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Biomedical subjects

J R Wesley

Publications and source records attributed to J R Wesley.

At least 73 records · Page 4Linked to original sources
PubMed1980

Corticosteroid therapy in hemorrhagic and septic shock in puppies.

The efficacy of corticosteroid therapy in the treatment of shock remains controversial. In order to evaluate this question, the following controlled experimental study was undertaken. There were 44 puppies (2-6 kg) used to examine the effects of methylprednisolone (30 mg/kg) in both hemorrhagic and live Escherichia coli septic shock. In order to isolate the effects of steroid treatment, no volume or antibiotic therapy was given. Arterial, venous, and pulmonary artery catheterization allowed continuous hemodynamic and metabolic monitoring. One control group received steroid treatment and was not subjected to shock. Septic shock was achieved by a rapid bolus infusion of 10(9) live E. coli organisms. Hemorrhagic shock was produced by bleeding the puppy an average of 43% of his blood volume. Four septic and four hemorrhagic shock groups received either no treatment, steroids at the time of shock, or steroids 30 min before or after shock. Cardiac outputs of less than 50% of control values and significant lactic acidosis were documented in all of the shock animals. The septic groups showed more profound alterations in these parameters and a decreased overall survival. No statistically significant differences could be found, however, in the hemodynamic, metabolic or survival figures among the different septic shock groups, or among the various hemorrhagic shock animals. The anticipated preservation of cardiac output and decrease in leakage of lysosomal acid phosphatase were not seen with any treatment schedule. The theoretical benefits of corticosteroid treatment in shock could not be documented in these two models of severe septic and hemorrhagic shock in puppies.

Acid Phosphatase↗
PubMed1980

Fluid resuscitation in live Escherichia coli shock in puppies.

The infusion of live E. coli in the puppy produces a severe and usually lethal model of pediatric septic shock with characteristic reduction in cardiac output and blood pressure. Hemodynamic abnormalities are partially reversed with fluid resuscitation alone, and large volumes, supplemented with albumin well within tolerated fluid loads, produce the most pronounced corrections of these derrangements. Certain metabolic changes appear to be unique to the young animal and their correction is less successful regardless of resuscitation regimen. These findings suggest that the initial fluid management of the bacteremic pediatric patient should include Ringer's lactate and 5% albumin at approximately 105% of patient's blood volume. Further resuscitation fluid, as well as the role of steroids and antibiotics, remain work currently being carried out in our laboratory.

Animals↗
PubMed1980

Multiple surgical problems in two patients with Ehlers-Danlos syndrome.

Ehlers-Danlos syndrome is a genetically determined disorder of connective tissue, the internal manifestations of which carry significant morbidity and mortality rates. During the past 14 years, we have treated multiple life-threatening surgical complications of this disease in two patients. The difficulties encountered at operation require modification of anesthetic and surgical techniques to accommodate the sometimes surrealistic situations that develop with alarming suddenness in patients with the Ehlers-Danlos syndrome. These techniques include handling the extremely friable tissues, dissecting and ligating vessels that disintegrate under the pressure of a hemostat, stemming spontaneous arterial hemorrhage, and special care in harvesting and placing split-thickness skin grafts.

Child↗
PubMed1979

Esophageal atresia. A 41-year experience.

Since the first attempted repair in 1935, a total of 365 infants have undergone treatment for esophageal atresia with or without tracheoesophageal fistula. To evaluate the improvement in our results, we have divided our patients into four, approximately equal, time periods. The overall late survival has indeed improved during each of the four decades from between 36% and 53% to 68% in the last ten years. During this past decade, the group A risk infants (35 patients) had a 3% mortality, the group B (20 patients) had a 5% mortality, but the group C babies (22 patients) had a 41% mortality due to associated anomalies or severe prematurity. Anastomotic leaks and recurrent fistulas were each encountered in approximately 5% of the cases in all decades. Postoperative stricture has been encountered in 20% of the entire series and no esophageal replacements have been required.

Abnormalities, Multiple↗
PubMed1979

Preoperative diagnosis of splenic cysts in children by gray scale ultrasonography.

