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Biomedical subjects

F I Luks

Publications and source records attributed to F I Luks.

At least 19 recordsLinked to original sources
PubMed2003

Open and laparoscopic appendectomy are equally safe and acceptable in children.

BACKGROUND: The aim of this study was to evaluate prospectively whether laparoscopic (LA) and open appendectomy (OA) are equally safe and feasible in the treatment of pediatric appendicitis. METHODS: A total of 517 children with acute appendicitis were randomly assigned to undergo LA or OA appendectomy, based on the schedule of the attending surgeon on call. Patient age, sex, postoperative diagnosis, operating time, level of training of surgical resident, length of postoperative hospitalization, and minor and major postoperative complications were recorded. Chi-square analysis and the Student t-test were used for statistical analysis. RESULTS: In all, 376 OA and 141 LA were performed. The two groups were comparable in terms of patient demographics and the incidence of perforated appendicitis. The operative time was also similar (47.3 +/- 19.7 vs 49.9 +/- 12.9 min). The overall incidence of minor or major complications was 11.2% in the OA group and 9.9% in the LA group. CONCLUSION: Pediatric patients with appendicitis can safely be offered laparoscopic appendectomy without incurring a greater risk for complications. Nevertheless, a higher (but not significantly higher) abscess rate was found in patients with perforated appendicitis who underwent laparoscopy.

Abdominal Abscess↗
PubMed2003

Experience with a multidisciplinary antenatal diagnosis and management model in fetal medicine.

BACKGROUND: Fetal medicine is a new and evolving specialty. Complex fetal conditions may require the multidisciplinary input of clinicians from many different specialties. METHODS: Referral of fetal patients was made to a multidisciplinary antenatal diagnosis and management (MADAM) board if more than one specialty (in addition to maternal-fetal medicine) needed to be intimately involved in the evaluation or care of the fetus; consultation would probably lead to alterations in fetal or perinatal management; or development or revision of management guidelines was anticipated. The case log of the MADAM conferences was reviewed retrospectively for number and type of fetal anomalies, and outcome of the presentation to the MADAM board. RESULTS: During a 5-year period, 1% of 25654 pregnant women who were evaluated required consultations with individual pediatric and pediatric surgical specialists. Of these, 114 patients were referred to one of 77 MADAM conferences for consensus recommendation. Of these 77 discussions, 32 (42%) led to an alteration in prenatal management, 14 (18%) led to co-ordination of postnatal management and 12 (16%) led to the establishment of a new treatment guideline, or the modification of an existing one. In all, perinatal management was altered in 75% of cases. CONCLUSION: The MADAM model functions as a forum for exchange of up-to-date scientific information, development of evidence-based treatment protocols and continuity of care through the pre-, peri- and postnatal periods.

Female↗
PubMed2002

Laparoscopic gastrostomy in infants and children.

Gastrostomy is a common procedure in children. Percutaneous endoscopic gastrostomy (PEG) is less traumatic than open surgery, but carries a higher risk in small children. We report our experience with laparoscopic gastrostomy, which appears to combine the advantages of the PEG and the safety of an open operation. Operative technique. An umbilical port (5 or 10 mm, depending on the patient's weight) and a left subcostal cannula (site of the future gastrostomy) are used. The stomach is pulled to the abdominal wall with two T-anchors, and the gastrostomy is performed using the Seldinger technique. A 17-Fr peel-away sheath is placed, through which a 5 mm endoscope is introduced to confirm its intragastric position. A 14-Fr balloon gastrostomy tube or button is then introduced. Results. Fifty-one children, aged 0 to 19 years (mean 4.4 +/- 6.4 years), underwent a total of 54 laparoscopic gastrostomies in a 42-month period. Thirty-three patients were younger than 2 years, and 22 weighed less than 5 kg. Thirty-three children had failure-to-thrive, 12 suffered from cerebral palsy and 8 from cystic fibrosis. Operative time was 33.6 +/- 14.3 minutes; in 18 cases, a concomitant Nissen fundoplication was performed (total operative time 76.5 +/- 58.7 minutes). In all cases, gastrostomy feedings were started the following day, and hospital stay in the gastrostomy-only group was 3.3 +/- 0.6 days. There were two (recognized) perforations of the back wall of the stomach, which were repaired laparoscopically, and two tube dislodgments, at 24 hours and at 4 months, requiring reoperation. Conclusions. Laparoscopy allows a quick and simple technique of gastrostomy placement under direct vision in even the smallest newborn and infant. It carries minimal operative risks and allows initiation of feedings within 24 hours.

