Search PubMed⌕ Search

Biomedical subjects

J L Grosfeld

Publications and source records attributed to J L Grosfeld.

At least 163 records · Page 9Linked to original sources
PubMed1987

Ventricular gallbladder shunts: an alternative procedure in hydrocephalus.

Hydrocephalus is a frequently encountered problem in infancy and is most commonly treated by placement of ventriculoperionteal (VP) or ventriculoatrial (VA) shunts. Other sites for insertion of the distal shunt have included the stomach, ureter, and fallopian tube. This report describes an experience with ventricular gallbladder shunts (VGB) in 25 children performed from 1970 to 1985. There were 13 girls and 12 boys ranging in age from 6 months to 16 years. Diagnosis included meningomyelocoele (7), congenital hydrocephalus (7), postmeningitic complications (5), intracranial tumor (4), and intraventricular hemorrhage (2). Indications for operation included VP shunt infection (15), massive ascites following VP shunt (3), VA shunt infection (4), and distal shunt malfunction due to fibrinous adhesions or cysts (secondary to infection; (3). Three patients had early shunt failure due to proximal obstruction (2) and gallbladder atony (1). Shunt revision was required in two and the atony was successfully treated with cholecystokinin in one. Fourteen shunts remain in place, two patients have been lost to follow-up, and three children died from unrelated causes. Seventy percent of the 20 patients available for long-term follow-up have functional shunts in place. The VGB shunt procedure remains an attractive alternative for patients with hydrocephalus in whom intraperitoneal and intravascular shunts are no longer feasible.

Adolescent↗
PubMed1987

Is preserving the entire aganglionic colon reasonable in the surgical treatment of total colonic aganglionosis?

Clinical reports describe an increased incidence of severe enterocolitis in infants with total colonic aganglionosis (TCA) following the Martin extended Duhamel procedure using the entire aganglionic colon. This study evaluates the efficacy of this procedure in an experimental model of TCA in comparison with an antimesenteric aganglionic colon patch in rats. TCA was produced by serosal application of 0.1% benzalkonium chloride in 18 Sprague-Dawley rats (250 g). Five additional rats served as operated controls. Ileoanal pull-through was performed in 18 TCA rats, in conjunction with the Martin extended Duhamel procedure using the entire colon in six rats, with an aganglionic colon patch in nine (using the right [3 rats], transverse [3 rats] and left [3 rats] colon), and without other procedures in three rats. Animals were evaluated for survival, weight change, food intake, stool consistency and volume, barium enema, complete blood cell count (CBC), total protein, and serum electrolytes at 4 and 12 weeks. Survival was 83% (5/6) rats with the Martin procedure, 100% in the nine rats with various colon patches, zero in three rats with ileoanal pull-through alone, and 100% in controls. Rats with the Martin procedure gained 2.2 +/- 3.27% of preoperative weight, while controls gained 11.2 +/- 0.52% at 4 weeks. All other rats showed an early weight loss. At 12 weeks, right and transverse colon patched rats had weight gain. Blood count and laboratory studies were similar in each group. Barium enema showed rapid transit in rats with ileoanal pull-through, and slower transit in rats with colon patches or the Martin procedure.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1987

Chemically induced bowel denervation improves survival in short bowel syndrome.

This study evaluates the effect of chemically induced bowel denervation on survival, weight gain or loss, transit time, and d-xylose absorption in rats following 80% small bowel resection. Forty-three male Sprague-Dawley rats (150 g) underwent 80% midsmall bowel resection and anastomosis. Twenty rats were short bowel controls (group I). In 23 rats (group II), a 2.0 cm segment of jejunum proximal to the anastomosis was denervated by application of 0.1% benzalkonium chloride (BK) for 30 minutes. Ten additional rats underwent sham laparotomy without bowel resection. Five remained untreated (group III) and in 5 (BK) denervation was added (group IV). Bowel denervation was confirmed by histologic study in all (BK) rats. Weight and daily food and water intake were measured for 30 days and the groups compared. Weight in group I was 43.8 +/- 52.9 g, group II 95.0 +/- 50.1, (P less than .005), group III 177 g, and group IV 175 g. Food intake was greater in group I than II (P less than .05) and was similar to groups III and IV. Water intake calculated as animal weight (g)/mL H2O ingested was lowest in group I (P less than .05). Mortality was 30% in group I (6/20) and only 8.6% in group II (2/23). No deaths were observed in unresected controls (III and IV). Twenty-four additional rats were evaluated for d-xylose absorption and transit time by bringing out a loop enterostomy 10.0 cm from the Ligament of Treitz. Twelve rats were ostomy controls (group V).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1987

The effect of various types of gastrostomy on the lower esophageal sphincter.

