Biomedical subjects

C A Musemeche

Publications and source records attributed to C A Musemeche.

25 records · Page 2Linked to original sources

PubMed1987

Enterostomy in necrotizing enterocolitis: an analysis of techniques and timing of closure.

Resection and enterostomy are the standard operative procedures for necrotizing enterocolitis (NEC). In order to compare the results of two different methods of enterostomy, a study was carried out in 100 infants with NEC who underwent enterostomy formation and closure. A single surgeon at each of the two collaborating institutions conducted the majority of operations. Level of enterostomy was jejunum in 10, ileum in 75, and colon in 15. Type of enterostomy was separate stomas (usually brought out side by side) in 50, Mikulicz enterostomy in 39, single stoma with Hartmann's pouch in 10, and loop colostomy in 1. Complications of enterostomy formation occurred in 24 infants (24%). When infants with separate stomas were compared with those with the Mikulicz enterostomy, there was no difference in the rate of stomal or wound complications. The separate stomas had a higher rate of stricture formation in the distal bowel (36% v 18%), which may be accounted for by earlier reestablishment of intestinal continuity in the Mikulicz group. Both methods exteriorized the bowel ends close to one another, which was advantageous because subsequent closure was usually performed without a formal laparotomy. After enterostomy closure, 17 (17%) infants had complications. There was no difference in complication rate between early (before 3 months or under 2.5 kg) v late closure, or between closure of the Mikulicz enterostomy v separate stomas (although the Mikulicz enterostomy closure was accomplished more rapidly than closure of separate stomas). Morbidity was unrelated to level of enterostomy, type of enterostomy, maturing the stoma, bringing it through a separate incision, or age or weight of the infant at closure.(ABSTRACT TRUNCATED AT 250 WORDS)

Colostomy↗

PubMed1987

Selective management of pediatric pelvic fractures: a conservative approach.

An analysis of clinical characteristics and pelvic fracture management in a recent 5-year period is presented. Ninety-eight percent of pelvic fractures were the result of a motor vehicle accident, which included 61% auto-pedestrian accidents. Seventy-nine percent of patients sustained one or more major injuries while 21% sustained an isolated pelvic fracture. Head injury was the most common concomitant injury (23% of patients). Forty-six percent of patients required blood transfusions (mean 15.8 mL/kg). Forty-one (72%) patients were treated with bedrest. The remainder were treated with traction (5), spica cast immobilization (5), open reduction and internal fixation (4), or anterior external fixation (2). Overall mortality was 14%. In comparing nonsurvivors with survivors there were significant differences in Modified Injury Severity Scores and Glasgow Coma Scores. The types of pelvic fractures that occur in children were found to be similar to those of adults. There was no significant difference in mortality among children with different types of pelvic fractures. In contrast to adults, pelvic fracture hemorrhage was not a major contributing cause of death in this series of patients. All eight deaths were secondary to severe closed head injury.

Adolescent↗

PubMed1986

Selective placement of the Broviac catheter in the infant.

Infants frequently require the placement of a Broviac or Hickman catheter for prolonged administration of total parenteral nutrition. Proper catheter care in these patients may be difficult. We have addressed this problem in selected patients by exiting their central venous catheters from their backs.

Catheterization↗

PubMed1986

Comparative effects of ischemia, bacteria, and substrate on the pathogenesis of intestinal necrosis.

This study was undertaken to evaluate the relative contribution of ischemia, bacteria, and luminal substrate, the pathogenetic components of necrotizing enterocolitis (NEC), to the development of intestinal necrosis. Sprague-Dawley rats, either germ-free (No. = 25) or conventionally colonized (No. = 20) underwent laparotomy. Isolated ileal segments were created, two per rat. Ischemia was produced in one segment by application of a microaneurysm clip; the other segment served as a control. Segments were injected with 1 mL of either normal saline, dilute Similac formula, or standard formula. Groups were as follows: Group I (germ-free), received saline; Group II (germ-free), dilute formula; Group III (germ-free), standard formula; Group IV (conventional), saline; Group V (conventional), dilute formula; Group VI (conventional), standard formula. At 48 hours, the rats were evaluated for survival, gross bowel integrity, histologic severity of necrosis (graded 0 to 4+), and bacteriology. Gross analysis of bowel integrity showed no lesions in the ischemic segments of the germ-free rats (Groups I, II, and III) and necrosis in 75% of conventionally colonized animals (Groups IV, V, and VI; P less than 0.001). Microscopic necrosis was more common (P less than 0.001) in ischemic segments of conventional rats than in ischemic segments of germ-free rats. There was no difference in necrosis attributable to ischemic time or to the presence of either standard or dilute formula. Of the three pathogenetic factors evaluated, the presence of bacteria was most crucial to the development of bowel necrosis in this model. Improved treatment and prevention of NEC may depend upon suppression and/or modification of the gut flora.

