Demonstrating relief of cardiac compression with the Nuss minimally invasive repair for pectus excavatum.

Background/purpose: Anatomic and physiological parameters have not been routinely used in the preoperative and postoperative evaluation of pectus excavatum. Most symptomatic patients have had significant subjective improvement after pectus correction. This study is based upon the use of noninvasive upright echocardiography/electrocardiogram (echo/EKG) with exercise to both identify and provide evidence of correction of cardiac abnormalities resulting from pectus excavatum.

Early experience with the Nuss minimally invasive correction of pectus excavatum in adults.

Nuss described a minimally invasive technique for correcting pectus excavatum in children. A curved stainless-steel bar is inserted behind the sternum through the chest cavity with the convex surface face down, then rotated 180 degrees to elevate the sternum and correct the deformity. The procedure gained wide acceptance in children.

Antegrade continent enema management of chronic fecal incontinence in children.

Background/purpose: Fecal incontinence impedes social and psychological development in children. Conventional bowel management with rectal enemas, medication, and biofeedback frequently will provide intervals free of fecal soiling sufficient for children to be socially continent.

Methods: This report details the improvement achieved by antegrade irrigation of the colon when conventional bowel management programs have failed to provide satisfactory intervals free of fecal soiling.

Computed tomography in the evaluation of children with blunt abdominal trauma.

Objective: This study determined the sensitivity, specificity, and accuracy of CT in pediatric patients with blunt trauma. Correlation of the CT-identified injuries and intraoperative findings with comparison to the results of DPL was performed.

Summary Background Data: Clinical evaluation frequently is unreliable in determining the presence of intra-abdominal injury in children with blunt trauma.

Changes in red blood cell electrolytes and ATP in newborn shock.

Previous studies show an inability of the skeletal muscle cell and red blood cell to maintain sodium, potassium, and calcium homeostasis during hemorrhagic shock in adults. However, there is no information on the cellular effects of shock in the neonate. This study examined the effects of hemorrhagic shock on red cell membrane function in a newborn canine model.

Methotrexate (MTX) concentration in tumors following low-dose MTX.

Methotrexate (MTX) is a folate analog competitive with reduced folates for cellular transport and metabolism. Since the normal plasma folate concentration is only 10(-8) M, we tested the possibility that there may be a saturable uptake of MTX by proliferating tumor tissue at plasma MTX concentrations of only 10(-7) to 10(-6) M. Patients with advanced malignancies, refractory to accepted therapy, were given low-dose oral MTX (30-60 mg/m2 total dose in four to eight divided doses).

Influence of diversion on the development of cholangitis after hepatoportoenterostomy for biliary atresia.

This study was undertaken to determine if the incidence of cholangitis is reduced when external diversion is added to hepatoportoenterostomy for biliary atresia. Nineteen children undergoing hepatoportoenterostomies without diversion between 1975 and 1984 were compared with 12 children who had hepatoportoenterostomies with diverting jejunostomies. Patient data were analyzed for the episodes and severity of cholangitis and other factors known to influence the outcome of biliary atresia.

Experience with esophageal stenting for caustic burns in children.

Seven children with deep circumferential esophageal burns were treated with antibiotics, steroids, and intraluminal silastic stents. Strictures did not develop if the esophagus was healed at the time the stent was removed. However, strictures developed if healing was incomplete.

Cardiovascular function and fluid compartments in newborn canine hemorrhagic shock.

Hemorrhage in the adult disrupts cellular function, resulting in a redistribution of fluids and electrolytes. There is little data about the effects of hemorrhage on body fluids in the neonate. The purpose of this study was to determine the effects of hemorrhage on cardiovascular function, coronary blood flow, red blood cell mass (RBCM), plasma volume (PV), and extracellular fluid (ECF) volume in newborn dogs.

Cardiovascular effects of haemorrhagic shock in spleen intact and in splenectomized dogs.

