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Biomedical subjects

J G Randolph

Publications and source records attributed to J G Randolph.

At least 37 records · Page 2Linked to original sources
PubMed1983

Pediatric trauma: an algorithm for diagnosis and therapy.

Management of the pediatric patient sustaining a traumatic injury is influenced by patient size, surface area to body mass ratio, thermoregulation, and fluid requirements. A predetermined and systematic approach to the injured child guarantees recognition of life-threatening injuries and provides a method for rapid stabilization. The algorithm is divided into two distinct phases: life support and post-stabilization. The unique aspects of care of the injured child are highlighted to emphasize the significant differences in resuscitation and diagnosis from that of the adult patient.

Child↗
PubMed1982

Combination chemotherapy (vincristine, adriamycin, cyclophosphamide, and 5-fluorouracil) in the treatment of children with malignant hepatoma.

Members of Childrens Cancer Study Group and the Pediatric Division of the Southwest Oncology Group conducted a study of chemotherapy for children with malignant liver tumors. All patients received vincristine, cyclophosphamide, Adriamycin and 5-fluorouracil in 6 weekly cycles for one year. Surgical resection and irradiation were employed when indicated. Between January 1976 and August 1978, 62 patients were entered on study; one was rejected for a protocol error, and ten had inadequate trials of chemotherapy, dying within one month of entry. The median time on study for all patients was 12 months. Twenty-four patients had no measurable disease following surgical treatment and chemotherapy was employed as adjuvant treatment; 20/24 (83%) remain relapse-free from 8-42+ months, (median, 30 months). In 27 patients, residual measurable disease was available to determine the response to chemotherapy. The response rate was 12/27 (44%), lasting 3-45 months (median, 18 months). The median follow-up of all survivors is 30 months. Hematologic toxicity was significant, particularly during the initial courses of chemotherapy; 28/57 patients developed severe toxicity which was fatal in three. The results from the current study were compared to those from a previous one initiated in 1972, in which actinomycin D, vincristine, and cyclophosphamide were given in sequence, one during each month for one year. Although the population of the two studies was not identical, there was a difference in the response rates (P = 0.02), relapse-free interval (P = 0.008), and survival (P = 0.003). The most striking improvement was seen in the patients with Group I disease, there were 7/11 relapses in the first study and 1/16 in the current one.

Antineoplastic Agents↗
PubMed1982

Solitary thyroid nodules in children and adolescents.

Thirty-nine children and adolescents with a solitary nodule of the thyroid gland were seen over a 16-yr period and 35 had their nodules removed surgically. All of the patients had preoperative thyroid scintiscans, of which 27 showed a cold nodule. The most common cause of solitary thyroid nodules was follicular adenoma. Five of the 27 cold nodules were malignant (18.5%) while no malignancies were present in the warm or hot nodules. Available diagnostic methods of attempting differentiation of benign from malignant solitary nodules are reviewed and an approach to the clinical management of such nodules as derived from our experience is presented.

Adenoma↗
PubMed1981

Aerobic and anaerobic bacterial flora of burns in children.

Aerobic and anaerobic bacterial flora of burn sites in 180 children were monitored. Specimens were obtained twice a week; each patient had between one and 21 cultures taken (mean 2.4). A total of 392 specimens were collected over 2 years, of which 319 were positive. Aerobic bacteria alone were present in 225 specimens (71%) and anaerobic bacteria alone were present in 26 (8%). Mixed aerobic and anaerobic bacteria were present in 68 burn specimens (21%). A total of 580 isolates (448 aerobes and 132 anaerobes) were recovered, accounting for 1.8 isolates per specimen (1.4 aerobes and 0.4 anaerobes). The predominant aerobic isolates were S. epidermidis, S. aureus, alpha hemolytic streptococcus, Pseudomonas sp., and Group D streptococcus. The predominant anaerobic isolates were: P. acnes, anaerobic Gram-positive cocci, and Bacteroides sp. Blood cultures were drawn from 45 children: four showed bacterial growth of one of each of the following isolates: S. aureus, E. coli, Peptococcus asaccharolyticus, and B. fragilis. The numbers of isolates per specimen were higher in the oral and anal area (3.2 and 2.8) than in the extremities and trunk (1.8 and 0.9). Gram-negative enteric rods and Group D streptococci were more frequently recovered from the anal area. S. aureus, S. epidermidis, and P. acnes were more frequently recovered from extremities. Bacteroides sp. and Fusobacterium nucleatum were more frequently recovered from the anal and oral areas. All children were treated with local application of silver sulfadiazine, and antimicrobial therapy was used in 128 children. Statistical analysis showed no correlation between the bacteria isolated and use of antimicrobial agents. These data suggest a role for anaerobic bacteria in the colonization of burns in children, especially in burns of the anal and oral areas.

Adolescent↗
PubMed1978

Gastric tube interpostion: a satisfactory alternative to the colon for esophageal replacement in children.

The gastric tube was used as the primary method of esophageal reconstruction in 15 infants and children, 9 with isolated esophageal atresia and 6 with lye stricture. The youngest patient was 8 months old and the oldest, 5 years old at the time of the procedure. The technique of gastric tube construction is described. There have been both major and minor complications but the gastric tube has proved very satisfactory as a conduit from mouth to stomach. Growth and development have been acceptable in all 15 children, although most remain in the lower percentiles for growth and height, a condition that usually predates the esophageal substitution. In our institution the gastric tube is the preferred method of esophageal substitution.

Burns, Chemical↗
PubMed1978

Liver resection in children with hepatic neoplasms.

