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Biomedical subjects

C W Wagner

Publications and source records attributed to C W Wagner.

At least 19 recordsLinked to original sources
PubMed1995

Gastric teratoma with intramural extension.

Gastric teratoma is an extremely rare neoplasm which accounts for less than two percent of all teratomas. Unlike other teratomas, gastric teratomas are all benign and predominantly occur in males. As gastric teratomas generally present as a palpable abdominal mass, more aggressive solid masses of childhood must be excluded. In this case, CT imaging delineates both cystic and fatty components characteristic of teratoma and displays the rare gastric origin of the lesion.

Humans↗
PubMed1995

Malrotation in the older child: surgical management, treatment, and outcome.

Malrotation in the neonate is an anomaly for which there are clear indications for surgery. However, the management of the older patient with this entity is not well defined. At Arkansas Children's Hospital, we reviewed our patients who were older than two years of age with malrotation. Between 1978 and 1993, 22 cases ages 2-23 years were identified. The most common presenting symptoms were vomiting 15 (68%), colicky abdominal pain 12 (55%), and diarrhea 2 (9%). Other symptoms were hematemesis 1 (5%), and constipation 1 (5%). The duration of symptoms averaged 28 months, range 2-96 months. All diagnoses were made by upper gastrointestinal (UGI) series, except for one that was recognized during an exploratory laparotomy for an intestinal duplication. A Ladd's procedure with appendectomy was performed in all cases. A significant number of patients in our series (41%) were found to have either a volvulus or internal hernia at exploration that was not clearly demonstrated by the diagnostic studies. Intestinal resection was performed in two patients for ischemic bowel. There were no perioperative deaths. Postoperative complications consisted of a wound infection in one patient. Total relief of symptoms occurred in 64% of patients. All patients with volvulus or internal hernia had resolution of symptoms, and all patients reported partial relief of their chronic symptoms. Surgical therapy eliminates the possibility of loss of bowel from volvulus or internal hernia, which is not always evident on diagnostic radiographic examination. Surgery is also highly effective in alleviating the chronic symptoms in these children. We believe, therefore, that surgical treatment is clearly indicated in the older child with proven malrotation.

Adolescent↗
PubMed1991

Shotgun injuries in pediatric patients.

Firearms, particularly high-powered automatic weapons, injure progressively younger children in urban environments. At Arkansas Children's Hospital, 32 children have been admitted for gunshot wounds in 12 years. Air guns (3), handguns (19), and shotguns (10) caused the injuries. Shotgun wounds occurred during hunting accidents (2), flights from houses (3), and mistaken identity in the home (5), usually by family members (5). All victims of shotgun wounds were boys; seven were black. Their ages ranged from 6 to 20 years. Two injuries involved the abdomen, one the flank, one the chest, one the axilla, and five the legs. Accidental discharge of a weapon at close range caused extensive multisystem damage and long-term sequelae. Most of the wounds could have been avoided with the use of common sense and simple measures to identify the person within the household.

Accidents, Home↗
PubMed1991

Pectus excavatum: a 15-year perspective.

Pectus excavatum is relatively uncommon. Our experience with 177 children during a 15-year period produced changes in our surgical technique, which now includes a small transverse incision, minimal subcutaneous flap elevation, a muscle-relaxing incision over the fifth costal cartilage, complete resection of involved cartilage, use of Adkins' strut, suspension of sternum to strut, taut reefing of intercostal muscle, no tubes or drains, epidural analgesia, a patient-controlled analgesia device postoperatively, and eventual strut removal. Use of the evolved technique gives excellent cosmetic results, good functional results with minimal discomfort, and a shorter convalescent period.

Adolescent↗
PubMed1990

Pediatric pilonidal disease: a method of management.

Pilonidal disease is a common problem; its many management options are testimony to the difficulty in its eradication. Its etiology is distention of midline skin orifices with ingestion of hair shafts from hirsute buttocks. Thus, the disease does not usually appear until after puberty. Nine children were treated by aspiration and incision and antibiotics, followed by curettage of the pits; they had no recurrence. Two children who had midline procedures had recurrent disease. The female-male ratio in children is 4.5:1.

Adolescent↗
PubMed1990

Transthoracic fundoplication after previous abdominal surgery: an alternate approach.

Fundoplication for gastroesophageal reflux is a frequent procedure for pediatric surgeons. Reoperation in the abdominal cavity can be time-consuming and hazardous. Therefore, 33 patients (16 male and 17 female) with symptomatic gastroesophageal reflux after previous abdominal procedures had transthoracic fundoplications. Previous procedures included gastrostomy (18), Nissen fundoplication (12), ventriculoperitoneal shunt (9), omphalocele (4), paraesophageal hernia (3), necrotizing enterocolitis (2), abscess drainage (2), intestinal atresia (2), and abdominal burn (1). The three complications encountered were a bronchopleural fistula, esophageal leak, and small bowel obstruction. Of five deaths, one was related to operation. The remaining patients did not have recurrent reflux. Transthoracic fundoplication after previous abdominal surgery is effective and rapid, and it has a relatively low complication rate in high-risk patients. This approach avoids reentry into the abdominal cavity and allows precise repair.

