Small bowel transplantation in the rat: the effect of donor-specific transfusion 24 hours pretransplant and cyclosporine.
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Animals↗
Biomedical subjects
F M Guttman
Publications and source records attributed to F M Guttman.
Laparoscopic cholecystectomy: a treatment option for gallbladder disease in children.
Laparoscopic cholecystectomy was performed safely in two children ages 7 and 15 years. Special considerations were required in the younger child because of the discrepancy between the length of the instruments and the size of the peritoneal cavity. Both children remained in hospital less than 24 hours and were able to resume normal diet and activity quickly. Pediatric surgeons with special training in laparoscopic surgery may want to use this treatment modality for children with biliary tract disease.
Adolescent↗
Pyloric stenosis associated with malrotation.
Three cases of pyloric stenosis associated with malrotation are presented. In one case, the diagnosis was made synchronously, and in two cases, pyloric stenosis was noted following correction of malrotation. All three patients underwent pyloromyotomy and Ladd's procedure. These cases differ from the few reported hereditary cases of pyloric stenosis associated with malrotation, which have congenitally shortened bowel, functional obstruction, and poor prognosis. The unusual finding of pyloric stenosis and malrotation occurring together in the first patient was diagnosed with upper gastrointestinal series, obtained because of a high index of suspicion despite a palpable pyloric tumor and positive ultrasound examination. The second and third cases illustrate that vomiting following Ladd's procedure may be due to pyloric stenosis. When clinical findings do not support the presumed diagnosis, further investigation prior to operation is recommended so that rare concommitant pathology can be corrected.
Female↗
Infectious complications of pediatric liver transplantation.
Twenty-five pediatric orthotopic liver transplantations (OLTs) performed in 22 patients at Sainte-Justine Hospital were reviewed for infections complications. One patient died within 12 hours posttransplantation and is excluded. The patients had an average age of 6.1 years (range, 1.25 to 19 years) and an average weight of 20.4 kg (range, 11 to 55 kg). Two patients (9%) were cytomegalovirus (CMV) seropositive and 9 of 19 patients (48%) were Epstein-Barr virus (EBV) seropositive preoperatively. Five of the donors (20%) were CMV seropositive. The most common indications for OLT were biliary atresia (8) and tyrosinemia (7). There were 4 deaths, for an overall mortality rate of 19%. In 3 patients, deaths were related to infection (CMV hepatitis and duodenitis with aortoduodenal fistula, adult respiratory distress syndrome [ARDS] with Streptococcus viridans pneumonia, Escherichia coli cholangitis with progressive hepatic failure). Fifteen patients (72%) had 41 major infections, most of them bacterial, during the first month posttransplantation. These include pneumonia (25%), line sepsis (17%), cholangitis (14%), and tracheitis (14%). There was only one major viral infection, a CMV hepatitis that occurred in the first month posttransplantation. Three patients had fungal infections (8%) associated with hepatic artery thrombosis and recurrent cholangitis. All three patients required retransplantation. There was only one protozoal infection (Pneumocystis carinii pneumonia) causing life-threatening respiratory failure, from which patient recovered without sequelae. Infection still remains a serious complication of OLT. Bacterial infection is common and is usually associated with technical complications. The low rate of CMV infection is related to low incidence of CMV in the donor pool and the minimal use of strong immunosuppressants.
Adolescent↗
Congenital adenomatoid malformation of the lung: current management and prognosis.
A retrospective 10-year review of congenital adenomatoid malformation (CAM) included 10 cases diagnosed in utero by ultrasound and 13 cases that presented postnatally. Two prenatally diagnosed cases were aborted because of associated lethal anomalies. All remaining patients underwent resection. Up to one third of all cases, whether diagnosed prenatally or postnatally, were asymptomatic. Resection is recommended to avoid respiratory distress, infection, or associated malignancy. There were 5 nonsurvivors, including 2 therapeutic abortions and 3 who died postoperatively. All had either polyhydramnios or ascites. All patients who died postoperatively had a respiratory arrest at birth and underwent immediate lobectomy. All died on the first day of life after a brief period and were found to have associated pulmonary hypoplasia. One had undergone a prenatal transthoracic cyst aspiration at 34 weeks gestation in an attempt to allow lung growth and prevent premature labor. Prenatal ultrasound findings suggestive of poor prognosis included polyhydramnios, ascites, mediastinal shift, and noncystic type III CAM. However, there is a spectrum of severity of CAM. The lesion can either regress and be asymptomatic at birth, or it can progress to cause either fetal death from hydrops or neonatal death caused by associated pulmonary hypoplasia. These findings should be considered in prenatal counseling for CAM.
