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Biomedical subjects

C A Sheldon

Publications and source records attributed to C A Sheldon.

At least 73 records · Page 4Linked to original sources
PubMed1987

Renal transplantation in children.

The application of the principles underlying successful renal transplantation in children has led us to increasing success in achieving our goals, which involve more than simple renal function replacement and include effective growth in stature, skeletal and central nervous system development, as well as social development. To succeed in these diverse areas, all modalities of therapy for ESRD may be needed at various times in some patients. Pretransplant therapy must be judiciously selected, and post-transplant protocols often modified to reflect individualized needs.

Child↗
PubMed1987

Hypospadias.

This article outlines the basic etiologic, anatomic, and reconstructive considerations needed for screening, evaluating, counseling, and following patients with hypospadias.

Humans↗
PubMed1985

Improving survival in the very young renal transplant recipient.

Sixty-one patients ranging in age from 6 weeks to 30 months have undergone renal transplantation over a 19-year period. The overall survival is 80% with a 90% survival in those patients transplanted since 1980 (41 patients). Seventy-five percent of the original allografts have survived with 83% of the last 41 allografts surviving. The unique challenges presented by the very young renal transplant recipient are outlined along with those aspects of management felt to be most important in ensuring a successful outcome.

Age Factors↗
PubMed1985

Newborn surgical emergencies of the gastrointestinal tract.

Intestinal obstruction and necrotizing enterocolitis are two of the most common surgical emergencies of the gastrointestinal tract. This article reviews the signs and symptoms of these conditions and presents guidelines for their management.

Colon↗
PubMed1985

Undescended testis and testicular torsion.

This article reviews the concepts basic to the management of the undescended testis and testicular torsion and provides specific guidelines for the management of the many variations of these entities.

Animals↗
PubMed1985

Pediatric renal transplantation.

This article outlines the current status of pediatric renal transplantation and emphasizes a practical approach to patient management. It discusses two areas of renal transplantation in children in which results differ significantly between children and adults. These areas are renal transplantation in the very young child and transplantation in children with renal failure secondary to urologic disease.

Blood Transfusion↗
PubMed1984

Undiversion in children with renal failure.

Four children with moderate and 9 with severe chronic renal failure and cutaneous ureterostomies or vesicostomies underwent undiversion to facilitate the eradication of urinary tract infection, reestablish bladder function, and to avoid ablating posterior urethral valves in a dry urethra. This allowed for proper preparation for renal transplantation. In addition, for the less severe cases for whom renal transplantation was more remote, the psychosocial benefits of undiversion were equally important. There were three complications that were easily managed. In four cases of moderate chronic renal failure and in seven cases of severe renal failure not requiring hemodialysis, there was no deterioration of renal function following undiversion. Two patients were on hemodialysis prior to undiversion. The urinary tract became sterile in 12 patients. These preliminary results suggest that chronic renal failure is not a contraindication for urinary undiversion and that this procedure may facilitate future management of the patient, including renal transplantation.

Child, Preschool↗
PubMed1984

Malignant urachal lesions.

Urachal cancers are uncommon malignancies with a location that often permits considerable local extension before they are discovered. The most common histological type is adenocarcinoma, which may produce mucus that is a valuable aid in diagnosis. The presence of stippled calcification in a midline abdominal wall mass is almost pathognomonic for urachal carcinoma. More commonly, however, the symptoms are less specific, such as hematuria and an abdominal mass. Many lesions are visible endoscopically and, thus, the diagnosis can be made preoperatively from a biopsy. Most treatment failures occur because the tumor is not controlled locally by the initial operation and, therefore, we recommend en bloc cystectomy with umbilectomy and pelvic lymphadenectomy unless the tumor is known to be a sarcoma or early stage (I) carcinoma. If these patients are undertreated and there is a local recurrence then the patient usually is not salvageable. Because of the difficulty in identifying the origin of a bladder adenocarcinoma, any tumor on the dome or anterior wall should be approached initially as if it were a urachal tumor.

Adult↗
PubMed1984

Differentiation of upper and lower urinary tract infections: how and when?

The principal purpose of differentiating upper and lower urinary tract infections is to prevent renal damage by determining which patients require long-term antibiotic treatment and follow-up. This article takes a critical look at the method now in use for differentiation of these infections. Special attention is given to the problems of locating a urinary tract infection in a child, both because this is exceptionally difficult in this population and because kidney infections in children carry a high risk of permanent damage including renal failure and hypertension.

