Management of the infant with congenital diaphragmatic hernia (CDH) and persistent pulmonary hypertension (PPHN).
Explore the source record for details and available documents.
Animals↗
Biomedical subjects
R P Altman
Publications and source records attributed to R P Altman.
Potential errors in the diagnosis and surgical management of neonatal jaundice.
Despite advances and refinements in diagnostic techniques, distinguishing between cholestatic syndromes and extrahepatic biliary atresia is not always possible. Because there are inherent errors in all diagnostic studies including nuclear scanning, ultrasonography, and liver biopsy some infants presumed to have biliary atresia will come to surgery when, in fact, the bile ducts are partially or completely patent. The decision to proceed with a portoenterostomy or to terminate the procedure depends upon the appearance of the liver and histology of the biopsy.
Biopsy, Needle↗
Pediatric hepatobiliary disease.
The surgical aspects of pediatric hepatobiliary disease concern a unique set of diagnoses, disease processes, diagnostic issues, and treatment problems. In this context, this article discusses features of biliary atresia, choledochal cyst, gallbladder disease, and liver abscess in the infant, child, and adolescent.
Adolescent↗
Percutaneous sclerosis of an external biliary fistula.
Explore the source record for details and available documents.
Biliary Fistula↗
Healing of ischemic colonic anastomoses in the rat: role of antibiotic preparation.
In this study we evaluated the relative effects of ischemia with and without antibiotic bowel preparation on colonic wound healing. Thirty-two Sprague-Dawley rats (185 to 300 gm) were divided into five study groups: Groups I and II (n = 14) had no colonic ischemia, half receiving antibiotic bowel preparation before colocolostomy. Groups III, IV, and V (n = 18) had colonic ischemia induced by division of the marginal artery and ligation of the arteries to the splenic flexure and pelvic colon, assuring that all blood supply to the left side of the colon was intramural. Enteral (neomycin and erythromycin) antibiotic preparation was given in group III, no antibiotics were given in group IV, and parenteral (clindamycin and gentamicin) preparation was given in group V. The mid-left side of the colon was transected and an everting anastomosis was constructed with continuous 6.0 silk sutures. All animals were killed on the seventh postoperative day. Anastomotic healing in unprepared, ischemic rat colon was severely impaired, with an 83% dehiscence rate. In the colon prepared with enteral antibiotics, no adverse effect of ischemia was found. No animal had dehiscence, proximal dilation of the colon, or intra-abdominal abscess. This study may have clinical relevance in patients with ischemic intestinal disorders.
Administration, Oral↗
Chronic lymphadenopathy due to mycobacterial infection. Clinical features, diagnosis, histopathology, and management.
This report provides clinical information, diagnostic criteria, management, and outcome of 153 cases of mycobacterial lymphadenitis; 22 patients (14%) had Mycobacterium tuberculosis (TB) and 131 patients (86%) had nontuberculous mycobacterial (NTM) disease. Correct diagnosis of TB v NTM disease is essential, since antituberculous chemotherapy was effective for TB adenitis, while excisional biopsy was the treatment of choice for NTM adenopathy. Dual (PPD-NTM, PPD-T) Mantoux tests discriminated between TB and NTM adenitis in 151 (99%) of 153 patients, while dual (PPD-Battey [B], PPD-T) tests differentiated between NTM and TB adenitis in 135 (88%) of 153 cases. A PPD-T reaction of 1 to 14 mm suggested either an NTM or TB infection, whereas a PPD-T of 15 mm or greater was strongly associated with TB disease. We recommend the use of PPD-B and PPD-T antigens as reliable diagnostic discriminators between TB and NTM adenitis.
Antitubercular Agents↗
Localized pneumothorax adjacent to a collapsed lobe: a sign of bronchial obstruction.
In the presence of lobar collapse due to bronchial obstruction with increased recoil of the affected lobe, an unusual localized pleural collection of air may result. Three patients are reported in whom obstruction of the right upper lobe bronchus resulted in radiographic findings of a dense contracted right upper lobe with an adjacent apical intrapleural gas collection. The gas resolved after bronchoscopic removal of foreign bodies in two patients and after removal of an endotracheal tube from the intermediate bronchus in the third patient.
Airway Obstruction↗
The significance of anaerobic bacteria in biliary tract infection after hepatic portoenterostomy for biliary atresia.
Aspiration of the biliary atrium was performed in six children who developed cholangitis after hepatic portoenterostomy (Kasai procedure). All aspirates were cultured for aerobic and anaerobic bacteria. Aerobic bacteria were recovered in all six specimens and anaerobic organisms were recovered in three. The predominant aerobic organisms were Klebsiella pneumoniae (four isolates), enterococcus (three isolates, and Escherichia coli (two isolates). The anaerobes recovered were Bacteroides fragilis (two) and Clostridium perfringens (one). These findings demonstrate the recovery of anaerobic as well as aerobic organisms in cholangitis after hepatic portoenterostomy.
Bacteria, Anaerobic↗
Decreased pulmonary alveolar macrophage bactericidal activity in splenectomized rats.
