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Biomedical subjects

B M Rodgers

Publications and source records attributed to B M Rodgers.

At least 73 records · Page 4Linked to original sources
PubMed1985

Triplication of the esophagus with gastric duplication.

A 2 1/2-year-old girl was seen with an upper abdominal mass. Evaluation by abdominal ultrasonography, esophagography, upper gastrointestinal series, and computerized axial tomography suggested the possibility of duplication of the esophagus, stomach, and duodenum. Surgery revealed a triplication of the esophagus with a gastric duplication, which was resected. The patient recovered and greatly increased her weight-for-age percentile. Of the theories proposed to explain gastrointestinal duplications, the split notochord hypothesis most closely fits this patient's anomalies. It is unusual for a patient with a gastrointestinal duplication to develop symptoms after the first year of life. This is the first report of a triplication of the esophagus with a gastric duplication.

Abnormalities, Multiple↗
PubMed1984

Esophageal atresia with double fistula: the missed anomaly.

Of the various anatomical types of atresia, that of esophageal atresia and double fistula is said to be the least common. In most series, frequency is less than 1%. Seventy-eight patients with esophageal atresia were treated at the University of Virginia Medical Center between 1955 and 1983. Six of them had esophageal atresia and double fistula, and in 5 of these 6, this anomaly was not diagnosed preoperatively and was not detected intraoperatively. Our experience suggests that proximal "pouchograms" are essential in the preoperative evaluation of these patients to detect the presence of esophageal atresia and double fistula. The morbidity and mortality occasioned by overlooking this anomaly far exceed the risk of the contrast study.

Barium Sulfate↗
PubMed1984

Uterine prolapse in the neonate.

The rare condition of neonatal uterine prolapse is usually associated with congenital spinal defects and is often resistant to simple reduction. Previously, treatment has been primarily surgical and often deforming. In this case report a silastic-ensheathed pessary fashioned from a rubber Penrose drain allowed a nonoperative, simple and permanent correction, permitting the more important, yet less obvious, associated defects to take therapeutic precedence.

Female↗
PubMed1984

Risk factors for microwave scald injuries in infants.

An infant sustained second- and third-degree scald burns of the oropharynx from drinking formula heated in a microwave oven. The circumstances leading to the scald injuries were recreated. Factors contributing to the injury included the volume of formula, the initial temperature of the formula, and the temperature gradient between the liquid core and the bottle surface after microwave heating. These studies indicate that infant formula should be warmed only with extreme care in microwave ovens and should be tested for suitability of temperature prior to feeding.

Burns↗
PubMed1984

Physiology of serum gastrin production in neonates and infants.

Conflicting data exist regarding the physiology of serum gastrin production in neonates and infants, and the response of the neonatal gastric antrum to feeding. Normal neonates and infants underwent serial determination of fasting and postprandial serum gastrin levels from birth to 4 months of age. The mean fasting serum gastrin levels in newborns and infants up to 4 months remained considerably higher than the mean maternal levels, the elevations being statistically significant until 2 months of age. In addition, in the first 2 months of life, there was no evidence of postprandial stimulation of serum gastrin levels 30 minutes following normal feeds consisting of breast milk or commercial formula. At 3 and 4 months of age, the response appears to revert to an adult pattern with statistically significant postprandial elevations following normal feeds (p = 0.003 and p = 0.02, respectively). This study confirms the presence of neonatal hypergastrinemia and reveals a persistence of elevated serum gastrin levels through early infancy. A maturation of the antral gastrin release response with postprandial elevations of serum gastrin levels occurs at approximately 3 months of age.

Age Factors↗
PubMed1983

Endotracheal cryotherapy in the treatment of refractory airway strictures.

In 1977 we reported the successful use of endotracheal cryotherapy in the treatment of experimental tracheal strictures. This technique has now been employed in the treatment of 29 refractory airway lesions in 27 patients ranging in age from 3 months to 42 years. The technique utilizes a nitrous oxide cryoprobe measuring 3 mm in diameter and 43 cm in length. The tip of the probe is applied directly to the stricture through the endoscope and cooled to -80 degrees C for 45 seconds. On removal of the probe, the frozen tissue is resected with biopsy forceps. Cryotherapy has successfully relieved the airway strictures in 20 of the 24 lesions in which treatment was completed. The technique of endotracheal cryotherapy has proved helpful in the management of selected patients with refractory airway strictures.

Adolescent↗
PubMed1983

Pleuroperitoneal shunts in the management of neonatal chylothorax.

