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Biomedical subjects

T E Lobe

Publications and source records attributed to T E Lobe.

At least 91 records · Page 5Linked to original sources
PubMed1992

Sacrococcygeal teratoma: the experience of four decades.

To determine the extent of progress in the treatment of sacrococcygeal teratomas (SCTs), we evaluated the experience with 73 patients over 40 years. The medical records of the children were reviewed for demographics, histology, clinical course, and outcome. Therapy differed depending on the type of SCT, histology, and decade of diagnosis. The female:male ratio was 4.2:1 and did not vary significantly with the histology of the tumor. Fifty-seven patients presented with benign disease. There were five recurrences in this group, only one of which did not have an initial coccygectomy. One tumor, originally thought to be benign with immature elements, had a local recurrence at 7 months, 10 months, and 16 months after the original operation and was discovered to have embryonal carcinoma with nodal involvement. This child was treated with chemotherapy and is disease-free at 7 years. Morbidity in the benign group included 3 postoperative wound infections. Three infants died, one before operation with beta-hemolytic Streptococcus sepsis. Two neonates died in the early postoperative period, one on day 1 with a ruptured subcapsular hematoma of the liver, and the second on day 2 with disseminated intravascular coagulation/sepsis. Benign SCT occurs at a younger age than malignant tumors. The average age of presentation of benign tumors is 20 days versus 468 days in children with malignant disease. The technique of wide resection of benign lesions with coccygectomy is helpful in preventing recurrence and has changed little over the last four decades. Malignant SCT occurred in 16 children (22%).(ABSTRACT TRUNCATED AT 250 WORDS)

Child, Preschool↗
PubMed1992

Endoscopic laser ablation of obstructing congenital duodenal webs in the newborn: a case report of limited success with criteria for patient selection.

Standard approaches to intrinsic obstructing duodenal lesions in the newborn include laparotomy with enteroenterostomy, bypassing the obstruction, or duoduodenotomy with excision. The advent of improved pediatric flexible fiberoptic endoscopes and fiberoptic laser technology makes endoscopic ablation of duodenal webs and windsocks in the newborn possible.

Duodenal Obstruction↗
PubMed1992

Recombinant human granulocyte colony-stimulating factor promotes wound healing in a patient with congenital neutropenia.

We report a patient with congenital neutropenia or Kostmann's Syndrome who suffered many complications after presenting with Clostridium septicum enterocolitis, including absence of wound healing. Because of several reports of the use of granulocyte colony-stimulating factor (G-CSF) in patients with various complications of neutropenia, we treated this patient with recombinant human (rh) G-CSF. We found that once rhG-CSF restored neutrophil counts to normal, progressive wound healing followed. Thus, rhG-CSF therapy may be useful in treating neutropenic patients with wound complications.

Adolescent↗
PubMed1992

Evolving uses of laparoscopy in children.

As the technology evolves, the number of procedures that can be performed laparoscopically will continue to expand (Table 3). The impact on the field of pediatric surgery, which encompasses surgical oncology, gastrointestinal surgery, trauma, and gynecologic surgery, will be significant. There are several hurdles for the pediatric surgeon to overcome before beginning operative laparoscopy. The acquisition of the initial instrumentation is expensive, and the credentialing process may be time-consuming. And there remains a healthy suspicion on the part of many pediatric surgeons that these techniques represent a fad. We believe that operative laparoscopy has advantages and disadvantages. Some of the procedures require more time and are frequently tedious, thus trying the patience of the surgeon. It is difficult for experienced surgeons to subject themselves electively to the learning curve associated with a new procedure. While the benefits are mostly in the postoperative period, we believe exposure is vastly improved in obese patients. Patients appear to have less pain and postoperative ileus, and they may return to unrestricted activity sooner. We are still discovering which laparoscopic procedures can be done safely to the patient's advantage. Solving the dilemma of what procedures should be performed using laparoscopic techniques will require extensive experience and study, and minimally invasive surgery will be a subject of controversy and debate for many years. It is difficult to imagine that open cholecystectomy would once again become the standard. We predict that we will see a continued expansion in the types of procedures to be performed using minimal-access techniques. And in the future, we may have to justify our opening of a patient's abdomen when the procedure could have been performed laparoscopically, as is now the case for cholecystectomy in some areas of the country.

