Search PubMed⌕ Search

Biomedical subjects

M W Gauderer

Publications and source records attributed to M W Gauderer.

At least 73 records · Page 4Linked to original sources
PubMed1987

Gastroschisis and extraabdominal ectopic testis: simultaneous repair.

During a 10-year span, three males with gastroschisis were seen in whom one of the testes exited through the paraumbilical opening with the exteriorized intestine. In each case, prior to correction of the abdominal wall defect, the testes (left side in 2, right side in 1) were placed into the ipsilateral scrotum and anchored. In the first child, the undescended gonad, very small at birth, continued hypoplastic at 1 year. The second patient (8 years) required a second stage orchidopexy at age 2 years. The third child, a 1.3-kg premature infant, has good testicular size and position at 6 1/2 years. Undoubtedly because of the magnitude of the main pathology, recommendations on how to handle the gonad in this association are not available. This report focuses on the simplicity of concomitant repair. A similar approach was employed in two children with omphalocele and undescended testes.

Abdominal Muscles↗
PubMed1987

Pseudomonas aeruginosa as a primary pathogen in children with bacterial peritonitis.

This prospective study compared the efficacy of sulbactam/ampicillin and clindamycin/gentamicin in the treatment of children with bacterial peritonitis. Of the 29 children enrolled, 17 were evaluable; eight received sulbactam/ampicillin/gentamicin and nine clindamycin/gentamicin. Sixteen patients were previously healthy children with appendicitis. An average of 3.6 bacterial species were recovered from the peritoneal fluid of each patient. E coli and B fragilis were the most common aerobic and anaerobic isolates, recovered from 15 and ten patients, respectively. Pseudomonas aeruginosa was recovered from seven of 17 children; the three children with P aeruginosa infections randomized to the sulbactam/ampicillin group received gentamicin in addition to the investigational agents throughout the treatment course. Although the study groups were small, there was no difference in age, sex, number of pathogens per patient, duration of hospitalization, toxicity, or treatment failures between the two treatment groups or between children infected with P aeruginosa and controls. As a result of the high prevalence of P aeruginosa in the peritoneal exudate of otherwise healthy children with appendicitis, initial antimicrobial therapy in this patient population should include agents effective against this organism.

Adolescent↗
PubMed1987

Percutaneous endoscopic gastrostomy for gastrointestinal decompression.

From September 1980 to April 1986, 185 percutaneous endoscopic gastrostomies were performed at University Hospitals of Cleveland. Of these, nine (5%) were done for chronic gastrointestinal decompression and form the basis of this report. Patients ranged in age from 21-73 years (mean: 51 years) and all had prolonged, complex hospitalizations extending 25-122 days (mean: 63 days). The only complication associated with the procedure was the identification of transhepatic placement of the catheter, which caused no adverse effects. Two of the nine patients died during hospitalization of causes unrelated to the gastrostomy construction. The goals of gastric decompression and elimination of nasogastric intubation were achieved in all patients. In one patient with gastric intestinal disconnection, the percutaneous gastrostomy was effective as the sole means for elimination of swallowed saliva and gastric output. Three patients continued to use the gastrostomies for chronic decompression after discharge for the remainder of their lives (2 months, 6 months, and 2 years, respectively). Percutaneous endoscopic gastrostomy may provide a safe, secure, and comfortable method of long-term gastric decompression in a select group of high-risk patients with complex intra-abdominal processes.

Adult↗
PubMed1987

A simple technique for correction of severe gastrostomy leakage.

A simple method for the correction of severely leaking or prolapsing gastrostomies, or both, is presented. The stoma is relocated using a new catheter in a manner similar to our previously described percutaneous endoscopic gastrostomy. The old stoma is closed extraperitoneally. The procedure is simple, fast and safe and has proved to be effective in seven high risk patients.

Catheters, Indwelling↗
PubMed1986

Antenatal ultrasonography: the experience in a high risk perinatal center.

