Biomedical subjects

M Giacomantonio

Publications and source records attributed to M Giacomantonio.

24 records · Page 2Linked to original sources

PubMed1984

Blunt hepatic trauma in children: experience with operative and nonoperative management.

Between 1974 and 1982, 32 children were treated for blunt hepatic trauma. Twenty-three injuries were secondary to motor vehicle accidents. Twenty-three patients had associated injuries. The hepatic injury was treated surgically in 18 patients. Urgent surgery for massive bleeding was required in 7 patients; 8 underwent laparotomy for continued bleeding after initial stabilization; 2 underwent laparotomy for marked abdominal tenderness, and 1 for an expanding hepatic hematoma. Various excisional, debridement, suture, and drainage procedures were employed. Seven patients died, 5 from uncontrollable bleeding and 2 from associated severe head injury. The eleven survivors did well. The only postoperative complications were two wound infections. Fourteen patients were managed nonoperatively. Liver scan provided the diagnosis in all. Five of these patients required blood transfusion, and the mean volume of transfusion was 33cc/kg. The hospital courses in all cases were uneventful, and there were no late complications. A follow-up liver scan was obtained in 11 patients, showing resolution of the injury in all. We conclude that laparotomy is necessary for hepatic injury when it is associated with continuous massive bleeding. Hemodynamically stable patients can be managed nonoperatively, even when the blood-transfusion requirements are significant.

Adolescent↗

PubMed1984

Thirty years of experience with pediatric primary malignant liver tumors.

Since 1950, 48 infants and children from 10 weeks to 16 years of age presented with primary hepatic malignancy. Signs and symptoms ranged from asymptomatic to those of malignant disease. All patients had a palpable abdominal mass. Jaundice was seen in five patients, four of whom had preexisting cirrhosis. Three male children had evidence of precocious puberty. Whereas liver function tests were usually normal, alpha-fetoprotein levels, when elevated, proved useful diagnostically and as a tumor marker in follow-up. Hepatic angiography and computed tomography (CT) scans have provided the most valuable preoperative assessment of hepatic architecture. Sixteen infants and children underwent resection for cure. Eleven of these patients are alive and disease free 6 months to 23 years later. Six additional patients had incomplete resection with subsequent radiotherapy and/or chemotherapy; only one such patient is disease-free past 3 years. Twenty-six tumors could only be biopsied; most of these patients died within 12 months regardless of what treatment they received. The histology was hepatoblastoma in 39 patients, hepatocellular carcinoma in 4, fibrolamellar carcinoma in 4, and malignant mesenchymal tumor (mesenchymoma) in 1. The patients with hepatocellular carcinoma and mesenchymoma all died. Three of four patients with fibrolamellar carcinoma are alive and disease-free following resection up to 3 years; this histology seems favorable. The other survivors had hepatoblastoma. The role of adjunctive chemotherapy and/or radiotherapy has not yet been determined.

Adolescent↗

PubMed1982

Should prophylactic antibiotics be given perioperatively in acute appendicitis without perforation?

The authors question the need to give prophylactic antibiotics perioperatively in all cases of acute appendicitis without perforation to reduce the rate of wound infection. A retrospective study of 82 patients showed a wound infection rate of 4.8%; 3 of 53 patients who did not receive antibiotics had a wound infection compared with 1 of 29 patients who received antibiotics. A prospective double-blind clinical trial was performed comparing the results of perioperative administration of cefamandole and placebo. One of 21 patients who received the placebo had a wound infection; none of the 21 patients given cefamandole had infection. Thus, the authors conclude that, although reports in the literature suggest that antibiotics given perioperatively decrease the rate of wound infection in acute appendicitis without perforation, the incidence of such infection is too low to warrant routine administration. They suggest that such antibiotic use be reserved for those suspected of having more serious disease.

Acute Disease↗

PubMed1981

Torsion of the testicle in the newborn.

Torsion of the testicle in the neonate is uncommon. Only nine cases were seen in a 10-year period at the Izaak Walton Killam Hospital for Sick Children in Halifax, Nova Scotia. The authors describe briefly five of their cases to exemplify the features of and problems associated with this condition. They emphasize that (a) a reddish blue, nontender, scrotal or hemiscrotal swelling in the neonate should be considered as torsion of the testicle until proven otherwise and (b) torsion of the testicle in the neonate is a surgical emergency. If testicular tissue is to be saved urgent scrotal exploration is mandatory. The torsion may occur in utero (as is the usual case), at time of birth or post partum, but the time of occurrence cannot be judged. Finally, the authors discuss some of the controversies in the surgical management of this entity, including the surgical approach and management of the contralateral hemiscrotum.

Humans↗

PubMedDate not supplied

Fine needle aspiration cytology of metastatic malignant rhabdoid tumor.

The diagnosis and management of pediatric neoplasms using fine needle aspiration (FNA) has been neglected as compared to neoplasms occurring in adults. A case of metastatic malignant rhabdoid tumor diagnosed by FNA cytology is presented, and the cytologic morphology, which to our knowledge has not previously been reported, is described. The ultrastructural findings in the histologic specimen are also depicted. This case demonstrates the feasibility and need for further exploration of the use of FNA in pediatric oncology.

Biopsy, Needle↗

PubMedDate not supplied

Perianal ependymoma presenting in the neonatal period.

Extraspinal ependymomas are a rare type of glioma that may arise in the sacrococcygeal region, presenting as a pelvic mass in an infant or child. Ependymoma presenting in the newborn period has not been described previously. Herein we describe a case of a newborn boy who presented with a perianal ependymoma, which was subsequently found to have presacral extension. The major diagnostic challenge this case presented was to rule out the alternative diagnosis of sacrococcygeal teratoma or a developmental malformation/heterotopia.

Anus Neoplasms↗