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Biomedical subjects

R M Arensman

Publications and source records attributed to R M Arensman.

At least 37 records · Page 2Linked to original sources
PubMed1988

Klippel-Trenaunay syndrome: rarely a surgical disease.

The various combinations of varicose veins, limb hypertrophy, and hemangiomas necessitate diagnostic consideration of the Klippel-Trenaunay syndrome versus Weber's syndrome and cavernous hemangioma. The wide spectrum of this disease has generated diverse approaches, and treatment must be individualized. Whereas the Klippel-Trenaunay syndrome is rarely a surgical disease, the gigantic proportions of our patient's anomaly warranted prompt amputation.

Amputation, Surgical↗
PubMed1988

Persistent pulmonary hypertension in the neonate.

Respiratory failure is the leading cause of death in the neonatal period. The anatomic and functional basis for this, particularly in full-term infants, most often is persistent pulmonary hypertension of the neonate (PPHN). This condition is reversible but can cause very severe and unrelenting respiratory failure and ultimate death when uncontrolled. Recent technologic advances have expanded the scope of therapy available for PPHN, resulting in increasing therapeutic success for these critically ill infants. This article reviews the anatomic and functional anomalies of PPHN, as well as the methods of diagnosis and discusses current treatment.

Adaptation, Physiological↗
PubMed1987

Diagnosis and management of hydrohematometrocolpos syndromes.

Hydrohematometrocolpos anomalies denote the different types of accumulation of fluid and menstrual products in the vagina and the uterus. They are rare conditions due to an intact hymen, vaginal membrane, or vaginal atresia. They may present at different times during development. The method of presentation is variable, and the presence of other genitourinary abnormalities and anorectal anomalies makes prompt diagnosis and treatment necessary. Review of our experiences with these conditions for the last ten years reveals a total of ten cases. This study reports three cases in detail and describes the others in tabular form.

Adolescent↗
PubMed1987

Extracorporeal membrane oxygenation for respiratory and cardiac failure in infants and children.

Fifty-three neonates and seven pediatric patients were treated with extracorporeal membrane oxygenation from September 1983 until April 1986. Venoarterial bypass was achieved by cannulating the right atrium via the right internal jugular vein and the aortic arch via the right common carotid artery. In the neonatal group, 40 infants with acute respiratory failure were treated, and 36 (90%) survived. Five infants with congenital heart disease were treated and three (60%) survived. Among the eight patients with congenital diaphragmatic hernia, there were three (38%) survivors. In the pediatric group, four patients were treated for ventricular failure after cardiac operations. Two were weaned from bypass, with one long-term survivor. Three patients with acute respiratory failure were treated, with one survivor. salvaging high-risk neonates with minimal morbidity and mortality. It has also been useful in the support of infants with congenital heart disease and congenital diaphragmatic hernia. In pediatric patients one cannot expect to get results that are comparable to those found in neonates. Still, this modality can be useful in salvaging some moribund patients with pulmonary or cardiac failure, or both.

Extracorporeal Circulation↗
PubMed1986

Improving survival in the treatment of congenital diaphragmatic hernia.

Thirty-two infants were treated for congenital diaphragmatic hernia at our institution from 1979 to 1984. Eight were in no or minimal distress at birth and had operative intervention when they were more than 24 hours old; survival was 100%. The remaining 24 neonates required immediate intubation and ventilation followed by operation at less than 12 hours of age. Overall survival was 54%; survival was 31% (4 of 13 patients, Group 1) in the first three years of the series and 82% (9 of 11 patients, Group 2) in the last three years (p less than 0.001). Apgar score, gestational age, birth weight, and incidence of associated congenital heart disease were equal for the two groups (all, p greater than 0.05). The two groups also were examined with reference to alveolar-arterial oxygen differences P(A-a)O2 and mean airway pressure (MAP). The best preoperative P(A-a)O2 was greater than 600 mm Hg for 7 neonates in Group 1 and 6 in Group 2, and survival was 0% and 71%, respectively (p less than 0.001). Infants with a postoperative MAP of 13 cm H2O or greater had a higher mortality (100% in Group 1 and 50% in Group 2, p greater than 0.05). Our treatment protocol was studied to determine those methods related to improved survival. Sodium bicarbonate infusion was used earlier in Group 2 as a prophylaxis against persistent fetal circulation (PFC) (p greater than 0.05). The incidence of severe PFC dropped from 85 to 54% (p greater than 0.05). Higher ventilator rates rather than pressures were used to achieve equally effective ventilation.(ABSTRACT TRUNCATED AT 250 WORDS)

Apgar Score↗
PubMed1985

Extracorporeal membrane oxygenation for newborn respiratory failure.

Respiratory failure is the leading cause of death in the newborn. Conventional therapy is very successful with 80% of infants weaned from ventilatory support. For neonates with severe respiratory failure, unresponsive to maximal medical therapy, extracorporeal membrane oxygenation (ECMO) offers an alternative means of management. Venoarterial bypass is achieved by cannulating the right atrium via the internal jugular vein and the aortic arch via the right common carotid artery. A 5-inch roller pump is used to circulate the blood through a 0.4 or 0.8 m2 silicone membrane lung. Management includes heparinization, intravenous alimentation, antibiotic coverage, and reduction of FiO2 and airway pressure. Thirty infants aged 12 to 186 hours were placed on ECMO. Each met strict criteria designed to predict greater than 90% mortality. Time on bypass ranged from 37 to 250 hours. Success, defined by weaning from ECMO and ventilatory support, was achieved in 23. Twenty-one remain alive; 18 have excellent outcome with normal growth and development although follow-up is short (1 to 19 mos). These results corroborate reports from the pioneers of the technique and further support the use of ECMO for neonates with respiratory failure unresponsive to conventional therapy.

