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Biomedical subjects

T V Ballantine

Publications and source records attributed to T V Ballantine.

At least 37 records · Page 2Linked to original sources
PubMed1981

Accessory diaphragm in an infant.

Accessory diaphragm is a rare congenital abnormality that almost always occurs on the right side and is often associated with cardiovascular anomalies. This paper describes the clinical presentation, radiologic diagnosis, and surgical treatment of the condition. Early recognition and prompt surgical treatment will prevent the chronic pulmonary complications reported in the literature.

Diaphragm↗
PubMed1981

Appendicitis.

Explore the source record for details and available documents.

Abdomen, Acute↗
PubMed1980

Colostomy complications in children. An analysis of 146 cases.

This report analyzes the course of 146 pediatric patients with colostomies in reference to problems with colostomy formation, management, and subsequent closure. Colostomy was performed predominantly for Hirschsprung's disease (70 cases) and imperforate anus (46 cases). A transverse colostomy was done in 120 patients (82%), and a sigmoid colostomy in the remaining patients. Loop colostomies were five times more frequent than divided colostomies. Early major complications occurred in 24 patients (16%). Stomal complications occurred in 69 patients and were more frequent after loop colostomies. Colostomy revision was required in 24 cases. Sigmoid colostomy had a significantly lower complication rate (P less than .01). One hundred nine patients underwent colostomy closure. Major complications occurred in 16 cases (15%). There were no deaths related to colostomy closure. The use of a sigmoid colostomy when possible and close attention to technical details, principles of stomal care, and proper parental instruction should minimize morbidity.

Adolescent↗
PubMed1980

The relationship between peak inspiratory pressure and positive end expiratory pressure on the volume of air lost through a bronchopleural fistula.

A bronchopleural fistula (BPF) may complicate the management of patients with major pulmonary disease or thoracic surgery. Neonates with idiopathic respiratory distress syndrome and requiring ventilation are especially susceptible to pulmonary barotrauma, which may result in a BPF. Morbidity and mortality are consistently high. In ventilating patients with BPF, the effects of peak inspiratory pressure (PIP) and positive and expiratory pressure (PEEP) on air leak have not been documented. These relationships were studied in rabbits prepared by thoracotomy and creation of a standardized BPF. Randomized trials of various levels of PIP and PEEP were applied, and the percent of inspired tidal volume lost through the BPF calculated. The percent of inspired volume lost does not increase significantly from 10 to 30 cm H2O PIP (p greater than 0.05). Percent leak does increase significantly when increasing PEEP frm 0 to 16 cm H2O (p less than 0.001). Any PEEP greater than 6 cm H2O results in more air loss through the BPF than any level of PIP (p less than 0.01). Linear regressions through a common origin were calculated to illustrate the relationship of PIP versus leak and PEEP versus leak. The slopes of these lines (0.572 and 3.97, respectively) are significantly different (p less than 0.001). When using equal increments of PIP and PEEP, PEEP will have over a sixfold greater effect on air leak than doses PIP. These data suggests that PIP should be increased preferentially when ventilating patients with BPF in order to minimize air leak. PEEP less than 6 cm H2O can be used without any significant increase in the volume of air lost.

Animals↗
PubMed1980

Emergency thoracotomy for acquired bronchopleural fistula in the premature infant with respiratory distress.

Pneumothorax is a common complication of ventilator therapy and usually responds to tube thoracostomy. Persistent pneumothorax with a large air leak may indicate the presence of a bronchopleural fistula (mean weight 1360 g) with (BPF) required FIO2 of 1.0, a peak inspiratory pressure of 33 cm H2O and were hypoxemic (x pH 7.19) despite insertion of multiple chest tubes. Four patients treated nonoperatively died while nine of ten survived emergency thoracotomy and suture of BPF. BPF was probably related to suction catheter trauma. These observations suggest that emergency thoracotomy may be a life-saving procedure in selected infants requiring ventilator support who demonstrate a large air leak, persistent pneumothorax, and progressive hypoxia that is unresponsive to chest tube insertion.

Bronchial Fistula↗
PubMed1980

Transabdominal esophagomyotomy for achalasia in children.

Achalasia is an uncommon esophageal problem in children. Nine cases accumulated over 7 yr at one institution are reviewed. Infants present with failure to thrive and may be misdiagnosed as suffering from chalasia. older children demonstrate dysphagia, nocturnal regurgitation, and failure to thrive. Contrast studies and esophageal manometry are diagnostic of the disease. Transabdominal esophagomyotomy is advocated, especially if Nissen fundoplication is also felt to be indicated to prevent reflux. All nine patients were treated successfully with this variation of the operation.

Abdomen↗
PubMed1980

Effectiveness of enteral and parenteral nutrition in the nutritional management of children with Wilms' tumors.

