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Biomedical subjects

J R Wesley

Publications and source records attributed to J R Wesley.

At least 55 records · Page 3Linked to original sources
PubMed1983

The quantitative transperitoneal absorption of a fat emulsion: implications for intraperitoneal nutrition.

Intraperitoneal (IP) administration of nutrients would be an attractive alternative to intravenous nutrition since it eliminates intravascular complications. If glucose alone were used as the nonprotein calorie source, associated fluid shifts might not be well tolerated by the patient. A fat emulsion does not have osmotic properties and thus might be incorporated into a program of IP nutrition as a calorie source. Transperitoneal absorption of a commercial fat emulsion (Liposyn 10%, Abbott Laboratories, N Chicago, IL) was studied in 12 beagle puppies divided into two groups. One group received 2.5 gm/kg of fat and the other group received a similar volume of 3.5% crystalline amino acids and 5% glucose in one IP dose. In the first group, the serum triglyceride (TG) increased three fold from 61 +/- 25 mg% to 185 +/- 61 mg% at 15 minutes and then decreased slowly while remaining significantly elevated (p less than 0.05) at 4 hours. 1.94 +/- 0.20 gm/kg of TG were absorbed from the peritoneal cavity over 4 hours. Concommitant IP administration of amino acids and glucose did not affect that absorption. Radiolabeled amino acids and glucose instilled IP were demonstrated in the blood immediately after administration and their absorption was not affected by the presence of a fat emulsion. Plasma free fatty acids showed a small increase at 4 hours (from 0.32 +/- 0.09 mEq/L to 0.59 +/- 0.22 mEq/L). Animals receiving no IP fat showed no change in serum TG. Serum glucose rose in both groups and serum cholesterol showed no changes in either group. Peritoneal fluid accumulation 4 hours after IP fat administration was minimal at 12.7 +/- 6.4 mL/kg. This study shows that a fat emulsion can be quantitatively absorbed from the peritoneal cavity over four hours and that IP nutrition may be feasible.

Absorption↗
PubMed1983

Cervical teratomas in the newborn.

Cervical teratomas are rare neoplasms which have been infrequently reported. During the period of July 1974 to April 1982, six newborns with this lesion were seen at the Mott Children's Hospital. There were three males and three females, all of whom presented at birth with large semicystic neck masses. In four infants, calcifications were seen on x-ray. Four patients required intubation within the first hours of life for respiratory distress. One child of 33 weeks gestation expired prior to operation because of a hypoplastic left ventricle and bilateral hypoplastic lungs. Cord blood T3 and T4 values were normal in three patients; the TSH was elevated 1.5 and 2 times normal in two of these infants. Four neonates were operated upon within 24 hours of birth and suffered no postoperative complications. One baby presented on the third day of life and expired three hours postoperatively from persistent respiratory distress. The tumors were well encapsulated and arose from or were surrounded by a lobe of the thyroid gland. In each case, the tumor was removed by performing a total thyroid lobectomy. The presence of normal thyroid tissue at the resection margin (in the isthmus) was verified by frozen section. One patient presented with cervical node metastases but is currently free of disease one year postoperatively. These six cases bring the total reported cases in the literature to 136. The 80% mortality in cases not operated upon has been reduced to 15% by prompt operation. This series substantiates the significant respiratory distress that can occur in newborns with cervical teratomas and confirms the need for emergency surgery in this group of patients.

Diseases in Twins↗
PubMed1983

The endorectal pull-through for the management of ulcerative colitis in children and adults.