Adolescent↗
PubMed1989

Management of empyema in children.

The antibiotic era has changed the incidence, causal factors, and gravity of empyema. Between 1977 and 1988, 27 children with empyema were surgically managed. Ten cases occurred after an operation (8 esophageal and 2 abdominal). There were 15 girls and 12 boys. The age range was newborn to 12 years. Symptoms included fever, cough, tube drainage postoperatively, anorexia, weight loss, chest pain, tachypnea, and lymphadenitis. Multiple aerobic and anaerobic organisms were cultured. Treatment included thoracentesis and antibiotics, tube thoracostomy, tube thoracostomy and bronchoscopy, decortication, or decortication with lobectomy. The total hospital stay averaged 28.3 days, and after decortication, 11.6 days. Empyemas in children frequently have multiple organisms and should be treated with broad-spectrum antibiotics while awaiting culture results. Thoracentesis and tube thoracostomy are often ineffective in curing the disease. Decortication can abbreviate hospital stay if performed promptly for persistent pleural sepsis.

Anti-Bacterial Agents↗
PubMed1989

Crotalid envenomation in children: selective conservative management.

Snake bites in children remain an uncommon injury. In general, there is a wide disagreement by knowledgeable authorities on a uniform approach to therapy. In the last 5 years, 29 children have been treated in our institution for snake bites, all with signs of envenomation. Treatment consisted of diagnostic laboratory studies, intravenous fluids, tetanus prophylaxis, antibiotics, bed rest, elevation, and observation. There were no deaths. A fasciotomy was required in three children. Cryotherapy initiated elsewhere resulted in tissue loss. Seven children received antivenin. All developed signs and symptoms to serum sickness. From this experience, it appears that the majority of snake bites in children, especially copperhead bites, can be treated selectively and conservatively. Care must be exercised in using antivenin as it is associated with a high rate of serum sickness. Cryotherapy adds to the morbidity of the bite and is not to be used.

Adolescent↗
PubMed1988

Respiratory complications in cervical thymic cysts.

Thymic cysts are considered uncommon lesions in the differential diagnosis of pediatric neck masses. They have been described as asymptomatic and of little clinical consequence. Recent reports have stressed the possibility of respiratory compromise associated with these lesions. We reviewed our experience with cervical thymic cysts with emphasis on respiratory problems. Ten pediatric patients underwent surgery and were found to have cervical thymic cysts. Ages ranged from newborn to 14 years. There were four boys and six girls. Two were found to have the thymic cysts at time of neck exploration for Grave's disease and hyperparathyroidism. Of the remaining eight patients, all had mobile cystic masses, located anterior to but extending beneath the lower third of the sternocleidomastoid muscle. The size of the mass ranged from 3.0 to 8.5 cm. Preoperative diagnosis included cystic hygroma/branchial cleft cyst (five), lymphoma (one), teratoma (one), and thymic cyst (one). All had a history of rapidly developing neck mass. Seven of the eight gave a history of upper respiratory tract infection (URI) prior to the development of the mass. Five had imaging studies that showed tracheal compression. Three of these required airway management in the early postoperative period. All were excised through a neck incision, with two requiring sternal extension. Histology showed cholesterol crystals, Hassall's corpuscles, and giant cell reaction diagnosis of thymic cysts. There has been no recurrence and no permanent respiratory sequela in the ten patients. Cervical thymic cysts are benign lesions that may be more common than literature suggests.(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗
PubMed1988

Cardiac arrhythmias during arousal from hibernation in three species of rodents.

Cardiac activity was monitored during arousal from deep hibernation in three species of hibernators (Citellus tridecemlineatus, Marmota monax, and Mesocricetus auratus). Individuals of each species showed marked arrhythmias, and these were confined to a body temperature range of between 11 and 20 degrees C, measured orally or rectally. The arrhythmias consisted of intermittent periods of asystole and bradycardia and were sometimes marked by the appearance of premature ventricular contractions and elevated or depressed S-T segments. Surgical manipulation of euthermic M. monax, under pentobarbital sodium anesthesia, indicated that none of the arrhythmias observed was inducible by injections of cold saline into the vena cava.

Animals↗
PubMed1988

Pancreas divisum and pancreatitis in children.

