Biomedical subjects

S J Bond

Publications and source records attributed to S J Bond.

At least 37 records · Page 2Linked to original sources

PubMed1994

Diamond flap anoplasty in infants and children with an intractable anal stricture.

After posterior sagittal anorectoplasty for imperforate anus a prolonged course of anal dilatations is necessary until the scar softens. Although rare, severe stricture after this procedure is difficult to resolve. Y-V plasty is not entirely satisfactory because the pedicle advanced into the anus has some tension, which tends to retract producing recurrent stricture. The authors performed a diamond-shaped island anoplasty in eight children with postoperative and strictures (one after an unsuccessful Y-V plasty), with prompt resolution of the stricture in five. The island flap anoplasty consists of a diamond-shaped flap of skin formed laterally, with complete separation of skin and subcutaneous attachments around the periphery of the flap. The skin island is supplied with blood from the deep tissue. An incision is made through the scarred anal ring and into the mucosa, a distance of half the length of the diamond, which is then advanced into the mucosal defect. The defect lateral to the advanced flap is sutured closed. The island of skin descends naturally into the anus, under no tension. The procedure can be performed simultaneously in the 3 o'clock and 9 o'clock positions, and can later be repeated anteriorly and posteriorly, although this has not been necessary. Two of the eight children have required no dilatation postoperatively, a distinct advantage in the 4-year-old patient. One segment in one child sloughed, resulting in repeat stricture that is responding to dilatation. The other seven children are doing well with their colostomies closed.

Anus, Imperforate↗

PubMed1993

Management of pediatric postoperative chylothorax.

Questions persist about the management of postoperative chylothorax in infants and children. Our experience with postoperative chylothorax over the most recent decade (1980 to 1990) has been reviewed. The type and amount of drainage, data from cardiac catheterization and echocardiography, operative decisions and details, and eventual outcomes have been cataloged. All patients were initially treated with total gut rest, with operation reserved for unabated drainage. Chylothorax developed postoperatively in 15 infants and 11 children (18 with a cardiac procedure and 8 with a noncardiac procedure). The average age was 3.1 years. Spontaneous cessation and cure occurred in 19 (73.1%) of these 26 patients, with an average drainage duration of 11.9 days (range, 4 to 30 days). Those for whom operation was chosen drained preoperatively for an average of 29.2 days (range, 25 to 40 days). There were no deaths in either group. Complications were lymphopenia (2 patients) and fungal sepsis (1 patient). The amount of drainage per day was not significantly different between patients treated operatively and those treated nonoperatively. Failure of nonoperative management was associated with venous hypertension from increased right-sided cardiac pressures or central venous thrombosis (p < 0.05, Fisher's exact test). Presumably this increased pressure is transmitted to the lymphatic system. These patients should be identified early and considered for thoracic duct suture or pleuroperitoneal shunting.

Cardiac Surgical Procedures↗

PubMed1992

Appendicitis: usefulness of US in diagnosis in a pediatric population.

One hundred eighty pediatric patients with suspected appendicitis were prospectively examined with graded compression ultrasonography (US) to assess the sensitivity, specificity, and accuracy of graded compression US in the diagnosis of appendicitis in children and to compare those results with results of clinical assessment in the diagnosis of this disorder. Patients were assigned to one of three groups prior to US based on the clinical level of confidence that appendicitis was present and on the planned management decision. Of 141 patients in the low- and intermediate-clinical risk categories, 20 (14%) had appendicitis: US had a sensitivity of 100%, specificity of 97%, and accuracy of 97% in these two groups. Of 39 patients in the high-clinical risk category, 32 (82%) had appendicitis: US had a sensitivity of 81%, specificity of 86%, and accuracy of 82%. Of 52 patients with surgically proved appendicitis, the initial management decision was to discharge to home or admit for observation and further testing in 18 (35%). Results at US were positive for appendicitis in all 18 patients in the latter two categories.

Adolescent↗

PubMed1992

Fetal surgery: correction of anatomic and constitutional defects.

