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Biomedical subjects

H G Andrews

Publications and source records attributed to H G Andrews.

At least 19 recordsLinked to original sources
PubMed2000

ED evaluation of the pediatric trauma patient by ultrasonography.

The purpose of this study was to determine the accuracy of ultrasound examination of pediatric trauma patients by emergency physicians. Pediatric (age less than 18 years) trauma patients presenting to the emergency department of a level I trauma center were prospectively examined with bedside ultrasound during the secondary survey of their trauma resuscitation. Examinations were performed by emergency medicine residents and attending physicians who had completed an 8-hour course on trauma ultrasonography. Trauma physicians providing care to the patient were blinded to the results of the examination. In 47 children (median age 9 years) computed tomography of the abdomen/pelvis or laparotomy were also performed and served as gold standards to verify the presence or absence of free fluid in the abdomen. Sensitivity, specificity, and accuracy of the ultrasound examination for the detection of free fluid in the abdominal cavity was 75% (95% confidence interval [CI] 36% to 95%), 97% (95% CI 81% to 100%), and 92% (95% Cl 77% to 98%). Positive and negative predictive values were 90% (95% CI 46% to 100%) and 92% (95% CI 74% to 99%), respectively. Ultrasound examinations took an average of 7 minutes and 36 seconds, although this did not take into consideration delays created by interruptions for other diagnostic tests or procedures. An emergency physician and radiologist agreed on blinded interpretations of 83% of the examinations (kappa = 0.56). Bedside ultrasonography is a reliable and rapid method for screening traumatized children for the presence or absence of free fluid in the peritoneum even in the hands of novice sonographers.

Adolescent↗
PubMed1995

Intraoperative radiotherapy in the treatment of neuroblastoma: report of a pilot study.

BACKGROUND: External beam radiotherapy in advanced neuroblastoma is limited by the volume of normal radiosensitive tissues included in the radiation field. Limitations to external radiation are the late effects to these tissues. Intraoperative radiotherapy (IORT) delivers a single high-radiation dose to a tumor while displacing normal tissues that would have been included in an external field. Standard external radiotherapy can still be done after "boost" IORT. METHODS: Eight advanced-stage neuroblastoma patients who received IORT as part of their multimodality therapy were reviewed to identify the impact of IORT on operative time, complications, and tumor control in the treatment field. The IORT was accomplished by patient transport from the OR to the radiation therapy suite; these were separated by three floors. RESULTS: IORT added 30-75 min to the operative procedure. Tumors in the resection/IORT fields showed no evidence of disease (one), stable tumor size (six), and tumor recurrence (one). Two complications were identified: a urinary fistula and CO2 retention, which was detected and corrected before the IORT. Neither of these complications was related to the IORT. Two patients who had subsequent tumor resection after IORT demonstrated tumor differentiation to ganglioneuromatous tissue. CONCLUSIONS: IORT usually can be completed in less than an hour. No IORT-associated complications were identified. IORT along with maximal tumor resection, external radiation, and chemotherapy enhances local tumor control.

Child↗
PubMed1995

Gastroschisis: a simple technique for staged silo closure.

In conjunction with the Neonatology Department at Loma Linda University Children's Hospital, a new protocol has evolved for the management of infants with gastroschisis, which obviates both risks associated with primary and staged silo closure. After stabilization of the infant in the neonatal intensive care unit, under sterile conditions, a 5- or 7-cm SILASTIC silo with a spring-loaded ring is placed over the exposed viscera, under the fascial defect. No sutures are required. A fentanyl drip is given, and the bowel is gradually reduced over the next few days. The transparent material of the silo allows for continuous monitoring of the condition of the bowel. Second-stage closure in the operating room is performed using a purse-string suture in the fascia to create a pseudoumbilicus. From October 1992 to April 1994 the authors managed 10 infants using this protocol. The results are compared with those of infants with gastroschisis treated at the same institution between August 1982 and June 1993. Outcome parameters to be compared include time until closure, time on ventilation, days of total parenteral nutrition, time until start of oral feeding, time until toleration of full-volume oral feeding, and time until discharge. The authors conclude that silo closure in the neonatal intensive care unit is simple, quick, and effective. It eliminates multiple trips to the operating room, allows the natural accommodation of the bowel into the abdominal cavity with little edema and minimal vascular compromise, and has become the authors' treatment of choice for infants with gastroschisis.

Abdominal Muscles↗
PubMed1995

Pediatric laparoscopic splenectomy.

