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Biomedical subjects

S Ein

Publications and source records attributed to S Ein.

At least 19 recordsLinked to original sources
PubMed2005

Prenatal ultrasonography and neonatal imaging of complete cleft sternum: a case report.

The prenatal diagnosis of a complete cleft sternum was established in a fetus of a twin pregnancy at 22 weeks' gestation. We present the prenatal imaging and correlation with postnatal magnetic resonance imaging and high-resolution ultrasonography. Thinned and depressed midline anterior chest wall transmitting the cardiac pulsation was the clue to the diagnosis, and the defective sternum could be identified on close sonographic observation. Successful surgical correction was undertaken at 2 months of age. There were no major associated abnormalities such as ectopia cordis or midline abdominal wall defects.

Adult↗
PubMed2001

Corrosive esophagitis in children: a 30-year review.

Caustic ingestion with resultant corrosive esophagitis in the pediatric population comprises a heterogeneous group in terms of offending agent, location of burn and the degree of damage. Consequently, the treatment of these injuries has also varied over the years and the optimal management remains controversial. Another area of concern that is seldom reported in the otolaryngology literature is the socioeconomic impact of such injuries both on the child and on the family. We report a 30-year retrospective review of aerodigestive tract caustic injuries at The Hospital for Sick Children. Eighty patients were identified with an age range from 1 month to 16 years. Early and late complications are reviewed including 23 patients (29%) that developed medical complications and 16 patients (20%) that developed severe esophageal strictures. Five of these children required repeat prograde dilatation, while 11 children required gastrostomy and stringing with subsequent retrograde dilatation. All the 11 children required esophageal replacement surgery. The economic and social consequences to the child and family were also noted with particular attention to hospital costs, parental absenteeism from work, and the need for job relocation. A partial cost analysis using a child with a severe injury is presented as an example. Psychological aspects such as attempted murder, jail terms and attempted suicides are also documented. We also present an analysis of those children requiring esophageal replacement surgery, and examine the possible role of esophageal stents in recalcitrant strictures.

Adolescent↗
PubMed1999

Nonocclusive small bowel infarction in familial dysautonomia syndrome.

The authors report a case of a 14-year-old boy with familial dysautonomia (FD) in whom a small-bowel infarction developed during a dysautonomic crisis. Atypical features of the presentation included hypotension with prolonged fever and abdominal distension. The authors postulate that the bowel infarction was caused by prolonged hypoperfusion. It is recognized that the small bowel in normal subjects can adapt to periods of ischemia without irreversible injury. The authors speculate that the known abnormal systemic cardiovascular regulation in patients with FD may adversely affect splanchnic blood flow, which led to the catastrophic consequences in this case. This report draws attention to the risk of significant ischemic complications during a dysautonomic crisis, especially in the face of atypical features, and emphasizes the challenging cardiovascular management of such patients.

Adolescent↗
PubMed1998

Multidisciplinary evaluation of the distended abdomen in critically ill infants and children: the role of bedside sonography.

Abdominal distention and metabolic acidosis are common in critically ill infants and children, and can be manifestations of an intra-abdominal catastrophe. This series demonstrates the value of bedside sonography (US) in this difficult assessment. Eight infants and children presented with the above situation. Seven were immediately post-cardiopulmonary resuscitation and none had antecedent histories of abdominal pain or bilious vomiting. Abdominal radiographs could not rule out intra-abdominal pathology such as ischemic bowel. Review of all laboratory and radiological data showed US to be a discerning modality for acute bowel pathology. A characteristic pattern of echogenic ascites, thickened bowel wall, dilated, fluid-filled bowel lumen, and lack of peristalsis was seen in those children with gangrenous bowel. Sonographic examination accurately predicted the status of the bowel in all patients. Four patients survived: two had segmental ileal necrosis, one had localized gangrene of the jejunum (twice), and one had necrotic bowel from a closed-loop obstruction. The four who died had malrotation with volvulus (two), superior mesenteric venous thrombosis, and one was immunocompromised with pulmonary aspiration. We conclude that bedside US can be extremely valuable as an adjunct in assessing the abdomen and diagnosing gangrenous bowel in critically ill infants and children.

Abdomen↗
PubMed1998

The role of peritoneal drains in treatment of perforated necrotizing enterocolitis: recommendations from recent experience.