Pancreas divisum, a congenital variant of pancreatic ductal anatomy first described by Opie in 1903, has only recently been thought of as a cause of pancreatitis. The majority of reported patients presenting are middle-aged, with the exact pathogenesis not clearly understood. The reason for this late clinical presentation of a congenital abnormality is also not clear. However, reports of children with recurrent pancreatitis and an associated pancreas divisum have now appeared. None had any identifiable cause of pancreatitis. Pancreas divisum was diagnosed or suspected preoperatively in two, with findings on endoscopic retrograde cholangiopancreatography (ERCP) and gastroduodenoscopy. All findings were confirmed at operation. All underwent surgical treatment with good results within 6 months. Review of the literature showed eight patients younger than 18 years with pancreas divisum and pancreatitis requiring operation. All had good results after surgical repair. It appears that this anomaly can be associated with recurrent pancreatitis in children. Children with recurrent pancreatitis with no obvious cause should be evaluated for pancreas divisum and, if it is found, be surgically treated. The role of ERCP, while not clearly defined, may become critical in the evaluation of pancreas divisum in children.

Amylases↗
PubMed1987

Pyelonephritis following pediatric renal transplant: increased incidence with vesicoureteral reflux.

The association between pyelonephritis and vesicoureteral reflux (VUR) following pediatric renal transplantation is unclear. To understand the relationship of vesicoureteral reflux with urinary tract infection (UTI) and pyelonephritis, 67 patients were evaluated for reflux and pyelonephritis. Sixty-seven pediatric patients, aged 2 to 18 (39 males and 28 females) underwent renal transplantation. Beginning in 1982, all patients underwent voiding cystourethrography or radionuclide voiding studies 1 to 3 months postoperatively to assess the incidence of VUR. Techniques of ureteroneocystostomy (UNC) included the Leadbetter-Politano (L-p) in 39 cases, and two different modifications of the LICH (herein called LICH-1 and LICH-2) in 30 cases. Urinary cultures were performed routinely. Pyelonephritis was considered present in any patient with UTI and increased serum creatinine or fever greater than 38.5. VUR occurred in 36% of patients; highest in LICH-1 (79%), intermediate in L-P (22%), and lowest in LICH-2 (9%). VUR was not statistically significantly higher in females (43%) v males (31%). UTI occurred in 37% of patients. The difference in incidence between females (54%) and males (26%) was significant (P less than .05). The frequency of UTI in patients with VUR was 46% v 33% in patients without reflux (NS). However, pyelonephritis that occurred in 16% of cases overall was present in 82% of UTIs in patients with reflux v 14% of UTIs in patient without reflux (P less than .01). Pyelonephritis is significantly increased in pediatric renal transplant patients with UTI was have VUR. A nonrefluxing UNC is advocated in all patients. All renal transplant patients should have routine monitoring of urinary cultures and should be evaluated of VUR posttransplant.

Adolescent↗
PubMed1987

Retrieval of an umbilical artery catheter: a potential for misadventure.

We have described an infant in whom migration of a transected umbilical artery catheter resulted in sudden vascular ischemia of an extremity. Early operative retrieval was successful, but long-term effects of this complication were encountered. We have outlined an approach to the initial management of the complication. In addition, this case demonstrates the need for careful follow-up for identification and treatment of the long-term sequelae in the involved extremity.

Catheters, Indwelling↗
PubMed1987

Response of diabetic basement membrane--producing cells to glucose and insulin.

The effect of insulin and glucose on the synthesis of basement membrane components was studied in organ cultures of a basement membrane-producing tumor grown in diabetic and normal mice. Tumor tissue grown in diabetic mice produced more protein and basement membrane-specific proteoglycan in response to insulin than tissue grown in normal mice. Addition of high levels of glucose to the culture medium did not alter insulin-stimulated protein synthesis by diabetic or normal tissue but dampened insulin-stimulated production of proteoglycan. These data suggest that basement membrane-producing cells in diabetic hosts may be hypersensitive to insulin and that stimulation of protein production by insulin may play some role in the in situ hypertrophy of basement membranes.

Animals↗
PubMed1987

The central venous anatomy in infants.

A study of 21 consecutive autopsy specimens of infants less than one year of age and weighing less than 6 kilograms was performed to determine the topographic anatomy and regional relationships of the central venous anatomy. This anatomy was compared with 14 additional autopsies performed upon older children. There was no significant difference in diameter between the internal jugular and subclavian venous system, on either the right or left side. In the infant, the right and left subclavian veins entered the central system at an acute angle. The left innominate vein joined the right innominate vein at a right angle. These angulations become less acute after one year of age. This adult configuration may account for the relative ease of central venous cannulation through the percutaneous subclavian approach in the older patient. In contrast, the external and internal jugular veins entered centrally in almost a straight line even in the infant. The findings of this study suggest that the internal and external jugular veins should be considered as safe and reliable portals for percutaneous entry into the central venous system in infants. In the infant less than one year of age, the difficult patient (for example, those with thrombocytopenia or severe pulmonary failure) or when the surgeon is less familiar with the infraclavicular approach, the veins of the neck may, in fact, be the site of choice. Additionally, we believe that a surgeon should not hesitate to switch to the internal or external jugular site after unsuccessful attempts at percutaneous entry into the subclavian vein.

Brachiocephalic Veins↗