The advent of improved obstetrical care and innovative advances in fetal diagnostic techniques have mandated multidisciplinary approaches to pregnancies that are complicated by prenatally diagnosed defects. The concept of fetal therapy, previously limited to in utero transfusions for Rh disease and induction of lung maturation, has now been extended to open fetal correction of congenital hydronephrosis, diaphragmatic hernia, and sacrococcygeal teratoma. Additional inquiries are now being made into the possibility of hematopoietic stem cell transplantation in utero as well as prenatal gene therapy. Continued investigation into these therapeutic interventions largely revolves around improving their efficacy and guaranteeing the safety of the mother and her unborn child.

Anemia, Sickle Cell↗

PubMed1991

Predictors of abdominal injury in children with pelvic fracture.

During a 48-month period, 2,248 children (aged less than 15 years) were consecutively admitted to a regional pediatric trauma center with blunt trauma (ICD-9-CM code greater than or equal to 800). Fifty-four children (2.4%) had injury to the pelvic circle, as diagnosed by radiographic examination; 13 of these children had concomitant abdominal or genitourinary (GU) injury. Contingency table analysis and stepwise logistic regression were used to determine the best predictors of abdominal injury. The mean age of the children was 8.6 years. Eighty-nine percent of the injuries were motor-vehicle related (59% pedestrian; 30% crash occupant). Nine children (17%) required transfusions of packed red blood cells; 9 children (17%) required surgery. There were 6 deaths in this group, a mortality rate of 11.1%. The most common fracture sites in the pelvis were the pubic rami (59%), ilium or pelvic rim (17%), and the sacrum (6%). Ten children (19%) had multiple pelvic fractures. Location of fracture was strongly associated with the probability of abdominal injury: 80% of children with multiple pelvic fractures had concomitant abdominal or GU injury, compared with 33% with fracture of the ilium or pelvic rim, and 6% with isolated pubic fractures (p less than 0.001). The variables that best predicted abdominal or GU injury using a backward-elimination, stepwise logistic model were the presence of multiple pelvic fractures (p less than 0.002) and unweighted Revised Trauma Score (p less than 0.05); age of child, systolic blood pressure, respiration rate, Glasgow Coma Scale score, and mechanism of injury were not predictive.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdominal Injuries↗

PubMed1990

Characteristics of Parker's rat coronavirus (PRC) replicated in L-2 cells.

Parker's rat coronavirus (PRC) is a naturally-occurring viral infection of the laboratory rat. On the first passage, ATCC strain 8190 of PRC replicated in L-2 cells. Using the tenth passage of PRC in L-2 cells, the characteristics of the virus were compared with previous studies of sialodacryoadenitis virus (SDAV) replicated in L-2 cells. Based on light and immunofluorescence microscopic examination of control and inoculated cell cultures, PRC-associated CPE was frequently confined primarily to individual cells, and there were relatively few syncytial giant cells. Maximum titers were recovered at 36 h post inoculation (pi). Infectious virus was demonstrated at pH values ranging from 6.0 to 9.0 and a pH of 7.5 was determined to produce the highest titers of PRC. The optimum temperature for viral replication was 33 degrees C. Up to 15 passages of PRC in L-929 cells failed to produce detectable virus. However, after adaptation in L-2 cells (20th passage), PRC replicated to high titers in L-929 cells. Previously, in vitro studies of rat coronaviruses have been hampered by the lack of an identified continuous cell line to replicate these viruses in the laboratory. L-2 cells represent a readily-available continuous cell line that can support the replication of relatively high titers of PRC.

Animals↗

PubMed1990

Death due to high-output cardiac failure in fetal sacrococcygeal teratoma.

Fetal sacrococcygeal teratoma (SCT) is being recognized with increasing frequency. Placentomegaly and hydrops fetalis are preterminal events, and it has been suggested that fetal death may be due to high-output cardiac failure from arteriovenous shunting through the tumor. We had a chance to examine this hypothesis when a 21-week fetus presented with a huge sacrococcygeal teratoma. There were marked placentomegaly, cardiomegaly, hyperdynamic ventricles, and a pericardial effusion. Doppler studies showed tremendous flow through the SCT with extreme enlargement of the inferior vena cava, consistent with congestive heart failure from increased flow through the tumor. Hydrops developed, and the fetus was delivered because of placental abruption. This case provides supportive evidence that the teratoma acts as a large arteriovenous shunt, causing high-output cardiac failure. We have now collected 18 more cases of sacrococcygeal teratoma diagnosed in utero. Of the total 45 cases of fetal SCT, 9 had placentomegaly and/or fetal hydrops and all 9 fetuses died in utero or shortly after birth. We conclude that the only hope for survival in these severely affected fetuses is to reduce blood flow to the tumor before birth.

