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Biomedical subjects

B M Rodgers

Publications and source records attributed to B M Rodgers.

At least 55 records · Page 3Linked to original sources
PubMed1989

Laparoscopically applied fibrin glue in experimental liver trauma.

We have investigated the feasibility of applying fibrin glue to liver injuries using laparoscopic guidance and have examined the gross and microscopic changes that occurred in hepatic lacerations treated with fibrin glue. These studies indicate that fibrin glue may be effectively applied to liver injuries using laparoscopic control, hepatic bleeding may be rapidly controlled when fibrin glue is applied into the base of the wound, there is no gross or microscopic evidence of hepatic toxicity related to the use of fibrin glue, and healing of liver lacerations treated by fibrin glue occurs by ingrowth of granulation tissue coupled with fibrinolysis of the fibrin glue.

Animals↗
PubMed1989

Patient-controlled analgesia as postoperative pain treatment for children.

The purpose of this study was to determine if patient-controlled analgesia (PCA) is an effective method of postoperative pain relief for children. Fifteen general surgery patients, aged 11 to 18 years, were treated for pain with PCA. Self-report of pain intensity by the child, parent, and nursing staff and a posttreatment questionnaire were analyzed. The average amount of medication administered by PCA was compared with the amount given to similar group of children treated by traditional administration; overall, the PCA group received less morphine than the traditional group. This study indicates that PCA is a valuable addition to pain management for the pediatric patient.

Adolescent↗
PubMed1988

Morphologic and functional effects of renal cryoinjury.

Wilms' tumor presents with bilateral renal involvement in 10% of patients. With the current treatment protocols for Wilms' tumor emphasizing maximal preservation of renal parenchyma, cryosurgery may offer an alternative to bilateral tumor resections in these patients. This study was designed to examine the effects of profound cryotherapy on a significant portion of the renal parenchyma, simulating the clinical application of this technique. Eighteen New Zealand white rabbits underwent unilateral nephrectomy, with four serving as controls. The contralateral kidney in the experimental animals was subjected to cryoinjury with a liquid nitrogen probe. Needle thermocouples monitored surface temperature 1/2 cm from the margin of the probe tip and renal "core" temperature 1 cm within the renal parenchyma directly beneath the tip. The kidney was cooled until the "core" temperature reached -40 degrees C, and this was achieved with a probe temperature of -180 degrees C for an average of 11.8 min. All animals tolerated the cryoinjury well and were sacrificed in pairs at 24 and 72 hr, and 1, 2, 3, 4, and 8 weeks. Transient gross hematuria was noted in 25% of the animals and microscopic hematuria in 50%. Serum blood urea nitrogen and creatinine levels reached maximum levels at 72 hr (BUN, 92 +/- 28 mg%; Creatinine, 7.2 +/- 1 mg%) and gradually returned toward normal thereafter. The cryolesion at 24 hr resembled a hemorrhagic infarct involving 40% of the kidney. By 8 weeks this lesion had contracted to a fibrotic lesion involving 20% of the kidney by weight. The surrounding uninjured renal parenchyma underwent compensatory hypertrophy.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1988

The effect of antral acidification on serum gastrin levels in neonatal pigs.

The cause of the physiologic hypochlorhydria and hypergastrinemia of the newborn is not understood. The effect of antral acidification on basal serum gastrin was studied in 32 anesthetized Landrace piglets divided into four groups of eight animals each: Group A, 1 to 7 days old; Group B, 8 to 15 days old; Group C, 16 to 24 days old; and Group D, 25 to 48 days old. After a 2-hr fast, halothane anesthesia was administered. Inflow and outflow cannulae were inserted into the gastric lumen to create an intact isolated gastric antrum. HCl in saline (pH 2.5) was infused (10 cc/min) for 15 min and drained by continuous suction. The effluent was confirmed to be pH 2.5. Portal venous blood samples were obtained at basal levels and at 5, 10, and 15 min and assayed for gastrin. All groups had markedly elevated serum gastrin levels, as compared to normal adult values, in the basal state. Basal gastrin levels declined with increasing age to approach adult values by 7 weeks. Following antral acidification in Groups A, B, and C, there was a significant reduction in serum gastrin. All suppressed values remained significantly higher than adult basal, however. There was no significant change in gastrin levels in Group D with acidification.(ABSTRACT TRUNCATED AT 250 WORDS)

Aging↗
PubMed1988

Successful cryotherapy of a benign tracheal neoplasm.