Adult↗
PubMed1984

Experience with 95% pancreatectomy and splenic salvage for neonatal nesidioblastosis.

Conventional 85% pancreatectomy with splenectomy performed for management of hypoglycemia of neonatal nesidioblastosis has been followed by a dismal prognosis characterized by post-splenectomy sepsis, recurrent hypoglycemia, permanent brain damage, and a high mortality. For our last eight infants we have found it possible to remove at least 95% of the pancreas, preserving the blood supply to the spleen as well as the duodenum. This has permitted satisfactory control of the hypoglycemia and long-term septic complications have been avoided. Follow-up evaluation up to 20 years with successful control of hypoglycemia without progressive brain damage indicates the value of this primary extensive surgical approach.

Adenoma, Islet Cell↗
PubMed1983

Carcinoma at the site of ureterosigmoidostomy.

A 31-year-old woman who had undergone bilateral ureterosigmoidostomy at age five had a moderately differentiated adenocarcinoma at the anastomotic site that was not detected by preoperative studies or intraoperative palpation. The authors review other reports of anastomotic carcinomas occurring after ureterosigmoidostomy for benign disease and recommend a diagnostic protocol. Whenever the urine is diverted away from the sigmoidostomy (rediversion), the anastomotic site should be resected. Ureterosigmoidostomy should be undertaken only with the understanding that meticulous long-term follow-up is mandatory.

Adenocarcinoma↗
PubMed1983

Peripheral postcapillary venous pressure: a new, more sensitive monitor of effective blood volume during hemorrhagic shock and resuscitation.

Peripheral postcapillary venous pressure (PCVP) and mixed venous oxygen saturation (SvO2 or PASO2) have been shown to be sensitive indicators of volume status and appear to reflect the adequacy of peripheral perfusion during controlled bleeding. This study demonstrates that in an open-chest dog model with controlled venous return, PCVP is closely and linearly (r2 = 0.6) correlated with cardiac output (CO). Furthermore, oxygen saturation as measured in the central venous system (CVSO2) and peripheral vein PVSO2) were found to be closely and linearly related to PASO2 (r = 0.72 to 0.99 and 0.91 to 0.98, respectively). Thus PCVP, CVSO2, and PVSO2 represent easily and safely obtainable parameters that closely reflect major physiologic variables. During resuscitation after controlled hemorrhage, the PCVP and PVSO2 accurately reflected the restoration of blood volume and were as good as CO and central saturations. Central venous and pulmonary wedge pressures both poorly reflected the return to full volume repletion (P less than 0.01). Thus, PCVP and PVSO2 seem to be reliable indices of volume status and perfusion and do not require invasive, central monitoring.

Animals↗
PubMed1982

Artificial sphincters in children with neurogenic bladders: long-term results.

Inflatable bladder sphincters (models AS 721 and AS 792) were implanted in 10 boys and 5 girls, between 5 and 17 years old, who had neurogenic bladders without residual urine or reflux and with normal renal function. Of the boys 9 are continent with an average followup of 51.5 months, whereas only 1 of the girls is continent. The incidence of mechanical failures is lower with the new AS 792 sphincter (2 of 11 versus 7 of 13 devices), and the 2 erosions occurred in girls whose bladder necks were opened during implantation. The artificial sphincter is useful in boys with neurogenic bladders without residual urine if bladder spasticity is controlled. We use the device in girls only when pharmacological methods and intermittent catheterization have failed. We have been satisfied with the long-term results even if reoperations were needed.

Adolescent↗
PubMed1982

Wilms' tumor: an approach to vena caval intrusion.

Wilms' tumor invades the renal vein in 12% of patients and extends into the inferior vena cava in another 6%. In a few cases, the tumor propagates into the right side of the heart. Since patients with Wilms' tumor seldom require renal arteriography, and because vena cava involvement may be silent, venous invasion may go undetected until the time of radical nephrectomy. A preoperative vena cavogram is recommended, and if a thrombus is found, a right heart angiogram is needed to determine the superior extent of thrombus. An understanding of the collateral venous circulation of the kidneys and of the physiological effects of malignant or iatrogenic obstruction of the inferior vena cava are essential to formulating the operative approach. Various operative maneuvers, intraoperative studies, and surgical aids (including cardiopulmonary bypass and hypothermia) have made forms of intracaval Wilms' tumor amenable to excision.

Child↗