Ultrasonography is a useful noninvasive modality for the diagnosis of splenic cysts in children. Characteristic features plus the typical clinical and radiographic presentation should obviate the need for further more invasive and costly techniques which add little to diagnostic accuracy. Additional advantages offered by ultrasound a minimal patient discomfort, no ionizing radiation, and immediate reassurance to parents that the mass is a cyst. We report two cases of epidermoid splenic cysts preoperatively diagnosed by ultrasonography. The typical sonographic characteristics are presented and the sonographic differential diagnosis is discussed.

Adolescent↗
PubMed1979

An evaluation of the modified endorectal procedure for Hirschsprung's disease.

During the past 4 yr, 60 patients with Hirschsprung's disease have been treated at our institution. Twenty-eight patients within this group have undergone a modified endorectal pull-through procedure. There are 18 males and 10 females in the series. There are 5 children with total colonic involvement, 3 patients with aganglionosis to the mid-transverse colon, and one child with Hirschsprung's disease extending to the distal jejunum. The associated anomalies have consisted of four cases of Down's syndrome, one of whom also has transposition of the great vessels. There has been no operative-related mortality or late mortality in our series. Two major complications (anastomotic leak following a colostomy closure and incorrect pathological diagnosis of aganglionic level) and five minor complications have occurred. The average follow-up period is 31.3 mo. The functional results postoperatively have been excellent. The 18 patients over the age of 3 yr are completely toilet-trained. The remaining patients are too young to be toilet-trained, but are continent in the sense that they do not soil between bowel movements. Because of the satisfying functional results in this series, we have now expanded our indications for this procedure to patients requiring total colectomy for ulcerative colitis and familial polyposis. During the past 2 yr, 8 patients with ulcerative colitis have undergone the endorectal pull-through together with a total colectomy.

Anal Canal↗
PubMed1979

Crohn's disease in children and adolescents: is inadequate weight gain a valid indication for surgery?

Seventy children and adolescents hospitalized for Crohn's disease at the University of Michigan Medical Center between 1966 and 1976 are reviewed. Thirty-three of these children were managed medically and 37 underwent a total of 60 operative procedures. There were 33 bowel resections, 7 appendectomies, 4 abscess drainages, 3 bowel bypasses, and 13 miscellaneous operative procedures. The total operative mortality was 1.7%, and there were 10 complications, all of which were successfully managed. Among the 26 children undergoing bowel resections, 22 were below the third percentile for weight preoperatively. Nearly two-thirds of these gained weight to the 35th percentile following resection. The remainder of the children had a variety of growth and symptomatic responses to surgery. Resection aimed at complete removal of diseased bowel can be expected to yield substantial weight gain in children with Crohn's disease.

Adolescent↗
PubMed1979

Total body water changes during high volume peripheral hyperalimentation.

A premature baby with gastroschisis, ileal atresia and secondary short gut syndrome was sustained with the use of peripheral hyperalimentation consisting of 2 per cent Amigen, 12 per cent glucose and 10 per cent Intralipid at an average rate of 140 to 160 milliliters per kilogram per day or 100 to 111 kilocalories per kilogram per day. The weight of the child increased during the first four months to approximately 14 grams per day, with body length increasing by about 6 millimeters per week. Six reliable measurements of the total body water of the child during the four month period were obtained using deuterium oxide dilution followed by double vacuum distillation and falling drop analysis in a constant temperature chamber. Measurements obtained showed a gradual decrease of total body water from 77.13 per cent of body weight to 60.50 per cent during the study period, with values consistently on the lower end of the spectrum of known normal controls, even during periods of increased growth rates of as much as 35 grams per day. These data on total body water, coupled with the observed gains in body weight and length, support tissue accretion rather than fluid retention as the mechanism of weight gain in long term, high volume peripheral hyperalimentation.

Body Height↗
PubMed1979

The importance of different calorie sources in the intravenous nutrition of infants and children.

The intravenous infusion of amino acid and carbohydrate solutions is a well-established technique for nutritional support of the pediatric surgical patient. By using peripheral veins for total parenteral nutrition (TPN), weight gain can be achieved and the complications of central venous catheters avoided. Over a 2-year period, 45 patients from 1 day to 16 years of age received peripheral TPN in which fat provided a major portion of the daily calories. Treatment periods ranged from 5 to 74 days. Each patient received 125 cc/kg/day, with 30% of the calories derived from a fat emulsion and the remainder from a 12% glucose-2% amino acid solution. All 29 patients under 1 year of age gained weight, averaging 18 gm/day. These infants received an average of 98.8 calories/kg/day, with 31 calories provided by fat. In this group, the mean nonprotein calorie to nitrogen ratio (CNR) was 285 calories/gm, ranging from 239 to 343. Fat calorie and carbohydrate CNRs were determined and no correlation to weight gain could be found for either calorie source. The few complications related to this technique included three episodes of phlebitis, two small skin sloughs, two subcutaneous abscesses, and two episodes of jaundice. Normal weight gain can be achieved in infants after operation by employing peripherally infused, intravenous fat as a major calorie source. Furthermore, regardless of calorie source, a CNR of 285 calories/gm allows normal growth and weight gain in these critically ill neonates.

