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Biomedical subjects

J H Seashore

Publications and source records attributed to J H Seashore.

At least 37 records · Page 2Linked to original sources
PubMed1987

Early ileostomy closure in necrotizing enterocolitis.

The nutritional and metabolic complications following intestinal resection and ileostomy for necrotizing enterocolitis (NEC) in low birth weight preterm infants often necessitate repeated prolonged hospitalization for salt and water imbalance and reliance on total parentaral nutrition (TPN). The traditional concerns about anesthetic and anastomotic complications delays the restoration of intestinal continuity until the infant has attained a weight of about 5 kg, but recent nutritional balance studies in our unit have shown a combination of nutrient and mineral malabsorption in neonates with ileostomies. Beginning 4 years ago, a prospective study of early closure of the ileostomy was undertaken in infants weighing as low as 2 kg to examine the effect on surgical morbidity, infant growth, and gastrointestinal function using the preclosure infant as his/her own control. Ten infants with birthweights ranging from 670 to 2,000 g developed NEC requiring ileostomy at age three days to 11 weeks. In addition to partial ileal resection, the cecum was resected in 10 patients, ascending colin in 7, transverse in 4, descending colon in 1 patient. Postoperative treatment, including short-term TPN and elemental diet, preceded closure of ileostomy at a mean age of 18 weeks (range 5 to 36 weeks). Mean weight at time of closure was 3,052 +/- 994 g. There were no short-term complications of early closure in this series, nor was there any incidence of anastomotic dysfunction, colon stricture, or recurrent NEC.(ABSTRACT TRUNCATED AT 250 WORDS)

Body Weight↗
PubMed1987

Laparoscopy in the management of the nonpalpable testis.

Laparoscopy was performed at operation in 32 patients between 7 and 63 months old (average age 31 months), who had 33 nonpalpable testes. Of the testes 7 (21.2 per cent) were in the inguinal region or just proximal to the internal ring, 5 (15.2 per cent) were in a high intra-abdominal position and 21 (63.6 per cent) were absent. In every instance of a nonpalpable gonad in which a testis was found to be absent at operation the vas and gonadal vessels were observed laparoscopically to exit the inguinal ring or to end blindly just proximal to the internal inguinal ring. A hernia or patent processus vaginalis was not observed in these 21 cases. In every case of an absent testis the contralateral testis was located normally in the scrotum. Furthermore, when a hernia was observed laparoscopically a testis was found on the ipsilateral side at the level of the internal ring or more distally.

Abdomen↗
PubMed1987

Familial apple peel jejunal atresia: surgical, genetic, and radiographic aspects.

Fifty-seven cases of apple peel jejunal atresia have been reported in the English literature. Patients with this anomaly have a high incidence of prematurity (70%), malrotation (54%), short gut syndrome (74%), multiple atresias (15%), complications (63%), and mortality (54%). Mortality has decreased from 63% to 47% since 1970. We report three new cases of apple peel jejunal atresia, including two from one family. Radiographic evidence of high small bowel obstruction and a malrotated microcolon on preoperative roentgenogram with barium enema should suggest this diagnosis. Five families, including ours, have been reported in which more than one child was affected, and it has been suggested that this disorder is transmitted by an autosomal recessive gene. However, the occurrence of conventional intestinal atresia in other siblings, the association with multiple atresias, and discordance in a set of apparently monozygotic twins indicate that there may be a more complex spectrum of genetic transmission. Subsequent siblings are at increased risk for apple peel atresia or related malformations. Prenatal ultrasound can facilitate early diagnosis and treatment.

Anastomosis, Surgical↗
PubMed1987

Appendicitis in children. Accuracy of the barium enema.

The barium enema (BE) may be useful in the diagnosis of atypical appendicitis in children. We analyzed our experience with 18 children in whom appendicitis was suspected and BE was performed. All of the children underwent surgical exploration. Nonfilling of the appendix with cecal indentation, extravasation of barium from the appendix, or both, were considered positive signs of an inflamed appendix on BE. Using these criteria, 12 of 14 cases of proved appendicitis were true positive and two were equivocal. Four children were proved not to have appendicitis; one of these patients had a true-negative BE, two had equivocal BEs, and there was one false-positive BE (Schönlein-Henoch purpura). Extravasation of barium into the peritoneal cavity was noted in one patient; this was a rare complication.

Adolescent↗
PubMed1985

Management of giant cystic hygromas in infants.