The effectiveness of enteral and parenteral feeding in supporting a satisfactory nutrition status and/or reversing protein-energy malnutrition was evaluated in nine children, ages 1 to 7 years (eight female), with Wilms' tumors. At the onset of treatment, eight patients received comprehensive enteral nutrition (CEN) which included intense nutritional counseling and oral supplements while one received total parenteral nutrition (TPN). Despite CEN, the initial, intense treatment period was associated with a decreased energy intake (64 +/- 27% Recommended Dietary Allowances), dramatic weight loss (22 +/- 7% by 26 +/- 17 days from the beginning of treatment), decreased skinfold thickness (< 10th percentile), and decreased albumin concentrations (< 3.2 g/dl). Four of those who initially received CEN subsequently required TPN. A total of five patients received TPN for a mean of 31 days (range 11 to 60); kcal averaged 105 +/- 9% Recommended Dietary Allowances during weight gain. At onset of TPN, the mean albumin, transferrin, total lymphocyte count were 3.02 +/- 0.45 g/dl, 155 +/- 40 mg/dl, and, 655 +/- 437/mm3, respectively; all children had abnormal anthropometric measurements and anergy to recall skin test antigens. TPN for 28 or more days supported weight gain (+ 2.44 kg), increased serum albumin (+ 0.58 +/- 0.47 g/dl) and transferrin (+ 76 +/- 34 mg/dl), and reversed anergy despite low total lymphocyte counts. During maintenance treatment, nutritional status was maintained or restored with CEN in the group who responded. These preliminary data document the severity of protein-energy malnutrition which accompanies initial, intense treatment of children with Wilms' tumors, the nutritional and immunological benefits of TPN during continuing intense treatment and the effectiveness of CEN in maintaining a satisfactory nutritional status during maintenance treatment.

Body Height↗
PubMed1980

Jejuno-renal injury following traumatic hyperextension.

A 4-year-old boy suffered hyperextension injury with small-bowel obstruction and renal injuries. This unusual constellation of findings is discussed in light of the pathophysiologic mechanisms of the injury. Hyperextension of the spine resulted in rupture of the anterior longitudinal ligament and avulsion of the L1-L2 disc; a loop of bowel was then drawn into the disc space. There also was an internal tear of the renal artery. Two years after uretero-ureterostomy with nephrostomy tube, the child is normotensive with adequate renal function and with normal growth and development.

Accidents, Traffic↗
PubMed1979

Gastroesophageal reflux in infants and children. Diagnosis and management.

Eighty-three infants and children underwent surgical correction of gastroesophageal reflux (GER) from 1973 to 1978. Fifty-four patients had coexistent brain damage (most commonly due to cerebral palsy), eight were previously treated for esophageal atresia, and four had gastroschisis or omphalocele repair. Clinical presentation included failure to thrive in 64 patients, vomiting in 59, and recurrent bouts of aspiration pneumonitis in 43. Barium roentgenography showed GER in 61 patients, whereas additional tests (particularly pH monitoring) were required for detection of GER in 22 patients. After failure of medical management, transabdominal Nissen fundoplication was performed in 80 cases and a Hill repair in three cases. The surgical mortality was zero, but there were five late deaths. Results were considered excellent in 54 patients, good in 22 patients, and poor in seven. Ten of 12 patients with preoperative stricture responded to dilation after fundoplication. Nissen fundoplication was a safe and effective antireflux procedure in 76 of the 83 cases.

Adolescent↗
PubMed1979

Respiratory paralysis to improve oxygenation and mortality in large newborn infants with respiratory distress.

The nonsynchronous respiratory efforts of neonates with surgically correctable disorders may inhibit effective mechanical ventilation. The records of 25 infants treated with metocurine for muscular paralysis to improve mechanical ventilation were reviewed. All patients were greater than 35 (37.6 +/- 2.1) weeks gestation and 2.27 (2.98 +/- .47) kg. All required ventilatory support with an FiO2 of 100%. The mortality rate of this group of infants was 20% as compared with 73% (p < .001) in a similar group of 26 infants managed without paralysis. In 10 of the 25 infants treated with metocurine, pre- and 1 hr postparalysis paO2 values were available. The mean paO2 prior to paralysis was 62 (45--111) mm Hg and the mean post-paralysis paO2 was 144 (75--227) mm Hg, representing at 132% increase in paO2 (p < .001). The mean dosage for metocurine was 3.5 (1.45--6.79) mg/kg/day; however, those requiring paralysis for greater than 7 days showed a dramatically increasing requirement. These preliminary data suggest that respiratory paralysis reduces right-to-left shunting, improves paO2 and decreases mortality in large infants with severe respiratory distress requiring ventilatory support.

Diaphragm↗
PubMed1979

Reversal of protein-energy malnutrition in children during treatment of advanced neoplastic disease.

The effectiveness of enteral and parenteral feeding in supporting a satisfactory nutritional status and/or reversing protein-energy malnutrition was evaluated in 28 children, ages 1-19 (14 female) with advanced malignant disease (21 solid tumors, 7 leukemia-lymphoma). At the onset of treatment, 21 patients received intensive nutritional counseling (INC) and oral supplementation while seven received total parenteral nutrition (TPN). Sixteen of 21 patients who received INC had a decreased intake (x 48 +/- 24%) Recommended Dietary Allowances (RDA) for kilocalories and dramatic weight loss (x 16.4 +/- 12.4%). A total of 18 patients received TPN for a mean of 24 days (7-60); kcal averaged 90 +/- 26% RDA during weight gain. At onset of TPN, the mean serum albumin, transferrin and total lymphocyte counts were 3.06 +/- 0.38 g/dl, 175 +/- 62 mg/dl, and 1102 +/- 966/mm3 respectively, 15/18 children had subnormal anthropometric measurements and 17/18 patients were anergic to recall skin test antigens. TPN for less than 9-14 days neither repleted weight, skinfold reserves, nor serum albumin concentrations (greater than 3.2 g/dl) although an early increase (p less than .02) in transferrin concentration was observed. However, TPN for 28 days supported weight gain (3.27 kg, 16 +/- 6%), increased serum albumin (0.62 +/- 0.43 g/dl, p less than .001) and transferrin (62 +/- 42, p less than .002) to normal concentrations and reversed anergy in 7/11 patients retested. This study documents the severity of protein energy malnutrition which accompanies intense treatment of children with cancer and the nutritional and immunological benefits of a 28 day course of TPN.

Adolescent↗