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Biomedical subjects

D W Vane

Publications and source records attributed to D W Vane.

At least 73 records · Page 4Linked to original sources
PubMed1987

Vitelline duct anomalies. Experience with 217 childhood cases.

Of 217 children with vitelline duct anomalies, 85 (40%) had symptomatic lesions (mean age, 2.4 years). Forty-eight patients presented with rectal bleeding; 28, with intestinal obstruction; five, with abdominal pain; and four, with bilious umbilical drainage. An asymptomatic Meckel's diverticulum was discovered incidentally at laparotomy in 132 children. Surgical therapy included bowel resection in nine patients with volvulus, four with intussusception, seven with bleeding, three with vitelline cysts, and one with a perforation. Diverticulectomy was performed in 189 cases, and excision of a patent vitelline duct was accomplished in four neonates with umbilical drainage. Ectopic gastric mucosa was present in all 48 patients with bleeding and in four of five with inflammation but in only two asymptomatic specimens. More than one third of the cases were symptomatic and presented in younger patients. This suggests that elective resection of asymptomatic vitelline remnants in early childhood is reasonable at the time of laparotomy for other conditions.

Appendicitis↗
PubMed1987

Complications and reoperation after Nissen fundoplication in childhood.

Over a 10 year period, 429 Nissen fundoplications were performed on children with gastroesophageal reflux. Postoperative complications occurred in 69 children (16 percent), including wrap herniation or breakdown in 29; postoperative bowel obstruction in 18; stricture in 10; intraabdominal abscess and enterocutaneous fistula in 3 patients each; and wound infection, wound dehiscence, and inadvertent splenectomy in 2 patients each. The postoperative mortality rate was 0.9 percent (4 of 429 patients) and was related to sepsis in 1 patient, a metabolic disorder in 1 patient, and underlying pulmonary disease in 2 patients. All four patients were neurologically impaired. Fundoplication successfully controlled symptoms of gastroesophageal reflux in 395 children (92 percent) over a follow-up period ranging from 6 months to 10 years. Thirty-eight patients (8.8 percent) required a second antireflux operation because of recurrent symptoms. Twenty-nine patients had severe neurologic impairment (76 percent), 5 had associated congenital malformations (13 percent), and 3 had significant pulmonary problems (8 percent). Only one child requiring reoperation was considered otherwise normal. Indications for reoperation included wrap breakdown or herniation (28 patients), stricture (6 patients), and inadequate wrap (4 patients). Twenty-four of 28 children with wrap herniation or breakdown had neurologic impairment. A second fundoplication was successful in 35 of 38 patients (92 percent). A second procedure failed in three children, who required subsequent resection and colon interposition.

Adolescent↗
PubMed1987

Changes in lower esophageal sphincter pressure (LES) after Stamm gastrostomy.

Previous clinical and experimental reports have implicated placement of a Stamm gastrostomy (SG) as a cause of gastroesophageal reflux (GER) in children. This study evaluates this problem by measuring alterations in the lower esophageal sphincter pressure (LES) after SG with and without maintenance of the esophagogastric angle of Hiss. In 20 cats (2.8-3.2 kg) general anesthesia was induced using 20 mg/kg ketamine im. Esophageal manometrics were measured using a continuous perfusion catheter and recording system, evaluating three measurements for each animal. Eight cats (Group I) underwent SG placement in the anterior stomach wall two-thirds of the way down from the fundus. This was tacked to the anterior abdominal wall 3 cm lateral to the midline at the appropriate level. Six cats (Group II) had standard SG tube placement and in addition, two interrupted sutures were placed between the fundus and the esophagus maintaining the gastroesophageal angle of Hiss. Six cats (Group III) had sham laparotomy. After awakening, the animals were fed cat chow and water ad libitum. At 7 and 14 days, the animals were reanesthetized with ketamine and manometrics were repeated. Preoperative LES pressure measured 11.3 +/- 4.7 Torr. LES pressure in Group I decreased to 6.61 +/- 1.6 Torr at 7 days (P less than 0.01) and 4.8 +/- 1.6 Torr at 14 days postoperatively (P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1987

Reduction of lower esophageal sphincter pressure with Stamm gastrostomy.