In the past ten years, 28 patients with primary tumors of the liver have been treated. There were 11 benign tumors, including four hamartomas, three patients with focal nodular hyperplasia, and two each with congenital cysts and hemangioma. Hamartomas and masses of focal nodular hyperplasia should be excised when possible, but both are benign lesions; therefore life threatening excisions at the porta hepatis should be avoided. Cysts are often resectable, but when occupying all lobes of the liver, they can be successfully managed by marsupialization into the free peritoneal cavity. If resectable, hemangiomas should be removed; when occupying most of the liver as they often do, patients may be subject to platelet trapping or to cardiac failure. In some instances these lesions have been controlled by steroids, radiation therapy or hepatic artery ligation. Of 17 malignant tumors seen, 12 proved to be hepatoblastomas. Nine of the 12 patients underwent liver resection, of whom four are cured, (33%). There were three children with hepatocellular carcinomas and two with embryonal rhabdomyosarcoma. One child from each of these groups is cured by surgical excision. At present the only known cures in children with primary malignant liver neoplasms have been achieved by operative removal.

Carcinoma, Hepatocellular↗
PubMed1977

Experience with in-service examinations of pediatric surgical trainees.

A formal examination is an effective device for assessing certain aspects of a resident's competence. Participation by outside examiners is advisable. Generalizations on the basis of 2 yr of experience may be premature, however, the oral examination, strengthened by outside examiners and complemented by a written clinical problem-solving test, has provided insight into the candidates' abilities and into their progress from the first to the second year. In addition, this process has identified strengths and weaknesses in the training program, which has led to modifications of the surgical curriculum. It is concluded that comprehensive oral and written examination of pediatric surgical trainees at the completion of their first year and again at the end of their second year yields information that is of importance to the trainee and to the faculty.

Clinical Competence↗
PubMed1977

Total surgical reconstruction for patients with abdominal muscular deficiency ("prune-belly") syndrome.

In the past decade, seven children with the prune-belly syndrome have been seen. Their management has consisted of immediate high tubeless urinary diversion, usually pyelostomy. Thereafter, total reconstruction has been carried out, preferably at one stage. This consists of (1) bilateral shortening, tapering and reimplantation of the ureters, (2) reduction cystoplasty, (3) bilateral orchiopexy, and (4) excision of that part of the abdominal wall that is most redundant and least endowed with musculature. This early effort at mechanical reconstruction has led to gratifying progress in six of the seven children.

Abdominal Muscles↗
PubMed1977

Repair of pectus excavatum in children under 3 years of age: a twelve-year experience.

From 1964 to 1975, 50 children under 36 months of age had operative repair of severely deforming pectus excavatum. No child died or suffered a serious complication from the operation. Most young children needing early repair of progressive pectus excavatum can be identified by 18 months of age. Forty-five patients in this series (90%) have had a totally satisfactory cosmetic and anatomical result on one- to twelve-year follow-up. Early repair of marked pectus excavatum in young children is safe and is efficacious in providing a suitable body contour.

Age Factors↗
PubMed1977

Evolution of surgical treatment of bilateral Wilms' tumor.

Bilateral Wilms' tumor (stage V) accounts for 10 to 15% of patients with nephroblastoma. Heretofore, surgical resection in many of these children presented insoluble technical problems. Ex vivo renal perfusion with "bench" surgical excision and revascularization has been applied in the management of a child with bilateral Wilms' tumor unresectable by conventional techniques. Complete extirpation of tumor was accomplished. Furthermore, the autotransplanted kidney was removed from the field of radiation therapy given after operation. By selective application of this technique, the child with bilateral Wilms's tumor can be approached with a greater expectation of cure.

Child, Preschool↗
PubMed1977

Ethical issues in pediatric surgery: a national survey of pediatricians and pediatric surgeons.

The findings reported in this article are based on a nationwide survey of the attitudes and practices of pediatric surgeons and pediatricians with respect to some of the difficult ethical choices confronting them in medical practice. Four hundred fifty-seven physicians completed a questionnaire in the spring of 1975 in which they reacted to a wide range of issues that have been of increasing concern to the public, as well as to the medical profession. The survey attempts to identify some areas of physician consensus as well as some of the factors, personal and professional, influencing physicians' attitudes. The survey and its statistical analysis are intended to provide current sociological data and are not intended by the authors as an endorsement of any particular point of view or course of action.

Adult↗
PubMed1975

Split portal flow in heterotopic hepatic transplantation.

Heterotopic hepatic transplantation was carried out in 31 pigs using three different methods of homograft revascularization. In one experimental group the host portal inflow was split between the homograft and native liver so that the graft was provided with intestinal-pancreatic effluent; the host liver with gastric-splenic venous blood. The liver grafts flourished in this environment. A small and variable degree of atrophy took place in the host liver. In the other two experimental groups in which the grafts were supplied with different kinds of systemic inflow only, atrophy invariably followed. Long-term homograft analysis was prevented by the intensity of immunologic rejection regardless of the location of the ectopic liver. The implications for clinical auxiliary liver transplantation are (1) heterotopic liver homografts must be supplied with a portal inflow from the host splanchnic bed, but (2) the total host splanchnic effluent is unnecessary. (3) The portal inflow must contain the pancreatic venous blood. (4) There is a criticial recipient--donor size relationship for successful portal revascularization in this type of auxiliary hepatic graft.

Animals↗
PubMed1975

Peptic ulcer in children with gastric tube interposition.

An infrequent, but potentially serious, complication of gastric tube interposition is ulceration within the conduit. It is important, therefore, to recognize ulcer formation in its early stages by serial radiographs throughout the childhood years. While redundancy and partial obstruction with impaired drainage of the tube appear to be etiologic factors, distension of the transposed antrum may lead to hyperacidity and may play a role in ulcerogenesis. A course of dietary and antacid therapy may heal the ulcer, but surgical revision of the tube may prove necessary.

Burns, Chemical↗