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Biomedical subjects

J R Lilly

Publications and source records attributed to J R Lilly.

At least 109 records · Page 6Linked to original sources
PubMed1979

Immediate operation for ectopia cordis.

Forty-one infants with thoracoabdominal ectopia cordis have been reported to date; 9 of them survived. Among the patients with an omphalocele as the abdominal wall defect, however, only 2 survived. Death in this group of patients occurred almost exclusively as a consequence of either attempted coverage of the heart or secondary to the associated intracardiac lesion. We report here the case of a patient recently treated in whom coverage with a temporary Silastic prosthesis protected the exposed heart from infection and rupture of the sac, thus permitting full cardiac investigation before operation.

Abdominal Muscles↗
PubMed1979

Surgery of coexisting biliary malformations in choledochal cyst.

Five of 13 infants and children with a choledochal cyst had coexisting biliary malformations. The specific lesions were main hepatic duct cyst (2), common hepatic duct stenosis (1), left hepatic duct stenosis (1), and Caroli's disease (1). The malformations were corrected or partially corrected at the time of operative resection of the cyst. The lateral portion of either or both of the major hepatic ducts was incised to the liver hilus thereby dividing areas of stenosis or laying open cystic malformations. Biliary reconstruction was by Roux-en-Y jejunostomy to the fileted common hepatic bile duct. The opportunity to correct coexisting biliary malformations is another advantage of total excision of choledochal cysts.

Adolescent↗
PubMed1979

Hepatic portocholecystostomy for biliary atresia.

Four infants with biliary atresia had gross obliteration of the common hepatic duct but residual patency of the gallbladder, cystic duct and common bile duct. The patients were treated by hepatic portocholecystostomy utilizing the extant bile ducts for biliary reconstruction. Bile drainage was achieved in all four infants. There was a conspicuous absence of postoperative cholangitis. Subsequent obstruction of the distal ducts in two patients necessitated reoperation and construction of a standard biliointestinal conduit. The other two children are surviving, jaundice-free, 5 1/2 and 5 years after operation with minimal sequelae of biliary atresia. Hepatic portocholecystostomy is a feasible surgical alternative to intestinal reconstruction in patients with biliary atresia in whom the disease is limited to the proximal extrahepatic bile ducts.

Bile Ducts↗
PubMed1979

Determinants of survival after Kasai's operation for biliary atresia using actuarial analysis.

Survival after Kasai's operation for "noncorrectable" biliary atresia is influenced by (1) age, (2) large bile ducts, and (3) concentration of the bile bilirubin. Critical values are: age less than 10.5 wk, any evidence of a large bile duct, and a bile bilirubin concentration greater than 8.8 mg/100 ml. Using these 3 factors, a predictive model is able to identify a favorable group with an 89% expected 4 yr survival.

Actuarial Analysis↗
PubMed1979

Surgical lesions of the colon in the hemolytic uremic syndrome.

Hemolytic uremic syndrome (HUS) is characterized by hemolytic anemia, thrombocytopenia, and acute renal failure, usually in children under 10 years of age. Gastrointestinal symptoms, including abdominal pain and bloody diarrhea, frequently precede the onset of renal failure. It has not been generally appreciated that the intestinal disease process may proceed to frank ischemic lesions of the colon requiring surgical intervention. An illustrative patient is presented in whom total infarction of the descending colon occurred. The patient represents the fourth reported case of surgical colonic disease as a consequence of the hemolytic uremic syndrome.

Adolescent↗
PubMed1979

The surgical treatment of choledochal cyst.