Although recent clinical studies suggest an association between Stamm gastrostomy and gastroesophageal reflux (GER), no significant experimental data is available. This study evaluates alterations in lower esophageal sphincter (LES) pressure after Stamm gastrostomy in cats. Eight male cats (average weight 3 to 4 kg) were induced under general anesthesia using 20/mg/kg ketamine intramuscularly (IM). Esophageal manometrics were determined for each animal using a continuous perfusion catheter and recording system. Three measurements were taken for each animal. Stamm gastrostomy was then placed in the anterior wall of the stomach two thirds of the way down from the fundus. This was tacked to the anterior abdominal wall 3.0 cm lateral to the midline at the appropriate longitudinal level. Esophageal manometry was repeated after abdominal closure. The animals were awakened and returned to their cages for ad libidum feedings. The animals were reanesthetized with ketamine and manometrics repeated at 7 and 14 days. Each animal served as its own control. Five animals underwent barium esophagram 14 days postoperatively to evaluate for GER. Preoperative mean LES pressure measured 11.4 +/- 3.5 torr. This decreased to 7.8 +/- 2.8 torr immediately after Stamm gastrostomy (P less than .025). When evaluated at 1 and 2 weeks after gastrostomy, further decrease in LES pressures to 6.6 +/- 1.6 torr and 4.8 +/- 1.6 was observed (P less than .02 v preoperative). Three of five cats undergoing barium swallow demonstrated significant reflux radiographically. Stamm gastrostomy caused significant reduction of the LES pressure in all cats studied. This resulted in clinical GER as documented by barium swallow in three of five cats.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1987

Ventricular gallbladder shunts: an alternative procedure in hydrocephalus.

Hydrocephalus is a frequently encountered problem in infancy and is most commonly treated by placement of ventriculoperionteal (VP) or ventriculoatrial (VA) shunts. Other sites for insertion of the distal shunt have included the stomach, ureter, and fallopian tube. This report describes an experience with ventricular gallbladder shunts (VGB) in 25 children performed from 1970 to 1985. There were 13 girls and 12 boys ranging in age from 6 months to 16 years. Diagnosis included meningomyelocoele (7), congenital hydrocephalus (7), postmeningitic complications (5), intracranial tumor (4), and intraventricular hemorrhage (2). Indications for operation included VP shunt infection (15), massive ascites following VP shunt (3), VA shunt infection (4), and distal shunt malfunction due to fibrinous adhesions or cysts (secondary to infection; (3). Three patients had early shunt failure due to proximal obstruction (2) and gallbladder atony (1). Shunt revision was required in two and the atony was successfully treated with cholecystokinin in one. Fourteen shunts remain in place, two patients have been lost to follow-up, and three children died from unrelated causes. Seventy percent of the 20 patients available for long-term follow-up have functional shunts in place. The VGB shunt procedure remains an attractive alternative for patients with hydrocephalus in whom intraperitoneal and intravascular shunts are no longer feasible.

Adolescent↗
PubMed1987

The effect of various types of gastrostomy on the lower esophageal sphincter.

Previous studies have demonstrated a cause and effect relationship between standard Stamm gastrostomy (SG) and subsequent gastroesophageal reflux (GER). To further investigate this clinical problem, three additional types of gastrostomy were evaluated in regard to their influence on the lower esophageal high pressure zone (LEHPZ). Twenty-three male cats were entered in the study weighing 2.6 to 3.6 kg. Baseline manometric studies of the LEHPZ were determined after ketamine anesthesia. In group I (n = 9), Witzel gastrostomy was performed over a 12 Fr catheter without fixation of the stomach to the anterior abdominal wall. In group II (n = 7), percutaneous gastrostomy was performed without fixation of the stomach to the anterior abdominal wall. In group III (n = 7), percutaneous gastrostomy was performed but the stomach was firmly fixed to the abdominal wall. LEHPZ pressures were then repeated 2 weeks postoperatively. Mean preoperative LEHPZ pressure for group I was 16.2 +/- 3.72 mmHg, group II was 16.5 +/- 6.91 mmHg, and group III was 18.3 +/- 5.59 mmHg. Mean postoperative pressure for group 1 was 14.7 +/- 4.26 mmHg, group II was 16.5 +/- 5.77 mmHg, and group III was 10.8 +/- 3.97 mmHg. LEHPZ pressure was similar preoperatively and postoperatively in groups I and II but was significantly decreased postoperatively (P less than .01) in group III. Contrast studies demonstrated maintenance of the angle of His in group 1 and II and alteration of the angle of His in group III. Gastrostomy associated with fixation of the stomach to the anterior abdominal wall results in decreased LEHPZ pressures. This predisposes the subject to GER.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1987

Intussusception: current management in infants and children.

Intussusception remains a leading cause of bowel obstruction in early infancy and childhood. From 1970 to 1985, 83 patients with intussusception were treated. There were 51 boys and 32 girls ranging in age from 2 months to 22 years. Ten patients had a total of 14 separate recurrences; nine occurred during the initial hospitalization. Symptoms on presentation included abdominal pain (80%), palpable mass (60%), rectal bleeding (53%), and lethargy or sepsis (45%). Fifteen children underwent exploration without contrast studies based on duration of symptoms (greater than 5 days) and evidence of severe obstruction on plain abdominal x-ray films. In the remaining children, diagnosis was confirmed by barium enema and hydrostatic reduction was achieved in only 34 patients (42% success rate). Symptoms were present more than 48 hours in 55% of the reduction failures. At operation, five children had spontaneously reduced and an appendectomy was performed. Manual reduction was possible in 32 patients. The intussusception was irreducible in 26 patients, and 18 required temporary stomas. Pathologic lead points were found in 11 patients. Average length of hospitalization was 1.5 days after barium enema reduction, 9.6 days after manual reduction, and 13.8 days after bowel resection. There were no recurrences of intussusception after surgical reduction. A significant morbidity rate was observed with a delay in diagnosis. Adequate preoperative preparation and prompt surgical intervention are associated with 100% survival.