Adolescent↗
PubMed2001

Effect of lung fluid composition on type II cellular activity after tracheal occlusion in the fetal lamb.

BACKGROUND/PURPOSE: Fetal tracheal occlusion (TO) causes accelerated lung growth. However, prolonged TO is associated with a decline in the type II cell number. Type II cell function after TO is unclear. Herein, the authors examine type II cell function after TO and the role of tracheal fluid. METHODS: Fetal lambs (term, 145 days) underwent TO at 122 days. Tracheal pressure was recorded daily. In one group of animals (TF; n = 6), lung fluid was aspirated, measured, and reinfused daily. In their respective twins, NS group, lung fluid was replaced milliliter per milliliter with normal saline (NS; n = 6). At death near term, lung weight was obtained, and tissues were processed for stereologic volumetry. Type II cells were quantitated using antisurfactant protein B immunohistochemistry. Surfactant protein B-mRNA expression was studied by Northern analysis. Wilcoxon signed rank test and single factor analysis of variance (ANOVA) were used for statistical analysis (P<.05 was significant). RESULTS: In both experimental groups, intratracheal pressure rose from 1.9+/-1.0 torr to 3.7 to 4.8 torr by day 1, and remained constant thereafter. Lung fluid volume increased from 11.9+/-4.2 on day 0 to 36.8+/-8.0 mL/kg in TF, and to 28.4+/-9.3 mL/kg in NS by day 1 (P<.05). At death, lung weight/body weight ratio was higher in TF (5.45% +/- 0.91%) than in NS (4.40% +/- 0. 67%) or control (3.83%+/-0.58%; P<.05). Type II numerical density was substantially reduced after TO: 57.7+/-12.8 x 10(6)/mL (TF) and 45.0 +/-25.9 x 10(6)/mL (NS), versus 82.3+/-13.6 x 10(6)/mL in controls. Ultrastructurally, remaining type II cells in TF were enlarged and engorged with lamellar bodies; in NS, they were smaller and contained fewer lamellar bodies. Surfactant protein B mRNA expression was significantly decreased in NS, but not in TF, compared with controls. CONCLUSIONS: Type II cell function as well as overall lung growth are stimulated by TO. Lung growth after TO is therefore not unavoidably detrimental to type II cells. After isobaric saline exchange of lung fluid, type II cell function is severely inhibited, confirming the role of tracheal fluid composition in type II stimulating type II cell function.

Analysis of Variance↗
PubMed2001

Preoperative planning with magnetic resonance imaging and computerized volume rendering in twin-to-twin transfusion syndrome.

Our purpose was to illustrate the feasibility of preoperative planning with magnetic resonance imaging, 3-dimensional reconstruction, and volume-rendering techniques in twin-to-twin transfusion syndrome treated by endoscopic laser ablation of communicating vessels. After ultrasonographic determination of the syndrome and the indications for intervention, 2 patients with an anterior placenta underwent magnetic resonance imaging without the need for maternal or fetal sedation. Raw image data were downloaded into a desktop computer and manipulated with 3-dimensional reconstruction, volume rendering, and surgical navigation software. In both patients a virtual rendering of the fetuses, placenta, and uterus could be manipulated to expose all sides, demonstrate the location of the intertwin membrane, and plan the point of entry and curve of the endoscopic instruments. Preoperative planning and virtual surgical navigation in fetal surgery are now possible, as a result of shorter magnetic resonance imaging acquisition times and volume-rendering software. In this manner an entire virtual endoscopic fetal operation can be performed and fine-tuned before the actual procedure is to take place.

Endoscopy↗
PubMed2001

Fetal surgery.

Explore the source record for details and available documents.

Cystic Adenomatoid Malformation of Lung, Congenita↗
PubMed2000

Late-gestation tracheal occlusion in the fetal lamb causes rapid lung growth with type II cell preservation.