Eleven consecutive infants and children with choledochal cyst were evaluated for operative resection of the cyst as the primary surgical therapy. Total excision and biliary reconstruction by choledochojejunostomy was successfully performed in nine patients. Simple intestinal drainage of the cyst was used in two instances because of severe liver disease. Four patients had coexisting biliary malformations. In all five infants, biopsy of the liver was consistent with biliary atresia. In addition, the extrahepatic bile ducts proximal to the cyst were obliterated in two infants. The findings suggest that pathogenesis of choledochal cyst may be different in infants than in older children. The indications for excision of the cyst in four patients were due to complications from earlier internal drainage procedures. In most patients, including all those having had a cystoenterostomy earlier, resection was done from the inside of the cyst, thus minimizing the danger of injury to the neighboring vascular structures. There were no operative deaths, and morbidity was minor. The traditional operation for a choledochal cyst has been internal drainage of the cyst into the intestine. Because of the high incidence of late complications and the frequent association of major co-existing biliary malformations, the procedure should be reserved for highly specific indications. Total surgical excision is the procedure of choice for a choledochal cyst.

Adolescent↗
PubMed1978

Identification, quantification, and significance of bacterial growth within the biliary tract after Kasai's operation.

Cholangitis is a universal complication of successful hepatic portoenterostomy for biliary atresia. In this study 283 bacteriologic cultures were obtained from 19 patients during a 23-mo period. All bilioenteric conduits were colonized with colonic flora by 1 mo after operation. Cholangitis was characterized by fever and a decrease in bilirubin clearance, but not by a change in the number of different types of bacteria nor a change in the total bacteriologic concentration within the conduit. No overall antibiotic effect on the flora could be found. Cholangitis remains a condition that is necessarily treated empirically.

Anti-Bacterial Agents↗
PubMed1978

Paracentesis and lavage for diagnosis of intestinal gangrene in neonatal necrotizing enterocolitis.

A study to evaluate peritoneal fluid as an index of intestinal gangrene in infants with necrotizing entercolitis (NEC) was begun in 1974. Twenty samples of peritoneal fluid were obtained by paracentesis or lavage from 15 infants with nonperforated NEC. A brown color in the peritoneal fluid was noted in all 8 patients found to have intestinal gangrene at subsequent operation. Gram stain showed bacteria in 6 of these 8 patients and bacterial cultures were confimatory in all but one. In 12 samples of peritoneal fluid in patients without intestinal gangrene, the fluid was straw-colored or pink and Gram stain showed no bacteria. The decision to operate on an infant with intestinal gangrene and impending perforation may be aided by analysis of the peritoneal fluid.

Ascitic Fluid↗
PubMed1977

Alpha1-fetoprotein in neonatal hepatobiliary disease.

It has been suggested that the quantitative estimation of serum alpha-1-fetoprotein may help in distinguishing the neonatal hepatitis syndrome from biliary atresia. We measured the serum AFP concentration in 52 neonates and infants with various hepatobiliary disorders, including neonatal hepatitis syndrome (group I), biliary atresia (group II), and other hepatopathies such as choledochal cyst (group III). The mean serum AFP concentration in patients with neonatal hepatitis was significantly greater than the mean concentration in the other two groups. There was no significant difference between the mean serum AFP concentrations in patients with biliary atresia and in group III patients. Patient age was noted to be an important factor: Serum AFP levels greater than 35 microgram/ml in infants one to four months of age suggpst the diagnosis of neonatal hepatitis syndrome. Serum AFP levels below 10 microgram/ml in infants less than four months of age suggest the diagnosis of biliary atresia or hepatopathies other than neonatal hepatitis. However, the variable and significant overlapping of serum AFP values between 10 and 35 microgram/ml limit the diagnostic value of this test.

Biliary Tract↗
PubMed1977

Surgical jaundice in infancy.

The surgery of congenital malformations of the biliary system has undergone a revolutionary change during the past decade. Although Kasai's hepatic portoenterostomy operation for biliary atresia is the most dramatic example, radical departures from conventional surgical treatment also have been advocated for choledochal cyst, Caroli's disease, congenital perforation of the bile ducts and biliary hypoplasia. This communication describes the lesions responsible for obstructive jaundice in the early months of life, briefly reviews standard treatment and consolidates the available information about the new operative procedures currently proposed for congenital anomalies of the biliary tract.

Bile Ducts↗