Between June 1977 and November 1981, 26 children and adults with ulcerative colitis have undergone a total colectomy, an endorectal dissection of the rectal mucosa, and an ileoanostomy. A combined abdominoperineal approach was used to perform the operation, and the mucosal-submucosal rectal tube was dissected out intact from the abdominal approach. Every patient survived the operation and showed marked clinical improvement presumably due to resection of the diseased colon. Three patients developed intestinal obstruction that was successfully treated with an enterolysis. A rectal cuff abscess and a retroperitoneal abscess were the only other complications. The postoperative stooling pattern of each patient was obtained through detailed interviews. All the patients were continent during the day and at night one month after surgery. Twenty-two patients had a median stool frequency of seven per 24 hours one month after surgery. At one year, the average number of stools was seven per day. Six patients experienced a stool frequency of seven per 24 hours two years after surgery. The results with this series of patients had encouraged the authors to continue to recommend this approach to children and adults with ulcerative colitis, since it offers an alternative lifestyle that is more attractive to certain patients than the presence of an abdominal stoma.

Adolescent↗
PubMed1982

Modification of the serum bromide assay for the measurement of extracellular fluid volume in small subjects.

Serum bromide has been used in the past to measure extracellular fluid volume in infants. In this report, a modification and refinement of a previously described spectrophotometric assay suitable for determining bromide levels in blood is presented. The assay involves sample deproteinization with perchloric acid followed by spectrophotometric analysis of the complexes formed by the reaction between sodium bromide and gold chloride. Linear standard curves were obtained by diluting 1:2 with pooled serum at the following bromide concentrations: 10, 20, 30 and 40 mg%. Intra- and interassay variation using this technique was extremely small (n = 6, correlation coefficient, 0.995, and n = 5, correlation coefficient, 0.988, respectively). For toxicological analysis, a linear standard curve was derived from sodium bromide standards at the following concentrations: 40, 60, 80, and 100 mg%. The reproducibility and reliability of this assay have been excellent and the correlation with neutron activation analysis was excellent. The assay is easily adapted for the analysis of large numbers of samples, is easy to perform, and requires only small sample volumes.

Age Factors↗
PubMed1982

The impact of pediatric surgery training on the attitudes and practice patterns of general surgeons.

In order to evaluate how experience in pediatric surgery during residency training affects attitudes and practice patterns of general surgeons, questionnaires were sent to the 51 residents who graduated from our general surgical residency program since the establishment of a Section of Pediatric Surgery in 1974. There were 51 respondents (100%) of whom 50 were male and 1 female. Three were pediatric surgeons and their responses to the questionnaire were not included in the analysis. During the past year, 29 of the respondents had performed from 2 to 55 pediatric operations, with a mean of 23.7. Most of these were herniorrhaphies, appendectomies, and sub-specialty cases. Thirty-two of the 48 respondents referred most pediatric cases to a board certified pediatric surgeon nearby. Ninety-two percent of the respondents indicated that pediatric surgery rotations were of great value in their training (6.3 mean response on a scale of 7) and 92% felt that pediatric surgery was a necessary part of a general surgery training program. Respondents had a mean exposure of 1.8 mo to pediatric surgery as junior residents, and 2.1 mo as senior residents; 90% felt that their operative experience was good to excellent (5.5 mean on a scale of 7). Most respondents felt qualified to do many more pediatric procedures than they actually performed; however, their perception was that these cases were best done by fully trained pediatric surgeons. The 51 graduates of our general surgical residency program considered pediatric surgery an important factor in the development of their technical skills and surgical judgment.

Attitude of Health Personnel↗
PubMed1982

The successful management of chronic constipation in infants and children.

During a 3 yr period, 77 patients with functional constipation and 34 patients with constipation related to organic lesions of the anorectal area were managed with a strict regimen employing the long-term use of daily enemas. Seventy-four percent of the patients with functional constipation had excellent results and the rest had good results. In children with associated anorectal anomalies, 52% had excellent results, 35% had good results and only 13% had a poor result. A detailed flow chart of the workup and treatment regimen is presented.

Adolescent↗
PubMed1982

A new syndrome of symptomatic cutaneous mastocytoma producing vasoactive intestinal polypeptide.

