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Biomedical subjects

J A Haller

Publications and source records attributed to J A Haller.

At least 127 records · Page 7Linked to original sources
PubMed1981

Histochemical studies of experimental fetal intestinal obstruction.

Experimental intestinal atresia can be produced by mesenteric disruption in fetal lambs. In previous reports, a detailed histochemical study of the bowel in this atresia model demonstrated: (1) hyperplasia of ganglion cells in the dilated proximal segment, (2) involutional changes in the area of maximal distension, (3) decreased to absent adenosine triphosphatase (ATP-ase) production in the area of the atresia, (4) gradual increase of ATP-ase production to normal proximally, and (5) greater reduction of ATP-ase production along the antimesenteric border compared to the mesenteric border. In the present study, a model of fetal intestinal obstruction by simple ligation of the bowel has been created to observe the effects of pure obstruction of the lumen of the fetal bowel without the possible ischemic effects of any vascular interruption. Studies with this model reveal: (1) hyperplasia of ganglion cells in the dilated proximal segment, and (2) decreased ATP-ase production proximal to the obstruction, but (3) no involutional changes in the area of maximal distension. These findings show a pattern of disturbance of bowel morphology and function caused by obstruction of the fetal bowel that is similar to but less severe than that seen with intestinal atresia.

Acetylcholinesterase↗
PubMed1981

Tracheostomy in neonates and small infants: problems and pitfalls.

Newborn babies and small infants who require tracheostomy often follow a complicated clinical course characterized by frequent sepsis, altered ventilatory dynamics, and eventual respiratory decompensation. Many of these problems are avoidable with use of a properly placed endotracheal tube during tracheostomy, a special surgical technique in the performance of the tracheostomy, and silicone rubber tracheostomy tubes. Seventy-four babies underwent tracheostomy at our Children's Center between 1963 and 1976. A review of this experience demonstrates the benefits of unhurried, standardized technique and management. In the 48 newborns requiring tracheostomy, no technical difficulties were encountered, and no complications occurred as a result of the tracheostomy. In the group of 26 older infants, however, there were significant complications, especially in children undergoing emergency tracheostomy without a previously placed endotracheal tube. Although there were no deaths directly related to tracheostomy, one case of pirulent tracheitis and one case of interstitial thyroid hemorrhage were noted at autopsy. Among survivors, there was one case of bilateral pneumothoraces, two cases of severe subcutaneous emphysema, and three cases of postoperative bleeding. Review of the long-term complications in this series demonstrates the benefits of the silicone rubber polymer tube. Since its routine use, problems with stomal granulation have almost disappeared. There have been no problems in extubating the very young babies. Our operative technique and intensive care management of these babies will be emphasized as the keys to the improved outcome.

Airway Obstruction↗
PubMed1980

Bacteremia after esophageal dilation: a clinical and experimental study.

Patients with esophageal stricture caused by caustic ingestion, reflux esophagitis, or esophageal anastomosis often require repeated dilation. These patients frequently have a short febrile course after dilation. After development of brain abscess following esophageal dilation in 1 patient, positive blood cultures were obtained in 4 patients immediately following esophageal dilation. Caustic strictures were produced in cats and esophageal dilations performed. Blood cultures were positive at one minute after dilation in 6 cats and at five minutes in 2 of those cats. The organism responsible in all clinical and three of four experimental examples was Staphylococcus aureus. It is suggested on the basis of this clinical and experimental data that patients undergoing esophageal dilation should have prophylactic coverage if they are immunosuppressed, if endocarditis prophylaxis is necessary, if they are infants, if they are diabetic, or if they had severe bacteremia following dilation.

Animals↗
PubMed1980

Absence of the caudal somatopleure in a twin: a combined thoraco-abdominal defect.

