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At least 1,621 records · Page 90Linked to original sources
PubMed2002

Fetal gastric size in normal and abnormal pregnancies.

OBJECTIVE: The aim of this observational study was to construct an ultrasound index of fetal gastric size for the prenatal detection of congenital digestive tract obstruction. SUBJECTS: A total of 386 fetal measurements were performed in routine ultrasonographic examinations of women with normal singleton pregnancies between 18 and 39 weeks of gestation. Gastric measurements were also performed in 13 fetuses with digestive tract obstruction. METHODS: The ultrasound plane which included the pylorus and which provided the largest stomach area was used for definition and measurement of gastric area and maximal longitudinal dimension. The transverse section at the center of the gastric corpus was used for transverse and anteroposterior dimensions. Gastric volumes were calculated as a prolate ellipsoid. The gastric area ratio was defined as the gastric area divided by the transverse abdominal area. Biparietal diameter (BPD) and abdominal transverse area were also measured. RESULTS: The fetal gastric area was significantly correlated with fetal gastric volume (r = 0.91) and gestational age (r = 0.74). However, the correlation coefficient for gastric area with gestational age was smaller than those of the BPD (r = 0.97) with gestational age and abdominal transverse area with gestational age (r = 0.97). Gastric area ratio decreased slightly towards term. The gastric area ratio was below the 95% confidence intervals for the predicted values in all five fetuses with esophageal atresia, and exceeded the 95% confidence intervals in seven of the eight fetuses with duodenal atresia or intestinal tract obstruction. CONCLUSION: Fetal gastric area correlates with ultrasound-determined gastric volume measurements and appears to be useful in the assessment of digestive tract anomalies.

Case-Control Studies↗
PubMed1985

[Problems of and possibilities in fetal surgery].

Recent developments and improvements in prenatal diagnostic methods, and in particular antenatal ultrasonography, have made intrauterine detection of fetal abnormalities possible. Most defects are best treated after birth, only a few disorders are potentially amenable to surgical treatment in utero. Studies in animal models have helped us to define the pathophysiology, to recognize the interference of the abnormality with organ development and to determine whether elimination of the anomaly might allow fetal development to proceed normally. In-utero repair of congenital diaphragmatic hernia has been practiced on a fetal lamb model but has not yet been attempted in human beings. Treatment of fetal hydrocephalus has been investigated in sheep and rhesus monkeys, and the pathophysiology and intrauterine treatment of fetal hydrocephalus has been studied in fetal lambs and monkeys, but the question of the reversibility of renal dysplasia has not been resolved. Animal models have been described for possible intrauterine treatment of skeletal abnormalities like spina bifida. But more knowledge of embryology and of the pathophysiology of the malformation is needed, as well as about the efficacy and feasibility of this method before it can be attempted in human beings. Prerequisites for fetal surgery include the selection of those fetuses who might benefit from intrauterine treatment, counselling of the family concerned, and a highly experienced multidisciplinary team including a perinatal obstetrician, an ultrasonographer, a pediatric surgeon and a neonatologist. In human beings intrauterine treatment has been performed in erythroblastosis fetalis, urinary tract obstruction and hydrocephalus with encouraging results. There are many ethical, legal and social questions which cannot be answered; new guidelines and rules will have to be laid down.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1990

[Surgical therapy of malrotations in childhood].

From a total of 174 children treated with malrotations from 1971 to 1988, 148 could be evaluated for long-term results of surgical treatment. The various modalities of treatment were: no correction, dissection of Ladd's bands only, caecoascendopexy, Ladd's procedure and the so-called total correction. Comparing the late results in children with and without correction it was found that those without correction, i.e. without pexy, had to be reoperated in 17% of the cases, whereas the totally corrected children required reoperation in 8% of the cases only. Corrected cases needed to be admitted but not operated later because of pain, constipation, vomiting or poor weight gain in 23%, the uncorrected ones in 6%. Likewise, corrected malrotations resulted in complaints in 27% in contrast to the noncorrected ones in 9%. The conclusion is that total correction results in fewer reoperations but in more symptoms not requiring surgery.

Cecum↗
PubMed1984

Long-term results after surgical correction of anorectal malformations.

