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Biomedical subjects

J R Lilly

Publications and source records attributed to J R Lilly.

At least 91 records · Page 5Linked to original sources
PubMed1982

Esophageal endosclerosis in children with portal vein thrombosis.

During the past 3 2/3 yr, 6 children with portal vein thrombosis were treated for esophageal hemorrhage by direct injection of esophageal varices with sodium morrhuate (endosclerosis). Four children were actively hemorrhaging at the time of initial endosclerosis; 2 patients were treated electively. Endosclerosis was performed by (1) employment of an especially slotted rigid esophagoscope, (2) direct intravariceal injection, (3) injection of varices at the gastroesophageal junction only. In patients actively hemorrhaging, endosclerosis was repeated every 3 to 4 days until the bleeding ceased. Once bleeding was controlled the procedure was done at 6-wk intervals until esophageal varices were obliterated. In the four patients actively hemorrhaging, bleeding was controlled by 2 to 3 separate injection sessions. Four patients have completed treatment and varices are absent radiographically and endoscopically. No patient has rebled during or after treatment in follow-up from 1/6 to 3 2/3 yr. Esophageal endosclerosis is advocated as a legitimate alternative to portosystemic shunt operations and nonoperative management of esophageal variceal hemorrhage in children with portal vein thrombosis.

Adolescent↗
PubMed1982

Catheter decompression of hepatic portocholecystostomy.

Temporary catheter decompression of the gallbladder was employed in three infants having hepatic portocholecystostomy for biliary atresia. Postoperative biliary obstructive complications were avoided. A progressive increase in the calibre of the distal bile ducts was observed.

Bile↗
PubMed1982

The developmental status of children undergoing the Kasai procedure for biliary atresia.

Children with biliary atresia who have undergone the Kasai procedure suffer prolonged illness and recurrent hospitalizations, both of which may interfere with normal growth and development. The developmental status of 20 children with this disorder is described. The mean cognitive developmental quotient of the entire group of children was within the normal range. The mean motor developmental quotient was within the borderline normal range. The developmental test results suggested an interesting pattern of development including normal cognitive and motor development until the age of 6 to 8 months, followed by a decreasing rate of development between ages 8 and 24 months with the potential for improved developmental outcome at the age of school entry. The overall developmental status of these children was better than might be expected considering the numerous high-risk medical/surgical and social/emotional stresses that these children must face. The effort required in the care of children with this disorder certainly seems warranted by their subsequent developmental outcome.

Bile Ducts↗
PubMed1982

A dual approach to tracheobronchial foreign bodies in children.

From 1974 to 1980, 57 consecutive cases of children with tracheobronchial foreign bodies were treated by a new protocol in which peripherally located foreign bodies were treated nonoperatively and centrally located foreign bodies were removed bronchoscopically. Bronchoscopic removal was ultimately successful in all of the 29 children in whom the foreign body was located in the trachea or mainstem bronchus. There were eight minor complications, and in three instances it was necessary to repeat the bronchoscopy for retained fragments. In the other 28 children the foreign body was located in the segmental or lobar bronchi, and initial treatment consisted of a program employing inhalation bronchodilators, pulmonary drainage, and thoracic percussion. Treatment was successful (foreign body coughed out) in 18 patients (64%). Of the other 10 children subsequent bronchoscopy was successful in eight and failed in two patients. Of the latter patients, one required bronchotomy, and the other coughed out the foreign body. There were no deaths, major complications, or permanent pulmonary damage in either treatment series.

Adolescent↗
PubMed1982

The changing spectrum of pulmonary operations in infants and children.

During the 37 year period between 1943 and 1980, 68 pediatric patients underwent 86 major pulmonary resections during 73 separate operations. The surgical procedures included lobectomy (55), segmentectomy (25), pneumonectomy (three), and cyst excision (three). The 73 operations were performed for nontuberculous infection, congenital malformation, tuberculosis, tumor, obstructive lung disease, cardiac-related problems, immunologic disease, and trauma in decreasing order of frequency. The operative mortality was 4.4%; the disease-relate late mortality was 6.2%, due to either chronic respiratory failure or metastatic disease. Complications occurred in 21.9% of the operations. Only one death occurred during the last two decades, but the morbidity rate remained constant through all decades. Analysis by decade showed a striking change in the spectrum of pediatric pulmonary operations over the 37 year study period. Three major trends were identified: (1) Bronchiectasis and tuberculosis, once the major indications for pulmonary resection, have, from a surgical standpoint, virtually disappeared. (2) Congenital pulmonary anomalies now account for the majority of major pediatric pulmonary resections. As a consequence, the patient age at operation has steadily decreased, and pulmonary resections in infants (under 1 year of age) make up almost half of the surgical resections currently being done. (3) Despite the marked decline in the number of operations performed for infectious pulmonary disease, the total number of pulmonary operations in the pediatric age group has not decreased.

Adolescent↗
PubMed1981

Fat soluble vitamin deficiency in biliary atresia.

Between January 1973 and January 1980, 29 patients with biliary atresia treated by Kasai hepatic portoenterostomy were evaluated for deficiencies of vitamin A, D, and E. The mean vitamin A level in 11 patients with successful operations was 25.5 +/- 3.8 (SE) micrograms/100 ml whereas the level was 16.0 +/- 8.8 (SE) micrograms/100 ml in three patients with failed operations (normal: greater than 30 micrograms/100 ml). Vitamin E levels in 6 children (5 with sustained bile drainage) were 2.9 +/- 1.7 (SD) micrograms/ml (normal: greater than 4 micrograms/ml). Vitamin D deficiency was evaluated in 22 patients by serial radiographs of knees and wrists. Four children (18%) had pure osteomalacia and 13 children (59%) had combined osteoporosis and osteomalacia. The four oldest survivors (age 5-5.5 yr) resolved their bone disease without specific treatment. Serologic deficiencies of vitamins A and E and radiographic evidence of vitamin D deficiency exist in patients with biliary atresia despite operative establishment of bile flow. These deficiencies are present in both the younger and the older children. In the case of vitamin D, resolution may occur without specific treatment.