Pleuroperitoneal shunts have been placed in five ventilator-dependent newborns with persistent chylothorax. The etiology of the chylothorax appeared to be secondary to superior vena caval obstruction in three patients and was idiopathic in the remaining two. Despite traditional therapies these infants were on a progressively deteriorating clinical course. Hakim-Cordis low-pressure ventricular-peritoneal shunt catheter systems were used in each infant. Ultrasonography was used to follow the regression of pleural effusions and to determine the need for shunt compression. Shunt patency was confirmed with radionuclide studies. Four of five infants had a complete resolution of their chylothorax and pulmonary insufficiency. Three of these infants were extubated within 28 days following the placement of the shunt. Nutritional and metabolic stability was rapidly achieved. The shunts were removed several weeks later without recurrence of the chylothorax. A fifth infant failed to improve after the placement of the pleuroperitoneal shunt and died of progressive pulmonary insufficiency. The placement of pleuroperitoneal shunts in infants with refractory chylothorax is safe, technically easy to perform, and is associated with few complications.

Catheterization↗
PubMed1983

Hepatic artery ligation for hepatic hemangiomatosis of infancy.

Capillary and cavernous hemangiomas of the skin and subcutaneous tissue, usually follow a benign course with enlargement in the first year of life followed by gradual involution. Hemangiomas of the liver, on the other hand, can be responsible for life threatening complications in infancy. The presence of major intrahepatic arteriovenous communications may produce a high output cardiac failure, refractory to intensive medical therapy. Use of radiation therapy and high doses of steroids have proven to be of limited success with a 90% mortality in infants managed with nonoperative therapy. Hepatic artery ligation in such patients may provide dramatic control of the high output failure, with negligible side effects. Two infants are reported in whom bilateral hepatic artery ligation provided prompt control of fulminant congestive failure secondary to hepatic hemangiomatosis, after failure of medical therapy.

Female↗
PubMed1983

Hydrops of the gallbladder in children.

Gallbladder disease in children today is being diagnosed increasingly because of better awareness of its existence and of improved diagnostic capability. A case is presented to describe an unusual pathologic variant termed "acute hydrops" of the gallbladder. This entity occurs specifically in children and is characterized by an acute illness with massive distention of the gallbladder in the absence of stones, bacteria, or congenital malformations. Differential diagnoses include appendiceal abscess, intussusception, volvulus, peritonitis, and pyelonephritis. Routine and contrast radiographic techniques may be combined with abdominal ultrasound to aid in the preoperative diagnosis. The etiology of hydrops is not known, but bile stasis and mesenteric lymphadenitis seem to be important factors. Treatment has varied from supportive observation to operative aspiration or cholecystectomy.

Child, Preschool↗
PubMed1982

Near-total pancreatectomy in persistent infantile hypoglycemia.

To prevent the devastating effects of hypoglycemia on the CNS of the infant, persistent infantile hypoglycemia should be recognized early and treated promptly. To avoid mental retardation, surgical intervention should not be considered as a last resort. When an insulinoma is identified at surgery, subtotal pancreatectomy is adequate in achieving normoglycemia. However, the most common cause of insulin excess in infancy appears to be islet cell hyperplasia or nesidioblastosis, both diffuse processes. In these patients, subtotal pancreatectomy is often ineffective in achieving normoglycemia. Near-total pancreatectomy, retaining the spleen and duodenum, is a safe procedure, well tolerated by infants and children, and should be considered early for the correction of hypoglycemia of infancy that is not readily controlled by medical intervention.

Adenoma↗
PubMed1982

Thoracoscopy for intrathoracic neoplasia in children.

The technique of thoracoscopy allows a unique opportunity to examine the entire hemithorax. Between July 1975 and April 1981 we performed over 150 thoracoscopic procedures for evaluation of intrathoracic pathology at the University of Florida. Twenty-five of these procedures, performed in 23 patients, were undertaken for the diagnosis or staging of intrathoracic tumors in patients whose ages ranged from 8 mo to 18 yr. Forty-eight percent were for parenchymal tumors, 44% for mediastinal masses, and 8% for pleural disease. Twelve of these patients had at least 1 invasive procedure performed prior to thoracoscopy without a diagnosis being established. In 17 procedures a positive tissue diagnosis of malignancy was obtained, and in 6 of these cases areas of previously unsuspected intrathoracic tumor involvement were identified by thoracoscopy. In 3 patients simultaneous thoracoscopy-guided transdiaphragmatic needle biopsy of the liver was performed with a positive tumor diagnosis being achieved in 1. The clinical course of the patients following the 8 procedures in which neoplasia was not encountered confirmed the diagnosis of benign disease in all but 1. A single patient with an enlarged mediastinal lymph node had a falsely negative thoracoscopy biopsy and was subsequently diagnosed as having recurrent Hodgkin's disease. The overall diagnostic accuracy in these patients was, therefore, 92%. Complications in these patients have been minimal, and there was not mortality due to the thoracoscopic procedure. These clinical results would suggest an important role for thoracoscopy in the evaluation of intrathoracic neoplasia in children.