A 10-year-old black male with a 6-month history of progressive dyspnea and stridor was found to have a submucosal mass occupying 75% of the subglottic airway. Biopsy specimens showed a pleomorphic adenoma of minor salivary gland origin--a tumor with a predilection for local recurrence after resection. A tracheostomy was performed for airway control and the lesion was treated with endotracheal cryotherapy. Two months later, the tracheostomy was removed and the patient has remained asymptomatic for 9 years. Pulmonary function studies 2 years following cryotherapy demonstrated a forced vital capacity (FVC) of 81% predicted, and a forced expiratory volume-one second (FEV-1) of 73% predicted. Bronchoscopy with biopsy at 5 years showed no evidence of recurrent airway obstruction or persistent tumor. This represents the first reported case of successful treatment of an airway tumor in a child utilizing profound cryotherapy. The case illustrates the utility of endotracheal cryotherapy in the treatment of certain benign and malignant obstructing lesions of the airway in children.

Adenoma↗
PubMed1988

Patient-controlled analgesia in pediatric surgery.

Patient-controlled analgesia (PCA) with a microprocessor-operated infusion syringe was first suggested for human use in 1965. Clinical studies from the United States and Europe have shown this form of analgesia to be well accepted by adults, but the use of this technology for children has not been studied. We evaluated PCA in 15 consecutive pediatric surgical patients between the ages of 11 and 18 years undergoing major thoracic or abdominal surgery. The patients and their parents were instructed in the use of the equipment prior to surgery and PCA was initiated after the patients left the recovery room. The mean duration of PCA was 2.6 days. No serious mechanical difficulties with the infusion apparatus were encountered. The acceptance of PCA was excellent with only two patients preferring some other method of analgesia. Pain relief was assessed twice daily by a registered nurse using a verbal-visual pain scale. On a 1 to 10 scale average pain relief was 7.2. Eight of the patients had had a previous operation, and seven of these reported that PCA was a better method of achieving pain control. A comparison of the 15 study patients with 15 previous patients with similar procedures indicated that PCA patients used less analgesia in the postoperative period, although they tended to use more in the first 24 hours. PCA is found to be a safe and effective means of analgesia in pediatric patients. Adequate pain relief was achieved with less analgesia and with less nursing attention. This technology is recommended for postoperative pediatric patients.

Adolescent↗
PubMed1987

Partial splenectomy for Gaucher's disease.

Gaucher's disease is an autosomal recessive disorder caused by deficiency of beta glucocerebrosidase, resulting in an accumulation of glucocerebroside in the reticuloendothelial system. These patients have massive splenomegaly and bone pain, but may have normal life expectancy. Traditionally, splenectomy has been used to treat hypersplenism, but may be associated with a high incidence of postsplenectomy sepsis and accelerated hepatic and bone lipid deposition. Two children are reported who had partial splenectomy for symptoms of Gaucher's disease. Both patients had laboratory evidence of hypersplenism. A 90% splenectomy was performed, and the residual splenic fragment was wrapped in Vicryl mesh. Both patients are currently asymptomatic with normal hematologic parameters. Postoperative radionuclide scans demonstrate increase in the size of the residual splenic fragment. Partial splenectomy may benefit patients with Gaucher's disease, but long-term follow-up care is necessary.

Child↗
PubMed1987

A new technique for wrapping the injured spleen with polyglactin mesh.