Appendectomy↗
PubMed1992

Inguinal hernias in pediatrics: initial experience with laparoscopic inguinal exploration of the asymptomatic contralateral side.

Laparoscopic inguinal "exploration" was undertaken in 22 consecutive pediatric patients to assess the value of this technique in detecting the presence or absence of occult inguinal hernias on the asymptomatic side of patients with unilateral disease. After a CO2 pneumoperitoneum was established using a Veress needle, a 2 mm 0 degree laparoscope was passed via a 3 mm cannula and both inguinal rings were inspected. Eleven cases (50%) had previously unsuspected bilateral disease diagnosed at laparoscopy and had bilateral inguinal hernias confirmed at exploration. Nine cases, in which the asymptomatic side was assessed as being negative at laparoscopy, were confirmed negative by open exploration. In one misdiagnosed case of bilateral hernias, no hernias were found at laparoscopy and one side had a non-communicating hydrocele at exploration. There was one failure, an infant less than 2 months of age, in whom the inguinal anatomy could not be adequately visualized at laparoscopy and a hernia was found at exploration. There were no complications. Thus, laparoscopic inguinal "exploration" was 96% accurate in this initial evaluation. The adoption of this approach to the assessment of the asymptomatic contralateral side in infants with unilateral hernias would eliminate many inguinal operations and the complications associated with unnecessarily manipulating the delicate cord structures.

Child↗
PubMed1992

Thoracoscopy in children: an initial experience with an evolving technique.

Recent technological innovations have improved our ability to perform thoracoscopy in children. Video imaging improves thoracoscopic visualization and enhances the role of the surgical assistant. The placement of multiple access ports improves the thoracoscopic manipulation of tissue. The laser permits the application of thermal energy to intrathoracic tissue for hemostasis without the risk of cardiac fibrillation. The endoscopic stapler allows hemostatic, airtight lung resection which obviates the need for routine tube thoracostomy. Our initial experience with these innovations applied to thoracoscopy was successful in 9 of 12 patients, ages 5 months to 17 years. For diagnostic cases, adequate tissue for histologic evaluation was always obtained. Complications of successful thoracoscopy included suspected air embolus on establishing the initial pneumothorax and persistent air leak requiring tube thoracostomy after resection of a bronchogenic cyst. There were no perioperative deaths. We performed biopsy of mediastinal masses or nodes, and lung, drainage of loculated pleural effusions, and excision of bronchogenic cysts. Thoracoscopy provides a safe, effective alternative to thoracotomy in children and will continue to be enhanced by improving technology.

Adolescent↗
PubMed1991

Epithelioid hemangioendothelioma of the lung (intravascular bronchioloalveolar tumor) in a young girl.

This report describes a 7 year old girl who presented with scoliosis and a small right hemithorax. Findings on spine roentgenographs were pleural thickening on the right and parenchymal densities. Computed tomography of the chest and abdomen revealed multiple pulmonary nodules and two hypervascular lesions within the liver. The diagnosis established by lung biopsy was intravascular bronchioloalveolar tumor (epithelioid hemangioendothelioma of the lung). This is the youngest reported case of this rare tumor.

Biopsy↗
PubMed1991

Early hemodynamic indicators of gram-negative sepsis and shock in an infant pig model.

To assess the hemodynamics of early shock and to determine to what extent hemodynamic indicators of sepsis and shock can be predictive, we evaluated data from several series of experiments (including 136 piglets) in which animals were subjected to fecal-Escherichia coli peritonitis-induced septic shock. Serial measurements of 39 parameters were obtained and their values taken at baseline, at hyperdynamic sepsis, and at shock were compared by analysis of variance. Piglet weights ranged from 1.2 to 7 kg (mean, 3.5) and ages ranged from 5 to 29 days (mean, 15). Of the 39 parameters assessed, 9 (CO*, CI*, SVI*, LVSWI*, SVR*, a-vDO2, VO2, O2 delivery*, and CaO2*) proved valuable as indicators of sepsis and shock. Of these parameters, seven (*) can be measured or calculated by noninvasive techniques and easily can be determined in human neonates. Serial determinations of these hemodynamics in high-risk neonates may be able to accurately predict gram-negative sepsis and shock before these entities are otherwise clinically apparent.

Age Factors↗
PubMed1991

The application of solvent-processed human dura in experimental tracheal reconstruction.

