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Biomedical subjects

D Coln

Publications and source records attributed to D Coln.

At least 19 recordsLinked to original sources
PubMed1998

Antegrade continent enema management of chronic fecal incontinence in children.

BACKGROUND/PURPOSE: Fecal incontinence impedes social and psychological development in children. Conventional bowel management with rectal enemas, medication, and biofeedback frequently will provide intervals free of fecal soiling sufficient for children to be socially continent. METHODS: This report details the improvement achieved by antegrade irrigation of the colon when conventional bowel management programs have failed to provide satisfactory intervals free of fecal soiling. Twenty-three children had conduits performed to administer antegrade continent enemas in the colon from December 1993 to May 1997. RESULTS: Twenty of the children were available for evaluation. One child was lost to follow-up, and two were noncompliant with the irrigation program. Fourteen of the 20 children are out of diapers. Four of the six wearing diapers, do so for urinary, not fecal incontinence. Two patients (10%) still require diapers for fecal incontinence. Parents were pleased with the efficacy of antegrade irrigation and the decrease in family stress with the elimination of fecal soiling. CONCLUSIONS: Ninety percent of the children available for follow-up benefited from antegrade irrigations of the colon. The antegrade irrigations were an improvement over conventional bowel management programs because a predictable interval free of soiling could be established. This allowed families to plan activities and improved the self-esteem of their children.

Adolescent↗
PubMed1993

Computed tomography in the evaluation of children with blunt abdominal trauma.

OBJECTIVE: This study determined the sensitivity, specificity, and accuracy of CT in pediatric patients with blunt trauma. Correlation of the CT-identified injuries and intraoperative findings with comparison to the results of DPL was performed. SUMMARY BACKGROUND DATA: Clinical evaluation frequently is unreliable in determining the presence of intra-abdominal injury in children with blunt trauma. Peritoneal lavage has been used to establish the need for operative intervention and has been found to be safe, efficient, and reliable (98%). In many institutions, abdominal CT scans are used to evaluate these children. Because most reports involve nonoperative management, operative confirmation of CT-identified injuries is available only for those children in whom nonoperative treatment is unsuccessful. METHODS: Sixty children sustaining blunt abdominal trauma were included in the study. CT scans with both oral and IV contrast were performed before open lavage, and positive results were confirmed by operation in 18 patients. RESULTS: CT had a sensitivity of 67%, however, only 60% of the actual organ injuries were identified by the scan. In contrast, DPL has a sensitivity of 94%. Both studies were equally specific (100%). DPL was also more accurate, 98% as compared with 89% for CT. CONCLUSIONS: Although the abdominal CT scan is useful in evaluating children with blunt abdominal trauma, a number of significant injuries were missed. Based on the low sensitivity of the CT, the authors suggest diagnostic peritoneal lavage may offer advantages over CT as the initial study in the evaluation of children with blunt abdominal trauma.

Abdominal Injuries↗
PubMed1988

Changes in red blood cell electrolytes and ATP in newborn shock.

Previous studies show an inability of the skeletal muscle cell and red blood cell to maintain sodium, potassium, and calcium homeostasis during hemorrhagic shock in adults. However, there is no information on the cellular effects of shock in the neonate. This study examined the effects of hemorrhagic shock on red cell membrane function in a newborn canine model. Changes in sodium, potassium, calcium, and magnesium concentrations in red blood cells and plasma were correlated with changes in intracellular and plasma ATP levels. Newborn dogs (n = 36), 10 to 14 days of age and weighing 501 to 707 g, were studied. After baseline studies (blood pressure, heart rate, temperature), electrolyte and ATP concentrations in red blood cells and plasma were measured. The dogs were then bled 40% of their estimated blood volumes. All parameters were measured after 1 h of shock. This shock model produced hypotension, bradycardia, and acidosis. The red blood cell sodium, calcium, water, and ATP content increased in shock, whereas intracellular magnesium fell. Red blood cell potassium levels, plasma sodium, and calcium concentrations were not significantly altered in shock, although plasma potassium and magnesium levels rose. Our data show that shock in the newborn disrupts cell membrane integrity. Intracellular accumulation of sodium and calcium occurred despite cellular ATP uptake, suggesting that high energy deficits are not the primary mechanism contributing to electrolyte imbalance in newborn shock.

Acid-Base Equilibrium↗
PubMed1987

Methotrexate (MTX) concentration in tumors following low-dose MTX.

Methotrexate (MTX) is a folate analog competitive with reduced folates for cellular transport and metabolism. Since the normal plasma folate concentration is only 10(-8) M, we tested the possibility that there may be a saturable uptake of MTX by proliferating tumor tissue at plasma MTX concentrations of only 10(-7) to 10(-6) M. Patients with advanced malignancies, refractory to accepted therapy, were given low-dose oral MTX (30-60 mg/m2 total dose in four to eight divided doses). Tumor tissue was biopsied 18-24 h after the last oral dose of MTX. The concentrations of MTX and its polyglutamated derivatives were measured in these samples. Forty-eight percent of the drug in the tumor samples was present as a polyglutamated derivative.

