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Biomedical subjects

C E Koop

Publications and source records attributed to C E Koop.

At least 127 records · Page 7Linked to original sources
PubMed1979

Sequelae of prolonged ventilatory support for pediatric surgical patients.

The evolution of intensive prolonged respiratory support has been a major development in improving survival in the critically-ill child. That intensive respiratory support can be maintained for prolonged periods of time even in the home with survival of good babies is the subject of this report. In a 3-yr period, 2112 surgical patients were admitted to intensive care facilities with an over-all survival of 95%. Ventilatory support was required in 368 (17.4%) of these children, and survival in this group was 75.3%. Prolonged mechanical ventilation was necessary in 13 of the 368 children (3.5%) for a mean support time of 359 days (range 101 to 1095). Of these 13 children, 4 died while hospitalized (30.8%), and 3 died subsequently after being discharged (23.1%) for a total mortality of 53.8%. However, 6 children (46.2%) survive, 3 free of ventilatory support and 3 being weaned from their machine at home. The greatest cost in this expensive program was delivered to the survivors and psycho-social and developmental data confirm that these children are good babies with favorable long-term prognoses.

Child↗
PubMed1978

Mesenchymal hamartoma of the liver in infants.

Mesenchymal hamartoma of the liver is a rare benign tumor of childhood which has been confused with various other benign liver lesions, particularly vascular hamartomas which are mesodermal but not mesenchymal. The mass, frequently cystic, is characterized by an admixture of epithelial structures in a loose connective tissue stroma with fluid accumulation suggestive of lymphangiomatous channels. Four patients are presented and reviewed with 25 previously reported cases. The patients, usually asymptomatic, present during the first two years of life with progressive abdominal distention, which may be rapid because of increasing fluid content in the connective tissue stroma and cysts. Exploration and biopsy may be necessary before definitive excision. The present cases include a newborn, the youngest known, and a case in which radiation resulted in hyalinization of the mesenchyme, decrease in fluid content, and easlier resection. Respiratory distress and signs of vena caval obstruction due to intra-abdominal pressure were noted. Prognosis after extirpation is very good.

Diagnosis, Differential↗
PubMed1977

Surgical manifestations of eosinophilic gastroenteritis in the pediatric patient.

Eosinophilic gastroenteritis, an inflammatory bowel disease of unknown etiology, occurs in one of 10,000 admissions to this Children's Hospital. We had added 4 cases to the 11 retrieved from a literature review. The inflammation is characterized by mature eosinophils predominating a transmural process which may produce pain, obstruction, perforation, bleeding, or fistulae. All levels of the gastrointestinal tract are involved, but stomach (25.9%) and small bowel (66.7%) lesions are most common. Eosinophilia occurs in 61% of children and allergy in 13%. X-rays may demonstrate a diffuse or localized process. Operative intervention may be necessary to exclude tumors or regional enteritis, and at times to extirpate complications of local disease, but conservative therapy is the treatment of choice for this exacerbating-remitting disease.

Adolescent↗
PubMed1977

Neuroblastoma.

Neuroblastoma is the most common solid malignant tumor in children. The prognosis is poor, and despite varying chemotherapy and radiation regimens, its status has not been altered much in the past 20 years. Seventy per cent of the patients have abdominal neuroblastomas, which carry the worst prognosis of all the possible sites for the disease. Seventy per cent of the patients have metastases at the time of diagnosis. Survival is best in children under one year of age and in those patients (8 per cent) who are fortunate enough to have only stage I disease. Stage IV disease has only a 3 per cent survival rate. Surgical removal of the tumor is still the primary therapy; irradiation is of significant benefit in patients with stage III disease. Immunotherapy offers an optimistic modality for future improvement in survival rates.

Abdominal Neoplasms↗
PubMed1976

Hepatic hemangiomatosis. Successful management by hepatic artery ligation.

Successful management of severe congestive heart failure secondary to a hepatic hemangioma was accomplished by ligation of the hepatic artery in a 2-month-old infant. In the two years since the operation, follow-up observations including liver biopsy and hepatic angiography have indicated complete regression of the tumor. This report provides reassurance that this procedure is effective in the prompt control of severe heart failure, as well as in safely providing time for the spontaneous regression of the vascular tumor.

Follow-Up Studies↗
PubMed1976

Editorial.

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Ethics, Medical↗
PubMed1975

The management of abdominal neuroblastoma.

Although survival of children with abdominal neuroblastoma seems at this time to be unrelated to the therapeutic effort, a method of management according to the stage of disease has been developed. Seventy-three percent of patients have metastases at the time of diagnosis. Survival is best in children under 1 year of age. Survival by stage of disease drops progressively from 90% in Stage I disease to 2.4% in Stage IV disease. Irradiation therapy seems unrelated to survival in Stage I, II, and IV disease, while chemotherapy has not been shown to alter survival rates in any stage. Surgical removal of the tumor is still the primary therapy; irradiation is of significant benefit in patients with Stage III disease.

Abdominal Neoplasms↗
PubMed1975

Silastic abdominal patch for temporary hepatomegaly in Stage IV-S neuroblastoma.

Of our 174 neuroblastoma patients, 11 were classified as Stage IV-S. The primary tumor is usually small and there is widespread disease in the liver, skin, bone marrow, or any combination of these. The prognosis is favorable and radiation and chemotherapy should be avoided if possible. In some of these children the rapidly enlarging liver may cause respiratory distress and vena caval compression. The creation of a ventral hernia by means of a Silastic patch is a useful, temporary procedure during the life-threatening period of rapid growth and increased intra-abdominal pressure. Closure is simple once the liver has returned to normal.

Abdominal Muscles↗