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Biomedical subjects

D L Collins

Publications and source records attributed to D L Collins.

At least 55 records · Page 3Linked to original sources
PubMed1993

Chronic stress from the Goiania 137Cs radiation accident.

At the invitation of the Brazilian government, the authors conducted a multidisciplinary field study in Goiania, Brazil, 3 1/2 years after an accident involving 137Cs, a radioactive cesium isotope. They compared subjects exposed to low levels of ionizing radiation, subjects who experienced anticipatory stress from fear of radiation exposure, and a nonirradiated control group. Results indicated the presence of chronic stress, as measured by psychological, behavioral, and neuroendocrine indices, in subjects who were exposed as well as in subjects fearful of potential radiation exposure. Anticipatory stress associated with potential exposure to ionizing radiation resulted in a level of stress similar to that from actual exposure to ionizing radiation. These findings have implications for past and future radiation accidents.

Accidents↗
PubMed1992

Operative intervention for pediatric liver injuries: avoiding delay in treatment.

To identify the physiological and anatomic factors that characterize the need for operative management of blunt pediatric liver injuries, the case records of 106 pediatric trauma victims with liver injuries over a 6-year period were reviewed. Sixty-nine patients were managed without operation (nonoperative) and 37 underwent operation, 7 with penetrating and 30 with blunt liver injuries. Of these 30 patients, 21 underwent laparotomy due to blunt liver injuries (operative); the remaining 9 patients required operation due to associated intraabdominal injuries. Nine (45%) of the 21 operative patients had major hepatic vein or retrohepatic vena caval injuries, 7 of whom died. Overall mortality was 9.4% (10/106). When nonoperative and operative groups were compared, those who underwent laparotomy due to blunt liver injuries: (1) had significantly lower Champion and Pediatric Trauma Scores due to multisystem injury; (2) had 25% or greater lobar disruption with pelvic blood collections on computed tomography scan; (3) underwent early transfusion within 2 hours of admission (18/21); and (4) were frequently found to have a major hepatic vein or retrohepatic vena caval injury at the time of operation. Only one patient successfully managed without operation received greater than 30 mL/kg of blood products within 24 hours of admission. As selective nonoperative management of pediatric liver injuries gains widespread acceptance, the identification of factors that predict the need for operative intervention will limit the potential risks of delay in treatment.

Abdominal Injuries↗
PubMed1992

Behavioral differences of irradiated persons associated with the Kyshtym, Chelyabinsk, and Chernobyl nuclear accidents.

Three nuclear accidents besides Chernobyl have occurred in the former Soviet Union. The accidents occurred around Kyshtym and Chelyabinsk in the Ural Mountains between 1949 and 1967 and contaminated over one-half million people. The health ministries are now interested in the data previously collected on these irradiated populations in order to examine the health (e.g., psychological, hereditary, genome damage, etc.) implications of long-term radiation exposure.

Accidents↗
PubMed1991

Hepatic vein and retrohepatic vena caval injuries in children. Sternotomy first?

Major hepatic vein and retrohepatic vena caval injuries are often fatal because of massive uncontrollable hemorrhage. Children with these injuries can be identified by their unique and dramatic clinical presentation and the selective use of computed tomographic imaging. Volume resuscitation promotes abdominal wall tamponade and hemodynamic stability until the abdomen is opened, at which point there may be sudden exsanguination before vascular control can be obtained. An alternative approach is to open the sternum before opening the abdomen. Management in this sequence provides rapid vascular control and improves the efficiency of hepatic exclusion. To date, five children with major hepatic vascular injuries have been treated with the sternotomy-first approach and four have survived; an atriocaval shunt was used on two occasions. Although sternotomy before laparotomy improves the efficiency of hepatic exclusion and may offer improved survival, accurate preoperative case selection limits its routine use.

Adolescent↗
PubMed1991

Three-dimensional display of cortical anatomy and vasculature: magnetic resonance angiography versus multimodality integration.

We present two methods for acquiring and viewing integrated three-dimensional (3D) images of cerebral vasculature and cortical anatomy. The aim of each technique is to provide the neurosurgeon or radiologist with a 3D image containing information which cannot ordinarily be obtained from a single imaging modality. The first approach employs recent developments in MR which is now capable of imaging flowing blood as well as static tissue. Here, true 3D data are acquired and displayed using volume or surface rendering techniques. The second approach is based on the integration of x-ray projection angiograms and tomographic image data, allowing a composite image of anatomy and vasculature to be viewed in 3D. This is accomplished by superimposing an angiographic stereo-pair onto volume rendered images of either CT or MR data created with matched viewing geometries. The two approaches are outlined and compared. Results are presented for each technique and potential clinical applications discussed.

Brain↗
PubMed1991

Laparoscopic bilateral orchiectomy for testicular feminization syndrome.

A 13-year-old female patient with complete androgen insensitivity (testicular feminization syndrome) had an excision of bilateral intra-abdominal testicles via the laparoscopic approach. The patient had a very smooth, fast recovery from her surgery. The laparoscopic approach should be considered for most patients in need of surgical removal of undescended or intra-abdominal testes.

