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Biomedical subjects

B Shandling

Publications and source records attributed to B Shandling.

At least 109 records · Page 6Linked to original sources
PubMed1979

The Kasai operation (hepatic portoenterostomy) for biliary atresia--experience with 20 cases.

Twenty infants have undergone hepatic portoenterostomy at The Hospital for Sick Children in Toronto. Sigificant bile flow was obtained in six babies. No correlation was found between the size of the ducts in excised portal tissue and postoperative bile flow. Ascending cholangitis has not been a major problem. Progressive cirrhosis leading to portal hypertension is the main late problem in those patients who have had bile flow successfully reestablished.

Bile↗
PubMed1979

Meconium ileus: laparotomy without resection, anastomosis, or enterostomy.

During the 14 yr from 1965 through 1978, 49 infants presented shortly after birth with intestinal obstruction due to impacted meconium. Three of these patients did not have fibrocystic disease. Eight patients were cured by a Gastrografin enema. There were 18 patients who had complications that included associated atresia, volvulus, and/or peritonitis. Various operations were done including resection with either primary anastomosis or enterostomy or varieties of the foregoing. Twenty-three babies had the simple uncomplicated form of meconium ileus. Eleven of these underwent resection and six patients died. Twelve patients were treated by laparotomy, ileotomy through a purse-string suture and prolonged irrigations using acetylcysteine. Of this group only one succumbed. This latter course of management is recommended for patients with simple uncomplicated meconium ileus as it involves no resection, no enterostomy, nor any primary anastomosis.

Cystic Fibrosis↗
PubMed1979

Partial gastric wrap-around as an alternative procedure in the treatment of hiatal hernia.

The Allison, Belsey, and Nissen antireflux operations have been widely used over the last 15 yr. A number of problems have followed from these procedures that have prompted us under certain circumstances to seek alternative operations. In the last 2 yr, in selected patients, we have done a partial gastric wrap-around (Dor-Nissen) operation on 16 children from age 2 wk to 13 yr for the following reasons: failed Allison and Nissen repairs, two infants with such a small stomach that only a partial stomach wrap-around was possible, with a Heller cardiomyotomy, and for reflux with or without an accompanying hiatal hernia. All of these Dor-Nissen partial wrap-around operations were technically easy to do and all the postoperative patients have been problem-free both clinically and radiologically. Moreover, the gass bloat syndrome seen with the Nissen fundoplication has not been encountered. We recommended this partial wrap-around antireflux operation as a primary procedure, an alterative to one of the more widely used operations, or when re-operating for recurrence of gastroesophageal reflux.

Adolescent↗
PubMed1978

Hepatic function following portoenterostomy for extrahepatic biliary atresia.

Liver structure and function in 10 patients with extrahepatic biliary atresia were studied after portoenteric anastomosis (Kasai operation). Bile flow adequate to reduce the serum bilirubin concentration was established in five patients (improved group), three of whom became anicteric. The serum bilirubin concentration did not decrease in the remaining five patients (unimproved group). Hepatic effluent collected postoperatively from both groups contained small amounts of cholesterol and bilirubin; bile salts, however, were present in the hepatic effluent of only the improved patients. Liver biopsy specimens obtained postoperatively from the five improved patients showed partial (in two) or complete (in three) relief of cholestasis; hepatic fibrosis, however, was unchanged (in one) or worse (in four). The serum concentrations of bile salts were markedly elevated, despite normal excretion of sodium sulfobromophthalein and rose bengal, in two anicteric patients studied 14 and 24 months postoperatively. It is concluded that neither structure nor function of the liver is normalized by portoenterostomy even in clinically well, anicteric patients.

Bile Ducts↗
PubMed1978

Assessment of the cardiovascular system in conjoined thoracopagus twins.

The thoracoomphalopagus conjoined twins comprise 75% of all conjoined twins. In the assessment of the organ systems of the twins, the cardiovascular system is important since union of this system in the twins has occurred in 75% of the cases. Of the five cases reported here, two had separate hearts and vessels with a common pericardium only. Two twins were joined at the right atrial level. The fifth pair were connected at both atrial and ventricular levels. It has been suggested that the presence of two separate QRS complexes in the ECG indicates complete separation of the two hearts. Case 4 shows that even in the presence of atrial union, the existence of an atrioventricular block in one twin may produce a very slow heart rate, while the other twin may have a normal rate that will not influence the ventricular rate of the other. In our experience, angiocardiography has been the most useful diagnostic procedure.

Angiocardiography↗
PubMed1978

Perfusion of malignant hyperthermia susceptible and normal isolated pig livers with halothane.

We have perfused malignant hyperthermia susceptible and normal isolated pig livers with halothane for one hour. The liver temperatures, oxygen and carbon dioxide tensions, the base deficits and lactate concentrations in blood entering and leaving the liver have been measured at the beginning and at the end of the perfusion. Statistical analysis has shown that there are no significant differences in these parameters between the beginning and the end of the perfusion period or between the normal and the malignant hyperthermia susceptible livers. We conclude, therefore, that the livers of malignant hyperthermia susceptible pigs are either normal or else, if abnormal, the abnormalities are sufficiently benign as to be not measurably expressed.

Anesthesia, Inhalation↗
PubMed1978

Nonoperative management of traumatized spleen in children: how and why.

In the absence of the apleen, overwhelming infection is a real threat. Therefore, there is a trend to try to preserve all spleens. Recognizing this, and realizing that not every damaged spleen must be removed, a nonoperative approach has been advocated and practiced for 35 yr at the Hospital for Sick Children in Toronto. This experience is recorded herein, providing indications and methods of management. The results are considered to be very satisfactory.

