Omphalocele and gastroschisis.
This brief article outlines our philosophy and management of omphalocele and gastroschisis based on personal experience with more than 200 patients.
Abdominal Muscles↗
Biomedical subjects
L W Martin
Publications and source records attributed to L W Martin.
Blunt hepatic injury and elevated hepatic enzymes: a clinical correlation in children.
During a recent prospective nonrandomized comparison of noninvasive imaging techniques in 100 children with suspected major blunt abdominal injury, an interesting subset of patients was defined. Of 95 hemodynamically stable patients, 44 were found to have immediate elevation of hepatic enzymes (SGOT, SGPT greater than 30 IU). Nineteen of these children (43%) were subsequently shown to have significant liver injuries. No child with a liver injury had normal enzymes on admission. The level of enzyme elevation (SGOT chi 890 +/- 142 IU, SGPT chi 536 +/- 105 IU) in those with liver injuries is significantly greater than those without injury (SGOT chi 273 +/- 44 IU, SGPT chi 115 +/- 19 IU) (P less than or equal to 0.0001 SGOT. P less than or equal to 0.0001 SGPT). Our study has allowed definition of a group of children who are at significant risk for liver injury based on immediately available serum determinations of GOT and GPT. We have begun to use this information in our institution to select children for further noninvasive imaging. We recommend that these studies be obtained emergently in all children with suspected upper abdominal trauma.
Alanine Transaminase↗
Notes from a director's wish book.
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General Surgery↗
Experience with 95% pancreatectomy and splenic salvage for neonatal nesidioblastosis.
Conventional 85% pancreatectomy with splenectomy performed for management of hypoglycemia of neonatal nesidioblastosis has been followed by a dismal prognosis characterized by post-splenectomy sepsis, recurrent hypoglycemia, permanent brain damage, and a high mortality. For our last eight infants we have found it possible to remove at least 95% of the pancreas, preserving the blood supply to the spleen as well as the duodenum. This has permitted satisfactory control of the hypoglycemia and long-term septic complications have been avoided. Follow-up evaluation up to 20 years with successful control of hypoglycemia without progressive brain damage indicates the value of this primary extensive surgical approach.
Adenoma, Islet Cell↗
Staging of the endorectal pull-through operation for ulcerative colitis.
Of 43 patients undergoing operation for ulcerative colitis or polyposis, we found staging of the operation advisable in 7 instances. The initial operation consisted of subtotal colectomy with a Hartman's pouch and an ileostomy. The second procedure was a mucosal proctectomy, ileoanal anastomosis, and construction of a pelvic reservoir into the terminal ileum. The ileostomy was closed as a third procedure with approximately 6 months between each operation. Staging is recommended when emergency operation is required because of bleeding, perforation, or toxic megacolon; when significant technical problems are encountered with the mucosal stripping; or when the surgeon has had limited experience with the procedure. With the addition of staging to the surgeon's armamentarium, it is now possible to offer total colectomy with preservation of rectal continence to virtually all patients suffering from chronic ulcerative colitis.
Adolescent↗
A new 'gravity-flow' nipple for feeding infants with congenital cleft palate.
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Bottle Feeding↗
Total colonic aganglionosis preservation and utilization of entire colon.
Thirteen patients with total colonic aganglionosis are reported. Nine were treated with an operation to preserve and utilize the descending colon. Because of the encouraging results with this group, the operation for the four most recent infants consisted of a side-to-side anastomosis of the entire aganglionic colon to the ganglionated small bowel. The operation provides a greater surface area for absorption and also a greater area for fecal storage. All patients are continent and the ability to evacuate does not appear to have been affected.
Colon↗
Preservation of anorectal continence following total colectomy.
The search for continence in the surgical management of ulcerative colitis has resulted in the evolution of a method that has yielded gratifying results in the last 18 patients. The disease process is removed; all patients are continent; they have no postoperative perineal excoriation; the frequency of stools is not excessive and the patients are returning to work or to school within three weeks following ileostomy closure. Their ages were eight to 52 years. The procedure consists of a total of colectomy with mucosal proctectomy, ileoanal anastomosis and construction of a terminal ileal, pelvic reservoir. A proximal ileostomy diverts the fecal stream until healing is complete. The authors are now recommending the operation be considered for patients of all ages who require surgery for chronic ulcerative colitis as well as polyposis.
Adolescent↗
Early operation with intestinal diversion for necrotizing enterocolitis.
Necrotizing enterocolitis (NEC) remains a highly lethal disorder despite significant advances in management during the past decade. Increased mortality with perforation and the frequent finding of massive intestinal necrosis have hampered efforts to improve survival. A recent experience with early operation and intestinal diversion in selected patients with clinical features suggesting impending intestinal gangrene suggests a place in the management of infants with rapidly progressive NEC.
Enterocolitis, Pseudomembranous↗
Extra-anatomical vascular bypass and external skeletal fixation in limb replantation.
