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Biomedical subjects

A Gorenstein

Publications and source records attributed to A Gorenstein.

At least 37 records · Page 2Linked to original sources
PubMed1994

Postappendectomy intra-abdominal abscess: a therapeutic approach.

Four hundred and sixty two children were operated on between January 1989 and June 1993 for acute appendicitis; 10 developed an intra-abdominal abscess. Intra-abdominal abscesses were accompanied by fever above 38 degrees C (nine out of 10 patients) and leucocytosis (mean leucocyte count 20.3 x 10(9)/l) and were detected sonographically four to 14 days after operation. Management included intravenous administration of antibiotics effective against both aerobes and anaerobes, and follow up with serial sonographic studies. Eight patients responded favourably to antibiotic treatment without any drainage procedure, with gradual shrinkage and collapse of abscesses. Two patients, in whom enlargement of collection was demonstrated on serial sonographic examination, eventually underwent percutaneous drainage under sonographic control. These results suggest that some paediatric patients with an intra-abdominal abscess after appendicectomy and who are followed up closely by sonography may be managed successfully with appropriate antibiotics alone.

Abdomen↗
PubMed1992

Giant cystic hygroma associated with venous aneurysm.

Complete excision of giant cystic hygroma requires meticulous dissection of the multilocular lymphatic cysts from the adjacent vascular and neural structures. The association of venous aneurysms with cystic hygroma is extremely rare. We report two infants with cystic hygroma in whom preoperative diagnosis of venous aneurysm was helpful in planning complete excision of the lymphatic lesions.

Aneurysm↗
PubMed1991

Gastrointestinal protein loss in children recovering from burns.

Qualitative gastrointestinal protein loss was evaluated in 10 children with second- and/or third-degree burns covering 10% or more of their body surface area (BSA) by using fecal alpha-1-antitrypsin (FA-1-AT) as a marker. Patients were subdivided according to the extent of the burned area: group I (5 patients) had burns covering less than 20% of BSA; group II (5 patients) had burns covering more than 20% of BSA (mean, 37.2% = 24.9%). Results were compared with those of 12 healthy normal controls. Mean maximal FA-1-AT excretion in group II patients (2.71 +/- 1.35 mg/g) was significantly greater than that found in group I children (0.43 +/- 0.26 mg/g; P = .006) and in the controls (0.62 +/- 0.25 mg/g; P = .004). The mean maximal FA-1-AT excretion positively correlated to the percent of BSA covered with burns (r = 0.83). Although the mean septic score (SS) of group I patients (7 +/- 2.9) was significantly greater than that calculated for group II children (3 +/- 2.45; P = .047), only 2 patients in group II had positive microbiological cultures. Patients in both groups had received more than the recommended enteral caloric and protein allowance during the 96 hours prior to the maximal FA-1-AT measurements. Within this range, no correlation was found between the amount of FA-1-AT and the number of calories per kilogram protein consumed. By using the method of FA-1-AT quantification, this study provides the first report on postburn intestinal protein loss in children.

Burns↗
PubMed1990

Familial Hirschsprung's disease--a report of 22 affected siblings in four families.

Twenty-two infants, belonging to four families from Gaza, presenting with typical features of Hirschsprung's disease are reported. Eight patients died at home shortly after birth, prior to 1974, due to low intestinal obstruction. Fourteen patients were referred to Hadassah University Hospital after 1974 and diagnosed, by rectal biopsy, as having Hirschsprung's disease. Thirteen underwent laparotomy and multiple intestinal biopsies. Ten had total intestinal aganglionosis, two had total or near total aganglionosis, and in only one patient was the common rectosigmoid aganglionosis found. One patient died prior to surgery. This unusual familial disease, involving very long aganglionic segments, raises the possibility that these infants suffered from a unique variant of Hirschsprung's disease.

Family↗
PubMed1988

A new intratracheal stent for tracheobronchial reconstruction: experimental and clinical studies.

An intraluminal tracheal stent (ITS) was used experimentally in rabbits and piglets, as well as clinically in infants with tracheal stenosis, to facilitate airway reconstruction. The ITSs were constructed of stainless-steel springs covered with silicone rubber. They were implanted in seven piglets (6 to 8 kg), five rabbits (3 to 5 kg) and three infants. No animals developed severe respiratory distress and all appeared to tolerate the ITS. Postmortem examinations 1 to 8 weeks after surgery showed (1) loss of stent fixation (one pig), (2) increased tracheal secretions, (3) pneumonia (one pig, two rabbits), and (4) focal squamous metaplasia of tracheal mucosa. Stents used to treat three infants (2 to 5 months of age) with complex tracheobronchial stenosis were placed at the time of periosteal tracheoplasty in two. Recurrent stenosis necessitated a second tracheoplasty and stenting in one, and a long tracheostomy tube and balloon dilatations in the other. The third child had endoscopic stent insertion to alleviate severe airway collapse after esophageal tracheoplasty. The child died from progressive respiratory failure after stent dislodgment. Although the stents were well tolerated in animals and they enhanced critical ventilation of all pulmonary lobes in infants after tracheal reconstruction, certain modifications such as alternative methods of fixation, accommodation for tracheal growth, and reduction in tissue reactivity are necessary before further use of the ITS can be advocated.

