Search PubMed⌕ Search

Biomedical subjects

D W Shermeta

Publications and source records attributed to D W Shermeta.

At least 37 records · Page 2Linked to original sources
PubMed1981

Tracheostomy in neonates and small infants: problems and pitfalls.

Newborn babies and small infants who require tracheostomy often follow a complicated clinical course characterized by frequent sepsis, altered ventilatory dynamics, and eventual respiratory decompensation. Many of these problems are avoidable with use of a properly placed endotracheal tube during tracheostomy, a special surgical technique in the performance of the tracheostomy, and silicone rubber tracheostomy tubes. Seventy-four babies underwent tracheostomy at our Children's Center between 1963 and 1976. A review of this experience demonstrates the benefits of unhurried, standardized technique and management. In the 48 newborns requiring tracheostomy, no technical difficulties were encountered, and no complications occurred as a result of the tracheostomy. In the group of 26 older infants, however, there were significant complications, especially in children undergoing emergency tracheostomy without a previously placed endotracheal tube. Although there were no deaths directly related to tracheostomy, one case of pirulent tracheitis and one case of interstitial thyroid hemorrhage were noted at autopsy. Among survivors, there was one case of bilateral pneumothoraces, two cases of severe subcutaneous emphysema, and three cases of postoperative bleeding. Review of the long-term complications in this series demonstrates the benefits of the silicone rubber polymer tube. Since its routine use, problems with stomal granulation have almost disappeared. There have been no problems in extubating the very young babies. Our operative technique and intensive care management of these babies will be emphasized as the keys to the improved outcome.

Airway Obstruction↗
PubMed1980

Absence of the caudal somatopleure in a twin: a combined thoraco-abdominal defect.

Many congenital defects of the ventral thoracoabdominal wall have been described. Among the most severe of these malformations are ectopia cordis, omphalocele, and vesicointestinal fissure. The simultaneous occurrence of all three of these anomalies has not been previously reported. We have recently seen an infant with an extensive anomaly combining these three defects of the ventral wall. The case is more remarkable because the infant's twin was normal.

Abnormalities, Multiple↗
PubMed1980

Hyperinsulin hypoglycemia in the neonate: therapeutic choices.

Lack of elevated serum insulin in 3 patients with nesidioblastosis following 95% pancreatectomy leaves one with the theoretical possibility that the recurrent hypoglycemia is not due to excess insulin secretion, but rather an iatrogenic hypoglucagon state. If this explanation is correct, progression to a "total" pancreatectomy may not be the appropriate form of therapy. It seems to us that further evaluation of other hormones secreted by the endocrine portion of the pancreas must be clarified before continuing extensive or total pancreatic resections for nesidioblastosis in infancy.

Glucagon↗
PubMed1980

Esophageal reconstruction with free jejunal grafts: an experimental study.

Replacement of a long segment of esophagus for esophageal atresia or severe stenosis remains a special problem in children. The following studies were designed to test the hypothesis that a section of small bowel without serosa could survive as a free autologous transplant to replace part of the mediastinal esophagus. Laparotomy was performed in 20 adult cats, a loop of small bowel was resected and an end-to-end jejunojejunostomy was completed. The serosa of the resected bowel was removed and the mucosa-muscularis graft was used to replace a segment of the middle esophagus that was resected via a right thoracotomy. The interposed graft was entirely wrapped with adjacent skeletal muscle flaps. Postoperative studies include barium swallow and cine esophagograms, histology and blood vessel casts. Results are presented which show anatomical and functional survival of 16 grafts without blood vessel anastomoses or intrinsic vascular pedicles.

Animals↗
PubMed1980

Hyperinsulinemic hypoglycemia of the neonate associated with persistent fetal histology and function of the pancreas.

Early in development, the fetal pancreas is characterized by the presence of two distinct generations of endocrine cells and a B-Cell mass that is unresponsive to acute changes in circulating glucose levels. Near the end of intrauterine development, the normal pancreas has "matured" and contains a single generation of endocrine cells and B-Cells that are responsive to changes in glucose concentrations. Recent microscopic examination of resected pancreatic tissue from an infant with hyperinsulinemic hypoglycermia revealed a combination of all three of the currently accepted findings in this neonatal condition: hyperplasia, adenomatosis, and nesidioblastosis. These observations prompted the following hypothesis: When compared to the usual histology of the developing pancreas, nesidioblastosis may be interpreted as an abnormal continuation of normal proliferation of endocrine cells; hyperplasia may be a specific overproduction of the Secondary Islands of Langerhans; and adenomatosis may be an abnormal continuation or overgrowth of the Primary Island of Langerhans. Such extrapolation suggests that infants with hyperinsulinemic hypoglycemia may represent a failure in the normal histological and functional maturation of the endocrine portion of the fetal pancreas.

Adenoma↗
PubMed1979

Surgical management of lung bud anomalies: lobar emphysema, bronchogenic cyst, cystic adenomatoid malformation, and intralobar pulmonary sequestration.

