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Biomedical subjects

E S Golladay

Publications and source records attributed to E S Golladay.

At least 37 records · Page 2Linked to original sources
PubMed1989

Crotalid envenomation in children: selective conservative management.

Snake bites in children remain an uncommon injury. In general, there is a wide disagreement by knowledgeable authorities on a uniform approach to therapy. In the last 5 years, 29 children have been treated in our institution for snake bites, all with signs of envenomation. Treatment consisted of diagnostic laboratory studies, intravenous fluids, tetanus prophylaxis, antibiotics, bed rest, elevation, and observation. There were no deaths. A fasciotomy was required in three children. Cryotherapy initiated elsewhere resulted in tissue loss. Seven children received antivenin. All developed signs and symptoms to serum sickness. From this experience, it appears that the majority of snake bites in children, especially copperhead bites, can be treated selectively and conservatively. Care must be exercised in using antivenin as it is associated with a high rate of serum sickness. Cryotherapy adds to the morbidity of the bite and is not to be used.

Adolescent↗
PubMed1989

Rectal anticonvulsants in seizure patients undergoing gastrointestinal surgery.

Gastrointestinal (GI) surgery in children with seizure disorders is often complicated by difficulties in administering oral anticonvulsant medications in the preoperative and postoperative periods. Because many newer anticonvulsants do not have parenteral formulations, intravenous phenobarbital, phenytoin, and benzodiazepines may appear necessary in the perioperative period. Eight children with neurologic disease with severe seizure disorders underwent gastrostomy placement and Nissen fundoplication. Perioperatively, their anticonvulsants were given successfully via the rectum. Rectal administration of anticonvulsants is a useful alternative route for drug therapy in seizure patients who are undergoing GI surgery.

Administration, Rectal↗
PubMed1988

An experience with an implanted port system in 66 children with cancer.

Totally implanted port catheter systems have a lower incidence of infection and are more easily used in home care that external catheters in adult cancer patients. Experience with this method in children has been limited. During the past 2 years, we have implanted 71 ports in 66 children with cancer. Our experience demonstrates an infection rate (0.15 episodes of bacteremia per 100 patient days) slightly lower than that reported for children with Broviac or Hickman catheters, but not as low as that seen in adults with implanted systems. Patients and families have been extremely satisfied with the devices. Our experience supports further use of implanted systems in children with cancer.

Adolescent↗
PubMed1988

The ultrasonographic diagnosis of typhlitis (neutropenic colitis).

Typhlitis is a necrotizing inflammatory disease of the cecum, usually with secondary infection. It is most often found in acute leukemia patients on chemotherapy but has also been reported in other patients on chemotherapeutic drugs. Diagnostic features of typhlitis have been reported on plain radiographs, barium enema, angiography, CT, and one other reported case with ultrasound. We report three cases of typhlitis with a characteristic echogenic thickening of the mucosa on ultrasound. The sonographic findings in the one previous report were identical to those of our three cases. We believe that the sonographic findings of typhlitis are unique and that ultrasound offers an easy noninvasive method of diagnosing this potentially lethal disease.

Adolescent↗
PubMed1988

Respiratory complications in cervical thymic cysts.

Thymic cysts are considered uncommon lesions in the differential diagnosis of pediatric neck masses. They have been described as asymptomatic and of little clinical consequence. Recent reports have stressed the possibility of respiratory compromise associated with these lesions. We reviewed our experience with cervical thymic cysts with emphasis on respiratory problems. Ten pediatric patients underwent surgery and were found to have cervical thymic cysts. Ages ranged from newborn to 14 years. There were four boys and six girls. Two were found to have the thymic cysts at time of neck exploration for Grave's disease and hyperparathyroidism. Of the remaining eight patients, all had mobile cystic masses, located anterior to but extending beneath the lower third of the sternocleidomastoid muscle. The size of the mass ranged from 3.0 to 8.5 cm. Preoperative diagnosis included cystic hygroma/branchial cleft cyst (five), lymphoma (one), teratoma (one), and thymic cyst (one). All had a history of rapidly developing neck mass. Seven of the eight gave a history of upper respiratory tract infection (URI) prior to the development of the mass. Five had imaging studies that showed tracheal compression. Three of these required airway management in the early postoperative period. All were excised through a neck incision, with two requiring sternal extension. Histology showed cholesterol crystals, Hassall's corpuscles, and giant cell reaction diagnosis of thymic cysts. There has been no recurrence and no permanent respiratory sequela in the ten patients. Cervical thymic cysts are benign lesions that may be more common than literature suggests.(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗
PubMed1988