Many congenital defects of the ventral thoracoabdominal wall have been described. Among the most severe of these malformations are ectopia cordis, omphalocele, and vesicointestinal fissure. The simultaneous occurrence of all three of these anomalies has not been previously reported. We have recently seen an infant with an extensive anomaly combining these three defects of the ventral wall. The case is more remarkable because the infant's twin was normal.

Abnormalities, Multiple↗
PubMed1980

Pelvic fractures in children--review of 120 patients with a new look at general management.

Retrospective analysis of 120 pelvic fractures in children revealed many differences from reports of this injury in adults. Most of the children injured are pedestrians. Ruptured urethra and bladder are less commonly associated with pelvic fractures in children. Associated head injury with residual neurologic deficits are more common in children. Mortality in adults is approximately 10%, while in children it is about 5%. The mortality in our series was 1.4%, the lowest reported in the literature. The rectal examination is a most important part of the physical evaluation, IVP and cystourethogram are necessary in distinguishing serious genitourinary injuries (10%) when hematuria is present (57%) and are also helpful in evaluating retroperitoneal hematoma. Retroperitoneal hemorrhage and secondary infection are the main causes of death in children and adults with pelvic fractures. Although recognizable retroperitoneal hematomas were present in 46% of our patients, only 3% of these children had continuing massive retroperitoneal hemorrhage requiring intervention. Initial arteriography is valuable in management of children with continuing bleeding and large retroperitoneal hematomas. A new technique, silicone balloon embolization, may be combined with selective arteriography to occlude bleeding arteries. This was invaluable in two of our patients; hemorrhage from the hypogastric arteries, was successfully arrested in both cases. We believe this technique deserves more evaluation in the control of massive hemorrhage from pelvic fractures.

Adolescent↗
PubMed1980

Esophageal reconstruction with free jejunal grafts: an experimental study.

Replacement of a long segment of esophagus for esophageal atresia or severe stenosis remains a special problem in children. The following studies were designed to test the hypothesis that a section of small bowel without serosa could survive as a free autologous transplant to replace part of the mediastinal esophagus. Laparotomy was performed in 20 adult cats, a loop of small bowel was resected and an end-to-end jejunojejunostomy was completed. The serosa of the resected bowel was removed and the mucosa-muscularis graft was used to replace a segment of the middle esophagus that was resected via a right thoracotomy. The interposed graft was entirely wrapped with adjacent skeletal muscle flaps. Postoperative studies include barium swallow and cine esophagograms, histology and blood vessel casts. Results are presented which show anatomical and functional survival of 16 grafts without blood vessel anastomoses or intrinsic vascular pedicles.

Animals↗
PubMed1980

A new percutaneous technique for occluding arterial flow to massive congential A-V malformations to prevent major hemorrhage during resection.

In this experience, life-threatening hemorrhage and operative excision of large cranial congenital A-V malformations were managed in two young patients. The major feeding arteries were selectively occluded, shrinking the masses dramatically and greatly facilitating resection which could then be followed by immediate skin grafting. This technique employs standard technology for arteriography and catheterization and should have widespread usefulness in children for control of large Congenital AV Malformations and other vascular masses, including malignant tumors.

Adolescent↗
PubMed1980

Intracranial pressure monitoring in the management of the pediatric trauma patient.

Intracranial pressure (ICP) monitoring is an important adjunct in the management of the severely injured child with major head trauma. From a series of 18 patients with multiple trauma, smoke inhalation, and near-drowning, we report an illustrative case of head injury and pulmonary aspiration in which ICP monitoring was vital to appropriate therapy. The two most common techniques of ICP monitoring, the intraventricular catheter and the subarachnoid bolt, are described. Treatment of intracranial hypertension is discussed based on physiological principles. The continuous, objective recording of ICP assumes particular importance when therapy directed at other injured organ systems (ie, institution of positive end-expiratory pressure) could adversely affect the ICP. It is suggested that optimal care of children with multiple trauma and head injury include early ICP monitoring.

Bacterial Infections↗
PubMed1980

Hyperinsulinemic hypoglycemia of the neonate associated with persistent fetal histology and function of the pancreas.

