Search PubMed⌕ Search

Biomedical subjects

K D Anderson

Publications and source records attributed to K D Anderson.

At least 109 records · Page 6Linked to original sources

Gastric tube esophagoplasty.

After a short review of the historical development of replacement of the esophagus, the possibilities, techniques, and results of gastric-tube esophagoplasty are discussed. Ten of 14 patients were followed up for 14 years, two were lost to follow-up and two died. Fistulas, anastomotic strictures, and also reflux could be treated successfully. A single perforation by endoscopy was surgically corrected. A peptic ulcer in the gastric tube was healed with antacid therapy. The gastric tube can be assumed to be a sufficient esophageal substitute. Long-term follow-up is still necessary.

Esophageal Atresia↗

Segmental aganglionosis of the appendix.

Ignoring the pathologist's dictum that the appendix is not reliable for the identification of ganglion cells in suspected cases of total colonic aganglionosis, the author (K.D.A.) performed an ileostomy in a child whose appendix contained no ganglion cells. The ascending colon was later found to be ganglionic. The appendices from 36 cases of Hirschsprung's disease were examined and the number of ganglion cells in 10 high power fields was compared with 10 appendices from patients who did not have Hirschsprung's disease. There were no ganglion cells in any of the patients with total aganglionosis of the colon. Twenty-two patients with Hirschsprung's disease involving the sigmoid colon had an average of 3.0 ganglion cells per high power field (range 0.5 to 5.1). Five patients with longer segment aganglionosis had 2.2 cells per high power field (range 0 to 4.1). The index case fell into this group and was serially sectioned without finding any ganglion cells. The control group averaged 3.41 cells per high power field (range 1.4 to 5.9). There was no significant difference between the control group and the groups with less than total colonic aganglionosis. It is speculated that this case represents segmental Hirschsprung's disease with the skip area in the ascending colon.

Appendix↗

Ischemic enterocolitis as a complication of Hirschsprung's disease.

Enterocolitis is a recognized complication of Hirschsprung's disease. However, little distinction has been made in the literature between inflammatory enterocolitis and ischemic (necrotizing) enterocolitis when seen with Hirschsprung's disease. We report on four cases of ischemic enterocolitis complicating Hirschsprung's disease. The characteristics of ischemic enterocolitis are compared to those of inflammatory enterocolitis.

Enterocolitis, Pseudomembranous↗

Criteria for extracorporeal membrane oxygenation in a population of infants with persistent pulmonary hypertension of the newborn.

Extracorporeal membrane oxygenation (ECMO) has been available since 1975 as a therapy of last resort to provide adequate oxygenation for term infants with acute lung disorders that do not respond to maximal medical therapy. Virtually all term infants with serious lung disease have persistent pulmonary hypertension of the newborn (PPHN) characterized by significant right-to-left shunting of blood and severe diffusion defects manifested as increased alveolar-arterial oxygen gradients (AaDO2). Criteria for initiation of ECMO therapy have been developed in several institutions but at the present time there are no universal criteria applicable to all infants with PPHN. We have attempted to establish entry criteria that may be used for different populations of infants with PPHN. Based on a retrospective review of 30 infants with PPHN in our institution, we have defined standards of maximal medical therapy. An alveolar-arterial oxygen difference (AaDO2) of greater than or equal to 610 for 8 hours has been shown to be associated with 79% mortality in this population. This AaDO2/time interval is established as a major criterion for institution of extracorporeal membrane oxygenation.

Carbon Dioxide↗

An antireflux procedure for use with the reversed gastric tube.