Bile↗
PubMed1981

Diagnosis of hepatobiliary disease in infants and children with Tc-99m-diethyl-IDA imaging.

Thirteen infants and children from 42 days to 14 years old with hepatobiliary disease underwent Tc-99m-diethyl-IDA hepatobiliary imaging. Five patients had biliary atresia, four had biliary hypoplasia, two had neonatal hepatitis, and there were single examples of alpha-1-antitrypsin deficiency and congenital hepatic fibrosis. Tc-99m-diethyl-IDA imaging accurately differentiated biliary atresia (complete bile duct obstruction) from other forms of childhood hepatobiliary disease by demonstrating no intestinal radioactivity in the former and the presence of intestinal radioactivity in the latter. In addition, two of four patients with biliary hypoplasia had nonhomogeneous parenchymal transit, and the one patient with congenital hepatic fibrosis showed possible intrahepatic cysts. In conclusion, these preliminary data indicate that Tc-99m-diethyl-IDA provides information not previously available with I-131-rose bengal; this information is likely to be useful in the noninvasive evaluation of childhood hepatobiliary disease.

Adolescent↗
PubMed1980

Copper kinetics in infantile hepatobiliary disease.

Copper metabolism was investigated in 33 infants with hepatobiliary disease. In 25 paients with biliary atresia, 37-135 days old, hepatic copper ranged from 5 to 133 microgram Cu/g wet weight (mean:43.3 microgram). In over two-thirds of the liver samples copper content was elevated above normal. There was no correlation between hepatic copper concentration and patients' age or degree of liver fibrosis. The mean hepatic copper content was also elevated in six infants with other hepatobiliary diseases (mean:41.6 microgram). Serial assays of copper excretion in bile were made in 25 infants having Kasai procedures for biliary atresia. The average daily excretion of biliary copper in 12 patients with successful operations was 3.3 to 33.7 microgram (mean:15.1 microgram), whereas in 13 patients without postoperative bile drainage, the daily values were 0.3-6.4 microgram (mean:2.7 microgram) (p < 0.0001). In five patients with active bile excretion who had repeated liver biopsies there was a steady decrease in hepatic copper concentration. The results indicate that derangement of copper homeostasis occurs frequently in infants with hepatobiliary disease and that in patients with biliary atresia successful reestablishment of bile flow effects a return toward normal copper metabolism probably because of enhanced biliary excretion.

Adolescent↗
PubMed1980

Common bile duct calculi in infants and children.

Of 62 infants and children undergoing biliary tract operations 4 had common bile duct stones. The primary diseases in the four patients were inspissated bile plug, correctable biliary atresia, neonatal hepatitis, and choledochal cyst, respectively. Biliary obstruction secondary to choledocholiths was total or near total in three patients. Nevertheless, diagnosis was unsuspected, leading to major delays in treatment and probably, irreversible liver damage in two patients. The stones were pigmented in all instances; their genesis believed to be a consequence of hemolysis in three patients and infection in one. Surgical extraction of the biliary calculi was successful by standard methods. All patients are currently alive; one by virtue of liver transplantation. Infants and children with chronic liver disease or biliary tract malformations are predisposed to formation of biliary calculi.

Adolescent↗
PubMed1980

Biliary atresia and the Kasai operation: continuing care.

Surgical intervention utilizing the Kasai hepatic portoenterostomy has improved the outcome of patients with biliary atresia and provided a population of patients with unique health problems. The clinical course of 21 children followed for three years or longer was reviewed, focusing on their medical management. Ten (47.6%) had successful bile drainage following surgery and experienced a number of specific problems including recurrent cholangitis, nutritional and growth deficiencies, delayed developmental landmarks, portal hypertension, osteomalacia and osteoporosis, and social and psychiatric difficulties. These complications responded to aggressive medical therapy and support. Although the overall three-year survival of this series was 38.1%, in children who were operated upon prior to 2 months of age and in whom the enteric conduit was externalized the three-year survival rate was 66.7%.

Bile Ducts↗
PubMed1980

Recognition of bilateral neonatal testicular torsion.

Two cases of bilateral neonatal testicular torsion are reported and combined with 6 previously reported ones. These infants with bilateral testicular torsion are compared with neonates with unilateral torsion. Both have similar signs and symptoms: (1) a swollen bluish-red firm scrotum at birth, and (2) no evidence of spontaneous pain. Infants in neither group had any systemic symptoms. Immediate investigation with reduction is mandatory to prevent testicular atrophy.

Humans↗
PubMed1980

Right trisegmentectomy for hepatic neoplasms.

Thirty patients had right trisegmentectomy for 19 primary hepatic malignant tumors, seven localized liver metastases and four benign lesions. A technical refinement that aided resection of bulky posterior and superior tumors was intrahepatic identification and control of the right hepatic vein. The operative mortality was 3.3 per cent. Late hepatic insufficiency was not observed. More than one-half of the patients operated upon a year or more ago for primary hepatic malignant growths had a tumor-free state at the 12 month follow-up period. Beyond this time, there was only one recurrence. The results in children were twice as good as in adults. The results in treating localized liver metastases from distant primary sites were inferior to those in treating primary hepatic tumors. A hypothetical case was made for combining hepatic resection with adjuvant chemotherapy, even though our experience could not be construed as direct support for this practice.

Adolescent↗