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Biomedical subjects

C W Wagner

Publications and source records attributed to C W Wagner.

At least 19 recordsLinked to original sources
PubMed1997

Is nasogastric tube decompression necessary after major abdominal surgery in children?

Nasogastric (NG) decompression has traditionally been used after major abdominal surgery in pediatric patients. This study was designed to determine if NG tubes could be routinely omitted in pediatric patients undergoing major abdominal procedures. Between January 1993 and December 1995, 83 patients had follow-up prospectively without NG decompression after a variety of major abdominal surgeries. NG tubes were inserted for persistent vomiting or abdominal distension. Exclusion criteria included bowel obstruction, intestinal atresia, and perforation of the stomach or duodenum. Ages ranged from 13 days to 22 years. Seventy-four patients (89%) were treated successfully without postoperative NG decompression. There were no cases of pneumonia, wound dehiscence, anastomotic leak, or delay in return of gastrointestinal function. Nine patients required NG tubes for persistent vomiting or abdominal distension. An anastomotic leak developed in one patient after endorectal pull-through. NG decompression is unnecessary after most major abdominal operations in pediatric patients. The endorectal pull-through may represent a group of patients that benefit from routine decompression.

Adolescent↗
PubMed1997

Neonatal ultrasonography to distinguish between meconium ileus and ileal atresia.

Meconium ileus can be difficult to distinguish from ileal atresia on plain radiographs and on contrast enema. Both show a microcolon in the face of a small bowel obstruction. The treatment of the two is very different. Meconium ileus obstruction may be relieved medically by contrast enema; ileal atresia requires prompt surgical intervention. This study was made to determine if abdominal ultrasonography might be helpful in distinguishing between these two entities. Abdominal ultrasonograms from the past 10 years of all patients with these two diseases who were studied with preoperative ultrasonography at Arkansas Children's Hospital were reviewed. Six of 16 patients with meconium ileus had preoperative ultrasonograms. All six patients with meconium ileus had multiple loops of bowel filled with very echogenic thick meconium. Four of 22 patients with ileal atresia had preoperative ultrasonograms. These four patients with ileal atresia had dilated loops of bowel filled with fluid and air. None had a dilated bowel filled with thick echogenic contents. Preoperative abdominal ultrasonography is proposed as a simple method for distinguishing between these two disease entities with very different treatment plans.

Diagnosis, Differential↗
PubMed1995

Gastric teratoma with intramural extension.

Gastric teratoma is an extremely rare neoplasm which accounts for less than two percent of all teratomas. Unlike other teratomas, gastric teratomas are all benign and predominantly occur in males. As gastric teratomas generally present as a palpable abdominal mass, more aggressive solid masses of childhood must be excluded. In this case, CT imaging delineates both cystic and fatty components characteristic of teratoma and displays the rare gastric origin of the lesion.

Humans↗
PubMed1995

Malrotation in the older child: surgical management, treatment, and outcome.

Malrotation in the neonate is an anomaly for which there are clear indications for surgery. However, the management of the older patient with this entity is not well defined. At Arkansas Children's Hospital, we reviewed our patients who were older than two years of age with malrotation. Between 1978 and 1993, 22 cases ages 2-23 years were identified. The most common presenting symptoms were vomiting 15 (68%), colicky abdominal pain 12 (55%), and diarrhea 2 (9%). Other symptoms were hematemesis 1 (5%), and constipation 1 (5%). The duration of symptoms averaged 28 months, range 2-96 months. All diagnoses were made by upper gastrointestinal (UGI) series, except for one that was recognized during an exploratory laparotomy for an intestinal duplication. A Ladd's procedure with appendectomy was performed in all cases. A significant number of patients in our series (41%) were found to have either a volvulus or internal hernia at exploration that was not clearly demonstrated by the diagnostic studies. Intestinal resection was performed in two patients for ischemic bowel. There were no perioperative deaths. Postoperative complications consisted of a wound infection in one patient. Total relief of symptoms occurred in 64% of patients. All patients with volvulus or internal hernia had resolution of symptoms, and all patients reported partial relief of their chronic symptoms. Surgical therapy eliminates the possibility of loss of bowel from volvulus or internal hernia, which is not always evident on diagnostic radiographic examination. Surgery is also highly effective in alleviating the chronic symptoms in these children. We believe, therefore, that surgical treatment is clearly indicated in the older child with proven malrotation.