Animals↗

PubMed1986

Drainage of pediatric lung abscess by cough, catheter, or complete resection.

We treated eight children, aged 7 weeks to 17 years, for lung abscess. Each abscess followed an episode of aspiration or a bacterial pneumonia. Associated conditions were leukemia, congenital immune deficiency, endocarditis, cerebral palsy, and prematurity. Seven of the 8 children had polymicrobial infections, usually containing both aerobic and anaerobic bacteria. The success of medical treatment by antibiotics and chest physiotherapy was age related; 3 of the 8 children, aged 10 to 17 years, recovered on this regimen, whereas five children, aged 7 weeks to 7 years, required catheter drainage or resection for cure. Drainage by catheter pneumonostomy was performed for solitary peripheral bacterial abscesses. A large intercostal catheter was inserted into the cavity, either operatively or percutaneously. Wedge resection was performed for multiple, central, or fungal abscesses. Pneumonostomy was curative in 3 of 4 children. One chronic abscess recurred after pneumonostomy and required resection. Wedge resection was curative in the two children who came to thoracotomy; lobectomy was not necessary. Although all eight children recovered from their lung abscesses, three of them died within a year of sepsis. Lung abscess today occurs in immunocompromised children who are vulnerable to fatal infections. Chest physiotherapy is unlikely to achieve good drainage in children under 7 years of age. Medical failures can be identified within the first week of treatment. Early and aggressive surgical treatment is indicated in such children, and may be lifesaving.

Adolescent↗

PubMed1986

Normal radiographic findings after foreign body aspiration. When the history counts.

Foreign body aspiration in children is frequently associated with unilateral emphysema or atelectasis on chest x-ray. Two cases are reported of tracheal or bilateral foreign bodies in which the original chest x-rays were read as normal, but the history was suggestive of the foreign body aspiration. Early bronchoscopy can prevent the long-term morbidity that results from unrecognized tracheobronchial foreign bodies.

Bronchoscopy↗

PubMedDate not supplied

Developmental susceptibility to intestinal injury by platelet-activating factor in the newborn rat.

Platelet-activating factor (PAF) is an important endogenous mediator of neonatal necrotizing enterocolitis (NEC). Injection of PAF into weanling and adult rats causes ischemic bowel necrosis that is morphologically similar to NEC. The purpose of this study was to adapt the PAF model of intestinal injury to the suckling rat and to attempt to alter susceptibility to PAF-induced bowel necrosis by early weaning and formula feeds. At ages 15 to 20 days, rat pups were selected to be weaned to either formula or 5% dextrose or to nurse ad lib (total n = 54). At ages 16, 18, 20, 21, 23, or 25 days of life, animals received PAF (50 micrograms/kg) and endotoxin (1 mg/kg) by intraperitoneal injection. Animals were sacrificed 2 h after injection. Intestinal samples were submitted to be graded by a pathologist in a blinded fashion. Injury scores ranged from 0 to 10, based on the percentage of villous necrosis. Prior to age 20 days, minimal histologic injury was present (mean scores on days 16, 18 = 1.7 +/- 0.9, 1.7 +/- 0.6). Combined injury scores for weaned and nursed animals on days 20 and 23 were significantly greater than on days 16 and 18 (p = .0001). Histologic injury in the dextrose group was significantly less than the formula-fed group on day 21 and greater on day 25. Suckling rats showed resistance to PAF-induced bowel necrosis prior to 20 days of age, during the middle of the weaning period. Early weaning to formula did not alter susceptibility to injury, which suggests that PAF-acetylhydrolase from breast milk does not confer this resistance to PAF.

Aging↗