A study was undertaken to determine whether reflux could be reduced or prevented by creation of a nipple valve at the distal end of a reversed gastric tube. The gastric tube was constructed in standard fashion in six adult dogs. The tube was placed through a substernal tunnel to a cutaneous ostomy in the neck. An antireflux valve was then created by invaginating the lower end of the tube into the gastric remnant. The following observations were made before and after creation of the valve: (1) gastric distending pressure required to produce efflux of saline from the ostomy; (2) manometric pressure at the stomach-tube junction; and (3) 2-hour pH monitoring within the tube after acid infusion into the stomach. The valve shortened the gastric tube by 2.0 to 2.5 cm. It did not obstruct antegrade flow of saline. Prior to creation of the valve, reflux of saline out of the cutaneous ostomy occurred at an average pressure of 62 cm H2O (range 25 to 80). The antireflux procedure prevented reflux with distending pressures up to 200 cm H2O. Manometry revealed an average pressure of 18 cm H2O (range 5 to 25) at the lower end of the tube before creation of the valve. The antireflux procedure raised this high pressure zone to 60 cm H2O (Range 50 to 65) (P less than 0.05). Spontaneous reflux was rarely observed in the anesthetized dog when acid was infused into the stomach and the pH was monitored in the gastric tube. Acid reflux could easily be produced by application of minimal manual pressure to the closed abdomen.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

Cholelithiasis in infancy: resolution of gallstones in three of four infants.

Cholelithiasis in infancy is believed to be a rare finding. It is also held that all cholelithiasis in infancy has a predisposing factor such as hemolysis, prolonged fasting, congenital abnormality of the biliary tree, or the administration of TPN and is associated with severe morbidity and mortality. In the last three years, four infants at our hospital have been found on real-time ultrasonography to have gallstones. Their ages ranged from 3 weeks to 6 months. One patient had a hemolytic disease but the finding of cholelithiasis in the other three patients was incidental. A repeat sonogram in the infant with hemolysis three months after initial recognition and one day before scheduled cholecystectomy revealed spontaneous resolution of the gallstones. This led us to a conservative approach in the other three patients. Two more infants had spontaneous resolution of their gallstones and one child, now aged 16 months, is thriving with a persistent asymptomatic gallstone visible on sonogram.

Cholelithiasis↗

Photoperiodic control of testicular size in the golden hamster: lack of a role for the deep pineal gland.

Removal of the superficial pineal gland prevents testicular regression from occurring in golden hamsters exposed to a short-day photoperiod, but to date no studies have examined the role of the deep pineal gland in the photoperiodic control of gonadal function. We investigated the role of the deep pineal gland in this process by monitoring testicular size in hamsters with an electrolytic lesion of the deep pineal gland. Sexually mature hamsters that had been sham-lesioned or that had received a lesion aimed at the deep pineal gland were transferred from 14L:10D to 6L:18D or were maintained in 14L:10D for 73 d. Testicular widths were determined at 2-3-wk intervals and after 73 d the testes were removed and weighed. The mean testis widths of the seven animals with histologically confirmed deep pineal lesions and exposed to 14L:10D remained large, similar to those of the sham-operated control animals exposed to the same photoperiod. The testes regressed in the five animals with confirmed deep pineal lesions and exposed to 6L:18D in a similar manner to those of the sham-operated control animals exposed to the same photoperiod. No significant difference (P greater than .05) was found between the testicular weights of lesioned and unlesioned animals exposed to either photoperiod. The lack of a significant effect of a deep pineal lesion on testicular size demonstrates that this portion of the pineal complex is not required for normal regulation of testicular function by photoperiod. These results also suggest that nerve fibres projecting from the brain to the superficial pineal gland via the deep pineal gland are not involved in photoperiodic regulation of testicular function.

Animals↗

Kynurenic acid as an antagonist of hippocampal excitatory transmission.

Kynurenate, an endogenous tryptophan metabolite, was bath-applied to hippocampal slices while recording extracellular synaptic field potentials. Kynurenate antagonized the medial and lateral entorhinal projections to dentate granule cells, the Schaffer collateral projections to CA1 pyramidal cells, and inputs to the CA3 stratum radiatum of regio inferior with similar potencies. Concentration-response curves for these pathways paralleled theoretical antagonist curves with a Hill coefficient of 1, and the KdS were in the range of 130-400 microM. Projections to the stratum lucidum of regio inferior were much less sensitive to kynurenate. Inputs to CA3 pyramidal cells showed varying sensitivities to kynurenate, L-2-amino-4-phosphonobutanoic acid (L-APB), and (-)-baclofen depending on the placements of the stimulating and recording electrodes. When both electrodes were located in area CA3, outside the hilus of area dentata, all responses were insensitive to inhibition by L-APB. Under these conditions, responses recorded within the stratum radiatum were sensitive to inhibition by kynurenate and baclofen, while responses recorded within the stratum lucidum were insensitive to these drugs. When the stimulating electrode was placed within the hilus of area dentata, variable patterns of sensitivity to APB, baclofen, and kynurenate were observed from recording electrodes in area CA3. These results suggest that stimulation in the hilus, while recording in the stratum lucidum, produces responses that show composite effects resulting both from direct stimulation of mossy fibers and from stimulation of neuronal elements in the hilus which produce outputs to mossy fibers.

