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Biomedical subjects

J Randolph

Publications and source records attributed to J Randolph.

At least 19 recordsLinked to original sources
PubMed1992

Functional results in young women having clitoral reconstruction as infants.

Nine young women who had clitoral recession for clitoromegaly as infants have been evaluated for anatomical appearance, psychosocial adjustment, and sexual function. Highly satisfactory anatomic results were obtained, although two patients required subsequent revision. The tested psychological parameters were essentially normal. Virtually all patients were sexually active and all but one have achieved regular painless orgasm. Surgical reconstruction has been accomplished by recessing the entire disfigured clitoris, thereby conserving all erectile tissue and preserving sensation. In addition to assessment of anatomical appearance, long-term follow-up of children with ambiguous genitalia requires regular evaluation of social, psychological, and sexual parameters.

Adolescent↗
PubMed1992

A strategy for resection of Wilms' tumor with vena cava or atrial extension.

Resection of a Wilms' tumor that extends into the vena cava or right atrium results in excellent survival when combined with adjuvant therapy. Preoperative identification of the presence of intravascular tumor thrombus and the level of vascular involvement is essential. It facilitates safe surgical resection, with cardiopulmonary bypass immediately available for retrohepatic and atrial tumors. Six patients with intracaval or intracardiac tumor thrombus were treated over a 5-year period with no perioperative deaths. Preoperative chemotherapy was useful in two patients with extensive tumors and pulmonary metastases. Our results using an integrated management plan suggest that an aggressive surgical approach is justified for this extensive variant of Wilms' tumor.

Algorithms↗
PubMed1992

The surgical management of infants and children with ambiguous genitalia. Lessons learned from 25 years.

Over a 25-year period, 91 children with ambiguous genitalia have received surgical management. Female sex assignment was made for 79. Of these, 60 patients underwent extensive clitoral reconstruction consonant with the female assignment. Forty-two patients had vaginal reconstruction. Factors relating to success include: (1) prompt and appropriate sex assignment; (2) early and accurate diagnosis; (3) conservative reconstruction of the clitoris at an early age (less than 1 year); and (4) choice of vaginal reconstruction based on the severity of the malformation. Long-term follow-up demonstrates satisfactory anatomic and functional results when clitoral surgery alone was required. Functional results for patients with extensive vaginal reconstruction have been compromised. Physicians caring for children with congenital intersexual anomalies can expect to encounter a wide spectrum of anatomic and physiologic derangements. Cosmetic appearance alone is an inadequate measure of success because endocrinologic, social, psychological, and sexual factors must be blended into comprehensive evaluation of these patients. The management plan must be flexible and individualized, incorporating long-term follow-up to adulthood.

Clitoris↗
PubMed1992

Heterotopic ossification in children with burns: two case reports.

Heterotopic ossification is the formation of ectopic bone in soft tissue, and has been reported as a rare complication in pediatric burn patients. At our hospital, two 86% body surface area burn patients developed heterotopic ossification in the shoulder, elbows, distal femur, proximal tibia, fibula, and ribs approximately four months after the burn injury. These two rare and unusual cases are presented documenting the clinical involvement, radiological studies, laboratory data, as well as treatment of their heterotopic ossification. Discussion will focus on the incidence, diagnosis, pathophysiology, and treatment of heterotopic ossification in burn patients and how this information relates to the specific diagnosis and management of the complication of heterotopic ossification in the burn child.

Burns↗
PubMed1989

Hypersomatotropism and insulin-resistant diabetes mellitus in a cat.

In this report, we described the clinical, radiographic, and echocardiographic findings in a cat with hypersomatotropism and insulin-resistant diabetes mellitus. Growth hormone determinations were made because of persistent hyperglycemia despite insulin requirements exceeding 2.2 U/kg of body weight, and the acromegalic features of the cat. Also, the results of a therapeutic trial in which a long-acting analogue of somatostatin was used are discussed.

Acromegaly↗
PubMed1988

Evidence for inhibition of growth related to compromised DNA synthesis in the interaction of daunorubicin with H-35 rat hepatoma.