To evaluate the role of solvent-processed human cadaveric dura in experimental tracheal reconstruction, anesthetized piglets underwent an elliptical excision of a four-ring segment of the trachea. Twelve animals were randomly divided into two equal groups: in group I, the resected trachea was rotated 180 degrees and sutured into position; in group II, the resected trachea was replaced with dura. The animals were extubated after the operation, and endotracheal stents were not used. Tracheal dimensions were recorded, and tissues were evaluated for mechanical compliance (percent elongation/displacement). Histology of the grafts was characterized by fibrosis and granulation tissue, and there were no distinguishing features between groups. The data suggest that solvent-processed human dura has compliance and patency comparable to those of autologous free-grafted trachea and that it may prove useful as an adjunct to reconstructive tracheal surgery in infants.

Animals↗
PubMed1991

Ibuprofen therapy in experimental porcine gram-negative septic shock.

To evaluate the effects of ibuprofen on gram-negative septic shock, immature piglets were subjected to fecal-Escherichia coli peritonitis. Group I (n = 5) received a 12.5 mg/kg bolus of ibuprofen in 0.9% benzyl alcohol, followed by a continuous infusion of 6.25 mg/kg/h. Group II (n = 5) received the vehicle, benzyl alcohol, and Group III (n = 5) received lactated Ringer's solution. Mean survival times among the three groups were not significantly different. Ibuprofen-treated animals had a mean survival time (+/- S.E.M.) of 17.1 +/- 2 h vs. 19.2 +/- 2.4 h in the benzyl alcohol group and 15.7 +/- 2.7 h in the animals receiving lactated Ringer's solution. Thromboxane B2 levels were not significantly different in the treatment vs. non-treatment groups while 6-keto-PGF1a levels were significantly lower in the ibuprofen-treated animals. Neutropenia and thrombocytopenia were not prevented by treatment with ibuprofen.

6-Ketoprostaglandin F1 alpha↗
PubMed1991

Extracorporeal membrane oxygenation for gram-negative septic shock in the immature pig.

Extracorporeal membrane oxygenation (ECMO) can provide total cardiopulmonary support via extrathoracic vascular cannulation. We evaluated the effects of ECMO in gram-negative septic shock in immature piglets subjected to fecal-Escherichia coli peritonitis. Group I, SEPSIS CONTROL (n = 10), had an intraperitoneal injection of E. coli but did not receive ECMO. Group II, ECMO CONTROL (n = 5), had 24 hr of ECMO support without the intraperitoneal injection of E. coli, and Group III, ECMO SEPSIS (n = 4), had an intraperitoneal injection of E. coli and was treated with ECMO. In the SEPSIS CONTROL group, mean survival time (+/- SD) was 13.8 +/- 6.3 hr with two survivors to 24 hr. In the ECMO CONTROL group, all five animals survived 24 hr on ECMO and then weaned successfully to conventional ventilatory therapy with return of spontaneous circulation. In the ECMO SEPSIS group, one of the animals died after 22 hr on ECMO and the other three animals died at 24 hr immediately upon withdrawal of ECMO support. Conventional ventilatory therapy was unsuccessful in each. Systemic arterial blood pressure was significantly higher in ECMO CONTROL animals (P less than 0.01) as were leukocyte counts (P less than 0.01). In this model of gram-negative septic shock, ECMO did provide cardiopulmonary support but did not improve mortality.

Animals↗
PubMed1990

Fatal refractory hyperkalemia due to tumor lysis during primary resection for hepatoblastoma.

Infants with large, rapidly growing tumors of the liver who exhibit preoperative signs of tumor necrosis (elevated uric acid or K+), having received no prior chemotherapy or radiation therapy, may be at risk for acute hyperkalemia during operative manipulation of the mass. In these patients, consideration should be given to careful monitoring of serum potassium throughout operative manipulation; cardiopulmonary bypass, to protect the heart from acute hyperkalemia; or to primary biopsy of the tumor with resection planned after chemotherapy. A case of fatal refractory hyperkalemia due to tumor lysis during a trisegmentectomy for hepatoblastoma in a 7-month-old girl who presented with a large, rapidly growing tumor and hyperuricemia is described.

Carcinoma, Hepatocellular↗
PubMed1990

A comparison of placement techniques and complications of externalized catheters and implantable port use in children with cancer.

