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Biomedical subjects

J B Pietsch

Publications and source records attributed to J B Pietsch.

At least 37 records · Page 2Linked to original sources
PubMed1989

Capillary hemangioma of the vagina and urethra in a child: response to short-term steroid therapy.

Short-term oral steroid therapy was used to treat a capillary hemangioma of the vagina and urethra in a young child. After 8 weeks of prednisolone therapy (40 mg every other day decreasing to 2.5 mg every other day), vaginal bleeding has not recurred. At 2 years and 8 months, the patient presented with severe hematuria. Visualization revealed hemangioma within the bladder, but the urethra and vagina were normal by cystoscopy and vaginoscopy, respectively. After cauterization of a single bleeding point, the patient again received prednisolone. She has had no hematuria for 4 months. Steroid therapy should be considered for the management of genitourinary hemangiomas.

Child, Preschool↗
PubMed1988

Acute abdominal conditions in children and adolescents.

Evaluation and management of the acute abdomen in childhood require a thorough familiarity with the numerous disorders that may cause abdominal emergencies. Many of these entities are rarely seen in adults or have clinical features that are very different from those observed in adults. Diagnosis is often confounded by difficulties in obtaining an accurate history and physical examination. In infants and young children, complications of various congenital abnormalities are more common causes of abdominal pain, whereas acquired disorders are observed more frequently in older children and adolescents.

Abdomen, Acute↗
PubMed1988

Right atrial thrombus formation screening using two-dimensional echocardiograms in neonates with central venous catheters.

Two-dimensional echocardiograms were used to prospectively screen 49 patients with 56 central venous catheters for right atrial thromboses from October 1985 to May 1986. All but four patients received a two-dimensional echocardiogram prior to insertion of the catheter. Once the catheters were in place, two-dimensional echocardiograms were performed no later than 3 weeks after insertion and then every 14 days until the catheter was removed. A single thrombus was detected 79 days after catheter placement (an incidence of 1.8%). Previous recommendations for weekly screening with two-dimensional echocardiogram were based on case reports alone. The 95% confidence limits for a negative two-dimensional echocardiogram result suggest that the initial two-dimensional echocardiogram screen for thrombus be obtained no sooner than 3 weeks after catheter insertion. In addition, significant gastrointestinal disease requiring operative intervention was present in 10 of 11 previous case reports as well as in our patient. Further studies with larger sample sizes are needed to determine whether subgroups of infants exist who are at a relatively higher risk for right atrial thrombus formation.

Catheterization, Peripheral↗
PubMed1985

Inguinal hernias in premature infants operated on before discharge from the neonatal intensive care unit.

Sixteen premature infants were operated on during the two-year period from 1981 through 1982 for inguinal hernia prior to discharge from the hospital. There were no complications from the hernias before surgery and during administration of anesthesia and postoperative recovery, and no recurrences, would infections, or testicular atrophy was noted in long-term follow-up. In contrast to a controlled group of 11 full-term patients of this same age who were operated on as outpatients, the operating room time, operation time, and time in the recovery room were significantly increased for the premature infants. This resulted in a 22% increase in cost for the correction of the premature inguinal hernias. Analysis of the factors in repair of these hernias indicates that this increased cost will have to be accepted as part of the care of premature infants in neonatal intensive care units.

Hernia, Inguinal↗
PubMed1985

Early excision of major burns in children: effect on morbidity and mortality.

The advantage of early excision and grafting in the treatment of limited full-thickness burns has been clearly established. The goal of the present study was to evaluate the role of early burn wound excision in major pediatric burns. Of the 470 pediatric burn admissions between 1979 and 1984 that were reviewed, 53 patients met the criteria of deep second or third degree burns greater than 25% total body surface area (TBSA). Of these, 20 had burn wound excision within 7 days (Early) and 33 had delayed excision and grafting (Late). The Early group, despite having greater transfusion requirements (69.4 v 36.2 cc/kg), had shorter hospital stays (35.3 v 49.1 d, P less than 0.05), fewer metabolic complications (20% v 79%, P less than 0.001), and less burn wound contamination (55% v 90%, P less than 0.01) than the Late group. Mortality was lower in the Early group (0% v 12%), but this was not statistically significant. Early excision and grafting are therefore recommended in the care of major burns in children.