Administration, Oral↗
PubMed1986

Influence of diversion on the development of cholangitis after hepatoportoenterostomy for biliary atresia.

This study was undertaken to determine if the incidence of cholangitis is reduced when external diversion is added to hepatoportoenterostomy for biliary atresia. Nineteen children undergoing hepatoportoenterostomies without diversion between 1975 and 1984 were compared with 12 children who had hepatoportoenterostomies with diverting jejunostomies. Patient data were analyzed for the episodes and severity of cholangitis and other factors known to influence the outcome of biliary atresia. The groups were similar with regard to age of patient at the time of operation, degree of liver damage on biopsy, and the establishment of bile flow after hepatoportoenterostomy. There was no difference in the incidence of cholangitis between the nondiverted (32%) and the diverted (33%) groups. However, the addition of external diversion increased the morbidity and mortality. Four patients with diversion required surgery for bleeding, prolapse, or retraction of the jejunostomy, and two additional patients died as the result of stomal complications. External diversion does not decrease the incidence or severity of cholangitis after hepatoportoenterostomy, but significantly increases the risk of severe and fatal complications.

Bile↗
PubMed1986

Experience with esophageal stenting for caustic burns in children.

Seven children with deep circumferential esophageal burns were treated with antibiotics, steroids, and intraluminal silastic stents. Strictures did not develop if the esophagus was healed at the time the stent was removed. However, strictures developed if healing was incomplete. Esophageal stenting needs to be continued until healing has been demonstrated endoscopically.

Anti-Bacterial Agents↗
PubMed1985

Cardiovascular function and fluid compartments in newborn canine hemorrhagic shock.

Hemorrhage in the adult disrupts cellular function, resulting in a redistribution of fluids and electrolytes. There is little data about the effects of hemorrhage on body fluids in the neonate. The purpose of this study was to determine the effects of hemorrhage on cardiovascular function, coronary blood flow, red blood cell mass (RBCM), plasma volume (PV), and extracellular fluid (ECF) volume in newborn dogs. Group 1 consisted of 88 dogs, 1-20 days old, and group 2 was 81 dogs, 3-6 wk old. There is a significantly higher ECF volume in younger (256 +/- 10 ml/kg) compared with older puppies (121 +/- 5 ml/kg). A 40% hemorrhage caused ECF to fall less in the younger (-27%) than in the older puppies (-51%), whereas PV and RBCM decreased to a similar extent in both groups. After returning shed blood, PV and RBCM returned to prehemorrhage values, but there was a 12% deficit in functional ECF volume in both groups. A similar degree of bradycardia, myocardial depression, and acidosis occurred in both groups during shock and after returning shed blood. Cardiac output and coronary blood flow, measured only in group 2, fell significantly in shock (-60 and -50%, respectively; P less than 0.05) and remained below control values after returning shed blood. Our data indicate that inadequate perfusion of the myocardium and persistent acidosis impairs cardiac function in newborn shock.

Age Factors↗
PubMed1984

Cardiovascular effects of haemorrhagic shock in spleen intact and in splenectomized dogs.

Cardiac performance was evaluated during haemorrhagic shock in 27 dogs with spleens intact, 24 splenectomized, and 23 splenectomized transfused dogs that were given a volume of packed red blood cells simulating splenic contraction. Contractile changes were evaluated by calculating dP/dt at 20 mmHg developed pressure (dP/dt DP20), and by relating stroke work to left ventricular end-diastolic volume measured by biplane cinefluorography. Although heart rate increased comparably during early shock, cardiac output, stroke volume, maximal dP/dt, dP/dt DP20, and arterial blood pressure decreased more in splenectomized and splenectomized transfused dogs than in those with spleens intact. During shock dP/dt DP20 was more depressed in the splenectomized and splenectomized transfused dogs than in those with spleens intact. In addition, an increase in left ventricular end-diastolic volume was accompanied by an increase in left ventricular stroke work in dogs with spleens intact. In contrast, stroke work remained depressed in both splenectomized groups despite increased left ventricular volume. Progressive acidosis and decreased left ventricular blood flow were similar in all dogs during haemorrhage. The greater reduction in left ventricular performance during haemorrhagic shock in the splenectomized and splenectomized transfused dogs was not related to excess lactate, changes in plasma volume, or red blood cell mass. Decreased left ventricular performance, despite improved ventricular filling, indicates greater cardiac dysfunction during haemorrhagic shock. This study suggests that, in dogs, the spleen maintains left ventricular performance during haemorrhage by mechanisms other than autotransfusion.

