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Biomedical subjects

J R Wesley

Publications and source records attributed to J R Wesley.

At least 37 records · Page 2Linked to original sources
PubMed1988

Rationale and guidelines for parenteral and enteral transition feeding of the 3- to 30-kg child.

To provide optimal nutrition support for the pediatric patient in transition from parenteral to enteral support, the clinician must select an appropriate formula, design a feeding regimen, and taper the parenteral support accordingly. Formula selection is based on the child's age, any overriding disease entity, and the caloric density, osmolarity, carbohydrate and fat source, protein content, and nutrient complexity of the formula. The feeding regimen is designed to allow for adaptive increases in digestive enzymes and digestive surface area within the gut. Small advances in volume are made first; increases in concentration of the formula follow. A systematic, six-step method for the progression of enteric support and the tapering of parenteral support provides the clinician with guidelines for managing this interval.

Body Weight↗
PubMed1986

Gastroesophageal reflux in children: is there a place for the upper gastrointestinal study?

Objective tests for gastroesophageal reflux in children have shown only fair correlation with clinical symptoms. Thirty-four children referred to the pediatric surgery service for evaluation of gastroesophageal reflux had both 24-hour pH probe monitoring and standardized upper gastrointestinal examinations. A total of 16 children (47%) had documented significant or pathologic gastroesophageal reflux, 11 on pH monitors and 9 on contrast examinations. There were 4 in whom both tests were positive. None of the pH monitoring criteria correlated with the radiographic studies. The patient population documented by contrast study did not differ from the general test-positive population by age or associated clinical findings. The 2 studies probably measure different aspects of significant gastroesophageal reflux, are confirmatory and complementary, and must be correlated with the clinical symptoms.

Adolescent↗
PubMed1986

Sonography of ruptured appendicitis.

Three girls and 4 boys with the final diagnosis of ruptured appendicitis underwent 19 sonographic studies, 5 before any therapy was instituted and 14 follow-up studies. Four abscesses identified before treatment and 2 seen postoperatively were ovoid, irregularly marginated, and contained low-amplitude echoes. Gastrointestinal ileus with gas-and fluid-filled loops of bowel made the studies technically difficult. Follow-up studies also showed fluid collections distant from the original abscesses. The complete resolution of the abscess was followed sonographically in 1 patient treated with antibiotics. Ultrasound can be useful in confirming or suggesting the diagnosis of ruptured appendicitis in the child with abdominal pain, but careful attention to detail is necessary in these technically difficult studies.

Abscess↗
PubMed1986

Diagnosis and management of congenital cystic disease of the lung in children.

Pulmonary sequestration, congenital adenomatoid malformation (CAM), congenital lobar overinflation (CLO), and bronchogenic cysts are four congenital lesions that may present as abnormal cystic areas within the pleural cavity in early life. They share similar clinical and embryologic characteristics, are frequently difficult to diagnose, and all require surgical treatment. From December 1974 to January 1985, 22 patients were operated upon on the Pediatric Surgical Service for congenital cystic disease of the lung. There were eight females and 14 males, ranging in age from 1 day to 18 years; 12 were under 6 months of age, and 14 were under one year. There were 7 CAMs, 5 extralobar pulmonary sequestrations, 5 intralobar pulmonary sequestrations, 3 bronchogenic cysts, and 3 cystic lobes caused by CLO. One patient had bilateral pulmonary sequestrations, intralobar on one side and extralobar on the other, with both sharing a common systemic artery arising from the infradiaphragmatic aorta. All except two asymptomatic patients presented with either progressive respiratory distress or recurrent pulmonary infections, and had cystic changes noted on chest roentgenograms. The differentiation of these congenital lesions from resolvable inflammatory cysts is important. Diagnosis was aided by selective utilization of barium contrast studies, ultrasonography, computed tomography, and arteriography. Operation consisted of resection alone of the extralobar pulmonary sequestrations and bronchogenic cysts, and total lobectomy in CAM, intralobar sequestration, and CLO. One infant with CAM died 1 day postoperatively from bilateral hypoplastic lungs. The other 21 patients are alive and well with follow-up ranging from 1 month to 9 years, with a mean of 3.5 years.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1986

Fifty years' experience with esophageal atresia and tracheoesophageal fistula. Beginning with Cameron Haight's first operation in 1935.