The introduction of absorbable polyglycolic or polyglactin mesh has added a new dimension to splenic repair. Three patients with splenic disruption caused by blunt abdominal trauma underwent splenic wrapping with polyglactin mesh at the University of Virginia. The technique is described in detail. In all three instances, the spleen was saved, and postoperative nuclear medicine scans confirmed continued splenic function.

Female↗
PubMed1986

Bilateral congenital eventration of the diaphragms: successful surgical management.

Bilateral congenital eventration of the diaphragms is a relatively rare occurrence, associated with an almost uniform mortality. We recently have had experience with three patients who underwent successful treatment of this anomaly. Each patient presented as a newborn with severe respiratory insufficiency. One had had a sibling who died shortly after birth with a congenital diaphragmatic hernia. One infant had associated respiratory distress syndrome. PA and lateral chest roentgenograms demonstrated the anomaly in each patient. In two, the use of ultrasound clearly demonstrated the presence of attenuated diaphragms and paradoxical motion. Each infant underwent transabdominal bilateral diaphragmatic plication, reinforced with transversus abdominis muscle, within the first 2 weeks of life. Two infants showed prompt improvement in arterial blood gases and were extubated following the operation. The infant with respiratory distress syndrome required a tracheostomy for continued mechanical ventilation. This infant developed a recurrent eventration of the left diaphragm 6 months after the initial operation and has undergone a secondary plication with clinical improvement. Unlike unilateral eventration, bilateral eventration of the diaphragms is associated with persistent and significant respiratory symptoms. Surgical plication should be performed urgently in all of these patients, before chronic pulmonary changes occur.

Diaphragm↗
PubMed1986

Pediatric trauma associated with all-terrain vehicles.

The frequency of injuries secondary to use of all-terrain vehicles (ATV) is increasing at an alarming rate, and these injuries are usually multiple and severe. Between January 1, 1983, and February 28, 1985, 415 pediatric patients were admitted to the University of Virginia Hospital for care of injuries secondary to trauma; 66 of these patients required intensive care. Of the 415 patients, 12 were injured secondary to ATV use, and four of these required intensive care. The average age was 12 years (range 2 to 16 years), and the average hospital stay was 20 days. Injuries included five closed head injuries, two associated with a basilar skull fracture requiring intracranial pressure monitoring; five long bone fractures, two requiring open reduction and internal fixation; two small bone fractures; two splenic ruptures; two liver lacerations, one of them requiring laparotomy; and one renal hematoma. One patient has required long-term rehabilitation for neurologic deficits. Physicians and the public should be aware of the injury potential of these vehicles and should advocate legislation promoting helmet laws and high safety standards for ATV users.

Abdominal Injuries↗
PubMed1986

Bronchopulmonary foregut malformations. The spectrum of anomalies.

Ventral anomalies of accessory pulmonary tissue have been classified as "bronchopulmonary foregut malformations." Between July 1, 1981, and May 31, 1985, 10 children with bronchopulmonary malformations have been cared for on the Pediatric Surgical Service at the University of Virginia. Six patients had bronchogenic cysts, one in an extrathoracic location and one associated with a pulmonary sequestration. Diagnosis was suspected in each case by plain chest radiographs and confirmed by computed tomography scans and ultrasound. Four patients had pulmonary sequestrations, two in association with diaphragmatic hernias. One patient had accessory pulmonary tissue, best classified as a tracheal lobe. Diagnosis in this patient was confirmed by bronchography. Nine patients underwent excision of the malformation without event. In one patient, a bronchogenic cyst was treated successfully by thoracoscopy. Review of the anatomy of these malformations leads to the conclusion that three embryologic events are cardinal in determining their ultimate form: (1) investment of the anomalous pulmonary tissue by the pulmonary artery; (2) the degree of involution of the original foregut communication; and (3) the stage of development leading to pleural investment.

Bronchial Diseases↗
PubMed1986

Talc poudrage in the treatment of spontaneous pneumothoraces in patients with cystic fibrosis.