Recently we saw 9 infants with life-threatening respiratory distress. Four patients had bronchogenic cyst, 2 had cystic adenomatoid malformation, and 9 had congenital lobar emphysema. Another group of 14 older children had recurrent infection and hemodynamic abnormalities, which responded to operative intervention. Each child required an appropriate resection following definitive diagnosis. These lesions represent a spectrum of closely related anomalies that arise during an early stage of embryonic lung bud maturation. Bronchoscopy is rarely useful, but special roentgenographic studies, including perfusion scans and arteriography, are usually diagnostic. Our operative experience is used to emphasize the urgency of precise diagnosis and surgical management of this poorly recognized clinical syndrome.

Bronchopulmonary Sequestration↗
PubMed1979

Pectus carinatum: results of surgical therapy.

There are a variety of protrusion defects of the anterior chest which are collectively referred to as pectus carinatum. Over a 14-yr period, 13 patients have had surgical correction of pectus carinatum at The Johns Hopkins Hospital. Technique includes costal cartilage resection and a sternal osteotomy. There was no mortality, complications were few and results are good. Repair is recommended for patients in late adolescence due to the cosmetic nature of the procedure, the apparent lack of an associated postural deformity and the good results of operation in this age group.

Adolescent↗
PubMed1979

Epididymal abnormalities associated with undescended testis.

In a prospective study of 42 patients with undescended testes 15 (36 per cent) had epididymal abnormalities. These anomalies were divided into 3 groups, including agenesis of the epididymis, atresia of the epididymis and loop or elongated epididymis. In the second group atresia could occur at the head, body or tail of the epididymis.

Abnormalities, Multiple↗
PubMed1979

Experimental evaluation of 2F transthoracic thermodilution cardiac outputs in small animals.

Cardiac output can be measured with a computer using a 2F transthoracic catheter placed during surgery. When injections are made into a central venous catheter, this technique allows for cardiac output measurements to be made in children with complex congenital heart disease not appropriate for placement of a transvenous pulmonary artery catheter. Using rabbits similar in size to the infants most likely to need this technique, 26 experimental comparisons of thermodilution and indocyanine green dye cardiac outputs were made with cardiac outputs as low as 0.2-0.4 liter/min. The relationship between green dye and thermodilution was statistically significant (p less than 0.001) and almost linear (r = 0.92). This documents the validity of both the 2F transthoracic catheter technique in the low range of cardiac outputs appropriate for infants and children.

Animals↗
PubMed1979

Effect of pulmonary artery ligation on the developing fetal lung.

Ligation of the left pulmonary artery was performed in fetal lambs. The procedure was well tolerated and most animals survived to birth. At birth, the animals were in no distress but had mild pulmonary hypertension. The lung to which the pulmonary artery was ligated underwent normal intrauterine maturation.

Animals↗
PubMed1978

Correction of pectus excavatum without prostheses or splints: objective measurement of severity and management of asymmetrical deformities.

From 1949 to 1977, 254 children underwent surgical reconstruction of pectus excavatum by means of a variety of operations at The Johns Hopkins Hospital. From 1970 to 1977, 68 children had a modified Ravitch repair, with the addition of a tripod internal fixation technique for support of the sternum. These children obtained excellent cosmetic reconstruction without prosthetic support or splints. During an 18-month period we used a new system of caliper measurement of the spatial anatomy of the thoracic cage in more than 50 children. During the same period, we originated an operative step to correct the not uncommon asymmetrical excavatum that is usually deeper on the right and associated with a troublesome rotation of the sternum, found in 9 of the last 27 children seen. Correction was accomplished with an oblique anterior sternal osteotomy. The groups were analyzed and compared with respect to age, postoperative complications, and end results in order to identify trends in the management of children with this condition. On the basis of this experience, we feel confident in recommending a standardized operation for all forms of pectus excavatum at an elective age between 4 and 6 years and without prosthetic splints.

Adolescent↗
PubMed1978

Total management of short gut secondary to midgut volvulus without prolonged total parenteral alimentation.

Absorption studies in rats have shown that intestinal adaptation after catastrophic injury can be stimulated by early enteral feeding. Using this concept, we have devised a technique of early initiation and advancement of oral feedings that begins with Cho-Free and Polycose and gradually adds sucrose and MCT in increasing proportions. The increasing complexity and caloric density of this diet provide sufficient nutrition to allow weaning from total parenteral alimentation within 2--3 wk. Our preliminary experience in babies with midgut volvulus, necrotizing enterocolitis, and gastroschisis has been successful and uncomplicated. These patients have demonstrated consistent weight gain and have been spared the complications associated with prolonged parenteral alimentation.

Animals↗
PubMed1978

Preoperative occlusion of the hepatic artery with isobutyl 2-cyanoacrylate for resection of the "unresectable" hepatic tumor.

The case of a child with an "unresectable" hepatic tumor is presented to introduce a new technique of preoperative selective tumor vascular occlusion by means of injection of isobutyl 2-cyanoacrylate on the morning of surgical resection. This technique provides a well demarcated, significantly smaller, and relatively avascular field, allowing for a safe and total removal of the hepatic neoplasm.

Antineoplastic Agents↗