The scientific background for limb replantation began 75 yr ago with the work of Hopfner and of Carrel and Guthrie. Thirty-five years ago, Hall indicated that the techniques were available, but it was not until 17 yr ago that Malt and McKhann performed the first successful replantation of a limb in man. Since then, the techniques have become more sophisticated and guidelines have been formulated. Many successful replantations have been reported. We present two children with partial amputation of a lower limb. Both had severe soft tissue and bone damage sufficient to contraindicate replantation by conventional criteria. Wound sepsis resulted in failure of replantation of the first child's limb replanted by conventional methods. The second child's limb was salvaged. Extra-anatomical vascular bypass graft separated the critical vascular anastomoses from the open contaminated wound. External skeletal fixation allowed aggressive open wound treatment. In selected cases, these two techniques would appear to increase the chances for successful limb replantation.
Amputation, Surgical↗
Use of the appendix to replace a ureter. Case report.
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Appendix↗
Renal homotransplantation in children.
Ninety-six renal transplants in 77 pediatric patients are reported with follow-up as long as 12 1/2 years. Thirteen of the first 14 patients are living with a functioning kidney after eight to 12 1/2 years. The patient survival for the entire group is 78%. Sixty-four percent are living with a functioning transplanted kidney. Splenectomy was initially performed at the time of transplant but has been discontinued because of concern that splenectomy in the immunosuppressed patient was related to an increased occurrence of septic complications. Anencephalic newborn infants have been found to be a satisfactory source of cadaver donor kidneys. Growth and development have been satisfactory when the transplant is performed prior to 12 years of age, if it functions well, and if an alternate-day regimen of steroid administration is followed. Both boys and girls have now passed through puberty with their transplanted kidneys, have married, become parents, and are leading essentially normal lives. A plea is made for earlier transplantation in small children with irreversible progressive renal failure before they develop severe stunting of growth and before the need for prolonged dialysis.
Adolescent↗
Hirschsprung's disease with skip area (segmental aganglionosis).
Hirschsprung's disease is characterized by a single aganglionic segment of colon extending distally to the anal margin. Well documented reports of segmental aganglionosis have been rare. We report a case of segmental aganglionosis in which there were two distinct aganglionic segments resected. The entire transverse colon between the two aganglionic segments was normally ganglionated, preserved, and utilized and functions in a normal fashion.
Colon↗
Retroperitoneal lymph node dissection for Wilms' tumor.
Nephrectomy for Wilms' tumor was performed on 58 patients over a 20-yr period, and retroperitoneal lymphadenectomy was performed on 35 who presented with no demonstrable metastases. The survival rate was 100% for 19 clinical group I patients with negative nodes. Positive nodes in 9 instances led to 5 long-term survivors and significantly influenced staging as a guide for further therapy.
Humans↗
Portal hypertension secondary to choledochal cyst.
Two patients with portal hypertension secondary to choledochal cyst are reported and combined with four others previously reported in the literature. Choledochal cysts may, by extrensic compression, cause partial or complete portal vein obstruction, portal hypertension and esophageal varices. Needle biopsy of the liver is probably not a reliable means of differentiating choledochal cyst from other intrahepatic causes of portal hypertension. Internal drainage of the choledochal cyst has been performed in four patients and in each instance resulted in satisfactory portal decompression.
Adolescent↗
Leukemic infiltration of the testis during long-term remission.
Of 33 boys with acute lymphocytic leukemia treated at the Cincinnati Children's Hospital during 1971--1974, 14 remained in clinical and bone marrow remission for periods longer than 2.5 yr. Of these 14 patients, 8 then developed testicular leukemia. In 7 of these 8 patients, testicular infiltration was the first or only evidence of relapse. In 2 of the patients the gonads were not grossly abnormal, and testicular relapse was discovered as a result of routine wedge biopsy before therapy was to have been stopped. This experience has led to our policy of routine testicular biopsy in boys with acute lymphocytic leukemia who have had continuous remission for 3 yr and who are otherwise candidates for discontinuance of maintenance therapy.
Adolescent↗
Technical considerations in performing total colectomy and Soave endorectal anastomosis for ulcerative colitis.
Total colectomy, mucosal proctectomy, and ileoanal endorectal anastomosis have been successful in 17 of 19 children with chronic ulcerative colitis. No significant complications were encountered in our recent 9 cases. The technique of the operation as it is now performed in our institution is described.
Adolescent↗
Emergency splenectomy for idiopathic thrombocytopenic purpura in children.
Splenectomies were performed in 30 children out of a total of 183 with idiopathic thrombocytopenic purpura (ITP). Of these 30, ten splenectomies were performed on an emergency basis. Significant spontaneous gross hematuria, gastrointestinal bleeding or epistaxis appear to represent harbingers of intracranial hemorrhage and constitute indications for emergency splenectomy.
Adolescent↗