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Biomedical subjects

F C Ryckman

Publications and source records attributed to F C Ryckman.

67 records · Page 4Linked to original sources
PubMed1985

Multisystem trauma.

Several unique features of childhood anatomy and physiology mandate an approach to evaluation and treatment of multiply injured children that differs from that applied to adults. Details of this approach have been presented, with particular emphasis, on early, aggressive multimodal imaging, nonoperative management of splenic, hepatic, renal, and duodenal injuries, and specific aids in early precise definition of extent of injury (contrast-enhanced CT, serum levels of hepatic enzymes, and diagnostic peritoneal lavage). The outcome of this approach preserves maximum function and minimizes morbidity when performed in an institution having the requisite supportive resources.

Blood Transfusion↗
PubMed1985

Thoracic surgical problems in infancy and childhood.

Thoracic surgical problems in infants and children range from congenital anomalies to acquired inflammatory problems. This article reviews the most common parenchymal, pleural, and mediastinal problems encountered in infants and children and presents recommendations for prompt and accurate diagnosis and therapy.

Bronchi↗
PubMed1985

Achalasia mimicking peptic esophageal stricture.

Peptic stricture of the esophagus and achalasia both cause dysphagia. They are not always readily distinguished by history. The usual workup with upper gastrointestinal x ray and endoscopy may also fail to differentiate the two disorders. Two cases are presented wherein antireflux procedures were mistakenly performed when achalasia was present rather than peptic stricture. Dysphagia was unrelieved and extensive further procedures were required. In a third patient referred for a peptic stricture, manometry revealed the correct diagnosis and heller myotomy provided relief. It is recommended that manometry be performed as a part of the preoperative workup in patients in whom there is any element of dysphagia.

Deglutition Disorders↗
PubMed1984

Experience with 95% pancreatectomy and splenic salvage for neonatal nesidioblastosis.

Conventional 85% pancreatectomy with splenectomy performed for management of hypoglycemia of neonatal nesidioblastosis has been followed by a dismal prognosis characterized by post-splenectomy sepsis, recurrent hypoglycemia, permanent brain damage, and a high mortality. For our last eight infants we have found it possible to remove at least 95% of the pancreas, preserving the blood supply to the spleen as well as the duodenum. This has permitted satisfactory control of the hypoglycemia and long-term septic complications have been avoided. Follow-up evaluation up to 20 years with successful control of hypoglycemia without progressive brain damage indicates the value of this primary extensive surgical approach.

Adenoma, Islet Cell↗
PubMed1983

Spontaneous perforation of a colonic duplication.

Alimentary tract duplications are rare anomalies that present with a wide spectrum of clinical manifestations. Mass lesions or obstructive symptoms predominate in infancy, while pain and hemorrhagic complications often herald their recognition in childhood. Spontaneous perforation, a rarely encountered complication, accounted for the acute exacerbation of previously chronic abdominal pain in a three-year-old girl. This case emphasizes the potential for these benign lesions to present with progressive abdominal symptoms and ultimately pressure-induced ischemic perforation.

Child, Preschool↗
PubMed1982

Thoracoscopy for intrathoracic neoplasia in children.

The technique of thoracoscopy allows a unique opportunity to examine the entire hemithorax. Between July 1975 and April 1981 we performed over 150 thoracoscopic procedures for evaluation of intrathoracic pathology at the University of Florida. Twenty-five of these procedures, performed in 23 patients, were undertaken for the diagnosis or staging of intrathoracic tumors in patients whose ages ranged from 8 mo to 18 yr. Forty-eight percent were for parenchymal tumors, 44% for mediastinal masses, and 8% for pleural disease. Twelve of these patients had at least 1 invasive procedure performed prior to thoracoscopy without a diagnosis being established. In 17 procedures a positive tissue diagnosis of malignancy was obtained, and in 6 of these cases areas of previously unsuspected intrathoracic tumor involvement were identified by thoracoscopy. In 3 patients simultaneous thoracoscopy-guided transdiaphragmatic needle biopsy of the liver was performed with a positive tumor diagnosis being achieved in 1. The clinical course of the patients following the 8 procedures in which neoplasia was not encountered confirmed the diagnosis of benign disease in all but 1. A single patient with an enlarged mediastinal lymph node had a falsely negative thoracoscopy biopsy and was subsequently diagnosed as having recurrent Hodgkin's disease. The overall diagnostic accuracy in these patients was, therefore, 92%. Complications in these patients have been minimal, and there was not mortality due to the thoracoscopic procedure. These clinical results would suggest an important role for thoracoscopy in the evaluation of intrathoracic neoplasia in children.

Adolescent↗
PubMed1981

Thoracoscopy for intrathoracic tumors.