Cardiac Output↗

PubMed1990

Duration of protection from reinfection following exposure to sialodacryoadenitis virus in Wistar rats.

Wistar rats [Cr1:(WI)BR] were inoculated intranasally with approximately 10(3) median mouse lethal infective doses of sialodacryoadenitis (SDA) virus. Animals were subsequently selected at random, removed to a separate isolation room, and reinfected with SDA virus at 3, 6, 9, 12 or 15 months. Pre- and postinoculation serum samples were collected from all animals during the course of the study and evaluated for antibody titers to SDA virus. All experimental, control and sentinel animals, following inoculation with SDA virus, were necropsied and examined for lesions consistent with SDA. Salivary gland lesions were minimal to absent in rats reinfected with SDA virus for up to 12 to 15 months after the initial exposure and minimal to moderate in the respiratory tract at 12 or 15 months. SDA-associated lesions were extensive in age matched control animals examined at each time period of reinfection with SDA virus. Thus, prior exposure to SDA virus did protect against the development of typical salivary gland lesions for up to 15 months. Recovered animals were evaluated for their ability to transmit the virus following reinfection. Rats reinfected at 6 or 9 months were infectious to their naive cage mates. The results indicate that reinfection with homologous rat coronavirus can occur as early as 6 months after the initial infection, and such rats can transmit the infection to contact controls.

Animals↗

PubMed1989

Etiology of intestinal damage in gastroschisis. I: Effects of amniotic fluid exposure and bowel constriction in a fetal lamb model.

Gastroschisis is often complicated by damage to the herniated small bowel, resulting in motility and absorption disturbances and occasional intestinal necrosis and atresia. To study the pathophysiology of this process, a model of gastroschisis was developed in fetal lambs. At 80 days' gestation, the anterior abdominal wall was partially excised to create a small peritoneal cavity, and the small bowel was extruded through a Silastic ring to create a defect of uniform size. In one experimental group, a tie was placed around the herniated bowel at the level of the abdominal wall to provide gradual constriction as the fetus grew. In a second group, no tie was placed. Control animals had a simple laparotomy and no abdominal wall defect; some also had a constrictor placed around the base of the bowel. The animals were delivered near term, and the bowel was evaluated histologically and by an in-vitro bowel motility assay. Histologic examination showed normal ganglion cells in all groups and no evidence of ischemic injury. A fibrous peel was seen only in bowel exposed to amniotic fluid, with or without a constrictor. Lymphatic and venous dilation, smooth-muscle thickening, and focal mucosal blunting were seen in bowel subjected to chronic obstruction by a constrictor, regardless of whether it was exposed to amniotic fluid. Both constriction of the bowel and amniotic fluid exposure were associated with a decrease in motility; these two effects were independent and additive.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdominal Muscles↗

PubMed1989

Cesarean delivery and hysterotomy using an absorbable stapling device.

The absorbable stapling device was used in 22 hysterotomies in gravid rhesus monkeys. The efficacy of the device, subsequent fertility and delivery route, fetal effects, and pathohistology were all studied. No statistically significant difference between experimental and control animals was noted.

Animals↗

PubMed1988

Severity of intestinal damage in gastroschisis: correlation with prenatal sonographic findings.