BACKGROUND: Fetal tracheal occlusion (TO) results in varying degrees of lung growth. This study examines whether gestational age influences lung growth response following TO. MATERIALS AND METHODS: Fetal lambs (term = 145 days) underwent TO early (108 days, n = 6) or late (122 days, n = 6) in gestation. Aspirated lung fluid volume (LFV) and intratracheal pressure (ITP) were recorded daily. Two weeks after TO, the fetuses were sacrificed. Lung growth was assessed by lung weight and stereologic volumetry. Type II cellular density was assessed by computer-assisted morphometry using antisurfactant protein B antibody. RESULTS: After early TO, ITP remained below 2 mm Hg for all but one of the first 5 days. In late TO, ITP rose to 4.8 +/- 1.7 mm Hg by Day 1 and remained elevated. LFV remained lower after early than after late TO (P < 0.05) for 8 days. Thereafter, pressure and volume reached similar levels in both TO groups; both were significantly higher than their respective controls (P < 0.05). Parenchymal fraction (1 - air-space fraction) was significantly smaller after late TO (22.8 +/- 1.2%) than after early TO (31.3 +/- 0.5%). Type II density was 38.0 +/- 12.4 x 10(6)/mL after early TO and 84.0 +/- 24.3 x 10(6)/mL in control (P < 0.05); the difference between late TO and control was not significant. CONCLUSIONS: Late tracheal occlusion in fetal lambs caused more rapid lung growth than earlier TO, although ultimate lung size was similar in both groups. Late TO also resulted in greater air-space fraction and better preservation of the type II cell population than early TO. Late-gestation tracheal occlusion may therefore be preferable to prolonged occlusion initiated earlier.

Airway Obstruction↗
PubMed2000

Requirements for fetal surgery: the diaphragmatic hernia model.

Fetal surgery for congenital diaphragmatic hernia and other fetal conditions can only be considered if (1) the morbidity of antenatal intervention is acceptable, (2) the diagnosis of the condition can be made accurately, (3) the condition can be differentiated from other, non-surgical anomalies. In addition, (4) the natural evolution of the disease, if left untreated, should be predictable, and the condition should be lethal or severely debilitating, (5) there should not exist adequate postnatal treatment, and (6) the proposed in utero operation should be technically feasible. Open fetal surgery has proven too invasive to be justified for the treatment of diaphragmatic hernia, and progress in postnatal therapy (including ECMO) has dramatically improved the neonatal outcome in all but a severe subgroup of patients. Recently, advances in endoscopic fetal surgery (which appears to be less stressful for the fetus and the gravid uterus) and a new approach to accelerate fetal lung growth and maturation have renewed the feasibility of in utero intervention for diaphragmatic hernia.

Female↗
PubMed2000

Short-term tracheal occlusion in fetal lambs with diaphragmatic hernia improves lung function, even in the absence of lung growth.

BACKGROUND/PURPOSE: Prolonged tracheal occlusion (TO) accelerates lung growth but impairs surfactant production. Short-term TO results in less lung growth but preserves type II cell function. The authors studied the effects of short-term TO on lung physiology in diaphragmatic hernia. METHODS: Diaphragmatic hernia was created in 9 fetal lambs at 90 to 95 days. Five were left uncorrected (CDH), 4 underwent 2-week TO (108 to 122 days; CDH + TO). Five unoperated lambs served as controls. Near-term (136 days) fetuses were ventilated for 90 to 150 minutes. Pulmonary arterial pressure, postductal blood gases, quasistatic compliance, total lung capacity (TLC), and lung weight to body weight (LW/BW) were measured. RESULTS: There was an overall survival rate of 89% at full term. Short-term occlusion did not induce lung growth (TLC and LW/BW, 6.07 +/- 2.92 mL/kg and 0.022 +/- 0.008 in CDH, 4.86 mL/kg and 0.019 +/- 0.005 in CDH + TO, 10.81 +/- 3.55 mL/kg and 0.036 +/- 0.006 in controls, respectively). However, pulmonary hypertension in CDH (47.4 +/- 12.32/35.8 +/- 12.19 torr) was corrected by short-term occlusion (20.2 +/- 4.0/16.0 +/- 4.8 torr in CDH + TO, P< .05, single-factor analysis of variance [ANOVA]; similar to control). Best pO2 and pCO2 improved after occlusion (CDH, 48.6 +/- 6.7 torr and 107.1 +/- 34.3 torr, respectively; CDH + TO, 101.5 +/- 16.3 torr and 81.9 +/- 2.4 torr; control, 291.4 +/- 4.7 torr and 37.7 +/- 17.3), as did oxygenation index (P < .05, CDH vCDH + TO; CDH, 97.2 +/- 23.0; CDH + TO, 28.7 +/- 3.1; control, 5.6 +/- 0.6). CONCLUSIONS: Short-term TO corrects pulmonary hypertension and improves gas exchange in fetal lambs with diaphragmatic hernia despite failure to produce accelerated lung growth. Inducing lung maturation and correcting the physiological derangement in diaphragmatic hernia may be more important than achieving lung growth alone.

