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Biomedical subjects

J L Ternberg

Publications and source records attributed to J L Ternberg.

At least 37 records · Page 2Linked to original sources
PubMed1986

Postsplenectomy sepsis and other complications following staging laparotomy for Hodgkin's disease in childhood.

This is a survey of 234 pediatric patients in whom staging laparotomy/splenectomy was carried out (1975 to 1981) in the course of the Intergroup Hodgkin's Disease in Childhood Study (IHDCS). Relapse has occurred in 44 of these patients, and 12 have died, 7 secondary to extension of lymphoma, 2 with herpes or pneumocystis infections, 2 with leukemia, and 1 from an unrelated accident. During the period of surveillance (mean 5.5 yr), five episodes of bacterial sepsis (positive blood cultures) have occurred, including two due to Streptococcus pneumoniae; and three, to Hemophilus influenzae. The former occurred in the small group of patients in this series who had not received the prescribed pneumococcal vaccination. No fatalities were associated with these septic episodes. Intestinal obstruction secondary to adhesions (benign) occurred in eight patients and was managed without intestinal resection or mortality. One patient required operative release of an obstructed ureter following laparotomy, and one, oophorectomy for an infarcted (transposed) ovary.

Adolescent↗
PubMed1985

Intestinal perforations by tube feedings in small infants: clinical and experimental studies.

The clinical and radiographic findings of eight low-birth-weight neonates (mean, 900 g) with perforations of the duodenum or jejunum associated with transpyloric feedings are reported. In four patients, the perforations occurred distal to any known tube position. In experimental studies in young rabbits, Silastic or polyvinyl chloride tubes were sewn in place with the tube tips in the proximal duodenum or proximal jejunum, and either normal oral feedings or feedings through the tubes were given. Perforations and gross or microscopic abnormalities of the bowel mucosa in the area of the tubes and beyond were more frequent in rabbits with tube feedings than those given normal oral feedings. It appears that tube feedings induce some degree of mucosal damage and contribute to bowel perforation.

Animals↗
PubMed1984

Surgical treatment of idiopathic hyperinsulinemic hypoglycemia in children. First successful subtotal pancreatectomy with preservation of spleen reported by Evarts A. Graham (1934).

The first successful subtotal pancreatectomy for idiopathic hypoglycemia in a child was performed by Dr. Evarts Graham in 1934. He did an extended resection and preserved the spleen. Although both of these aspects of the operation are now identified as important principles, it is apparent from a review of the literature that their importance was not recognized for many years.

Child↗
PubMed1984

Complications related to 234 staging laparotomies performed in the Intergroup Hodgkin's Disease in Childhood study.

This is a study of 234 children and young adult patients entered in the Intergroup Hodgkin's Disease in Childhood (stage I-II) Study from November 1975 to June 1981 and followed for a mean of 3.8 years after laparotomy. All patients had a staging laparotomy with total splenectomy, liver biopsy, and sampling of abdominal lymph node groups. Four patients (1.7%) have had documented sepsis, and three have had possible sepsis. There has been no sepsis-related death. Intestinal obstruction requiring operation was noted in four patients (no intestinal resection required). Urgent operation was necessary in two patients, one with ureteral obstruction and one with ovarian torsion, following a repositioning procedure, neither of these patients died. Organisms in the four patients with positive blood cultures were Streptococcus pneumoniae (two) and Haemophilus influenzae (two). Of the 234 patients in the study, 194 (83%) had received polyvalent pneumococcal vaccine, and 174 (74%) were taking prophylactic antibiotics. One of the two patients with pneumococcal sepsis had not been vaccinated, and the second was vaccinated only during radiotherapy. Only one of the four patients with positive blood cultures was on a prophylactic antibiotic treatment regimen at the time of the septic episode. The liabilities in employing laparotomy-splenectomy for the evaluation of pediatric patients with Hodgkin's disease include both general surgical complications and an increase in the risk of hyperacute infection, specifically related to encapsulated species. The latter appears to be modified to a major degree by current prophylactic measures or therapy.

Adolescent↗
PubMed1983

Surgical mortality and morbidity in extremely low-birth-weight infants.

