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Biomedical subjects

D W Shermeta

Publications and source records attributed to D W Shermeta.

At least 55 records · Page 3Linked to original sources

Fetal surgery: general management and operative technique for creating anomalies in sheep.

Sheep are the best experimental animals for intrauterine surgical research because the fetal lamb is sufficiently large at approximately one-third of gestation to allow handling without prohibitive fetal loss, the lamb has a relatively brief period of gestation (145 days) which allows evaluation of results in a short time, the mother sheep is easily handled and cared for, anesthetic techniques produce smooth, easy induction and steady intraoperative management with a brief recovery period appropriate uterine relaxation is readily attained without dangerously deep anesthetic levels and the sheep is a relatively inexpensive laboratory animal both in initial cost and subsequent maintenance. All aspects of preoperative, intraoperative and postoperative management of intrauterine surgery in sheep is discussed in detail and examples of specific congenital anomalies which can be created in utero are discussed. Finally, the lamb at term may be delivered by caesarian section under control conditions and then studied for evidences of altered physiology and function resulting from the intrauterine procedures.

Animals↗

Simplified treatment of large congenital ventral wall defects.

A preformed silicone polymer silo has been used in eleven infants with omphalocele and gastroschisis. This prosthesis has significant advantages over other forms of silo construction. Among these advantages are: (1) easy and rapid primary application; (2) a totally nonreactive and closed system which prevents peritoneum fluid loss and bacterial contamination; (3) a uniform constant stretching force applied to the abdominal wall which promotes expansion of the peritoneal cavity; and (4) the transparent material of the silo which permits constant evaluation of the contained viscera. These factors all contribute to a smoother operative and postoperative course than that which occurs with skin closure or the self-sutured prosthetic silos.

Abdominal Muscles↗

Lower esophageal sphincter dysfunction in esophageal atresia: nocturnal regurgitation and aspiration pneumonia.

The association between lower esophageal sphincter (LES) incompetence, gastroesophageal reflux, and recurrent pneumonia in patients who have undergone successful repair of esophageal atresia (EA) and tracheoesophageal fistula is demonstrated in this study. The efficacy of esophageal manometric examination in the evaluation of the LES in young children after EA repair is documented. This study also provides evidence that infants and children with LES incompetence associated with EA may have LES responsiveness to bethanechol. Once established by manometry, this responsiveness may be used to manage the patient until surgical repair would be advantageous.

Adolescent↗

Role of lower esophageal sphincter incompetence in recurrent pneumonia after repair of esophageal atresia.

The etiology of recurrent aspiration pneumonitis after the successful repair of esophageal atresia has not been defined. In order to explain this occurrence, we performed esophageal manometric examinations on eight patients who had undergone repair of EA and tracheoesophageal fistula. Two patients who had had recurrent pneumonia had subnormal pressure of the lower esophageal sphincter; they also had a history of severe regurgitation, and a barium esophagram demonstrated free gastroesophageal reflux. The LES incompetence in these patients was apparently corrected by administration of bethanechol.

Adolescent↗

Operative correction of pectus excavatum: an evolving perspective.

From 1949 to 1975, 220 children have undergone surgical reconstruction of pectus excavatum using a variety of operations on our Pediatric Surgical Service. The first 183 were previously reported and have had subsequent, careful followup evaluation. From 1970 to 1975, an identifiable group of 45 children had a standard operation, a modified Ravitch repair, with the addition of a three-point or tripod internal fixation technique for support of the sternum. These children have all obtained satisfactory reconstruction without prosthetic support of any kind. We have thus avoided the possible danger of foreign material within the chest and have obviated the need for another procedure to remove a supporting stent. The two groups have been analyzed and compared with respect to age distribution, postoperative complications and end results to see if we could detect any trends in the evolving management of children with this condition. The main indications for surgical correction remain cosmetic and postural. Specific trends which have emerged from our experience include an increased percentage of patients between 3 and 8 years of age (average 5.8 years); a decreased need for blood transfusion (10%); a near resolution of postoperative seromas with the use of substernal and subcutaneous suction drains; and in the last 45 children, a 100% excellent or acceptable result to date. We feel that age selection is an important factor in the improved operative result and in the emotional impact on these young patients. Eighty per cent of the children in the recent series were between 3 and 8 years of age at the time of repair. On the basis of this experience, we now feel confident in recommending our standardized operation for pectus excavatum at an elective age of 4 to 6 years.

Adolescent↗

Life-threatening respiratory distress from mediastinal masses in infants.

From 1972 through 1974, 5 infants with severe respiratory distress secondary to mediastinal tumors were treated in the Division of Pediatric Surgery of The Johns Hopkins thospital; The mediastinal masses included 2 intramural bronchial cysts, a giant esophageal duplication, a benign teratoma, and a highly malignant neuroblastomamindividualized management was carried out successfully in all: total resection of the bronchial cysts and teratoma; partial resection of the duplication cyst with stripping of the remaining mucosa from the contiguous esophageal wall, thereby preserving esophageal integrity; and excision of involved chest wall and tumor combined with radiotherapy and chemotherapy for the neuroblastoma. This experience emphasizes the potential for lethal respiratory distress from mediastinal tumors in infants and supports the experience reported by others of serious consequences if resection is not performed. Primary physicians and thoracic surgeons must be aware of the lethal potential of such mediastinal tumors among the many other "surgical" causes of respiratory distress in neonates and infants.

Bronchial Diseases↗