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Biomedical subjects

B M Rodgers

Publications and source records attributed to B M Rodgers.

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

Pediatric thoracoscopy: where have we come and what have we learned?

The procedure of thoracoscopy was employed in adult patients for more than half a century before the first report evaluating its use in children was published in 1976. Initially thoracoscopy was proposed as a technique for obtaining pulmonary biopsy specimens in immunocompromised children when interstitial pneumonia developed, but, as more experience with the technique was gained, new indications for its use in children have arisen. A review of the published reports on the use of thoracoscopy in children has brought to light areas in which the procedure has been particularly useful as well as several limitations of the procedure. In properly selected patients, thoracoscopy is an extremely accurate method of tissue diagnosis for diffuse and localized pulmonary infiltrates. This technique may be the procedure of choice in the diagnosis of mediastinal lesions in children and in the surgical treatment of empyema and pneumothorax. Most of the morbidity and mortality reported for the procedure have been in patients with diffuse interstitial pneumonias. Such patients, who are on high-pressure ventilator support, are best managed by a standard open lung biopsy. Maintenance of a sufficient pneumothorax has proved difficult in very small infants and children, and the procedure may not be applicable in children who weigh under 8 kg. Refinements in thoracoscopy instrumentation will allow the performance of more complicated surgical dissections as pediatric surgeons acquire more familiarity with this technique.

Child↗
PubMed1993

Thoracoscopy in the management of empyema in children.

Many pediatric surgeons advocate early open drainage or decortication for children with acute empyema. Unfortunately, such procedures can be associated with significant morbidity. Since 1981, we have used early thoracoscopic adhesiolysis and pleural debridement as an alternative to open thoracotomy in 9 children with acute empyema. The average age was 7.8 +/- 1.8 years (range, 2 to 16). All patients had failed initial treatment, which included antibiotics and chest tube drainage. All procedures were performed under general anesthesia. Following thoracoscopy, 8 of the 9 patients were managed with a single drainage tube and the average duration of tube drainage was 8.4 +/- 1.4 days. One patient died of underlying leukemia. Of the 8 patients who recovered, the average postoperative hospital stay was 13.4 +/- 2.9 days. No complications resulted from the thoracoscopies and there was no need for further surgical intervention in any of these patients. We conclude that thoracoscopy allows for minimally invasive, yet effective treatment of acute empyema with loculated collections. Thoracoscopic visualization of the pleural cavity permits efficient debridement, thorough adhesiolysis, and optimal placement of drainage tubes. Since we have begun using early thoracoscopy in the treatment of pediatric empyema, open drainage or decortication has not been required in any of these patients. Thoracoscopy is a useful adjunct in the treatment of empyema in children and its early application may eliminate the need for decortication.

Chest Tubes↗
PubMed1993

Spermatic cord torsion in an infant receiving human chorionic gonadotropin.

Human chorionic gonadotropin and gonadotropin-releasing hormone administration has been advocated for the nonoperative management of undescended testes. Proponents of hormonal manipulation cite the low morbidity of endocrine treatment as its major advantage over conventional surgical repair. We report a serious potential complication of human chorionic gonadotropin administration, intravaginal spermatic cord torsion and testicular infarction, in an infant with bilateral cryptorchidism.

Chorionic Gonadotropin↗
PubMed1993

Thoracoscopic surgery for diseases of the lung and pleura. Effectiveness, changing indications, and limitations.

OBJECTIVE: This study compared the results of video-assisted thoracic surgery (VATS) with thoracoscopic surgery (TS) for diseases of the lung and pleura. SUMMARY BACKGROUND DATA: No studies exist that compare the capabilities of VATS with advanced video systems and instrumentation to that of TS which has been done for 80 years. METHODS: A retrospective study was done comparing the effectiveness, indications, complications, and limitations of TS and VATS done for four categories of pleural disease: 1) pleural fluid problems, 2) diffuse lung disease, 3) lung masses, and 4) pneumothorax. The TS period was 1981-1990. The VATS period was 1991-1992. RESULTS: Eighty-nine consecutive TS cases and 64 consecutive VATS cases were reviewed. TS for resolution of pleural fluid problem was successful in 29 of 34 patients (85%), and VATS was successful in 18 of 20 (90%). Diffuse lung disease was diagnosed by TS using a cup biopsy on end-stage patients in respiratory failure. Since 1991 the diagnosis has been made with VATS using stapled wedge excisions on ambulatory patients. Surgical mortality decreased from 33% (10 of 30) to 9% (1 of 11) and the postoperative stay from 16.6 +/- 2.4 days to 8.2 +/- 2.2 days. Lung masses were diagnosed entirely by incisional biopsies using TS. Diagnosis was made in 83% and postoperative stay was 5.3 +/- 1.0 day. VATS allowed excisional biopsies permitting diagnosis in 100% with a postoperative stay of 3.0 +/- 0.2 days (p = 0.05). However, 20% required conversion to thoracotomy to locate the subpleural mass. TS was performed for spontaneous pneumothorax in only 26% (5 of 19) of the total pneumothorax cases, whereas, VATS was used for spontaneous pneumothorax in 67% (12 of 18). CONCLUSION: VATS has continued the effectiveness of TS for treating pleural fluid problems, has resulted in earlier surgical diagnostic intervention in diffuse lung disease and earlier therapeutic intervention in primary pneumothorax states, and has markedly expanded the safety, efficacy and indications for lung mass biopsy.

