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Biomedical subjects

L Spitz

Publications and source records attributed to L Spitz.

305 records · Page 17Linked to original sources
PubMed1971

Management of ingested foreign bodies in childhood.

A total of 660 patients with ingested foreign bodies admitted to the general surgical services in two children's hospitals in Liverpool are reviewed. Endoscopic removal (205 cases) is recommended for all foreign objects impacted in the oesophagus, with the exception of rounded or blunt objects in the lower third, which should be observed for a maximum of 12 hours. The indications for laparotomy for removal of a foreign body (43 cases, 6.5%) are the danger of perforation and failure of progression. The ingestion of a long slender object-for example a hair-grip-in a child under 2 years of age, is an absolute indication for prophylactic operative removal owing to the high incidence of impaction and perforation of the duodenum.

Adolescent↗
PubMedDate not supplied

Management of esophageal atresia.

A total of 303 infants with esophageal atresia and/or tracheoesophageal fistula were treated over 10 years (1980-1989). The overall survival rate was 86.5%. Associated anomalies were identified in 51.8% of patients, the most common being cardiac malformations which affected 24.4% of infants and was responsible for the majority of deaths. The dramatic increase in survival of infants with esophageal atresia in the past half century is due to improvements in pre- and postoperative management, meticulous operative technique to reduce anastomotic complications, and aggressive treatment of associated congenital anomalies.

Anastomosis, Surgical↗
PubMedDate not supplied

Congenital alveolar capillary dysplasia and associated gastrointestinal anomalies.

Congenital alveolar capillary dysplasia is a rare cause of irreversible pulmonary hypertension with 100% mortality. We present three cases of congenital alveolar capillary dysplasia with associated gastrointestinal abnormalities. Three full-term neonates presented with pulmonary hypertension needing ventilatory support by oscillation. Of the three, two neonates subsequently needed extracorporeal membrane oxygenation. Abdominal distension associated with bilious aspirates was the gastrointestinal manifestation. One child had duodenal atresia and anorectal anomaly, one with intestinal malrotation and the other with a rare combination of intestinal malrotaion and total colonic Hirschsprung's disease. All three infants succumbed to pulmonary hypertension at mean age 34 days. The etiopathogenesis and pathology of this condition are discussed with a comprehensive review of the literature.

Capillaries↗
PubMedDate not supplied

Imaging in the preoperative assessment of conjoined twins.

Conjoined twins are rare and present a unique challenge to pediatric surgeons and radiologists. Planning of surgical separation is aided by accurate preoperative imaging. Such twins are classified according to the most prominent site of connection: the thorax (thoracopagus), abdomen (omphalopagus), sacrum (pygopagus), pelvis (ischiopagus), skull (craniopagus), face (cephalopagus), or back (rachipagus). The area of fusion largely determines the imaging modalities used. Thoracic conjunction is most common and requires cardiac assessment. Magnetic resonance imaging and computed tomography provide excellent anatomic and bone detail, demonstrating organ position, shared viscera, and limited vascular anatomy. Contrast material radiography allows evaluation of the gastrointestinal and urogenital tracts, and a shared liver requires assessment of anatomy, vascularization, and biliary drainage. Angiography helps define specific vascular supply, which is useful in determining the distribution of shared structures between the twins at surgery. Each set of conjoined twins is unique. An imaging strategy to accurately define anatomic fusion, vascular anomalies, and other associated abnormalities is important for surgical planning and prognostic information.

Algorithms↗
PubMedDate not supplied

Necrotizing enterocolitis induced by local circulatory interruption in the ileum of neonatal piglets.

Occlusion of groups of vessels in the mesenteric vascular arcades of distal ileum for 48 h induced necrotizing enterocolitis lesions in low birth weight, spontaneously delivered, neonatal piglets. Lesion severity increased with numbers of adjacent groups of vessels occluded and with proximity to the ileocecal junction. A previously undescribed feature, "prepneumatosis," was confined to the lymphatic vessels of the submucosa and serosa. This feature closely resembled the position, shape, and distribution of classical pneumatosis intestinalis. Occlusion of vessels for 30 min followed by reperfusion did not induce any detectable changes 48 h later. Identical procedures (48-h occlusions) did not induce any detectable changes in 35-kg pigs.

Animals↗
PubMedDate not supplied

Collateral blood flow in the distal ileum of neonatal piglets: a clue to the pathogenesis of necrotizing enterocolitis.

Normal blood flow was measured in two regions of the ileum (distal and proximal) of normal birth weight (NBW) and low birth weight (LBW) neonatal piglets. Compensatory collateral blood flow in response to occlusion of vessels in the mesenteric vascular arcades was also measured in distal and proximal ileum of NBW and LBW neonatal piglets. Under normal control conditions the blood flow in the distal ileum of NBW piglets is reduced (40% less than proximal) and in LBW animals this reduction is greater (55% less than proximal). Both proximal and distal ileum of NBW animals but the proximal ileum only of LBW animals could mount compensatory collateral flow, whereas the distal ileum of LBW animals was unable to do so. This decompensation in LBW distal ileum may explain the predilection of NEC lesions for the distal ileum and proximal colon.

Animals↗
PubMedDate not supplied

Histological investigations into the relationship between low birth weight and spontaneous bowel damage in the neonatal piglet.

Experimental models for the study of neonatal necrotizing enterocolitis (NEC) using the small for gestational age (SGA), viable, term-delivered piglet have recently been described. A spontaneous model, especially of the early phases of NEC, has not been reported. Pig litters usually include one or two lethally or sublethally SGA "runted" piglets culled from the litters by breeders. We have examined four groups of piglets: group A, SGA, lethally runted animals who died spontaneously before 12 h postpartum; group B, SGA, sublethally runted animals, showing some signs of vitality and left alive for 24 h before culling; group C, appropriate for gestation age (AGA) animals subjected to hypoxia and hyperviscosity known to induce NEC-like lesions; and group D, AGA control animals. Acute, multiorgan pathology common to pre- and dysmature neonates was seen in groups A and B. Animals in group B also showed evidence of early postnatal complications such as urinary tract infection and diffuse pulmonary damage. All animals of groups A and B showed unequivocal early changes in the distal ileum, with mucosal and submucosal necrosis, suggestive of ischemic injury. One animal in group B had developed mural necrosis involving the whole of the submucosa. No similar changes were seen in control group D animals. The very-SGA, lethally and sublethally runted, spontaneously term-delivered piglet offers sufficient spontaneous early NEC-like changes for studies of the early pathogenesis of this condition.

Animals↗