Adolescent↗
PubMed1982

Secretin levels in plasma and tissue of the neonatal swine.

The mean fasting serum secretin level determined in newborn swine was found to be 298.0 +/- (SEM) 5 pg/ml, significantly higher than that in the adult animal. Intraduodenal infusion of 0.1 N HCl produced dramatic elevation of the mean serum secretin level to 2,090 +/- 340 pg/ml. The tissue secretin concentration of duodenal mucosa as well as the molecular species of tissue secretin were found to be identical to that of the adult swine. The mean disappearance half-life of exogenously administered secretin in the newborn swine was significantly prolonged over adult values, to 3.6 min. These data suggest that delayed secretin degradation can be implicated as a factor in the etiology of the hypersecretinemia in the newborn swine.

Animals↗
PubMed1982

The effects of profound cryotherapy upon the pulmonary parenchyma.

Cryotherapy, the application of supercool temperatures to living tissue, has proved successful in the treatment of many superficial neoplasms. Recent clinical studies have suggested the efficacy of an aggressive surgical excision of multiple pulmonary metastatic nodules. The current experiments were designed to study the effects of profound cryotherapy upon the pulmonary parenchyma as a preliminary to the use of this modality clinically in patients in whom further pulmonary resection is impossible. Six dogs were subjected to temperatures of -120 degrees C on the visceral pleural surface of the lingula for three successive freeze/thaw cycles. Serial roentgenograms were obtained on all animals and surviving animals were killed between 4 and 28 days following cryotherapy. Radiographically, an infiltrate developed in the region of cryotherapy within 3 to 5 days, clearing completely by 28 days. There was no instance of delayed pneumothorax developing. Histologically, a subpleural hemorrhagic infarct developed in the region of cryotherapy with mesothelial proliferation on the overlying pleural surface. Within 28 days the infarct had resolved to a subpleural fibrous scar with normal surrounding pulmonary parenchyma. These studies demonstrate the safety of profound pulmonary cryotherapy and suggest cautions clinical trials.

Animals↗
PubMed1981

Thoracoscopy for intrathoracic tumors.

The technique of thoracoscopy has been performed on 49 occasions in 45 patients for the diagnosis or staging of intrathoracic tumors. The patients ranged from 8 months to 68 years old. Eight procedures were performed for pleural disease, 16 for mediastinal masses, 22 for parenchymal lesions, and 3 for intrathoracic staging. Seventeen patients had had previous invasive procedures performed without a pathological diagnosis being established. In 28 thoracoscopy procedures, a positive diagnosis for malignancy was obtained; in 6 instances, areas of unsuspected tumor involvement were identified. A correct diagnosis was obtained by thoracoscopy in 45 procedures for a 92% overall accuracy rate. There was no clinically significant morbidity in this series and no procedure-related mortality. Thoracoscopy, performed under stellate ganglion block and regional anesthesia, has proved to be a very attractive method of diagnosing intrathoracic neoplasia with very low morbidity.

Adolescent↗
PubMed1981

Blunt transmediastinal total esophagectomy with simultaneous substernal colon interposition for esophageal caustic stricture in children.

The management of caustic strictures of the esophagus continues to be a challenge to the pediatric surgeon. Many of these patients develop refractory strictures and esophageal reconstruction becomes necessary. Most of the currently employed surgical techniques for this reconstruction leave the injured esophagus in situ and most surgeons have been unwilling to perform a secondary thoracotomy for removal. Many authors have suggested a vastly increased risk of development of esophageal carcinoma in the caustically injured esophagus. In the past five years, techniques for blunt transmediastinal esophagectomy have been developed for adult patients with carcinoma of the cervical region of the esophagus. The current report describes the use of these techniques in two pediatric patients for performing total esophagectomy with simultaneous substernal colon interposition, without the need for thoracotomy. With careful adherence to several technical aspects, this procedure safely allows for complete removal of the injured esophagus and alleviates the concerns of subsequent complications from this organ.

Burns, Chemical↗