuscitation by restoration of MAP and CO to 85%-97% of the baseline values. Tumor necrosis factor was not detectable before injury and remained undetectable in all these animals during the 120 minutes of the experiment despite hemorrhage alone or combined hemorrhage and blunt trauma, with or without fluid resuscitation. The test animals receiving the E. coli responded with markedly elevated TNF levels, which peaked at 90 minutes after injection.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1991

Traumatic renal avulsion into the chest: case report.

This is a case report of a patient who survived blunt renal avulsion and herniation of the kidney through a ruptured diaphragm. Symptoms were mild considering the severity of injury. Prompt diagnosis of this unusual combination of injuries was aided by contrast-enhanced computed tomography (CT).

Accidents, Traffic↗
PubMed1990

Seatbelt use and patterns of central nervous system injury in children.

Family protocol often dictates that children too old for car seats occupy the rear seat when travelling with adults. In most vehicles, the only available rear seat restraint is a lap belt. Our recent experience with a group of children who were rear seat passengers at the time of a motor vehicle accident suggests that patterns of injury may be influenced by use of lap belts.

Abdominal Muscles↗
PubMed1989

Creating pediatric trauma systems.

The establishment of a pediatric trauma system is an exercise in regionalization. The first step in program development is the acquisition of data necessary to understand the region. What are its boundaries? How many children are injured each year? How many die? What facilities already exist for the care of these patients? Who controls EMS? Are any referral systems in place? Next, agreement must be reached among the participants regarding which patients will be transferred. Who will make the transfer decision? Will it be made in the field or in the hospital? Will a numerical scoring system be used, or accident descriptors, or both? How and by whom will patients be transported? What method of communication will be used to link the components of the system? The linchpin of effective trauma systems is public involvement, yet in most parts of the United States and Canada the public is unaware of the trauma problem, and the importance of trauma as the number one child health problem remains unrecognized. Since trauma is as much a societal problem as a medical one, the enthusiasm of individuals and public service organizations should be cultivated and a coalition formed to create a regional system. The educational, research, and prevention programs of a pediatric trauma center are not usually self-supporting, making progress in these areas dependent upon outside support. In several cities, grants and endowments have been received from service organizations, foundations, public-spirited companies, and individual philanthropy. Some assurance of a continuing source of funds usually is necessary before hospitals will accept part of the financial risk.(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗
PubMed1989

National Pediatric Trauma Registry.

The National Pediatric Trauma Registry (NPTR) is a multi-institutional database designed to compile information concerning all aspects of pediatric trauma care. The registry is designed and operated in a manner that maximizes data accuracy and provides this information to all participating investigators. The growth of the database has allowed the NPTR to provide the first accurate epidemiologic description of pediatric trauma as a national disease, as well as to develop national norms for pediatric trauma care. The registry presently contains 10,177 patients, and is undergoing revisions (phase II) to allow a more focused evaluation of various aspects of the clinical care and rehabilitation of the pediatric trauma patient.

Child↗
PubMed1989

The hidden morbidity of pediatric trauma.

In an attempt to characterize the emotional and behavioral consequences of severe multisystem injury on pediatric trauma patients and members of their immediate family, 54 former trauma patients and their families were studied at least 1 year after discharge. Of those in a home setting, 60% had residual personality changes. Physical and cognitive handicaps, often multiple, were present in 50%; and social, affective, and learning disabilities were present in like number. Only 20% of the 50 children are in a regular school class; the other 80% require special-needs education. An unexpected finding was the effect of the accident on uninjured siblings, 66% of whom were reported to have developed emotional disturbances, school problems and aggressive personality changes. Parents reported a worsening of their martial relationship in 32% of cases, and new social and financial problems in 60%. Twenty-one mothers who were previously employed have stopped working to care for their child and 20% of families have exhausted their savings or gone into debt. Although a variety of support services were available to these families, they reported little use of extended care facilities, visiting nurses, and counselors. There is a hidden morbidity in pediatric trauma. It manifests years after injury, not only as physical disability but also as changes in cognition, personality and behavior, and as family stress. Since success in pediatric trauma care is the restoration of the child as nearly as possible to his premorbid state, these data suggest that more attention and resources should be directed to the late consequences of multisystem injury in children.

Child↗
PubMed1989

A protocol for pediatric trauma receiving units.

Management of the child with multiple injuries is among the most challenging problems in pediatric surgery. The first 20 minutes are crucial in determining the outcome. Our conceptual model of accomplishing 60 minutes' work in 20 minutes by the additive efforts of three teams working together is a simple, practical, and proven method for a pediatric trauma receiving unit. The checklist approach is recommended as the surest way to organize treatment and accomplish a thorough evaluation while effectively stabilizing pediatric trauma patients.

Child↗