Biomedical subjects

B J Hancock

Publications and source records attributed to B J Hancock.

At least 19 recordsLinked to original sources

PubMed2002

Blunt splenic injuries in a Canadian pediatric population: the need for a management guideline.

OBJECTIVES: To review practice patterns in a Canadian pediatric centre and develop a safe and effective care plan for managing children with splenic injuries. DESIGN: A chart review. SETTING: Winnipeg Children's Hospital. PATIENTS: All patients with splenic injuries under the age of 17 years admitted to the hospital between December 1994 and April 1999. OUTCOME MEASURES: These included patient demographics, length of stay, location of care, grade of splenic injury (American Association for the Surgery of Trauma Organ Injury Scale), imaging tests performed in hospital and after discharge, follow-up care and time to return to full activity. RESULTS: Forty-four patients received nonoperative management. The mean age of the patients was 10.4 years. The average grade of splenic injury was 2.8. Sixteen patients (36%) were admitted to the intensive care unit for an average of 1.9 days. Mobilization was allowed after a mean of 5.2 days. Average length of hospital stay was 9.2 days. At the time of admission 98% of the patients underwent computed tomography, but at follow-up only 20% of patients underwent this investigation. None of the follow-up imaging studies altered the postdischarge management plan. The median time to full activity was 12 weeks (range from 0-17 wk). One patient had a delayed hemorrhage and required splenectomy. CONCLUSIONS: Reduced admissions to the intensive care unit, shorter overall stays, omission of follow-up imaging and an earlier return to full activity should be considered in the management of children with blunt splenic injuries. Standardization of nonoperative care for such children would result in safe and more efficient delivery of health care.

Adolescent↗

PubMed2001

Pediatric trauma registries: the foundation of quality care.

BACKGROUND/PURPOSE: Traumatic injuries cause substantial morbidity and mortality in children. Trauma registries are essential to assess and improve standards of trauma care. An interprovincial study of pediatric trauma between 6 centers across Canada who use identical software components was completed. METHODS: Data were collected from April 1, 1995 to December 31, 1998 for children aged 1 day to 17 years with an injury severity score of > or = 12. Cause of injury, injury time and day, gender, age, injury scores, length of hospital stay, and outcomes were compared. RESULTS: A total of 1,276 patients were included. Mean age was 10.3 +/- 5.6 years. Motor vehicle collisions were the most common mechanism of injury (56%). Boys were more often injured (66%; P < .05). Injuries occurred mainly between 1600 and 2400 hours (P < .0001). Mean hospital stay was 11.5 +/- 16.6 days. The longest stays in the hospital were among those who had an abdominal abbreviated injury score (AIS) of 1 (P < or = .03). Patients with similar injury severities remained twice as long in Winnipeg Children's Hospital (hospital 5), hospital 2, and hospital 6 as compared with patients in hospital 3 (P < .05). Differences existed in discharge placement between hospitals (P < .0001). CONCLUSIONS: This study was the first to compare pediatric patients in multiple Canadian centers using identical trauma registries. Variations in length of stay and discharge placements between hospitals were identified. Further analysis of data in the registries may clarify these differences and serve as a foundation for hospitals to improve the quality of patient care.

Accidents, Traffic↗

PubMed1999

Primary antiphospholipid syndrome: a cause of catastrophic shunt thrombosis in the newborn.

This is a unique report of systemic-to-pulmonary artery shunt thromboses secondary to primary antiphospholipid syndrome and antithrombin III deficiency in a neonate with cyanotic congenital heart disease. This infant with tricuspid atresia experienced thromboses of two modified Blalock-Taussig shunts en route to a bidirectional cavo-pulmonary shunt and potential future Fontan operation. Chronic warfarin anticoagulation has prevented additional thrombo-embolic events.

Antiphospholipid Syndrome↗

PubMed1998

Trauma outcomes.

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Canada↗

PubMed1996

Spinal cord infarct after arterial switch associated with an umbilical artery catheter.

Paraplegia after an open heart operation in a neonate is a rare complication. We report a case of a infant in whom paraplegia developed after a successful arterial switch operation for transposition of the great arteries. The infant was monitored and resuscitated in the preoperative period with umbilical arterial and venous catheter tips located in the midthoracic region. He likely suffered a clinically silent thromboembolic event predisposing him to a localized hemorrhagic infarction during the repair.

Cardiopulmonary Bypass↗

PubMed1993

Cat-scratch disease: an unusual presentation.