BACKGROUND/PURPOSE: Intraperitoneal drains have been used in the treatment of perforated necrotizing enterocolitis (NEC), especially in infants less than 1,000 g, yet their role is still debated. The authors wished to examine their more recent experience in the treatment of NEC to make recommendations for operative management. METHODS: The authors reviewed the records of all infants seen between 1989 and 1995 who had clinical and radiological evidence of NEC at the Hospital for Sick Children, Toronto, Ontario. One hundred sixty-seven infants were treated for NEC and 73 (44%) infants required surgical intervention. RESULTS: Forty-five patients had perforated NEC; 23 were treated initially by peritoneal drainage and 22 by primary laparotomy. The 23 newborns who had peritoneal drainage were of significantly lower birth weight, and 19 (83%) of these infants required subsequent laparotomy for worsening disease. The overall mortality rate for perforated NEC was 36%. CONCLUSION: Insertion of a peritoneal drain is still useful in resuscitating small critically ill infants with NEC; however, the majority of these infants will also require laparotomy.

Drainage↗
PubMed1998

Congenital thymic cysts in children--mostly misdiagnosed.

BACKGROUND/PURPOSE: Thymic cysts are rare lesions of the neck and mediastinum that are difficult to diagnose. Often considered inconsequential, these lesions can frequently be symptomatic. In this report the authors contrast their experience with that of the literature. METHODS: From 1984 through 1997, the authors encountered 14 patients with this lesion. All cysts were completely excised. Patients that had an acquired cyst of the thymus were excluded from this series. RESULTS: Of the 14 patients ranging in age from 2 weeks to 16 years, seven patients had cervical masses, five had mediastinal masses, and two children had both sites involved. Seven children were symptomatic with wheezing and upper respiratory infection, with cough and fever being the most common clinical features. Investigations included chest radiograph, contrast esophagram, sonography (US) and computerized tomography (CT). Displacement of vital mediastinal or neck structures was observed in eight patients. Only two patients received correct diagnosis before surgery. Successful and complete excision of all cysts was achieved. The cysts were benign and ranged in size from 2 to 22 cm in diameter. CONCLUSION: Often forgotten, thymic cysts are rare benign lesions that should be considered in the differential diagnosis of cervical and mediastinal masses in children.

Adolescent↗
PubMed1996

A 45-year experience with surgical treatment of peptic ulcer disease in children.

Peptic ulcer disease (PUD) requiring surgical treatment has become rare with the availability of modern medical management. A retrospective study of all patients who required operations for PUD between 1949 and 1994 (n = 43) was done. The patients were classified into 3 groups: A (n = 38): pre-histamine-2 (H2) blocker era (1949-1975); B (n = 3): pre-hydrogen-potassium (H-K+) ATPase inhibitor era (1976-1988); C (n = 2): H-K+ ATPase inhibitor era (1989-1994). Data, analyzed using X2 analysis (P < .01), included preoperative medical therapy, surgical indications, type of operation performed, complications, and postoperative medical therapy. The indication for surgery in group A was bleeding (26), perforation (8), or obstruction (4); in group B the indication was obstruction (2) or perforation (1); in group C the indication was obstruction (1) or bleeding (1). The incidence of obstruction as an indication for surgery did not differ among the groups (P < .01). Two of the three patients who had surgery for obstruction in groups B and C had biopsy-proven Helicobacter pylori. The postoperative morbidity rate was lower for groups B and C, although not significantly. The relative mortality among the groups did not change (P > .01). Children with PUD can have complications similar to those of adults with PUD. Since the introduction of H2 antagonists, the recognition and treatment of H pylori, and the use of H-K+ ATPase inhibition, the incidence of operations for bleeding and perforation has decreased dramatically. However, the incidence of surgery for obstruction remains the same.

Anti-Ulcer Agents↗
PubMed1995

Perforation during attempted intussusception reduction in children--a comparison of perforation with barium and air.

This paper compares the effects on patients of perforation with barium and with air during attempted intussusception reduction by reviewing the clinical, radiological, surgical and pathological findings and sequelae in seven children who received barium and seven who received air. In both groups perforation occurred in infants under 6 months of age (with one exception) with a long duration of symptoms. All patients with barium enema required resection of bowel whereas only four with air enema required resection. Anesthetic times were longer in those patients with barium perforation in whom the intussusception did not move and there was a large leak. The patients with perforation due to air had a shorter hospital stay with decreased morbidity compared to those with perforation due to barium. Perforation occurred through areas of transmural necrosis in a minority of patients in each group. Perforations through normal bowel and shear injury (with air enema) indicate that increased pressure during the examination is an important factor in some patients. Because perforation with air is so much easier to deal with surgically and the children do better clinically, there is a tendency for some to consider perforation with air an inconsequential situation. However, a potential rare complication with this technique is tension pneumoperitoneum. Keeping this in mind, we continue to use air as the contrast of choice because the procedure in our hands is a safe, quicker and easier technique and we have achieved a substantial improvement in reduction rates. Overall reported perforation rates with air enema compare favourably with those due to barium enema.(ABSTRACT TRUNCATED AT 250 WORDS)

Air↗
PubMed1995

Tailoring the small-bowel follow-through examination postoperatively in gastroschisis patients.

