Reduced lower esophageal sphincter (LES) pressure after acute and chronic brain injury.
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Acute Disease↗
Biomedical subjects
D W Vane
Publications and source records attributed to D W Vane.
One-stage resection for massive cervicomediastinal hygroma.
Cervicomediastinal cystic hygroma has long been recognized as a serious cause of respiratory distress in infancy. This report describes the management of ten infants and children with large cervicomediastinal hygromas. Ages ranged from the newborn to 4 years (average 18.4 months). Six were boys and four were girls. Eight presented with respiratory distress. Neck examination, ultrasonography, and chest x-ray examination were usually diagnostic. In four infants the intrathoracic component was initially clinically unsuspected. The neck lesion descends into the chest between the subclavian vein and artery. At operation the mass was dissected off the pericardium; phrenic, vagus, and recurrent laryngeal nerves; esophagus; aortic arch; and subclavian vessels. Complete resection was possible in each case. Nine of ten patients survived. Death occurred in a newborn with bilateral tumor and pulmonary hypoplasia. Three patients developed Horner's syndrome. There were no recurrences (follow-up 9 months to 10 years). These data indicate that a one-stage resection using an inverted hockey stick (sternum-splitting) incision is well tolerated, curative, and superior to other methods of treatment in infants with cervicomediastinal cystic hygroma.
Child, Preschool↗
Graft length affects outcome in fetal small bowel transplants.
Multiple studies have demonstrated the ability of the fetal rat small intestine to be transplanted successfully as a free graft, devoid of its mesentery. While maintaining normal histologic architecture, portal circulation, and digestive and absorptive properties, the initial myeloelectric activity is delayed. The purpose of this study was to investigate how abnormal early motility affects functional outcome and survival. Using a syngeneic model, fetal rat small intestine segments were transplanted into adolescent rat recipients as free grafts into the omentum. After a maturation period, viable segments measuring 1 or 2 cm were placed into continuity with the native intestine after a standardized resection of either jejunum-ileum, ileum-cecum, or cecum. Control animals had native intestinal resection without graft interposition. Survival, daily weight gain, oral intake, and fecal output were monitored. In this model, overall survival was improved with the use of the shorter 1-cm graft segment compared with the 2-cm and more distal interpositions. No animals survived with proximal graft placement after jejunal-ileal resection. Nutrient use was improved in the transplant recipients compared with nontransplant controls but did not differ between the two graft lengths. These data suggest that outcome in this model is improved using shorter fetal intestine graft lengths. The use of multiple segments in multistaged procedures and early defunctionalization may improve results.
Animals↗