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Biomedical subjects

D L Dudgeon

Publications and source records attributed to D L Dudgeon.

At least 37 records · Page 2Linked to original sources
PubMed1987

Efficacy of emergency room thoracotomy in pediatric trauma.

With improved rapid transportation systems, an increasing number of children may arrive at the emergency room (ER) without detectable vital signs and may undergo vigorous resuscitation, including emergency room thoracotomy, aortic cross clamping, and open cardiac massage. Of 1,287 pediatric trauma admissions between 1980 and 1985, 101 deaths were recorded. Fifty (50%) of the deaths occurred in the ER. Thirty-three of the patients were pronounced dead with obvious irreversible injuries, while 17 (34%) with suspected thoracoabdominal injuries underwent ER thoracotomy during resuscitation. None of the 17 patients had detectable vital signs upon arrival to the ER. Fifteen patients had multisystem injuries associated with blunt trauma and two with isolated penetrating injuries. Despite maximal conventional resuscitation and ER thoracotomy, none of the 17 patients survived. In this group of pediatric blunt trauma victims who appear initially salvageable, and present in the ER with no detectable vital signs, ER resuscitative thoracotomy did not influence survival. ER thoracotomy in children, therefore, should be reserved for patients presenting with penetrating thoracic injuries or blunt injuries associated with detectable vital signs and deterioration despite maximal conventional therapy.

Adolescent↗
PubMed1987

The efficacy of computed tomography in evaluating abdominal injuries in children with major head trauma.

Physical examination may be unreliable in the evaluation of children with blunt abdominal trauma particularly in those with associated major head injuries. In the absence of obvious clinical signs or physical findings of intraabdominal injury, the usefulness of abdominal computed tomography in children is controversial. To test the efficacy of CT scans, a 12-month prospective study of computed tomography for the initial assessment of children with blunt abdominal trauma and major head injuries was carried out. Of 320 pediatric trauma admissions to our regional trauma center, 65 consecutive patients with Glasgow Coma Scores less than ten were managed with sequential head and abdominal computed tomography in the emergency room for (1) closed head injury and (2) suspected abdominal trauma. Fifteen patients (23%) were found to have significant intraabdominal injury. Only two required operative intervention. No patients died as a result of the abdominal injuries. In children with significant head trauma and suspected abdominal trauma, combined head and abdominal CT proved to be reliable.

Abdominal Injuries↗
PubMed1987

Intestinal ischemic injury following mild hypothermic stress in the neonatal piglet.

The core body temperature of unanesthetized neonatal piglets was lowered 4 +/- 1 degrees C for 4.5 h. Although systolic blood pressure, arterial blood gases, and pH were similar in hypothermic and control animals, grossly evident small intestinal injury occurred in 94% of hypothermic piglets but in none of the controls (p less than 0.01). The histopathology of the intestinal lesions in the experimental animals was characteristic of ischemic injury and ranged from superficial mucosal necrosis to transmural infarct. The lesions were more frequent in the mid- and distal small bowel and involved the muscularis propria only in the distal small bowel. The location and histopathologic characteristics of the bowel lesions in these animals support the concept that mild hypothermia could be a pathogenetic factor in the ischemic bowel lesions of human neonatal necrotizing enterocolitis.

Animals↗
PubMed1985

The effects of total parenteral nutrition on gastrointestinal growth and development.