Adolescent↗
PubMed1994

Delayed gastric emptying in neurologically impaired children with gastroesophageal reflux: the role of pyloroplasty.

The presence of delayed gastric emptying in neurologically impaired children with gastroesophageal reflux has led to controversy regarding appropriate surgical management. The authors reviewed the charts of neurologically impaired children requiring fundoplication to answer two questions: (1) is pyloroplasty needed in addition to fundoplication for delayed gastric emptying? and (2) Does delayed gastric emptying influence the morbidity associated with fundoplication? To answer the first question, 40 neurologically impaired children with delayed gastric emptying undergoing fundoplication were divided into two groups: Nissen and pyloroplasty (n = 21) and Nissen only (n = 19). The Nissen and pyloroplasty group had significantly more postoperative complications (23.8% v 5.0%) and took longer to reach full feeding (14.6 v 3.9) days. There were no differences in the incidence of recurrent symptoms, readmissions, or reoperations. To answer the second question, 58 neurologically impaired children undergoing fundoplication were grouped based on gastric emptying scan results: normal gastric emptying (> 32% in 1 hour) (n = 29) and delayed gastric emptying (n = 29). There were no differences in postoperative feeding tolerance, postoperative complications, recurrent symptoms, readmissions, or reoperations between the two groups. Delayed gastric emptying in neurologically impaired children with gastroesophageal reflux did not increase postoperative morbidity after fundoplication, and the addition of a pyloroplasty to fundoplication provided no additional benefit. The authors conclude that the procedure of choice for neurologically impaired children with gastroesophageal reflux is a fundoplication without pyloroplasty, regardless of the degree of delay in gastric emptying.

Child↗
PubMed1993

Monitoring asthma.

Explore the source record for details and available documents.

Adrenergic beta-Agonists↗
PubMed1991

Shotgun injuries in pediatric patients.

Firearms, particularly high-powered automatic weapons, injure progressively younger children in urban environments. At Arkansas Children's Hospital, 32 children have been admitted for gunshot wounds in 12 years. Air guns (3), handguns (19), and shotguns (10) caused the injuries. Shotgun wounds occurred during hunting accidents (2), flights from houses (3), and mistaken identity in the home (5), usually by family members (5). All victims of shotgun wounds were boys; seven were black. Their ages ranged from 6 to 20 years. Two injuries involved the abdomen, one the flank, one the chest, one the axilla, and five the legs. Accidental discharge of a weapon at close range caused extensive multisystem damage and long-term sequelae. Most of the wounds could have been avoided with the use of common sense and simple measures to identify the person within the household.

Accidents, Home↗
PubMed1991

Pectus excavatum: a 15-year perspective.

Pectus excavatum is relatively uncommon. Our experience with 177 children during a 15-year period produced changes in our surgical technique, which now includes a small transverse incision, minimal subcutaneous flap elevation, a muscle-relaxing incision over the fifth costal cartilage, complete resection of involved cartilage, use of Adkins' strut, suspension of sternum to strut, taut reefing of intercostal muscle, no tubes or drains, epidural analgesia, a patient-controlled analgesia device postoperatively, and eventual strut removal. Use of the evolved technique gives excellent cosmetic results, good functional results with minimal discomfort, and a shorter convalescent period.

Adolescent↗
PubMed1990

Pediatric pilonidal disease: a method of management.

Pilonidal disease is a common problem; its many management options are testimony to the difficulty in its eradication. Its etiology is distention of midline skin orifices with ingestion of hair shafts from hirsute buttocks. Thus, the disease does not usually appear until after puberty. Nine children were treated by aspiration and incision and antibiotics, followed by curettage of the pits; they had no recurrence. Two children who had midline procedures had recurrent disease. The female-male ratio in children is 4.5:1.

Adolescent↗
PubMed1990

Transthoracic fundoplication after previous abdominal surgery: an alternate approach.

Fundoplication for gastroesophageal reflux is a frequent procedure for pediatric surgeons. Reoperation in the abdominal cavity can be time-consuming and hazardous. Therefore, 33 patients (16 male and 17 female) with symptomatic gastroesophageal reflux after previous abdominal procedures had transthoracic fundoplications. Previous procedures included gastrostomy (18), Nissen fundoplication (12), ventriculoperitoneal shunt (9), omphalocele (4), paraesophageal hernia (3), necrotizing enterocolitis (2), abscess drainage (2), intestinal atresia (2), and abdominal burn (1). The three complications encountered were a bronchopleural fistula, esophageal leak, and small bowel obstruction. Of five deaths, one was related to operation. The remaining patients did not have recurrent reflux. Transthoracic fundoplication after previous abdominal surgery is effective and rapid, and it has a relatively low complication rate in high-risk patients. This approach avoids reentry into the abdominal cavity and allows precise repair.