Analysis of Variance↗
PubMed2000

The unpredictable character of congenital cystic lung lesions.

BACKGROUND: The spectrum of congenital cystic disease of the lung ranges from hydrops and neonatal respiratory distress to asymptomatic lesions. Surgical management is dictated by the presence of symptoms, recurrent infection, and the potential risk of malignant transformation. METHODS: Since 1995, all consecutive patients with congenital cystic lung lesions underwent follow-up for symptoms, treatment, and correlation of presumptive with pathological diagnosis. RESULTS: Twelve cystic lung lesions were identified. Seven were diagnosed with mediastinal shift in utero; in 6 of 7, the shift subsequently resolved. Overall, 6 of 7 lesions that were followed up serially decreased in size. Two patients were symptomatic in utero; 1 underwent thoracoamniotic shunting, 1 pleurocentesis for impending hydrops. Postnatally, these 2, and 2 other newborns required urgent surgery. Five of 8 asymptomatic patients had elective resection by 16 months, and 4 await operation. In 6 of the 9 surgical cases (67%), there was a discrepancy between preoperative and pathological diagnosis. There were 4 hybrid congenital cystic adenomatoid malformation (CCAM)/sequestrations. CONCLUSIONS: At least 6 of 7 congenital cystic lung lesions decreased in size regardless of gestational age or presence of mediastinal shift. Antenatal intervention is therefore rarely indicated. Hybrid morphology may necessitate resection of stable, asymptomatic lesions to prevent the theoretical concern for associated malignancies as well as other complications of CCAM.

Adult↗
PubMed2000

Short-term tracheal occlusion corrects pulmonary vascular anomalies in the fetal lamb with diaphragmatic hernia.

BACKGROUND: Sustained fetal tracheal occlusion (TO) results in accelerated lung growth but causes severe type II cell depletion. Temporary TO fails to cause lung growth in a congenital diaphragmatic hernia (CDH) model but preserves type II cells and corrects pulmonary hypertension. Herein, we study the pulmonary vascular changes caused by temporary TO. METHODS: CDH was created in 12 fetal lambs (65-70 d; term, 145 days). In 6 lambs, the trachea was occluded for 2 weeks (CDH + TO; 108-122 d). Animals were killed at 136 days. The lungs were processed with elastin stains and anti-alpha-smooth muscle actin antibody. Partial or circumferential presence of inner and outer elastic lamina was used to determine muscularization of pulmonary arterioles. The percent of medial wall thickness was plotted against vessel diameter for each group. RESULTS: Lung weight/body weight was smaller in lambs with CDH (1. 35% +/- 0.56%) and CDH + TO (1.70% +/- 0.34%) than in control lambs (3.55% +/- 0.56%; P <.05, single-factor analysis of variance). The smallest muscularized vessel was 113 +/- 50 microm, and the largest nonmuscularized vessel was 138 +/- 49 microm in lambs with CDH, significantly different from control lambs (185 +/- 69 microm and 350 +/- 116 microm, respectively) and lambs with CDH + TO (185 +/- 97 microm and 245 +/- 100 microm, respectively; P <.05). In lambs with CDH, only 25% of vessels of less than 60 microm were nonmuscularized, compared with 81% in control lambs (P <.05) and 74% in lambs with CDH + TO.Conclusions. Temporary tracheal occlusion, from 108 to 122 days, corrects the abnormal muscularization of pulmonary arterioles seen in CDH. These morphometric findings parallel physiologic results at birth and further suggest that short-term occlusion, which preserves surfactant-producing type II pneumocytes without lung growth, may be sufficient to improve neonatal outcome of diaphragmatic hernia.