Delayed diagnosis in pediatric appendicitis.

Delay in appendectomy occurs from failure to contact a physician, or from a physician's failure to make a proper diagnosis. In our study delay was due to physician error in 32 of 422 children who had appendectomy. Symptoms consistent with appendicitis were documented on the initial visit in each case, but 22 patients had a history of previous similar pain or recent viral illness to confuse the diagnosis. Misdiagnosis was responsible for the delay in 14 cases (gastroenteritis in ten and urinary tract infection in four). Antibiotics given before proper diagnosis in 22 instances increased diagnostic difficulty in 20. Late referral is increasing, perhaps because of a perceived innocuous nature of appendicitis. Complicated appendicitis was found in 26 children (81%), compared with 38% of the total experience. Their hospital stay averaged nine days, as opposed to 6.6 days in the nondelayed group. Failure of resolution of symptoms after therapy begins mandates reassessment to avoid progression of this common surgical disease.

Abscess↗
PubMed1988

Treatment of keloids by single intraoperative perilesional injection of repository steroid.

Keloid management remains controversial, and recurrence and untoward side effects limit the use of many techniques. During a seven-year period, I surgically treated 19 children, aged 3 to 17 (mean 10.5 years), with a total of 28 keloids. After aseptic skin preparation, the interface between the keloid and normal skin or subcutaneous tissue was injected with betamethasone sodium phosphate and betamethasone acetate suspension (Celestone Soluspan). The lesion was excised, and the defect was closed with subcutaneous polyglycolic acid suture. No further therapy was given. There has been no dermal or subcutaneous atrophy, and there have been no recurrences after an average follow-up of 35.5 months (six months to nine years). The technique is simple and successful, and avoids the painful postoperative series of injections often advocated.

Adolescent↗
PubMed1988

Diffuse juvenile polyposis: management by ileoendorectal pull-through.

Two children with diffuse juvenile polyposis were managed by ileoendorectal pull-through. The procedure was more difficult and time-consuming because each stalk in the rectum had a well established blood supply, thus causing bleeding, and because it was difficult to manipulate the mucosal sleeve, as the polyps obstructed the lumen. Both children had satisfactory long-term results after reconstruction with an isoperistaltic pouch. I believe that in cases of diffuse juvenile polyposis, proctoscopic removal of all of the rectal polyps two to three weeks before the definitive procedure may greatly facilitate it.

Adolescent↗
PubMed1988

Pancreas divisum and pancreatitis in children.

Pancreas divisum, a congenital variant of pancreatic ductal anatomy first described by Opie in 1903, has only recently been thought of as a cause of pancreatitis. The majority of reported patients presenting are middle-aged, with the exact pathogenesis not clearly understood. The reason for this late clinical presentation of a congenital abnormality is also not clear. However, reports of children with recurrent pancreatitis and an associated pancreas divisum have now appeared. None had any identifiable cause of pancreatitis. Pancreas divisum was diagnosed or suspected preoperatively in two, with findings on endoscopic retrograde cholangiopancreatography (ERCP) and gastroduodenoscopy. All findings were confirmed at operation. All underwent surgical treatment with good results within 6 months. Review of the literature showed eight patients younger than 18 years with pancreas divisum and pancreatitis requiring operation. All had good results after surgical repair. It appears that this anomaly can be associated with recurrent pancreatitis in children. Children with recurrent pancreatitis with no obvious cause should be evaluated for pancreas divisum and, if it is found, be surgically treated. The role of ERCP, while not clearly defined, may become critical in the evaluation of pancreas divisum in children.