Giant cystic lymphangioma is a rare lesion that presents major therapeutic challenges. Four infants presented in the first weeks of life with diffuse cysts in the neck. The tongue was involved in three, the mediastinum in one, and the pharynx and supraglottic larynx in two. These lesions are characterized by hundreds of cysts that infiltrate in and around muscles, nerves, and vessels. Complete excision is not possible without damaging the normal structures. All four infants initially had partial removal with unroofing and drainage of the remaining cysts and temporary tracheostomy to protect the airway. One infant died from a thrombosed sagittal sinus. She had severe venous congestion of the head and neck postoperatively which may have been caused by an overzealous attempt to remove all of the cysts. The other three have required nine additional operations for removal of recurrent neck cysts (one operation), removal of mediastinal cysts (one operation), partial glossectomy (three operations), and laser excision of lymphangiomas of the pharynx and supraglottic larynx (four operations). Two patients have required partial glossectomy which should be performed early to protect the airway, to allow normal speech development, and to prevent malocclusion and prognathism from constant pressure of the tongue against the teeth. Removal of wedges of tissue from each side and from the center of the dorsum of the tongue reduces bulk with minimal risk to the lingual arteries and nerves. Recurrent tongue enlargement is common and can be treated by repeated partial glossectomy. Lymphangiomatosis of the pharynx and supraglottic larynx is difficult to treat. The carbon dioxide laser allows very precise excision of individual cysts with minimal drainage to adjacent mucosa, but in our limited experience it has not prevented recurrence. Despite the extensive nature of these lesions, the impossibility of complete excision, and the need for multiple operations, the long-term results in the three surviving patients have been satisfactory. Asymmetry of the neck and face due to lymphedema tends to improve with time. All three children have an acceptable appearance and normal speech for their ages.

Female↗
PubMed1985

Management of recalcitrant bronchopleural fistulas with muscle flap obliteration.

Use of muscle flap obliteration for bronchopleural fistulas appears to be indicated with (1) failure of a previous thoracoplasty, (2) anticipated failure of a thoracoplasty alone, and (3) the need to obviate a formal debilitating thoracoplasty. With the use of well-vascularized muscle flaps to fully obliterate the densely scarred cavities associated with persistent bronchopleural fistulas, we may hope to see improved healing in the bronchial stump and, in cases of residual infection, better resistance of the flap to necrosis, as well as improved delivery of chemotherapeutic agents to the local tissues. These factors may confer improved cure rates for bronchopleural fistulas similar to those seen in lower extremity salvage surgery for osteomyelitis following the introduction of vascularized pedicle and free muscle flaps. In this article we have described the versatility of the island pedicle latissimus dorsi muscle flap for closure of recalcitrant bronchopleural fistulas and associated empyema cavities. Utilizing either the dominant thoracodorsal or the minor paraspinal pedicle(s), it can reach any intrathoracic cavity by means of the appropriate thoracotomy incision.

Aged↗
PubMed1984

Hirschsprung disease: accuracy of the barium enema examination.

To determine the relative accuracy of the various radiologic signs of Hirschsprung disease (HD), we retrospectively reviewed both radiographs obtained after a barium enema and the medical records of 62 children who had surgery to prove or exclude the diagnosis of HD. The visualization of a rectosigmoid transition zone was highly predictive of HD, but nonvisualization did not rule out HD. A false positive transition zone at the splenic flexure was seen in four neonates who had small left colon syndrome rather than HD. Retention of barium seen on radiographs obtained 24 hours after a barium enema was not a specific sign, but it was the only sign of HD in seven neonates, including two who had total colonic aganglionosis. Anal manipulation prior to the barium enema examination did not affect the diagnostic value of that procedure. We conclude that the single most reliable radiographic sign of HD is the presence of a rectosigmoid transition zone. Statistically, the use of three radiographic features combined (rectosigmoid transition zone, retention of barium, and stool mixed with barium) correlated better with the presence or absence of HD than did any of these features alone. A comparison of 24 and 48 hour postevacuation radiographs may help to differentiate HD from meconium plug syndrome.

Barium Sulfate↗
PubMed1983

Major surgery in infants weighing less than 1,500 grams.

From 1979 through 1981, 64 premature infants who weighed less than 1,500 g underwent 68 operations and 52 survived (81 percent). Twenty-six of 31 infants who weighed less than 1,000 g (84 percent) and 26 of 33 infants who weighed between 1,000 and 1,500 g survived (84 and 79 percent, respectively). The most common operation was ligation of a patent ductus arteriosus in 53 infants, of whom 43 survived (81 percent). Ten infants were operated on for necrotizing enterocolitis and 7 survived (70%). Four of five infants (80 percent) survived other major operations. Factors which influence survival include appropriate timing of operation, preoperative and postoperative mechanical ventilation, and parenteral nutrition. Intraoperative management includes short-duration anesthesia, continuous monitoring of vital signs, and judicious use of small amounts of amnestic and neuromuscular blocking agents combined with low fractional inspired oxygen concentration to reduce the risk of oxygen toxicity. Utilizing these principles, the survival rate compared favorably with the survival rate of all premature infants, which establishes that major surgery can be undertaken with only moderate risk in the infant with very low birth weight.

Anesthesia↗
PubMed1983

Z-shaped duodenojejunal loop: sign of mesenteric fixation anomaly and congenital bands.

