Fatal intraoperative tumor embolism in a child with hepatoblastoma.
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Carcinoma, Hepatocellular↗
Biomedical subjects
L Spitz
Publications and source records attributed to L Spitz.
Results and complications of surgery for gastro-oesophageal reflux.
One hundred and six children undergoing antireflux surgery were studied; 41 were severely mentally retarded and 29 had reflux strictures. Although the eventual rate of success was 92%, 20 patients developed complications that required a second operation. Prolapse of the fundoplication into the mediastinum was the commonest complication (in seven patients), followed by intestinal obstruction (in five), and intractable fibrous oesophageal strictures (in five). The incidence of postoperative complications was highest in patients with mental retardation or oesophageal strictures. Referral of these patients for operation was invariably delayed, and earlier referral may have avoided many of the complications.
Adolescent↗
Interleukin-2 in vivo: production of and response to interleukin-2 in lymphoid organs undergoing a primary immune response to heterologous erythrocytes.
In this report, we describe experiments which demonstrate that antigenic stimulation in vivo causes the appearance of cells in both spleen and lymph node which secrete interleukin-2 (IL-2). Cells also appear in these organs which proliferate in response to IL-2. For these experiments, sheep red cells (SRBC) were injected into the spleens or footpads of mice, and cell suspensions from spleens or popliteal lymph nodes prepared at various times after antigenic stimulation. These cells were assayed for their ability to respond to IL-2, and their cell culture supernatants for secreted IL-2. The proliferative response to IL-2 steadily increased following SRBC injection to reach a peak at Day 2 for spleen cells and at Day 3 for lymph node cells. Maximal production of IL-2 was displaced from the maximal response to the lymphokine by peaking one day later for both organs. Our results strongly implicate the participation of IL-2 in the in vivo immune response and suggest the existence of in vivo regulatory mechanisms, which can control the time of IL-2 production and also the appearance of cells with receptors for IL-2.
Animals↗
[Tracheomalacia in a child with atresia of the esophagus: surgical treatment by aortopexy].
A child who developed apneic spells during feeding, following repair of oesophageal atresia is reported. Symptoms were relieved by suspending the aortic arch to the undersurface of the sternum. Tracheomalacia, its diagnostic and management is discussed.
Aorta↗
Intrasplenic primary immunization for the production of monoclonal antibodies.
A novel immunization procedure for eliciting monoclonal antibodies ( McAbs ) is described. With intrasplenic inoculation only small amounts of immunogen are required. As little as 20 micrograms of protein antigen or 2.5 X 10(5) cells have been found sufficient to immunize mice or rat spleen cells for the production of specific McAbs . A high proportion of hybridomas secreting McAbs against cell surface antigens and soluble proteins has been obtained with this immunization procedure. The system could facilitate McAb production in many instances in which only small quantities of immunogen are available.
Animals↗
Posture in the postoperative management of infantile pyloric stenosis.
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Humans↗
Neonatal hyperparathyroidism.
We describe a girl with congenital hyperparathyroidism who presented soon after birth with respiratory distress, hypotonia, feeding difficulties, and bone deformities. Hypercalcaemia, hypophosphataemia, and raised alkaline phosphatase were present and plasma parathyroid hormone levels measured by radioassay and bioassay were raised. X-rays showed gross demineralisation with metaphyseal fractures, erosions, and sub-periostal reaction along the bones. Following surgical removal of four hyperplastic parathyroid glands and subsequent maintainance therapy with 1-alpha-hydroxycholecalciferol there has been virtually complete reversal of her bone abnormalities.
Female↗
Gastric transposition via the mediastinal route for infants with long-gap esophageal atresia.
Gastric replacement of the esophagus using the posterior mediastinal route is reported in four infants with esophageal atresia without tracheoesophageal fistula. The procedure is recommended for the ease with which the operation can be performed and the low incidence of anastomotic complications. Growth and development in the short-term follow-up has been satisfactory and reflux has not been a problem.
Esophageal Atresia↗
Dumping syndrome following Nissen's fundoplication: a cause for refusal to feed.
Two cases of infantile dumping syndrome which developed following Nissen fundoplication for gastroesophageal reflux are described. Both infants were fed postoperatively via a gastrostomy and showed the typical clinical picture of dumping with failure to thrive, intermittent diarrhea, lethargy and pallor postprandially. Several glucose tolerance tests were highly pathological with marked hyperglycemia immediately after a gastrostomy meal followed by hypoglycemia two hours later. In one case HbA1c was significantly elevated which is thought to be an expression of recurrent hyperglycemia. In both infants the first and most impressive clinical sign was absolute refusal or oral feeds. Normal oral food intake was slowly re-established after normalization of blood glucose homeostasis.
