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Biomedical subjects

C E Koop

Publications and source records attributed to C E Koop.

At least 109 records · Page 6Linked to original sources
PubMed1982

Acute pancreatitis: the difficulties of diagnosis and therapy.

Acute pancreatitis in children is uncommon but is being recognized frequently. Twenty-four children provided clinical data to review the various manifestations and therapy of acute pancreatitis, all of these patients having survived a clinical episode. Recognition of acute pancreatitis has been improved by the advent of new diagnostic procedures such as serum amylase isoenzymes, amylase/creatinine ratio, ultrasonography, endoscopic retrograde cholangiopancreatography (ERCP), computerized axial tomography (CAT) scan, and peritoneal lavage. The causative factors in our series were: trauma, biliary disease,, viral (mumps), and steroid therapy. Treatment of acute pancreatitis was nonsurgical unless a specific surgical lesion was present.

Acute Disease↗
PubMed1982

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Health Policy↗
PubMed1982

Cancer in neonates: the experience at the Children's Hospital of Philadelphia.

Among 22 neonates treated at the Children's Cancer Research Center of Philadelphia, 11 had neuroblastoma, which in two cases was widely metastatic. There were three infants with teratoma, three with sarcoma, three with leukemia, one with Wilms' tumor, and one with parotid carcinoma. Nine of eleven patients (82%) are long-term survivors following complete surgical excision of tumor, whereas only one of eight (13%) has survived following incomplete surgical excision. All three neonates with leukemia died. The overall two-year actuarial survival is 45% (10/22). The problems associated with treating neonates with chemotherapy, radiation therapy, or both are especially difficult because of the immaturity of the organs and structures. Surgical excision alone has been the treatment of choice for solid tumors. Chemotherapy or radiation therapy, when indicated, require careful monitoring for both acute toxicities and potential long-term morbidities.

Female↗
PubMed1981

Use of military antishock trouser in a child.

Angiographic localization and embolization has emerged as the preferred mode of therapy for arterial bleeding associated with pelvic fractures but is not always definitive. Our experience demonstrates the use of an external counter pressure device (MAST) as an essential part of the pediatric surgeon's armamentarium and suggests the need for concurrent venography during angiographic localization of pelvic bleeding sites.

Child↗
PubMed1981

Percutaneous subclavian venous catheters in neonates and children.

There were 191 central venous catheters placed through the subclavian vein in 135 neonates and children over a 20-mo period, providing central venous access for a total of 4525 patient days. There were 132 (69.2%) catheters inserted in patients who were in their first year of life and 60 (31.4%) weighed less than 2.5 kg. The procedure was associated with a low technical complication rate. The greatest potential intermediate or long-term complication was the development of primary catheter sepsis that occurred in 11 (5.8%) of the catheters placed.

Adolescent↗
PubMed1981

Nutritional assessment: an integral part of the preoperative pediatric surgical evaluation.

Comprehensive nutritional assessment in adults has revealed that 50% of hospitalized patients suffer from acute protein calorie malnutrition (PCM), a state which correlates with increased surgical morbidity and mortality. We report our results examining the same question in children, and on the basis of these data suggest that nutritional assessment be a routine part of the preoperative evaluation of all pediatric surgical patients. We studied 198 children and found that the overall prevalence of acute PCM was 54%; but if premature and term infants less than three months of age are selected, the prevalence of acute PCM was a striking 63%. If only surgical patients are considered, the prevalence of acute PCM among patients hospitalized for trauma or burns was 31% for elective operation 39%, and for acute but complex operative procedures 64%. These data demonstrate that a remarkably high prevalence of acute PCM exists among hospitalized pediatric and pediatric surgical patients. Whether aggressive perioperative nutritional support can reverse such acute PCM and favorably influence morbidity and mortality is currently speculation, but that acute protein calorie malnutrition is far more prevalent among hospitalized pediatric patients that is generally realized, and that comprehensive nutritional assessment is essential to identify the "at risk" nutritionally deprived pediatric surgical patient, have now been proven.

Adolescent↗
PubMed1981

Acute pancreatitis and increased intracranial pressure.

A retrospective review of 41 patients with post-mortem evidence of acute pancreatitis revealed that 19 patients (46%) showed concomitant evidence of increased intracranial pressure (ICP). A prospective analysis of five patients with increased ICP demonstrated two patients with evidence of acute pancreatitis. The pathogenesis of acute pancreatitis in these patients appears to be dependent on the following risk factors: increased intracranial pressure, steroids, hypovolemia, morphine infusion and hypothermia. These factors increase vagal stimulation, predispose to pancreatic duct obstruction and enhance cellular hypoperfusion. Acute pancreatitis occurring in Reye's Syndrome is probably a consequence of increased ICP and the therapy instituted.

Acute Disease↗
PubMed1981

The liver and immunoregulation of neuroblastoma growth.