Previous studies have demonstrated a cause and effect relationship between standard Stamm gastrostomy (SG) and subsequent gastroesophageal reflux (GER). To further investigate this clinical problem, three additional types of gastrostomy were evaluated in regard to their influence on the lower esophageal high pressure zone (LEHPZ). Twenty-three male cats were entered in the study weighing 2.6 to 3.6 kg. Baseline manometric studies of the LEHPZ were determined after ketamine anesthesia. In group I (n = 9), Witzel gastrostomy was performed over a 12 Fr catheter without fixation of the stomach to the anterior abdominal wall. In group II (n = 7), percutaneous gastrostomy was performed without fixation of the stomach to the anterior abdominal wall. In group III (n = 7), percutaneous gastrostomy was performed but the stomach was firmly fixed to the abdominal wall. LEHPZ pressures were then repeated 2 weeks postoperatively. Mean preoperative LEHPZ pressure for group I was 16.2 +/- 3.72 mmHg, group II was 16.5 +/- 6.91 mmHg, and group III was 18.3 +/- 5.59 mmHg. Mean postoperative pressure for group 1 was 14.7 +/- 4.26 mmHg, group II was 16.5 +/- 5.77 mmHg, and group III was 10.8 +/- 3.97 mmHg. LEHPZ pressure was similar preoperatively and postoperatively in groups I and II but was significantly decreased postoperatively (P less than .01) in group III. Contrast studies demonstrated maintenance of the angle of His in group 1 and II and alteration of the angle of His in group III. Gastrostomy associated with fixation of the stomach to the anterior abdominal wall results in decreased LEHPZ pressures. This predisposes the subject to GER.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1987

Multiple esophageal duplication cysts.

During thoracic exploration for resection of an esophageal duplication cyst, a second such cyst was encountered and removed. Although the association of esophageal duplication cysts with other intestinal duplications has been described, to our knowledge this is the first reported case of multiple esophageal duplication cysts.

Esophageal Cyst↗
PubMed1987

Intussusception: current management in infants and children.

Intussusception remains a leading cause of bowel obstruction in early infancy and childhood. From 1970 to 1985, 83 patients with intussusception were treated. There were 51 boys and 32 girls ranging in age from 2 months to 22 years. Ten patients had a total of 14 separate recurrences; nine occurred during the initial hospitalization. Symptoms on presentation included abdominal pain (80%), palpable mass (60%), rectal bleeding (53%), and lethargy or sepsis (45%). Fifteen children underwent exploration without contrast studies based on duration of symptoms (greater than 5 days) and evidence of severe obstruction on plain abdominal x-ray films. In the remaining children, diagnosis was confirmed by barium enema and hydrostatic reduction was achieved in only 34 patients (42% success rate). Symptoms were present more than 48 hours in 55% of the reduction failures. At operation, five children had spontaneously reduced and an appendectomy was performed. Manual reduction was possible in 32 patients. The intussusception was irreducible in 26 patients, and 18 required temporary stomas. Pathologic lead points were found in 11 patients. Average length of hospitalization was 1.5 days after barium enema reduction, 9.6 days after manual reduction, and 13.8 days after bowel resection. There were no recurrences of intussusception after surgical reduction. A significant morbidity rate was observed with a delay in diagnosis. Adequate preoperative preparation and prompt surgical intervention are associated with 100% survival.

Adolescent↗
PubMed1986

The value of nutrition support in children with cancer.