Amylases↗
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

Invasive aspergillosis in children.

Aspergillosis may complicate the course of the child in an immunocompromised state. When sinus or pulmonary infections present in immunocompromised children, one third of these patients are diagnosed accurately premortem as resulting from aspergillosis and two thirds remain undiagnosed. Mortality remains quite high, despite prompt treatment. Four children in our hospital during the last 4 years have had invasive aspergillosis presenting other than sinus or pulmonary infections. Each presented with extensive soft tissue infection. Three presented after traumatic devascularizing injuries to the leg in which massive soil and fecal contamination occurred. One child presented with absolute neutropenia secondary to treatment of acute lymphocytic leukemia. The child had a chest wall lesion develop at the site of an EKG electrode. All patients had a punctate black skin lesion with a halo of intense erythema surrounded by a zone of blanching. These lesions rapidly expanded. Initial extensive debridement of the lesions, combined with systemic chemotherapy with amphotericin B failed to halt the progression of the disease. Histology showed vascular invasion with hyphal forms. Each patient then responded well to radical debridement (three hemipelvectomies and one chest well resection). The child in an immunocompromised state who develops a red papule, then a black eschar with surrounding erythema, should have immediate biopsy that can easily demonstrate the characteristic hyphal forms. Early radical surgical debridement and antifungal therapy can be lifesaving. The initial debridement should include tissues well beyond any apparent involvement.

Amphotericin B↗
PubMed1987

Intermediate imperforate anus: clinical and radiographic implications.

Five male infants are described with imperforate anus with external signs of a low lesion but with subsequent evidence of a higher lesion with demonstration of a fistula into the anterior urethra either at surgery or by radiographic studies. The cases should be considered an intermediate form of imperforate anus with external signs of a low lesion but with fistula characteristically to the membranous or bulbous urethra. These infants should be treated surgically as high lesions with initial diverting colostomies.

Anus, Imperforate↗
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↗
PubMed1986

Chromosome abnormalities in familial hemophagocytic lymphohistiocytosis.

Familial hemophagocytic lymphohistiocytosis (FHLH) is an uncommon disorder characterized by multiorgan infiltration with phagocytic histiocytes/macrophages. It may be inherited as an autosomal recessive trait, but specific associated cytogenetic abnormalities have not been documented. The authors describe a 10-week-old white female without prior family history of FHLH, who fulfilled the histologic and clinical criteria for the diagnosis. In addition, cytogenetic abnormalities, including the presence of double minute chromosomes and occasional loss of chromosomes 7 and 12, were documented in unstimulated peripheral blood cells. These karyotypic findings are usually associated with dyserythropoietic and leukemic states, and have not been described previously in the context of FHLH. It may be useful to do chromosome analyses on unstimulated peripheral blood cultures from FHLH patients before treatment to examine the karyotype of proliferating cells, which may represent the infiltrative histiocytes seen in the disorder.

Chromosome Aberrations↗
PubMed1986

Apparent gut excretion of Tc-99m-DISIDA in a case of extrahepatic biliary atresia.

Our patient had DISIDA scan at 39 days of age to exclude biliary atresia. Gut excretion was seen 18 h after injection and the diagnosis of neonatal hepatitis was made. Because of continued elevated liver function values, liver biopsy was performed and demonstrated findings consistent with biliary atresia. Exploratory laparotomy performed 8 days after the scan showed patent cystic duct, bile duct, and gallbladder, but an atretic common hepatic duct. This case is an example of documented biliary atresia demonstrating gut excretion on the DISIDA scan.

Bile Ducts↗