Adolescent↗
PubMed1986

Burn care in children: special considerations.

Burn injuries are common in children. In this article, the epidemiology, initial resuscitation, nutritional management, and wound management of pediatric burn injuries are reviewed with emphasis on the special problems of children.

Adolescent↗
PubMed1986

Esophageal replacement in children: experience with thirty-one cases.

Esophageal replacement procedures in adults are often performed for malignancy and are associated with significant morbidity and death. This article describes 31 children who underwent esophageal replacement procedures between 1970 and 1985. Diagnosis in the 18 boys and 13 girls included esophageal atresia in 23, caustic ingestion in six, and distal esophageal stricture caused by reflux in two. Replacement procedures performed included right colon isoperistaltic segments in 23 children, left colon antiperistaltic interposition in two, and gastric tube in four. Immediate complications included atelectasis (20), pneumothorax (four), and ventilator support greater than 2 days (eight). Ten patients developed leaks at the cervical anastomosis and required subsequent dilation. Seven patients had pulmonary restrictive disease caused by recurrent aspiration despite compliance with anti reflux measures. Four of these same children developed peptic ulceration before pyloroplasty. No patient who had a gastric drainage procedure as part of the initial operation has developed ulcer disease or aspiration pneumonitis. These data suggest that esophageal replacement procedures are relatively well tolerated in children with no deaths observed in this series. A gastric drainage procedure is an important adjunct in minimizing long-term morbidity. Since reflux, peptic ulceration, and pulmonary complications may occur, long-term follow-up essential.

Adolescent↗
PubMed1985

Esophageal sclerotherapy: an effective modality in children.

During the past five years, sclerotherapy has been used at our institution in 13 children for the management of recurrent major variceal bleeding. The varices were secondary to extrahepatic portal hypertension in seven patients and to intrahepatic portal hypertension in the remaining six. Sclerotherapy was performed under direct vision using either rigid or flexible endoscopic equipment, and the sclerosing agents were injected directly into the varices. The average age at initiation of sclerotherapy was 9 years (range: 1 to 19 years). The follow-up has ranged from 2 to 4 1/2 years with a mean of 3 1/2 years. Complete obliteration of all varices was obtained in eight of these patients. Two children have minimal residual varices, in one of whom 17 sclerotherapy procedures have been performed to date. One additional patient had a severe episode of bleeding during esophagoscopy, and transesophageal ligation of varices was required for control. Two patients have died following initiation of sclerotherapy. In neither case was the death the result of bleeding esophageal varices or a complication of endosclerosis. Bleeding from varices was the major clinical problem in all of these children, and this problem has been largely corrected by the sclerotherapy program. With one exception, there have been no episodes of variceal bleeding requiring transfusion in these patients following initiation of this therapy. One child developed an esophageal ulcer postinjection, but none have developed esophageal strictures. One patient developed an allergic reaction to the sclerosant that was treated during subsequent injections with prior administration of an antihistamine (diaphenhydramine chloride) and steroids.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1985

The effectiveness of Nissen fundoplication in neurologically impaired children with gastroesophageal reflux.

Fifty-seven of 101 Nissen fundoplications during the 4-year period, July 1979 to July 1983, were performed on neurologically impaired children. Mean age at the time of surgery was 5.9 years (range 1 month to 22 years). Indications for operation included: persistent vomiting, 57 patients (100%); failure to thrive, 49 patients (86%); repeated episodes of pneumonia, 49 patients (86%); esophagitis, 18 patients (32%); hiatal hernia, 14 patients (25%); episodes of apnea, 10 patients (18%); and esophageal stricture, six patients (10%). Forty-six of the 57 patients had previously failed a standard trial of nonsurgical management. Gastroesophageal reflux was documented by barium esophagograms in 51/56 patients (91%), chalasia scans in 28/32 patients (88%), esophagitis or stricture at endoscopy in 21/23 patients (91%), and acid reflux on pH monitoring in 13/16 patients (80%). Operative management included gastrostomy in 55 of the 57 patients and this was permanent in 50. Gastrostomies had previously been performed in nine patients but had failed to provide a reliable method of enteral feeding because of chronic reflux and aspiration. The surgical complication rate was 12%. Intraoperative esophageal perforation occurred in two patients, splenic tear in one, hepatic vein laceration in one, and a tight wrap in one. After surgery, bowel obstruction from adhesions developed in one patient and a midgut volvulus in another. Five of the children have died, none from causes related to the surgical procedure. Clinical and radiologic follow-up evaluations of all survivors have been done, with a mean follow-up of 3 years. In four patients the repair was felt to be inadequate. One patient had an esophageal stricture and three had recurring episodes of pneumonia. Three children showed radiologic evidence of persistent reflux, but only two were symptomatic. Two patients required a second antireflux procedure for reflux and are now free of symptoms. Nissen fundoplication appears to be a safe and beneficial procedure in neurological impaired children. Long-term follow-up evaluation of these patients showed satisfactory growth as well as a significant decrease in pulmonary disease associated with aspiration.