Cystic Adenomatoid Malformation of Lung, Congenita↗
A more than 25-year experience with end-to-end versus end-to-side repair for esophageal atresia.
End-to-end anastomosis has become the standard technique for repair of esophageal atresia with distal tracheoesophageal fistula. End-to-side anastomosis with ligation of the fistula in continuity has also been advocated. For over 25 years both methods have been used in this hospital. The purpose of this report is to compare retrospectively the results obtained with these two techniques. Between 1962 and 1988, 111 neonates underwent repair of esophageal atresia and distal tracheoesophageal fistula. 74 patients had an end-to-end repair and 37 had end-to-side anastomosis with fistula ligation, according to the surgeons' preference. There were no significant differences between the two groups with respect to preoperative variables and Waterston classification. There was a significantly increased incidence of fistula recanalization (22% v 3%, P = .003) and mortality directly related to the esophageal atresia (16% v 3%, P = .03) in the end-to-side group versus the end-to-end group. The end-to-end group had a significantly higher incidence of gastroesophageal reflux. Logistic regression analysis showed that the end-to-side repair was associated with a greater overall mortality. We conclude that the end-to-end repair appears to be a safer procedure than the end-to-side technique.
Analysis of Variance↗
Distal congenital esophageal stenosis associated with esophageal atresia.
A series of six patients with congenital esophageal stenosis associated with esophageal atresia (EA) and distal tracheoesophageal fistula is presented. Three patients required only repeated dilatations, and have had good results. Two patients required limited resections of the distal esophagus, with excellent results. One patient died following a Heller myotomy. Tracheobronchial rests were present in the distal esophagus in the latter three patients. Diagnosis of congenital distal esophageal stenosis following repair of EA requires a high index of suspicion and a careful review of previous esophagrams. It is important to exclude anastomotic stricture and stenosis associated with gastroesophageal reflux. This requires barium esophagram, esophagoscopy with biopsy, and esophageal pH monitoring. Once a congenital basis for distal esophageal stenosis is suspected, management consists of dilatation by bouginage followed by balloon dilatation. Resection is reserved for persistent stenoses from tracheobronchial rests, which usually do not respond to dilatations.
Biopsy↗
Management of complex ovarian cysts presenting in the first year of life.
With more frequent antenatal and postnatal diagnosis, the management of ovarian cysts has become somewhat controversial. Management protocols for simple ovarian cysts have been proposed. The purpose of this study was to establish a management protocol for complex ovarian cysts presenting antenatally and in the first year of life. We reviewed the records of nine infants who underwent surgical treatment for ovarian cysts over a 10-year period (1980 through 1989). Antenatal ultrasound performed between 24 and 34 weeks of gestation showed ovarian cysts in six infants. All six infants had complex cysts ranging in size from 3 to 10 cm on postnatal ultrasound. Exploration with oophorectomy or salpingooophorectomy was carried out at 2 days to 3 months of age for ovarian torsion. Ovarian cysts measuring up to 7 cm were diagnosed postnatally in three infants from 1 day to 7 months of age with ultrasound confirmation of complex, cystic intraabdominal masses. All patients underwent salpingooophorectomy, two for tuboovarian torsion and the third patient for a juvenile granulosa cell tumor. We recommend that all complex ovarian cysts, regardless of size, be surgically removed because they represent torsion, neoplasm, or alternate diagnoses, and removal can prevent possible complications.
Diagnosis, Differential↗
Appendicitis in children: current therapeutic recommendations.
Wound infection is the most common source of morbidity in appendicitis. Most recent pediatric series use protocols of preoperative antibiotics with aerobic and anaerobic coverage, intraoperative lavage, no peritoneal or wound drains, and continuation of antibiotics postoperatively with complicated appendicitis. There still remains controversy concerning skin closure and the duration of antibiotic therapy. We report the results of a prospective protocol followed over 2 years with 420 children. The protocol was designed to determine whether the skin could be closed primarily in all patients undergoing appendectomy. Preoperatively all patients received triple antibiotics (ampicillin, gentamicin, and clindamycin) that were continued postoperatively for two doses if there was a normal appendix or simple acute appendicitis, for at least 3 days with gangrenous appendicitis, and at least 5 days with perforated appendicitis. Antibiotics were continued if the patient remained febrile or had a white count greater than 10,000. No drains were used and the skin was closed primarily. The overall infectious complication rate was 1.0% (4/420). Among those with a normal appendix or simple acute appendicitis there were no infectious complications. Among those with gangrenous or perforated appendicitis there were 1.7% wound infections (2/117) and 1.7% intraabdominal abscesses (2/117). Duration of hospitalization was 2.1 days (range, 1 to 5 days) after simple acute appendicitis and 6.9 days (range, 3 to 40 days) after gangrenous or perforated appendicitis. These results set new standards in terms of wound management, infectious complications, and length of hospital stay.