Laparoscopic surgery is becoming widely accepted as an alternative to conventional procedures. It is becoming more and more evident that laparoscopic techniques can be applied successfully to pediatric patients. Advantages of these techniques include less postoperative pain, decreased ileus, fewer pulmonary complications, and shorter hospital stays. Elective splenectomy for hematologic disease or for staging of Hodgkin's lymphoma also appears to be amenable to laparoscopic techniques. This report details 12 consecutive splenectomies successfully performed laparoscopically since July 1993. No case required conversion to laparotomy. Each case was reviewed with respect to operative time, estimated blood loss, identification of accessory spleens, time until full oral intake, analgesia requirements, and length of stay. Factors contributing to morbidity such as ileus, pulmonary complications, and would infections were evaluated. Documentation was also reviewed for late sequelae such as intestinal obstruction and incisional hernias. These patients were compared with 20 consecutively treated patients who underwent open splenectomy in the period immediately preceding the use of laparoscopic splenectomy. Laparoscopic splenectomy, in the authors' experience, is a safe alternative to open splenectomy, has few complications, is cost effective, and has been well accepted by patients and families.

Adolescent↗
PubMed1993

Gastroschisis in successive siblings: further evidence of an acquired etiology.

In recent years, we have treated two families that had successive siblings with gastroschisis. In the first family, the delivery of their second child, a boy with gastroschisis, was followed 11 months later by the delivery of a girl also with gastroschisis. The mother admitted to use of tobacco, alcohol, and marijuana during both pregnancies; the father was the same for both children. In the other family, the second child was a boy with gastroschisis, and the third, born 6 years later, was also a boy with gastroschisis. The mother denied any use of tobacco, alcohol, or recreational drugs; these two boys had different fathers. Gastroschisis in siblings has been reported only rarely, and has been noted in both identical and dizygotic twins. Our second set of siblings is the first documented case involving paternity by different fathers. Although a genetic factor cannot be excluded completely, teratogenic factors operative through the mother seem most probable. In conjunction with other reports of "epidemics" of gastroschisis, these two families amid our own recent outbreak of gastroschisis strongly suggest that the teratogenic factors may be environmental.

Abdominal Muscles↗
PubMed1992

The splenic snood: an improved approach for the management of the wandering spleen.

A wandering spleen is in constant danger of torsion and infarction. Splenectomy, the traditional treatment, leaves children in danger of postsplenectomy sepsis. Three children with wandering spleens were treated by a new splenopexy technique, the splenic snood. After detorsion, the spleens were wrapped in polyglycolic mesh and anchored by the mesh subdiaphragmatically in the left upper quadrant. All have retained their spleens which have remained where anchored up to a 4-year follow-up. The simplicity and technical ease of the splenic snood operation recommend it as an improved method to avoid splenectomy and safely normalize intraabdominal anatomy in the management of the wandering spleen.

Child↗
PubMed1992

A critical analysis of blood transfusion requirements in children with blunt abdominal trauma.

Over the past 2 years, 178 children with blunt abdominal trauma were admitted for observation. Fifty-five patients (31.5%) had intra-abdominal injury confirmed by computerized tomography (CT) scan, laparotomy, or postmortem examination. Forty-four children (80%) were managed with observation only; nine had other operations. Eleven patients (20%) required an operation for their intra-abdominal injuries. Thirteen patients died, ten from head or spinal injuries and three from intra-abdominal injuries (5.5%). Of 35 children with intra-abdominal injuries observed without any type of operation, 27 (77%) were not transfused (mean Pediatric Trauma Score [PTS] 8, Injury Severity Score [ISS] 19.3, average low hemoglobin [ALH] 10.1). The other eight were transfused an average of 49 cc/kg (mean PTS 4.5, ISS 26.5 ALH 6.1). Twenty children had operations. Eleven 11 (20%) of these were laparotomies; nine were transfused an average of 200.6 cc/kg (mean PTS 6, ISS 33, ALH 9). Nine had neurosurgical/orthopedic procedures (mean PTS 6.2, ISS 27.7), with six transfusions averaging 84.9 cc/kg (ALH 8.9). There were no significant complications. Blood transfusion was necessary only for 33 per cent of the observed cases, usually with multiple injuries. Blood should be transfused only to maintain hemodynamic stability (normal vital signs and tissue perfusion). Hemoglobin levels as low as 7 gm% do not mandate transfusion in children who are hemodynamically stable.

Abdominal Injuries↗
PubMed1991

Modern treatment of cloacal exstrophy.

