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Biomedical subjects

T P Votteler

Publications and source records attributed to T P Votteler.

At least 19 recordsLinked to original sources
PubMed1992

Management of common bile duct obstruction associated with spontaneous perforation of the biliary tree.

Spontaneous perforation of the extrahepatic biliary tree during infancy is an uncommon event. The cause of bile duct perforation is unclear, but one-quarter of reported cases have been associated with a stone or bile sludge obstructing the distal common bile duct. A 4-week-old girl had jaundice, and a DISIDA (99m technetium diisopropyl iminodiacetic acid) scan revealed perforation of the biliary tree. Exploratory surgery showed distal common bile duct obstruction with proximal perforation. No attempt was made to remove the obstructing lesion because of duct inflammation. Common bile duct obstruction persisted until week 5 after surgery when cholangiography revealed free flow of contrast into the duodenum through a common bile duct of normal caliber without a filling defect. In the presence of acute inflammation associated with perforation of the biliary tree, exploration of the common bile duct to relieve a distal obstruction could prove hazardous. Our case and a review of the literature suggest that the obstructing stone or sludge may pass spontaneously if managed expectantly.

Biliary Tract Diseases↗
PubMed1989

Transient abdominal granulomas in children.

Space-occupying liver lesions in febrile patients are usually caused by tumor or infection and other causes are seldom encountered. In five patients age 20 months to 12 years who were evaluated for fever of unknown origin, imaging studies revealed hepatic nodules consisting of transient, sterile granulomas for which no cause could be determined. Stellate architecture histologically supported clinical evidence of subacute bacterial infection. Imaging modalities included: 99Tc-sulfur colloid (n = 2) and 67Ga (n = 2) scintigraphy; ultrasound (n = 5); computed tomography (n = 4); and magnetic resonance imaging (n = 2). Peripheral low density, as revealed by computed tomography in one and hyperintense halos on magnetic resonance imaging of another patient are both considered predictive for neoplastic disease but were associated with granulomas. The differential diagnosis of macroscopic liver lesions seen on imaging studies in febrile children should include the possibility of transient, idiopathic granulomas.

Child↗
PubMed1987

Epididymitis in children and adolescents. A 20-year retrospective study.

We identified 35 patients who had epididymitis from 1965 to 1984 by hospital chart review. The common clinical presentation was swelling, pain, and erythema. Twenty-two patients had onset of symptoms within 24 hours of hospital admission. Surgery was performed in 31 patients, 22 of whom had cultures taken from the epididymis at the time of surgery. Bacterial agents were recovered from cultures of 13 patients: coagulase-negative staphylococci were identified in nine patients. In two patients, a polymicrobic cause was found. Six patients had associated urologic abnormality. Three patients had concurrent urinary tract infection. Urologic investigation should be undertaken in children younger than 2 years old and in older patients with recurrent episodes suspected to be due to reflux of urine and associated genitourinary abnormality.

Adolescent↗
PubMed1984

Primary peritonitis in previously healthy children.

In a review of 22 years of clinical experience, we found seven previously healthy children with primary peritonitis. The diagnosis was made at laparotomy in all patients. Their symptoms included diffuse abdominal pain, fever, vomiting, and diarrhea. Abdominal tenderness was maximal in the right lower quadrant in five children, which led to confusion with the diagnosis of acute appendicitis. Streptococcus pneumoniae was identified as the etiologic agent in three patients and group A beta-hemolytic Streptococcus in one patient. The remaining three patients all had prior antibiotic therapy, and peritoneal fluid cultures were sterile. All children had a prompt response to treatment with antibiotics and recovered without complications. Long-term follow-up (4 1/2 to 15 years) was available for three patients; all three remained healthy.

Adolescent↗
PubMed1983

The hazard of ingested alkaline disk batteries in children.

We have treated eight cases of childhood ingestion of alkaline disk batteries, one resulting in an esophagotracheal fistula. These batteries are capable of rapid tissue destruction on contact with moist membranes. We recommend that packaging include proper warning of this hazard and urge that retained batteries be promptly removed from the esophagus and stomach by endoscopy or laparotomy. If the battery has reached the small intestine, further transit should be monitored carefully by roentgenographic studies until recovery. Perforation is possible after eight-hour retention at a specific site.

Accidents, Home↗
PubMed1982

Necrotizing enterocolitis in a pygopagus conjoined twin.

Necrotizing enterocolitis in one of pygopagus conjoined twins developed 72 hr after delivery. The unaffected twin supported the postcolectomy twin through sepsis, renal failure, and hyperbilirubinemia, permitting planned surgical separation at 2 mo of age.

Catheterization↗
PubMed1981

Amputated calcified ovaries in children.

A calcified abdominal mass was an identical finding in four asymptomatic girls, ages 2 weeks to 9 years. At laparotomy the right ovary was absent, and in three patients the ipsilateral oviduct was at least partially absent. The most likely explanation is antenatal or subclinical torsion of the adnexa with subsequent amputation, necrosis, and calcification.

Calcinosis↗
PubMed1980

Mesenchymal neoplasia and congenital pulmonary cysts.

A malignant mesenchymoma exhibiting a varied spectrum of differentiation developed within a congenital pulmonary cyst 6 1/2 years after the cyst was first recognized. Related tumors with a similar gross appearance have been previously described and have included rhabdomyosarcomas and so-called pulmonary blastomas. There is a low but distinct risk for the development of mesenchymal sarcomas within congenital peripheral pulmonary cysts.

Child↗
PubMed1979

Management of atypical mycobacterial lymphadenitis in childhood: a review based on 380 cases.

The medical and surgical therapy of 82 cases of atypical mycobacterial adenitis from Dallas and 298 cases from the literature was reviewed. The 92% cure rate in 149 patients with total surgical excision alone was comparable to the 95% cure rate in 156 patients when excision was followed by antituberculous drug therapy. With incision and drainage in 63 patients the cure rate was 16% whether drugs were given or not. Ten patients were initially treated with antituberculous drugs alone and only one was cured. It is concluded that total surgical excision is definitive therapy for this disease and that antituberculous drugs should be used only when surgery cannot be performed or when complete excision is not possible.

Antitubercular Agents↗
PubMed1978

Anal agenesis with rectobulbar fistula.

Anal agenesis with a rectobulbar urethral fistula is an uncommon type of male imperforate anus. Six cases are presented with a review of the main features of the disorder, the possible embryologic origin, and the surgical management.

Anus, Imperforate↗
PubMed1969

Meconium ileus.

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Cystic Fibrosis↗