The complications associated with the placement and use of Hickman catheters (n = 120), Broviac catheters (n = 146), and implantable ports (n = 93) in children with cancer were analyzed. Percutaneously placed central venous access devices (CVADs) tended to fail less often (P = .86) and to develop infections less often (P = .056) than surgically placed CVADs. The difference in complications with percutaneous versus surgically placed CVADs requires confirmation in a randomized trial to assure they are not a result of differences in patient characteristics. When all catheter failures (removal due to infection, obstruction, or dislodgement) were considered, ports had a significantly longer failure-free duration of use than externalized Hickman and Broviac catheters (P = .0009). Ports also remained infection-free longer than externalized catheters (P = .0014). The greatest risk of infection occurs in the first 100 days of use, particularly for ports. This study demonstrates that for long-term use (greater than 100 days) ports are superior to externalized catheters in children with cancer.

Bacterial Infections↗
PubMed1990

Does heparin improve survival in experimental porcine gram-negative septic shock?

To evaluate the effects of heparin on gram-negative septic shock, immature piglets were subjected to fecal Escherichia coli peritonitis. One group of animals received a continuous infusion of heparin 25 units/kg/hr, while the control animals were given an equivalent volume of lactated Ringer's solution. Heparin-treated animals (n = 5) had a mean survival time (+/- SEM) of 18.8 +/- 2.2 hr vs. 11.9 +/- 2.8 (P less than 0.05) in controls (n = 5). Animals receiving heparin tended to have improved hemodynamic profiles and less leukopenia than controls.

Animals↗
PubMed1990

Hyperosmolal formula in neonatal piglets: effects on gastrointestinal hormone concentrations, enteric bacterial titers, and small intestinal histology.

Ingestion of hyperosmolal formula (HOF) by neonatal piglets has been shown to cause significant time-dependent reduction in phase 3 myoelectric activity, which persists in the terminal ileum. To determine whether a single hyperosmolal meal leads to elevated concentrations of gastrointestinal (GI) hormones that inhibit intestinal motility and/or promote bacterial proliferation and disruption of intestinal mucosa, we studied 20 healthy neonatal piglets following feeding with an increased HOF (872 +/- 32 mOsmol/kg, n = 10) and commercial pig milk formula (481 +/- 41 mOsmol/kg, n = 10). Gastrin, secretin, cholecystokinin, and motilin concentrations were determined by radioimmunoassay during fasting and postprandial periods (15, 30, 45, 120, 180, and 240 min). Gastrin concentrations were significantly increased at 15 and 30 min following a hyperosmolal meal (p less than 0.01), but there were no statistical differences in GI hormone concentrations between groups. These transient elevations of gastrin concentrations are associated with significant postprandial reductions in phase 3 small intestinal myoelectric activity (SIMEA) that we have observed. Aerobic bacterial titers were not significantly different between proximal and distal small intestinal segments or between experimental groups, and anaerobic bacteria were seldom recovered. Thus, SIMEA was not sufficiently altered to produce significant bacterial proliferation. Small intestinal histology, assessed by light microscopy, showed normal proximal and distal small intestinal mucosa in 8 of 10 piglets from each group. Therefore, orogastric instillation of a single hyperosmolal feed does not result in intestinal mucosal damage. Further studies are warranted to determine the effects of hyperosmolal feeds when additional risk factors exist in the neonate.

Animal Feed↗
PubMed1989

Vascular sling with tracheomalacia: surgical management.

Surgical repair of pulmonary artery sling without concomitant correction of associated tracheal abnormalities has yielded poor results in the past. We combined vascular sling repair done during cardiopulmonary bypass through a median sternotomy incision with tracheopexy for severe associated tracheomalacia in 2 infants. Neither experienced substantial postoperative respiratory difficulties and both had patent vascular anastomoses at 1 year after repair, thus supporting this approach when this combination of lesions is present.

Cardiopulmonary Bypass↗
PubMed1989

Successful separation of a conjoined biliary tract in a set of omphalopagus twins.

Omphalopagus twins were separated in the first 48 hours of life. Preoperative evaluation did not disclose either their conjoined intestines or their conjoined biliary tract; intraoperative evaluation, including an operative cholangiogram, was required to determine if separation was possible. The intestines were divided to give each infant an equal share, and an hepaticoenterostomy was constructed in each of the twins.

Bile Ducts↗