We have treated 12 newborns with cloacal exstrophy (10 classical and 2 variants) since 1980. Eleven infants underwent repair and they are all surviving; the one nonoperated infant died of pulmonary hypoplasia. There are six genetic females and six genetic males, five of whom are being raised as females. The initial operation consisted of separating the bowel from the bladder to create an intestinal stoma; closing the omphalocele; and reapproximating (5), closing (4), or leaving the exstrophied bladder undisturbed (2). The importance of creating a "tailgutostomy" instead of an ileostomy to prevent problems with diarrhea, dehydration, and acidosis is emphasized. There have been 71 subsequent operations in these 11 patients (28 general surgical, 25 urological, 9 neurosurgical, and 9 orthopedic). Quality of life, rather than survival, is now the major issue facing patients with cloacal exstrophy. All of these patients except one are neurologically normal. The defect is closed in all patients. Three patients wear no appliances, 7 wear one (gastrointestinal [GI]), and one wears two (GI and genitourinary [GU]). We developed a scoring system to analyze bowel and bladder continence: voluntary control = 3; control with an enema program or intermittent catheterization = 2; incontinence with a well-functioning stoma = 1; and incontinence without a stoma = 0. The best continence score is 6 (GU + GI). We currently have 7 patients with a continence score of 1 (colostomy + incontinent bladder); 1 with a score of 2 (ileostomy + incontinent ureteroenterostomy); 2 with a score of 4 (enema program + continent urinary diversion); and 1 with a score of 5 (enema program + continent bladder).(ABSTRACT TRUNCATED AT 250 WORDS)

Bladder Exstrophy↗
PubMed1986

Biliary atresia: an evolving perspective.

From 1967 to 1984, 50 of our patients with extrahepatic biliary atresia had surgical exploration. Of 40 biliary drainage procedures, bile drained in 21 (52%). Thirty-four patients had portoenterostomy, three had portocholecystostomy, and the most recent six patients had a valved hepatoduodenal conduit. Successful biliary drainage was related to the presence of microscopic ducts at the porta hepatis in 20 of 21 infants. Twenty patients are alive, 12 from two to six years postoperatively (one with a liver transplant). Seven have normal serum bilirubin values. Height and weight exceed the 50th percentile in 5/15 patients studied. Multiple episodes of cholangitis have occurred in 11 patients with portoenterostomy and two with hepatoduodenal conduits. In 12 patients, hemorrhage from the stoma necessitated closure of the stoma before 1 year of age. Five of the six patients with hepatoduodenal conduit are alive two years postoperatively.

Bile Ducts↗
PubMed1985

Characteristics of children with endoscopically proved chronic bronchitis.

This study evaluated by chart review the clinical, allergic, pathologic, and immunologic characteristics of 20 children found to have chronic bronchitis (CB) by bronchoscopic evaluation, including 13 children in whom CB was documented by endobronchial biopsy. Two additional children likely to have had CB also are described. In this study group, all of the patients were believed to have asthma as well. Chronic bronchitis was predicted by chronicity of symptoms and incomplete response to bronchodilators and corticosteroids, but it was not predicted by a history of allergy or laboratory evidence of systemic infection or inflammation. In the children described herein, CB often was associated with an IgG subclass abnormality. Bronchoscopic evaluation documented CB and provided biopsy and secretion samples. Although the histomorphic findings were heterogeneous, patients with CB usually had white blood cells present on Gram stains of secretions in addition to mononuclear cell infiltrates on biopsy specimens. Chronic bronchitis in these children seems to be distinct from CB in adults. Further studies will be needed to define CB in children.

Adolescent↗
PubMed1981

Total colectomy with ileo-endomuscular pull-through in the treatment of ulcerative colitis in children.

Since ulcerative colitis is primarily a mucosal disease, total colectomy with rectal mucosectomy and ileo-endomuscular pull-through (Soave) offers many theoretical advantages. The diseased colon is removed, the anal sphincteric mechanism is preserved, and permanent ileostomy is avoided, bladder and sexual function are preserved, and problems with perineal wound healing are avoided. Of critical importance is the state of rectal mucosal disease in the selection of patients for this operation. Our experience with four children in whom the operation has been performed is presented. Postoperative diarrhea has not proved to be a significant problem and continence has been maintained.

Adolescent↗
PubMed1976

Cloacal exstrophy: 18-year survival of untreated case.

A patient is described who was 18 years old and attending high school when initially treated for cloacal exstrophy. The history, embryology and treatment of cloacal exstrophy are discussed, emphasizing that this congenital anomaly is compatible with a useful and happy life.

Adolescent↗
PubMed1975

Significance of absent vas deferens at hernia repair in infants and children.

An absent vas deferens may be associated with unilateral renal agenesis or undiagnosed cystic fibrosis. Such patients should be further evaluated with a sweat chloride and intravenous pyelogram. The finding of absent vas deferens during exploration for an undescended testis does not provide absolute evidence for absence of the testis, since these structures have independent embryologic origins.

Child↗