Actins↗
PubMed2000

Fas ligand expression coincides with alveolar cell apoptosis in late-gestation fetal lung development.

Apoptosis plays a central role in the cellular remodeling of the developing lung. We determined the spatiotemporal patterns of the cell death regulators Fas and Fas ligand (FasL) during rabbit lung development and correlated their expression with pulmonary and type II cell apoptosis. Fetal rabbit lungs (25-31 days gestation) were assayed for apoptotic activity by terminal deoxynucleotidyltransferase-mediated dUTP nick end labeling (TUNEL) and DNA size analysis. Fas and FasL expression were analyzed by RT-PCR, immunoblot, and immunohistochemistry. Type II cell apoptosis increased significantly on gestational day 28; the type II cell apoptotic index increased from 0.54 +/- 0.34% on gestational day 27 to 3.34 +/- 1.24% on day 28, P < 0.01 (ANOVA). This corresponded with the transition from the canalicular to the terminal sac stage of development. The day 28 rise in epithelial apoptosis was synchronous with a robust if transient 20-fold increase in FasL mRNA and a threefold increase in FasL protein levels. In contrast, Fas mRNA levels remained constant, suggestive of constitutive expression. Fas and FasL proteins were immunolocalized to alveolar type II cells and bronchiolar Clara cells. The correlation of this highly specific pattern of FasL expression with alveolar epithelial apoptosis and remodeling implicates the Fas/FasL system as a potentially important regulatory pathway in the control of postcanalicular alveolar cytodifferentiation.

Animals↗
PubMed1999

Cost-effectiveness of laparoscopy in children.

BACKGROUND: Laparoscopy may offer fast recovery and improved cosmesis, but its cost has been perceived as excessive. OBJECTIVE: To analyze the total hospital costs of laparoscopy vs open surgery. DESIGN: Retrospective cost-effectiveness analysis evaluating all cases performed in a 36-month period (September 1995 to August 1998). Cases were evaluated for operative time, itemized cost of supplies, and length of hospitalization. SETTING: Operations performed by pediatric surgeons in a tertiary care children's hospital. PATIENTS: Consecutive children undergoing laparoscopic or open appendectomies, cholecystectomies, fundoplications, and splenectomies. Patients were not randomized to laparoscopy, or open surgery. INTERVENTIONS: Laparoscopic procedures performed with a core set of reusable equipment and a limited number of disposable instruments. MAIN OUTCOME MEASURES: Cost surplus of laparoscopy was evaluated, and compared with savings associated with decreased hospital stay, to obtain cost-effectiveness of laparoscopy per procedure. RESULTS: There were 26 laparoscopic and 359 open appendectomies; 33 laparoscopic and 3 open cholecystectomies; 16 laparoscopic and 18 open fundoplications; and 16 laparoscopic and 7 open splenectomies. Excess operating costs per procedure were $442.00 for appendectomy, $634.60 for fundoplication, $847.50 for cholecystectomy, and $1551.30 for splenectomy. Hospital stay was decreased for all laparoscopies, resulting in an overall savings per laparoscopic procedure of $2369.90 for appendectomy, $5390.90 for fundoplication, $1161.00 for cholecystectomy, and $858.90 for splenectomy. CONCLUSIONS: Laparoscopy is cost-effective, particularly for fundoplication, appendectomy, and cholecystectomy. Detailing the costs of supplies, operating time, and length of stay allows interinstitutional comparison and critical cost-analysis of laparoscopy. With a more selective use of reusable instruments and further shortening of operative time, the global savings of laparoscopy may increase.

Adolescent↗
PubMed1999

Primary laparoscopic placement of peritoneal dialysis catheters in children and young adults.

BACKGROUND: Primary placement of peritoneal dialysis catheters in children often requires suturing of the catheter into the pelvis. We describe our experience with a gasless laparoscopy technique in children and young adults. METHODS: During an 18-month period, 12 patients (mean age, 14 years) underwent primary laparoscopic placement of peritoneal dialysis catheters. A single umbilical port was used for abdominal wall elevation, telescope, and catheter. A needleholder was introduced via an accessory port at the future catheter exit site or through the umbilical port. Omentectomy was performed through the umbilical incision. The catheter was tunneled to the lateral abdominal wall. Follow-up data (>/= 15 months) included time to initiation of dialysis, hospitalization, and outcome. End points were cure, transplantation, or death. RESULTS: Diet was started on the day of surgery and dialysis on the following day. Four patients had seven complications, including leakage and entanglement of the catheter in tubal fimbriae. Long-term revision-free catheter survival was 67% at 24 months. CONCLUSIONS: This minimal access technique for primary placement of peritoneal dialysis catheters includes securing of the catheter tip in a dependent location and omentectomy. It allows nearly immediate use of the catheter, leads to a minimal hospital stay, and has acceptable long-term patency.

