Delayed skeletal maturation in young children with sickle cell anemia.
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Biomedical subjects
Publications and source records attributed to V J Harris.
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A 4 1/2-year-old girl with S-S sickle-cell anemia was found to have papillary necrosis on excretory urography. This is believed to be the first reported case of papillary necrosis in a child with homozygous S-S sickle-cell anemia.
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Of 338 children with hydrocarbon ingestion, 134 (40 percent) had pneumonia. Pneumonia was most common after kerosene, furniture polish and lighter fluid ingestion. The pneumonia was most severe, however, with furniture polish. Pneumatoceles occurred in 14 children, most commonly with charcoal lighter fluid ingestion. Pneumatoceles generally appeared late, after the consolidation had cleared. Pneumatoceles were often large, septate and irregular, and sometimes contained fluid levels.
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PURPOSE: To compare the results and costs of three different means of achieving direct percutaneous gastroenteric access. METHODS: Three groups of patients received the following procedures: fluoroscopically guided percutaneous gastrostomy/gastrojejunostomy (FPG, n = 42); percutaneous endoscopic gastrostomy/gastrojejunostomy (PEG, n = 45); and surgical endoscopic gastrostomy/gastrojejunostomy (SEG, n = 34). Retrospective review of the medical records was performed to evaluate indications for the procedure, procedure technical success, and outcome. Estimated costs were compared for each of the three procedures, using a combination of charges and materials costs. RESULTS: Technical success was greater for FPG and SEG (100% each) than for PEG (84%, p = 0.008 vs FPG and p = 0.02 vs SEG). All patients (n = 7) who failed PEG subsequently underwent successful FPG. Success in placing a gastrojejunostomy was 91% for FPG, and estimated at 43% for PEG and 0 for SEG. Complications did not differ in frequency among groups. For gastrostomy, the average cost per successful tube was lowest in the PEG group ($1862, p = 0.02); FPG averaged $1985, and SEG $3694. SEG costs significantly more than FPG or PEG (p = 0.0001). For gastrojejunostomy, FPG averaged $2201, PEG $3158, and SEG $3045. CONCLUSION: Technical success for gastrostomy is higher for FPG and SEG than PEG. Though PEG is the least costly procedure, the difference is modest compared with FPG. For gastrojejunostomy, FPG offers the highest technical success rate and lowest cost. Due to high costs associated with the operating room, SEG should be reserved for those patients undergoing a concurrent surgical procedure.
PURPOSE: The authors sought to develop a safe, efficacious technique for percutaneous transhepatic drainage of nondilated biliary systems. PATIENTS AND METHODS: Twenty-three drainage procedures were performed on 14 consecutive patients with nondilated ducts. Fourteen procedures were carried out for primary placement of a transhepatic biliary drain, eight for placement of a second drain, and one for placement of a third drain. Drainage catheter access into the biliary tree was gained via direct puncture of a peripheral duct (fourth order or smaller branch) in four procedures. In the remaining 19 procedures, peripheral duct punctures were facilitated by retrograde passage of a 5-F catheter from a previous, remote percutaneous access site into the fourth-order duct to be punctured. Nine of these 19 duct punctures were facilitated by the use of a nitinol Goose Neck snare passed through the intraductal catheter. RESULTS: Of the access methods used, the nitinol snare technique was the fastest. Successful peripheral access was achieved in all patients without bleeding complications. One patient developed symptoms of bacteremia, which resolved within 12 hours with antibiotic therapy and external biliary drainage. CONCLUSION: Percutaneous peripheral access can be achieved safely in the nondilated biliary tree and can obviate surgery for some patients and facilitate future interventions.