Irrigation of the peritoneal cavity for appendicitis in children: a double-blind study.
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Biomedical subjects
Publications and source records attributed to J O Sherman.
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Twenty-seven infants from 1 day to 9 months of age with severe intractable diarrhea were fed an oral elemental diet (Vivonex) consisting of crystalline amino acids, glucose, electrolytes, and vitamins by continuous nasogastric drip. Complete control of diarrhea was achieved in 24 patients (89 percent) who had an average weight gain of 28 gm/day. Nitrogen balance and plasma amino acids were measured in five patients while they received 2.25 gm of amino acid/kd/day for two weeks and 4.58 gm of amino acid/kg/day for two weeks; the nitrogen balance and weight gain in three patients was proportional to the amino acid intake. When compared to normal levels, plasma amino acids were not appreciably increased with the lower amino acid intake. With the higher amino acid intake, there were significant increases in plasma values for 11 amino acids.
In 1948 one of us (O.S.) proposed a new method of treatment, abdominoperineal resection, for patients with congential megacolon. Since then, 483 patients have been treated by 13 pediatric surgeons in Chicago and Boston using this technique. Two hundred and eight-two of the patients were last interviewed and examined more than 5 years after the resection. There were 16 postoperative deaths (3.3%) and 6 late deaths (1.2%) from enterocolitis. Both early and late complications were infrequent and are discussed in detail. Almost 90% of the patients reported that they now have normal bowel habits. None of the patients developed urinary incontinence or impotence, although ten patients (2.1%) reported permanent fecal soiling. This is the first large group of patients treated for congenital megacolon who have been followed to adulthood. The low incidence of postoperative complications and minimal frequency of long-term complications indicate that the abdominoperineal resection is a safe, effective method of treatment for congenital megacolon.
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