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J J White

Publications and source records attributed to J J White.

At least 19 recordsLinked to original sources
PubMed1992

The splenic snood: an improved approach for the management of the wandering spleen.

A wandering spleen is in constant danger of torsion and infarction. Splenectomy, the traditional treatment, leaves children in danger of postsplenectomy sepsis. Three children with wandering spleens were treated by a new splenopexy technique, the splenic snood. After detorsion, the spleens were wrapped in polyglycolic mesh and anchored by the mesh subdiaphragmatically in the left upper quadrant. All have retained their spleens which have remained where anchored up to a 4-year follow-up. The simplicity and technical ease of the splenic snood operation recommend it as an improved method to avoid splenectomy and safely normalize intraabdominal anatomy in the management of the wandering spleen.

Child↗
PubMed1992

Comparison of MRI and discography in the diagnosis of lumbar degenerative disc disease.

Recent reports have attempted to compare the relative value of discography and MRI in the evaluation of lumbar degenerative disc disease. None has compared the accuracy of the two techniques in regard to the detection of disc herniation specifically, and none has offered surgical correlation. In this prospective study, both techniques were used to evaluate 264 disc levels in 90 patients with incapacitating low back pain or radicular pain. The results showed an 86% agreement level both between tests and between the orthopaedist and radiologist on each test. Surgical findings agreed with diagnostic studies at 63 of 76 levels in 57 patients who underwent operative treatment. An analysis of the relative sensitivity and specificity of each test in the diagnosis of degeneration and herniation revealed that the greater sensitivity of MRI in the detection of herniation was the only statistically significant difference (p < 0.05).

Adult↗
PubMed1992

A critical analysis of blood transfusion requirements in children with blunt abdominal trauma.

Over the past 2 years, 178 children with blunt abdominal trauma were admitted for observation. Fifty-five patients (31.5%) had intra-abdominal injury confirmed by computerized tomography (CT) scan, laparotomy, or postmortem examination. Forty-four children (80%) were managed with observation only; nine had other operations. Eleven patients (20%) required an operation for their intra-abdominal injuries. Thirteen patients died, ten from head or spinal injuries and three from intra-abdominal injuries (5.5%). Of 35 children with intra-abdominal injuries observed without any type of operation, 27 (77%) were not transfused (mean Pediatric Trauma Score [PTS] 8, Injury Severity Score [ISS] 19.3, average low hemoglobin [ALH] 10.1). The other eight were transfused an average of 49 cc/kg (mean PTS 4.5, ISS 26.5 ALH 6.1). Twenty children had operations. Eleven 11 (20%) of these were laparotomies; nine were transfused an average of 200.6 cc/kg (mean PTS 6, ISS 33, ALH 9). Nine had neurosurgical/orthopedic procedures (mean PTS 6.2, ISS 27.7), with six transfusions averaging 84.9 cc/kg (ALH 8.9). There were no significant complications. Blood transfusion was necessary only for 33 per cent of the observed cases, usually with multiple injuries. Blood should be transfused only to maintain hemodynamic stability (normal vital signs and tissue perfusion). Hemoglobin levels as low as 7 gm% do not mandate transfusion in children who are hemodynamically stable.

Abdominal Injuries↗
PubMed1991

Assignment of the human prohibitin gene (PHB) to chromosome 17 and identification of a DNA polymorphism.

Prohibition is a recently identified antiproliferative protein whose exact role in the cell is under investigation. To determine the human chromosomal location of the prohibition gene (PHB) and whether this site corresponds to that of any suspected tumor suppressor gene, we have analyzed DNA from three sources by hybridization analysis: mouse--human hybrid cell lines, hybrid cell lines containing portions of human chromosomes, and human metaphase chromosomes in situ. All three techniques confirm a location in the region 17q21-q22, a region genetically linked to early-onset human breast cancer. Further analysis will be required to establish the significance of this relationship; Southern hybridizations show a polymorphic EcoRI site that may be useful for this purpose.

Blotting, Southern↗
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↗
PubMed1976

Prognostic factors in neuroblastic tumors.

Data of 101 patients with neuroblastic tumors from 1950 to1974 at The Johns Hopkins Hospital have been abstracted onto specially designed summary sheets, and subjected to multifactorial analysis. One-third of the 21 benign ganglioneuromas showed evidence for spontaneous maturation. The overall cure rate among the malignant tumors was 39%. Cures were higher with an extraabdominal primary, with more mature histologic differentiation, and if excision, even partial, was carried out. Neither radiotherapy nor evolving modalities of chemotherapy appear to have had benefit over this 25-yr period. An age at diagnosis less than 2 yr, and a less extensive clinical stage both were independent predictors of survival. The apparent effects of a favorable site of tumor origin, or more mature histologic differentiation were not of major impact in and of themselves, but correlated better with clinical stage. Two prognostic schemata, based on stage plus age, and stage plus histologic differentiation plus age respectively, proved to be 95% accurate in our experience. With more extensive evaluation and experience, either or both may be helpful in the management of malignant neuroblastic tumors, and assessment of therapeutic regimens.