Adolescent↗
PubMed1989

Management of empyema in children.

The antibiotic era has changed the incidence, causal factors, and gravity of empyema. Between 1977 and 1988, 27 children with empyema were surgically managed. Ten cases occurred after an operation (8 esophageal and 2 abdominal). There were 15 girls and 12 boys. The age range was newborn to 12 years. Symptoms included fever, cough, tube drainage postoperatively, anorexia, weight loss, chest pain, tachypnea, and lymphadenitis. Multiple aerobic and anaerobic organisms were cultured. Treatment included thoracentesis and antibiotics, tube thoracostomy, tube thoracostomy and bronchoscopy, decortication, or decortication with lobectomy. The total hospital stay averaged 28.3 days, and after decortication, 11.6 days. Empyemas in children frequently have multiple organisms and should be treated with broad-spectrum antibiotics while awaiting culture results. Thoracentesis and tube thoracostomy are often ineffective in curing the disease. Decortication can abbreviate hospital stay if performed promptly for persistent pleural sepsis.

Anti-Bacterial Agents↗
PubMed1989

Crotalid envenomation in children: selective conservative management.

Snake bites in children remain an uncommon injury. In general, there is a wide disagreement by knowledgeable authorities on a uniform approach to therapy. In the last 5 years, 29 children have been treated in our institution for snake bites, all with signs of envenomation. Treatment consisted of diagnostic laboratory studies, intravenous fluids, tetanus prophylaxis, antibiotics, bed rest, elevation, and observation. There were no deaths. A fasciotomy was required in three children. Cryotherapy initiated elsewhere resulted in tissue loss. Seven children received antivenin. All developed signs and symptoms to serum sickness. From this experience, it appears that the majority of snake bites in children, especially copperhead bites, can be treated selectively and conservatively. Care must be exercised in using antivenin as it is associated with a high rate of serum sickness. Cryotherapy adds to the morbidity of the bite and is not to be used.

Adolescent↗
PubMed1988

Respiratory complications in cervical thymic cysts.

Thymic cysts are considered uncommon lesions in the differential diagnosis of pediatric neck masses. They have been described as asymptomatic and of little clinical consequence. Recent reports have stressed the possibility of respiratory compromise associated with these lesions. We reviewed our experience with cervical thymic cysts with emphasis on respiratory problems. Ten pediatric patients underwent surgery and were found to have cervical thymic cysts. Ages ranged from newborn to 14 years. There were four boys and six girls. Two were found to have the thymic cysts at time of neck exploration for Grave's disease and hyperparathyroidism. Of the remaining eight patients, all had mobile cystic masses, located anterior to but extending beneath the lower third of the sternocleidomastoid muscle. The size of the mass ranged from 3.0 to 8.5 cm. Preoperative diagnosis included cystic hygroma/branchial cleft cyst (five), lymphoma (one), teratoma (one), and thymic cyst (one). All had a history of rapidly developing neck mass. Seven of the eight gave a history of upper respiratory tract infection (URI) prior to the development of the mass. Five had imaging studies that showed tracheal compression. Three of these required airway management in the early postoperative period. All were excised through a neck incision, with two requiring sternal extension. Histology showed cholesterol crystals, Hassall's corpuscles, and giant cell reaction diagnosis of thymic cysts. There has been no recurrence and no permanent respiratory sequela in the ten patients. Cervical thymic cysts are benign lesions that may be more common than literature suggests.(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗
PubMed1988

Cardiac arrhythmias during arousal from hibernation in three species of rodents.

Cardiac activity was monitored during arousal from deep hibernation in three species of hibernators (Citellus tridecemlineatus, Marmota monax, and Mesocricetus auratus). Individuals of each species showed marked arrhythmias, and these were confined to a body temperature range of between 11 and 20 degrees C, measured orally or rectally. The arrhythmias consisted of intermittent periods of asystole and bradycardia and were sometimes marked by the appearance of premature ventricular contractions and elevated or depressed S-T segments. Surgical manipulation of euthermic M. monax, under pentobarbital sodium anesthesia, indicated that none of the arrhythmias observed was inducible by injections of cold saline into the vena cava.

Animals↗