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Biomedical subjects

J J Tepas

Publications and source records attributed to J J Tepas.

71 records · Page 4Linked to original sources
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↗
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

Total management of short gut secondary to midgut volvulus without prolonged total parenteral alimentation.

Absorption studies in rats have shown that intestinal adaptation after catastrophic injury can be stimulated by early enteral feeding. Using this concept, we have devised a technique of early initiation and advancement of oral feedings that begins with Cho-Free and Polycose and gradually adds sucrose and MCT in increasing proportions. The increasing complexity and caloric density of this diet provide sufficient nutrition to allow weaning from total parenteral alimentation within 2--3 wk. Our preliminary experience in babies with midgut volvulus, necrotizing enterocolitis, and gastroschisis has been successful and uncomplicated. These patients have demonstrated consistent weight gain and have been spared the complications associated with prolonged parenteral alimentation.

Animals↗
PubMed1978

An improved method for retaining retrieval line in children undergoing repeated esophageal dilatation.

Children undergoing repeated retrograde esophageal dilatation using gastrostomy introduced Tucker dilators must retain a retrieval line between dilations. Generally, the line is tied into a loop coursing through the esophageal lumen and exits at the gastrostomy and nose. This technique, while effective in maintaining the line in situ, is fraught with hazards of chronic erosion at both exits sites, with significant cosmetic deformity, necessitated by the taped external line and, in the pediatric age group, with frequent harassment by peers and siblings pulling the exposed line. We have modified this technique, leaving the line looped around the nasal septum with both ends extending down the esophagus into the stomach where they are tied to the tip of the gastrostomy catheter. This results in an almost completely internalized line that is protected, well tolerated, and easily retrieved for subsequent use with the dilators.

Child↗
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↗
PubMedDate not supplied

Morbidity and mortality conference: enhancing delivery of surgery residency curricula.

PURPOSE: To determine the exposure of surgical residents to educational subjects contained in the APDS 2000 Curriculum from a weekly Morbidity and Mortality (M&M) conference. METHODS: The departmental quality assurance data base was queried for content presented in a residency program's M&M conference. The presentation topics, the services involved, and the occurrence causation were all cataloged to assess the extent of material covered. The topic was logged if the case occurrence generated discussion beyond a superficial notation. An attending moderated the discussions, with resident and faculty interaction on causality determination. Imaging studies were available as appropriate to the case discussed. RESULTS: At least 95 discrete topics in 149 separate occurrences were covered in the weekly M&M conference in 1 academic year from July 1999 through June 2000. Common topics included wound infection (9), deep venous thrombosis (7), small bowel obstruction (5), and pulmonary embolus (4). Five topics were discussed 3 times, 23 were discussed twice, and 63 were discussed once. Although many occurrences had multiple causes, Pareto analysis of causation determined that nature of disease was prominent in 78 (52.4%), diagnostic difficulty in 31 (20.8%), technical error in 27 (18.1%), and error in judgment in 13 (8.7%). Pareto analysis of the surgical domains addressed included trauma (37, 24.8%), general surgery (35, 23.5%), common issues independent of service (32, 21.5%), vascular (20, 13.5%), cardio thoracic (11, 7.4%), critical care (9, 6.1%), and all other services (5, 3.4%). CONCLUSIONS: A weekly M&M conference in a residency program provides broad exposure to material contained in the APDS 2000 curriculum. A peer-reviewed M&M conference provides ongoing examination of common problems encountered in the delivery of surgical care. By so doing, it promotes interactive teaching of the most relevant surgical problems.

Journal Article↗
PubMedDate not supplied

Jacksonville Pediatric Injury Control System: a multidisciplinary quality improvement program.

The Jacksonville Pediatric Injury Control System is a multidisciplinary forum created to identify, discuss, and recommend actions that improve the care of pediatric trauma patients in the Jacksonville, Florida, area. Daily events that affect the outcome of injured children are measured. Outcome can no longer be measured by merely decreasing mortality and patient impairment but must also include how efficiently this is achieved. To improve our ability to treat pediatric injury, factors that undermine this efficiency must be controlled. The Jacksonville Pediatric Injury Control System accomplishes this in a manner that uses existing resources to focus the pursuit of excellence for an entire community of professionals committed to improved care for the injured child.

Adolescent↗