The purpose of this paper is to establish a small-bowel follow-through (SBFT) protocol in post-operative gastroschisis patients. In 15 years, 19 SBFT examinations have been performed to diagnose or exclude obstruction in 61 gastroschisis patients. The average examination required 6.7 overhead films (range 3-15) and lasted 34 h (1-190 h). The diagnosis of intestinal obstruction was supported on SBFT in only 1 of 19 patients who underwent this examination. In the other 18, the examination showed no obstruction (13 patients) or was nonconclusive (5 patients). The inherent dysmotility associated with gastroschisis can result in redundant overhead films being made during SFBT. We recommend that an SBFT examination in gastroschisis patients consist of (1) fluoro-evaluation of esophagus, stomach, and duodenum; (2a) if normal peristalsis is noted, then an overhead film at 30 min, or (2b), if altered peristalsis or little movement of contrast medium is noted on the 30-min overhead film, then an overhead film at 4 and 12 h. This is followed by overhead films every 24 h if required. This protocol can result in a decrease in patient radiation, department costs, and staff work load.

Abdominal Muscles↗
PubMed1995

Colonic atresia combined with Hirschsprung's disease: a diagnostic and therapeutic challenge.

Three new cases of patients with co-occurrence of colonic atresia and Hirschsprung's disease and a review of the literature (n = 5) are presented in this report. All patients (n = 8) except one were full-term infants who had no other significant anomalies. The preterm infant had associated tetralogy of Fallot in addition to Hirschsprung's disease and colonic atresia. Six patients had atresia of the ascending colon, and two had atresia of the colon to splenic flexure. All colonic atresias were diagnosed neonatally; however, there was mean delay of 15.4 months (range, 1 mo to 5 years) in diagnosing associated Hirschsprung's disease. There were two deaths. A careful examination of the resected specimen to rule out Hirschsprung's disease is recommended. Performing a rectal biopsy must be considered for patients who initially were treated for colonic atresia and who have a slow return of normal gut function.

Anal Canal↗
PubMed1993

Minute ventilation during mask halothane anaesthesia in infants and children.

The pattern of respiration in infants during anaesthesia is not well documented. In this study, minute ventilation (MV) during elective mask halothane anaesthesia (HA) was measured during spontaneous ventilation in infants (Group I) and children (Group II). Airflow was measured with pneumotachography (#0 Fleisch in Group I and #1 Fleisch in Group II). Analogue signals of pressure and flow were recorded on magnetic tape for off-line playback. The flow signal was mathematically integrated to volume. The surgical procedure was divided into three stages: A, B and C representing HA, surgical stimulation and emergence respectively. The pattern of respiration during spontaneous ventilation was described as tidal volume (VTx), respiratory frequency (fx), mean inspiratory flow (VT/TIx), inspiratory duty cycle (TI/TTotx) where the subscript x denoted the stage. Seven infants (2.7 +/- 0.5 mo, 5.8 +/- 0.5 kg) and five children (3.1 +/- 1.1 yr, 15.8 +/- 1.7 kg) were studied. There was no difference in MV between Groups I and II. Halothane anaesthesia in both groups was characterized by rapid shallow breathing: VTA was lower in Group I (2.90 +/- 0.8 ml.kg-1) than in Group II (3.74 +/- 0.40 ml.kg-1) (P < 0.05). Tidal volume was lower during anaesthesia than emergence in both groups (P < 0.05). There was no difference in VT/TIx between groups. The VT/TIA was lower than VT/TIC in Group I (P < 0.05) but not in Group II. There was no intra or intergroup difference in TI/TTot between stages. We suggest that during HA infants have a greater reduction in VT than children, which may predispose infants to hypercarbia during HA.

Anesthesia Recovery Period↗
PubMed1993

Thrombosis of the portal venous system after splenectomy for pediatric hematologic disease.

