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Biomedical subjects

D L Mollitt

Publications and source records attributed to D L Mollitt.

At least 73 records · Page 4Linked to original sources
PubMed1983

Management of the newborn with gastrointestinal anomalies and tracheoesophageal fistula.

A standard approach to the otherwise healthy newborn with esophageal atresia and tracheoesophageal fistula has been well established. A significant number of these infants have additional gastrointestinal anomalies that necessitate alteration of the usual operative management. Over 2 1/2 years, nine such newborns have been managed. There were 17 additional gastrointestinal abnormalities, the most frequent being an imperforate anus (5), malrotation (5), and intestinal atresia (4). Management consisted of initial formal laparotomy, thoracotomy, and central line placement. In four infants these procedures were performed at a single sitting. Eight infants survived (89 percent); the single death resulted from intracerebral hemorrhage. Detection of coexisting gastrointestinal anomalies is mandatory in the management of the newborn with esophageal atresia. Standard local gastrostomy and subsequent thoracotomy may delay recognition of these associated anomalies, increase morbidity, and complicate subsequent correction. Preliminary abdominal exploration with correction, diversion, or both followed by thoracotomy, either immediate or staged, is indicated.

Abnormalities, Multiple↗
PubMed1983

Ovarian masses in the child and adolescent.

Over a five-year period, we treated 16 children ranging in age from 8 weeks to 16 years for ovarian masses. The most frequent clinical manifestation was abdominal pain and/or mass. Ultrasonography correctly localized the lesion and delineated its nature in nine of ten cases. Operation in 15 showed teratoma (six benign, two malignant), endodermal sinus tumor (two), dysgerminoma (two), follicular cyst (two), and leukemic ovarian infiltrate (one). Adnexal torsion was present in three. Three children had tumor metastases at initial operation. Resection of the tumor with conscious preservation of uninvolved pelvic structures was performed if possible. For unresectable tumor, debulking was undertaken. Multiagent chemotherapy was used for all malignant tumors. Survival was 94%. The proper therapy for ovarian lesions in children requires familiarity with the unique nature of these lesions, as well as consideration of future endocrine and reproductive function.

Adnexal Diseases↗
PubMed1983

Multiple endocrine adenopathy.

Since the original descriptions of the MEA syndrome, wide interest has been evinced for these familial endocrine disorders. Initially, screening investigations with the advent of the automated blood chemical analyses, and thus, the enhanced ease of detection of serum calcium levels have been followed by a flurry of diagnostic and therapeutic advances. Formal recognition of three MEA types, with their characteristics, has occurred over the last 20 years. Certainly in the future, other variants will be recognized and pose new problems. MEA poses fundamental questions of the embryologic origin and derivation of endocrine glands as well as issues of chromosomal operations of specific gene loci which have not yet been fully investigated.

Adenoma, Islet Cell↗
PubMed1982

Adverse effect of splenectomy on growth and survival with murine lymphosarcoma.

Recent reports suggest that splenectomy may improve host resistance and inhibit solid tumor growth. The effect of splenectomy on lymphoid tumors in less clear. This study evaluates and compares the effect of splenectomy on tumor growth, therapy and survival in murine lymphosarcoma and mammary tumor. Gardner lymphosarcoma (5 x 10(5) cells) was implanted subcutaneously into 400 6C3HED mice (20 g). Two hundred mice underwent splenectomy 10 days previously. Animals were randomly placed into four groups. Group I (tumor alone) and Group II (splenectomy and tumor) received no further therapy. Group III (tumor) and Group IV (splenectomy and tumor) received cyclophosphamide (50 mg/kg/day x 3 days) beginning 10 days after implantation. The rate of implantation was similar in all groups (greater than 90%). Tumor growth was localized in controls, but was widespread in splenectomized mice. Survival analysis at 30 days showed an increased mortality in untreated mice (Group II) following splenectomy (p less than .02). Survival was (13/102) 12.75% Group I versus (8/103) 7.77% Group II. Survival was similar in mice receiving chemotherapy (36%) and was (p less than .001) greater than the untreated groups (12%). A similar protocol in mice with mammary tumor showed no differences between groups in tumor localization or survival postsplenectomy. These data suggest that splenectomy adversely affects localization and survival in murine lymphosarcoma but not in solid tumor. The variable effect of this operation on the natural history of lymphoid versus solid neoplasia questions the advisability of splenectomy in staging of patients with lymphosarcoma.

