Search PubMed⌕ Search

Biomedical subjects

D L Mollitt

Publications and source records attributed to D L Mollitt.

At least 37 records · Page 2Linked to original sources
PubMed1991

The nature and reversibility of hypothermia-induced alterations of blood viscosity.

This study evaluates the nature and reversibility of the increase in whole blood viscosity known to be induced by hypothermia. Anticoagulated samples were obtained from normal volunteers and were assayed for cellular deformability by 4.7 microns membrane filtration of whole blood (n = 12) and washed RBCs (n = 10). Results were expressed as filtration rate. Specimens were evaluated for plasma (n = 10) and whole blood (n = 12) viscosity by cone plate viscometer. All assays were sequentially performed at 30 degrees, 34 degrees, and 37 degrees C and difference analyzed by paired t test. Hypothermia resulted in significant impairment of cellular deformability, which was reversed by rewarming: [table: see text] Hypothermia also resulted in a significant increase in plasma viscosity (mean difference = 0.5426 centipoise, p less than 0.02), which was likewise reduced on rewarming. The increase in whole blood viscosity associated with hypothermia is secondary to both diminished cellular deformability and increased plasma viscosity. Both of these alterations are reversible with appropriate rewarming.

Blood Viscosity↗
PubMed1991

Does patient age or intestinal pathology influence the bacteria found in cases of necrotizing enterocolitis?

To evaluate the relationship between bacterial colonization in neonatal peritonitis and patient age or intestinal pathology, we retrospectively reviewed peritoneal culture results from 96 infants having surgery for necrotizing enterocolitis. Microorganisms recovered mirrored those usually found as fecal flora within the neonatal intensive care unit. These reflect, in turn, the abnormal colonization intrinsic to care in the intensive care nursery. Analysis revealed no significant correlation between the disease and either age of the infant or intestinal site of disease.

Age Factors↗
PubMed1991

A randomized clinical trial of ampicillin, gentamicin and clindamycin versus cefotaxime and clindamycin in children with ruptured appendicitis.

This prospective, randomized, double-blind study compares the efficacy, safety and cost-effectiveness of ampicillin, gentamicin and clindamycin (AGC) or cefotaxime and clindamycin (CC) for the treatment of children with complicated appendicitis. Ninety-seven children were randomized. Forty-seven were assigned to the AGC regimen and 50 received CC. Forty-two patients in the AGC group had an appropriate therapeutic outcome, whereas 48 of 50 children who received CC completed the trial successfully (p = NS). There were no differences between the groups with reference to the duration of antibiotic administration, fever, leukocytosis or length of hospitalization. Complications of therapy were uncommon and neither regimen demonstrated a significant advantage from an economic standpoint. We concluded that, in childhood, complicated appendicitis can be treated with either CC or AGC with equal efficacy.

Adolescent↗
PubMed1989

The effect of initial operative repair on the recovery of intestinal function in gastroschisis.

Recent reports concerning the treatment of gastroschisis suggest that primary closure results in more rapid return of gastrointestinal function, a shortened hospitalization, diminished perinatal complications, and improved long-term survival. A 4-year retrospective review of infants treated for gastroschisis at the University of Florida yielded 30 infants requiring repair of this abdominal wall defect. The series included 19 males and 11 females, and the average abdominal wall defect measured 4 cm in its greatest dimension. Nine infants (mean weight, 2,275 gm) were repaired using a staged closure using a silastic (six) or cutaneous (three) silo. Complete fascial closure was accomplished in an average of 8 days in the silastic group and 15 days in the infants with skin flaps. Mean age at start of enteral feeds was 23 days, with complete oral feedings at 43 days. Twenty-one infants (mean weight, 2,127 gm) underwent primary fascial closure. Three deaths occurred in the perioperative period: one from acute renal failure and two from sepsis secondary to a segment of necrotic intestine. An additional infant developed postoperative necrotizing entercolitis but recovered. Two infants in this group also had jejuno-ileal atresia requiring extensive small bowel resection. In the remaining 15 infants, oral alimentation was initiated for an average of 23 days, with full oral alimentation at 46 days. The data suggest that the recovery of the gastrointestinal system, adequate enough to support total oral alimentation, is unrelated to the initial surgical procedure chosen to obtain fascial closure in the newborn with gastroschisis. In addition, vigorous attempts at primary fascial closure may jeopardize intestinal viability, diminish ventilatory function, and result in unnecessary morbidity and mortality.

