Biomedical subjects
Publications and source records attributed to Y Berlatzky.
This paper describes an approach to prevent reflux and ascending cholangitis after hepatic portoenterostomy for biliary atresia. The method utilizes the terminal ileum and right colon as the conduit and a Nisson-type plication to the area of the ileocecal valve. It was used in one patient.
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Two cases are reported of the development of mucoid adenocarcinoma of the colon in young patients, nineteen and thirty-four years after ureterocolic anastomosis for benign conditions. One patient showed implantation of the colonic neoplasm on the mucosa of an upper calyx in the obstructed kidney. Patients who have undergone ureterocolic anastomosis have a greatly increased risk of the development of large-bowel neoplasms. When suspected, radiologic examination of the colon using a water-soluble contrast material, together with rectosigmoidoscopy or colonoscopy, is essential. Because of the serious nature of this complication, it is suggested that the recent trend to return to the use of large bowel in urinary diversion may be hazardous, especially in the young patient with a benign disease.
Diaphragmatic rupture due to blunt trauma is rare in childhood. The possibility of such injury must be borne in mind whenever blunt abdominal and chest trauma is encountered. This paper reports a case of diaphragmatic rupture in a child with multiple injuries sustained in a road accident.
A technique for percutaneous catheterization of the internal jugular vein in infants and children was used since January 1975 in 206 patients ranging in age from a few hours to 12 years old. The series included 31 premature infants weighing less than 2,500 grams and 107 babies weighing less than 4,000 grams. Five attempts at cannulation failed. Each catheterization procedure required an average of 1.8 needle insertions before the vein was entered. In 129 patients, the first attempt was successful. Sixteen complications related to the procedure occurred early in our experience, seven of which were life threatening. One death was directly ascribed to the actual insertion of the catheter and mediastinal extravasation of infusion material. Most of the early complications probably could have been injected through the catheter immediately after cannulation, in addition to aspirating the blood and lowering the infusion bottle. The 22 late complications were related to infection; one infant died because of catheter sepsis. To minimize septic complications, an arbitrary limit of seven days was set, after which the catheter was replaced. Cannulation of the internal jugular vein in infants and children should be regarded as a serious surgical procedure to be performed by a trained team and only when properly indicated.
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Serious disturbances in respiration and venous return developed in 2 infants in whom infusion into a central vein was controlled by a peristalic pump. The effects were the result of extravasation which led to build-up of pressure in the medistinum.
The present study was an attempt to create a simple reservoir with a reliable continent ileostomy, so as to overcome the many drawbacks of the regular ileostomy. The ileocolonic segment was isolated and the ileum was intussuscepted into the colon to augment the ileocolonic sphincter. Pressure recordings disclosed a high pressure zone in the ileocolonic sphincter area reacting with a significant pressure increase to colonic distention. The proximal ileal end was anastomosed to the colonic part of the ileocolonic segment, and the ileal part of the ileocolonic segment was maturated as an ileostomy. The colonic reservoir was emptied by catheterization. Between catherizations, the ileostomies remained completely continent to small intestinal contents and gas. The reservoir and continent ileostomy are easily constructed, offer convenience and safety, voluntary and controlled emptying and conservation of part of the water and sodium excessively lost with conventional ileostomies. The procedure should be applied only to those patients in whom the right colon is unaffected or only slightly affected by the inflammatory process.
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Recurrent surgical interventions on the biliary system for benign biliary tract diseases carry high morbidity and mortality. Choledochoduodenostomy creates a large and easily performed biliodigestive anastomosis enabling good drainage of the biliary system. Among 27 patients undergoing choledochoduodenostomy for benign biliary tract diseases, recurrent cholangitis occurred in only one patient, in whom a stenosed anastomosis was probably the culprit. The other patients have been free of abdominal complaints, cholangitis, or pancreatitis for follow-up periods of from six months to eight years. There was no operative mortality; morbidity was 45%, but hospital stay averaged only 14.7 days. The traditional objections to this procedure do not seem valid where choledochoduodenostomy is rightly indicated, the common bile duct is dilated, and a wide enough anastomosis is constructed. Our favorable results mark choledochoduodenostomy as a safe, simple, and effective procedure in the management of benign biliary tract disease, particularly in the high risk patient.
During an 18-month period, five patients ranging in age from 3 1/2 to 79 years old were treated for small paraduodenal hernia. Three had acute strangulated obstruction, while in the other two patients the hernia was found incidentally, during surgery for other causes. As the mortality of obstructing internal hernias exceeds 50%, all paraduodenal hernias, even small and asymptomatic ones, should be considered an operable condition. The operating surgeon must be aware of the various types and locations of paraduodenal hernias and look for them whenever operating for unexplained abdominal pain or obstruction. Contrary to the common assumptioh that paraduodenal hernias are rare congenital anomalies, we believe the rarity of this condition to be due to insufficient attention to the clinical picture and inadequate exploration of the paraduodenal hernia during laparotomy.
Blank cartridges may produce serious injury and the recognition of this hazard must be borne in mind when treating these wounds. This paper reports two cases of complicated abdominal injury inflicted by a blank cartridge.
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A very rare coincidence of paraduodenal and paracecal hernia with volvulus of the intervening small intestine is reported. The unusual anatomical set up predising to volvulus of a large loop of small bowel has been described. Restoration of normal anatomy was made possible by the application of principles of treatment of internal herniae.
The combination of clindamycin and gentamicin was used to treat 25 pediatric surgical patients. In 9 of the 11 patients with perforated appendicitis, B. fragilis was isolated from the peritoneal cavity. There was a rapid clinical response to treatment in all cases. No side effects were observed. Clindamycin and gentamicin seem to be the antibiotics of choice for such infections.
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