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Biomedical subjects

P Bugmann

Publications and source records attributed to P Bugmann.

25 records · Page 2Linked to original sources
PubMed1992

Comparison of totally implanted and external catheters in paediatric oncology patients.

From June 1982 until December 1989, 93 permanent central venous catheters [59 external catheters (ECs) and 34 implanted catheters (ICs)] were placed in 69 patients. The median age of these patients at placement was 5.6 years for ECs and 8.8 years for ICs (P less than 0.05). Follow-up evaluation was possible on 86 catheters (58 ECs and 28 ICs). The median time of insertion was 236 days and 316 days for ECs and ICs, respectively (P less than 0.05). The median number of open days was 58 for ECs and 66 for ICs (not significant). 17 catheters (6 ECs and 11 ICs) were transiently obstructed (P less than 0.005). 30 episodes of bacteraemia were documented in 20 patients. The incidence of catheter sepsis and bacteraemia of unknown source was one in 278 and 283 open days for ECs and ICs, respectively (not significant). In this retrospective study, ECs appeared to be as safe as ICs when infection was correlated with use of the catheter, but this finding should be confirmed in a randomised design.

Bacteremia↗
PubMed1992

Splenic cysts in pediatric patients--a report on 8 cases and review of the literature.

8 cases of splenic cysts are reported: treatment was surgical in 4 large cysts (greater than 5 cm, 3 epidermoids and 1 pseudocyst), and non-operative in 4 small cysts (less than 5 cm, 3 post-traumatic pseudocysts and 1 congenital cyst, probably epidermoid). Follow-up was over a period of 3 months to 7 years. 3 among the 4 post-traumatic pseudocysts were followed up by ultrasound until resolution (3 months to 3 years), and 1 large pseudocyst was operated on due to rupture following benign trauma. 3 large cysts were epidermoid in origin, 1 was electively operated, and 2 were discovered and operated on because of complications (rupture, infection). Only one total splenectomy was performed; surgery preserved the spleen in all other cases; but 1 epidermoid cyst presents now with a recurrence. Based on this experience, we suggest frozen section of the cyst wall during surgery, to decide the type of partial splenectomy to be performed: total cystectomy or marsupialization.

Abscess↗
PubMed1992

Blunt injuries to liver, spleen, kidney and pancreas in pediatric patients.

96 children with blunt injuries to liver, spleen, pancreas and kidney were analysed. The aim of this review was to determine the accuracy of radiologic imaging and to define clinical factors present on admission which could be predictive of major injuries resolving only by operation. Two thirds of the lesions could be treated non-operatively. Diagnostic accuracy of ultrasound examination (US) varies between 60 and 90%, depending on the type of the injured organ. Peritoneal lavage was progressively abandoned in favour of US. CT scan has a 100% accuracy in the determination of the type and the extension of the injury. Our review revealed 6 clinical factors present on admission with a statistically significant predictive value for surgical intervention.

Adolescent↗
PubMed1991

Postoperative chylothorax in children: differences between vascular and traumatic origin.

Twenty-four children with postoperative chylothorax were encountered among 1,264 consecutive thoracic operations over a 7-year period and form the basis of this study. Chylothorax was caused by direct lesion to the thoracic duct or lymphatic vessels in 17 patients and was associated with superior vena cava (SVC) obstruction in seven. Of the latter, five had bilateral chylothorax. Chylothoraces secondary to venous hypertension and thrombosis have a longer interval between operation and diagnosis compared with direct trauma as well as a longer duration and larger volume of chylous drainage. Treatment was entirely nonoperative in 16 patients and operative in 8. Nonoperative treatment consisted of pleural needle aspiration or suction drainage in association with a medium chain triglyceride (MCT) diet (n = 11) or total parenteral nutrition (TPN) after failure of MCT (n = 5). Direct operation on the thoracic duct was performed in 5 patients, four had pleurodesis, and 2 had pleuroperitoneal shunts inserted. All patients were cured of their chylothorax and there were no deaths. Patients with major vein thrombosis were the most difficult to treat. On the basis of this experience, we suggest a step-by-step approach: (1) insertion of chest tube after 3 to 4 pleural punctures; (2) 1-week trial of MCT diet, with intravenous support to correct protein losses; (3) TPN if chylothorax increases or persists with large volumes; (4) Doppler echocardiography or phlebography to rule out obstruction of major thoracic veins; and (5) insertion of TPN line in inferior vena cava in case of such obstruction; and (6) direct surgical approach to the thoracic duct after 4 weeks of unsuccessful nonoperative treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗
PubMed1989

Repair of hypospadias using a bladder mucosal graft in 76 cases.

A bladder mucosal graft was used to repair hypospadias in 76 patients. Indications included 19 hypospadias cripples and 57 primary repairs. Of the operations 53 were completely successful, while 20 patients required a secondary minor procedure and 3 required more than a minor procedure. There were no cases of stenosis of the proximal anastomosis. Attention is focused on certain points of the technique to avoid fistulas and meatal problems. Mucosal grafts provide excellent functional and cosmetic results with only a small percentage of complications. Therefore, we use a mucosal graft not only in patients without available preputial skin but also for primary repair when a flip-flap technique is not possible.

Adolescent↗
PubMed1988

Active subluxation in extension, radiological control in intercondylar eminence fractures in childhood.

Twelve patients treated for intercondylar eminence fracture were controlled by a radiological Lachman test performed two and a half years after trauma. The mean differential active subluxation was 3.34 mm, corresponding to a "late hard stop" on clinical examination of the injured knee. In spite of correct reposition of the epiphyseal fragment we always found a difference between the injured and normal knee. The question of permanent damage secondary to anterior cruciate ligament (ACL) overload before intercondylar eminence fracture occurs is discussed. Surgical treatment should include careful control of ACL isometrical stretching and precise osteochondral fracture reduction, with retightening of the ACL if isometry during the last 30 degrees of extension is insufficient.

Child↗