A 2-year-old child was found to have mesenteric lymphoadenopathy during investigation of a fever of unknown origin. The lymphadenopathy persisted at follow-up 2 months later. Workup for an infectious etiology was negative. A laparotomy and excisional biopsy was performed to eliminate lymphoma. Pathology showed enlarged lymph nodes containing granulomas with giant cells and central caseating necrosis. Warthin-Starry staining showed cat-scratch bacilli within the necrotic material. Cat-scratch disease is a well-recognized cause of regional adenopathy in children and usually resolves without treatment. Intraabdominal involvement, consisting of hepatic and splenic lesions, often associated with retroperitoneal adenopathy, has been reported. Isolated mesenteric adenopathy is an unusual presentation of this disease but should be included in the differential diagnosis of intraabdominal lymphadenopathy.

Cat-Scratch Disease↗

PubMed1993

Childhood primary pulmonary neoplasms.

Nine children (6 boys, 3 girls) were diagnosed with a primary endobronchial or pulmonary parenchymal neoplasm. The average age at diagnosis was 9 years. Presenting complaints included cough (7), fever (5), pulmonary infection (3), respiratory distress (3), weight loss (2), pain (2), and hemoptysis (1). Pulmonary x-rays showed persistent atelectasis, pneumonic infiltrates or mass lesions. A computed tomography scan was performed in 8. Five of six endobronchial tumors were diagnosed with bronchoscopy and biopsy. Treatment consisted of thoracotomy and pulmonary resection in 7 cases and laser resection in 2. The pathologic diagnoses were bronchial carcinoid (3), bronchial mucoepidermoid carcinoma (1), inflammatory pseudotumor (plasma cell granuloma) of the bronchus (2) and of the lung parenchyma (1), fibrosarcoma (1), and rhabdomyosarcoma (1). Postoperative chemotherapy was given only to the patient with pulmonary rhabdomyosarcoma; this child died. One child has developed a local recurrence while 7 children are alive and free of disease at an average of 2.4 years postresection. Pulmonary neoplasms are unusual in the pediatric age group and represent a wide spectrum of pathology. Including the present series, 383 tumors have been described. Seventy-six percent were malignant. Early investigation and surgical intervention are essential in children with persistent pulmonary symptoms or x-ray abnormalities. In most cases, the prognosis is excellent with complete surgical resection; however, malignancies other than bronchial adenoma are associated with significantly mortality.

Bronchial Neoplasms↗

PubMed1993

Surgical and metabolic aspects of liver transplantation for tyrosinemia.

Tyrosinemia is the diagnosis of a very small percentage of patients undergoing liver transplantation worldwide. Tyrosinemia is endemic within our referral area however, and fully one-third of the liver transplantations at our institution are done for this disease. Since 1986, 15 patients with tyrosinemia (TYR) and 31 patients with various other indications (non-TYR) have undergone a total of 51 liver transplantations. The 36-month actuarial survival for TYR patients is 87%, compared with 74% for non-TYR patients. Liver transplantation for hereditary tyrosinemia and other metabolic disorders without portal hypertension or previous portohepatic operations is notably easier to perform. Intraoperative blood loss was less, length of hospital stay was shorter, and incidence of infections was lower in TYR than in non-TYR patients. Less than 10% of TYR patients had foci of hepatocellular carcinoma at the time of transplantation. For this reason, and while most patients with tyrosinemia will eventually require liver transplantation, our results do not support systematic early transplantation before the age of two years.

Adolescent↗

PubMed1992

Diaphragm of the gallbladder: a case report.

Gallbladder anomalies are rare and normally affect its shape, size, and position. We report on a 3-year-old boy with a gallbladder divided transversally by a windsock-type diaphragm, isolating the fundus from the rest of the biliary tree. Bilobed and multiseptated gallbladder have been described before, but this is the first isolated case of a congenital hourglass gallbladder.

Child, Preschool↗

PubMed1992

Cholelithiasis in newborns and infants.

Cholelithiasis in infants is rare, and has usually been associated with hemolysis, ileal disease, congenital anomalies of the biliary tree, hyperalimentation, and prolonged fasting. With the increased use of abdominal ultrasonography (US), more cases of cholelithiasis are being discovered. We report our experience with 13 infants diagnosed on abdominal US to have gallstones. There were 9 boys and 4 girls with an average age at diagnosis of 2.6 months (range, 0 to 9 months). Predisposing factors could be identified in only 6 of the 13 patients. Two patients with obstructive jaundice underwent cholecystectomy and common bile duct exploration. One patient with choledocolithiasis and common bile duct dilatation was observed. His stone passed spontaneously, with resolution of symptoms. Ten patients without cholestasis remained asymptomatic, with disappearance of lithiasis in five of them. Neonatal cholelithiasis is more common than previously suspected; it seems to affect males more often than females and is usually not associated with known predisposing factors. It appears to be a temporary, self-limiting phenomenon, and an aggressive approach is not warranted in the asymptomatic infant. Surgical or radiological intervention should be reserved for the symptomatic patients or those with underlying lithogenic disorders.