The organism most frequently encountered in postsplenectomy sepsis is Streptococcus pneumoniae, which is thought to invade via the upper respiratory tract. This study assesses the phagocytic and bactericidal activity of pulmonary alveolar macrophages (PAM) in normal, splenectomized, and one-third splenectomized autotransplanted rats at 8 weeks of age, 7 weeks post surgery. The PAMs from both the splenectomized and control rats all expressed the same ability to phagocytose latex beads and Fc-receptor-mediated phagocytosis of SRBC. In the bactericidal assay, bacterial growth, after 1 hr without macrophages, was 31 X 10(3) colony-forming units (CFU). In the presence of PAMs from splenectomized rats, the colony count was 22 X 10(3) (P less than 0.2). Bactericidal activity was highly evident when PAMs from control and autotransplanted rats were assayed, with CFU of 11.3 X 10(3) and 14.6 X 10(3), respectively (P less than 0.001, P less than 0.002, respectively). It is concluded that antibody-dependent and independent phagocytic activity of PAMs is unimpaired in splenectomized rats as compared to controls. The defect in rats splenectomized at 1 week of age resides in poor pneumococcal bactericidal activity of PAMs and is almost completely corrected by ip autotransplantation of one-third of the spleen.
Animals↗
Ammonia metabolism in dogs with portacaval shunts.
Plasma ammonia, arginine, citrulline and urine ammonia, total nitrogen, and orotic acid were measured in shunted and control dogs. The progressive rise in plasma ammonia in the experimental group could not be explained solely by shunt hemodynamics. Similarity of control and experimental urinary nitrogen does not implicate nitrogen load. Urea synthesis was similar in experimental and control liver slices and was augmented by ornithine only in the experimental slices. Additionally, elevated urine orotic acid suggests urea cycle compromise at the ornithine transcarbamylase step.
Ammonia↗
Portal hypertension: American Academy of Pediatrics Surgical Section survey--1981.
Hepatic (cirrhosis) accounts for a higher percentage of portal hypertension than extrahepatic portal vein obstruction. Some patients with extrahepatic portal hypertension (portal vein obstruction) have a more favorable clinical status. Nonoperative management (balloon tamponade, vasopressin) will usually succeed in controlling bleeding (both groups). Most patients can be stabilized before surgical procedure. Results of devascularization procedures are encouraging. Central splenorenal shunt was most commonly employed (both groups). The Warren shunt is gaining popularity. There are no clear advantages of any particular method of portosystemic shunting in either group. The results of shunt therapy in cirrhotic patients are comparable to those observed in patients with extrahepatic portal hypertension.
Arteriovenous Shunt, Surgical↗
Surgical management of intractable cholangitis following successful Kasai procedure.
Anastomotic revision/resection procedures were carried out in five patients in whom refractory cholangitis jeopardized an apparently favorable surgical outcome after portoenterostomy for biliary atresia. Mobilization and displacement of the liver improves exposure of the porta hepatis. All five patients remain jaundice-free seven months to 4 yr after reoperation.
Bile Ducts↗
Effect of phenobarbital on 99mTc-IDA scintigraphy in the evaluation of neonatal jaundice.
Hepatobiliary scintigraphy with 99mTc-IDA derivatives was used to evaluate 40 neonates with mixed jaundice. Fourteen patients proved to have biliary atresia. The remaining 26 patients had intrahepatic cholestasis with patent extrahepatic ducts. Sixteen of the 40 patients underwent examinations without phenobarbital stimulation. Sixteen patients had two examinations, one before and one after 3-7 days of phenobarbital therapy. The remaining 8 patients had their initial examinations after phenobarbital therapy. The results of this study show that administration of phenobarbital in a dose of 5 mg/kg/day for at least 5 days prior to the examination enhances and accelerates biliary excretion of IDA compounds and thereby significantly increases the accuracy of 99mTc-IDA scintigraphy in differentiating extrahepatic biliary atresia from neonatal hepatitis. Its routine use in the evaluation of neonatal jaundice is therefore highly recommended.
Bile Ducts↗
The retroperitoneal approach for peritoneovenous shunting in infants and small children.
The technical limitations of peritoneovenous shunting in small children were overcome by placing the valve in the iliac fossa. Both collecting and venous tubing are readily positioned from this approach. The valve is easily accommodated in this location.
Humans↗
Hepatobiliary scintigraphy with 99mTc-PIPIDA in the evaluation of neonatal jaundice.
Hepatobiliary scintigraphy with technetium 99m-labeled p-isopropylacetanilido iminodiacetic acid (99mTc-PIPIDA) was used to evaluate 22 neonates with mixed jaundice. Ten patients were proved to have biliary atresia; ten others were diagnosed as having neonatal hepatitis. In the remaining two, jaundice was secondary to prolonged hyperalimentation. Initial studies in all ten patients with biliary atresia showed no evidence of excretion of the tracer into the intestinal tract. Following three to seven days of oral administration of phenobarbital, repeat studies were performed in six of the ten patients. None showed evidence of excretion. Initial studies of the 12 patients with intrahepatic cholestasis showed definite excretion in five, questionable evidence of excretion in two, and no demonstrable excretion in five. Studies after phenobarbital therapy in five of the seven patients with questionable or no excretion on the initial studies showed definite excretion in four. Only in one patient who had poor hepatic extraction did the phenobarbital therapy not change the scintigraphic pattern. The authors conclude that hepatobiliary scintigraphy with 99mTc-PIPIDA after three to seven days of phenobarbital therapy is a highly accurate test for differentiating biliary atresia from other causes of neonatal jaundice.
Bile Ducts↗
Results of re-operations for correction of extrahepatic biliary atresia.
Explore the source record for details and available documents.
Bile Ducts↗