Adolescent↗
Comparison of omental and subcutaneous implantation after cryopreservation of fetal rat small bowel.
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Animals↗
In vitro studies of intestinal lymphocytes following rat syngeneic intestinal transplantation.
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Animals↗
A study of the separate effects of influence factors and their coupled interactions on cryoinjury of human erythrocytes.
The separate effects of five influence factors and their coupled interactions on cryoinjury of human erythrocytes were investigated experimentally and statistically. The five factors, each having three levels, were as follows: (1) cooling rate: -0.5, -140, and -800 degrees C/min; (2) warming rate: +0.5, +25, and +200 degrees C/min; (3) hematocrit: 2, 11, and 60%; (4) concentration of cryoprotectant (glycerol): 1, 2, and 4 M in PBS; and (5) holding temperature at which the frozen samples were kept: no hold, -75 degrees C for 1.5 hr, and -196 degrees C for 1.5 hr. Twenty-seven special tests, which were chosen from the 243 possible tests by using the Fractional Factorial Design Technique, an optimum seeking technique, were performed. The conclusions are: (1) the cooling rate is the most significant or sensitive factor causing cryoinjury to the cells; (2) the main effects of the hematocrit and the concentration of cryoprotectant, the interaction between the cooling rate and the warming rate, and the interaction between the cooling rate and the concentration of cryoprotectant are next most significant; (3) the main effect of warming rate, and the interaction between the holding temperature and the cooling rate are less significant; (4) the holding temperature below -75 degrees C, and the remaining interactions between two factors are relatively not significant; and (5) in the present study, the optimal combination of the five factors for the survival of the cells is: cooling at -0.5 degrees C/min, warming at +0.5 degrees C/min, hematocrit at 11%, glycerol concentration at 4 M in PBS, and holding temperature below -75 degrees C.
Biometry↗
Unusual patterns of congenital neck masses in children.
Congenital neck masses--thyroglossal duct cysts (TDC) and branchial cleft cysts (BCC)--are frequently encountered in any pediatric surgical practice. While their diagnosis is usually straightforward, unusual or combined presentations may occur. We report eleven cases of unusual patterns of congenital neck masses in children. Two patients underwent resection of a BCC with a sinus tract extending through the carotid bifurcation. Both patients subsequently presented with a new mass near the previous scar, which was thought to be a recurrence but was found at surgery to have TDCs with sinus tracts extending through the hyoid bone. In one patient, a lateral neck mass (presumed to be a BCC) was found at surgery to be a TDC. In all three cases the diagnoses were confirmed histologically. Eight patients presented with a solitary thyroid nodule. Six of these had intrathyroid branchial cleft remnants, and two had intrathyroid TDCs. The diagnosis became apparent at operation in six patients, while in two it was made by the pathologist after hemithyroidectomy. Ages at presentation ranged from 16 months to 14 years. The embryology of these neck structures is closely related. It should not come as a surprise that errors in their development may occur, at times paralleling the occurrence of intrathyroid location of parathyroid glands. The possibility of an embryologic rest in the neck should therefore be kept in mind with all clinically evident neck masses. TDCs and BCCs may coexist in the same patient. The histologic differentiation may be difficult in the presence of inflammation, but differences in structure are often characteristic.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Pediatric liver transplantation: the Montreal experience.