Extracorporeal Circulation↗
PubMed1985

Small bowel trauma in children and adolescents.

Fifty-five children and adolescents with blunt and penetrating small bowel injuries were treated during a 17-year period. Fourteen patients had blunt injuries, and there were no deaths in this group. The remaining 41 patients had penetrating small bowel injuries, with a mortality of 10 per cent. A decision to operate based on physical examination can be made in the pediatric age group without unduly delaying operation or increasing mortality.

Abdominal Injuries↗
PubMed1985

Sigmoid volvulus in children.

Volvulus of the sigmoid colon is rare in children. The authors have reviewed a total of 29 cases, including five from our institution. The most common clinical picture is crampy abdominal pain and abdominal distention. In contrast to adults, in children plain abdominal films will often not yield a diagnosis. Barium enema examination can be done to locate the obstruction. Nonoperative reduction was successful in 27 per cent of all reported cases, while operative treatment was necessary in 69 per cent of pediatric patients reported. Recurrence following derotation by any means was rare. However, adequate long-time follow-up is lacking. From available data, it seems that in most cases resection is not necessary. Primary resection may be indicated for recurrence or if the bowel is compromised. Mortality was 14 per cent, occurring in poor risk patients, the very young, and patients with associated anomalies. A redundant sigmoid may undergo intermittent torsion over a period of years, making diagnosis difficult. At laparotomy, these patients have scarred striae on the sigmoid mesocolon.

Adolescent↗
PubMed1984

Emergency care of the injured child.

Emergency care of the injured child can be rapid and efficient if the treatment facility is properly prepared to manage children. At Ochsner Foundation Hospital, a mobile tool cabinet is used to store the materials needed for standard pediatric emergency care. The initial evaluation involves rapid assessment of pulmonary function and cardiac action and control of external hemorrhage. Secondary evaluation covers all other areas of the body, with possible problems assessed in descending order of seriousness. In many cases, after initial care and stabilization, the severely injured child should be transported to a pediatric intensive care or trauma unit for definitive treatment.

Abdominal Injuries↗
PubMed1984

Familial polyposis in children: early detection and preferred treatment.

Familial polyposis is a disease with high malignant potential. When the diagnosis is established, surgical removal of the premalignant tissue should be complete. Reports of early malignant expression of the disease have led us to recommend early surveillance and treatment of children from affected families. We describe four children who had total colectomy, rectal mucosectomy, and ileoanal anastomosis, and relate our reasons for preferring this modality of therapy for familial polyposis in young patients.

Anal Canal↗
PubMed1982

Polysplenia syndrome: spectrum of gastrointestinal congenital anomalies.

This report describes four children with polysplenia syndrome seen in our hospital during the past year. Each had gastrointestinal abnormalities as their predominant problem, and two presented with gastrointestinal duplications not previously reported with this syndrome.

Abnormalities, Multiple↗
PubMed1980

Ruptured congenital mesoblastic nephroma: chemotherapy and irradiation as adjuvants to nephrectomy.

A neonate underwent nephrectomy for a congenital mesoblastic nephroma which was found to be ruptured at the time of removal. Two years after operation there is no evidence of recurrent tumor. Present evidence is that nephrectomy alone is adequate treatment for mesoblastic nephroma, but close observation is mandatory if rupture has occurred. Recurrence should be countered with adjunctive chemotherapy.

Humans↗
PubMed1980

Abortive H-tracheal esophageal malformation.

This communication describes a bizarre esophageal anomaly (abortive H-tracheoesophageal malformation) in a 4-yr-old boy. Our review of the literature failed to uncover an exact duplicate of the surgical findings in this case, which were corrected by an end-to-end anastomosis.

Child, Preschool↗
PubMed1979

Esophageal stenosis due to cartilaginous tracheobronchial remnants.

In cases of congenital esophageal stenosis, tracheobronchial remnants in the distal esophagus should be considered a possible diagnosis. The cause is thought to be esophageal sequestration of a tracheobronchial anlage before embryologic separation. Primary resection of the stenotic portion of the esophagus with re-anastomosis is recommended. Such a case is reported.

Bronchi↗
PubMed1979

Vitamin A effect on tumor angiogenesis.

The inhibitory effect of vitamin A on tumor establishment and growth has been studied in two animal models. The C57L/J hepatoma, when placed in C57L/J mice receiving inoculations of vitamin A, showed slow growth and the hosts had significantly prolonged survival over untreated mice. The V-2 carcinoma, when implanted in the corneas of New Zealand white rabbits receiving injections of vitamin A, showed decreased vascular response in the limbic vessels. The absence of an induced vascular response prevents vascularization of the tumor and subsequent tumor growth. The evidence suggests that vitamin A may exert its inhibitory effect by modifying the normal vascular response to neoplastic tissue.

Animals↗