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Biomedical subjects

J R Lilly

Publications and source records attributed to J R Lilly.

At least 127 records · Page 7Linked to original sources
PubMed1976

Segmental lung resection in the first year of life.

Segmental lung resection was performed in 5 infants with congenital lung disease. The lesions were cystic adenomatoid malformation in 2, congenital cystic disease in 2, and congenital lobar emphysema in 1. A higher than expected incidence of major segmental bronchovascular anomalies was encountered (3 of 5 patients). Other than prolonged air leak in 1 patient, complications were negligible. All patients were well from one to six and one-half years after operation. Segmentectomy is a sensible operation for congenital pulmonary disease and ultimately may have as its greatest virtue the preservation of normal lung tissue.

Bronchi↗
PubMed1976

Biliary lipid excretion after hepatic portoenterostomy.

Since 1974, 16 consecutive infants with biliary atresia have been treated by hepatic portoenterostomy employing an exteriorized Roux-en-Y intestinal segment (Miluliez). Simultaneous, sequential analyses of bile pigments and lipids in serum and biliary drainage were performed. In the 11 patients with sustained bile drainage, progressive increases in bile volume, bilirubin and biliary lipid concentrations correlated well with their subsequent return toward normal in the serum. Despite relief of biliary obstruction, four patients have had progressive liver cirrhosis. The other 7 have residual liver damage which has been stable, or in two instances, improved, at late biopsy. The clinical and biochemical results suggest that both obstructive and parenchymal factors are operative in infants with biliary atresia.

Bile↗
PubMed1975

Split portal flow in heterotopic hepatic transplantation.

Heterotopic hepatic transplantation was carried out in 31 pigs using three different methods of homograft revascularization. In one experimental group the host portal inflow was split between the homograft and native liver so that the graft was provided with intestinal-pancreatic effluent; the host liver with gastric-splenic venous blood. The liver grafts flourished in this environment. A small and variable degree of atrophy took place in the host liver. In the other two experimental groups in which the grafts were supplied with different kinds of systemic inflow only, atrophy invariably followed. Long-term homograft analysis was prevented by the intensity of immunologic rejection regardless of the location of the ectopic liver. The implications for clinical auxiliary liver transplantation are (1) heterotopic liver homografts must be supplied with a portal inflow from the host splanchnic bed, but (2) the total host splanchnic effluent is unnecessary. (3) The portal inflow must contain the pancreatic venous blood. (4) There is a criticial recipient--donor size relationship for successful portal revascularization in this type of auxiliary hepatic graft.

Animals↗
PubMed1975

Bench surgery and renal autotransplantation in the pediatric patient.

A new operative procedure in renal surgery has evolved from the extensive recent experience in kidney transplantation. Bench surgery and autotransplantation have not been, as yet, fully exploited by surgeons caring for children. This approach to reconstruction of renal substance and renal vessels has as its greatest dividend conservation of kidney tissue. The operation has specific applicability for selected cases of: (1) renovascular hypertension; (2) congenital obstructive uropathy; (3) bilateral Wilms' tumor, and; (4) renal trauma in children.

Adult↗
PubMed1975

Ongoing cirrhosis after successful porticoenterostomy in infants with biliary atresia.

Thirty-one patients were treated by portoenterostomy procedures for extrahepatic biliary atresia. In 20, there was unequivocal evidence of bile drainage. Eleven of these 20 were restudied from 3 to 23 mo postoperatively by liver biopsy. The clinical condition of most of these infants was satisfactory. Despite absence of clinical jaundice, normal rose bengal scan, and normal liver function studies, eight showed progressive degrees of hepatic fibrosis when compared to the results of the biopsy taken at the time of portoenterostomy. Two patients showed stable histology and one, after progressing on a second biopsy, had normal liver histology on a third study. The implications of progressive hepatic histopathology despite bile drainage are discussed.

Bile Ducts↗
PubMed1975

Peptic ulcer in children with gastric tube interposition.

An infrequent, but potentially serious, complication of gastric tube interposition is ulceration within the conduit. It is important, therefore, to recognize ulcer formation in its early stages by serial radiographs throughout the childhood years. While redundancy and partial obstruction with impaired drainage of the tube appear to be etiologic factors, distension of the transposed antrum may lead to hyperacidity and may play a role in ulcerogenesis. A course of dietary and antacid therapy may heal the ulcer, but surgical revision of the tube may prove necessary.

Burns, Chemical↗
PubMed1975

The Japanese operation for biliary atresia: remedy or mischief?

A case illustration is given of an infant with biliary atresia who had the Kasai operation more than 1 1/2 years ago and is now, by all biochemical and histological criteria, cured. The early results with this operation in 14 patients are similar to those reported by the Japanese, that is, 25% have had sustained postoperative bile drainage. Success has never been achieved in infants older than 4 months. A long-held notion in this country to withhold operation in infants with jaundice until after 4 months has thus far militated against a critical and impartial evaluation of the Kasai operation. A plea is made to complete diagnostic work-up for jaundice during the first months of life so that the operation, if elected, may have a genuine chance for legitimate long-term analysis.

Age Factors↗
PubMed1975

Hepatic portoenterostomy (the Kasai operation) for biliary atresia.

Twenty-two infants and children with extrahepatic biliary atresia were treated by Kasai's hepatic portoenterostomy operation since 1972. Postoperative bile drainage occurred in 11 infants. Success never was obtained in patients older than 12 weeks nor in the absence of microscopic biliary ductules in the excised fibrotic remnant of the extrahepatic bile ducts. With these exclusions almost 90 percent of infants with biliary atresia had sustained bile drainage after operation. In the early cases, ascending cholangitis was a major and recurrent complication with sequellae in many instances of permanent jaundice and probably irreversible liver damage. A new and simple modification of Kasai's original operation has prevented this complication thus far. Despite apparently normal bile drainage, postoperative studies by transhepatic cholangiography in some of these patients have demonstrated a grossly abnormal hepatobiliary intrastructure, suggesting that an underlying liver involvement may be present in biliary atresia.

Biliary Tract↗
PubMed1975

Technical details in the surgical correction of extrahepatic biliary atresia.

As in any new operation, what appear to be minor variations in surgical methods may be crucial to the success or failure of the procedure. Extended biliary drainage has been achieved in infants with extrahepatic biliary atresia by adherence to the details of the surgical technique just described. To date, results appear to be better in those infants having the definitive operation at the time of the initial exploration. Consequently, it appears that surgeons undertaking operative exploration should be able to carry out the porticoenterostomy procedures.

Biliary Tract↗
PubMed1975

Gastric outlet obstruction due to X-linked chronic granulomatous disease.

Children with chronic granulomatous disease (CGD) may develop a peculiar form of gastric outlet obstruction due to involvement of the stomach wall with granulomatous tissue. An illustrative case is presented (which occurred despite adequate control of infection with antibiotherapy), including details of surgical management, distinctive radiographic and pathologic findings, and a review of other reported cases.

Anti-Bacterial Agents↗