Adolescent↗
PubMed1976

Continuous dynamic monitoring of pressure and flow patterns during assisted ventilation.

A system for continuous, dynamic monitoring of children requiring ventilatory assistance has been developed and used in a critical care setting. Breath by breath airway pressure changes are measured on a specially adapted meter with high-and low-pressure limit alarms, and are displayed graphically on a bedside oscilloscope. This system has proved to be beneficial in detecting ventilator system malfunction; in adjusting ventilator settings, such as inspiratory/expiratory ratios, end-expiratory pressure, and phase duration and flow ratios; in assessing compliance of a child requiring ventilatory assistance and his capability for spontaneous breathing; and in the early recognition of potentially harmful problems attendant upon assisted ventilation. The system provides additional educational benefit for the I.C.U. personnel, who become more knowledgeable regarding ventilatory problems, and more apt to discover them promptly. The simplicity of the system, compatibility with other I.C.U. monitoring equipment, capability for continuous, dynamic monitoring, and broad scope recommended it for infants and children requiring assisted ventilation.

Child↗
PubMed1976

Operative correction of pectus excavatum: an evolving perspective.

From 1949 to 1975, 220 children have undergone surgical reconstruction of pectus excavatum using a variety of operations on our Pediatric Surgical Service. The first 183 were previously reported and have had subsequent, careful followup evaluation. From 1970 to 1975, an identifiable group of 45 children had a standard operation, a modified Ravitch repair, with the addition of a three-point or tripod internal fixation technique for support of the sternum. These children have all obtained satisfactory reconstruction without prosthetic support of any kind. We have thus avoided the possible danger of foreign material within the chest and have obviated the need for another procedure to remove a supporting stent. The two groups have been analyzed and compared with respect to age distribution, postoperative complications and end results to see if we could detect any trends in the evolving management of children with this condition. The main indications for surgical correction remain cosmetic and postural. Specific trends which have emerged from our experience include an increased percentage of patients between 3 and 8 years of age (average 5.8 years); a decreased need for blood transfusion (10%); a near resolution of postoperative seromas with the use of substernal and subcutaneous suction drains; and in the last 45 children, a 100% excellent or acceptable result to date. We feel that age selection is an important factor in the improved operative result and in the emotional impact on these young patients. Eighty per cent of the children in the recent series were between 3 and 8 years of age at the time of repair. On the basis of this experience, we now feel confident in recommending our standardized operation for pectus excavatum at an elective age of 4 to 6 years.

Adolescent↗
PubMed1976

Special problems of vascular injuries in children.

Vascular injuries in children are not rare. The rising incidence of general trauma in children and the frequent use of diagnostic procedures in this age group may contribute to an overall increase in these injuries. A 10-year experience with severe vascular injuries in children at The Johns Hopkins Hospital has been reviewed. The mechanisms of production may be similar to those in adults, but many injuries are unique to the pediatric age group. The sequelae of such injuries in infants and children may include abnormal growth and development of the involved extremity. Complications and special surgical management of our group of 71 children have been discussed and preventive measures have been suggested.

Blood Vessel Prosthesis↗
PubMed1976

Spontaneous rupture of the stomach in the newborn: clinical and experimental evaluation.

Our study presents an experimental model for studying gastric rupture in the newborn. We showed that gastric rupture could be produced in eight newborn rodents and in three puppies less than 10 days old after injection of 120 ml air at 100 mm Hg pressure in the rodents and 175 ml air at 240 mm Hg pressure in the puppies. Gastric rupture occurred with animals supine and with approximately 20 ml barium injected into the stomach. Positioning of the animal in the supine position permitted the barium to pool in the antral-pyloric region of the stomach.

Age Factors↗
PubMed1976

[Arvin anticoagulant for prolonged extracorporeal membrane oxygenation (author's transl)].

Treatment of overwhelming but reversible respiratory failure has broadened to include extracorporeal support with a membrane lung. Until recently, it has been necessary to rely on heparin to prevent clotting in an extracorporeal circuit. During prolonged bypass heparinisation may be attended by bleeding. We investigated the use of arvin for systemic anticoagulation in extracorporeal membrane lung bypass in lambs. Arvin is a purified fraction of the venom of the Malayan pit viper. Effective anticoagulation was obtained for an average of 4 days (range 2 to 12 days) through complete fibrinogen depletion by arvin. These preliminary data suggest that arvin anticoagulation may be suitable for prolonged extracorporeal membrane oxygenation.

Animals↗
PubMed1976

The syndrome of bronchial atresia or stenosis with mucocele and focal hyperinflation of the lung.

Three cases of "the syndrome of bronchial atresia or stenosis with mucocele and focal hyperinflation of the lung" are added to 28 proven cases (26 with atresia and 2 with stenosis) previously reported in the English literature. One case is of particular interest since serial roentgenograms during the first week of life showed fetal lung fluid to be trapped distal to the atresia. The radiographic findings in this syndrome are reviewed and the presumed etiology and pathophysiology discussed.

Body Fluids↗