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Biomedical subjects

L Spitz

Publications and source records attributed to L Spitz.

At least 199 records · Page 11Linked to original sources
PubMed1987

Gastric transposition for esophageal replacement in children.

Esophageal replacement by total gastric transposition was performed on 34 infants (32 with esophageal atresia) in the 5.5-year period from January 1981 to June 1986. There were three deaths (9%), two occurring in the early postoperative period, with the third occurring 1 year after surgery from persistent chronic respiratory problems. Fourteen infants had a totally uncomplicated course and have not required further admissions. Thirteen infants had early postoperative problems including six with delayed gastric emptying, four with anastomotic strictures requiring dilatation, and two with radiologic anastomotic leaks. Four late complications consisted of two adhesion intestinal obstructions, a perforation related to a jejunal feeding tube, and a child in whom malabsorption subsequently developed. An excellent result has been obtained in 24 infants, four doing well with only minor problems with feeding, and two are fair experiencing persisting difficulties. These results compare favorably with a large previous experience in colon interposition.

Abnormalities, Multiple↗
PubMed1986

Incidence of postoperative adhesion obstruction following neonatal laparotomy.

Of 649 neonates undergoing laparotomy in a 10 year period, 54 (8.3 per cent) developed adhesion related intestinal obstruction requiring surgical treatment. In 16 infants the obstruction followed a period of prolonged postoperative ileus, while the remaining 38 had completely recovered from the previous surgical procedure before the development of obstruction. The adhesion obstruction occurred after a single neonatal laparotomy in 35 cases but the remaining 19 had undergone subsequent laparotomies; 75 per cent of the obstructions developed within 6 months and 90 per cent within 1 year of surgery. The highest risk groups were infants undergoing correction of gastroschisis (15.4 per cent) and malrotation (15 per cent). There were nine deaths, two of which were a direct consequence of the adhesion obstruction.

Humans↗
PubMed1986

Dacron-patch aortopexy.

A new technique for aortopexy is described, which uses a dacron patch. The advantages of this procedure as compared with the classical technique are minimized trauma to the aortic wall and evenly distributed traction on the aorta over a large area. This technique was carried out successfully in eight patients with tracheomalacia.

Aorta↗
PubMed1986

The outcome of colonic replacement of the esophagus in children.

An analysis of 112 children undergoing colonic replacement of the esophagus over a 30-year period is presented. The indication for esophageal replacement was atresia in 92 children and intractable stricture (peptic, caustic, or congenital) in 20. The procedure consisted of a transthoracic replacement of the entire esophagus in 82 cases and a partial replacement in 18, while a retrosternal replacement was used in ten cases. Two colon loops had to be abandoned prior to reconstruction due to irreversible ischemic damage. There were 15 deaths (13.4%)--all in the atresia group. Failure of the colonic graft was encountered in 16 patients (14.3%) and accounted for six of the deaths. Leakage of the proximal esophago-colonic anastomosis occurred in 54 cases (48.2%). Strictures of this anastomosis developed in 34 cases (30.3%). A total of 20 patients required operative revision of the anastomosis. The final outcome was excellent in 43 of 77 cases followed up for up to 24 years postoperatively (55.9%), good in 27 cases (35%), and only fair in seven cases (9.1%).

Adolescent↗
PubMed1986

Enterocolitis in Hirschsprung's disease: a controlled study of the etiologic role of Clostridium difficile.

Cytopathic toxin neutralized by Clostridium sordellii antiserum was found in the feces of seven out of 13 children with Hirschsprung's disease complicated by enterocolitis (54%). Clostridium difficile was isolated from ten of these 13 children (77%). The frequency of fecal toxin positivity, the magnitude of toxin titers, and the isolation rate of C difficile were all significantly greater in children with Hirschsprung's enterocolitis than in children whose Hirschsprung's disease was not complicated by enterocolitis or in children without Hirschsprung's disease. It is suggested that C difficile may be causally related to enterocolitis in Hirschsprung's disease, but the age distribution of positive results indicates that the major etiologic role is confined to children under three years of age. Vancomycin was found to be an effective form of treatment in the children with enterocolitis in whom it was employed.

Bacteriological Techniques↗
PubMed1986

Bacterial colonisation of the upper pouch in neonates with oesophageal atresia.

The bacterial flora in the upper oesophageal pouch of forty neonates with oesophageal atresia was studied at daily intervals preoperatively. Of the twenty-nine infants whose oesophagus was anastomosed within 24 hours of admission, no organisms were isolated in sixteen, despite the fact that only nine of these patients had antibiotics. The remaining thirteen grew oropharyngeal organisms. Of eleven infants having delayed anastomosis eight received antibiotics. All eleven grew organisms in the upper pouch. Pseudomonas and serratia grew only in those receiving antibiotics. These results suggest that prophylactic antibiotics are rarely indicated. Efficient continuous aspiration of the pouch is probably more important.

Anti-Bacterial Agents↗
PubMed1986

Intestinal malrotation presenting outside the neonatal period.

We report 37 patients ranging in age from 1 month to 14 years treated for intestinal malrotation during a five year period. The main presenting features consisted of intermittent attacks of vomiting (15 patients), failure to thrive (seven), and recurrent colicky abdominal pain (seven). The diagnosis was confirmed by gastrointestinal contrast studies in all but three patients. A standard Ladd's procedure comprised the definitive surgical treatment. We emphasise the poor nutritional state at the time of operation (49% of the cases were on or below the third centile). In contrast with neonatal presentation, volvulus of the midgut occurred in only five patients (14%) compared with 68% in neonates with malrotation. There were two deaths in the series. Ninety four per cent of the remaining patients responded favourably to the operative procedure. Malrotation should be considered in the differential diagnosis of a wide variety of symptoms and should be treated promptly once the diagnosis has been confirmed.