Four children (ages 3-9 years) with intermittent abdominal pain and vomiting are reported. Upper gastrointestinal examinations revealed a sharply angulated to-and-fro course (Z configuration) of the distal duodenum and proximal jejunum, rather than the usual smooth duodenojejunal loop at the ligament of Treitz. At operation this configuration was associated with broad peritoneal bands extending across the involved small intestine without an accompanying volvulus at this level. The Z sign is diagnostic of incomplete rotation, even in the absence of duodenal obstruction and with a proximal jejunum that may appear to be properly placed.

Child↗
PubMed1981

Urinary 3-methylhistidine/creatinine ratio as a clinical tool: correlation between 3-methylhistidine excretion and metabolic and clinical states in healthy and stressed premature infants.

We have investigated the role of the urinary 3-methylhistidine (3MH) excretion, a measure of protein catabolism, in the evaluation of the metabolic state of premature infants. Two-hundred and twenty-two 24 hr urine collections and 3MH/Cr ratio determinations (expressed as mumoles of 3MH per mg creatinine) were carried out in 36 infants (average gestational age 32.7 +/- 0.7 wk, weight 1640 +/- 120 grams) and the relationship between the 3MH/Cr ratios and the metabolic and clinical state has been investigated. Five or more 3MH/Cr measurements were carried out on each of 19 infants and serial determinations on four of those babies are presented. The urinary 3MH/Cr ratio of healthy infants with adequate caloric intake and normal growth curve was .148 +/- .039 (S.D.) mumol/mg, about 35% higher than the 3MH/Cr ratio in healthy adults. As long as the premature infants were healthy the degree of prematurity had no effect on the 3MH/Cr ratio. The relationship between 3MH/Cr ratio and nitrogen balance was highly significant (p less than .001). 3MH/Cr ratio also correlates very well with the metabolic status of the infants: in the group with normal 3MH/Cr ratios less than or equal to .175 (.148 + 1 S.D., n = 90) there were four clinically stressed infants (4.4% false negative rate) while in the group with elevated 3MH/Cr ratios greater than .225 (.148 + 2 S.D.; n = 79) there were only three clinically well infants (3.8% false positive rate). In comparing the clinical status and 3MH/Cr ratios, we found that in the group of infants who could not be clearly defined as clinically well or stressed (n = 108) the 3MH/Cr ratio was more useful than clinical judgment in the prediction of metabolic status. It can be concluded that 3MH/Cr ratio is a potentially useful clinical tool which describes with high accuracy the clinical and metabolic status of premature infants. This conclusion is further supported by the data of serial 3MH/Cr determinations.

Birth Weight↗
PubMed1980

Metabolic complications of parenteral nutrition in infants and children.

Metabolic complications of TPN in infants and children are numerous and frequent. Properly designed nutrient solutions, careful monitoring, knowledge of potential problems, and appropriate management are essential to avoid serious complications. Hepatic dysfunction is most likely to prevent achievement of adequate nutrient intake. Better delineation of trace metal, essential fatty acid, and vitamin deficiencies is necessary, particularly in patients who require long-term TPN.

Acid-Base Imbalance↗
PubMed1980

Urinary 3-methylhistidine excretion and nitrogen balance in healthy and stressed premature infants.

Conventional methods of assessing adequate nutrition in children may be inaccurate or change too slowly to be helpful during acute illness. Techniques to measure protein synthesis or breakdown provide more accurate information. Three-methylhistidine (3MH), an unusual amino acid found in actin and myosin, is not further metabolized and is quantitatively excreted following muscle degradation. Urinary excretion of 3MH has, therefore, been proposed as a marker of protein catabolism. The ratio of 3MH to creatinine in 24-hr urine collectons was studied in 14 healthy or stressed premature infants, and compared to nitrogen balance (N bal), caloric intake and clinical course. There is a significant inverse correlation between 3MH/Cr ratio and N Bal (R = -.507). The mean 3MH/Cr ratio was 0.140 +/- 0.037 mu mole/mg (n = 37) in healthy growing premature infants and 0.296 +/- 0.160 (n = 26) in infants who were stressed and/or had inadequate nutrient intake. Healthy growing infants almost invariably had a ratio below 0.200. Serial determinations in three infants consistently showed a rise in the ratio to above 0.200 during periods of stress or decreased intake. The 3MH/Cr ratio may be a more sensitive indicator of metabolic status and may be useful clinically, especially in infants receiving total parenteral nutrition.

Creatinine↗
PubMed1978

"Body-brace" oesophagitis, a complication of kyphoscoliosis therapy.

Oesophagitis developed in 4 patients, 3 of whom had scoliosis braces and 1 a body cast after surgery for kyphoscoliosis. Symptoms varied from chronic epigastric pain to gastrointestinal haemorrhage. Prophylaxis of oesophageal disease in children undergoing correction of scoliosis may prevent severe oesophagitis.

Adolescent↗