Blood Transfusion↗
PubMed1978

Splenic trauma--nonoperative management and long-term follow-up by scintiscan.

1972 TO April, 1977, 28 children with splenic rupture were managed nonoperatively. The diagnosis was confirmed by splenic scintigraphy with 99mTechnetium-sulfide colloid. Those patients whose condition was stable and satisfactory or maintained stable with intravenous fluids or blood transfusions were not operated upon. All patients sustained their ruptured spleens as a result of trauma, except for one spontaneous rupture in a patients with infectious mononucleosis. Emergency laparotomy for deterioration of clinical condition or late complications was never necessary. Splenic scans were repeated in 22 patients to assess resolution. Fourteen patients had minimal residual defects but there were no late complications detected.

Abdominal Injuries↗
PubMed1978

Fourteen years of gastric tubes.

Since 1964 gastric tube replacement of the esophagus has been done in 30 infants and children. This report reviews and brings up to date our entire series, which includes follow-up of 15 children over 5 yr, 7 of whom have been followed for more than 10 yr. The two-stage proximally based reversed antiperistaltic gastric tube placed retrosternally is still our procedure of choice, although since our last report in 1973 several other methods (one-stage, transthoracic, subcutaneous) have been used, and the spleen has not been removed in our more recent operations. Whether the esophagogastric tube anastomosis is primary or secondary or is in the chest or neck, leakage is still the most common complication (63%), with all but three closing spontenously. A continuing problem may be an anastomotic stricture (43%) that will require some dilatations. Mild sacculation or tortuosity of the gastric tube has been encountered only once. Despite the above problems, the eventual outcome in the growing child with a gastric tube replacement continues to be a satsifying one. We continue to use the gastric tube operation when replacement of the esophagus is required.

Adolescent↗
PubMed1978

A new nonoperative treatment of large omphaloceles with a polymer membrane.

The management of a huge omphalocele that cannot be primarily closed presents many difficulties. When surgery is technically impossible, the application of a Silon pouch carries a serious risk of infection and painting the sac with tinctures has its own peculiar problems. A newborn baby with a large unruptured omphalocele was successfully treated by covering the sac with a skin-like polymer membrane that is flexible, elastic, and impervious to bacteria and water. The covering did not adhere to the underlying tissues and did not interfere with gastrointestinal function. Infection was not a problem. This material was wrapped around the trunk and covered with a dry sterile dressing. The entire dressing was removed after 3 wk, revealing a small residual area of granulations that subsequently healed at home. This baby was not operated upon. We have also used this technique in a second newborn in whom the sac had ruptured. The rent was repaired and the membrane applied. This method does not eliminate later closure of the large ventral hernia, but ccertainly eliminates the necessity for surgery in the newborn period.

Bandages↗
PubMed1978

Increased serum immunoreactive gastrin levels in idiopathic hypertrophic pyloric stenosis.

The serum immunoreactive gastrin (IRG) level in infants with confirmed idiopathic hypertrophic pyloric stenosis (IHPS) has been determined and compared to that found in vomiting infants without IHPS, in normal infants, and in normal adults. The mean serum IRG level of normal infants (103 +/- 9 pg/ml (mean +/- SEM) exceeded that of normal adults (28 +/- 5 pg/ml). The preoperative mean serum IRG level in IHPS infants (256 +/- 26 pg/ml) was significantly higher than that of both normal infants and vomiting infants without IHPS (93 +/- 9 pg/ml). Twenty-five per cent (5/20) of the IHPS infants had serum IRG levels within the upper range of normal infants. Fasting serum IRG levels in IHPS infants were not altered immediately by pyloromyotomy. The results from this study suggest a relationship between gastrin and idiopathic hypertrophic pyloric stenosis.

Adolescent↗
PubMed1977

The morbidity and mortality of splenectomy in childhood.

One hundred and eighty-two patients undergoing splenectomy in infancy and childhood were followed for periods of 2 to 15 years. Serious infections occurred in 11 patients (6%) with death in 6 (3.3%). In 10 patients the infection was sepsis, and in all but one patient the infection occurred within 2 years of splenectomy. Among children over 2 years of age the risk of infection was still appreciable except when the spleen was removed incidentally or for traumatic rupture. Splenectomy for thalassemia and portal hypertension resulted in an increased risk of serious infections when compared with removal of the spleen for hereditary spherocytosis, idiopathic thrombocytopenic purpura, trauma, or for technical reasons in the course of another operation. Post-splenectomy infections tended to follow a characteristic pattern. The infecting organism was predominantly pneumococcus, the course was fulminating and the mortality high.

Adolescent↗
PubMed1976

A new approach to the diagnosis of testicular torsion.

The acutely painful, enlarged scrotum has necessitated urgent exploration of the scrotum so as not to miss testicular torsion. This has led to unnecessary operations. The urgency with which the diagnosis is made is particularly important in infants and children for in these patients the signs and symptoms of testicular torsion may be minimal. Since its introduction in 1973, scrotal scanning has allowed a precise evaluation of the testicular perfusion and thus refined the indications for operation. Using scrotal scanning in a series of 18 patients with possible testicular torsion a correct assessment of testicular perfusion was made in every patient. In only two patients did the interpretation differ from the ultimate clinical impression. In one, the torsion had relieved itself before the scan was performed and at operation the testis had adequate perfusion. In the second, clinically suspected epididymitis was not confirmed. Because of the ease and rapidity with which the test may be done in children more testes should be salvaged with fewer negative explorations.

Adolescent↗