Human fetal lung development and related animal models.
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Amniotic Fluid↗
Biomedical subjects
K C Pringle
Publications and source records attributed to K C Pringle.
The creation and repair of diaphragmatic hernia in fetal lambs: morphology of the type II alveolar cell.
A model for creating and repairing diaphragmatic hernia in fetal lambs has been developed. Morphometric studies of the type II alveolar cells were carried out in three groups of term lambs. The upper lobes only were sampled. Morphometric analysis of the 30 type II cells from each lobe showed that while there were no differences between the left upper lobe (LUL) and right upper lobe (RUL) cells in normal lambs, there were significant differences between sides in the experimental groups. In lambs with a nonrepaired diaphragmatic hernia (DH) the type II cells were significantly smaller in the LUL compared with the RUL. In lambs with a repaired DH, the LUL type II cells were significantly larger than those in the RUL. There were some trends when the groups were compared, but in general they did not reach statistical significance. These findings suggest that local factors profoundly influence the development of these cells.
Animals↗
Anorectal manometry for the exclusion of Hirschsprung's disease in neonates.
We studied the usefulness of anorectal manometry in excluding Hirschsprung's disease in 25 neonates with signs and symptoms of intestinal obstruction. An intraluminal pressure transducer or perfused side-opening catheters were used to evaluate anal tone, anal rhythmicity, and internal sphincter relaxation during rectal distention. Hirschsprung's disease was diagnosed by rectal biopsy in 16% of the neonates. Studies using anorectal manometry gave one false positive and one false negative diagnosis of Hirschsprung's disease, which resulted in 75% sensitivity, 95% specificity, and a kappa coefficient of 0.7. We found that anorectal manometry, a rapid and atraumatic test, is a reliable screening test for exclusion of neonatal Hirschsprung's disease. By using the combination of manometry and contrast enema, it is possible to eliminate the need for a confirmatory rectal biopsy in many neonates suspected of having Hirschsprung's disease.
Anal Canal↗
Creation and repair of diaphragmatic hernia in the fetal lamb: techniques and survival.
Diaphragmatic hernias were created in 54 fetal lambs at 72 to 82 days gestation via a left thoracotomy. The diaphragmatic hernia was repaired in 30 lambs at 106 to 123 days gestation, and 14 of these lambs subsequently aborted. The majority of those surviving to term were delivered for survival. Four lambs with an unrepaired diaphragmatic hernia were intensively resuscitated at delivery and their diaphragmatic hernias repaired; survival in these lambs ranged from 20 minutes to 89 hours. Nine lambs with repaired diaphragmatic hernia were resuscitated following delivery; survival times ranged from one hour, 45 minutes to 123 days, with three lambs surviving to be sacrificed at 43, 62, and 123 days. Three of the lambs that died before sacrifice, died of causes unrelated to their lung function. These results show that in-utero repair of the diaphragmatic hernia in the fetal lamb results in improved survival. We feel, however, that direct application of these results in humans would be premature.
Animals↗
The effect of chick embryo hyperflexion on tracheoesophageal development.
Chick embryos were hyperflexed by placement of a ligature at two critical stages in the development of the foregut, in order to test the theory that esophageal atresia and tracheoesophageal fistula result from embryonic hyperflexion. Only one "H-type" tracheoesophageal fistula was found. There were no significant disturbances of either tracheal or esophageal growth.
Animals↗
Creation and repair of diaphragmatic hernia in the fetal lamb: lung development and morphology.
Left-sided diaphragmatic hernias were created in 26 lambs at about 78 days' gestation and repaired at 106 to 124 days' gestation. Nine of these lambs were delivered at term and lived much longer than the nonrepaired lambs delivered at term. The normal development of the fetal lamb lung is compared and contrasted with the development of the lung after creation of a diaphragmatic hernia and also with the changes in morphology resulting from in-utero repair. Creation of a diaphragmatic hernia resulted in marked delay in the development of alveoli and at term the lung had small, thick-walled terminal air-spaces with few capillaries and no true alveoli when compared with the thin-walled alveoli in normal lungs. Another striking feature was an apparent increase in the frequency of type II alveolar cells in diaphragmatic hernia lungs. In-utero repair of the diaphragmatic hernia resulted in a more normal appearance with true alveoli developing by term, although capillaries appeared to be less numerous and type II cells more numerous than in normal lungs. Surprisingly, there appears to be little difference between the left and right lungs in lambs with diaphragmatic hernia.