Adolescent↗
PubMed1990

Cervicofacial mycobacterial adenitis in children: endemic to San Diego?

Nontuberculous mycobacteria (NTM) are an important cause of cervicofacial lymphadenitis in children. A dramatic increase has been seen in confirmed cases of NTM lymphadenitis in San Diego in the past few years. This report encompasses a span of 2 years 9 months, during which 22 children had confirmed NTM infection and another 14 had necrotizing granulomatous lymphadenitis in whom the specific diagnosis of NTM could not be made. This apparent increase in the prevalence of NTM as compared to previous reports in the literature suggests a possible endemic risk for NTM in the San Diego area. These cases are reviewed and our diagnostic and surgical approach to possible NTM infection is described. We also discuss possible explanations for the increasing occurrence of NTM in the San Diego area.

California↗
PubMed1989

Hydrostatic reduction of ileocolic intussusception: a second attempt in the operating room with general anesthesia.

Over a 3-year-period, standard treatment with hydrostatic pressure from a contrast enema failed to reduce ileocolic intussusception in 31 of 62 children. With the child anesthetized in the operating room, a second contrast enema was given before laparotomy. Of the 31 intussusceptions, 21 (68%) were reduced without complication, thereby avoiding the discomfort, longer hospitalization, complications, and expense of surgery. Nine of the remaining 10 intussusceptions were difficult to reduce manually during surgery or required resection. The overall nonoperative reduction rate for the 3-year period was 84%; for the last 2 years it was 90%. Success with the second enema may be related to the effects of general anesthesia. In addition, partial reduction with the first enema may improve blood flow from the intussusceptum so that it becomes smaller and easier to reduce with the second enema. Because it can easily be added to standard management protocols without increased risk, routine use of this second enema with anesthesia is recommended.

Anesthesia, General↗
PubMed1988

Pulmonary lysozyme--a secretory protein of type II pneumocytes in the rat.

A 14 kDa basic protein isolated from rat lung lavage was demonstrated to be lysozyme by its amino acid sequence analysis. An antiserum to rat lysozyme stained type II pneumocytes and alveolar macrophages. In rat lungs, no staining of the airway cells was noted. Lysozyme was detectable in type II pneumocytes by immunocytochemistry and by a quantitative immunoassay of lung homogenates of fetal lungs at Day 20 of gestation. An increase in the lysozyme content of the lung with increasing gestational and postnatal age of the rat was noted. In adult animals, lysozyme accounts for about 169.0 micrograms/g of wet lung weight and 0.3% of the soluble proteins in lung homogenate. Lysozyme constitutes about 6.6% of the total soluble proteins in rat lung lavage. Metabolic labeling and immunoprecipitation were used to demonstrate that rat type II pneumocytes synthesize and secrete lysozyme in vitro. However, in human lungs, lysozyme was identified in serous submucosal glands but not in alveolar type II pneumocytes. The results demonstrate differential distribution of a secretory protein in rodent and human lungs and indicate that in the rat lysozyme could be used as an immunohistologic marker for type II pneumocytes and as an indicator of secretory activity and maturation of type II pneumocytes.

Amino Acid Sequence↗
PubMed1986

Multiple intestinal atresia and amyoplasia congenita in four unrelated infants: a new association.

Four unrelated infants with multiple segments of nonduodenal intestinal atresia and amyoplasia congenita are described. The extreme rarity of each of these conditions as a single entity indicates that their concurrent incidence in four separate unrelated patients is of significance with respect to pathogenesis. The nature of the relationship between the two conditions is unknown.

Arthrogryposis↗
PubMed1985

Recent experience with a modified Sawaguchi procedure for biliary atresia.

The treatment of biliary atresia by variations of the original Kasai hepatoportoenterostomy has shown early success with good bile flow and the elimination of jaundice in 50% to 70% of cases in many series. Long-term follow-up in many of these patients shows continued problems with ascending cholangitis and progressive liver disease leading to death. Our recent experience with a modified Sawaguchi hepatoportoenterostomy is encouraging. Twelve patients were operated on before two months of age. All but one became jaundice free within 2 to 4 months and had biliary intestinal continuity reestablished within 3 to 6 months. These 11 patients have remained jaundice free with normal growth and development 1 to 8 years postoperatively. Two patients had one and two episodes of cholangitis, respectively. All have continued mild elevations of hepatocellular enzymes but no patient has obvious signs of liver failure. Serial liver biopsies have shown clearing of bile stasis and continued periportal fibrosis. Size and number of ductules in the excised biliary remnant did not correlate with clinical outcome. One patient remained jaundiced after hepatoportoenterostomy and reoperation, and eventually expired. In contrast, two patients operated at 4 and 9 months of age never drained bile and eventually died of bleeding varices and hepatic failure, respectively. The atypical success and relative lack of cholangitis in this series is not readily explained, but may be related to specific technical modifications of the original Sawaguchi procedure.