Adolescent↗
PubMed1978

Pseudomembranous colitis associated with antibiotic therapy in a child: report of a case and review of the literature.

A case of pseudomembranous colitis is presented in a child with multiple medical problems who received intraoperative antibiotics. Despite aggressive medical management and operative intervention, the patient died. All patients who develop diarrhea after receiving antibiotics should be suspected of having pseudomembranous colitis. Sigmoidoscopy and hyaque enema should be performed to confirm the diagnosis and all antibiotics should be discontinued. Aggressive medical management consisting of intravenous fluids, albumin, lactinex granules, fecal enemas, and cholestyramine should be instituted. Surgery should be considered only in the face of perforation, toxic megacolon, peritonitis, and failure of medical management with disease limited to the colon.

Anti-Bacterial Agents↗
PubMed1978

Small bowel reversal procedure for treatment of the "short gut" baby.

An increasing number of infants have undergone massive intestinal resection for various reasons: uncontrollable diarrhea, malabsorption, and failure to thrive makes these babies a difficult management problem and threatens their survival and later "quality of life." Five short gut babies have had a 3-cm small bowel reversal operation as part of the total salvage effort. It is recognized that very skilled care by dedicated personnel and parents, utilizing i.v. nutrition and special feeding techniques, is probably the most significant factor in achieving success with these babies. It is believed small bowel reversal helps in keeping these infants alive while their intestinal tract is making the adjustments necessary for long-term survival.

Female↗
PubMed1977

Peripherally located congenital arteriovenous fistulae in infancy and childhood.

Significant macrofistulae between arteries and veins of congenital origin may result in the extremes of life-threatening hemorrhage or simply a cosmetically displeasing mass. The most helpful diagnostic aid is that of adequate arteriography both to determine the size, location, and extent of the fistulae. After adequate clinical and angiographic evaluation, therapy should be conservative enough to afford optimal function and radical enough to prevent death due to hemorrhage. This report includes eight patients who underwent angiographic evaluation and surgical therapy for arteriovenous malformation. Of the six living patients, five are known to have residual arteriovenous shunting.

Adolescent↗
PubMed1977

Surgical treatment of hyperthyroidism in children.

During the past ten years, subtotal thyroidectomy for hyperthyroidism was performed upon 43 children at Childrens Hospital of Los Angeles. There were no deaths, no recurrent laryngeal nerve injuries and no permanent hypoparathyroidism. During the one to ten year follow-up period, one patient had recurrent hyperthyroidism develop and was treated with 131I. Twenty-five patients are hypothyroid and require thyroid supplement; 14 are euthyroid and receiv no medication. Postoperative thyroid function did not correlate well with gland remnant size, degree of fibrosis or the extent of lymphoid follicle formation. Lymphocytic infiltration was more severe in patients who had hypothyroidism develop postoperatively. Transient hypocalcemia developed in 22 patients. The effectiveness and safety of the surgical treatment for hyperthyroidism in children is reaffirmed, and it is advocated for consideration over 131I or prolonged medical therapy.

Adolescent↗
PubMed1977

Congenital intrinsic duodenal obstruction: a twenty-five year review.

From 1951 through 1975, 72 patients with congenital intrinsic duodenal obstruction were seen at the Childrens Hospital of Los Angeles. The survival rate was 55% during the first 15 years of the study, but this has increased to 88% during the last 10 years. Factors important to this increased survival rate include: earlier diagnosis and expeditious preoperative workup; expert administration of anesthesia; improved surgical technique with a greater awareness for common pitfalls, such as associated duodenal diaphragm or distal bowel atresia; frequent use of gastrostomy; use of parenteral nutrition; and better intensive nursing care.

Birth Weight↗