An 8-mo-old male child presented with generalized flushing and apnea which followed irritation of a 1.5 x 0.5 cm cutaneous mastocytoma on the left upper arm. Peripheral venous blood samples were drawn before and after manipulation of the tumor, immediately after excision, and again 30 days later. The plasma vasoactive intestinal polypeptide level before excision was high (345 pg/ml) and was accompanied by low acid secretion (15.4 mEq/L) and hypergastrinemia (209 pg/ml), all of which returned to normal after excision of the tumor (50 pg/ml, 35.7 mEq/L, and 131 pg/ml, respectively). Serum histamine levels were undetectable. Histology of the tumor showed only mast cells and no enterochromaffin tissue. The immunoreactive vasoactive intestinal polypeptide content of the tumor was 28 ng/g wet wt and the extracted vasoactive intestinal polypeptide was immunologically indistinguishable from natural porcine vasoactive intestinal polypeptide. The child has remained asymptomatic postoperatively. We conclude that the symptoms associated with this mastocytoma may have been produced by oversecretion of vasoactive intestinal polypeptide and not histamine.

Apnea↗
PubMed1981

Intragastric pressure measurement: a guide for reduction and closure of the silastic chimney in omphalocele and gastroschisis.

In newborn infants with omphalocele or gastroschisis, traditional criteria for reduction of the herniated viscera either primarily or after application of a Silastic chimney have been the baby's color, respiratory rate, and lower extremity turgor. These are not always accurate or immediately apparent. In order to define more objective guidelines for reduction, measurements of intragastric pressure through a gastrostomy tube using a water manometer were carried out. The validity of this pressure measurement was demonstrated in five puppies where intra-abdominal pressure correlated well with inferior vena cava pressure and intragastric pressure measured through a gastrostomy tube (R = .98 and .99, respectively). Over a 3.5-yr period, 25 newborn infants with omphalocele (9) or gastroschisis (16) were treated. Ten underwent primary closure, and 15 were treated by placement of a Silastic chimney with serial reduction and closure. Manual reductions were performed once or twice daily to a maximum intragastric pressure of 20 cm water. Greater pressures demonstrated cardiovascular and respiratory comprise both experimentally and clinically. The mean time required for removal of the Silastic chimney was 4.7 days. There were no infections related to the chimney. There were 2 early and 5 late deaths, a 28% mortality rate. The remaining patients are alive and well. Intragastric pressure measurement in patients with omphalocele or gastroschisis provides objective criteria for safe primary closure and Silastic chimney reduction, shortens the time of reduction, and reduces the number of associated circulatory, respiratory, and septic complications.

Abdominal Muscles↗
PubMed1981

Modified endorectal procedure for management of long-segment aganglionosis.

During the past five years, 65 patients with Hirschsprung's disease have been treated at our institution. Ten of these patients had long-segment aganglionosis, five with total colonic involvement, four with aganglionosis to the midtransverse colon, and one child with Hirschsprung's disease extending to the distal jejunum. There are six females and four males in the series, which is a reversal of the normal sex ratio for aganglionosis. An extensive literature review of long-segment Hirschsprung's disease has revealed a total of 489 reported cases. The mean frequency of long-segment aganglionosis in the literature is 12% of all cases of aganglionosis. Our series is comparable, with an incidence of 15%. The overall mortality rate in the literature of 54% indicates the poor therapeutic results obtained with this disease in the past. All ten of our patients have been definitively treated with a modified endorectal pull-through procedure. The mortality rate with this procedure has been zero. There has been one major complication (incorrect pathologic diagnosis of the level of aganglionosis) and four minor complications. The average follow-up period is 42.6 months. The functional results have been excellent with an average of three to four soft bowel movements per day. All of the children over 3 years of age are completely toilet trained. The remaining two patients are too young to be toilet trained, but are continent in the sense that they do not soil between bowel movements. Awareness of this entity of long-segment aganglionosis should lead to earlier diagnosis, appropriate operative therapy, and lower mortality rates.

Child, Preschool↗