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Biomedical subjects

D B Groff

Publications and source records attributed to D B Groff.

At least 19 recordsLinked to original sources
PubMed1998

Cutaneous burns caused by sulfuric acid drain cleaner.

BACKGROUND: Highly concentrated solutions of sulfuric acid are available to unclog drains. We have noted a substantial number of both accidental and intentional cutaneous burns caused by these agents. METHODS: A retrospective review was conducted of children and adults who sustained sulfuric acid burns over a 13-year period ending in May 1996. Reports of injuries related to drain cleaners filed with the United States Consumer Product Safety Commission between 1991 and 1995 were also reviewed. RESULTS: Twenty-one patients (13 children, 8 adults) sustained cutaneous burns caused by concentrated sulfuric acid solutions. In 8 instances, the burn was accidental, whereas in 13 cases, sulfuric acid was used as a weapon. Median total body surface area burned was 5% (range, 1-25%). Approximately 50% of burns involved the face and neck. Skin grafting was required in 14 patients (66%). It is estimated that nationwide approximately 3,000 injuries per year are related to drain cleaners and that one-third of these involve cutaneous burns. CONCLUSION: Highly concentrated sulfuric acid drain cleaner can produce full-thickness cutaneous burns that require skin grafting in the majority of cases. Proper use of these agents and sequestering them from children may reduce accidental contact; however, their abuse as agents of assault remains a source of significant morbidity.

Adult↗
PubMed1994

Evaluation of minor head injury in children.

The authors' goal was to determine criteria for hospitalization for children with minor head injuries. A retrospective review was performed of the hospital records of 401 children with isolated minor head injuries who were admitted to a level I pediatric trauma center between July 1988 and December 1990. Specific information regarding each patient was documented, including demographic data, pertinent physical findings, diagnostic studies, criteria for admission, and hospitalization costs. Fifty-one patients with a mechanism of injury compatible with minor head injury, a brief or no loss of consciousness, a Glasgow coma score of 15, and no abnormalities on radiographic examination did not have neurological complications. The authors believe that these 51 patients could have been discharged from the hospital to responsible parents, thereby decreasing the costs of hospitalization. Prospective studies to substantiate these data and determine which patients should be hospitalized are warranted.

Child↗
PubMed1993

Suprapubic dermoid sinus.

Two newborns with suprapubic sinuses ending in relationship to the urachus at the umbilicus are reported. Other recent reports indicate that these sinuses are not so uncommon and are due to abnormalities of urachal development in conjunction with a suprapubic dermoid sinus.

Abdominal Muscles↗
PubMed1992

Surgical complications and procedures in neonates on extracorporeal membrane oxygenation.

We report our experience from May 1985 to January 1991 with surgical complications and procedures performed in neonates on extracorporeal membrane oxygenation (ECMO) (218 venoarterial and 7 venovenous bypass). Eleven children older than 1 month were excluded. Total complications were 96 in 67 patients and included: bleeding (37), problems with initial cannula placement (17), thrombus formation (15), hemothorax, pneumothorax, or effusions (11), mechanical problems (11), and miscellaneous (5). Forty-eight procedures were performed in 37 patients while on ECMO. These were recannulation or reposition of cannulas (14), tube thoracostomy (11), cardiac surgery (6), cardiac catheterization (4), repair of congenital diaphragmatic hernia (5), thoracotomy (4), and others. Twenty-eight complications occurred in 15 of the 27 patients who died. Mortality rate was 12% for the entire group. Primary causes of death were hypoplastic lung (11), cardiac (8), sepsis (4), intraventricular hemorrhage (2), and pulmonary hypertension (2). No deaths were due solely to complications except for the two patients with intraventricular hemorrhage. Mortality in neonates who had complications while on ECMO was significantly higher (P less than .005) than in patients without complications. Hemorrhagic and thoracic complications were associated with higher mortality (P less than .001). Mortality was not affected by mechanical problems, thrombus formation, or catheter-related problems. While on ECMO cardiac defects, diaphragmatic hernia, lobar emphysema, and other conditions can be safely corrected. The use of echocardiography to position the cannulas, better control of coagulation factors and improvement in equipment may ultimately decrease complications.

Evaluation Studies as Topic↗
PubMed1991

Basilar skull fractures in childhood with cranial nerve involvement.

Cranial nerve palsies developed in 23% of 73 children with basilar skull fractures. The majority occurred in patients 10 years of age or older. Our overall incidence was higher than that in a review in which basilar skull fractures were indiscriminately included with all head injuries. Our experience with meningitis was similar to that present in the literature and would seem to support avoidance of prophylactic antibiotics. Because there was no improvement in neurological deficits in patients treated with steroids (the only case of meningitis in our series was associated with steroids), we believe that their use is unwarranted. It is important to discuss the prognosis with the patient's family, because, although the majority (53.3%) of cases resolve completely, those with residual deficits can have significant morbidity.

Adolescent↗
PubMed1990

Diagnosis of a Morgagni hernia complicated by a previous normal chest x-ray.

A normal chest x-ray in a child does not mean that a Morgagni hernia cannot develop in that patient. The case of a patient whose treatment was complicated by confusion of the herniation of fatty omentum with a primary mediastinal mass is presented here. The difficulty in diagnosing this case is illustrated by this patient report.

Child↗
PubMed1990

Rectal prolapse in infants and children.