Total parenteral nutrition (TPN) is vital for the nutritional support of infants with disorders of the gastrointestinal tract that prevent adequate enteral intake. Studies in adult rodents maintained on TPN have demonstrated intestinal atrophy and decreased activity of the brush border enzymes of the small bowel mucosa. We studied the effects of TPN during the phase of rapid intestinal growth and development in piglets. Matched groups of three 6-week-old weaned piglet littermates received a glucose (45 g/kg/d), amino acid (8 g/kg/d), and fat (2.5 g/kg/d) solution intravenously (IV) or by gastrostomy (GF), or were given hog chow (Chow) at an equivalent caloric value for three weeks. No differences were noted in the mean weight gain (13-15 g/kg/d), total serum protein (4.5-4.8 g/dL), BUN (9-12 mg/dL), or Hct (25% to 30%). The IV and GF animals, compared to the Chow animals, had decreased growth of the stomach, small bowel, and pancreas with decreased small bowel mucosal disaccharidase activity. The IV group, compared to Day 0 animal measurements, had decreased small bowel length and weight and pancreatic weight. Histology of the proximal small bowel mucosa in the IV animals showed decreased mucosal depth, villus height, crypt depth, and epithelial cell number from the crypt base to the midvillus. These findings suggest that stomach, small bowel, and pancreatic growth are dependent on the route of administration and/or the composition of the diet, the small bowel mucosa and the pancreas atrophies in young piglets maintained on TPN, the activity of some intestinal brush border disaccharidases are decreased in the small bowel in piglets maintained on either an intravenous or an intragastric infusion of a TPN solution.

Animals↗
PubMed1985

Life-threatening airway obstruction as a complication to the management of mediastinal masses in children.

Life-threatening airway obstruction from large mediastinal masses in children poses a difficult diagnostic and therapeutic dilemma, requiring the close coordination of a pediatric surgeon, anesthesiologist, radiologist, and oncologist. To focus on this problem, the anesthetic and surgical management of 50 consecutive children with mediastinal masses treated between 1978 and 1984 were reviewed. Thirty children presented with respiratory symptoms; nine had life-threatening respiratory compromise with dyspnea, orthopnea, and stridor. Thirteen of these symptomatic children had marked compression of the trachea and/or mainstem bronchi on radiographic studies. The tracheal cross-sectional area which was measured by computed tomography was decreased by 35% to 93% of the normal tracheal dimensions in these children. Nonresectable malignant neoplasms including lymphoma, Hodgkin's disease, rhabdomyosarcoma, and neuroblastoma were the eventual diagnoses in 10 of these patients. The other 3 patients were less than 4 years old and had benign lesions. General anesthesia was judged to be prohibitively risky in 5 of 13 patients. The diagnosis was established by node or needle biopsy under local anesthesia, and general anesthesia was deferred until the compromised airway was alleviated by radiation and chemotherapy. General anesthesia with endotracheal intubation was administered to 8 patients, 5 of whom developed total airway obstruction. Using a variety of maneuvers, ventilation was reestablished in all 5 patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1985

A muscle ablation sphincter to prevent diarrhea after total colectomy in puppies: a preliminary report.

Many adjunctive surgical techniques have been proposed to decrease diarrhea following total colectomy with an ileoanal anastomosis. A previously proposed method of longitudinal muscle ablation in canine small intestine to produce an "artificial sphincter" and increase transit time after massive small bowel resections has been applied to puppies who have had a total abdominal colectomy and ileoproctostomy. Total abdominal colectomy with ileoproctostomy at the level of the peritoneal reflection was performed in 6 mongrel puppies, aged 6-8 weeks. Two control puppies died within 2 weeks of the procedure with overwhelming diarrhea. Four experimental animals had "sphincters" (circumferential excision of a 1 cm length of longitudinal muscle) placed 5 cm proximal to the ileoproctostomy anastomosis. The puppies with colectomy plus sphincter were followed from 14 months to two years postoperatively and had intestinal transit times of 3-4 1/2 hours comparable to unoperated littermates. Intermittent postoperative barium enemas were performed and gross and histologic examination of the sphincters were carried out at necropsy. This muscle ablation technique when used in puppies with total abdominal colectomy and ileoproctostomy controls diarrhea, allows survival with normal growth and does not result in proximal small bowel enteritis.

Animals↗
PubMed1985

One-year experience in a regional pediatric trauma center.

