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Biomedical subjects

M R Harrison

Publications and source records attributed to M R Harrison.

At least 379 records · Page 21Linked to original sources
PubMed1980

Resection of distal tracheal stenosis in a baby with agenesis of the lung.

A newborn infant with agenesis of the left lung and critical distal tracheal stenosis required tracheal resection and reanastomosis. This case illustrates the combined use of flow-volume curves, radiology and endoscopy in the diagnosis and management of airway obstruction in infants. It also establishes the feasibility of complete tracheal reconstruction in small babies.

Female↗
PubMed1980

Correction of congenital diaphragmatic hernia in utero. II. Simulated correction permits fetal lung growth with survival at birth.

Infants with congenital diaphragmatic hernia (CDH) die because their lungs are hypoplastic. If hypoplasia is a developmental consequence of compression by herniated viscera, decompression before birth may allow pulmonary development and survival at term. A conical silicone rubber balloon progressively inflated (60 to 150 ml) in the left hemithoraxi of fetal limbs (days 100 to 145) simulated compression by growing viscera ("CDH"). Six of six neonates delivered by cesarean section died of severe respiratory insufficiency, despite maximal resuscitation. Lungs were hypoplastic. Lung weight and air capacity were significantly reduced (P less than 0.01) as compared with controls. Pressure-volume curves revealed decreased compliance and barium gelatin injections revealed decreased cross-sectional area of the pulmonary vascular bed. Deflation of the balloon at day 120 (simulated "correction") allowed sufficient lung growth and development to alleviate respiratory insufficiency and to assure survival in five of five lambs delivered by cesarean section. Simulated correction produced a significant (P less than 0.01) increase in lung weight, air capacity, compliance, and area of the pulmonary vascular bed. Efficacy of in utero correction was confirmed by three twin studies in which simulated CDH in one twin was compared with simulated correction in the other. Infants with CDH may be salvaged by in utero correction.

Animals↗
PubMed1980

Long gap esophageal atresia: primary anastomosis after esophageal elongation by bougienage and esophagomyotomy.

Treatment of infants with "long gap" esophageal atresia usually requires a staged procedure consisting of cervical esophagostomy and gastrostomy at birth, and then a bowel interposition between the esophagus and stomach at 1 year of age. Because this approach produces significant morbidity and swallowing dysfunction, an alternative method for treating the long gap atresia is recommended. The upper esophageal pouch can be elongated by preoperative bougienage during a 2 to 10 week period of delay. Intraoperative circumferential esophagomyotomy can further elongate the upper pouch by about 1 cm for each myotomy. Combining these two techniques allows successful primary esophageal reconstruction in infants with long gap esophageal atresia previously considered uncorrectable except by use of colonic or gastric tube interpositions.

Esophageal Atresia↗
PubMed1980

Correction of congenital diaphragmatic hernia in utero. I. The model: intrathoracic balloon produces fatal pulmonary hypoplasia.

A conical silicone rubber balloon was placed in the left hemithorax of fetal lambs and progressively inflated through an exteriorized catheter over the last trimester. Newborn lambs died of severe respiratory insufficiency, despite maximal resuscitation. The lungs were markedly hypoplastic with greatly reduced parenchymal mass and air capacity. This model of a progressively enlarging intrathoracic mass which produces severe pulmonary hypoplasia and fatal respiratory insufficiency simulates the pathophysiology of congenital diaphragmatic hernia in human neonates.

Animals↗
PubMed1979

The role and safety of early postoperative feeding in the pediatric surgical patient.

The authors report their experience with early postoperative feedings in a variety of pediatric surgical patients utilizing a needle catheter jejunostomy. A small caliber catheter, similar to that used for antecubital central venous cannulation, is inserted in the antimesenteric border of the jejunum providing a subserosal tunnel. A purse-string suture is placed around the catheter and then it is secured to the abdominal wall, and the catheter is brought out through the abdominal wall via a needle puncture wound. Our experience with 27 insertions in 25 patients ranging in age from 1 day to 17 yr, has demonstrated the ease of placement and feasibility of immediate postoperative feeding. Patients were generally started on a dilute elemental diet through the jejunostomy within 12 hr of the operative procedure. Patients were administered between one and 3.5 g of protein kg/day and between 45 and 100 cal/kg/day depending on age and weight. Duration of treatment with enteral nutrition ranged from 10 to 150 days. There was no catheter-related complications utilizing the technique described. Technical details of catheter placement and protocol for administration of early postoperative feedings are discussed. The ability to provide nutritional support via the gut has obviated the need for total parenteral nutrition in the majority of these patients.

