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Biomedical subjects

J L Talbert

Publications and source records attributed to J L Talbert.

At least 37 records · Page 2Linked to original sources
PubMed1985

Congenital anorectal malformations. Harbingers of sacrococcygeal teratomas.

Since 1973, seven infants treated at the University of Florida, Gainesville, for congenital anorectal anomalies have been found to have concomitant sacrococcygeal teratomas. As anorectal anomalies occur in approximately one in every 5,000 live births and sacrococcygeal teratomas are noted in one in every 40,000 live births, this presentation would suggest a prevalence that precludes a random association. The presence of significant anorectal strictures in these patients resulted in a delay in the diagnosis of the presacral teratomas. As the frequency of malignant change in sacrococcygeal teratomas has been documented to increase proportionately with age, early diagnosis and excision of these lesions is essential. Our experience with these children suggests that the presence of congenital anorectal malformations in infancy should raise the physician's index of suspicion for associated sacrococcygeal teratomas.

Anal Canal↗
PubMed1985

The effect of energy substrate manipulation on tumor growth and metastasis and intermediary metabolism in the parenterally fed mouse.

The effect of N-free energy substrate manipulation on tumor growth and metastasis, host maintenance, and intermediary metabolism was studied in parenterally fed Swiss mice bearing subcutaneously implanted Lewis lung carcinoma. Non-N energy was provided from dextrose (CHO), lipid emulsion (FAT), or a 75:25 balanced (BAL) solution, infused from day 14 through day 22 postimplant. Control mice were offered equivalent energy and N from a balanced, casein-based solid diet (CAS). Tumor-doubling time was significantly prolonged in the CHO group compared to FAT and CAS. Pulmonary metastatic nodules were decreased in number in all parenterally fed mice compared to CAS, suggesting that the route of administration altered pulmonary physiology in such a way that the transmissability and/or growth of the tumor cells was inhibited. Tumor-free body weight was maintained in the CHO (+ 1.3%) and BAL (+ 0.3%) groups. However, significant weight loss occurred, despite equal intake, in the FAT (-4.7%) and CAS (-7.5%) groups. The energy appeared to be channeled into nonoxidative pathways, reflected by an increase in hepatic and adipose tissue lipogenesis and hepatic glycogen content. During the period studied, parenteral dextrose/amino acid infusion in this host-tumor system resulted in a decrease in primary tumor growth and optimal host maintenance compared to fat-based TPN and enteral feeding of a balanced, solid diet. Tumor metastasis was decreased in all parenterally fed mice, a phenomenon related to the route of administration and apparently independent of energy substrate.

Adipose Tissue↗
PubMed1985

Total lung lavage for pulmonary alveolar proteinosis in an infant without the use of cardiopulmonary bypass.

Pulmonary alveolar proteinosis is a rare disease that usually affects the adult patient, but is now being recognized as a possible cause of neonatal respiratory distress. In the adult patient, whole lung lavage, as described by Ramirez-R in 1965, is considered the most effective therapy for management of this condition. The lavage can be accomplished safely and with relative ease by using a Carlens or Robertshaw tube to isolate and lavage one lung while ventilating the other. The unavailability of a small double-lumen tube makes this procedure impossible in the pediatric age group. Therefore, whole lung lavage has been possible in only a few children in the past with the help of cardiopulmonary bypass to allow simultaneous oxygenation during the pulmonary lavage. Due to the hazards and technical difficulties of cardiopulmonary bypass, total pulmonary lavage can not be considered a practical option in the very small infant. A 15-week-old infant is reported, weighing 2 kg with a diagnosis of pulmonary alveolar proteinosis, who underwent total pulmonary lavage safely on three different occasions without employing cardiopulmonary bypass. A double-lumen Swan-Ganz catheter, introduced transbronchoscopically through the side-arm of a rigid, 3.5-mm Storz bronchoscope was used to isolate and lavage one lung while ventilation to the other lung was maintained through the bronchoscope. A Nellcor oximeter, utilized for transcutaneous monitoring, revealed satisfactory oxygen saturation during the entire pulmonary lavage. The transbronchoscopic lavage was monitored under direct vision with a video monitor, ensuring correct position of the bronchoscope and the catheter at all times.(ABSTRACT TRUNCATED AT 250 WORDS)

Bronchoscopy↗
PubMed1984

Total parathyroidectomy and autotransplantation for tertiary hyperparathyroidism in children with chronic renal failure.