Four hundred twenty-six patients with esophageal atresia with or without tracheoesophageal fistula have been primarily cared for at the University of Michigan Medical Center since Cameron Haight's initial experience with this entity. Over the period of observation, the incidence of new cases as well as the number of associated anomalies has remained constant. The long-term survival of these patients has steadily improved over the past half-century from 36% in the pre-1950 era to 84% during the most recent 20 years. Conversely, operative mortality has shown a progressive decline from 56% early in the authors' series to 6.9% more recently, despite a steady increase in the proportion of high-risk neonates seen at the University of Michigan Medical Center during this time span. In the last 9 years, there have been no postoperative deaths in group A or B risk infants (36 patients), while the rate has been 18.2% in group C risk babies (27 patients); almost all of these deaths were due to severe associated anomalies. During the last 10 years, the authors have changed their technique of anastomosis from a two- to a one-layer method while still advocating a primary repair via an extrapleural approach. Although this change has resulted in a modest increase in the rate of anastomotic leak (17% vs. 6.2%, p less than 0.03), the leaks have been small and asymptomatic because of the extrapleural approach and, as a result, have been managed conservatively without any untoward sequelae. Conversely, there has been a significant decrease in the rate of stricture formation with the one-layer anastomosis (4.3% vs. 23.3%, p less than 0.002). While this may in part be explained by the change in anastomotic technique, it is felt that the more aggressive diagnosis and surgical management of gastroesophageal reflux (seen in 37.9% of our recent group) have contributed greatly to this decrease. The steady improvement in survival over this 50-year period, in spite of the increasing number of high-risk infants, is attributable to major improvements in neonatal care before, during, and after operation.

Esophageal Atresia↗
PubMed1985

Long-term survival of dogs maintained solely on intraperitoneal nutrition.

Total intraperitoneal nutrition (IPN) for patients in whom enteral nutrition is impossible would utilize the access techniques of peritoneal dialysis and avoid long-term central venous cannulation. We previously demonstrated that a lipid emulsion was quantitatively absorbed from the dog's peritoneal cavity over four hours. We have now investigated the efficacy of total IPN in dogs over periods up to four weeks. A solution of 1.25% amino acids, 1% glucose, 77 mEq/L Na, 4 mEq/L K, and 81 mEq/L Cl (AGE) was administered IP at 65 mL/kg every 12 hours in combination with 25 mL/kg of 20% lipid emulsion to five dogs allowed free access to food and water for ten days. Sixty percent of administered fluid was absorbed. When AGE and lipid were administered separately every 12 hours to six dogs, 90% was absorbed. In five dogs kept strictly NPO for two weeks while receiving alternating AGE and lipid, absorption averaged 60%. Removing the amino acids allowed absorption to remain at 70% for two weeks, although it dropped to 40% by four weeks. Nine dogs were maintained for a mean of 3.5 weeks while strictly NPO using a solution of 1% glucose and electrolytes at 120 mL/kg every 12 hours with 50 mL/kg of 20% lipid given at a third separate infusion. During the fourth week, they absorbed 118 mL/kg/24 hours of fluid and 26 calories/kg/24 hours. Body weight decreased to 75% of control over four weeks. Complete blood cell count (CBC), Na, K, Cl, total protein (TP), SGOT, and alkaline phosphatase (AP) remained unchanged during this time.(ABSTRACT TRUNCATED AT 250 WORDS)

Absorption↗
PubMed1985

Achalasia in children: treatment by anterior esophageal myotomy (modified Heller operation).

Although rare in children, achalasia can be the cause of debilitating symptoms and growth retardation. During a 4-year period, six patients (mean age 9.9 years) underwent a modified Heller operation (anterior esophageal myotomy) without complication. A concomitant modified Belsey fundoplication was performed in three patients who were judged at the time of operation to be at high risk for postoperative gastroesophageal reflux. Preoperative symptoms of dysphagia, postprandial vomiting, retrosternal pain, and pulmonary complications were eliminated in all patients. Follow-up interviews seven to 48 months (mean 23 months) following operation revealed normal diet and normal growth in all six children, with no recurrence of preoperative symptoms or evidence of gastroesophageal reflux. Technical details which we believe contribute to success in the operative management of pediatric achalasia include the transthoracic approach and the selective performance of complementary anti-reflux procedures.

Adolescent↗
PubMed1985

Venovenous perfusion in ECMO for newborn respiratory insufficiency. A clinical comparison with venoarterial perfusion.

Venoarterial (VA) extracorporeal membrane oxygenation (ECMO) has been successful in the treatment of newborns less than 1 week of age and greater than 2000 gm birthweight with respiratory failure resistant to current medical and surgical management. While VA ECMO supports the heart as well as the lungs, it has the disadvantage of requiring carotid artery ligation and the possibility of perfusing air bubbles or particles into the arterial tree. We have treated 11 newborns with respiratory failure with venovenous (VV) ECMO returning the oxygenated blood to a cannula in the distal iliac vein. We compared these patients with 16 patients treated during the same period of time with VA ECMO. Three of the 11 VV patients required conversion to VA ECMO because of inadequate oxygenation and unstable hemodynamic situations. Ten of the 11 VV patients survived. Eleven of the 16 VA patients survived. The better survival in these patients treated with VV ECMO is attributed to their more favorable initial condition compared to patients treated with VA ECMO. The disadvantages of VV ECMO include a longer operative time to place the cannulas, groin wound problems, and persistent leg swelling along with the necessity to convert some patients to VA ECMO. Although this experience demonstrates that newborns with severe respiratory failure can be supported with VV ECMO, the complications and lack of practical advantages over VA lead us to recommend VA ECMO for routine clinical use at present.