Adolescent↗
PubMed1993

Asymmetric radiographic findings in the pediatric chest: approach to early diagnosis.

Several conditions in children produce a mass effect within one hemithorax, which may be life threatening. The different radiographic appearances of these conditions provide a basis on which they can be classified. The three major categories include a large cystic hemithorax, a large lucent hemithorax, and a large opaque hemithorax. Some disorders may be seen within more than one major group. Within the large cystic hemithorax group, congenital cystic adenomatoid malformation and congenital diaphragmatic hernia may be life-threatening conditions that require emergency surgery. The large lucent hemithorax is usually caused by pneumothorax, partial bronchial occlusion, or compensatory hyperinflation of the unobstructed lung. The majority of cases within the large opaque hemithorax group involve pleural fluid collections. Because many conditions that cause a mass effect require intervention or surgery, accurate interpretation of the plain chest radiograph is essential for an early diagnosis. Classification of radiographic features into these three groups often allows accurate diagnosis without additional studies.

Child↗
PubMed1993

Thoracoscopic procedures in children.

Although thoracoscopy was initially reported in 1910, the first specific report in children came in 1976. Over the past 15 years, reports from a small number of institutions have described experience with this technique. For the past 2 years, as pediatric surgeons have become involved with minimally invasive abdominal surgery, there has been renewed interest in the application of endoscopy for thoracic disorders in children, the most common indication for thoracoscopy is evaluation of mediastinal masses. Other common indications include evaluation of localized or diffuse pneumonia, management of pleural diseases such as refractory empyema, and management of recurrent pneumothorax, with either pleurodesis or excision of subpleural blebs.

Adolescent↗
PubMed1992

Pleuroperitoneal shunts for refractory chylothorax after operation for congenital heart disease.

Between 1980 and 1990, 10 of 12 children with a symptomatic chylothorax after operation for congenital heart disease failed to respond to traditional medical therapy (thoracentesis, tube thoracostomy, low-fat diet). All 10 patients underwent placement of a pleuroperitoneal shunt, with complete resolution of the chylothorax in 9 patients (90%). Cardiac catheterization, performed before placement of the pleuroperitoneal shunt in 5 patients, demonstrated elevated right atrial pressure in all patients (range, 10 to 25 mm Hg). The pleuroperitoneal shunt functioned effectively in 4 patients with moderately elevated right atrial pressures (range, 10 to 16 mm Hg; median, 13.5 mm Hg) but not in 1 patient with a right atrial pressure of 25 mm Hg. Pleuroperitoneal shunting as treatment for chylothorax after operation for congenital heart disease is safe and effective, even in the face of moderate elevations in right atrial pressure.

Chylothorax↗
PubMed1992

Successful treatment of postoperative chylothorax using an external pleuroperitoneal shunt.

We report 3 patients with chylothorax who were successfully managed as outpatients using external pleuroperitoneal shunts. This external shunt has the advantage over subcutaneously placed shunts of pumping large volumes of fluid with each compression of the pumping chamber, of not causing the discomfort associated with pumping a subcutaneous chamber, of not becoming difficult to find in the subcutaneous space, and of being constructed of larger components which do not kink or become easily clogged with fibrinous debris.

Adult↗
PubMed1992

Paecilomyces lilacinus infection in a child with chronic granulomatous disease.

Chronic granulomatous disease (CGD) is a rare inherited disorder in which neutrophils do not appropriately generate cytotoxic superoxide anion, the respiratory burst, in response to invading bacteria or fungi as a part of normal host defence. We report the case of a child with CGD who had two abdominal wall abscesses caused by Paecilomyces lilacinus, an organism not previously known to cause infections in patients with CGD. The abdominal wall is a location that is rarely associated with Paecilomyces infections. Parenteral amphotericin B eradicated the infection in an immunocompromised child whereas this regimen has heretofore largely been unsuccessful in the treatment of this infection. Paecilomyces species and other fungi from immunocompromised hosts and thought to be laboratory contaminants, need to be carefully investigated for they may become pathogens in this clinical setting.

Abdominal Muscles↗
PubMed1990

Acute torsion of a renal transplant: cause of organ loss.

Acute torsion of a renal allograft has not been previously described as a cause of organ loss. We present a case of acute torsion of a transplanted kidney in a patient with prune-belly syndrome which led to renal necrosis, necessitating organ removal.

Humans↗
PubMed1990

Thoracoscopy and talc poudrage for pneumothoraces and effusions.