A positive stance towards nutrition support of the child with cancer assures potential for normal growth, development, and quality of life during extended oncologic treatment. Data from recent studies of children with cancer (advanced neuroblastoma, Wilms' tumor) demonstrate the importance of integrating nutrition staging, assessment, and support into treatment protocols. Patients with solid tumors and lymphomas who are malnourished at diagnosis have a poor outcome when compared to nourished counterparts. Enteral nutrition (intensive nutrition counseling and favorite, nutritious foods) is effective in low nutritional risk groups but ineffective in preventing or reversing protein-energy malnutrition in high nutritional risk groups. For high-risk groups, central parenteral nutrition is a relatively short-term, but important, support measure which allows children to grow despite extended periods of intense oncologic treatment. The patient's nutritional course may affect bone marrow suppression and the ability to tolerate aggressive chemotherapeutic treatment. Although treatment tolerance may be improved with nutrition support, adequacy of primary oncologic treatment outweighs other supportive factors as a determinant of ultimate survival.

Anthropometry↗
PubMed1986

Efficacy of magnetic resonance imaging in 139 children with tumors.

One hundred thirty-nine children with neoplasms were studied using magnetic resonance imaging (MRI). This procedure was as accurate as computed tomography in predicting tumor histology, except that MRI was unable to detect small areas of tumor calcification. Magnetic resonance imaging could accurately identify the organ of origin of tumor masses and differentiate soft tissue from fat, fluid, or hemorrhage. In addition, MRI was helpful in planning surgery in many cases: It was better than computed tomography in defining the size and extent of soft-tissue tumor masses. It was accurate in defining the extent of the spread of bone sarcomas in the bone marrow. Without requiring the injection of intravenous contrast agents, it accurately defined displacement, encasement, or invasion of major abdominal blood vessels by Wilms' tumors and neuroblastomas. As a means of evaluating pediatric neoplasms, MRI is noninvasive, painless, and well tolerated by children, and it uses no radiation.

Adolescent↗
PubMed1986

Generalized juvenile polyposis coli. Clinical management based on long-term observations.

Generalized juvenile polyposis occurred in five patients (age range, 18 months to 16 years). Clinical findings included abdominal pain, weakness, rectal bleeding, diarrhea, rectal prolapse, intussusception, clubbing, and failure to thrive. Laboratory findings included anemia, hypoalbuminemia, hypokalemia, and skin test anergy. Diagnosis is achieved by double contrast enema, endoscopy, and biopsy. Unlike patients with solitary juvenile polyps, patients with generalized involvement require surgical intervention. Subtotal colectomy and ileoproctostomy are the procedures of choice, and we performed them in four cases. An ileoanal-endorectal pull-through procedure was required in one patient with continued rectal disease. All five patients are currently alive and well. Long-term follow-up is important as polyps may persist into adult life. Family members are at risk for developing gastrointestinal tract tumors and should be screened.

Adolescent↗
PubMed1986

Short bowel syndrome in infancy and childhood. Analysis of survival in 60 patients.

This report concerns 60 infants and children with short bowel syndrome, most commonly caused by necrotizing enterocolitis in this study. Resection of atretic or gangrenous bowel was performed in 53 patients, tapering enteroplasty and primary anastomosis was performed in 13 patients, and temporary enterostomies were performed in 40 patients. Second-look laparotomy was useful in two of four cases of questionable bowel viability. The ileocecal valve was resected in 33 patients and remained intact in 27. The mean length of remaining bowel was 58.4 cm (range 13 to 150 cm). Seven patients with total aganglionosis and mid to proximal small bowel extension were managed with an initial enterostomy, whereas three had a pull-through procedure with an aganglionic patch enteroplasty. All patients received total parenteral nutrition and early enteral feedings. Home hyperalimentation was attempted when 50 percent of the calorie intake was enteral. Intestinal adaptation required from 3 to 14 months. Frequent setbacks were related to catheter sepsis, rotavirus infection, carbohydrate intolerance, and liver dysfunction. The overall survival rate was 85 percent, with mortality due to liver failure and sepsis associated with total parenteral nutrition.

Adolescent↗
PubMed1986

Synergistic effect of coumadin and cytoxan in reducing lung metastases.