The H-35 rat hepatoma is relatively insensitive to the anthracycline antibiotic, daunorubicin (DNR), requiring 0.25 microM daunorubicin for inhibition of cell proliferation by 50%. Studies were undertaken to investigate the basis for the apparent intrinsic resistance in this cell line. The relative insensitivity of the H-35 cells to DNR is not a function of metabolic inactivation of DNR to deoxyaglycone derivatives; after a 2-h incubation, less than 10% of drug is metabolized, exclusively by conversion to daunorubicinol. The limited toxicity of DNR to the rat hepatoma may be explained, in part, by the absence of DNA strand breaks at daunorubicin concentrations up to 1 microM while higher (supraclinical) DNR concentrations (5 and 10 microM) produce direct, "non-protein-associated" DNA strand breaks. Limited daunorubicin toxicity in this tumor cell line may also be related to the apparent absence of free radical-mediated cellular damage as the free radical scavengers dimethyl sulfoxide, catalase, methanol, and mannitol fail to reverse the inhibitory effect of 1 microM DNR on cell proliferation. Daunorubicin does not induce leakage of the cytoplasmic enzyme, glutamic oxaloacetate transaminase, or diminish mitochondrial enzyme function. Conversely, while drug effects on RNA synthesis are small, and protein synthesis is minimally diminished, inhibition of cell proliferation corresponds closely with inhibition of DNA synthesis.

Animals↗
PubMed1987

A comparison of thermal injury, healing patterns, and postoperative adhesion formation following CO2 laser and electromicrosurgery.

To further define the role of CO2 laser in infertility surgery, the authors compared the immediate tissue damage and the subsequent healing patterns that followed the randomized use of CO2 laser and electrocautery on opposite sides of the reproductive tracts of 20 mature, female rabbits. Blind histopathologic evaluations were performed on the ovarian and uterine tissues immediately to compare the extent of the acute thermal damage, and 4 weeks postoperatively to compare the healing patterns. There were no differences in the depth of thermal damage, extent of collagen deposition, or in postoperative adhesion formation between CO2 laser and electrocautery. However, the mean depth of the acute thermal damage was significantly less on the ovary than on the uterus, and the area of fibrosis was significantly less when the incised uterine surfaces were approximated.

Animals↗
PubMed1987

Current indications for decortication in the treatment of empyema in children.

Although most children with empyema respond to antibiotics and pleural drainage, a recognizable number fail to improve. This study reviews experience with ten children over the past 7 years who have been selected for lung decortication for refractory empyema. Decortication was performed because of lack of clinical improvement despite drainage and multiple antibiotics during an average 20-day preoperative hospitalization. Responsible organisms included beta-hemolytic Streptococcus, Streptococcus pneumoniae, and Hemophilus influenzae. A computerized tomographic (CT) scan of the chest was performed in the last eight patients and showed at least a 50% limitation of lung expansion by the products of the empyema in each case. Following decortication, chest tubes were removed, antibiotics stopped, and temperature and white blood cell count returned promptly to normal. The advantages of early decortication in selected patients with empyema who do not respond to antibiotics and drainage include low morbidity, shorter hospitalization, and excellent long-term results.

Adolescent↗
PubMed1986

Enhancing psychosocial adaptation to gastric partitioning for morbid obesity.

Gastric partitioning, a surgical treatment for morbid obesity, challenges patients to drastically change their eating habits and self-image. Preoperative psychiatric assessment should not be aimed simply at selecting patients in whom there are no psychiatric contraindications. Many patients have some degree of risk for postoperative problems. If the risk factors can be identified before surgery, appropriate pre- and postoperative psychologic intervention may help minimize maladaptation.

Adaptation, Psychological↗
PubMed1986

Long-term morbidity and mortality in morbidly obese adolescents after jejunoileal bypass.

To evaluate the long-term results of jejunoileal bypass in the treatment of morbidly obese adolescents, we studied 11 patients who underwent surgery between 1972 and 1974. More than 10 years after surgery, 45% of the patients had extremely satisfactory results (correction of morbid obesity). Three patients died within the year after surgery, two of them under extenuating clinical circumstances. There have been no subsequent deaths. All eight survivors were found to have metabolic abnormalities to various degrees. Two patients had a total of five pregnancies; each had one healthy infant, and three pregnancies ended in abortion (one spontaneous). Two patients had significant medical problems related to the procedure but basically remained in good health, whereas three patients had severe symptoms requiring reanastomosis. Of the five patients who continue with the bypass, none has become significantly obese. They have all maintained a weight loss of between 45 and 90 kg, and as adults express strong feelings in favor of the procedure. This series demonstrates that, although significant weight loss was maintained, and improvement in the quality of life for half of our patients was dramatic, side effects and complications continue to develop, mandating careful follow-up for an indefinite time.

Adaptation, Psychological↗
PubMed1986

Subclinical autoimmune disease and recurrent spontaneous abortion.

