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Biomedical subjects

M W Gauderer

Publications and source records attributed to M W Gauderer.

At least 91 records · Page 5Linked to original sources
PubMed1984

Nonoperative management of liver injuries following blunt abdominal trauma in children.

In a 4-year span, 12 patients with hepatic trauma were treated at our institution. After initial resuscitation, three underwent emergency celiotomy because of the severity of their injuries. This communication analyses the other nine. All of these had significant liver injuries and were managed nonoperatively. Hepatic injury was diagnosed and the severity defined by ultrasonography, radionuclide scintigraphy, or computed tomography (CT). These stable patients were initially admitted to the intensive care unit (ICU) and upon transfer to the ward, maintained on restricted activities. Seven of the nine children received blood transfusions. Although liver enzymes were initially elevated in each case, they returned to normal in 1 week. In-hospital and post-discharge imaging documented healing of the hepatic injuries in each case. Eight children are well at 3 months to 4 years follow-up. Only one of the nine nonoperatively managed patients died and this was secondary to severe head injuries. To date, there are no complications. Our nine children are added to the 23 nonoperatively treated pediatric hepatic injuries found in the literature.

Adolescent↗
PubMed1984

String placement and progressive dilatations in the management of high membranous rectal atresia.

A newborn with rectal atresia underwent a sigmoid colostomy followed by fluoroscopic placement of a string across the membrane. Progressive dilatations were done until normalization of the rectal canal occurred at 4 months. At 6 months, the colostomy was closed. Although moderate sigmoid dilatation persisted initially, the boy is now developing well and has a normal stooling pattern 3 years following the last procedure. The technique demonstrates the feasibility of high rectal-membrane management without excision.

Child, Preschool↗
PubMed1984

Ultrasonographic antenatal diagnosis: will it change the spectrum of neonatal surgery?

The outcome of 139 fetuses with anatomical abnormalities diagnosed by ultrasonography (out of 15,180 examinations) at our institution during the last 6 years was reviewed. Of these, 56 were diagnosed before 21 weeks gestational age and 83 thereafter. Fifty-four had anomalies of the central nervous system. Of these 27 were diagnosed early. Twenty-six had anomalies of the genitourinary tract, 11 diagnosed early. Four had anomalies of the musculoskeletal system diagnosed early in 3. Thirty-seven had miscellaneous anomalies and early diagnosis was made in 6. Only the early pregnancies were terminated, 38 in number. The fetal diagnosis was clearly confirmed in 33. Of particular interest were the 18 fetuses with anomalies of the gastrointestinal tract and abdominal wall. There were nine early diagnoses. The pregnancy was interrupted in seven. In all the diagnosis was confirmed. Five of these had associated anomalies. Among the 9 fetuses whose anomalies were diagnosed late, 3 had associated anomalies and died shortly after birth before corrective surgery. In all, two fetuses with abdominal wall defects had no detectable associated anomalies and were potentially correctable but the pregnancies were terminated. With earlier, accurate imaging diagnosis possible, special attention has to be directed toward multidisciplined counseling (including a pediatric surgeon) for ultimately satisfactory fetal-neonatal salvage. Otherwise the spectrum of neonatal surgical pathology could be seriously altered.

Abdominal Muscles↗
PubMed1984

Flexible fiberoptic bronchoscopy in the management of tracheobronchial foreign bodies in children: the value of a combined approach with open tube bronchoscopy.

Fifty-two pediatric patients suspected of having a pulmonary foreign body but in whom there was insufficient evidence to warrant open tube bronchoscopy. In 19% of these patients, foreign bodies were found. Twenty-six percent of patients who had previously had foreign bodies removed and who subsequently underwent flexible bronchoscopy for a variety of indications were found to have residual foreign bodies. Clinically unsuspected foreign bodies were found in 1% of 1,054 additional patients who had flexible bronchoscopy for other reasons. The diagnostic use of the pediatric flexible bronchoscope is a safe, definitive, and cost-effective method for the identification of patients with pulmonary foreign bodies when other techniques yield equivocal or negative results. Patients known to have a foreign body should undergo open tube bronchoscopy for foreign body removal.

Bronchi↗
PubMed1984

The gastrostomy "button"--a simple, skin-level, nonrefluxing device for long-term enteral feedings.