Abdominal Muscles↗
PubMed1989

Perinatal nonimmune hydrops: diagnostic ultrasonography and related aspects of management.

Nonimmune hydrops fetalis may become the commonest form of hydrops seen in Western countries during the perinatal period, and it has at least a 50% mortality. This report describes five infants with nonimmune hydrops associated with maternal hydramnios and with congenital fetal lesions or disorders, ie, mediastinal teratoma, pulmonary leiomyosarcoma, Beckwith-Weidemann syndrome with omphalocele, fetal tachycardia, and Down's syndrome. Three of the infants survived the neonatal period and two of these underwent surgery for resection of their tumors early in the neonatal period. The third had an omphalocele repaired at 6 hours of age. The literature is reviewed with respect to the pathophysiology of nonimmune hydrops. Its diagnosis and treatment are discussed, with special emphasis on the role of ultrasound in its early diagnosis and optimal prenatal and postnatal management, and on the morbidity seen in survivors.

Female↗
PubMed1988

The microbiology of neonatal peritonitis.

To review the bacteriology of neonatal intra-abdominal sepsis, we reviewed peritoneal cultures from 86 newborns undergoing operation for necrotizing enterocolitis (NEC) for the type and incidence of microorganism recovered. As a control, we conducted a similar review in 59 children with perforated appendicitis during the same period. Necrotizing enterocolitis was characterized by a lower incidence of polymicrobial contamination (1.7 organisms per patient vs 2.4 organisms per patient, NEC vs appendicitis) and an uncharacteristic pattern of isolates. Although enteric gram-negative bacilli were recovered in 80% of newborns, the incidence of Escherichia coli was only 21% in the NEC group vs 69% in the appendicitis group, while Klebsiella and Enterobacter species represented the most common gram-negative isolates recovered (63% vs 17%). More than 50% of neonatal cultures yielded gram-positive cocci, most frequently coagulase-negative staphylococci (30% vs 0%) and enterococci (17% vs 5%), as compared with more frequent streptococcal isolates in the appendicitis group (50% vs 10%). Anaerobes were seldom recovered in NEC cases (6%), but they were present in 50% of appendicitis cases. Additionally, Candida isolates were recovered in 10% of NEC cases (0% of appendicitis group). These results indicate the unique bacteriology of peritonitis in the critically ill newborn and probably reflect abnormal colonization in the neonatal intensive care unit.

Appendicitis↗
PubMed1988

The role of coagulase-negative Staphylococcus in neonatal necrotizing enterocolitis.

Coagulase-negative Staphylococcus has emerged as a prominent pathogen in the neonatal intensive care unit and a recent report has implicated this organism in necrotizing enterocolitis (NEC). This same study suggests that Staphylococcus epidermidis is most commonly associated with a "mild form of enterocolitis." This prompted a review of the role of coagulase-negative Staphylococcus in the surgical complications of NEC. Between 1982 and 1986, 86 newborns underwent operation for perforation or intestinal necrosis secondary to NEC. Blood cultures, obtained within 72 hours of surgery, were positive in nine of 71 infants (13%). One third of these grew coagulase-negative Staphylococcus. Peritoneal cultures obtained at the time of operation were positive in 71 neonates. The incidence of Staphylococcus epidermidis was 30%. In a third of these cases, coagulase-negative Staphylococcus was the only organism covered. Overall mortality within the group was 33%. Coagulase-negative Staphylococcus was the single most frequent organism recovered from those infants who expired (35%). This data clearly indicates that Staphylococcus epidermidis must be considered as a significant pathogen in NEC. It is associated with both morbidity and mortality and, therefore, warrants appropriate aggressive therapy when recovered from the neonate with enterocolitis.

Enterocolitis, Pseudomembranous↗
PubMed1988

The Pediatric Trauma Score as a predictor of injury severity: an objective assessment.