Abdomen↗
PubMed1986

High complete response rate in children with advanced germ cell tumors using cisplatin-containing combination chemotherapy.

A consecutive series of 13 children (five girls) with advanced malignant germ cell tumors (MGCTs) were treated with between four and seven (median, six) courses of cisplatin, bleomycin, and either vinblastine (BVP) or VP-16 (BEP). There were seven gonadal primaries (four testis, three ovary) and six at extragonadal sites (three sacrococcyx, two thoracic, one extradural). Total or subtotal removal of primary tumor was carried out in nine patients at diagnosis and two others after some chemotherapy. Clinical complete remission (CR) was achieved in nine of ten patients with measurable disease and serum markers returned to normal in all 13 patients. Eleven remain disease-free 17 to 48 months (median, 28 months) after diagnosis. One patient (stage IV sacrococcygeal tumor) relapsed at the primary site 3 months after completing treatment, but is disease-free after further surgery, radiotherapy, and chemotherapy. Serial glomerular filtration rates were performed during treatment. Audiometry and pulmonary function tests were carried out where possible. Toxicity led to alteration of drug scheduling in two cases, but there were no permanent clinical renal, auditory, or pulmonary sequelae. These encouraging results confirm that MGCTs in children are as responsive as those in adults to cisplatin-containing chemotherapy and indicate that they may be as curable. The regimens are relatively well-tolerated and, with close monitoring, clinically significant toxicity should be avoidable.

Adolescent↗
PubMed1985

Use of 'single shot' intrasplenic immunization for production of monoclonal antibodies specific for human IgM.

We report here the use of 'single shot' intrasplenic injection of human IgM for immunization of mice to obtain splenocytes for use in the production of hybridomas secreting antibodies against human IgM. Fusion was performed 3 days after intrasplenic injection of 20 micrograms of myeloma IgM. IgM-specific antibodies were found in 12% of the fusion wells; only 1 well contained antibodies which cross-reacted with other immunoglobulin classes. Two monoclonal antibodies (McAbs) have been fully characterized as specific for different epitopes on Fc mu. These antibodies can be used to detect IgM on the surface of human B cells by immunofluorescence and in solution by solid-phase radiobinding assay or single radial immunodiffusion. Both McAbs can also detect IgM fragments by immunoblotting from non-reducing SDS-polyacrylamide gels.

Animals↗
PubMed1985

Achalasia of the cardia in children.

Fifteen children with achalasia treated surgically over a period of 21 years are reported. All had a modified Heller's myotomy as a primary treatment. The thoracic approach was used in five and the abdominal route in ten. In three patients the myotomy was confined to the oesophagus. Six patients had antireflux procedures at the time of initial myotomy. The mean follow-up period was 6.2 years. Nine patients had excellent results, three had good results, two had fair results and one had a poor result. Of the nine children who did not have an antireflux procedure, three developed symptomatic and radiologically proven gastro-oesophageal reflux. The results of myotomy in children with achalasia are satisfactory but a significant number may develop gastro-oesophageal reflux. We believe that a modified Heller's myotomy combined with a short loose Nissen fundoplication should be the primary treatment of achalasia in children.

Child↗
PubMed1985

Layered versus mass closure of abdominal wounds in infants and children.

A prospective trial of layered versus mass closure of laparotomy wounds was performed on 507 infants and children over a 33 month period. All wounds were sutured using polyglycolic acid sutures. There were four wound failures including one disruption in the layered closure group and one wound failure in the mass closure group. The incisional hernias healed spontaneously. Either method of closure yields good results and non-absorbable sutures are unnecessary.

Child↗
PubMed1985

The absorptive function of colonic aganglionic intestine: are the Duhamel and Martin procedures rational?

The Lester Martin modification of the Duhamel procedure is an accepted definitive operation for long-segment Hirschsprung's disease, in which considerable use is made of aganglionic bowel. Whether the aganglionic segment contributes to fluid and electrolyte reabsorption is not known. We have modified the technique of nonequilibrium dialysis of the rectum in order to obtain simultaneous measurements of electrolyte transport and transmural potential difference (PD) in 9 infants with Hirschsprung's disease (HD), prior to operation. Six age-matched infants were studied as controls. In the control group Na+ was absorbed electrogenically while K+ secretion was passive and greater than HCO3- secretion. In HD, both NA+ absorption and Cl- absorption were greater than in control children, with Cl- absorption exceeding Na+ absorption. PD was higher in HD infants than in controls, with an associated increase in K+ secretion. HCO3- secretion accounted for the difference between Na+ and Cl- absorption. These data clearly show that aganglionic colon transports electrolytes, and that in the Lester Martin modification of the Duhamel procedure the refashioned colorectum contributes to overall colonic salvage of electrolytes.

Colon↗
PubMed1985

Choledocholithiasis in infancy.

Three cases of choledocholithiasis presenting with obstructive jaundice in infancy are reported. Ultrasonography demonstrated a grossly dilated common bile duct in all three cases. It failed, however, to demonstrate the calculi that were situated at the distal end of the common duct. Percutaneous transhepatic cholangiography was valuable in one patient in outlining the biliary tract and in identifying the cause of the obstruction. Endoscopic retrograde cholangiopancreatography (ERCP) was employed in a child, aged three years, in whom it was possible to proceed to endoscopic sphincterotomy with clearance of the common duct. In small infants, transduodenal sphincteroplasty would appear to be the procedure of choice.

Cholangiography↗