Twenty extremely premature infants (birth weight, less than 1,100 g) underwent 49 surgical procedures for acquired conditions, including necrotizing enterocolitis, other forms of gastrointestinal perforation, gastroesophageal reflux, patent ductus arteriosus, and hydrocephalus. Few congenital anomalies requiring operation were encountered in this group. The overall survival rate was 58%. Using a computerized data base to compare surgical patients with a weight-matched group of nonsurgical patients, it was shown that survival was similar and that adverse prenatal and perinatal influences were equally distributed between both groups. Surgery per se did not adversely influence survival in extreme low-birth-weight infants, and surgical patients are not a preselected group of stronger infants.

Birth Weight↗
PubMed1983

Compliance with staging laparotomy in the Intergroup Hodgkin's Disease in Children Study: a preliminary report.

The intergroup Hodgkin's Disease in Children Study was designed to determine minimum effective treatment for stage I and II Hodgkin's disease in children up to 18 years of age. Accurate staging of the disease was therefore critical. The number of cases in which the surgeons adhered to the principles and details of the protocol staging laparotomy were less than anticipated during the first 3 years of the study. Improvement in protocol compliance increased as the study progressed. The educational efforts by cooperative groups are credited with initiating this improvement.

Adolescent↗
PubMed1983

Sodium needs of infants and children with ileostomy.

We studied gastrointestinal tract excretion of sodium and water in seven infants with an abdominal ileostomy (group 1) and three children with a Soave ileoendorectal pull-through (group 2). When the daily sodium intake of the patients was 5 to 7 mEq/kg (twice usual maintenance), average daily ileal sodium losses were 2.4 mEq/kg body weight in group 1 and 3.3 mEq/kg in group 2. Ten days after ileostomy closure in group 1, when the infants' daily sodium intake averaged 2 to 3 mEq/kg/day, gastrointestinal tract sodium losses were reduced to 0.3 mEq/kg body weight/day. The mean daily fecal weight and water also decreased after closure. Mean serum aldosterone concentration before closure was 84 ng/ml, and declined to 58 ng/100 ml after closure; and mean plasma renin values fell from 8.8 to 2.9 ng/ml/hr. In the children with an ileoendorectal pull-through, daily sodium intake was restricted to 0.3 to 0.5 mEq/kg/day, an amount that would maintain balance in a child of similar age with normal sodium conservation. Mean serum aldosterone concentration increased to 501 ng/ml (normal 1 to 22.7). Although renal conservation of sodium occurred promptly, gastrointestinal losses of sodium and water continued and the patients' sodium balance became negative. The diet of a patient with an ileostomy should include increased amounts of sodium until bowel continuity is restored.

Aldosterone↗
PubMed1982

Appendectomy in childhood. Analysis of 105 negative explorations.

Laparotomy with a preoperative diagnosis of acute appendicitis disclosed a normal appendix in 105 children (22.1 percent). In less than half of these, another condition was found or later identified, which explained the symptoms leading to operation. Ovarian lesions, acute ileocolitis, and serositis were the most frequently identified abnormalities. Twelve patients (11 percent) underwent definitive procedures in addition to appendectomy. Among patients in whom no abnormality was identified at laparotomy, peritoneal cultures yielded a broad range of organisms in 42 percent of those who had cultures. This may represent a mild form of acute primary peritonitis and may explain the symptoms which were confused with acute appendicitis.

Adolescent↗
PubMed1982

Clinical and histologic indications for extensive pancreatic resection in nesidioblastosis.

Nine children with nesidioblastosis underwent pancreatic resection at St. Louis Children's Hospital. Four of these underwent 99 percent of near-total resection. Only one child required permanent insulin therapy postoperatively. Pathologic examination of the resected pancreases revealed a diffuse disturbance of the pancreatic architecture. Prolonged hypoglycemia can have devastating neurologic sequelae. Based on clinical experience and the pathologic demonstration of a diffuse process in the affected pancreas, it is advocated that near-total (99 percent) pancreatectomy is the primary procedure of choice for this disease.

Female↗
PubMed1982

Ileal dysgenesis in infants and children.