Animals↗
Cholelithiasis in childhood and adolescence. A review.
Cholelithiasis and cholecystitis are uncommon in childhood and adolescence. Misconceptions as to the aetiology, natural history, diagnosis, and therapy of these conditions prompted us to review our experience. Nineteen patients ranging in age from 7 to 18 years underwent cholecystectomy for gallstones at the University of Illinois Hospital, Chicago, between June 1970 and June 1979. Seventeen patients were female and 2 male (ratio 8.5:1). The cause was unknown in 12 patients (63%) but in 7 patients (37%) haematological disease was the underlying disorder. The most common presenting symptom (95%) was vague right upper quadrant or epigastric pain, often ignored or mistaken for peptic ulcer pain. Oral cholecystography demonstrated gallstones in 15 of 16 patients. Ultrasonography, used more recently, was positive in 3 patients intra-operative cholangiography in 12 patients, and common duct exploration in 1 additional patient, failed to demonstrate calculi. No patients were readmitted for recurrent or retained biliary calculi after cholecystectomy.
Adolescent↗
Aortic thrombosis after umbilical artery catheterization.
Neonatal arterial thrombosis has become more common with the use of umbilical artery catheters; however, catheter-induced aortic thrombosis is rare. A review of the literature disclosed a 100% mortality from medically managed neonatal aortic thrombosis. Two cases of umbilical artery catheterinduced acute neonatal thrombosis were managed successfully by surgical thrombectomy. Severe lower extremity ischemia and hypertension with aortic occlusion developed in two neonates, and intractable congestive heart failure developed in one of the neonates. This seems to be the first documented report of successful surgical treatment of umbilical artery catheter-induced aortic thrombosis. Acute neonatal aortic occlusion should be considered a surgical emergency.
Acute Disease↗
The role of imaging modalities in diagnosis and management of pyomyositis.
A case of tropical pyomyositis in a temperate climate is reported and 29 more cases are reviewed from the literature. Because of its rarity and deceiving clinical presentation, the disorder may go unrecognized for weeks in nontropical regions. The role of various imaging modalities in timely and accurate diagnosis and nonsurgical management of this disorder is discussed.
Child↗
Partial splenic embolization in the management of thalassemia major.
Six patients with beta-thalassemia major underwent partial splenic embolization as an alternative to splenectomy. One patient required 2 embolizations. All 6 patients showed a marked reduction in transfusion requirements. Transfusion requirements fell to a level within that reported by other authors following total splenectomy, although significantly above that of a group of patients from the same institution who underwent total splenectomy. It is felt that this procedure provides an acceptable alternative to splenectomy in these patients with the possible preservation of some splenic immune function.
Adolescent↗
Underreporting of postsplenectomy sepsis.
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Bacterial Infections↗
Sequestration of ureteric segments in dogs.
In 2 separate series of dogs a segment of ureter was isolated from both bladder and kidney and left in situ with an intact blood supply. Tense cysts formed in these sequestered segments regardless of whether the ends were occluded or the segments were split longitudinally and left open. The formation of these cysts can be prevented by the removal of the urothelium. The cyst contents were found consistently to have a sodium concentration below that of the simultaneously obtained serum concentration and urea concentration higher than the simultaneously obtained serum urea. Osmolalities and protein levels within the cysts were virtually identical to the serum levels.
Animals↗
Immunologic response in splenectomized and partially splenectomized rats.