The ability of the Pediatric Trauma Score (P.T.S.) to predict injury severity and mortality was evaluated by analysis of its relationship with the Injury Severity Score (I.S.S.) of 615 children entered into the National Pediatric Trauma Registry (N.P.T.R.). Mean age was 8.2 years and mortality was 3.5%. Mean I.S.S. of survivors was 8.1 in comparison to 59.7 for nonsurvivors. Linear regression coefficient determined from analysis of these variables produced a slope of -3.7 with a statistically significant correlation of P.T.S. to I.S.S. (p less than 0.001; r2 = 0.89). Analysis of the mortality for each cohort of patients with the same P.T.S. identified three categories of mortality potential. Children whose P.T.S. was greater than 8 had a 0% mortality. Children whose P.T.S. was between 0 and 8 had an increasing mortality related to their decreasing P.T.S. (r2 = 0.86), and children whose P.T.S. was below 0 had 100% mortality. This study documents the direct linear relationship between P.T.S. and injury severity, and confirms the P.T.S. as an effective predictor of both severity of injury and potential for mortality.

Child↗
PubMed1988

Pediatric appendicitis: efficacy of laboratory and radiologic evaluation.

We retrospectively reviewed 54 consecutive children (mean age, 12 years) evaluated for possible appendicitis to determine the efficacy of laboratory and radiologic procedures in establishing the diagnosis. The final diagnosis was appendicitis in 24 and abdominal pain not necessitating operation in the remaining 30. Two hundred two laboratory tests were obtained (average 3.7 tests per patient). The mean white blood cell count on initial CBC was 13,930/cu mm overall with a higher mean in the appendicitis group (16,704 vs 11,057/cu mm). Of the 148 tests besides CBC, only 12 (8%) yielded abnormal results; all of these were present on urinalysis and were nondiagnostic. A total of 117 roentgenograms were obtained on initial evaluation (average 2.2 x-ray films per patient). Films were considered abnormal by the ordering physician in 12 cases (24%). When reviewed by the radiologist, 17 abnormalities (33%) were detected. In only seven instances was there agreement in interpretation of abnormality between the ordering physician and the radiologist. This review indicates little usefulness of nonspecific laboratory and radiologic evaluation of possible appendicitis in children. Appendicitis remains a diagnosis of physical examination, and early referral with thorough evaluation by an experienced examiner may result not only in improved accuracy, but in less delay in appropriate therapy, with greater cost effectiveness.

Adolescent↗
PubMed1988

Impact of emergency room laboratory studies on the ultimate triage and disposition of the injured child.

One hundred sixty six surviving pediatric trauma patients were retrospectively studied to assess the contribution of initial laboratory evaluations to clinical decision making in the emergency department (ED). All laboratory tests ordered, the results of those tests and the number of test results available before patient disposition from the ED were reviewed. A total of 626 laboratory studies were ordered in 166 patients. Results from only 68.5 per cent of the laboratory tests were available in the ED prior to the patient's transfer from the ED. Only 6.4 per cent of these results were abnormal. This low incidence of abnormal test results and preadmission availability questions the utility of extensive initial routine laboratory evaluations of the pediatric trauma patient. Based on this data, the current protocol has been revised to include hemoglobin/hematocrit determinations, type and screen, and urinalysis. Additional blood is obtained and appropriately labeled so that further studies can be performed if the patient's management should require baseline laboratory evaluations. This approach is more efficient, cost-effective, and no less sensitive in the initial evaluation and management of the injured child.

Adolescent↗
PubMed1988

Abdominal complications of ventriculoperitoneal shunts. Case reports and review of the literature.

Ventriculoperitoneal (VP) shunting of cerebrospinal fluid (CSF) is the standard therapy for the management of hydrocephalus. Before the advent of silastic, early abdominal complications were frequent and finally led to the abandonment of this technique for management of hydrocephalus. With the use of silastic shunt tubing, VP shunts have once again gained favor as the procedure of choice. Although there are now considerably fewer complications from VP shunts, the presence of an intraperitoneal catheter can still initiate various complications. Abdominal complications of VP shunts are reported to be from 10-30 per cent, thus remaining clinically important for early recognition and treatment in patient management. An awareness of these complications is necessary in creating an index of suspicion for the primary physician whose patients harbor a VP shunt and present with abdominal symptoms. This report presents five cases of children with abdominal complications of VP shunts (four pseudocysts and one umbilical granuloma with spontaneous drainage of CSF). Additional abdominal complications of VP shunts are discussed, as well as diagnostic and therapeutic alternatives in order to improve and expedite accuracy in diagnosis and provide simplicity and efficiency in treatment.

Abdomen↗
PubMed1987

Pyloric stenosis--a timed perspective.