Lung metastasis is a frequent cancer complication resulting in significant mortality. This study evaluates the effect of coumadin and cytoxan alone and in combination on lung metastases in rats challenged with Morris hepatoma 3924A. Seventy-seven male American Cancer Institute (ACI) rats weighing 200 g were studied. Thirty-seven rats received coumadin orally for six days, which resulted in a prothrombin time 2 times that of controls (30 sec). All rats received 1 X 10(5) clumped Morris hepatoma cells via tail vein injection. Animals were divided into four groups: Group I (controls, n = 20) received no antitumor treatment; group II rats (n = 20) received 25 mg/kg cytoxan intraperitoneally at the time of tumor challenge; group III animals (n = 19) received coumadin alone; while group IV (n = 18) received both coumadin and cytoxan. Rats were evaluated for number of lung metastases and lung weight at 3 weeks postinjection. Data was subjected to statistical analysis by the Student's test. The mean number of lung metastases were 580 +/- 45 in group I, 350 +/- 310 in group II, 330 +/- 263 in group III, and 200 +/- 161 in group IV (P less than .005 [IV] v [I], P less than .05 [IV] v [II], [III]), (P less than .05 [II] v [I]), (P less than .05 [III] v [I]). Mean lung weights were 2.597 g +/- 1.65 in group I, 2.049 g +/- 0.75 in group II, 1.898 g +/- 0.80 in group III, and 1,677 g +/- 0.31 in group IV. (P less than .025 [IV] v [I], P less than .05 [IV] v [II]).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1986

Use of iohexol in the radiographic diagnosis of ischemic bowel.

This study evaluates the use of iohexol as a radiographic diagnostic contrast agent in normal animals and those with experimental bowel ischemia and obstruction. Eighteen rats and 12 rabbits were gavaged with iohexol in a dose of 7.5 mL/kg using concentrations of 140 mg I/mL (isotonic with blood) or 300 mg I/mL. In addition, four rabbits had intraperitoneal iohexol injection and three were given gastrografin gavage. Experimental groups included normal bowel controls, bowel injury induced by ischemia and alcohol contact, bowel obstruction by ligature, and intraperitoneal injection. Serial abdominal radiographs and plasma concentrations of iohexol were obtained. Iohexol remained stable throughout the gastrointestinal tract, retained its intensity, and was well visualized up to four days after administration. Bowel images were fair at concentrations of 140 mg I/mL and excellent at 300 mg I/mL. Gastrografin caused bowel distention and poor visualization related to dilution. It also precipitated in the stomach. Iohexol was rapidly absorbed from the peritoneal cavity and excreted by the kidneys, without causing peritonitis. Rat plasma iohexol levels were three times controls in obstructed bowel and 80 times controls if there was mucosal injury without perforation. Rabbit peak plasma levels were 30 times greater following intraperitoneal injection than with gastric gavage. These observations suggest that iohexol may be useful as a gastrointestinal contrast agent. Measuring plasma iohexol levels may be helpful in the evaluation of suspected bowel ischemia or perforation in the clinical setting.

Animals↗
PubMed1986

Long-term follow-up after surgical management of necrotizing enterocolitis: sixty-three cases.

One hundred twenty-five infants underwent surgical intervention for necrotizing enterocolitis between 1972 and 1984. Sixty-three infants, who survived more than 30 days postoperatively, were evaluated for long-term complications. There were 28 girls and 35 boys (mean birth weight 1,725 +/- 890 g; gestational age 32 +/- 4 weeks). Associated problems included hyaline membrane disease (43), cardiac anomalies (25), and trisomy 21(2). Thirty-six survivors required long-term ventilatory support. Fifty-nine infants underwent bowel resection and enterostomy, 3 decompressing enterostomies without resection, and 1, exploratory laparotomy only. Enterostomies were closed at four months. Twenty four had short bowel syndrome. Fifteen infants subsequently died for a late mortality rate of 23%. Mortality was related to sepsis (3), respiratory failure (5), cardiac anomalies (3), cardio-respiratory arrest (2), and TPN related liver failure (2), and was common with gestational age less than 31 weeks and birth weight less than 1,000 g. Medical problems included cholestasis (17), TPN induced cirrhosis (3), meningitis (3), seizures (8), and nutritional rickets (6). Significant developmental and intellectual delays were observed.