Adolescent↗
PubMed1983

Superoxide dismutase: a cellular protective enzyme in bowel ischemia.

Recent data suggest that the free-radical anion superoxide (O-2), an unstable, cytotoxic form of oxygen, is implicated in the pathogenesis of ischemic bowel injury. This study evaluates the role of superoxide dismutase (SOD), an enzyme specific for enzymatic conversion of O-2 in protecting the bowel from an ischemic insult. At laparotomy, the superior mesenteric artery was occluded for 1 min in 90-g weanling rats (n = 144). Animals were divided into four groups: I, untreated controls (n = 41); II, received aminophylline (AMN) 40 mg/kg ip, a substrate for (O-2) generation (n = 21); III, received superoxide dismutase (SOD) 2.5 mg/kg iv (n = 20); IV, received both AMN and SOD (n = 22). Rats were evaluated for bowel infarction, perforation, and mortality over a 7-day observation period. In 40 additional rats (10 per group) bowel ultrastructure was evaluated by scanning electron microscopy (EM) during occlusive ischemia and at various time intervals following reperfusion. Mortality was 63.4% in controls (26/41) with necrosis noted in 19 and perforation in 7. AMN resulted in a 90% mortality (19/21) (chi 2, P less than 0.05 vs control), with necrosis in 15 and perforation in 4. SOD reduced mortality to 25% (5/20) with necrosis in 4 and perforation in 1 (chi 2, P less than 0.02 vs controls) and, when added to AMN, 45.5% (10/22) (chi 2, P less than 0.01 vs AMN alone). On EM, tissue damage was minimal during occlusive ischemia, worsened by duration of reperfusion, enhanced by AMN, and reduced by SOD. These data suggest that following hypoxia, the injured bowel may be unable to appropriately handle reoxygenation. Tissue damage was related to duration of reperfusion and was worse following AMN, a xanthine derivative that might generate (O-2), a cytotoxic free radical. SOD detoxifies O2-, increases survival, and protects the bowel during reperfusion.

Aminophylline↗
PubMed1983

Neonatal lung abscess: resection using one-lung anesthesia.

Three neonates with lung abscess unresponsive to antibiotic therapy underwent successful resection of infected lobes with the aid of one-lung anesthesia. This was accomplished by selective endobronchial intubation of the opposite lung and obstruction of the ipsilateral main bronchus with a Fogarty balloon-tipped catheter. This valuable technique provides protection against tracheobronchial spillage of purulent material and results in the rapid recovery of these seriously ill neonates.

Catheterization↗
PubMed1983

The diagnostic dilemma of the posterior mediastinal thymus: CT manifestations.

Extension of the normal thymus into the posterior mediastinum is rare. The CT appearance of this anomaly in an infant is presented. A mass of soft-tissue density extended from the anterior mediastinum to the posterior chest wall. The absence of any tissue-cleavage plane in the lesion and a smooth continuous lateral margin are signs of posterior extension of the thymus, and they help to distinguish this from a normal anterior thymus being present with a posterior tumor.

Diagnosis, Differential↗
PubMed1982

Tapering enteroplasty in infants with bowel atresia and short gut.

Antimesenteric tapering enteroplasty was evaluated as an alternative to resection in 16 babies. Tapering enteroplasty was done for jejunal atresia (11), ileal atresia (three), total colonic aganglionosis (one), and colonic atresia (one). Most had short gut with proximal bowel dilation. There were no anastomotic leaks but slight functional delay (eight to 14 days). One patient with 14 jejunoileal atresias received continuous-drip feeding while the remainder took regular diet. Mean weight gain was in the 25th percentile at 1 year of age, and the 35th percentile at 2 years of age. There were two deaths from liver failure and brain damage. Antimesenteric tapering enteroplasty is particularly useful in selected instances of intestinal atresia associated with short gut, where preservation of bowel length may be essential for survival. Gastrointestinal function, bowel movement patterns and growth and development have been gratifying.

Colon↗