In an effort to eliminate the common problems associated with gastrostomy tubes in children, we developed a silicone rubber gastrostomy "button" designed to replace the standard long latex tube. Easily inserted and self-retaining, the device remains practically flush with the skin. The intragastric portion is similar to a dePezzer catheter, and a one-way valve prevents reflux of gastric contents. Prototypes were evaluated in five children for a time period of 3 to 18 months. In two additional patients with esophageal stricture, the device was used as a temporary plug to maintain gastric stoma patency. Parents and nurses are pleased with the button's low profile, appearance, and ease to use. It is neither painful nor irritating, and there is no fear of dislodgement.

Child, Preschool↗
PubMed1984

Percutaneous endoscopic gastrostomy following previous abdominal surgery.

During a 36-month period, 89 patients have undergone percutaneous endoscopic gastrostomy without mortality. Of these patients, 25 (13 infants and children, 12 adults) had prior abdominal procedures that increased their risk for the endoscopic procedure. With two exceptions, all gastrostomies were performed utilizing local anesthesia. There was one major complication, a gastrocolic fistula, which was successfully managed by repeating the endoscopic gastrostomy procedure at a location more cephalad in the stomach. Twenty-two of the gastrostomies were placed for feeding purposes and all of these patients were able to leave the hospital with alimentation accomplished via the tube. Three of the endoscopically placed gastrostomies were for gastrointestinal tract decompression. A total of 255 patient months have been accumulated in these patients with the endoscopically placed gastrostomy in situ. The technique can be safely performed in patients with prior abdominal surgery and in the majority of cases is the technique of choice for establishing a tube gastrostomy.

Adolescent↗
PubMed1983

Percutaneous endoscopic gastrostomy. Review of 150 cases.

Percutaneous endoscopic gastrostomy was performed on 50 children and 100 adults from June 1979 to May 1982 at Case Western Reserve University Hospitals and the Mt Sinai Medical Center in Cleveland. Morbidity was low (10%), and there were no procedure-related deaths. Complications included minor wound infections in seven patients early in the series, extrusion of the tube in three, unnecessary laparotomy in two suspected of having problems with the tube early in the series, a partial separation of the gastrostomy from the abdominal wall in one adult, and gastrocolic fistula in one adult and one child. The last condition disappeared after removal of the gastrostomy tube in both patients. No leakage around the catheter, hemorrhage, peritonitis, or gastric outlet obstruction was encountered. This procedure provided a rapid, safe, and effective method for creating a feeding gastrostomy and did not require general anesthesia and laparotomy. Percutaneous endoscopic gastrostomy should become the method of choice for the creation of a feeding gastrostomy.

Adolescent↗
PubMed1982

Broviac silastic catheter insertion in children: a simplified direct subclavian approach.

With the greatly expanded indications for central venous lines in children, and especially with the introduction of the Broviac silastic catheter, a new, safe, and fast method of catheter insertion has been developed. The method combines the advantages of direct major vessel approach and the use of a Broviac catheter. Originally Broviac et al. (1973) suggested insertion of the catheter by either a subclavian venipuncture or by a cephalic vein catheterization. The latter technique is commonly used, even though technical difficulties are not infrequent. Our method is based on a modified Seldinger catheter introduction employing an 8 French Peel Away Sheath Set for the adult Broviac catheter and a 5 French set for the pediatric catheter. Forty-six catheters were placed in 43 consecutive patients ranging in age from 2 mo to 21 yr. Perioperative complications were minimal and late catheter related complications few. An increase in the number of oncologic patients was observed.

Adolescent↗
PubMed1982

Transverse testicular ectopia.

In transverse or crossed testicular ectopia, the affected gonad lies in the same canal as the normally descended testis. During a 5-yr span, three children with this form of ectopia were seen. All presented with a symptomatic right inguinal hernia and an empty scrotum on the left side. The ages at operation were 1, 3, and 5 mo. Only the first patient was reoperated. In this child, the diagnosis of transverse testicular ectopia was made during the herniorrhaphy and the ectopic, but otherwise normal, gonad returned to the abdominal cavity. A subsequent left orchidopexy through a celiotomy was done. In the last two patients, the correct diagnosis was made preoperatively. Both gonads were of equal size and normal, occupying the same hemiscrotum. A herniorrhaphy with fixation of the ectopic gonad to the opposite hemiscrotum was done in both. All three children are otherwise normal. Cases collected from the literature are discussed. The condition should be suspected if a unilateral hernia is associated with a contralateral, nonpalpable testis and may not be as rare as formerly thought.