Adolescent↗
PubMed1986

Teratomas in childhood: analysis of 142 cases.

This report concerns 142 infants and children with teratomas treated from 1960 to 1984. The primary site of tumor was sacrococcygeal in 84, ovarian in 15, testicular in 15, mediastinal in 14, retroperitoneal in 7, cervical in 3, and other in 4. Malignancy occurred in 40 of 142 (28%) patients. Serum for alphafetoprotein (AFP) was obtained preoperatively in 29 patients. Elevated AFP was seen in all patients with malignancy, 3 of 6 with immature lesions and 1 of 19 with a benign lesion. Postoperative rise in AFP levels was a good indicator of malignant recurrence. Beta human chronic gonadotropin (BHCG) levels were only helpful in following teenage boys with testicular lesions. Benign tumors were treated by complete excision alone with a 97% survival. Testicular malignancies had a good prognosis with 13 of 15 surviving (87%) despite distant metastasis in four. In contrast, survival was only 32% with nontesticular malignancies. Survival was 17% for resectable malignant cases treated with surgery alone compared with 100% when operation was followed by multiagent chemotherapy. Unresectable malignant lesions were usually fatal despite multiagent chemotherapy and/or second-look procedures.

Adolescent↗
PubMed1986

Surgical treatment of total colonic aganglionosis: efficacy of aganglionic patch enteroplasty in the rat.

This study evaluates ileo endorectal pull-through (IEP) with and without an aganglionic colon patch in an experimental rat model for the surgical treatment of total colonic aganglionosis (TCA). Animals were randomly assigned to Group 1 (no patch, No. = 6), Group 2 (right colon patch, No. = 8), Group 3 (transverse colon patch, No. = 7), Group 4 (left colon patch; No. = 6), sham operation (SH, No. = 6), and unoperated controls (UC, No. = 10). Change in percent body weight at 4 weeks after operation was -30.9 +/- 3.68% in Group 1, +5.1 +/- 1.67% in Group 2, -3.4 +/- 3.96% in Group 3, -1.8 +/- 4.17% in Group 4, and +12.7 +/- 1.54% in SH (Group 1 v other groups: P less than .001). Restoration of initial body weight occurred in 100% in Group 2 and SH (8/8 and 6/6, respectively), 50% in Group 4 (3/6), 42.9% in Group 3 (3/7), and 0% in Group 1 (0/6). Transit time (stomach to anus) was significantly shorter in Group 1. All rats in patched groups had a prolonged transit time compared with Group 1. Manometric studies in IEP rats showed favorable anal canal pressures, which were slightly lower than SH and UC. Water and Na+ absorption were significantly greater in patched groups. Rats with a right colon patch (Group 2) showed slightly greater absorption at 4 weeks. These data suggest that an aganglionic colon patch may be an important adjunct in the surgical treatment of TCA.

Animals↗
PubMed1986

Nutritional support of children with neoplastic diseases.

There are numerous factors promoting the development of PEM in the child with cancer. Some of these factors are related to the tumor, many to the treatment itself, and some to failure of recognition of PEM. Not all children with cancer are at great risk for the development of PEM. These patients must be monitored and supported with comprehensive enteral programs. Children who have developed or are at risk for PEM must be identified and supported with CPN or PPN plus CEN during early intensive periods of treatment and during the later phases of abdominal radiotherapy, operative resection of tumor, or relapse. The decision to institute CPN must be based not only on the child's current nutritional status but also on the nature of the therapy he or she is soon to receive and the likelihood that he or she will be able to maintain an adequate intake during that therapy. Realistic goals must be set for nutritional support. The value of nutritional intervention lies in its ability to correct or prevent the development of adverse effects related to PEM. This support is hoped to contribute to improved tolerance of therapy, increased energy to complete normal day-to-day activities, and an improved sense of well-being for the child. If these goals have been accomplished, then the nutritional therapy has been successful.

Anthropometry↗