Ileal dysgenesis describes the segmental dilatation of the terminal ileum treated in seven patients presenting from birth to 15 yr. Manifestations included saccular segmental ileal dilatation adherent to the peritoneal surface of an omphalocele sac in two neonates, a radiographically delineated enterolith in a child studied for an unrelated disorder, and a syndrome including pallor, fatigue, and anemia in four children aged 10 to 15 yr. Literature review uncovered 11 similar patients to 38 yr of age. Other symptoms in that group included intestinal obstruction and recurrent abdominal pain. At laparotomy all patients were found to have segmental saccular or tubular dilatation of the terminal ileum. The dilated segments varied in length from 8 to 25 cm. Meckel's diverticula were present in two patients. Segmental resection and anastomosis was performed in all patients. No lumenal stenosis was present in any specimen to account for the dilatation. Previous reports have referred to this abnormality as "giant Meckel's diverticulum" or "segmental ileal dilatation." Evaluation of these 18 patients suggests that this entity is an intrinsic abnormality of ileal development at the morphologically active site of juncture with the yolk stalk.

Adolescent↗
PubMed1982

Ventilatory support and primary closure of gastroschisis.

Recent clinical reports suggest that the majority of neonates with gastroschisis are best managed with a silon pouch technique. Our results with primary closure and short-term ventilatory assistance show a survival rate equal to that of the silon pouch technique. In addition, multiple operations and the chances of complications related to the pouch are avoided. No complications relating to the ventilatory assistance were encountered. Better pediatric ventilators and improved pediatric respiratory management allow this technique to be used for gastroschisis now, whereas 10 years ago the complications ith neonatal ventilators may have outweighed the morbidity of the silon pouch.

Abdominal Muscles↗
PubMed1981

Controversial aspects of appendicitis management in children.

The areas of controversy in appendicitis management in children include antibiotic usage, drainage of the peritoneal cavity, and closure of contaminated incisions. Our results and bacteriologic data suggest that gentamicin sulfate and clindamycin phosphate should be routinely used in cases of suspected perforation, that only selective and limited use of drains is warranted, and that delayed primary closure should be used in all cases with perforation.

Adolescent↗
PubMed1981

Perforated stress ulcers in infants.

During a 5-yr period, 10 infants less than 1 yr of age developed gastroduodenal perforation during treatment for severe underlying illness. Brisk gastrointestinal hemorrhage preceded perforation in most patients. In contrast to stress ulceration in adults, infants appear to have a higher frequency of single ulcers, perforation, and duodenal (rather than gastric) location. The mortality of 40% in this group, and in those patients reported in the literature who have been treated since 1960, implies that effective preventive and therapeutic measures are not yet available and also emphasizes the serious nature of the underlying disorder.

Duodenal Ulcer↗
PubMed1981

Diagnostic value of the white blood count and neutrophil percentage in the evaluation of abdominal pain in children.

Only 15 of 382 patients with appendicitis had a normal white blood count and neutrophil percentage. Abnormal counts are nonspecific and are elevated in other inflammatory conditions, such as those which are observed in the patients of group 2. A much higher number of patients with negative laparotomy findings had both a normal white blood count and neutrophil percentage. The real value of the white blood count and neutrophil percentage is in selecting patients who can be observed safely rather than undergoing operation. This may decrease the incidence of negative exploratory findings. It is essential to give priority to the physical findings and to use the white blood count and neutrophil percentage only as part of the over-all clinical evaluation.

Abdomen↗
PubMed1980

The microbial flora and antimicrobial therapy of neonatal peritonitis.

Data from 31 infants with gastrointestinal perforation were analyzed to determine the microorganisms usually present in the peritoneum and blood, and the antibiotic susceptibility of those organisms. Multimicrobial contamination of the peritoneal cavity was present in over one-half of the patients and 23% were found to have mixed aerobic-anaerobic peritoneal flora. Most common organisms were E. coli and Bacteroides species. Blood cultures were positive in 32% of patients, most frequently growing E. coli. Among numerous antibiotics tested, only gentamicin was effective against all Enterobacteriaceae isolated. Clindamycin was 99% effective against Bacteroides species isolated and 90% against other anaerobes. Group D streptococcus was the most frequently isolated gram positive aerobe. Based on these findings, empiric therapy with ampicillin, gentamicin and clindamycin is recommended for neonates with gastrointestinal perforation. Adjustments in therapy for individual patients should be based upon culture and sensitivity data.

Anti-Bacterial Agents↗