Action Potentials↗

Oesophageal substitution.

Fourteen patients with oesophageal atresia, either isolated or with tracheo-oesophageal atresia have had reconstruction using a reversed gastric tube, developed from the greater curvature of the stomach. The technique of the procedure and the results in these patients are described.

Esophageal Atresia↗

Treatment of congenital microgastria and dumping syndrome.

Two children with congenital microgastria and associated anomalies requiring surgery as infants, developed severe dumping syndrome which necessitated a remedial operation. A Roux-en-Y jejunal pouch (Hunt-Lawrence) was formed at 22 months and 10 months respectively. Weight gain was immediate in both patients and has been sustained for 6 months and 8 years respectively. Symptoms of the dumping syndrome were relieved and the pouch delays filling of the jejunum.

Body Weight↗

Surgical management of intractable cholangitis following successful Kasai procedure.

Anastomotic revision/resection procedures were carried out in five patients in whom refractory cholangitis jeopardized an apparently favorable surgical outcome after portoenterostomy for biliary atresia. Mobilization and displacement of the liver improves exposure of the porta hepatis. All five patients remain jaundice-free seven months to 4 yr after reoperation.

Bile Ducts↗

Hepatocellular adenoma in a young woman with beta-thalassemia and secondary iron overload.

The occurrence of a hepatocellular adenoma is described in a young woman with beta-thalassemia and secondary iron overload. This patient had no history of oral contraceptive use, and in fact was hypogonadal as a result of iron deposition in pituitary and gonadal tissue. Although hepatocellular carcinoma frequently occurs in diseases associated with iron overload, this is the first report of a benign liver tumor associated with secondary iron overload.

Adolescent↗

Aerobic and anaerobic bacteriology of pilonidal cyst abscess in children.

Aspirates of pus from pilonidal abscesses in 25 children were studied for aerobic and anaerobic bacteria. A total of 76 isolates (63 anaerobic and 13 aerobic) were recovered from the patients, accounting for 2.52 anaerobes and 0.52 aerobes per specimen. Anaerobic organisms were recovered from all the specimens, and in eight cases (32%) they were mixed with aerobic organisms. The predominant anaerobic organisms were Bacteroides sp (36 isolates, including ten B fragilis group and ten B melaninogenicus group), Gram-positive anaerobic cocci (16). Fusobacterium sp (five), and Clostridium sp (four). The predominant aerobic organisms were Escherichia coli (four) and group D streptococci, alpha-hemolytic streptococci, and Proteus sp (two of each). We believe this study is the first to demonstrate the mixed anaerobic and aerobic bacteriology of pilonidal cyst abscesses in children.

Abscess↗

Growth of mouse hepatoma following liver resection.

Liver regeneration occurs after resection. Hepatic tumors may be subject to the same factors which influence cell mass in regenerating liver. Partial hepatectomy is shown to cause a significant transient augmentation of tumor growth compared to non-operated and nephrectomized controls. Skin grafting studies indicate this phenomenon is probably not immunologically mediated.

Animals↗

Gastric tube interpostion: a satisfactory alternative to the colon for esophageal replacement in children.

The gastric tube was used as the primary method of esophageal reconstruction in 15 infants and children, 9 with isolated esophageal atresia and 6 with lye stricture. The youngest patient was 8 months old and the oldest, 5 years old at the time of the procedure. The technique of gastric tube construction is described. There have been both major and minor complications but the gastric tube has proved very satisfactory as a conduit from mouth to stomach. Growth and development have been acceptable in all 15 children, although most remain in the lower percentiles for growth and height, a condition that usually predates the esophageal substitution. In our institution the gastric tube is the preferred method of esophageal substitution.

Burns, Chemical↗