Animals↗
PubMed1988

Congenital angiodysplasia of the superficial venous system of the lower extremities in children.

Congenital angiodysplasia of the superficial venous system (SVS) of the lower extremities was diagnosed in 24 children 3-15 years of age. Nine patients presented with painful swelling in the affected limb. Venectasia and spongy venous masses were the main morphologic changes in the current series. Selective ascending functional phlebography and superficial phlebography were used to assess the anatomic extension of the lesions and to evaluate the functional status of the involved extremity: 14 patients had only SVS angiodysplasia, in 10 patients additional pathologic features of the deep veins (DV) were found. Venous reflux was demonstrated in 16 patients and significant venous insufficiency was detected in five patients. The patients were classified into three groups according to the severity of the disease: mild (11 patients), moderate (8 patients), and severe (5 patients). The prognostic and the long-term outcome of surgical treatment can be predicted by the depth and the extension of the angiodysplastic lesions.

Adolescent↗
PubMed1988

Surgical treatment of varicocele in children.

Fifty boys aged 6 to 14 years underwent surgery for left varicocele. Thirty-four patients underwent preoperative retrograde left renal venography and pressure measurements of both renal veins and inferior vena cava. In all patients an intraoperative antegrade renal venography was performed via the internal spermatic vein. The preoperative venographic studies revealed renospermatic reflux in all patients examined. The intraoperative studies demonstrated impaired renal venous drainage in 38 patients (Group A) and normal venous return in 12 patients (Group B). Manometric studies revealed increased left renal venous pressure in Group A. In view of these anatomical and functional disorders, our preferred procedure is a retroperitoneal ligation and excision of the left internal spermatic vein. The retroperitoneum was thoroughly explored and all the visible collaterals of the internal spermatic vein ligated. Forty boys were followed for 1 to 5 years; the varicocele was completely resolved in 35 of them. Five patients had recurrent varicocele; recurrence was observed only in patients with increased left renal vein pressure (Group A).

Adolescent↗
PubMed1987

Blunt injury to the pancreas in children: selective management based on ultrasound.

Twenty-one children with blunt injuries to the pancreas were treated over a 5-year period. Group I consisted of 12 patients brought to our hospital within 24 hours of injury. Group II included nine patients who were referred to us more than 24 hours after injury following initial treatment at another hospital. Two group I patients died within four hours of admission from other causes. Three had early laparotomy for other injuries. Of these, two had a contusion and one had a complete transection of the pancreas. All recovered uneventfully after appropriate surgical treatment. The remaining seven were all treated nonoperatively. Two had obstructive pancreatitis secondary to duodenal hematomas, three had pancreatic contusions, and two developed pancreatic pseudocysts. All seven recovered completely without operation. In group II, three patients had undergone laparotomy elsewhere. All three had pancreatic contusions. However, only one had appropriate drainage of the injured pancreas; he recovered uneventfully. Two, who were not drained, developed pseudocysts and one of these required surgical drainage by cystgastrostomy. The other six patients in group II presented to our hospital with established pseudocysts. Three of these resolved with nonoperative treatment but three required drainage. Overall, six of ten posttraumatic pancreatic pseudocysts resolved without surgical treatment. The single most useful diagnostic test in the management of these patients was abdominal ultrasound (US). US revealed specific anatomic lesions of the pancreas--contusion, obstructive pancreatitis, or pseudocyst--and provided an objective guide to management. Surgical intervention is not necessary in all cases of pancreatic trauma.

Adolescent↗
PubMed1987

Intussusception in a premature infant simulating necrotising enterocolitis.

Intussusception in older infants is manifested by bloody stools, colicky abdominal pain and a palpable abdominal mass. In neonates the symptoms are often restricted to vomiting, guaiac positive stools and abdominal distension. These symptoms closely mimic necrotising enterocolitis. Surgical treatment of necrotising enterocolitis should be postponed until perforation of the gastrointestinal tract has occurred, whereas, prompt surgical treatment is recommended for intussusception. We report a case of intussusception that simulated necrotising enterocolitis in a 740 grammes premature infant in the second week of life. The clinical and radiographic features are described and the difficulty in distinction between the two conditions is emphasised. Neonatologists and paediatric surgeons should always include intussusception in the differential diagnosis of abdominal distension and guaiac positive stools in small premature infants.