C1300 neuroblastoma, like human neuroblastoma, elicits an immune response in its host and as a result provides an animal model in which to study the enigmatic behavior of this common childhood tumor. Since the liver is a favored site for neuroblastoma metastasis, especially the favorably regressing IV-S stage, and since the liver is a known producer of immunoregulatory factors, this study report a systematic assessment of liver cell tumor cell interaction, the effect on tumor immunogenicity, and the potential for tumor growth control. Immunization-excision-challenge assays in 120 A/J mice with C1300 demonstrate the tumor to be antigenic; but in a second experimental sequence with 120 mice, normal whole liver cells were admixed with C1300 tumor cells in vitro and incubated for one hour prior to animal innoculation. The immunogenicity is dramatically minimized in the admixture group when compared with controls (antigenic ratio = 1.67 versus 3.07, p less than .02). However, if prior to such liver cell-tumor cell admixture the liver cells are sonicated and the lysate ultracentrifuged, a contrasting result is obtained. In 4 additional experiments utilizing 120 mice, the tumor cell is rendered a more potent immunogen following soluble fraction admixture (antigenic ratio = 1.99 versus 1.56, p less than .05). These data suggest that such whole cell and subcellular soluble factor immunoregulatory interactions are operative in determining immunogenicity of a tumor innoculation. We speculate that the progression or regression of clinical neuroblastoma within the liver may be similarly influenced since a host-tumor interaction depends on eliciting an antitumor response to an antigenic stimulus.

Animals↗
PubMed1981

Colon interposition for the short bowel syndrome.

A 5-mo-old male had disabling diarrhea and malabsorption following massive small bowel resection. His transit time was 10 min. After 9 mo of conservative treatment, a 24-cm isoperistaltic segment of colon was interposed 6.5 cm from the ligament of Treitz. Transit time was increased to 105 min, and he was eventually able to be maintained on an enteric diet without significant diarrhea. Colon interposition requires little manipulation of the remaining small intestine and does not rely on active intestinal obstruction to effect an increased transit time.

Colon↗
PubMed1980

Multiple sequential pulmonary resections for metastatic pheochromocytoma with long-term survival.

Pheochromocytoma is not rare; indeed, it was discovered in 0.1 percent of consecutive autopsies and in 0.64 percent of a large group of patients screened for hypertension. A patient who underwent excision of a pheochromocytoma at age 7 years is presented. Seven years later, bilateral metastatic pulmonary nodules were excised. Fourteen years later, two metastatic pulmonary nodules were again excised. The patient is doing well 1 year after discharge. Surgical resection of multiple metastatic pheochromocytoma nodules is recommended.

Adrenal Gland Neoplasms↗
PubMed1980

Electrocoagulation induced immunity--an explanation for regression of neuroblastoma.

Electrocoagulation of tumor potentiates the host's antitumor immune response. Utilizing a murine neuroblastoma system and comparing surgical excision versus electrocoagulation we have demonstrated that electrocoagulation potentiates the immunogenicity of the neuroblastoma, potentiates the host antitumor immune response to residual primary tumor, and potentiates the host antitumor immune response to distant autochthonous neuroblastoma. These data suggest that such a heightened antitumor response might account for spontaneous regression of massive clinical neuroblastomas treated by electrocoagulation, and they suggest that electrococoagulation may be useful as a treatment modality for cytoreductive neuroblastoma surgery.

Animals↗
PubMed1980

Route of pediatric parenteral nutrition: proposed criteria revision.

This study reviews the experience of the Nutrition Support Service at the Children's Hospital of Philadelphia over a 13-mo period from 1977 to 1979. Parenteral nutrition was administered to 585 children, 385 by peripheral vein infusion and 200 by central vein infusion. Weight gain was seen in 63% of those patients receiving peripheral vein infusions and 82.5% of those receiving central vein nutrients, and this apparent difference is likely due to the longer duration of therapy in the central vein recipients (33.7 versus 11.4 mean days) and the greater caloric intake delivered to these same patients (128 Kcal/kg/day versus 63.2 Kcal/kg/day). The complication rates were calculated for the more than 11,000 patient days of therapy surveyed; 35 of the 385 peripheral vein patients developed complications, the primary type being solution administration soft tissue sloughs. This amounted to an incidence of 9.08%. Central vein patients in 40 circumstances likewise had complications, 21 being infectious and 12 being metabolic. This accounted for 20% of all central vein recipients, a difference from the peripheral vein group significant to a p value of less than .01. However, when total days of therapy are considered in this complication incidence, a per diem complication rate between these two groups is not different, and in fact, is somewhat worse for the peripheral vein nutrient recipients. Vascular access in this group of patients was via peripheral vein cannulation or via central venous catheter placement, the latter more recenty done exclusively by percutaneous subclavian vein catheter insertions. This technique was safe and allowed repeated access to the central venous system. These data suggest that the only legitimate determining factor for selecting proper nutritional support of the pediatric patient is the caloric need of the individual.

Amino Acids↗