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Biomedical subjects

B Shandling

Publications and source records attributed to B Shandling.

At least 73 records · Page 4Linked to original sources
PubMed1987

Intraoperative bupivacaine during outpatient hernia repair in children: a randomized double blind trial.

Postoperative pain is a major problem following surgery in the ambulatory child. A study was undertaken to test the effect of intraoperative bupivacaine on postoperative pain in children undergoing outpatient hernia repair. Ninety-nine children aged 1 to 7 years underwent outpatient inguinal herniorrhaphy under general anesthesia. Each was randomly assigned to receive bupivacaine (group 1) or saline (group 2), infiltrating the ilioinguinal and iliohypogastric nerves. Drug administration and patient evaluation were double-blinded. The groups were similar with respect to age, sex, side of procedure, and length of operation. In the immediate postoperative period, 17 group 1 patients required analgesics compared with 39 in group 2 (P less than .01); total codeine dosage was lower in group 1 (4.0 +/- 7.1 mg v 11.8 +/- 10.5 mg, P less than .05). Activity level 45 minutes after surgery (using a standardized scale) was greater in group 1 (P less than .05). Acetaminophen requirements at home were lower in group 1 on the day of surgery (3.1 +/- 4.3 mL v 5.7 +/- 7.4 mL, P less than .05) and over the following 48 hours (1.5 +/- 3.4 mL v 4.9 +/- 10.7 mL, P less than .05). Activity level at home on the day of surgery did not differ significantly between groups, but activity level over the following 48 hours was higher in group 1 (P less than .05). The two groups were similar with respect to all other parameters. We conclude that intraoperative bupivacaine decreases post-operative pain and analgesic use, and promotes early ambulation in children undergoing hernia repair.

Ambulatory Surgical Procedures↗
PubMed1987

The enema continence catheter in spina bifida: successful bowel management.

Patients with spina bifida who have fecal incontinence are managed by means of a large-volume saline enema. To facilitate administration of the enema, a special catheter has been devised that prevents leakage of the enema fluid. Continence has been achieved in 112 children and youths with spina bifida who were managed in this fashion.

Adolescent↗
PubMed1987

Bowel perforation with nonoperative treatment of meconium ileus.

Over the last 11 years, 22 neonates were treated with water-soluble contrast enemas to relieve the obstruction of meconium ileus. Fifteen babies had a gestational age of at least 36 weeks, and 16 weighed more than 2,500 g. All presented with clinical findings of a bowel obstruction, confirmed by roentgenograms, and each eventually had high sweat chloride levels. Each neonate had from 1 to 4 water-soluble contrast enemas administered slowly by syringe over 15 to 30 minutes. Eight enemas were successful in relieving the obstruction, four newborns requiring only one enema. Fourteen were unsuccessful, three having more than one enema. Seven of these 14 had intraabdominal pathology that would have required surgery. In five babies the bowel was perforated by the enema, the colon in three, and terminal ileum in two. These perforations were all immediately recognized during the course of the enema and operated on forthwith; a stoma was made in four cases. Only one of these five babies would have required an operation because of a volvulus. There were no fluid or electrolyte disturbances caused by the contrast material, and none of the babies with perforations died. Although this enema technique was successful in one third of cases, and despite the fact that perforations ensued in one quarter of cases, the procedure still seems warranted if the following precautions are taken: establishment of proper temperature, fluid, and electrolyte balance; the radiologist is not rushed, is extremely gentle, willing to repeat the study until no further progress is evident; the surgeon is available for an immediate laparotomy should a perforation occur.(ABSTRACT TRUNCATED AT 250 WORDS)

Diatrizoate Meglumine↗
PubMed1987

The anal sphincter force in health and disease.

The measurement of the strength of the anal sphincters has heretofore involved voluntary cooperation by the patient. In some children one cannot count on the maximum squeeze pressure being generated and in others the child is too young to understand what is required. We have devised an objective method of measuring the anal sphincter force (ASF) and have collected data derived from over 256 children over the course of 24 months. These include patients with Hirschsprung's disease, constipation, postoperative incontinence, spina bifida, and normal children both conscious and anesthetized. The results are presented and the value of the test and its applications are discussed.