Cardiac performance was evaluated during haemorrhagic shock in 27 dogs with spleens intact, 24 splenectomized, and 23 splenectomized transfused dogs that were given a volume of packed red blood cells simulating splenic contraction. Contractile changes were evaluated by calculating dP/dt at 20 mmHg developed pressure (dP/dt DP20), and by relating stroke work to left ventricular end-diastolic volume measured by biplane cinefluorography. Although heart rate increased comparably during early shock, cardiac output, stroke volume, maximal dP/dt, dP/dt DP20, and arterial blood pressure decreased more in splenectomized and splenectomized transfused dogs than in those with spleens intact.

The Toronto Western Hospital catheter in a pediatric dialysis program.

Following multiple technical problems with Tenckhoff catheters in children commencing prolonged dwell peritoneal dialysis, we have recently used the Toronto Western Hospital (TWH) catheter with considerable success. Six of the TWH catheters were inserted in children who had experienced either obstruction or leakage with prior use of 1-4 Tenckhoff catheters. Overall, we have used 15 TWH catheters in 12 children and have compared the results to 23 Tenckhoff catheters in 9 children.

Clearance of pneumococcal organisms after repair of injured spleens.

Although the safety of splenic preservation has been demonstrated in a small number of cases, the follow-up in these cases has been too short to determine whether the patients are adequately protected from sepsis. The purpose of this study was to test the ability of the spleen to clear pneumococcal organisms after repairing lacerations with a surface hemostatic agent. Three groups of 20 New Zealand white rabbits were studied.

Evaluation of hemostatic agents in experimental splenic lacerations.

Avitene, Collastat, Gelfoam, and Surgicel were evaluated for their effectiveness in the control of hemorrhage from an experimental splenic laceration. Effectiveness was determined by measuring the amount of blood loss per kilogram of body weight until complete hemostasis was achieved and by determining mortality from hemorrhage. The study group in which Collastat, a collagen hemostatic sponge, was used had the smallest amount of blood loss.

Left ventricular volumes and contractility during hemorrhagic hypotension: dimensional analysis and biplane cinefluorography.

Biplane cinefluorography was used to study left ventricular volume and contractility in hemorrhagic hypotension in nine dogs. A blood loss of 42% of the total blood volume caused end-diastolic volume to fall 20% without any change in end-diastolic pressure. There were decreases in cardiac output (63%), end-systolic volume (23%), stroke volume (63%), ejected fraction (27%); and dP/dt DP 40 (47%) during hemorrhage.

Serious air rifle injuries in children.

Seven potentially lethal air gun injuries in children are reported. Multiple-pump action air rifles have penetration velocities far in excess of the classic Daisy "BB" guns. However, these lethal weapons are sold to be used by children.

The importance of splenic blood flow in clearing pneumococcal organisms.

Overwhelming infection from encapsulated bacteria occurs after splenectomy. Decreases in IgM, tufsin, and serum opsonin are known to occur in animals and humans after splenectomy. A substantial immunologic advantage exists if some splenic tissue remains, but this may not offer sufficient protection from encapsulated bacteria if splenic arterial blood flow is reduced.

Successful management of hepatic vein injury from blunt trauma in children.

In children, the majority of deaths from blunt trauma to the liver are caused by large stellate fractures of the posterolateral aspect of the right lobe of the liver with extension into the hepatic veins. Four children with such injuries were successfully treated. Hypotension and abdominal tenderness are not early manifestations of this highly lethal injury in children.

Blunt trauma to the pancreas in children.

Sixteen children below the age of 12 were operated on for blunt injury to the pancreas during a ten-year period. Unless there was an associated injury, signs and symptoms did not immediately develop. Common to the delayed manifestation of an injury to the pancreas was history of an impaling force to the upper abdomen, abdominal tenderness, and an elevated serum amylase level.

Hepatic angiographic changes after trauma.

Selective hepatic arteriography has a limited role in determining the extent and prognosis of injuries to the liver after surgical exploration and treatment. In this small series of thirty asymptomatic patients, there was no difference in the type or extent of injury or in the postinjury convalescence in patients who had abnormal or normal hepatic arteriograms. Angiographic abnormalities of avascular filling defects, pseudoaneurysms, arteriobiliary fistulas, contusions, and occlusions of the hepatic artery were demonstrated in our patients.