Animals↗
PubMed1983

Evaluation of hemostatic agents in experimental splenic lacerations.

Avitene, Collastat, Gelfoam, and Surgicel were evaluated for their effectiveness in the control of hemorrhage from an experimental splenic laceration. Effectiveness was determined by measuring the amount of blood loss per kilogram of body weight until complete hemostasis was achieved and by determining mortality from hemorrhage. The study group in which Collastat, a collagen hemostatic sponge, was used had the smallest amount of blood loss. This group was also the only one with no deaths from breakthrough bleeding. The degrees of reaction in the spleens of the surviving animals 3 weeks after treatment were not significantly different when each of the various agents were compared. We believe that Collastat is the preferred topical hemostatic agent.

Animals↗
PubMed1983

Clearance of pneumococcal organisms after repair of injured spleens.

Although the safety of splenic preservation has been demonstrated in a small number of cases, the follow-up in these cases has been too short to determine whether the patients are adequately protected from sepsis. The purpose of this study was to test the ability of the spleen to clear pneumococcal organisms after repairing lacerations with a surface hemostatic agent. Three groups of 20 New Zealand white rabbits were studied. Group I animals received sham operations, group II animals were given total splenectomies, and group III animals had splenic lacerations repaired with Collastat (American Medical Products Corp., Freehold, New Jersey), a local hemostatic agent. Three months later, when challenged with intracardiac Streptococcus pneumoni type III, the animals without spleens failed to clear pneumococcal organisms. This spleen-intact and spleen-repaired animals, however, both cleared pneumococcal organisms in a normal fashion.

Animals↗
PubMed1983

The Toronto Western Hospital catheter in a pediatric dialysis program.

Following multiple technical problems with Tenckhoff catheters in children commencing prolonged dwell peritoneal dialysis, we have recently used the Toronto Western Hospital (TWH) catheter with considerable success. Six of the TWH catheters were inserted in children who had experienced either obstruction or leakage with prior use of 1-4 Tenckhoff catheters. Overall, we have used 15 TWH catheters in 12 children and have compared the results to 23 Tenckhoff catheters in 9 children. The rate of obstruction with TWH (7%) has been much less than with the Tenckhoff catheter (45%). We conclude that the TWH catheter represents a significant advance in peritoneal dialysis catheter technology for end-stage renal disease (ESRD) children starting continuous ambulatory peritoneal dialysis (CAPD) or continuous cycling peritoneal dialysis (CCPD).

Catheters, Indwelling↗
PubMed1983

Left ventricular volumes and contractility during hemorrhagic hypotension: dimensional analysis and biplane cinefluorography.

Biplane cinefluorography was used to study left ventricular volume and contractility in hemorrhagic hypotension in nine dogs. A blood loss of 42% of the total blood volume caused end-diastolic volume to fall 20% without any change in end-diastolic pressure. There were decreases in cardiac output (63%), end-systolic volume (23%), stroke volume (63%), ejected fraction (27%); and dP/dt DP 40 (47%) during hemorrhage. Without treatment of shock and dP/dt returned to the prehemorrhage level and the ejected fraction increased despite a decrease in end-diastolic volume, indicating a positive inotropic effect. Peripheral vascular resistance decreased after 2 h of hypotension at the same low cardiac output. These data suggest that in the spleen-intact dogs peripheral circulatory failure and not left ventricular dysfunction causes irreversibility in hemorrhagic hypotension.

Animals↗
PubMed1982

The importance of splenic blood flow in clearing pneumococcal organisms.

Overwhelming infection from encapsulated bacteria occurs after splenectomy. Decreases in IgM, tufsin, and serum opsonin are known to occur in animals and humans after splenectomy. A substantial immunologic advantage exists if some splenic tissue remains, but this may not offer sufficient protection from encapsulated bacteria if splenic arterial blood flow is reduced. This experiment was designed to examine the rate of pneumococcal clearance by the spleen and to determine the relationship between splenic blood flow and splenic tissue mass in bacterial clearance from the blood. Pneumococcal clearance, splenic blood flow, and residual splenic weight were measured in 171 rabbits with normal spleens, ligated splenic arteries, splenic autotransplants, hemisplenectomies, and splenectomies. Interruption of the splenic artery results in delayed pneumococcal clearance that is due to reduced blood flow and not to a decrease in splenic tissue mass. Splenic artery ligation to preserve an injured spleen cannot be assumed to give protection from sepsis.

Animals↗
PubMed1982

Serious air rifle injuries in children.

Seven potentially lethal air gun injuries in children are reported. Multiple-pump action air rifles have penetration velocities far in excess of the classic Daisy "BB" guns. However, these lethal weapons are sold to be used by children. Lack of effective regulatory legislation coupled with parental ignorance will continue to allow for serious injuries and deaths in children. Physicians should be aware of the potential lethality of any air gun injuries.

Adolescent↗