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Biomedical subjects

S R Lacey

Publications and source records attributed to S R Lacey.

25 records · Page 2Linked to original sources
PubMed1988

Successful treatment of Candida-infected caval thrombosis in critically ill infants by low-dose streptokinase infusion.

Chronic central venous catheters are an important component in the management of chronically ill infants and children. Sepsis and thrombosis are common complications of these catheters. When the combination of Candida sepsis and caval thrombosis occurs, the prognosis is very poor. Lysis of the thrombus is critical to effective therapy and allows preservation of vascular access. We report the successful treatment of four critically ill infants with Candida-infected caval thrombosis treated with low-dose infusion of streptokinase combined with standard antimicrobial therapy. All four infants survived, and in all cases thrombolysis was complete and Candida sepsis resolved. Each of the infants required continued central venous access, which was made possible by resolution of the caval thrombosis. There were no hemorrhagic or other complications of the therapy.

Anti-Infective Agents↗
PubMed1988

Giant hydronephrosis presenting as unilateral iliofemoral vein thrombosis.

We report a case of left iliofemoral vein thrombosis with extension to the inferior vena cava associated with giant right hydronephrosis secondary to ureteropelvic junction obstruction. Surgery revealed marked infrarenal vena caval compression and deviation to the left side caused by the dilated right renal pelvis, with resultant kinking of the origin of the left iliac vein. It is postulated that the reduction in blood flow caused by this compression and distortion predisposed this patient to venous thrombosis.

Adolescent↗
PubMed1987

The relative merits of various methods of indirect measurement of intraabdominal pressure as a guide to closure of abdominal wall defects.

Visceral ischemia secondary to increased intraabdominal pressure (IAP) following closure of abdominal wall defects presents a serious postoperative problem. Currently, the method of closure and postoperative management are determined by clinical impressions rather than measurement of IAP. In this study various methods of indirectly measuring IAP were compared in 17 rabbits in which IAP was sequentially increased with an intraabdominal balloon. Vesical and inferior vena caval (IVC) pressures were found to have good statistical correlation with IAP. Other methods tested were gastric, rectal, superior vena caval, femoral and brachial artery, and rectus compartment pressures. All were found to be poor indicators of actual IAP. In nine of the rabbits, radiolabeled microspheres were used to assess cardiac output and visceral blood flow. Renal blood flow was very sensitive to increased IAP with dramatic impairment at IAP above 10 to 15 mmHg. Small intestinal flow was less sensitive and did not become significantly diminished until IAP exceeded 25 to 30 mmHg. Our studies suggest that vesical and IVC pressure monitoring should be used to evaluate IAP in the clinical setting. If IAP is in excess of 10 to 15 mmHg surgical intervention is indicated to prevent the development of renal ischemia.

Abdominal Muscles↗
PubMed1986

Advances in the treatment of rhabdomyosarcoma.

Rhabdomyosarcoma is the most common soft tissue sarcoma in children under 15 years of age. Several decades ago it was associated with an 80% mortality rate. Recent advances with combined modality therapy have improved the 5-year survival rate to almost 70%. The focus for the improvement in treatment regimens is now shifting to concerns regarding the preservation of body function and the treatment of far advanced disease. Regardless of age, histology, stage, or site of primary tumor, there has been no group where chemotherapy has not been proven beneficial. The current recommendations used by the Intergroup Rhabdomyosarcoma Study, with regard to chemotherapy, are summarized. Radiation therapy adjunctive to surgery has a useful place in the treatment of rhabdomyosarcoma, but prophylactic nodal irradiation is not recommended. Involved nodes should, however, be treated. Since the potentially adverse side effects of chemotherapy and radiation are accentuated when combined, radiation therapy is no longer recommended in patients with group I rhabdomyosarcoma. Prognostic factors and future considerations from the operative standpoint are presented.

Adolescent↗
PubMed1983

Repair of agenesis of the hemidiaphragm by prosthetic materials.

Creation of a substitute hemidiaphragm for an infant born with agenesis of the hemidiaphragm is a formidable task. Subsequent growth of the infant may produce distortion or fracture of diaphragmatic prostheses. Our experience with a surviving two year old infant with agenesis led us to conclude that a Silastic prosthesis is unsatisfactory and that a polypropylene mesh prosthesis is satisfactory as a diaphragmatic substitute.

Diaphragm↗
PubMedDate not supplied

CT appearance of a surgically retained towel (gossypiboma).

A case of a surgically retained towel within the peritoneal space is reported. Computed tomography demonstrated an unusual appearance not unlike that previously described for retained surgical sponges. Computed tomography of the gastrointestinal tract served as a useful adjunct to barium radiography in this case, suggesting the correct diagnosis of foreign body.

Abscess↗