During 1982, 267 children with life-threatening injuries were admitted to the Maryland Regional Pediatric Trauma Center at the Johns Hopkins Hospital. Seventy-three percent of patients arrived directly from the injury scene by helicopter (46%), ambulance (50%), or other (4%). Mechanisms of injury included motor vehicle accidents (MVA; 55%), falls (27%), assaults (8%), and sports and other injuries (10%). In 75% of MVA the child was a pedestrian. Fifty-one percent of injuries were single organ system, 29% involved two systems, and 20% involved three or more systems. Remarkably, the mortality of 6.7% was not affected by the number of organ systems involved, but was directly related to the presence or absence of head injury. Fourteen of seventeen deaths resulted from head injury. Eighty percent of documented liver and spleen injuries were managed nonoperatively. This nonoperative plan of management simplified the optimal treatment of head injury. The high frequency of head injury has mandated a more aggressive approach to the management of brain trauma including intracranial monitoring to facilitate control of cerebral edema. Our data demonstrate that an excellent quality of life may be anticipated even in children with severe head injury.

Adolescent↗
PubMed1985

Transverse esophageal folds: association with corrosive injury.

Two cases are presented in which transverse esophageal folds were observed in children following ingestion of corrosive material. Strictures developed at the sites that initially manifested this serrated mucosal appearance. These findings lend additional credence to the concept that transverse folds, reflecting contractions of the muscularis mucosae, represent a pattern of pathologic motility rather than merely a variant of normal mucosal anatomy.

Burns, Chemical↗
PubMed1984

Pneumothorax in the Marfan syndrome: prevalence and therapy.

At least twenty-four reports of pneumothorax associated with the Marfan syndrome have appeared in the medical literature, but the frequency and optimal method of treatment remain unclear. We conducted a retrospective review of medical records from one genetics clinic and found that the frequency of spontaneous pneumothorax in patients older than 12 years with Marfan's syndrome was 4.4% (11 out of 249). Men were more commonly, but no more severely, affected than women. Seven patients had recurrent or bilateral pneumothorax. In 9 of the 11 patients, apical bullae were present and detectable on chest radiograph. Pneumothorax frequently recurred if not treated by resection of the offending bullae. We recommend that all adolescent and adult patients with the Marfan syndrome undergo chest radiography for ascertainment of the gross pathological condition of the lung. Definitive surgical treatment should be performed at the first occurrence of pneumothorax because of the high rate of recurrence after treatment with a chest tube, with or without pleurodesis.

Adolescent↗
PubMed1984

Neonatal necrotizing enterocolitis: an update.

We reviewed 91 cases of neonatal necrotizing enterocolitis (NNEC), which continues to be a devastating disease occurring in 2% to 4% of all newborn intensive care unit admissions. Onset now occurs in older infants (11.9 days). The morbidity is significant (22%), with strictures (8%) and recurrences (8%) the primary problems. Recurrences are more likely to require surgical intervention and result in a high mortality. Early diagnosis of necrotic bowel before perforation, peritoneal contamination, and sepsis is difficult and contributes to the still high, but improved, overall mortality of 36%.

Enterocolitis, Pseudomembranous↗
PubMed1984

Pediatric lipoblastomatosis: two unusual cases.

Lipoblastomatosis is a rare, fatty tumor of childhood that is usually located in the limbs. Two pediatric patients were seen with tumors that originated in the mediastinum and retroperitoneal area. The mediastinal tumor was the infiltrating form of lipoblastomatosis while the retroperitoneal tumor was the noninfiltrating type. Neither form is malignant but local recurrences are common. Both were surgically excised without sacrifice of important contiguous structures that were surrounded by tumor. There has been no recurrence 21/2 and 6 years after operation. Conservative excision of this malignant-appearing but histologically benign tumor is emphasized.

Child, Preschool↗
PubMed1983

Open lung biopsy in the immunocompromised pediatric patient.