One of the following procedures was carried out in 112, 200-gr, Sprague-Dawley rats: (A) sham operation, (B) hemisplenectomy, (C) 90% splenectomy, (D) total splenectomy and autologous spleen transplants in either omental, muscle, or subcutaneous pouch after total splenectomy, and (E) homologous splenic transplants after splenectomy. The rats were challenged intravenously with sheep, cat and guinea pig erythrocytes 6 wk, 3 mo, and 6 mo postoperative. All totally splenectomized rats had significantly reduced primary responses, regardless of whether fragments of splenic tissue had been grafted or not. There was initial lowering of primary response in partially splenectomized animals but they responded significantly better than totally splenectomized rats. After 6 mo the primary response in the hemisplenectomy group was not significantly different from the nonoperated control group. The primary response in the 90% splenectomy group had improved significantly when compared to the total splenectomy group and normal controls. Total splenectomy and partial splenectomy did not appreciably reduce the ability to mount secondary and teritary responses.
Animals↗
Preoperative and postoperative care of the pediatric surgical patient.
The preoperative and postoperative care of the pediatric surgical patient is considered under the headings of elective surgery, urgent surgery, surgery for trauma, and other emergency surgery. The specialized care of the neonatal surgical patient is not discussed. The approach outlined is the personal approach of the authors. Points stressed are the importance of preserving normal hydration and blood glucose levels before elective surgery, and the importance of correcting major deficits before urgent or emergency surgery.
Abdomen, Acute↗
Antibiotic sensitivity in hand infections.
A survey of patients presenting for primary treatment of infected lesions on their hands was carried out. Eight-nine lesions were cultured from which 116 organisms were isolated. The main organisms were coagulase-positive staphylococci. In 24 cases these were acting in concert with group A beta-haemolytic streptococci. Of the coagulase-positive staphylococci isolated, 19 percent were resistant to sulphonamides, and only 45 percent were resistant to penicillin.
Anti-Bacterial Agents↗
Postnatal follow-up of hydronephrosis detected by prenatal ultrasound: the natural history.
Babies with hydronephrosis detected antenatally who were born at or referred to our hospital from 1990 to 1995 were followed up with ultrasound (U/S), micturating cystourethrogram (MCU) or nuclear medicine studies after birth. One hundred and three patients were diagnosed antenatally at 17-42 weeks gestation. Twelve cases were excluded from the analysis of the results because of incomplete data. Fifty-one (56%) patients had hydronephrosis without organic obstruction, and 80% of these became normal in 3 years. Fifteen patients (17%) had a normal scan 4 days after birth. This suggests the possibility of antenatal spontaneous regression. Seven (8%) had a ureterocele and 4 (5%) had pelviureteric junction (PUJ) obstruction. Four (5%) had vesicoureteric reflux, and 4 (5%) had primary megaureter. Two (2%) had posterior urethral valves (PUV), 3 (3%) had refluxing primary megaureter, and 1 (1%) had urethral atresia. Fifteen patients (17%) underwent surgical intervention. Six had a nephrectomy, 1 a vesicostomy, 3 an Anderson-Hynes pyeloplasty, 3 had the ureterocele unroofed, 1 had a ureteric reimplant, and 1 ablation of valves. In 42 infants with 60 abnormal kidneys, the renal anteroposterior diameter of the pelvis was measured. Retrospectively, 48 kidneys diagnosed as having hydronephrosis, antenatally had a renal pelvis diameter > or = 4 mm before 33 weeks gestation or > or = 7 mm after 33 weeks gestation. One patient with PUJ obstruction lost kidney function, but there is no good marker to detect these patients. Early unroofing of ureteroceles may rescue kidney function. Our follow-up protocol for antenatal hydronephrosis is U/S at 4 days, 1 month and 1 year of age. An MCU is not required unless the ureter is seen on antenatal U/S. If dilatation persists past 1 month, a radionucleotide (MAG3) scan and repeat U/S are performed at 3 months. The methods for assessing obstruction and the indications for surgical intervention in these patients require reexamination.
Female↗
A case with duodenal duplication cyst: prenatal diagnosis and surgical management.
OBJECTIVE: We report the first case of a subhepatic cystic mass diagnosed in utero that subsequently proved to be a duodenal duplication cyst. METHOD: Conventional prenatal abdominal ultrasound. RESULTS: On prenatal ultrasonography, the differential diagnosis was choledochal cyst, bowel duplication cyst, or omental cyst. CONCLUSION: The prenatal detection of a cystic mass allowed close neonatal surveillance and timely surgical intervention prior to the onset of potentially serious complications.
Adult↗