Adolescent↗
PubMed1986

Hydrostatic reduction of intussusceptions caused by lead points.

It is generally accepted that an intussusception caused by a lead point will not be reduced by hydrostatic barium enema. This was reported several years ago, and has continued to be a consistent finding, prompting us to attempt hydrostatic barium enema reductions of recurrent intussusceptions in infants and children and also in older children with a first intussusception. However, in the last 9 years we have treated five children whose ileocolic intussusceptions were caused by lead points but which were reduced by hydrostatic barium enema. The histories and physical examinations were not any different than those of the average pediatric patient with an intussusception. The ileocolic intussusceptions diagnosed by barium enema were reduced with adequate reflux of barium into the terminal ileum. However, a residual and persistent filling defect in the colon or ileocecal area made laparotomy mandatory. In all five cases, a lead point was found and resected. This experience has suggested to us that a residual intraluminal filling defect in the barium column following what appears to be adequate flooding of the terminal ileum should be interpreted as a lead point, and an indication for a laparotomy.

Adolescent↗
PubMed1986

The prognosis of traumatic asphyxia in childhood.

Sixteen children with traumatic asphyxia (TA) over a 10-year period are reported. Follow-up was available in 12 of 14 survivors. Mortality and morbidity are the results of associated injuries or cerebral hypoxia, which are determined by the severity, nature, and duration of the compression force. Associated injuries should be treated in their own right, disregarding the manifestations of TA. The physical findings unique to TA usually resolve spontaneously. Neurologic sequelae such as peripheral nerve injuries or spinal cord injuries may be permanent. The cutaneous lesions uniformly disappear with time. Subconjunctival hemorrhages slowly fade and disappear. Visual defects are rare and usually clear within 24 hours, but may be permanent. No cognitive impairment results in children with uncomplicated TA, and the value of treating cerebral cortical depression with steroids is uncertain.

Adolescent↗
PubMed1986

Intussusception due to lymphoma.

Over 1,200 infants and children with an intussusception were treated at our hospital over the last 40 years and from this group, only 11 were found to have a lymphoma as a leading point for the intussusception. This number represents 17% of the 65 pathologic lesions that have caused an intussusception. Three children were under 41/2 years of age. All the children except two were chronically ill with pain for at least 1 week and usually for several months; weight loss and an abdominal mass in many instances provided the suspicion of a possible malignancy. When barium studies were done, there was almost always an ileocolic intussusception present with some obstruction. Reduction of the intussusception was accomplished with hydrostatic barium enema in 10 of the 11 patients; the one reduction, however, had a residual filling defect. Surgery confirmed the above findings and a resection of the leading point lymphoma was carried out in all of the children. In spite of all forms of treatment, death followed in all but three, usually within several months. One of these three survivors was treated with radiotherapy and steroids (after surgical excision) and is alive after 30 years; the second was also given chemotherapy and is alive and well after 6 years, and the third has not had radiotherapy and is alive after 10 months.

Child↗
PubMed1986

Pediatric surgery in Bangladesh.

Bangladesh, although a small country of only 55,000 square miles, is the world's eighth most populous nation, and its 90 million inhabitants occupy a land of harsh economic conditions. One half of this dense population is children, 90% of whom suffer from parasitic infestations, 10% are affected with neonatal tetanus, and one half are severely malnourished. Health care resources are scarce with one physician and hospital bed for about every 10,000 persons. A 1-month stay in Bangladesh at the Dhaka Shishu Hospital, made possible by the Canadian Association of Paediatric Surgeons, afforded an invaluable opportunity to be involved in Pediatric Surgery in such a setting. During the month, over 40 major pediatric surgical procedures were performed, including sequestrectomy, drainage of parietal wall abscess, and resection of massive neoplasms. Many unusual pathologic conditions, not commonly seen in Western countries, were encountered including canker otis, tuberculous ileitis, and ascaris-induced small bowel obstruction. In the setting of widespread malnutrition and limited diagnostic aids, appropriate surgical treatment remains crucial in many serious childhood conditions. Awareness of some of the more unusual infections and parasites seen in Third World nations is of great importance to Western surgeons due to increased travel and immigration and for a perspective on diseases rarely seen in more affluent countries.