During a 52-month span, 14,324 ultrasonographic examinations were performed on 9,453 pregnant patients. One-hundred and fifty-one anatomical malformations were found in 122 fetuses (1.29%). Our analysis of patients referred to the perinatal center for ultrasonography indicates that the number of high risk patients has increased, and a parallel increase of neonatal surgical anomalies has resulted. An analysis of fetuses concluded that anomalies of the: gastrointestinal tract had improved care, deaths occurred due to associated anomalies or severe prematurity; genitourinary system received earlier diagnosis and treatment; central nervous system/musculoskeletal system/hydrops--no difference in management, treatment or outcome was noted; teratoma/cystic hygroma--did not effect treatment; cardiovascular system--inutero medical treatment by digitalization of the mother was possible. Paradoxically, an increase in the mortality of diaphragmatic hernia patients was noted and concluded to be secondary to the extremely early detection of this anomaly.

Congenital Abnormalities↗
PubMed1986

Alterations of hepatic mitochondrial function in a model of peritonitis in immature rats.

Severe intra-abdominal infection results in significant metabolic dysfunction, multiple systems failure, and mortality. Although the course of peritonitis is particularly rapid and severe in neonates and small children, its physiologic consequences have been poorly studied in these age groups. In order to assess hepatic mitochondrial integrity in a model of fulminant peritonitis in immature animals, the following study was undertaken. Thirty-three immature Sprague-Dawley rats (21 to 28 days of age) and 32 mature rats (weight greater than 250 g) were anesthetized and laparotomies performed. The animals received either cecal ligation and gross perforation (CLP) or cecal manipulation alone (sham). Animals were killed at 2 and 4 hours and livers removed. Mitochondria were isolated by differential centrifugation. Mitochondrial respirations were studied polarographically with glutamate and succinate as substrates in the presence (state 3) and absence (state 4) of adenosine diphosphate (ADP). The Respiratory Control Index (RCI) is the ratio of state 3 to state 4 respiration and is a sensitive indicator of mitochondrial coupling. Results revealed that in mature animals, peritonitis produced a significant increase in RCI with glutamate as substrate (5.2 +/- 0.2) by 4 hours duration as compared with sham operated rats (4.3 +/- 0.1, P less than 0.01). Succinate as substrate revealed no significant alteration in mitochondrial coupling in mature rat hepatic mitochondria in animals subjected to peritonitis. By contrast, peritonitis in immature animals produced a significantly decreased RCI (3.6 +/- 0.2) with glutamate as substrate as compared with sham operated animals (4.8 +/- 0.2, P less than 0.01) by two hours duration.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1985

Percutaneous silastic catheter insertion in patients with thrombocytopenia.

A retrospective analysis of 33 patients with malignancy and thrombocytopenia of less than 100,000/microliter who underwent percutaneous Silastic (Evermed) catheter insertion is presented. Thirty-seven catheter insertions were performed in these patients during a 2-year period. The insertion technique includes intraoperative platelet transfusion for patients with platelet counts of less than 50,000/microliter, the use of general anesthesia for infants and children, and intravenous sedation with local anesthesia in adults. Minimizing the dissection required for the subcutaneous catheter tunnel is achieved with a modified shunt-tunneling device. The majority of catheters were placed by the subclavian approach. Fifty-nine percent of the procedures took place when the platelet count was less than or equal to 30,000/microliter. There was no mortality related to the procedure. Four complications directly related to the technique (arterial puncture, 3; cervical hematoma, 1) and eight related to the catheter occurred without serious sequelae. With appropriate precautions, percutaneous placement of Silastic catheters can be performed safely in patients with thrombocytopenia. This technique produces less tissue injury than operative venotomy, may be performed more rapidly, obviates sacrifice of the vein that is used and, consequentially, allows for multiple subsequent insertions via the same vein.

Adolescent↗
PubMed1985

Tumor metastasis from multiple myeloma and Burkitt's lymphoma in Broviac catheter tracts.

Placement of Broviac catheters for venous access resulted in metastatic tumor implantation along the catheter tracts in an adult with multiple myeloma and in a child with Burkitt's lymphoma. Both complications occurred in the setting of advanced malignancy. The tissue injury produced during the creation of the catheter tunnel may create an environment favorable for metastatic tumor growth. Swelling along catheter tunnel tracts will most frequently result from hematoma or infection, but the rare occurrence of tumor implantation should be considered. Biopsy is diagnostic.

Burkitt Lymphoma↗
PubMed1985

Percutaneous approaches to enteral alimentation.