Adolescent↗
PubMed1999

Gelatin sponge plug to seal fetoscopy port sites: technique in ovine and primate models.

Amniotic fluid leakage and rupture of membranes are common complications of fetoscopy. We describe a plug technique for leakproof removal of endoscopic cannulas. Thirty gelatin sponge plugs were introduced in 5 pregnant ewes and 5 pregnant rhesus monkeys. In the primate model no evidence of amniorrhexis was noted on postoperative ultrasonography. Myometrium and membranes at the port sites were intact at term. A gelatin sponge plug technique may facilitate leakproof port removal after fetoscopy.

Amniotic Fluid↗
PubMed1999

Selective use of ultrasonography for acute appendicitis in children.

BACKGROUND: To evaluate the role of ultrasonography in children with equivocal signs of acute appendicitis, and correlate with initial clinical impression and pathological findings. METHODS: This is a prospective evaluation of all children presenting with a possible diagnosis of appendicitis during a 14-month study period. Patients with unequivocal clinical signs of appendicitis underwent appendectomy without ultrasonography. Patients with equivocal signs had documentation of the clinical impression and subsequent abdominal ultrasound. Statistical analysis of results was performed using the chi-square test (P <0.05 significant). RESULTS: Two hundred fifteen consecutive children were enrolled. Signs were unequivocal in 116 and equivocal in 99. Seven patients in the first group had a normal appendix at operation. Of the 99 patients with equivocal signs, there were 28 true positives, 3 false positives, 64 true negatives, and 4 false negatives. In equivocal cases, sensitivity of the initial clinical impression versus ultrasound was 50% and 88%, respectively (P <0.05). Specificity was 85% and 96%, respectively. The positive and negative predictive values improved from 63% to 90% and 78% to 94%, respectively, with the use of ultrasonography. CONCLUSIONS: The low false positive rate (6%) in clinically obvious cases of appendicitis does not, in our opinion, warrant ultrasonography. In clinically equivocal cases, ultrasonography is a fast, sensitive, and specific diagnostic modality to diagnose or rule out appendicitis, avoiding the need for prolonged observation and/or hospitalization.

Acute Disease↗
PubMed1999

Incidence of contralateral inguinal hernia: a prospective analysis.

BACKGROUND/PURPOSE: Contralateral groin exploration in children with unilateral inguinal hernia is still controversial, particularly in infants. The authors have attempted to determine the age- and gender-stratified incidence of contralateral hernia and the necessity of routine bilateral procedures. METHODS: This is a prospective study of 656 patients during a 34-month period at a single institution. Patients with unilateral hernia underwent an ipsilateral procedure only, regardless of age, gestational age, or gender. Follow-up was 6 to 40 months (mean, 25.5 months). Chi-square analysis was used for intergroup comparison (P < .05 significant). RESULTS: Of 656 children, 108 (16.5%) presented with synchronous bilateral hernias. Bilateral inguinal hernia was significantly more common in premature infants (28.0%) and young children (33.8% if <6 months, 27.4% if <2 years). Of the remaining 548, a metachronous contralateral hernia developed in 48 (8.8%) at a median interval of 6 months (range, 4 days to 7 years). This incidence was 13 of 105 (12.4%) in infants less than 6 months of age, 20 of 189 (10.6%) in children less than 2 years of age, 8 of 54 (14.8%) in premature infants, 6 of 81 (7.4%) in girls, and 8 of 29 (27.6%) in children with an incarcerated hernia. In the latter group, P < .05, chi2 analysis. CONCLUSION: Routine contralateral inguinal exploration, without clinical evidence of a hernia, may be advisable in children with incarceration and possibly in premature infants. The low incidence of contralateral hernias in all other patients, regardless of gender or age, does not justify routine contralateral exploration.

Adolescent↗