Diagnosis, Differential↗
PubMed1987

Congenital aneurysms of the deep veins of the lower extremities.

This is a report of our experience with seven children with congenital aneurysms of the deep veins of the lower extremities. All the patients had various clinical features of angiodysplasia. With the use of ascending functional phlebography the patients were divided into two groups: four patients with fusiform aneurysms and three patients with saccular aneurysms. Patients in group 1 had venous reflux and a mild degree of venous insufficiency, which were surgically treated. Three patients with saccular aneurysms (group 2) showed no signs of venous insufficiency and are still being carefully followed. Anatomic and functional assessment of the deep venous system by ascending functional phlebography is essential for planning an appropriate treatment for this rare clinical entity.

Aneurysm↗
PubMed1986

Varicocele in children: "to treat or not to treat"--venographic and manometric studies.

The management of varicocele is still controversial in spite of its high incidence (15%) in prepubertal boys and young adults and although it is believed to represent a major contributing factor to male subfertility. Fifty boys between 6 and 14 years of age were operated on for left varicocele, and a long segment of the left internal spermatic vein was excised. Thirty-four of them underwent preoperative retrograde left renal venography and pressure readings in both renal veins and inferior vena cava. In all 50 patients, intraoperative antegrade (via internal spermatic vein) left renal venography was performed. This examination revealed impaired renal venous drainage in 38 patients (group A) and normal venous return through the left renal vein in 12 patients (group B). In all 34 patients (from both groups) on whom retrograde venography was performed, there was marked renospermatic reflux. The pressure readings in the left renal vein were significantly increased in group A only. Our data strongly suggest that left varicocele is caused by renospermatic venous reflux and that this condition is probably irreversible. The reflux in group A is explained by the impaired venous drainage through the left renal vein. In group B, it is our impression that the reflux is a result of a congenitally valveless left internal spermatic vein. If varicocele is indeed a major cause for infertility, then our data logically point toward surgery.

Adolescent↗
PubMed1986

Non-iatrogenic deep vein thrombosis of lower extremities in children.

Non-iatrogenic ileo-femoral vein thrombosis is rarely encountered in childhood. Six children with postphlebitic leg following venous thrombosis are presented. Venous thrombosis occurred following peritonitis, osteomyelitis and scarlet fever. None of the patients had history of trauma or intravenous treatment. Based on world literature and our experience, the main clinical and radiological manifestations of this rare entity are summarised. Early detection and aggressive anti-coagulant therapy of deep vein thrombosis may probably prevent post-thrombotic syndrome--a major disabling condition in children.

Adolescent↗
PubMed1986

Congenital aplasia of the deep veins of lower extremities in children: the role of ascending functional phlebography.

Eighty-two children with vascular diseases underwent phlebography. Congenital aplasia of the deep venous system of the lower extremities was diagnosed in 10 children. With ascending functional phlebography, three anatomic variations with different degrees of venous dysfunction were defined: aplasia of the femoral vein with collateral drainage into the common femoral vein, aplasia of the femoral vein with drainage into the internal iliac vein, and total aplasia with drainage into the axillary vein. The phlebographic findings correlated with the symptoms. Patients with type a aplasia had no clinical and radiologic signs of venous insufficiency. Patients with types b and c aplasia had severe venous insufficiency that necessitated supportive treatment. Palliative surgical procedures such as hemorrhoidectomy, clitoridectomy, and excision of bleeding vascular nevi were performed. Ligation or excision of the dilated superficial veins (usually the main channels for venous drainage from the extremity) is absolutely contraindicated. Ascending functional phlebography is therefore essential for correct diagnosis and planning of future therapy.

Adolescent↗
PubMed1985

Simultaneous superior and inferior vena cava pressure recordings in giant omphalocele repair--a possible guideline for prevention of postoperative circulatory complications.

Eleven children underwent second stage repair of giant omphaloceles containing the liver. Simultaneous SVC and IVC pressure before, during and after closure of the abdominal wall was recorded. In all patients with circulatory complications the SVC pressure decreased following surgery. The postoperative pressure ratios in IVC and SVC (Formula: see text) was found to be four times greater in the group with complications. It is suggested that this ratio might serve as an important index in the prediction of abdominal wall closure feasibility in giant omphaloceles.

Central Venous Pressure↗