The indications, technique, and results of thoracoscopic talc poudrage in the two clinical settings of pneumothorax and recurrent pleural effusion in chronically ill patients are reported. Forty patients underwent this treatment between May 1982 and September 1989. The patients ranged in age from 10 months to 78 years. Of the 20 patients who underwent treatment of pneumothorax, 9 had cystic fibrosis, 7 had severe chronic obstructive pulmonary disease, 2 had spontaneous pneumothoraces, and 2 had postoperative parenchymal bronchopleural fistulas. Nineteen patients (95%) had successful treatment. Of the 20 patients who underwent treatment of chronic effusions, 14 had malignant etiologies, 3 had chylothoraces, and 3 had other miscellaneous effusions. Eighteen patients (90%) in this group had successful treatment. There were two hospital deaths related to the underlying disease processes after the pleural space problems were successfully treated. This study suggests that proper selection of patients and full exploitation of the capabilities of thoracoscopy and talc poudrage will result in effective treatment with low morbidity and mortality.

Cystic Fibrosis↗
PubMed1990

The effects of talc pleurodesis on growing swine.

Talc pleurodesis is an effective means of preventing recurrent pneumothorax. We have successfully applied talc pleurodesis with thoracoscopy in children with cystic fibrosis presenting with pneumothorax. However, little is known about the effects of talc pleurodesis on lung compliance in growing children. Therefore, six young pigs (10 weeks old, weighing 15 +/- 1 kg) were prepared for study. In each pig, one hemithorax underwent thoracoscopy and talc pleurodesis (TALC). The other hemithorax underwent either thoracoscopy alone or no procedure (CONTROL). Dynamic and static respiratory mechanics were studied 5 and 10 weeks later. Air flow and airway pressure were measured to calculate dynamic transpulmonary and transrespiratory compliance, and static transpulmonary compliance. At 5 weeks, dynamic transpulmonary and transrespiratory compliance were less in the TALC lungs when compared with CONTROL lungs. At 10 weeks, the differences in dynamic transpulmonary and transrespiratory compliance between the TALC and CONTROL lungs had resolved. Static compliance was lower in the TALC lungs than in the CONTROL lungs at both 5 and 10 weeks, but this was significant only at 10 weeks. There was an improvement in static compliance in the TALC lungs between 5 and 10 weeks, but this only approached significance. At autopsy, there were marked adhesions and pleural thickening in the talc lungs. Histological examination demonstrated no differences in lung parenchyma between the TALC lungs and the CONTROL lungs. Talc pleurodesis causes a temporary impairment in dynamic transpulmonary and transrespiratory compliance that resolves with time and growth. Static compliance is more persistently compromised, but a trend toward improvement with time and growth exists.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1990

Management of chylopericardium.

Chylopericardium is a rare entity that may be congenital in origin or secondary to surgical trauma, mediastinal lymphangiomas-hygromas, or radiation. Current treatment progresses from dietary medium-chain triglycerides and pericardiocentesis, to pericardial drainage, to thoracotomy with pericardiectomy and thoracic duct ligation. Between January 1986 and January 1989, we treated four children with chylopericardium: three secondary to mediastinal lymphangioma-hygroma, and one following cardiac surgery. The patients ranged in age from newborn to 16 years. All had signs of cardiac tamponade and three underwent initial pericardiocentesis or tube drainage. One 6-week-old infant with a mediastinal cystic hygroma developed chylopericardium following resection of the hygroma and responded to 9 days of tube drainage. The remaining children did not respond to repeated pericardiocenteses or prolonged drainage and underwent pericardial-peritoneal shunting with Denver shunts. The shunt was removed in 14 days in one patient. One patient had the shunt exteriorized for 8 weeks and one patient continues to use the shunt after 3 years. The chylopericardium resolved in each case without recurrence. Pericardial-peritoneal shunting provides a simple and effective alternative to prolonged pericardial drainage or thoracotomy in patients with chylopericardium of various etiologies.

Adolescent↗
PubMed1989

Pleuroperitoneal shunts in the management of persistent chylothorax.

Between June 1981 and June 1988, we placed pleuroperitoneal shunts in 16 patients for the management of refractory chylothorax on the Pediatric Surgical Service, University of Virginia. The cause of the chylothorax was caval thrombosis from central venous catheters in 5 patients, idiopathic in 3, and mediastinal lymphangioma in 2, and in 6, it developed after a cardiac procedure. Chylothorax in each patient was unresponsive to thoracentesis, tube thoracostomy, and dietary manipulations. A Denver double-valved shunt system is currently employed and is implanted using general anesthesia. Manual pumping is required postoperatively for several months. Twelve (75%) of the 16 patients had excellent results with complete elimination of the chylothorax and resolution of symptoms. In 10 of these 12, the shunt has been removed. Four had an unsatisfactory result: 3 had inferior vena cava hypertension, and 3 were low-birth-weight premature infants. Four patients seen early in this series required revision of the position of the pleural catheter, with successful drainage in each instance. Pleuroperitoneal shunting is a safe, simple, and effective treatment of chylothorax in infants and children. In view of our success in treating chylothorax with these shunts, we recommend early shunting before the development of nutritional or immunological depletion.

Adolescent↗