From 1982 to 1986, 26 abdominal wall defects were detected prenatally. Seventeen pregnancies culminated in live births with ultrasound correctly distinguishing between omphalocele and gastroschisis in all cases. In the 11 cases of gastroschisis diagnosed before birth, we attempted to correlate the clinical outcome with the size of the abdominal wall defect, sonographic appearance of the eviscerated bowel, and known time of exposure to amniotic fluid (gestational age at birth to gestational age at diagnosis). Neither the time of exposure to amniotic fluid (median duration of 14 weeks) nor the defect size could be correlated with eventual clinical outcome. The presence of small bowel dilatation and mural thickening on prenatal sonography (four patients) had a high correlation with severe intestinal damage and poor clinical outcome. The absence of these two sonographic findings (seven patients) was associated with mild intestinal changes and benign clinical course with no morbidity or mortality. We conclude that obstetric ultrasound cannot only accurately detect the presence and type of abdominal wall defect, but it also gives an indication of the severity of intestinal damage and subsequent clinical course in prenatally diagnosed cases of gastroschisis. Early delivery of the fetus with prenatally diagnosed gastroschisis should no longer be performed to limit exposure to amniotic fluid. Now that reliable sonographic criteria of severe intestinal damage have been defined, the decision to deliver early can be restricted to those fetuses with bowel dilatation and mural thickening.

Abdominal Muscles↗

PubMed1988

Experimental sialodacryoadenitis virus infection in athymic CD-1 mice.

The purpose of the study was to investigate the susceptibility of nude mice to sialodacryoadenitis virus. Young adult male CD-1 nude mice were inoculated intranasally with virus, killed at 2, 4, 6, 8, 10 and 20 days postinoculation and examined for virus-induced lesions in tissues including respiratory tract. Inoculated and control mice were examined by virus isolation and serology. In a companion study, male Wistar rats were inoculated intranasally with the same inoculum, and examined by histopathology, immunofluorescence microscopy and serology. In virus-inoculated mice, lesions were minimal in the lower respiratory tract, and were absent in other tissues. Virus was isolated from the lower respiratory tract in animals sampled at six or eight days postinoculation. Antiviral antibody was not detected in sera from inoculated and control mice. Virus-associated lesions and antibodies were readily detected in rats following inoculation. Based on this study, there is no evidence that inadvertent exposure to sialodacryoadenitis virus should pose a threat to CD-1 nude mice, and their susceptibility to the disease appears to be similar to that reported in euthymic CD-1 mice.

Animals↗

PubMed1987

Diagnostic pericardial window. A safe alternative to exploratory thoracotomy for suspected heart injuries.

During a five-year period, 104 patients underwent a pericardial window procedure to diagnose possible cardiac injury. Eighty-eight procedures were performed by a subxiphoid approach, and 16 were transdiaphragmatic in combination with an exploratory laparotomy. There were 51 patients with stab wounds, 45 with gunshot wounds, and eight with blunt trauma. All penetrating wounds were near the heart. In seven patients the window disclosed cardiac damage with no clinical signs of tamponade or shock. Fifty-one patients had signs of tamponade; however, only 12 of them had a cardiac injury diagnosed by pericardial window. Nineteen patients had cardiac injuries. One examination had false-negative results and one study had false-positive results. Cardiac wounds repaired included the right ventricle (eight), left ventricle (three), right atrium (five), and cardiac vein or pericardial wounds (three). Complications were negligible and consisted of minor wound infections (two) and postpericardiotomy syndromes (two). The pericardial window provides a rapid and safe means of diagnosing cardiac injuries in patients with equivocal signs of heart injury while sparing the patient without a heart wound a major operation.

Adolescent↗

PubMed1987

Long-term percutaneous biliary drainage in an infant with hemangioendothelioma.

A 5-month-old female infant with jaundice (bilirubin = 11) and dilated intrahepatic and extrahepatic bile ducts was explored. A 3-cm mass in the head of the pancreas and portal region completely obstructed the cystic and common bile ducts. Cholecystectomy was done and biopsy of the tumor and regional nodes revealed hemangioendothelioma with no nodal involvement. After tissue diagnosis was made, the infant's biliary tract was decompressed percutaneously. External drainage was maintained for 22 months until the tumor regressed. This infant is the youngest patient ever reported to undergo percutaneous biliary drainage.

Catheters, Indwelling↗

PubMed1986

Colonoscopy after curative resection of colorectal cancer.