We describe a patient with no clinical complaints except 5 unexplained spontaneous abortions in whom investigations revealed a positive antinuclear factor, antibodies to native double-stranded DNA, LE cells, a positive Coombs' test, a positive lupus anticoagulant test, and anticardiolipin antibodies. Despite preeclampsia our patient successfully completed her 6th pregnancy after treatment with corticosteroids, subcutaneous heparin, and low dose aspirin throughout the pregnancy. Serial measurements of anticardiolipin antibody showed suppression of anticardiolipin antibody levels with corticosteroids. The response of the lupus anticoagulant was less obvious. No anticardiolipin antibodies were detected in the baby.

Abortion, Habitual↗
PubMed1983

Reconstruction of the renal artery after unsuccessful percutaneous transluminal angioplasty in children.

The use of percutaneous transluminal angioplasty as the primary treatment of renovascular stenosis in adults has recently been described. Previously, only three children have been reported to have undergone transluminal angioplasty for stenosis of the renal artery and hypertension. At our hospital, transluminal angioplasty was attempted in four children with renal artery stenosis; one attempt was successful and three were unsuccessful. The three patients who required surgical repair of the renal artery after unsuccessful transluminal angioplasty have been described in detail. The histopathology of the stenotic vessels is also discussed. Based on the analysis of the three children, certain criteria have been derived to select pediatric patients with renovascular hypertension either for attempted transluminal angioplasty or for primary surgical revascularization.

Angioplasty, Balloon↗
PubMed1983

Experience with the Nissen fundoplication for correction of gastroesophageal reflux in infants.

UNLABELLED: In the past 15 years at Children's Hospital in Washington, D.C., approximately 500 infants under 1 year of age have been evaluated because of symptomatic gastroesophageal reflux. A contrast esophagogram will demonstrate reflux in the majority of affected infants. However, this diagnostic method is not always reliable. Timed monitoring of esophageal pH, and extended radionuclide scan even in infants can document accurately the frequency and character of episodic reflux. Following diagnosis, most infants are treated by conservative therapy, which includes the upright position. Of the 500 patients, 72 infants (14%) were selected for operative correction using the Nissen fundoplication. The indications for surgery in these infants with gastroesophageal reflux were: (A) failure to thrive, (35); (B) chronic respiratory infection, (24); (C) apnea spells, (8); and (D) esophagitis. One infant was found to have a stricture. In these symptomatic patients, three had previous operative correction of esophageal atresia, and two had congenital gastric dislocation in the chest. RESULTS: 61 excellent; six recurrences, of whom five are satisfactory after a second operation; two lost to follow-up but doing well when last seen; three deaths from causes unrelated to reflux. The selection of infants with gastroesophageal reflux for surgical correlation is primarily based on life-threatening clinical effects. The Nissen fundoplication has worked well in this group of infants.

Apnea↗
PubMed1982

Omphalocele and gastroschisis: different entities, similar therapeutic goals.

Omphaloceles, varying widely in size and content, result from incomplete central fusion of the four somatic plates that come to form the abdominal wall. Gastroschisis, which permits the midgut to spill freely out of an otherwise properly formed abdominal wall, comes about from rupture of the cord membrane at its site of attachment to the umbilical skin. The advent of parenteral nutrition was a signal advance for babies born with both of these anomalies, allowing for their support while various surgical maneuvers are used to reconstruct the abdominal wall.

Abdominal Muscles↗
PubMed1981

Surgical correction of familial diaphragmatic hernia of Morgagni in the Golden Lion Tamarin.

The Golden Lion Tamarin (Leontopithecus rosalia) is an endangered species of primate indigenous to the coastal rain forest of Brazil. Since 1971 a propagation and behavioral research program has been carried out on a colony of these monkeys at the Zoological Park. Several related animals have died and at necropsy have shown absence of the anterior portion of the diaphragm with a variety of abdominal viscera in the thorax. Diagnostic studies undertaken on the living members of the colony include plain chest radiographs and gastrointestinal series. Four of the animals have been found to have major diaphragmatic defects with the liver, stomach, spleen, colon, and portions of the intestine in the chest. In three of the animals so affected clinical signs of failure-to-thrive were clearly manifest, although one female born in 1968 has reproduced successfully for 8 yr with no deleterious clinical effects from the hernia. Surgical repair of the diaphragm with relocation of the abdominal viscera has been carried out in three of the animals under a combination of intravenous and intra-tracheal anesthesia. The monkeys weighed 550, 685, and 710 g, respectively. All three Tamarins have survived the operative procedure, and subsequently have shown improved clinical status. These cases have been instructive from the genetic point of view, the major anatomical defect, the type of repair necessary, and the postoperative care in small vigorous mammals. Additionally this study documents a familial factor in diaphragmatic defects in higher mammals.

Animals↗