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Biomedical subjects

R K Danis

Publications and source records attributed to R K Danis.

10 recordsLinked to original sources
PubMed1979

[Cold nodules of the thyroid. Reevaluation of surgical excision on the basis of a new group of 607 patients(author's transl)].

In a serie of 607 cold nodules developing in normal or apparently normal (on preoperative clinical examination) thyroids, the results of histopathological examination were compared with those in an identical series studied 10 years before. Carcinoma was frequent: 9.7% in the current series and 19% in the first series. Insofar as neither clinical examination nor special investigations at the present time make it possible to affirm that a cold nodule is not malignant, surgical complete lobectomy with frozen section examination remains the required procedure in view of its harmless nature and the good prognosis in differentiated tumours operated upon before any visceral extension has taken place, contrasting with the poor prognosis of others. Recurrences may be prevented by special operative techniques (routine excision of Lalouette's pyramid, division of the contralateral ligament of Grubert) and routine postoperative thyroid extracts in patients with a morphological, familial or biological risk of recurrence.

Adenoma↗
PubMed1979

Preoperative embolization of Wilms' tumors.

In two patients with Wilms' tumors, the ipsilateral kidney was nonfunctional. To facilitate initial surgical removal of the tumors, a preoperative transcatheter embolization was performed following diagnostic arteriography. Preoperative embolization of a renal tumor reduces the vascularity of the lesion prior to surgery, and a patient in whom primary surgical removal of the tumor would carry unacceptable risk may be converted into one in whom primary surgical removal is safe.

Child↗
PubMed1979

Esophageal atresia and tracheoesophageal fistula: preoperative assessment and reduced mortality.

One hundred twenty-nine infants with esophageal atresia and tracheoesophageal fistula were reviewed from 1955 to 1978. The overall mortality was 38%. Factors associated with the increased mortality include prematurity, pneumonia, and congenital defects other than this anomaly. A classification based on these factors in introduced, which provides the clinician with a prognostic survival rate greater than 90% with only physical examination, chest and abdominal roentgenography, and intravenous pyelography. Postoperative mortality was reduced to 11% in the last five years of the study; this is attributed to the exclusive use of the retropleural approach to the esophagus, more intensive postoperative ventilatory support, and routine use of parenteral nutrition.

Esophageal Atresia↗
PubMed1978

Imperforate anus: avoiding a colostomy.

Early assessement of imperforate anus, combining clinical and radiographic data, determines the course of treatment. "High" lesions most often require combined abdominal and sacroperineal repair, usually preceded by a decompression colostomy. "Low" lesions are repaired through a perineal or sacroperineal approach not requiring a previous colostomy. Patients who do not have an apparent fistulous tract through which accurate radiographic assessment can be made frequently undergo preliminary colostomy to avoid colonic perforation. This occurs in patients who have "low" lesions and in whom colostomy may be avoided. Combining a new procedure and an old procedure may avoid unnecessary colostomy. A 14 Medicut intravenous cannula is inserted in the perineum and under fluoroscopic control is advanced into the radiolucent area identified in the pelvis as the probable lower rectal pouch. The position is confirmed by aspiration of gas or meconium and injection of contrast material. A limited contrast enema will clearly identify the level of the lesion and identify a fistula if one is present. If a low lesion is identified and no fistula is present to allow temporary colonic decompression, a fistulous tract may be created mechanically. A No. 4 Fogarty catheter is inserted through the previously placed cannula, the catheter balloon is inflated, and the entire apparatus is extracted under tension. This creates a small fistulous tract to the perineal surface. Subsequent dilation of this tract allows colonic decompression, and definitive operative repair may be planned at the most appropriate time. By employing this technique, we have avoided colostomy in 4 of 6 patients.

Anus, Imperforate↗
PubMed1978

Purulent pericarditis in children.

Acute purulent pericarditis was treated successfully in five children between the ages of 27 months and 11 1/2 years during the past 5 years. The responsible organism was Hemophilus influenzae, type b, in two cases and Meningococcus, Pneumococcus, and coagulase-positive Staphylococcus aureus in one case each. No primary source of infection could be identified in two patients. A high index of suspicion, combined with immediate echocardiograms and pericardiocentesis, led to the diagnosis. Immediate antibiotic therapy was instituted on the basis of the gram stain of the pericardial fluid. All five patients had a pericardial window established--four through subxyphoid approach and the fifth, because of a left pleural effusion, through a left thoracotomy. When the subxyphoid approach was used, sump drains were left for postoperative suction and irrigation. All five patients survived without sequalae during follow-up periods of from 18 months to 5 years. We advocate an aggressive approach to the diagnosis and treatment of this problem. This report documents the safety, ease, and effectiveness of the subxyphoid approach as a means of drainage.

Child↗
PubMed1977

Lymphangiography and bone scan in the study of lymphangiomatosis.

Lymphangiomatosis is a rare congenital systemic lymphatic malformation involving multiple bones and other sites. A 12-year old boy with lymphangiomatosis was studied with lymphangiography and bone scan. Lymphangiogram demonstrated irregular pooling of contrast medium in both the mediastinal tumor and bones. Bone scan also revealed increased activity in areas which were not demonstrated radiographically.

Bone Neoplasms↗
PubMed1976

Late repair of bronchial rupture in a child by bronchial replantation.

A 3-yr-old boy suffered blunt trauma to the anterior chest. Immediate treatment resulted in resolution of acute respiratory distress. Subsequent events led to the recognition of previous bronchial rupture six months later. Primary bronchial repair was not feasible and bronchial replantation onto the trachea was employed. An excellent early result was achieved.

Bronchi↗