In a review of 90 infants with pyloric stenosis who underwent pyloromyotomy, preoperative nasogastric drainage for more than six hours during the period of fluid resuscitation accompanied by a period of postoperative drainage for more than 12 hours resulted in better acceptance of a graduated feeding protocol with fewer emesis, earlier completion of full feeding, and shortened hospital stay.

Female↗
PubMed1987

The pediatric trauma score as a predictor of injury severity in the injured child.

The ability of the Pediatric Trauma Score (PTS) to accurately predict the degree of injury severity of the injured child was assessed by comparing two separate groups of pediatric trauma victims. The first group consisted of 110 patients evaluated at a regional pediatric trauma center whose data was collected and assessed by a single investigator. The second group consisted of a similar matched cohort of 120 patients from the National Pediatric Trauma Registry whose data was collated from multiple participating institutions. In both cases, a linear relationship between PTS and Injury Severity Score (ISS) was documented that was statistically significant to P less than .001. The linear regression coefficients of each group were similar as was the distribution of PTS and ISS. This study documents the validity of the PTS as an initial assessment tool and confirms its reliability as a predictor of injury severity.

Adolescent↗
PubMed1987

Cystosarcoma phylloides in the adolescent female.

Between 1979 and 1985, five adolescent females have undergone excision of cystosarcoma phylloides. Mean age at presentation was 15 years with a range of 13 to 18 years. Clinical characteristics unique to this diagnosis included a recent history of rapid growth and the large size of the breast mass (mean diameter 7 cm) at initial presentation. Each patient underwent "cosmetic" excisional biopsy utilizing either a circumareolar or inframammary approach. In four patients, the neoplasm was benign with no postoperative recurrence (mean follow-up 33.8 months). The remaining lesion was malignant (liposarcoma) and subsequent simple mastectomy was performed. There was no evidence of disease at 35 months.

Adolescent↗
PubMed1987

Ultrasonography in the diagnosis of pyloric stenosis.

We evaluated 101 children for hypertrophic pyloric stenosis (HPS) at Arkansas Children's Hospital. Diagnosis was based upon a palpable epigastric "olive" characteristic of HPS, or sonographic measurements of the pylorus. In 28 children, the diagnosis was confirmed by physical examination alone; the remaining 73 had ultrasound examination. Pyloric measurements included muscle thickness, transverse diameter, and total length. Pyloric function was also studied during examination. Using a thickness of less than 4 mm, a diameter of less than 13 mm, and a length of less than 17 mm as normal criteria, 31 cases of HPS were correctly diagnosed by ultrasonography. In the remaining 42, no pyloric abnormality could be demonstrated on further evaluation.

Evaluation Studies as Topic↗
PubMed1987

Caustic ingestion and its sequelae in children.

Management of caustic ingestion in children remains a difficult challenge, with the outcome ranging from an asymptomatic state to intractable esophageal strictures. We reviewed the cases of 56 children ranging in age from 10 months to 5 years treated from 1973 to 1984 at the University of Florida. For children seen primarily at our institution, initial management consisted of prompt endoscopy and early institution of steroids and antibiotics. Esophageal burns were confirmed in 37 patients, 21 (56.75%) of whom subsequently had esophageal strictures of varying severity. In seven patients, limited esophageal strictures were managed successfully by dilation, but 14 children with multiple strictures required eventual esophageal replacement. Substernal right colonic interposition was tolerated well by these patients, with few complications, and their growth and development have been satisfactory over follow-up periods ranging from nine months to 13 years. A review of these cases suggests that the character of the ingested caustic material is the most important determinant of the severity of esophageal injury, with preparations containing lye being the most injurious; that in the presence of full-thickness esophageal injury, there is a high potential for stricture formation, regardless of the type of initial management, including early use of steroids; and that multiple esophageal strictures are refractory to dilation, and esophageal replacement should be an early consideration.

Black or African American↗
PubMed1986

Liposarcoma arising within a cystosarcoma phyllodes.

A liposarcoma arising within a cystosarcoma phyllodes in a 17-year-old black female was treated by total mastectomy without the need of radiation and/or chemotherapy. The patient is alive and well with no evidence of recurrence or metastasis at 20 months recent follow-up. The clinicopathological features of malignant cystosarcoma phyllodes-liposarcoma are discussed.

Adolescent↗