Bangladesh↗
PubMed1986

The late nonfunctioning duodenal atresia repair.

Since 1979, three newborn males had duodenoduodenostomies for duodenal atresia, and all babies had smooth uncomplicated postoperative courses. There were no other anomalies. Between 6 and 18 months postoperatively, each infant developed an obstruction at the anastomosis that was initially treated with prolonged nasogastric suction. Because conservative management did not relieve the obstruction, the first two babies were operated on several times with revision of the anastomosis and bypass procedures, all of which were slow to function and required prolonged intravenous alimentation. It then became apparent that the duodenoduodenostomy was functionally obstructed. Therefore, the third infant was successfully treated with plication only of the dilated atonic proximal duodenum. All three children are now thriving more than 2 years after their surgery.

Duodenal Obstruction↗
PubMed1986

Adenocarcinoma of the pancreas in a neonate managed by pancreatoduodenectomy.

A 3-week-old infant presenting with jaundice and an abdominal mass was found to have juvenile adenocarcinoma of the pancreas (pancreatoblastoma). A pancreatoduodenectomy was performed, and the child is alive, well, and free of disease at age 4 years. The operative management and surgical technique are discussed.

Adenocarcinoma↗
PubMed1986

Anaphylactoid and systemic reactions following saline enema administration. Six case reports.

This report describes six children with spina bifida who have experienced a total of 13 episodes of generalized hives, angioedema and in two cases, anaphylactoid reactions immediately following saline enema infusions. The enemas were administered using a kit comprised of a plastic bag, tubing, and rectal end-piece. The reactions always occurred with the first use of new kits. A third child developed a systemic reaction with only the rectal end-piece in situ and without infusion of fluid. An in-hospital challenge using a new end-piece in one patient, who was clinically the most sensitive, produced an acute anaphylactoid reaction implicating the end-piece as the most likely source of the problem. The definitive mechanism(s) of the reactions and the agent(s) responsible for them presently remain unknown.

Anaphylaxis↗
PubMed1984

Total colon aganglionosis--a new operation.

The colon-conserving concepts described by Martin in total colonic aganglionosis all presuppose that the distal end of the bowel is secured at the anus by the method of Duhamel. Many surgeons prefer a modification of the endorectal operation popularized by Soave when treating shorter segment Hirschsprung's disease. By combining the principles of the two methods we have evolved a technique in which the colon is anastomosed to the ileum using the GIA stapler. However, the anastomosis is commenced about 10 cm proximal to the distal cut end of the ileum, having first pulled the distal 10 cm through the muscular cuff of the rectum in the manner described by Soave. A temporary ileostomy is made. This method has been used clinically in two cases with gratifying results. By the use of this new technique the increase in absorptive area is achieved. At the same time the advantages of the endorectal pull-through operations are not compromised by any rectorectal dissection.

Child, Preschool↗
PubMed1984

Segmental dilation of the colon: a rare cause of chronic constipation.

Segmental dilation of the colon is a rare entity. It should be considered in any young patient with chronic constipation. The clinical picture and radiographic examination are indistinguishable from Hirschsprung's disease and the rectal biopsy is of paramount importance. This disease can be cured by resection of the dilated segment.

Child↗
PubMed1984

The problem of recurrent thyroglossal duct remnants.

The removal of a thyroglossal duct or sinus is a common pediatric surgical operation. It has been taught that if the duct remnant is removed down to and including the middle third of the hyoid bone, the "correct" operation has been done. The three authors have an experience totaling over 60 years in pediatric surgery during which time they operated on 270 thyroglossal duct cysts and sinuses. In this group were 27 recurrences of which three belonged to the authors. Most recurrent thyroglossal duct remnants were found to have the middle third of the hyoid bone still in place, and with its removal the patients were cured. However, during this period of time, there were thyroglossal duct cysts and sinuses which recurred in spite of the "correct" surgical procedure having been done. These patients had all been operated on between three and five times thus creating a difficult and unusual problem. The solution to these recurrent thyroglossal duct cysts and sinuses were deeper excisions to remove residual tracts deep to the previously removed hyoid bone, and/or wider excisions to excise previously missed respiratory epithelial remnants which deviated laterally from the midline. The latter tissue was found to be a more centrally directed branchial cleft sinus.