Our surgical experience with 101 cases of anorectal malformations during the past 21 years includes staged abdominoperineal rectoplasty in 49 patients, perineoplasty in 35 patients, and permanent colostomy in 2 patients. The observations of this clinical study are especially focused on long-term anal continence. The functional results were assessed clinically on the basis of Kelly's criteria (5), and by manometric and radiologic studies. Fifty-one patients, aged 5-25 years, were personally interviewed and 36 of these 51 had manometric and radiologic studies to evaluate postoperative continence. Patients with low-type lesions were more likely to be continent, while patients with high-type lesions had more problems with continence, because a functional internal sphincter is absent in high-type lesions. However, continent patients with high-type lesions as well as those with low-type lesions characteristically had a marked high-pressure zone in the anal canal and an acute anorectal angulation in the defecogram . On the other hand, in the patients with fair or poor results, neither a high-pressure zone in the anal canal nor marked anorectal angulation was found. These results indicate that achievement of continence in patients with a high-type anomaly treated by abdominoperineal rectoplasty depends upon bringing the terminal bowel down exactly within the sling of the puborectalis and careful dilatation of the new anal canal after the creation of a cosmetically satisfactory anal opening.

Adolescent↗
PubMed1984

Pericardial tamponade complicating central venous catheterization in a newborn infant.

Complications of central venous catheterizations are divided into immediate or early complications such as haematoma, pneumothorax and haemothorax, and late complications such as infection and venous thrombosis. One of the rare but life-threatening complications of central venous catheterization is pericardial tamponade. We review the literature and add an additional case, the first reported in a newborn infant.

Cardiac Tamponade↗
PubMed1981

Department of Anaesthesiology, Eastern Hospital, Gothenburg, Sweden.

Results of reconstruction of gastroschisis are presented. 27 consecutive patients operated upon during 1971 - 1980 are reviewed: 8 patients with primary closure, 19 patients reconstructed with a staged procedure (silon-pouch). It is concluded that both methods can be used, with low mortality: 1 patient in each group. The use of silon-pouch resulted, however, in a longer period of total parenteral nutrition (46 vs 18 days) and hospital care (8 vs 43 days).

Abdominal Muscles↗
PubMed1981

Gastroschisis: factors affecting prognosis.

Over a ten-year period 21 children with gastroschisis were treated either with a direct full-layer closure or with a silastic sac closure of the abdominal wall defect. No mortality or longterm morbidity resulted from either form of therapy in the group of patients that had no anatomical interruption of the gastro-intestinal tract. Silastic sac closure did, however, result in a higher incidence of septicemia. In the group of patients that presented with an anatomical interruption of the G.I. tract, considerable mortality and morbidity resulted. The outcome in these patients was determined by the associated bowel lesion rather than by the gastroschisis as such.

Female↗
PubMed1981

[Flapped and free muscle transplantation in the treatment of anal incontinence (author's transl)].

49 patients with continence-improving operations were reviewed. 41 children underwent a gracilis-transplantation according to Pickrell, 6 patients a free muscle transplantation according to Hakelius/Grotte and 2 patients a smooth muscle graft according to Schmidt. The clinical and manometrical results were compared with data from the literature. Furthermore a new technique of smooth muscle transplantation in the young infant is described. During an abdomino-sacroperineal pull-through procedure a flapped smooth muscle transplantation is performed simultaneously. The circular and longitudinal muscle layer of the pulled-through colon will be turned back and is fixed on the serosa under light tension. Afterwards the whole muscle cuff is repulled into the puborectalis sling. Examinations of the anorectal pressure as well as X-ray investigations showed a good function of the newly-established internal anal sphincter equivalent.

Adolescent↗
PubMed1992

Lactic acidosis from thiamine deficiency during parenteral nutrition in a two-year-old boy.

This is a case report of a two-year-old boy who was operated electively for a blind-loop syndrome of the proximal jejunum. Because of the appearance of chylous ascites, parenteral nutrition was carried out postoperatively. The boy developed a severe uncompensated acidosis and paralytic ileus. Relaparotomy on suspicion of ischemic bowel did not explain the cause of the acidosis and ileus. Postoperatively, the child's condition worsened, requiring intensive care. The drastically elevated lactate levels corroborated the eventually suspected diagnosis of a vitamin B1 deficiency syndrome. The administration of thiamine within two hours produced correction of the acidosis without further bicarbonate therapy. In 24 hours circulation was stabilized. Two months post-operatively the boy had completely recovered from the sequelae of his shock event.

Acidosis, Lactic↗
PubMed1993

Congenital duodenal obstruction: an approach to diagnosis.

53 neonates with congenital duodenal obstruction presented to Our Lady's Hospital for Sick Children over a consecutive 4-year period. Of these 53, 27 presented with intrinsic obstruction, and 26 with extrinsic obstruction. Diagnostic methods and features resulting in surgically proven diagnoses are discussed.

Barium Sulfate↗