Splenic, portal, or mesenteric venous thrombosis after splenectomy for hematologic disease has not been reported in the pediatric literature. It is a rare complication associated with significant morbidity and mortality in adult reports. Between 1981 and 1991, 3 patients (13-year-old boy with hereditary elliptocytosis [HE], 13-year-old boy with thalassemia intermedia [TI], and 18-year-old girl with idiopathic thrombocytopenic purpura [ITP]) presented with abdominal pain, nausea, with or without fever, at 4, 11, and 13 days postsplenectomy, respectively. Abdominal Doppler ultrasound (US) and/or computed tomography (CT) showed: (1) an intraluminal filling defect with partial obstruction to flow in the right branch of the portal vein with the remaining vessels patent (HE); (2) splenic vein thrombosis with complete occlusion of the main portal vein and proximal superior mesenteric vein (TI); and (3) complete thrombosis of the splenic vein, proximal superior mesenteric vein and portal vein (including central radicles), with retrogastric collateralization (ITP). Subsequent imaging showed either complete resolution of vascular obstruction on no treatment (patient 1), or portal venous cavernomatous transformation with hepatofugal flow after 6 months of systemic anticoagulation (patients 2 and 3), and all 3 patients are currently asymptomatic. Postoperative sonographic evaluation of a consecutive series of pediatric splenectomies for hematologic disease (n = 16), was performed at a median of 51 days (range, 3 to 124). This demonstrated one case of asymptomatic left portal venous thrombosis with subsequent recanalization in the absence of treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

Sonographic findings of testicular teratoma with pathologic correlation.

Testicular teratoma is a rare tumor in children. We recently encountered two boys, aged 18 months and 2 years respectively, with this tumor. Sonography revealed an intratesticular mass in both. The first revealed a predominantly cystic lesion with echogenic components along its wall. The second showed a complex mass occupying most of the right testicle, and containing several areas of calcifications and cysts. Excellent pathologic correlation was obtained in both. Preoperative diagnosis of testicular teratoma is possible if the characteristic features are recognized. The prognosis is good following orchiectomy in the pediatric patients.

Child, Preschool↗
PubMed1992

Chest wall motion during halothane anaesthesia in infants and young children.

Chest wall motion during anaesthesia may differ from the awake state because of the effect of anaesthetic agents on the muscles of respiration. The purpose of this study was twofold (1) to describe the pattern of chest wall motion in infants and children during halothane anaesthesia (HA) using respiratory inductive plethysmography (RIP) and (2) to calibrate the voltage output of RIP in units of volume. Seven infants (2.3 +/- 1.7 mo, 5.9 +/- 0.7 kg) and five children (2.9 +/- 1.1 yr, 15.5 +/- 1.5 kg) were studied. Since results in both age groups were qualitatively similar they are presented as a single group. Respiratory excursions of the rib cage (RC) and abdomen (ABD) were measured using RIP. Airflow was measured with a pneumotachograph. During spontaneous breathing the analogue signals of airflow, pressure, RC and ABD were recorded. Measurements were taken during (1) halothane anaesthesia and (2) during emergence from anaesthesia. The XY plots of the RC and ABD signals were plotted for each period. In addition the voltage output of the respiratory excursions of the RC and ABD signals was converted to units of volume using the simultaneous solution of equation method. The accuracy of conversion factors was validated by regression analysis of the predicted and measured tidal volume using breaths sampled at random throughout the entire period of study. Regression analysis of this relationship gave a slope between 0.85 and 1.15 (r2 value greater than 0.7) in five of the twelve patients. The pattern of chest wall motion in the XY plots showed synchronous motion between RC and ABD signals during HA in nine of the twelve patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia Recovery Period↗
PubMed1991

The anal sphincter force in the evaluation of postoperative imperforate anus.

Eight-four children, all of whom had imperforate anus, were evaluated by measuring the anal sphincter force (ASF). Sixty-three were boys, 46 of whom had a high imperforate anus and 17 of whom had the low anomaly. There were 7 girls with cloacal malformations, 7 girls with high type and 7 with low type of malformation. In all the boys with a high imperforate anus the ASF ranged from 50 to 300 g. Those boys with a low type had an average ASF of 513 g. Normal values vary from 480 to 600 g. Twenty-five of the boys with a high imperforate anus had undergone posterior sagittal anorectoplasty and none were clinically continent. Their ASF measurements were lower than in patients with spina bifida. Patients with a low anomaly, both boys and girls, were continent and had high ASF readings. The ASF is a simple, inexpensive, and objective measurement of fecal incontinence when this is the consequence of muscular inadequacy. A reproducible quantification is now available to compare results of different operations and different centres.

Adolescent↗