Cholecystectomy↗

PubMed1992

Complications of lymphangiomas in children.

One hundred ninety-three cases of lymphangioma presenting in children were reviewed over a 10-year period. The diagnosis was established before 5 years of age in 87.0%. The distribution of lymphangiomas was: cervical (31.4%), craniofacial (18.9%), extremity (18.9%), trunk (9.2%), intraabdominal (9.2%), cervicoaxillothoracic (4.9%), multiple (3.8%), cervicomediastinal (2.2%), and intrathoracic (1.6%). Of 164 patients undergoing primary therapy, total excision was performed in 77.4% and partial excision in 20.7% with recurrence rates of 11.8% and 52.9%, respectively. Thirty-eight percent of all operations for lymphangiomas were performed for resection of recurrent or residual disease. The incidence of postoperative complications was 31.3%. Forty-four additional procedures were required to manage these complications. Sclerotherapy with 50% dextrose was used as an adjunct in 9.5%. Recurrences were seen after total resection in 17.6% of operations in which 50% dextrose was used and 11.8% in which it was not used. Seroma formation was noted in 3.5% of total resections and 40.0% of resections for recurrent disease in which adjunctive sclerotherapy with 50% dextrose was used. Seromas occurred in 9.8% of wounds in which local drains were used and 3.6% of wounds in which drains were not used. Infectious complications occurred after 6.6% of operations using perioperative antibiotics and 3.5% not using antibiotics. The management of lymphangiomas in children remains a difficult problem. Despite being benign lesions, lymphangiomas are attended by a high rate of morbidity from complications of the disease and its management. Complete excision still offers the best chance for complete cure. Sclerotherapy with 50% dextrose is not beneficial in the management of recurrent disease or postoperative seromas. Local drains and perioperative antibiotics do not appear to diminish the incidence of seromas and infectious complications, respectively.

Child, Preschool↗

PubMed1991

Tracheobronchial injuries in children.

Five patients with tracheobronchial injuries secondary to blunt thoracic trauma were reviewed over a 9-year period. Bronchial disruption occurred in four cases and tracheal disruption in one. Of the four patients with bronchial disruption, a major airway injury was suspected early because of a large air leak or persistent pulmonary atelectasis. However, definitive diagnosis by bronchoscopy was delayed from 4 to 16 days due to initial response to conservative management. Bronchial repair was achieved in every case: additional lobectomy was required in only one instance. Postoperative bronchial stenosis occurred in one patient and responded well to dilatation. The child with a blowout perforation of the trachea was diagnosed early by bronchoscopy and was successfully managed without surgery. Tracheobronchial injury is one of the most severe injuries caused by blunt trauma and requires a high index of suspicion for early diagnosis and surgery. Bronchial repair is successful in most instances.

Adolescent↗

PubMed1990

Lethal short-bowel syndrome.

Infants with short-bowel syndrome are difficult to manage. Despite supportive measures with parenteral nutrition and surgery to lengthen remaining bowel or increase functional absorptive surface area, the outcome for many of these infants is poor. We have reviewed a series of seven infants diagnosed with severe short bowel. Causes included volvulus (3), multiple atresias (2), and total intestinal aganglionosis (2). Survival time ranged from 15 days to 8 months. During the hospital course, each infant underwent one to three operative procedures to diagnose and manage the short bowel and all received total parenteral nutrition (TPN) ranging from 10 days to 6 months. One infant died of liver failure and two others developed significant liver dysfunction secondary to TPN. Most infants remained hospitalized until their death. Death occurred at an average of 9 weeks following the diagnosis of short-bowel syndrome. This review suggests that infants with less than 6 cm of small bowel beyond the Ligament of Treitz will inevitably die of their disease or treatment complications. Until bowel transplant becomes a viable alternative, operative intervention and nutritional support may prolong survival but will not change the outcome of these infants and will only contribute to additional morbidity. A decision to withhold further therapy would be reasonable at the time the diagnosis is established.

Enteral Nutrition↗

PubMed1990

Slow phase of transvascular fluid flux reviewed.

In six circuit experiments using a clinical hemofiltration device, we validated a colorimetric technique to measure transvascular volume exchange (VE). In 12 isolated excised canine left lower lobes, continuous colorimetric measurements of VE correlated well with calculations of VE from changes in microhematocrit obtained simultaneously. We introduced step increases in microvascular hydrostatic pressure (Pc) of 9 +/- 4.8 (SD) cmH2O and followed the time course of weight and continuous hematocrit changes measured colorimetrically for 40 min, after which Pc was returned to base line, while measurements were continuously obtained. This procedure was repeated for an additional 30 min. VE was calculated from the hematocrit signals and compared with the time course of the weight signal. After increases in Pc, followed by a rapid weight gain, weight signals followed a slow exponential time course, whereas the calculated VE changed linearly. VE reflected approximately 60% of the slow weight gain. When Pc was decreased, weight signals decreased exponentially, whereas VE continued to increase linearly at a slower rate. These results suggest that a significant component of the slow weight signal represents slow vascular volume changes. Contrary to what the weight signal suggested, edema was never reabsorbed over the range of Pc measured.