Adult↗
PubMed1985

Necrotizing tracheobronchitis: a new indication for emergency bronchoscopy in the neonate.

Necrotizing tracheobronchitis (NTB) is a recently recognized cause of tracheal obstruction in the mechanically ventilated neonate. This process involves inflammation and necrosis of the mucosa of the distal trachea and mainstem bronchi. The sloughing of this material into the tracheal lumen results in plugging and acute respiratory distress. We documented this diagnosis in 19 infants. Four were diagnosed at autopsy. Fifteen had emergency bronchoscopy performed in the neonatal intensive care unit with removal of the obstructing debris. Ten of these 15 neonates survived (66.7%). The diagnosis of necrotizing tracheobronchitis should be suspected in those neonates requiring positive pressure ventilation in whom a sudden unexplained increase in ventilatory requirements develops. This is often associated with hypercarbia and a history of high-peak inspiratory pressures with or without hypoxia. Emergency bronchoscopy in these neonates is necessary both for diagnosis and treatment of the necrotizing tracheobronchitis.

Bronchitis↗
PubMed1984

Simplified insertion of central venous catheter in infants.

A technique for insertion of central venous catheters in infants is described. A needle is percutaneously positioned into the subclavian vein. Through this, a guide wire is passed and a catheter introduced over the wire. This method has proved to be safe and effective in over 100 infants.

Catheterization↗
PubMed1983

Effect of repeated delayed hypersensitivity skin tests on skin-test responses.

To determine whether repeated skin tests can augment a previously weak delayed hypersensitivity response or convert previously nonreacting tests and thus yield false-positive data, the authors carried out retrospective analysis of 426 skin tests on 107 patients who had a mean of 4.3 weekly tests with five recall antigens. They also skin tested 10 healthy volunteers weekly for up to 6 weeks. Reactions (induration measured in millimetres) were recorded and a regression and correlation analysis was carried out. Analysis of variance was used to compare reaction means of volunteers for each recall antigen at each time interval. All volunteers were reactive to two or more antigens. In the volunteer group there was no augmentation of initially reactive antigen responses except for Varidase and only after 5 weeks. Of 16 initially negative responses to some antigens in this same group, only 3 were converted to reactions of more than 5 mm, all responses being to purified protein derivative. No conversion occurred in the hospitalized patients. There was no significant correlation between repeated skin tests and the delayed hypersensitivity response to the antigens except for Candida in the retrospective patient group, up to 160 days from the original skin test. The data indicate that there is no augmentation of the delayed hypersensitivity response or conversion of initial nonreacting skin tests with any of the antigens tested except Candida.

Adult↗
PubMed1979

Predicting infection in surgical patients.

To date, simple skin testing using recall antigens has proved to be the most accurate method of assessing preoperative risk for serious infectious complications. When used in conjunction with measures to control the microorganisms and the environment, evaluation of host defense mechanisms with skin testing can aid in reducing postoperative infectious morbidity and mortality.

Antibody Formation↗
PubMed1978

Esophageal atresia with tracheoesophageal fistula: end-to-end versus end-to-side repair.

Despite early enthusiasm by some authors for the end-to-side repair of esophageal atresia with tracheoesophageal fistula, many have returned to the end-to-end technique. The present study compares the results of these two operative procedures. A retrospective analysis was made of 52 consecutive cases in which primary repair was performed. The patients were divided according to the three preoperative risk groups descibed by Waterston. The mortality for the end-to-end and end-to-side repairs was similar in each of the three risk groups. Similarly, there was no significant differnences in the incidence of anastomotic leak or recanalization of the fistula. However, the rate of anastomotic stricture in the end-to-end group was significantly higher (p less than 0.001) than in the end-to-side group. A description of the end-to-side technique is given, and its advantages are outlined.

Esophageal Atresia↗
PubMed1978

Delayed hypersensitivity and neutrophil chemotaxis: effect of trauma.