Bile Ducts↗
PubMed1984

A new X-linked syndrome comprising progressive basal ganglion dysfunction, mental and growth retardation, external ophthalmoplegia, postnatal microcephaly and deafness.

We report on 4 boys (3 in one family) who have a remarkably constant syndrome of childhood-onset choreoathetosis with later spasticity, postnatal microcephaly, growth and mental retardation, apparent external ophthalmoplegia and varying degrees of deafness. The pedigrees are consistent with X-linked inheritance. The syndrome is compared and contrasted with others comprising basal ganglion dysfunction in childhood. It is concluded that clinically and genetically the condition is unique.

Abnormalities, Multiple↗
PubMed1984

The advantages of reconstruction of the dome of the diaphragm in congenital posterolateral diaphragmatic defects.

Repair of a congenital posterolateral diaphragmatic defect (CPLDD) by direct suture results in a flat drum-head diaphragm, which has very little function. Other harmful effects of such a repair include enlargement of the thoracic cavity, resulting in more overexpansion of the hypoplastic lungs which may contribute to pulmonary vascular obstruction, and decrease in volume of the abdominal cavity, making closure of the laparotomy difficult. Reconstruction of a diaphragmatic dome would result in a more functional diaphragm and would prevent the above complications. This was substantiated in a series of 10 babies, all severely symptomatic from birth and treated according to the proposed technique. Eight babies survived, the two deaths occurring 36 hours and 3 months after surgery, in babies with severe cardiac anomalies. It is concluded that reconstruction of the dome of the diaphragm in patients with a CPLDD is well tolerated and may result in an increased survival.

Diaphragm↗
PubMed1983

Discordance for the Kleeblattschädel anomaly in monozygotic twins with thanatophoric dysplasia.

We describe monozygotic twins with thanatophoric dysplasia who were discordant for the Kleeblattschädel anomaly, but were identical in all other respects, including the histologic appearance of the endochondral growth plate. The observation suggests that the skull anomaly represents a variable manifestation of thanatophoric dysplasia, and that its occurrence in an infant with this bone dysplasia should not alter the low recurrence risk generally given.

Diseases in Twins↗
PubMed1983

Brachyolmia, recessive type (Hobaek): a clinical, radiographic, and histochemical study.

Brachyolmia recessive type (Hobaek) is a rare bone dysplasia characterized by short trunk dwarfism that becomes evident during childhood. The radiographic manifestations are primarily limited to the spine, and consist of universal platyspondyly with lateral extension of the vertebral bodies beyond the pedicles and irregularity of the vertebral end plates. Histologic changes seen on growth plate biopsy permit the diagnosis to be confirmed. The inheritance pattern appears to be autosomal-recessive.

Bone Diseases, Developmental↗
PubMed1983

Diagnosis and management of asymptomatic renal cell carcinomas in von Hippel-Lindau syndrome.

Renal cell carcinomas occurred in 6 of 17 subjects with the von Hippel-Lindau syndrome (HLS). In 4 patients, the tumors were discovered by abdominal computed tomography (CT) during a prospective study. Abdominal CT is recommended as a safe and accurate method for screening patients with HLS for renal cell carcinoma. Renal cell carcinoma in HLS tends to be multifocal and bilateral. Because of this, it is recommended that the tumors be treated by surgical enucleation rather than by more extensive surgical procedures which might ultimately lead to the need for dialysis.

Adenocarcinoma↗
PubMed1983

Primary fascial closure in infants with gastroschisis and omphalocele: a superior approach.

The optimal surgical management of neonates with gastroschisis and omphalocele remains controversial. Early attempts at primary closure were limited by respiratory and vena cava compromise and were gradually replaced by skin closure only, staged reduction of implanted prostheses, and escharification of the intact omphalocele. Advances in surgical technique, neonatal intensive care, and mechanical ventilation have made primary closure a viable alternative once again. We wish to report a consecutive series of 73 infants, including 54 with gastroschisis and 19 with omphalocele, over a 16-year period. Fifty gastroschisis patients were closed primarily, with four deaths (8%), and four with staged prostheses, with one death (25%). Sixteen omphaloceles were closed primarily, with three deaths (19%); two closed with a staged prosthesis, and one patient, closed with skin flaps only, died (100%). Overall survival for primary closure was 59/66 (89%) and for staged reduction, 5/7 (43%). In the past 5 years all patients have been closed primarily with no deaths (100% survival). All survivors were alive and well 1 to 15 years postoperatively. Our current operative technique involves vigorous manual stretching of the abdominal cavity, manual emptying of the entire Gl tract, and primary fascial closure, with no gastrostomy. Key points in postoperative management include total paralysis and mechanical ventilation, as the initially tense abdominal wall softens over 1 to 2 days, followed by weaning from the ventilator, and vigorous fluid support. Gl function returns more rapidly after primary closure (average of 3 days) and hospital stay is not prolonged. Other complications (intestinal obstruction, two patients; fistulae, one patient, etc) are much less frequent.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdominal Muscles↗