Colonoscopy is generally considered to be an important part of the follow-up program for patients who have undergone curative resection of colorectal cancer. However, there are few data available concerning the frequency with which colonoscopy should be performed and for what length of time after operation. Since 1978, our policy has been to examine the colon annually in these patients using colonoscopy alternating with barium enema. We have evaluated the results in 100 patients over a four-year period. Based on size and histology, the significant colonoscopic findings were new colon cancers in three patients and 11 polyps demonstrating increased risk for malignancy in nine patients. This represents an interval yield of 3% per year. From these results and other reports, we recommend that these patients undergo total colonoscopy in the perioperative period to identify and remove synchronous lesions of the colon, and that examination of the remaining colon should be performed annually, preferably with colonoscopy, for at least the first four years after curative resection.

Barium Sulfate↗

PubMedDate not supplied

Evaluation of post extracorporeal membrane oxygenation follow-up testing.

The purpose of this study was to evaluate all post extracorporeal membrane oxygenation (ECMO) tests for their ability to detect any change in the incidence of unanticipated medical problems, and their charge to the patient. The current post ECMO protocol consists of the following tests: brain stem auditory evoked response, head computed tomography, cerebral blood flow, head ultrasonography, electroencephalography, eye examination for retinopathy of prematurity, and pneumocardiography. A retrospective review was conducted for all surviving neonatal ECMO patients treated from January, 1985, to December, 1994. The results of each test were classified as either normal, having a minor abnormality, or having a major abnormality. Statistical analyses were performed on each test comparing the incidence of minor and major abnormalities to all neonates in the neonatal intensive care nursery. Two hundred ninety-six infants survived their course on ECMO, and composed the study population. There were no significant differences between the incidence of abnormal results compared with the expected values for the following tests: cerebral blood flow (p=0.13), the eye examination (p=0.54), and pneumocardiography (p=0.22). The analyses for the brain stem auditory response, head computed tomography, head ultrasonography, and electroencephalography showed higher than expected incidences of abnormal results (p < 0.01). The data also were evaluated for major abnormalities on computed tomography and head ultrasonography. Of 161 infants who had both tests performed, 11 (6.8%) had normal head ultrasonography results, yet had a major abnormality noted on computed tomography (p < 0.01). This study is the first to review the current post ECMO protocol comprehensively, and the results suggest excluding the cerebral blood flow, eye, and pneumocardiography tests. This would result in a significant savings of $1,400 without compromising patient care. In addition, comparisons of neuroradiographic studies indicate that computed tomography of the head is sensitive enough to detect all central nervous system abnormalities that were found by ultrasonography. Excluding the post ECMO head ultrasonography, an additional savings of $300 would occur. These recommended changes reflect the current post ECMO protocol at Kosair Children's Hospital.

Brain↗

PubMedDate not supplied

Complicated cannula insertions and cannula dislodgments associated with extracorporeal membrane oxygenation.

Extracorporeal membrane oxygenation therapy remains a life saving modality for neonates with cardiopulmonary disease that is unresponsive to conventional therapy. Vital to its success is the insertion and maintenance of appropriately sized vascular cannulas. Problematic insertion and accidental dislodgments can be life threatening. To determine the treatment and outcome of these complications, a survey of participating Extracorporeal Life Support Organization centers was undertaken. Venous cannulation complications (13 patients) were due to inadequate vein size or tearing during initial attempts at cannulation. Proximal and alternative site cannulation were used. Difficult arterial cannulations (seven patients) were most often due to creation of an intimal flap that was corrected by proximal cannulation of the same vessel. The 10 cases of accidental dislodgment were most often associated with changes in position. Despite copious hemorrhage in many instances, 6 of 10 patients survived with intact neurologic status. Methods for dealing with these life threatening cannula related complications are described.

Cardiovascular Diseases↗

PubMedDate not supplied

Exit site purse-string suture to secure long-term venous catheters.

A new method for the prevention of accidental dislodgment of long-term venous catheters involves the use of an exit site purse-string suture that holds the catheter cuff in place before the ingrowth of fibrous tissue. This method is safe, reliable, easily reproduced, and does not require any additional incisions or anchoring devices. In our clinical practice, it has drastically reduced the number of accidental dislodgments.

Catheterization, Central Venous↗