Female↗
PubMed1985

A ten-year experience with ninety-two cases of Hirschsprung's disease. Including sixty-seven consecutive endorectal pull-through procedures.

From July 1974 through November 1984, 92 patients with Hirschsprung's disease (congenital aganglionosis) have been treated at the University of Michigan-Mott Children's Hospital. This series includes 67 consecutive modified endorectal pull-through (ERPT) procedures in children. Fifty-one of these 67 patients had standard rectosigmoid disease and underwent a successful ERPT with only two major complications. One of these 51 children underwent a successful ERPT but died in the late postoperative period from severe congenital heart disease. Eighteen of the 92 patients suffered from total aganglionosis or long-segment disease. Sixteen of these have undergone an ERPT with no mortality or operative morbidity. The follow-up ranges from 6 months to 10 years. All of the children who have reached 3 years of age are continent. Of the remaining 23 patients, 12 were referred following an unsuccessful pull-through at another hospital. The 12 operations included five Swenson pull-throughs, five Duhamel procedures, one ERPT, and one subtotal colectomy. It was possible to redo or revise the pull-through procedures successfully in all but one patient, who required a permanent colostomy. Finally, 11 children were referred for management of a variety of complications following pull-through procedures performed at other institutions. None of these 11 patients required a reperformance of their pull-through, and all were successfully treated with lesser surgical procedures or with medical management. The excellent functional results and the low morbidity and zero operative mortality are attributed to the technical ease of performing the modified ERPT.

Adolescent↗
PubMed1985

Gastrointestinal complications of gastroschisis.

The mortality of infants with gastroschisis has been reduced markedly in the last decade with the application of new surgical techniques, improved metabolic monitoring, and total parenteral nutrition. The late complications of repaired gastroschisis are now emerging. In this series of 30 infants with gastroschisis (20% mortality) significant gastroesophageal reflux was identified in seven of 10 infants with the appropriate barium study. The clinical symptom complexes of dysmotility, a recognized problem in gastroschisis, and gastroesophageal reflux can be easily confused. In addition, 11 episodes of necrotizing enterocolitis were identified in seven infants, four with perforations. The children with necrotizing enterocolitis had a deceptively benign clinical presentation, which was easily misinterpreted in these ill infants. Awareness of these two significant gastrointestinal complications and close cooperation of clinicians and radiologists to detect them should insure better survival in the infant with gastroschisis.

Enterocolitis, Pseudomembranous↗
PubMed1985

Primitive cystic hepatic neoplasm of infancy with mesothelial differentiation: report of a case.

A malignant cystic neoplasm in the liver of a 6-month-old girl is reported. The neoplasm has unique clinical and morphological features, and despite ultrastructural and immunohistochemical studies, the tumor could not be clearly classified as any known primary hepatic neoplasm of infancy. A differentiated cystic component of the neoplasm had features of cystic peritoneal mesothelioma. Alpha-1-antitrypsin and alpha-fetoprotein were demonstrated in solid, anaplastic portions of the recurrent tumor by immunohistochemistry. The neoplasm recurred after surgical resection and proved fatal 11 months following diagnosis, despite multiple courses of chemotherapy.

Female↗
PubMed1985

Hepatic artery aneurysm associated with the mucocutaneous lymph node syndrome.

A case of a 4-year old child with a hepatic artery aneurysm after the mucocutaneous lymph node syndrome is reported. The child had obstructive jaundice and preoperative evaluation did not lead to the correct diagnosis. The aneurysm was resected and the postoperative course was unremarkable. The literature on this entity is reviewed.

Acute Disease↗
PubMed1984

The influence of tumor microfoci on recurrence and survival following pulmonary resection of metastatic osteogenic sarcoma.