Early in development, the fetal pancreas is characterized by the presence of two distinct generations of endocrine cells and a B-Cell mass that is unresponsive to acute changes in circulating glucose levels. Near the end of intrauterine development, the normal pancreas has "matured" and contains a single generation of endocrine cells and B-Cells that are responsive to changes in glucose concentrations. Recent microscopic examination of resected pancreatic tissue from an infant with hyperinsulinemic hypoglycermia revealed a combination of all three of the currently accepted findings in this neonatal condition: hyperplasia, adenomatosis, and nesidioblastosis. These observations prompted the following hypothesis: When compared to the usual histology of the developing pancreas, nesidioblastosis may be interpreted as an abnormal continuation of normal proliferation of endocrine cells; hyperplasia may be a specific overproduction of the Secondary Islands of Langerhans; and adenomatosis may be an abnormal continuation or overgrowth of the Primary Island of Langerhans. Such extrapolation suggests that infants with hyperinsulinemic hypoglycemia may represent a failure in the normal histological and functional maturation of the endocrine portion of the fetal pancreas.

Adenoma↗
PubMed1980

Transcatheter embolization in the management of congenital arteriovenous malformations.

Congenital arteriovenous malformations (AVMs) with multiple arterial feeders in eight patients were managed by transcatheter embolization with a combination of polyvinyl alcohol foam (Ivalon), detachable silicone balloons, and wool coils. Due to the extensive number of arterial feeders often present, multiple procedures with several days in between were frequently necessary. When possible, surgical resection after embolization is the procedure of choice. Inoperable AVMs are best managed by segmental distal embolization of all arterial feeders with a permanent occluding material. Embolization therapy as a primary form of management is considered palliative and temporary relief of symptoms is usually achieved.

Adolescent↗
PubMed1980

The natural history of bronchial atresia. Serial observations of a case from birth to operative correction.

A 10-year-old child presented with a history of intermittent respiratory symptoms since birth. Progressive shift of the mediastinum away from a hyperexpanded left upper lobe to the right side was evident on serial chest films, since birth. Bronchograms demonstrated atresia of the bronchus to the hyperexpanded segment. Xenon washout demonstrated prolonged half-time in the left upper lobe resulting from collateral ventilatory channels. Resection of the apical posterior segment of the left upper lobe was performed without complication. Bronchial atresia with collateral ventilation caused "lobar emphysema" in this patient.

Bronchi↗
PubMed1979

Surgical management of lung bud anomalies: lobar emphysema, bronchogenic cyst, cystic adenomatoid malformation, and intralobar pulmonary sequestration.

Recently we saw 9 infants with life-threatening respiratory distress. Four patients had bronchogenic cyst, 2 had cystic adenomatoid malformation, and 9 had congenital lobar emphysema. Another group of 14 older children had recurrent infection and hemodynamic abnormalities, which responded to operative intervention. Each child required an appropriate resection following definitive diagnosis. These lesions represent a spectrum of closely related anomalies that arise during an early stage of embryonic lung bud maturation. Bronchoscopy is rarely useful, but special roentgenographic studies, including perfusion scans and arteriography, are usually diagnostic. Our operative experience is used to emphasize the urgency of precise diagnosis and surgical management of this poorly recognized clinical syndrome.

Bronchopulmonary Sequestration↗
PubMed1979

Pectus carinatum: results of surgical therapy.

There are a variety of protrusion defects of the anterior chest which are collectively referred to as pectus carinatum. Over a 14-yr period, 13 patients have had surgical correction of pectus carinatum at The Johns Hopkins Hospital. Technique includes costal cartilage resection and a sternal osteotomy. There was no mortality, complications were few and results are good. Repair is recommended for patients in late adolescence due to the cosmetic nature of the procedure, the apparent lack of an associated postural deformity and the good results of operation in this age group.

Adolescent↗