The introduction of cyclosporine A in 1980 greatly improved the survival of children with end-stage liver disease undergoing orthotopic liver transplantation. The average 1-year survival rate following hepatic transplantation increased from 30% in 1963 to 70% in 1980. This report summarizes the initial experience of two pediatric hospitals in Montreal--Hôpital Ste-Justine and Montreal Children's Hospital. Since December 1985, 13 orthotopic liver transplantations have been performed in 11 patients: six females and five males. The median age was 18 months (range, 13 months to 17 years) and the median weight was 10 kg (range, 8.5 to 38 kg). The indications for transplantation were biliary atresia (5 patients), tyrosinemia (2 patients), biliary hypoplasia (1 patient), Amerindian cirrhosis (1 patient), Crigler-Najjar syndrome, type I (1 patient), and fulminant non-A, non-B hepatitis with grade IV encephalopathy (1 patient). Immunosuppression was ensured by cyclosporine A, azathioprine, and steroids. The function of 11 grafts was immediate following revascularization of the grafts. One graft had delayed function due to preservation injury, and one had primary nonfunction. Surgical complications included bile peritonitis (1), ruptured aneurysm of an aortic conduit (1), and thrombosis of the hepatic artery necessitating retransplantation (2). Three of our patients died, one from postoperative cerebral edema, one of primary nonfunction of the graft, and one of ruptured aneurysm of an aortic conduit. Our overall survival rate was 72% with a follow-up of 3 to 32 months. Pediatric liver transplantation can now provide successful treatment and cure of liver diseases considered, until recently, dismal and hopeless.
Adolescent↗
Hereditary sacrococcygeal teratomas.
Hereditary presacral teratoma and its associated anomalies have been described in six kindreds. We report on a similar family where the father presents with a presumed meningocele and his two children with sacrococcygeal teratomas, associated with anterior meningocele in one.
Adult↗
Congenital anal fistula with normal anus.
Three patients with a congenital anovestibular/perineal fistula were treated at the Montreal Children's Hospital. Two females (one of East Indian and the other of Japanese origin) had anovestibular fistulae that became symptomatic in the first few months of life. The third patient, a boy of Korean descent, presented at 9 months of age with a chronically draining perineal fistula. During surgery, a small fistula tract was easily dissected out and excised. Microscopic examination showed a well-preserved rectal mucosa throughout the tract. Most male patients described to date had anourethral fistulae, often accompanied by other major anomalies such as esophageal atresia or renal malformations. We believe our patient is the first male to be described with a congenital perineal fistula; this suggests that some fistula-in-ano in male infants may be due to a congenital sinus that secondarily becomes infected and drains to the skin.
Anus Diseases↗
Small intestinal transplantation in the rat: effect on physiological properties of smooth muscle and nerves.
The effect of transplantation on the physiological and pharmacologic properties of small intestine was evaluated in a syngeneic rat model. We examined the intrinsic contractile properties of the smooth muscle, the neural control of intestinal motility, and the sensitivity of the muscle and nerve endings to biologically active compounds in vitro, comparing transplanted tissue to controls. Both graft and control tissue contracted in a dose-dependent manner to cholinergic agonists, 5-hydroxytryptamine, and substance P and relaxed in response to noradrenaline. Contractile properties of smooth muscle and sensitivity to drugs were not altered by transplantation. Excitatory innervation was also similar in all specimens, but the inhibitory response was altered by transplantation. In the control intestine inhibition became maximal above 30 Hz, while in the graft maximal inhibition was obtained at 5 Hz. These findings imply an absence of extrinsic adrenergic inhibitory innervation in the graft. Intrinsic nonadrenergic inhibitory nerves and the excitatory innervation were intact after transplantation.
Animals↗
Function of smooth muscle and nerve after small intestinal transplantation in the rat: effect of storing donor bowel in Eurocollins.
Lewis rats received syngeneic heterotopic grafts of jejunum immediately, or after preservation for 24 or 48 hours in Eurocollins solution. Most recipients of tissue stored for 0 or 24 hours remained healthy. Longer storage caused death of the recipients. We evaluated the effect of tissue preservation by comparing grafts stored for 0 and 24 hours with control jejunum at successive intervals up to ten days after transplantation. The physiology and pharmacology of smooth muscle and nerve endings were studied in vitro. Circular and longitudinal muscle in all specimens contracted in response to cholinergic agonists, phenylephrine, and substance P, and was relaxed by isoproterenol and noradrenaline. 5-hydroxytryptamine caused contraction of longitudinal muscle in all cases, and of both muscle layers in grafts that had been stored prior to transplantation. In all grafts, the excitatory innervation was similar to control, while the extrinsic adrenergic inhibition was absent. Prior storage caused an additional loss of intrinsic nonadrenergic inhibition, but this recovered within eight days. These findings indicate that Eurocollins solution might be a useful vehicle for the preservation of donor intestine prior to transplantation, as long as the period of storage does not exceed 24 hours.
Animals↗