Child, Preschool↗
PubMed1982

Traumatic aneurysm of the suprarenal abdominal aorta: surgical reconstruction in a 7-yr-old patient.

A 7-yr-old sustained a gunshot wound of the upper abdomen lacerating the portal vein and liver requiring immediate repair. Postoperative angiograms demonstrated two false aneurysms of the aorta between the renal arteries and the superior mesenteric artery. On the thirteenth postoperative day the aneurysms were resected and a Dacron graft interposed between the level of the renal arteries and the celiac axis. The superior mesenteric artery was reattached utilizing a short segment Dacron graft. The boy made a good recovery and is normal after a 3-yr follow-up.

Aorta, Abdominal↗
PubMed1982

A perinatal approach to the diagnosis and management of gastrointestinal malformations.

Ultrasonography now offers the opportunity to evaluate selected high-risk pregnancies for the presence of fetal malformations that are amenable to corrective measures as well as of those that remain incompatible with life. The authors observed major fetal malformations in 1% of 6050 cases that underwent antenatal ultrasonographic evaluation. A series of 9 prenatally diagnosed gastrointestinal tract anomalies, including the first documented instances of esophageal atresia diagnosed in utero, is presented in detail. Abdominal wall defects were those most commonly encountered in this series and were diagnosed as early as 16 weeks' gestation. The gastrointestinal system is not only one of the most common sites of birth defects, but it is also the one wherein lies the greatest hope for a successful neonatal outcome. The value of prenatal diagnosis in a comprehensive perinatal approach to congenital gastrointestinal lesions is emphasized. Forewarning the obstetrician and altering the pediatric-surgical team for resuscitation, immediate postnatal evaluation, and timely intervention decrease neonatal mortality and increase the chance of long-term infant survival.

Abnormalities, Multiple↗
PubMed1981

A rationale for routine use of transverse abdominal incisions in infants and children.

Although transverse abdominal incisions (TAI) are valued for their excellent exposure in the newborn, infant, and child, measurements to support this clinical impression have been lacking. The abdomens of 80 infants and children and 11 premature infants were measured and evaluated and correlated with growth. It was demonstrated that the younger the child, the relatively larger the abdominal cavity and wall. Because of the anatomical differences between the abdomen of adults and small children, the cavity of the latter resembles a horizontally oriented ellipsoid; accordingly, TAI give greater exposure. The younger the child, the larger proportionately was the costoiliac space, allowing easier lateral extension of the incision, if necessary. The umbilicus is low in infants and small children and the transverse supraumbilical incision may be placed over the anatomical center of the abdominal cavity. The conclusion drawn was that the younger the child, the greater the rationale for routinely employing transverse abdominal incisions.

Abdomen↗
PubMed1981

Pathologic childhood aerophagia: a recognizable clinical entity.

Pathologic childhood aerophagia is a rarely recognized, often poorly treated entity that has remained almost undescribed in either the surgical or pediatric literature. In only 1 of 9 children the condition was recognized at presentation. The initial diagnosis of the others was Hirschsprung's disease (2), malabsorption syndrome (3), gastric outlet syndrome (1), constipation (1), and esophagitis (1). Five were hospitalized and two underwent surgical procedures. History disclosed a remarkably constant triad: previous normal stooling pattern, visible and often audible air swallowing and excessive flatus. Physical examination often demonstrated a markedly or intermittently distended and tympanitic abdomen. Abdominal musculature was thinned in children with chronic aerophagia. Roentgenographic evaluation showed massively distended loops of intestine throughout without associated air-fluid levels. There was marked compression of the diaphragm with limited excursion in some. Laboratory and malabsorption testing was normal. Treatment is limited to recognition of the problem, nasogastric decompression in severe cases and psychologic counseling when symptoms persist in the older child. The recognition of this condition may lead to a better understanding of its pathophysiology and will reduce the number of unnecessary admissions or surgical procedures.

Adolescent↗
PubMed1981

A simplified technique for constructing a tube feeding gastrostomy.

A technique has been developed to establish a tube feeding gastrostomy without the need for laparotomy or general anesthesia. To date, it has been used in 53 patients with excellent results. This technique should prove to be the preferred method in the performance of tube feeding gastrostomy.

Catheterization↗