An association between chronic renal failure and skeletal deformities in the adolescent patient was first documented by Lucas in 1883. Since then it has been established that the kidneys play a major role in the regulation of calcium, phosphate, and parathyroid hormone, and that chronic renal failure is characterized by profound alterations in the normal metabolic homeostasis of the human body. With the hyperphosphatemia of uremia, compensatory hyperparathyroidism is also a well known complication. Due to these factors, loss of normal renal function ultimately leads to derangement in mineral and bone metabolism resulting in severe skeletal deformities. Reports in the English literature suggest that the changes of renal osteodystrophy are much more pronounced in the pediatric patient, as compared to those in the adult. In the last two decades, renal transplantation has come to be recognized as a satisfactory modality for controlling renal failure and its complications. This procedure is often not available as an option, however, in small patients, especially those under three years of age. The pediatric nephrologist is often forced to manage these patients for long periods with conservative therapy, in an attempt to control the ravages of renal osteodystrophy. The problem becomes unmanageable when the compensatory hyperparathyroidism proceeds to autonomy. When this occurs, despite maintenance of normal serum calcium levels, the renal osteodystrophy progresses rapidly, producing pain, deformities and growth retardation. At this point, the condition is often refractory to medical management and resection of parathyroid tissue remains the only satisfactory modality for control.(ABSTRACT TRUNCATED AT 250 WORDS)

Chronic Kidney Disease-Mineral and Bone Disorder↗
PubMed1984

Inguinal hernias after ventriculoperitoneal shunt procedures in pediatric patients.

The results of this study of 134 patients confirm the increased incidence of previously unrecognized inguinal hernias after ventriculoperitoneal shunting procedures. Infants with intraventricular hemorrhage appeared to be the most susceptible, although associated prematurity may play an additional role. Close observation of infants and children who undergo ventriculoperitoneal shunting is required, to allow early detection and repair of inguinal hernias. Inguinal herniorrhaphy can be performed safely with few or no postoperative complications and no deleterious effects to the VP shunt.

Abdomen↗
PubMed1983

Pediatric neuroblastoma: postoperative radiation therapy using less than 2000 rad.

There is considerable controversy regarding the role of radiation therapy in the treatment of neuroblastoma. Postoperative irradiation in the range of 2500-4000 rad is commonly used in the treatment of Evans Stage II or III disease, but there are no data in the literature to suggest the optimum dose of radiation that is necessary. Because much lower doses have been used at the University of Florida, a retrospective study was undertaken in an attempt to determine the optimum dose necessary in conjunction with surgery. From March 1964 through July 1979, 21 children with Stage II or III neuroblastoma were seen at the University of Florida. One patient died postoperatively. The remainder received postoperative irradiation with doses ranging from 900 to 4500 rad. The lower dose of radiation used did not adversely influence survival, particularly for patients less than two years of age at diagnosis. In this group, no patient had a local recurrence or died of disease, even though nine of 15 available patients received doses of 900-1500 rad.

Abdominal Neoplasms↗
PubMed1983

Endotracheal cryotherapy in the treatment of refractory airway strictures.

In 1977 we reported the successful use of endotracheal cryotherapy in the treatment of experimental tracheal strictures. This technique has now been employed in the treatment of 29 refractory airway lesions in 27 patients ranging in age from 3 months to 42 years. The technique utilizes a nitrous oxide cryoprobe measuring 3 mm in diameter and 43 cm in length. The tip of the probe is applied directly to the stricture through the endoscope and cooled to -80 degrees C for 45 seconds. On removal of the probe, the frozen tissue is resected with biopsy forceps. Cryotherapy has successfully relieved the airway strictures in 20 of the 24 lesions in which treatment was completed. The technique of endotracheal cryotherapy has proved helpful in the management of selected patients with refractory airway strictures.

Adolescent↗
PubMed1983

Hepatic artery ligation for hepatic hemangiomatosis of infancy.

Capillary and cavernous hemangiomas of the skin and subcutaneous tissue, usually follow a benign course with enlargement in the first year of life followed by gradual involution. Hemangiomas of the liver, on the other hand, can be responsible for life threatening complications in infancy. The presence of major intrahepatic arteriovenous communications may produce a high output cardiac failure, refractory to intensive medical therapy. Use of radiation therapy and high doses of steroids have proven to be of limited success with a 90% mortality in infants managed with nonoperative therapy. Hepatic artery ligation in such patients may provide dramatic control of the high output failure, with negligible side effects. Two infants are reported in whom bilateral hepatic artery ligation provided prompt control of fulminant congestive failure secondary to hepatic hemangiomatosis, after failure of medical therapy.

Female↗
PubMed1983

Retroperitoneal malignant schwannoma: a case report.

Malignant schwannomas are primary nerve sheath tumors that usually arise from peripheral nerves and only rarely occur within the retroperitoneum. Only 13 instances of this neoplasm occurring in such an anatomic location have been reported in the English literature, and none have been described previously in children. The present report details a case of a retroperitoneal malignant schwannoma in a 14-yr-old child.