Adolescent↗
PubMed1978

Preoperative angiographic embolization for large hemorrhagic Wilms' tumor.

Preoperative angiographic embolization of the renal artery is a surgical adjunct not necessary for the majority of Wilms' tumors. However, on the basis of early experience, we would recommend this technique for those large vascular tumors with preoperative hemorrhage in which the risk of embolization is likely to outweight the risk of intraoperative disruption and hemorrhage.

Child, Preschool↗
PubMed1978

Congenital diaphragmatic hernia: the hidden mortality.

From 1969 to 1975, 33 cases of congenital diaphragmatic hernia (CDH) were treated at the National Hospital of Norway with a "visible" or operative mortality of 30%. At least 37 additional infants with CDH who died soon after birth and did not come to the attention of a major referral center were identified retrospectively from a comprehensive survey of neonatal deaths. CDH occurred at least once in every 5455 live births and the "true" mortality was 66%. More than half of the infants born with CDH during this 6-yr period died before they could be treated, contributing to a substantial "hidden" mortality.

Autopsy↗
PubMed1976

Maternal immunocompetence. I. The graft-versus-host reactivity of lymphocytes from pregnant rats and the distribution pattern of 51Cr-labeled lymphocytes in pregnant mice.

Lymphocytes from the peripheral blood, spleen, or para-aortic lymph nodes of prrimigravida L rats carrying (L X BN) F1 (LBN) fetuses are fully capable of mounting graft-versus-host (GVH) reactions in LBN F1 recipients. The reactivity of lymphocytes from interstrain pregnant (L X BN) or intrastrain pregnant (L X L) rats, or from rats postpartum from these pregnancies, is equivalent to that of normal virgin females over a full dose-response curve, ruling out both specific and nonspecific effects of pregnancy on the intrinsic GVH competence of the maternal thymus-derived (T) lymphocyte. Attempts to block GVH reactivity with serum from pregnant rats were unsuccessful. In addition, when the distribution pattern of 51Cr-labeled syngeneic and semiallogeneic lymphocytes was studied in intact primigravida mice, there was no difference between interstrain and intrastrain pregnant mice, and there was no evidence of immunologically specific 'trapping' in the para-aortic lymph nodes draining the interstrain pregnant uterus.

Animals↗
PubMed1976

Maternal immunocompetence. II. Proliferative responses of maternal lymphocytes in vitro and inhibition by serum from pregnant rats.

Peripheral blood and splenic lymphocytes from interstrain (L X BN) or intrastrain (L X L) primigravida rats were equivalent to those from virgin L females in their in vitro DNA synthetic responses to paternal strain cells (BN), to unrelated allogeneic cells (ACI), and to the mitogen phytohemagglutinin (PHA). Heat-inactivated serum from pregnant L rats, when compared to serum from virgin or postpartum L rats, regularly suppressed the in vitro response of L lymphocytes to paternal and allogeneic cells. The response of L cells to PHA was not suppressed. The degree of inhibition was related to the final concentration of pregnant serum in culture, concentrations above 2% producing more than 80% inhibition of the mixed lymphocyte reaction. The inhibiting sera were not cytotoxic by a sensitive 51Cr release assay. Histoincompatibility between mother and fetus is not required for production of this inhibitory effect, since it is consistently present in intrastrain (L X L) pregnant rats. Among interstrain pregnant rats, the degree of inhibition is influenced by, but not specific for paternal-strain alloantigens. Thus, the proliferative function of thymus-derived (T) lymphocytes from pregnant rats is intrinsically normal, but the response to allogeneic cells can be altered by factors present in pregnant serum.

Animals↗
PubMed1975

A genesis of the lung complicated by vascular compression and bronchomalacia.

A child with compression of a solitary left bronchus was treated by anterior fixation of the great vessels and dividing the ductus arteriosus, which proved ineffective. Bronchial resection was performed but was also ineffective because there was persistent compression by the aorta. Aortic graft was finally elected but the infant died later with sepsis. From this experience we believe it would be better in another similar case to graft the aorta initially if necessary to insure complete relief of bronchial compression, reserving resection of the collapsing bronchial segment as a secondary procedure should functional obstruction persist.

Aorta↗