Rectal prolapse that is intractable to the usual medical therapy was successfully managed without significant complications in 10 patients by simple subcutaneous encirclement of the anus with a heavy nonabsorbable suture, which was in place until the suture was removed or broke after 4 to 6 months. Four patients required two sutures and one needed a third insertion. Since this procedure is simple, has no serious complications, and controls rectal prolapse, it is recommended as the preferred initial surgical treatment of this condition.

Child↗
PubMed1988

Gastrointestinal perforation in infants.

We found that the mortality rate was no greater in patients with necrotizing enterocolitis complicated by perforation compared with the rate in those with other causes of perforation in similar weight classes. Iatrogenic injuries had a 50 percent mortality rate in all gestational age and birth weight categories and, therefore, great caution and surveillance are of utmost importance when using invasive monitoring and therapeutic modalities to prevent this cause of perforation. Term infants had a preponderance of mechanical causes of perforation which mainly occurred in the foregut and proximal midgut, whereas premature infants have a preponderance of asphyxial or ischemic events underlying perforations which mainly occurred in the ileocolic region and were often associated with necrotizing enterocolitis. Although neonatal intestinal perforation is a catastrophic event, the very premature infant weighing less than 1,000 g at birth is at significantly greatest risk. The discouraging 20 percent survival rate in the less than 1,000 g premature infants presents a challenge to the surgeon, since the overall survival rate was 59 percent and the term infants had a 78 percent survival rate. A substantial share of the mortality in the infants weighing less than 1,000 g at birth relates to the occurrence of intracerebral hemorrhage and bronchopulmonary dysplasia. Vigorous medical and surgical approaches can be used to salvage premature infants in all weight classes with gastrointestinal perforation.

Enterocolitis, Pseudomembranous↗
PubMed1985

Inguinal hernias in premature infants operated on before discharge from the neonatal intensive care unit.

Sixteen premature infants were operated on during the two-year period from 1981 through 1982 for inguinal hernia prior to discharge from the hospital. There were no complications from the hernias before surgery and during administration of anesthesia and postoperative recovery, and no recurrences, would infections, or testicular atrophy was noted in long-term follow-up. In contrast to a controlled group of 11 full-term patients of this same age who were operated on as outpatients, the operating room time, operation time, and time in the recovery room were significantly increased for the premature infants. This resulted in a 22% increase in cost for the correction of the premature inguinal hernias. Analysis of the factors in repair of these hernias indicates that this increased cost will have to be accepted as part of the care of premature infants in neonatal intensive care units.

Hernia, Inguinal↗
PubMed1985

Gruentzig balloon catheter dilation for acquired bronchial stenosis in an infant.

A long stricture of the left main bronchus, which was resistant to the traditional methods of treatment, developed in a 992-gm twin who was ventilated for 114 days. The patient had two bronchial dilations with the Gruentzig balloon catheter placed under fluoroscopic control and inflated to 6 atm of pressure. The treatment was well tolerated by the patient, and one year after the Gruentzig balloon dilation she had a normal chest roentgenogram. Gruentzig balloon catheter dilation is a new technique for repairing bronchial stenosis in infancy without major intrathoracic surgical intervention.

Bronchial Diseases↗
PubMed1985

Early excision of major burns in children: effect on morbidity and mortality.

The advantage of early excision and grafting in the treatment of limited full-thickness burns has been clearly established. The goal of the present study was to evaluate the role of early burn wound excision in major pediatric burns. Of the 470 pediatric burn admissions between 1979 and 1984 that were reviewed, 53 patients met the criteria of deep second or third degree burns greater than 25% total body surface area (TBSA). Of these, 20 had burn wound excision within 7 days (Early) and 33 had delayed excision and grafting (Late). The Early group, despite having greater transfusion requirements (69.4 v 36.2 cc/kg), had shorter hospital stays (35.3 v 49.1 d, P less than 0.05), fewer metabolic complications (20% v 79%, P less than 0.001), and less burn wound contamination (55% v 90%, P less than 0.01) than the Late group. Mortality was lower in the Early group (0% v 12%), but this was not statistically significant. Early excision and grafting are therefore recommended in the care of major burns in children.

Adult↗
PubMed1985

Necrotizing tracheobronchitis: a new indication for emergency bronchoscopy in the neonate.

Necrotizing tracheobronchitis (NTB) is a recently recognized cause of tracheal obstruction in the mechanically ventilated neonate. This process involves inflammation and necrosis of the mucosa of the distal trachea and mainstem bronchi. The sloughing of this material into the tracheal lumen results in plugging and acute respiratory distress. We documented this diagnosis in 19 infants. Four were diagnosed at autopsy. Fifteen had emergency bronchoscopy performed in the neonatal intensive care unit with removal of the obstructing debris. Ten of these 15 neonates survived (66.7%). The diagnosis of necrotizing tracheobronchitis should be suspected in those neonates requiring positive pressure ventilation in whom a sudden unexplained increase in ventilatory requirements develops. This is often associated with hypercarbia and a history of high-peak inspiratory pressures with or without hypoxia. Emergency bronchoscopy in these neonates is necessary both for diagnosis and treatment of the necrotizing tracheobronchitis.

Bronchitis↗
PubMed1984

Simplified insertion of central venous catheter in infants.

A technique for insertion of central venous catheters in infants is described. A needle is percutaneously positioned into the subclavian vein. Through this, a guide wire is passed and a catheter introduced over the wire. This method has proved to be safe and effective in over 100 infants.

Catheterization↗