Adolescent↗
PubMed1982

Near-total pancreatectomy in persistent infantile hypoglycemia.

To prevent the devastating effects of hypoglycemia on the CNS of the infant, persistent infantile hypoglycemia should be recognized early and treated promptly. To avoid mental retardation, surgical intervention should not be considered as a last resort. When an insulinoma is identified at surgery, subtotal pancreatectomy is adequate in achieving normoglycemia. However, the most common cause of insulin excess in infancy appears to be islet cell hyperplasia or nesidioblastosis, both diffuse processes. In these patients, subtotal pancreatectomy is often ineffective in achieving normoglycemia. Near-total pancreatectomy, retaining the spleen and duodenum, is a safe procedure, well tolerated by infants and children, and should be considered early for the correction of hypoglycemia of infancy that is not readily controlled by medical intervention.

Adenoma↗
PubMed1982

Compensatory renal growth and function in postnephrectomized patients with Wilms tumor.

The objective of this study was to determine whether or not renal growth and function were adversely affected in the remaining kidneys of patients who had undergone nephrectomy for Wilms tumor. These patients received chemotherapy and some radiotherapy (tumoricidal agents which might affect the remaining kidney). Renal growth was compared between the treatment groups and normal renal growth. Hypertrophy did occur and did not appear to be affected by subsequent treatment. Renal function was minimally altered in all treatment groups irrespective of the type of treatment.

Adaptation, Physiological↗
PubMed1981

Thoracoscopy for intrathoracic tumors.

The technique of thoracoscopy has been performed on 49 occasions in 45 patients for the diagnosis or staging of intrathoracic tumors. The patients ranged from 8 months to 68 years old. Eight procedures were performed for pleural disease, 16 for mediastinal masses, 22 for parenchymal lesions, and 3 for intrathoracic staging. Seventeen patients had had previous invasive procedures performed without a pathological diagnosis being established. In 28 thoracoscopy procedures, a positive diagnosis for malignancy was obtained; in 6 instances, areas of unsuspected tumor involvement were identified. A correct diagnosis was obtained by thoracoscopy in 45 procedures for a 92% overall accuracy rate. There was no clinically significant morbidity in this series and no procedure-related mortality. Thoracoscopy, performed under stellate ganglion block and regional anesthesia, has proved to be a very attractive method of diagnosing intrathoracic neoplasia with very low morbidity.

Adolescent↗
PubMed1981

Blunt transmediastinal total esophagectomy with simultaneous substernal colon interposition for esophageal caustic stricture in children.

The management of caustic strictures of the esophagus continues to be a challenge to the pediatric surgeon. Many of these patients develop refractory strictures and esophageal reconstruction becomes necessary. Most of the currently employed surgical techniques for this reconstruction leave the injured esophagus in situ and most surgeons have been unwilling to perform a secondary thoracotomy for removal. Many authors have suggested a vastly increased risk of development of esophageal carcinoma in the caustically injured esophagus. In the past five years, techniques for blunt transmediastinal esophagectomy have been developed for adult patients with carcinoma of the cervical region of the esophagus. The current report describes the use of these techniques in two pediatric patients for performing total esophagectomy with simultaneous substernal colon interposition, without the need for thoracotomy. With careful adherence to several technical aspects, this procedure safely allows for complete removal of the injured esophagus and alleviates the concerns of subsequent complications from this organ.

Burns, Chemical↗
PubMed1981

The use of preserved human dura for closure of abdominal wall and diaphragmatic defects.

The surgical management of large body wall defects presents special challenges. The prosthetic materials employed for these defects, although readily available, have the disadvantage of susceptibility to infection. Autologous tissue is frequently not available in sufficient quantity. The long-term functional and histologic results of the use of preserved human dura for closure of abdominal wall and diaphragmatic defects have been evaluated. Dural patches were sutured into abdominal wall and diaphragmatic defects of six dogs, using interrupted sutures of Dexon and Prolene. The animals were killed eight, 16 and 24 weeks after patch placement. The strength of the material was tested with a pneumoperitoneum prior to death and in all animals it appeared firmly incorporated into the host tissue. Histologically there was a mononuclear inflammatory response seen at eight weeks, with resolution by 24 weeks. Ingrowth of surrounding collagen and muscular tissue produced a firm union between the homologous material and the host tissue. The results of this study indicate that preserved human dura is an excellent material for closure of body wall defects. It appears to be well tolerated by host tissue and maintains its strength over prolonged periods of time.

Abdominal Muscles↗