Feeding gastrostomy and jejunostomy provide effective access for long-term enteral nutrition. Traditional operative techniques for the performance of these procedures requires laparotomy and often, general anesthesia. This report describes our experience with two relatively new methods, percutaneous endoscopic gastrostomy and percutaneous endoscopic jejunostomy. Results of percutaneous gastrostomy and jejunostomy to date in 323 cases include a morbidity of 5.9 percent and a 0.3 percent operative mortality. Percutaneous endoscopic gastrostomy and jejunostomy should become the procedures of choice for the establishment of enteral access in patients requiring long-term enteral alimentation.

Adolescent↗
PubMed1985

A technique for temporary control of colostomy prolapse in children.

Stomal prolapse is a common complication of colostomies and, if severe, may affect the timing of the definitive procedure. A simple technique for postreduction bowel fixation without stomal revision is presented. The reduced bowel is attached to the parietal peritoneum using a "U" type suture a few centimeters from the stoma. Two short parallel segments of latex tubing prevent the thread from cutting through. Suture and bolsters are removed when adhesions are established. In one of the four children, a percutaneous cecostomy was employed to connect a prolapse of the entire proximal colon.

Abdominal Muscles↗
PubMed1985

Subclavian Broviac catheters in children--technical considerations in 146 consecutive placements.

During a 42-month span, 146 subclavian Broviac type catheters were placed in 129 children. In an additional 6 patients, a venotomy was necessary for successful cannulation, bringing the total number of attempts to 152. Indications were: parenteral nutrition (78), chemotherapy/bone marrow transplant (54), longterm antibiotic or other medication administration (14). Fifty-two were under 1 year of age. Forty-one weighed less than 5 kg and 7 were under 1 kg. Thirty-five had previous central lines (subclavian Broviacs--15). Additional procedures were common (31). Eight had thrombocytopenia. Insertion related problems were inability to cannulate vein--6 (3.9%). All had successful catheter placement by cut down. Over five punctures--27 (17.7%). Initially misdirected catheters--13 (8.9%) and, Arterial puncture--four (2.6%). Complications were pneumothorax--two. Tube thoracostomy required in one (650 g). Subclavian vein thrombosis after unsuccessful cannulation--one (1500 g). Questionable phrenic nerve injury--one (900 g). Transient venous occlusion of left arm--one (650 g). Accidental catheter damage--two; and air embolization without consequences, perioperative catheter clotting, and hematoma of tract occurred once each. There was no catheter-related mortality. Because the only complications producing untoward sequelae were in very small infants, our present recommendation is that if successful cannulation of the subclavian is not possible with the first few passages of the needle, a cut-down insertion is preferred in this group. Our experience indicates that subclavian indwelling central catheter placement in the pediatric population can be accomplished with a low morbidity.

Age Factors↗
PubMed1985

Streptokinase dissolution of a right atrial thrombus.

A critically ill 20-month-old white male with severe bronchopulmonary dysplasia, cor pulmonale, and intolerance to enteral feeds, required a left percutaneous subclavian Broviac catheter. Echocardiogram showed a right atrial thrombus, resolution of which was demonstrated after infusion of streptokinase through the Broviac catheter for 16 hours. The catheter remained in place, functioning well, for a further 4 months. The patient suffered no bleeding complications, and was spared the prohibitive risk of right atrial thrombectomy. This use of streptokinase has not previously been reported.

Cardiac Catheterization↗
PubMed1985

Iatrogenic arteriovenous fistula after multiple arterial punctures.

Multiple arterial punctures in the neonate can result in iatrogenic arteriovenous fistula formation. In one case, a 3-month-old infant who had been born prematurely was noted to have physical findings consistent with arteriovenous malformation following approximately 90 arterial blood gas determinations over a 13-week period. The area was explored and the lesion was treated surgically with good results.

Arteriovenous Fistula↗
PubMed1984

Ileal atresia with long-segment Hirschsprung's disease in a neonate.

A newborn female had ileal atresia without mesenteric continuity associated with a small, shortened colon but without "malrotation." After correction by an ileocolostomy the infant remained obstructed, requiring an ileostomy at 24 days; subsequently, at 13 months, a Martin-Duhamel operation was done. since associated anomalies are uncommon in each of these conditions, since no cause and effect relationship has been developed, and since no prior survival has been clearly documented, this report is important. The recommendation of distal bowel biopsy is stressed to establish an early diagnosis and, thereby, correct treatment.

Colectomy↗