Factors that influence recurrence and survival following thoracotomy for metastatic osteogenic sarcoma are not well defined. We examined the clinical and pathological material from 51 patients who had no metastases at the time of operative treatment of osteogenic sarcoma at the University of Michigan from 1962 to 1982. Ages ranged from 2 to 30 years (mean, 15 years). Metastases developed in 37 patients (72.5%) at a mean of 8 months after initial operation. Thirteen patients were treated with chemotherapy only; 12 of them died after a mean survival of 7 months. Twenty-four patients were treated with chemotherapy and 45 thoracotomies (mean, 1.9 per patient; range, 1 to 5) during which 120 wedge resections or lobectomies were performed. Follow-up is available on 22 of these 24 patients, 11 (50%) of whom are alive (9, tumor free) at a mean of 51 months after thoracotomy. Eleven patients died after a mean survival of 27 months (p less than or equal to 0.001 compared with the group having chemotherapy only). Microfoci of tumor (tumor cells separate from the gross tumor nodule) were found in resection specimens in 12 patients at the first thoracotomy; in 11 of these 12 patients, new metastases subsequently developed resulting in 10 reoperations. Twelve patients had no microfoci at the first operation; new metastases developed in 5; 3 underwent reoperation. Overall, microfoci were found at 29 operations; in patients with this finding, new metastases developed twenty-seven times (93%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1984

Hirschsprung's disease in the newborn.

Hirschsprung's disease has become a more common cause of newborn intestinal obstruction in the past 30 years. In a group of 137 newborns with intestinal obstruction the most common diagnosis was necrotizing enterocolitis. The second most common cause, however, was Hirschsprung's disease. We have reviewed 26 infants with aganglionosis who presented at 32 days of age or less between 1972 and 1978. The average age at presentation was 8.3 days. There were 21 males and five females. Five infants had long-segment or total colonic disease. There was only one premature infant (34 weeks, 1840 g). The mean birthweight in the series was 3.6 kg. Six children had a family history of a congenital anomaly (23%). Three of these had a family history of Hirschsprung's disease (12%). Nine infants (35%) had associated congenital anomalies. Four of these newborns had Down's syndrome, and all four had a cardiac anomaly as well. Fifteen newborns presented with emesis (58%) which was bilious in nine (35%) cases. Seventeen babies (65%) had abdominal distension at the time of presentation. Eleven infants passed a meconium stool by 24 hours of age (42%), and 15 had passed meconium by 48 hours (58%). Twenty-two of 24 (92%) barium enema examinations available prior to diagnosis were diagnostic of Hirschsprung's disease. All of the 23 suction rectal biopsies were positive. All 26 patients underwent a colostomy or ileostomy following diagnosis. There was no enterocolitis and no mortality. All 26 patients have had an endorectal pullthrough performed at a mean age of 11.8 months without major complications.(ABSTRACT TRUNCATED AT 250 WORDS)

Abnormalities, Multiple↗
PubMed1984

Changes in total body water and extracellular fluid volume in infants receiving total parenteral nutrition.

The nature of weight gain seen in infants receiving total parenteral nutrition continues to be controversial. The debate centers around whether or not the weight gain represents an increase in body mass or water retention. The following study was carried out to answer this question. Eighteen infants receiving peripheral or central intravenous nutrition following major surgery were studied for periods ranging from 1 to 17 weeks. The following studies were carried out after receiving informed consent from the parents and in accordance with the standards established by the Human Use Committee. Total body water was measured using the nonradioactive isotope, deuterium oxide; extracellular fluid volume was assayed using the nonradioactive isotope, sodium bromide. Both body fluid compartments were calculated using the Fick principle of dye dilution. Following double vacuum distillation, serum deuterium oxide was assayed using the falling drop technique. Serum bromide was measured by a technique developed in our laboratory that involves the complexing of bromide with gold chloride and the measurement of this chemical complex colorimetrically. Weight gain was observed in all patients. Total body water percent body weight was 82% +/- 15% prior to the initiation of intravenous nutrition; it decreased within the first week to 71% +/- 12% and then stabilized for the remainder of the study period at 75% +/- 7%. The extracellular fluid volume percent body weight was 56% +/- 15% prior to the start of intravenous nutrition; it fell to 47% +/- 10% during the first week of parenteral nutrition, and then stabilized at 40% +/- 9%.(ABSTRACT TRUNCATED AT 250 WORDS)

Body Water↗
PubMed1984

An analysis of bowel perforation in patients with intussusception.

A barium colon examination is recommended for the diagnosis and reduction of intussusception in children, except when bowel perforation is evident either radiographically or clinically. In our experience and contrary to recent reports neither radiographic evidence of bowel obstruction nor an age of less than six months is a contraindication. We reviewed 40 patients diagnosed as having had intussusception and found five children aged more than six months with perforations discovered at operation. Three of the five children had plain radiographic findings of small bowel obstruction as did nine other children. In four of the 12 children with evidence of small bowel obstruction a successful hydrostatic reduction of the intussusception was carried out. Barium studies were performed for diagnosis and therapy in eight children with ileo-colic intussusception aged six months or less, four of whom had evidence of small bowel obstruction. In five, including two with obstruction, reduction of the intussusception was successful. The major contraindication to barium examination is radiographic or clinical evidence of perforation.

Adolescent↗