As patients with cystic fibrosis live longer, spontaneous pneumothoraces are seen with increasing frequency. Severe underlying pulmonary disease in these patients makes them particularly susceptible to life-threatening respiratory distress. Several modalities, including chemical sclerosis and open thoracotomy with pleurectomy, have been used to treat pneumothoraces in these patients. In the past 4 years, pneumothoraces in five patients (ages 9-22 years) with cystic fibrosis have been treated with thoracoscopy and talc poudrage. All procedures were performed under either regional or general anesthesia, depending on the age of the patient. Thoracoscopy was performed with a rod lens system and a 5.5-mm trocar, using biopsy forceps to lyse pleural adhesions, all of which ensures access to the entire pleural surface. United States Pharmacopeia-certified talc was insufflated to cover the entire pleural surface. There were no complications, and the patients had minimal pleural pain. Follow-up ranged from 6 months to 4 years. No patient has had a recurrent pneumothorax on the treated side. Thoracoscopy with talc poudrage is a preferable alternative to chemical sclerosis or thoracotomy for treating pneumothoraces in patients with cystic fibrosis. The procedure may be performed under regional anesthesia and allows rapid and complete sclerosis of the pleural cavity.

Adolescent↗
PubMed1985

Profound endoesophageal cryotherapy.

Studies are reported to define the tolerance of the feline esophagus to cryoinjury. Thirty-seven cats underwent endoesophageal cryotherapy to temperatures of -100, -120, -140 degrees C for 30 sec. Animals were sacrificed at 90 min, 4, 10, 14, and 20 days. The extent of cryoinjury was evaluated with ciné esophagogram, esophageal manometrics, and pathologic evaluation. Esophagograms demonstrated mural edema, coinciding with diminished amplitude of peristalsis in the area of freeze. All animals frozen to -100 degrees C survived with complete healing. Of the animals frozen to -120 and -140 degrees C, 14 and 15%, respectively, developed esophageal perforation. The feline esophagus tolerates local freezing to levels of -100 degrees C with complete healing. This modality may be useful in treating superficial lesions of the esophagus.

Animals↗
PubMed1985

Obstructive airway disease in infants and children.

Airway obstruction in infants and children can produce rapidly progressive life-threatening emergencies. An understanding of the common symptom complexes associated with regional obstructive abnormalities allows rapid evaluation and appropriate therapy. This article discusses the most common types of obstructive congenital and acquired airway anomalies, describes their symptomatology, and reviews the available diagnostic and treatment options.

Acute Disease↗
PubMed1985

Chylothorax: an assessment of current surgical management.

The development of chylothorax is a serious and often life-threatening clinical entity. Optimal management of this problem has not been well defined to date. We reviewed our experience with chylothorax in patients of all ages during the past 10 years. Ages ranged from 2 days to 69 years. The etiologies were traumatic in 17 and congenital or idiopathic in three. Six patients (five infants) were treated nonoperatively with either repeated thoracenteses or chest tube drainage. Fourteen patients (11 infants) underwent operative treatment: transthoracic thoracic duct ligation (five patients), pleuroperitoneal shunting (seven), pleuroperitoneal shunting combined with reoperation on a patient with congenital heart disease (one), and reoperation alone on a patient with congenital heart disease (one). Duration of preoperative therapy ranged from 9 days to 2 months (average 3.3 weeks). Five of six (83.3%) patients treated nonoperatively died. Of the surgically treated group, only two of 14 (14.3%) died, and 11 of the 12 survivors had resolution of the chylothorax and immediate clinical improvement. Our experience suggests that both pediatric and adult patients respond poorly to nonoperative treatment of chylothorax and that this treatment has a high mortality rate. Post-traumatic and congenital chylothorax should be treated operatively after a limited trial (1 to 2 weeks) of nonoperative therapy. Pleuroperitoneal shunting may offer a reasonable and effective alternative to thoracotomy and thoracic duct ligation.

Adolescent↗