Adolescent↗
PubMed1984

The relationship between PaCO2 and ventilation parameters in predicting survival in congenital diaphragmatic hernia.

Fifty-eight infants with congenital diaphragmatic hernia presenting within the first 6 hours of life, who underwent surgical repair, were analysed prospectively in order to produce a reliable index of severity of disease that would reliably predict eventual outcome. All were treated with paralysis hyperventilation and intravenous (IV) isoproterenol for the first 48 hours. There were 30 survivors and 28 deaths in this series (mortality 48%). Using arterial PCO2 values measured 2 hours after surgical repair and correlating them with an index of mechanical ventilation (mean airway pressure and respiratory rate), we have been able to clearly define two groups of diaphragmatic hernia based on their response to IPPV. The first group, with CO2 retention and severe preductal shunting, was unresponsive to hyperventilation with high rates and pressures; the mortality was 90%. The second group responded well to hyperventilation and demonstrated reversable ductal shunting only. Survival in this group was 97%. Only four patients out of 58 exhibited the "honeymoon period," with a period of stability followed by severe ductal shunting. Arterial CO2 accurately reflects the degree of lung development in this disease and separates those patients with severe pulmonary hypoplasia, where the outcome is invariably fatal, from those with a well-developed contralateral lung where there is excellent potential for survival.

Carbon Dioxide↗
PubMed1984

Neonatal intestinal pseudoobstruction.

In the past 10 years, the diagnosis of pseudoobstruction lasting more than two months was confirmed in 10 infants after sepsis, meconium ileus, and Hirschsprung's disease were excluded, and surgery or autopsy failed to demonstrate a site of mechanical intestinal obstruction. Four infants had undergone prior operation for another anomaly: gastroschisis (2) and ileal atresia (2). Five of the remaining infants also had megacystis. The lack of coordinated intestinal motility was best appreciated by radiocontrast small bowel studies, which showed degrees of aperistalsis or segmentation. Rectal manometric studies were not helpful. Histology of the intestine was normal in seven, while a gross deficiency of nerve fibres was noted in one patient and a myopathy of smooth muscle in another. A variety of drugs used to stimulate peristalsis were ineffective. Seven patients had 25 operations, often to exclude mechanical causes of obstruction. The mainstay of treatment was TPN and intestinal decompression. Six children survived; their ages ranged between 8 months and 9 years (median age, 16 months). There has been improvement in intestinal peristalsis in five children, three of whom now tolerate a regular diet and two of whom are on TPN and are currently increasing oral intake. Four infants died, two from sepsis, two from TPN-related hepatic failure. In contrast to previous reports, we conclude that intestinal pseudoobstruction may be self-limited in some neonates, including those with megacystis. Therapy should consist of long-term nutritional support and treatment of other anomalies that may be present.

Combined Modality Therapy↗
PubMed1983

A modified Sugiura operation for bleeding varices in children.

Objections to portal systemic shunting in children with life-threatening hemorrhage from esophageal varices include the high incidence of postshunt encephalopathy with neurologic and psychiatric sequelae and the inability to provide an adequate shunt in very young children. We have operated on eight children in the past 4 years for bleeding varices. The causes were: portal vein thrombosis (3), congenital hepatic fibrosis (2), chronic active hepatitis (2), and cystic fibrosis (1). The ages at operation were between 2 and 17 years. These children underwent various modifications of an operation described by Sugiura. The operation we have developed is done through a single thoracoabdominal incision, dividing and anastomosing the esophagus with a stapler, preserving the vagal innervation to the pylorus and antrum, and wrapping the fundus around the distal esophagus at the site of the anastomosis. The venous drainage of the lower esophagus and of the upper stomach is divided. The operation is therefore shorter and simpler, but adheres to the principles enunciated by Sugiura. Complications include one significant postoperative anastomotic leak and one symptomatic esophageal stricture. Longterm results have been gratifying with no evidence of rebleeding from esophageal varices. We believe that our modification of the original Sugiura operation is the preferred therapy of bleeding esophageal varices when surgical intervention is indicated because it preserves the normal structure and function of the upper gastrointestinal tract as well as the portal venous drainage to the liver.

Adolescent↗