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Biomedical subjects

J A Haller

Publications and source records attributed to J A Haller.

At least 145 records · Page 8Linked to original sources
PubMed1979

Special problems of cardiac injuries in infants and children.

Cardiac injuries occur infrequently in children. Although the mechanisms of injury are not unique to the pediatric age group, the frequency of the various injuries is quite different. This unusual nature dictates an enhanced awareness for proper management. Twenty cases were recognized in a 16-year retrospective review. There were six children with perforations from cardiac catheterizations, ten children with penetrating injuries, and four children with blunt injuries. Two of the children with blunt injuries presented as myocardial contusion and one child survived blunt rupture of the right atrium. Only one death occurred in the series--a newborn baby who died from an unrecognized cardiac tamponade secondary to perforation of the right ventricle during catheterization. The diagnosis and special techniques for management of injuries due to catheter perforation and blunt injuries of the heart in infants and children are discussed.

Adolescent↗
PubMed1979

Effect of pulmonary artery ligation on the developing fetal lung.

Ligation of the left pulmonary artery was performed in fetal lambs. The procedure was well tolerated and most animals survived to birth. At birth, the animals were in no distress but had mild pulmonary hypertension. The lung to which the pulmonary artery was ligated underwent normal intrauterine maturation.

Animals↗
PubMed1978

Correction of pectus excavatum without prostheses or splints: objective measurement of severity and management of asymmetrical deformities.

From 1949 to 1977, 254 children underwent surgical reconstruction of pectus excavatum by means of a variety of operations at The Johns Hopkins Hospital. From 1970 to 1977, 68 children had a modified Ravitch repair, with the addition of a tripod internal fixation technique for support of the sternum. These children obtained excellent cosmetic reconstruction without prosthetic support or splints. During an 18-month period we used a new system of caliper measurement of the spatial anatomy of the thoracic cage in more than 50 children. During the same period, we originated an operative step to correct the not uncommon asymmetrical excavatum that is usually deeper on the right and associated with a troublesome rotation of the sternum, found in 9 of the last 27 children seen. Correction was accomplished with an oblique anterior sternal osteotomy. The groups were analyzed and compared with respect to age, postoperative complications, and end results in order to identify trends in the management of children with this condition. On the basis of this experience, we feel confident in recommending a standardized operation for all forms of pectus excavatum at an elective age between 4 and 6 years and without prosthetic splints.

Adolescent↗
PubMed1978

Intestinal obstruction from appendiceal abscess in a newborn infant.

Perforated appendix in the newborn period is rare, its symptoms are occult and its outcome is disastrous. Associated mechanical small bowel obstruction as part of the clinical picture is rare indeed. We have treated a premature infant who presented with prolonged intermittent vomiting. Factors contributing to difficulty in diagnosis and to eventual succussful management are discussed.

Abscess↗
PubMed1978

N-type anorectal malformations.

Three cases of N-type anorectal malformations have been encountered. Two girls with anorectal-vestibular fistulas (one with a normal anus and the other with mild stenosis) were typical of 15 other such cases in the literature. A boy with an anorectal-urethral fistula and covered anus had a lesser variant than most of the other 8 males in the literature. The frequently accompanying esophageal, renal, and skeletal anomalies were not present, nor did he have anterior urethral hypoplasia. The constellation of other major associated anomalies in the boys, but not in the girls, follows the pattern of other types of anorectal malformations and suggests an earlier and/or more severe teratogenic insult in the boys. Anterior perineal resection of the fistula is appropriate for girls with N-type fistulas and for those boys with normal anterior urethras. An additional urethroplasty is necessary for boys with anterior urethral hypoplasia. Our experience and that from the literature suggest that N-type anorectal malformations constitute a rare but real entity, akin to N-type tracheoesophageal fistulas. A plea is made that they be included in classifications of anorectal anomalies.

Anal Canal↗
PubMed1978

Fetal surgery: general management and operative technique for creating anomalies in sheep.

Sheep are the best experimental animals for intrauterine surgical research because the fetal lamb is sufficiently large at approximately one-third of gestation to allow handling without prohibitive fetal loss, the lamb has a relatively brief period of gestation (145 days) which allows evaluation of results in a short time, the mother sheep is easily handled and cared for, anesthetic techniques produce smooth, easy induction and steady intraoperative management with a brief recovery period appropriate uterine relaxation is readily attained without dangerously deep anesthetic levels and the sheep is a relatively inexpensive laboratory animal both in initial cost and subsequent maintenance. All aspects of preoperative, intraoperative and postoperative management of intrauterine surgery in sheep is discussed in detail and examples of specific congenital anomalies which can be created in utero are discussed. Finally, the lamb at term may be delivered by caesarian section under control conditions and then studied for evidences of altered physiology and function resulting from the intrauterine procedures.

Animals↗
PubMed1977

Lower esophageal sphincter dysfunction in esophageal atresia: nocturnal regurgitation and aspiration pneumonia.

The association between lower esophageal sphincter (LES) incompetence, gastroesophageal reflux, and recurrent pneumonia in patients who have undergone successful repair of esophageal atresia (EA) and tracheoesophageal fistula is demonstrated in this study. The efficacy of esophageal manometric examination in the evaluation of the LES in young children after EA repair is documented. This study also provides evidence that infants and children with LES incompetence associated with EA may have LES responsiveness to bethanechol. Once established by manometry, this responsiveness may be used to manage the patient until surgical repair would be advantageous.

Adolescent↗
PubMed1977

Surgical management of congenital pulmonary valve dysplasia.

Pulmonary valvular stenosis secondary to congenital valve dysplasia differs markedly from the classic variety of pulmonary stenosis. The reported mortality of patients treated by standard commissurotomy is 38 to 66%. The clinical features and operative management of 14 patients with dysplastic pulmonary valves are reviewed. Three groups of patients were studied. Group 1 consisted of 5 patients treated by commissurotomy. Group 2 comprised 3 patients treated by partial excision of the valve. In neither group were there operative deaths, but 5 of the 8 patients developed recurrent stenosis; 3 required reoperation. In 1975, because of the high incidence of recurrent stenosis, total valvectomy was begun. Ten patients (Group 3) have undergone valvectomy with 1 death. Nine patients were doing well at 3 to 15 months of follow-up. Based on the reported mortality and present findings, total excision of the valve is recommended for relief of stenosis in pulmonary valve dysplasia.

Adolescent↗
PubMed1976

Permanent cardiac pacemakers in children: technical considerations.

Placement of permanent cardiac pacemakers in children presents technical problems that are not encountered in the adult. Problems unique to pacemaker implantation in children are related to the patient's size, the relative bulkiness of pulse generators, the lack of subcutaneous tissue, and the child's growth and long life expectancy. Based on our experience with implantation of 27 permanent cardiac pacemakers in 13 children, we have found that the use of small pulse generators, placement of epicardial leads, insertion of properitoneal pulse generators, and use of recharabeable pacemakers are satisfactory methods in children.

Adolescent↗