Rapidly progressive pulmonary distress occurs as a secondary complication in immunocompromised pediatric patients. These patients usually develop a pattern of diffuse alveolar and/or interstitial infiltrates on chest x-ray and pursue a rapidly downhill course despite intensive respiratory support with the use of multiple and varied antimicrobial regimens. These patients are subjected to diagnostic open lung biopsies to establish a diagnosis. The diagnostic value of open lung biopsy and its current impact on therapy is not clearly established. This retrospective study attempts to determine the impact of open lung biopsy on diagnosis and therapeutic outcome. Between November, 1974, and October, 1982, 40 diagnostic open lung biopsies were performed on immunocompromised patients with clinically progressive respiratory disease. Adequate follow-up for complete evaluation was possible in 34 of these patients. Most of these patients had hematologic malignancies and all were on chemotherapeutic drugs at time of open lung biopsy. Open lung biopsy was considered helpful, ie, resulted in a change in antimicrobial therapy or substantiated preoperative therapy, in 17 of our 34 patients (50%). A "treatable" condition, amenable to antimicrobial therapy, was diagnosed in 16 of our patients (47%). Pneumocystis carinii pneumonitis (PCP) was the most common diagnosis in 11 (69%) of our "treatable" patients. The remaining five "treatable" patients had sarcoidosis (1), histiocytosis X (1), bacterial pneumonitis (1) and fungal pneumonitis (2). No diagnosis was achieved by open lung biopsy in ten (30%) of our patients. There were two complications attributable to open lung biopsy (6%), including one death. All PCP patients treated with trimethoprim sulfamethoxazole (T/S) survived.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1983

New techniques in the diagnosis and operative management of Siamese twins.

New techniques of 2-D sonography and radionucleotide Disofenin scanning allowed noninvasive evaluation of thoracoomphalopagus Siamese twins and successful separation at four days of age. Twin girls joined at the lower sternum and upper abdomen and weighing 15 lbs, were transferred at five hours of age after caesarian-section delivery. Scout films revealed high intestinal obstruction in twin A. 2-D sonography showed separate and normal hearts with different rates and attached pericardial sacs. Labeled Disofenin given intravenously to twin A was excreted exclusively in her gallbladder and bile ducts; vice versa for twin B. Because operation was necessary to correct jejunal atresia in twin A, further growth and development was not an option and the parents agreed to total correction. Sternal and pericardial separation and division of common midline-liver was followed by primary diaphragmatic defect repair and Dacron-cloth fascial reconstruction to upper abdominal wall and complete soft-tissue and skin closure in a ten-hour operation. Segmental jejunal resection and anastomosis with gastrostomy was added in baby A. The new tests greatly simplified definition of the anatomical relationships and implemented rapid correction in these newborn conjoint twins.

Electrocardiography↗
PubMed1981

The effects of gastric hyperosmotic glucose feedings on regional perfusion in the neonatal piglet.

Regional blood flow and intestinal wall perfusion were studied in 13 anesthetized 1-5 day old neonatal piglets before and after gastric glucose infusion. The radionuclide labeled microsphere technique was used with 15 +/- 3 mu microspheres (85Sr, 141Ce) given in two separate left atrial infections. The 10% glucose with a patent blue dye marker did not affect CO but produced significant increases in blood flow to the adrenals bilaterally, to all layers of the proximal small intestine and to the mucosa of the distal small intestine. The glucose also caused a significant reduction in the animals' arterial pH, PaO2, and total CO2 with an increase in the blood glucose level. This response to gastric glucose infusion is different from adult animals since lower glucose concentrations produced blood flow changes in all layers of the exposed small intestine and the adrenals in our neonatal animals.

Adrenal Glands↗
PubMed1981

A comparison of medical and surgical treatment of gastroesophageal reflux in severely retarded children.

Of 31 severely mentally and physically handicapped children with gastroesophageal reflux treated with a standard medical regimen, only eight (26%) had complete or partial therapeutic response. Fourteen of 23 medical failures underwent Nissen fundoplication with a good therapeutic response in 12. There were 12 intra- and postoperative complications in six surgical patients. Two late postoperative deaths from pulmonary aspiration occurred in the surgical group (14%), both of whom had abnormal deglutition preoperatively. In nine patients who failed on medical management but in whom surgery was not performed there was continuing morbidity from emesis (88%), anemia (44%), and pulmonary disease (33%), and two deaths (22%) resulting from pulmonary aspiration. We conclude that conventional medical therapy of GER is less effective in retarded than in normal infants and children, and that surgical treatment is associated with high operative risk but has an ultimately acceptable outcome. Continued medical therapy after initial failure to control symptoms is associated with significant morbidity and mortality.

Adolescent↗