To investigate alterations in host defense produced by trauma, skin testing with five standard recall antigens was done on admission and weekly on 53 patients with blunt trauma and seven with penetrating missile injuries, who then were classified as normal (N), 2 or more positive responses; relatively anergic (RA), one positive response; or anergic (A), no response. Neutrophil chemotaxis was tested 145 times in 32 patients. Degree of injury was assessed by assigning one point to pelvic fracture, long-bone fracture, head, chest, or abdominal injury, to a maximum of five. The A and RA patients had greater trauma, 3 vs. 1.6 for N, and a significantly increased rate of sepsis (p less than 0.005) and mortality (p less than 0.05). Incidence of anergy depended upon age and extent of trauma. Neutrophil chemotaxis in A and RA patients was significantly (p less than 0.001) worse at 96.7 +/- 2.4 mu and 99.8 +/- 1.7 mu compared to N, 113.2 +/- 1.7 mu, and controls 121 +/- 4 mu. With recovery, chemotaxis returned to normal. It is concluded that failure of delayed hypersensitivity responses follows trauma, is related to the severity of injury and age of patient, and is associated with an abnormality of neutrophil chemotaxis and increased rate of sepsis.

Adolescent↗
PubMed1977

Delayed hypersensitivity: indicator of acquired failure of host defenses in sepsis and trauma.

Primary failure of host defense mechanisms has been associated with increased infection and mortality. Anergy, the failure of delayed hypersensitivity response, has been shown to identify surgical patients at increased risk for sepsis and related mortality. The anergic and relatively anergic patients whose skin tests failed to improve had a mortality rate of 74.4%, whereas those who improved their responses had a mortality rate of 5.1% (P < 0.001). This study documents abnormalities of neutrophil chemotaxis, T-lymphocyte rosetting in anergic patients and the effect of autologous serum. These abnormalities may account for the increased infection and mortality rates in anergic patients. Skin testing with five standard antigens has identified 110 anergic (A) or relatively anergic (RA) patients in whom neutrophil chemotaxis (CTX) and bactericidal function (NBF), T-lymphocyte rosettes, mixed lymphocyte culture (MLC), cell-mediated lympholysis (CML), and blastogenic factor (BF) were studied. The MLC, CML and BF were normal in the patients studied, and were not clinically helpful. Neutrophil CTX in 19 controls was 117.5 +/- 1.6 u whereas in 40 A patients, neutrophils migrated 81.7 +/- 2.3 u and in 15 RA patients 97.2 +/- 3.8 u (P < 0.01). In 14 patients whose skin tests converted to normal, neutrophil migration improved from 78.2 +/- 5.4 u to 107.2 +/- 4.0 u (P < 0.01). Incubation of A or control neutrophils in A serum reduced migration in A patients from 93 +/- 3.7 u to 86.2 +/- 3.5 u (P < 0.01) and in normals from 121.2 +/- 1.6 u to 103.6 +/- 2.6 u (P < 0.001). The per cent rosette forming cells in 66 A patients was 42.5 +/- 3.1 compared to 53.6 +/- 2.8 in normal responders (P < 0.02). Incubation of normal lymphocytes in anergic serum further reduced rosetting by 30%. Restoration of delayed hypersensitivity responses and concurrent improvement in cellular and serum components of host defense were correlated with maintenance of adequate nutrition and aggressive surgical drainage.

Adolescent↗
PubMed1977

1976 Davis & Geck surgical essay. The delayed hypersensitivity response: clinical application in surgery.

The detection of anergy or relative anergy by delayed hypersensitivity skin tests was predictive of infection and related mortality in 354 surgical patients. Cancer or advanced age alone did not account for the increased morbidity and mortality seen in this study. Altered delayed hypersensitivity response is a reflection of abnormalities in cell-mediated immunity and possibly humoral or phagocytic defects, or both. Skin testing is of value to the clinical surgeon both in identifying the population at risk and in monitoring the immune response to therapy in the seriously ill patient. Failure to improve skin-test response may indicate underlying infection or malnutrition, which, if untreated, results in a high mortality.

Adolescent↗