Animals↗

PubMed1989

Congenital duodenal obstruction: the impact of an antenatal diagnosis.

In a series of 34 infants with congenital duodenal obstruction, 15 were diagnosed by antenatal ultrasound between the fifth month of gestation and term. Fourteen patients were available for follow-up. In 10 of 14 cases, patients were available for follow-up. In 10 of 14 cases, parents were informed of the diagnosis antenatally and, in 9, were advised of the possibility of surgery in the neonatal period. Parents felt the information helped them prepare for the surgical and medical interventions necessary in the postnatal management of their infants. The mean birth weight and gestational age of these infants were comparable with those diagnosed postnatally. Associated congenital anomalies were more common in the patients with a postnatal diagnosis. In the total group of 34 infants with duodenal obstruction, 32 had surgical repair with a survival rate of 94%. Surgical procedures were comparable between the two groups. Surgical intervention occurred earlier in the neonatal period when an antenatal diagnosis was made. Overall survival in the entire series was 88% with four deaths attributed to severe associated congenital anomalies. We conclude that (1) the antenatal diagnosis of duodenal obstruction influences parents positively in coping with the anomaly, and (2) although surgery was performed sooner, the outcome of infants with duodenal obstruction was not changed by providing an antenatal diagnosis.

Duodenal Obstruction↗

PubMed1989

Bile duct stricture in an infant with gastroschisis treated by percutaneous transhepatic drainage, biliary stenting, and balloon dilation.

A newborn twin with an antenatal diagnosis of gastroschisis underwent staged repair of the abdominal wall defect. She developed multiple fistulae due to ischemic bowel and then abdominal wall dehiscence requiring additional surgical interventions. Obstructive jaundice, first evident at 3 weeks of age, became progressively severe. A stricture of the common bile duct was diagnosed by percutaneous transhepatic cholangiography. The stricture was treated by percutaneous biliary drainage, biliary stenting, and balloon dilation of the common bile duct. These procedures, commonly used in adults for biliary decompression, may be useful alternatives to surgical intervention in infants and children with obstructive jaundice due to bile duct stricture.

Abdominal Muscles↗

PubMed1989

Do transvascular forces in isolated lobe preparations equilibrate?

We used the stepwise pressure elevation technique to study the relationship between rate of constant weight gain (Qf) and microvascular pressure (Pc) in eight isolated canine left lower lobes. The slope of this relationship, which is assumed to represent lobar conductance to filtration (Kf) was 0.0022 +/- 0.003 ml.min-1.cmH2O-1.g dry wt-1. The intercept when Qf = 0, Pcrit, commonly interpreted as the Pc at which the balance of forces across the microvasculature is overwhelmed, was 9.53 +/- 1.18 cmH2O, a lower Pc than commonly used in weight transient experiments. Consequently, at Pc greater than 9.53 cmH2O, isogravimetric conditions were never achieved. In 12 additional experiments, the perfusate's colloid osmotic pressure (II) was increased from 12 to 37 mmHg with albumin. On average, Pcrit increased from 12.2 to 23 cmH2O. Using the changes in Pcrit and II, we estimated the microvascular drag reflection coefficient for albumin (sigma d) to be 0.67. After the addition of albumin, Pc less than Pcrit induced constant weight loss along the same Qf-to-Pc relationship. To control for time, five additional lobes were observed at constant Pc for 100-180 min. Slight acceleration of the rate of weight gain occurred after they increased their weight by 30-40%. The low Kf and high sigma d, as well as the stability of the preparation, suggest a well-preserved microvasculature. Qf at Pc between 12 and 24 cmH2O did not influence measurements of Kf using the weight transient method. The low Pcrit may reflect obliteration of lymphatic channels.

Animals↗

PubMed1988

Incarcerated congenital lumbar hernia associated with the lumbocostovertebral syndrome.

Congenital lumbar hernias are uncommon, with only thirty-three reported cases. They have been associated with the lumbocostovertebral syndrome. This report describes a patient with a congenital lumbar hernia and manifestations of the lumbocostovertebral syndrome. The diagnosis of the hernia was delayed due to its juxtaposition to a posterior meningomyelocele, resulting in incarceration. The patient's course was also complicated by recurrence of the lumbar hernia requiring prosthetic repair.

Abnormalities, Multiple↗