Dumping Syndrome↗
Persistent left superior vena cava and central venous feeding.
The dangers of left-sided superior vena cava have received insufficient attention in the literature on central venous catheterisation. Three infants have recently been encountered with this anomaly in a series of 160 central venous catheterisations . This is much higher than the reported incidence of the anomaly. Certain safeguards are suggested when it is encountered.
Catheterization↗
Faecal flora in neonates with oesophageal atresia.
The bacteriological findings of a study of intestinal colonisation in 24 neonates with oesophageal atresia are reported. Only five of the patients received antibiotics. When compared with published findings in healthy neonates, the rate of intestinal colonisation in our series was prolonged, with Staphylococcus albus predominating in the first week. Anaerobic colonisation was delayed and bacteroides spp were present in only five patients by the third week. Bifidobacteria were almost completely absent. The onset of intestinal colonisation seemed to be related temporally to enteral feeding. The use of antibiotics in five patients resulted in colonisation by candida in four and clinical thrush in three.
Bacteroides↗
Clostridial toxins in neonatal necrotising enterocolitis.
Clostridium difficile cytopathic toxin was found in the faeces or gut content of five of 39 neonates with necrotising enterocolitis (NEC). Toxin concentrations were uniformly low and did not differ from those found in healthy neonates. C difficile is unlikely to be involved in the pathogenesis of NEC. Stools from 33 babies with NEC were also tested for C perfringens alpha toxin, with negative results.
Bacterial Proteins↗
Transport of the surgical neonate.
We have shown that the critically ill neonate may be safely transferred over long distances provided some essential criteria are fulfilled. There are obvious advantages in centralising neonatal surgery in a limited number of regional centres where surgical expertise and adequate support services are concentrated and there seems to be no justification, except in situations of dire emergency, for neonatal surgery to be performed in district general hospitals in the United Kingdom. The fact that neonates requiring surgery can be safely transferred adds strength to the plea for the paediatric surgeon to have an absolute monopoly of surgery in this age group.
Body Temperature↗
Extrahepatic biliary obstruction due to stone.
Jaundice developing after the neonatal period requires prompt investigation. Surgical causes of cholestatic jaundice, apart from extrahepatic biliary atresia and choledochal cyst, are rare. We describe a case of bile duct dilatation associated with an impacted calculus at the ampulla of Vater in a haemophiliac. The ultrasound finding of a dilated duct was an indication to proceed to surgery.
Cholelithiasis↗
Balloon catheter dilatation of oesophageal strictures in children.
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Adolescent↗
Peptic ulceration in children.
An analysis of 84 children with peptic ulcer disease seen at The Hospital for Sick Children, in London, revealed only 30 primary ulcers over a period of 30 years. While most of these responded to conservative measures, it is recognized that a significant proportion may ultimately require surgical treatment for recurrence of the disease in adult life. Secondary ulcers occurred with almost twice the frequency of primary disease. Hemorrhage was the first sign of the ulceration in 55 per cent of these seriously ill children and could be controlled with conservative measures in 14 of 17 patients. Only three patients required surgical treatment for uncontrolled hemorrhage. Secondary ulceration was largely a terminal event and despite intensive resuscitation carried a high mortality (77.7 per cent).
Child↗
Detection and affinity purification of beta-endorphin precursors using a monoclonal antibody.
A monoclonal antibody to porcine beta-lipotropin has been produced which binds to the N-terminal (gamma-lipotropin) portion of the molecule. The antibody can be used to detect beta-lipotropin as well as other beta-endorphin precursors (predominantly a Mr 38 000 polypeptide) using radiobinding assay or the immunoblotting technique. Purification of the peptides can be readily achieved by affinity chromatography using the monoclonal antibody covalently bound to Sepharose 4B. As the antibody recognises the N-terminal part of beta-lipotropin, it can be used to detect and purify beta-lipotropin and other beta-endorphin precursors in the presence of beta-endorphin.
Animals↗
A comparison of Nissen fundoplication and Boerema gastropexy in the surgical treatment of gastro-oesophageal reflux in children.
The results of surgical treatment of gastro-oesophageal reflux in 133 infants and children clearly demonstrated the superiority of the Nissen fundoplication over the Boerema gastropexy. The failure to control reflux in the gastropexy group (50 patients) was 42 per cent compared with a 9.6 per cent failure rate in the fundoplication group (83 patients). This resulted in a reoperation rate of 24 per cent for the gastropexy procedure compared with 8 per cent for the fundoplication. There was no difference in the incidence of postoperative complications.
Child, Preschool↗