The technique of thoracoscopy has been performed on 49 occasions in 45 patients for the diagnosis or staging of intrathoracic tumors. The patients ranged from 8 months to 68 years old. Eight procedures were performed for pleural disease, 16 for mediastinal masses, 22 for parenchymal lesions, and 3 for intrathoracic staging. Seventeen patients had had previous invasive procedures performed without a pathological diagnosis being established. In 28 thoracoscopy procedures, a positive diagnosis for malignancy was obtained; in 6 instances, areas of unsuspected tumor involvement were identified. A correct diagnosis was obtained by thoracoscopy in 45 procedures for a 92% overall accuracy rate. There was no clinically significant morbidity in this series and no procedure-related mortality. Thoracoscopy, performed under stellate ganglion block and regional anesthesia, has proved to be a very attractive method of diagnosing intrathoracic neoplasia with very low morbidity.

Adolescent↗
PubMed1981

Blunt transmediastinal total esophagectomy with simultaneous substernal colon interposition for esophageal caustic stricture in children.

The management of caustic strictures of the esophagus continues to be a challenge to the pediatric surgeon. Many of these patients develop refractory strictures and esophageal reconstruction becomes necessary. Most of the currently employed surgical techniques for this reconstruction leave the injured esophagus in situ and most surgeons have been unwilling to perform a secondary thoracotomy for removal. Many authors have suggested a vastly increased risk of development of esophageal carcinoma in the caustically injured esophagus. In the past five years, techniques for blunt transmediastinal esophagectomy have been developed for adult patients with carcinoma of the cervical region of the esophagus. The current report describes the use of these techniques in two pediatric patients for performing total esophagectomy with simultaneous substernal colon interposition, without the need for thoracotomy. With careful adherence to several technical aspects, this procedure safely allows for complete removal of the injured esophagus and alleviates the concerns of subsequent complications from this organ.

Burns, Chemical↗
PubMedDate not supplied

Pediatric burn patients with respiratory failure: predictors of outcome with the use of extracorporeal life support.

Extracorporeal life support (ECLS) for pediatric burn patients is a viable option for respiratory failure that is unresponsive to maximal conventional therapy. No criteria have been identified that are predictive of the success of the use of ECLS for these patients. This article presents a retrospective review of the pediatric burn patients placed on ECLS at a single pediatric medical center. It was found that 12 patients (mean age, 30.3 months; range 6 to 69 months) were placed on ECLS because of profound pulmonary failure that was unresponsive to aggressive ventilatory support. The mean size of the burns of these patients was 50.2% of the total body surface area (average size of full-thickness burns, 41.8% total body surface area), with 6 patients having scald burns and 6 having flame burns. The overall survival was 67% (8 of 12). Nonsurvivors had greater positive end-expiratory pressure, mean airway pressure, peak inspiratory pressure, and oxygenation index before ECLS. It is felt that ECLS is a life-saving therapy for pediatric patients with thermal injury. Greater ventilator requirements before ECLS are associated with nonsurvival. Early institution of ECLS in pediatric burn patients with severe respiratory failure may prevent excessive barotrauma and thus discourage the onset of irreversible lung injury.

Burns↗
PubMedDate not supplied

A simple technique to redirect malpositioned Silastic central venous catheters.

A simple and noninvasive method to redirect malpositioned Silastic central venous catheters is described. A syringe is connected to the catheter hub, and burst injections of saline cause the tip of the catheter to flip into the correct intravascular position. The present technique has been applied to more than 30 pediatric patients with excellent results. A detailed description of the technique and case examples are presented.

Catheterization, Central Venous↗
PubMedDate not supplied

New methods for assessing liver function in infants and children.

Assessment of liver function in infants and children has traditionally relied on static indices of hepatic structure, cellular integrity, or function and are often based on the release of substances from damaged tissues. There has been a rapid development of dynamic tests based on the measurement of substances metabolized or cleared from blood by the liver. These tests, which have been touted to offer a more precise quantitative estimation of hepatic functional capacity, include the measurement of serum bile acids and the hepatic metabolism of xenobiotic compounds such as caffeine and lidocaine. Serum bile acid measurements appear to be reliable indicators of enterohepatic circulation and may be useful in screening for liver disease. It has been observed that caffeine metabolism is decreased in patients with various forms of liver disease in correlating with disease status. Caffeine has the advantage of being well tolerated when administered orally; the saliva level parallels the serum concentration, making a non-invasive test feasible. Lidocaine is metabolized by oxidative de-ethylation to monoethylglycinexylide (MEGX); analysis of MEGX by common laboratory instrumentation makes rapid evaluation of liver function possible. The MEGX values correlated were with pretransplant liver disease assessment. These tests are currently being evaluated at other centers and, if the initial studies are repeated, they offer the hope for reliable dynamic tests of hepatic function.

Adult↗