Animals↗
PubMed1982

The sore psoas: a difficult diagnosis in childhood.

Nontuberculous psoas abscess is an unusual disease of childhood. The symptoms closely mimic those of other disorders and delay of treatment is commonplace. Eight children (age range 1.5-12 yr) have been treated for psoas abscess. Each presented with a history of fever (38-40 degrees C) and pain. The pain was localized to the hip (3-right, 4-left) and aggravated by ambulation in 7 cases. In 6 children, there was associated lower abdominal tenderness and flexion of the involved hip at rest with resistance to extension. Only 1 child was correctly suspected of having a psoas abscess. Delay in appropriate therapy averaged 5 days (range 1-20 days). Five children underwent joint aspiration and an additional 3 underwent abdominal exploration prior to diagnosis. Surgical drainage was subsequently performed in each case. A retroperitoneal approach, either flank or inguinal, was employed. Staphylococcus aureus was isolated from all cultures. Primary psoas abscess is seldom included in the differential diagnosis of septic lower abdominal and/or lower extremity pain. It should, however, be considered, particularly in the child with classic findings of psoas irritation.

Abdomen↗
PubMed1982

Operative management of stress ulcers in children.

The operative management of stress ulcer in children is controversial. Between the years 1969 and 1981, ten children were operated on at the Babies Hospital for stress ulcer. Their illnesses included connective tissue disorders (3), sepsis (2), Reye's syndrome (1), hemolytic uremic syndrome (1), leukemia (1), closed head injury (1), and renal failure (1). In those with bleeding (8), aggressive conventional medical management was attempted prior to operation. Four children also received intravenous cimetidine. Four patients underwent embolization of a feeding artery and/or selective vasopressin infusion. In those patients who perforated (2), operation was performed after a brief period of resuscitation. Ten patients underwent 11 operations. In those who bled, multiple ulcerations were the most common finding. Operative procedures consisted of partial gastrectomy and vagotomy (4), partial gastrectomy alone (2), and vagotomy and pyloroplasty (2). One child who underwent vagotomy and pyloroplasty required partial gastrectomy for recurrent bleeding. Of the two children who perforated, one was managed by plication and the other by partial gastrectomy. There were two deaths (20%), both occurring in patients who had undergone gastrectomy. One survivor has mild dumping. This experience suggests that in children (1) stress ulcers are commonly multiple when associated with major medical illnesses; (2) partial gastrectomy with or without vagotomy affords maximum protection against recurrent bleeding; (3) lesser procedures are effective for solitary bleeding duodenal ulcers or perforation; and (4) selective arterial embolization or vasopressin infusion are unreliable methods for controlling bleeding.

Adolescent↗
PubMed1981

Complications at menarche of urogenital sinus with associated anorectal malformations.

Persistent urogenital sinus is frequently associated with a wide spectrum of complex anatomic abnormalities involving the urinary, genital, and gastrointestinal tracts. Failure to accurately define these abnormalities can result in serious complications. One such group of complications occurs relatively late in the clinical course of these children and has received little attention. These are the complications related to menarche. This report reviews the anatomy, complications, and management in five such patients. In this group the onset of menses was associated with hydrosalpinx, pyosalpinx, hematocolpos, hematometrocolpos tubo-ovarian abscess, ruptured ovarian endometrioma, endometriosis, and peritonitis. Anatomic abnormalities included double and septate vagina, vaginal atresia and stenosis, uterus didelphys, and uterus bicornis unicollis, all predisposing to inadequate menstrual flow. Each of these children required surgical intervention. These cases stress the need for an awareness of not only the urinary but the vaginal and uterine abnormalities. Careful early definition of the anatomy and long-term follow-up of children with urogenital sinus malformation is important in order to avoid potential future complications.

Abnormalities, Multiple↗
PubMed1981

Selective management of iatrogenic esophageal perforation in the newborn.

Since 1974 nine neonates have been treated for iatrogenic esophageal perforation. They ranged in weight from 480 to 3900 g. Four of them had been resuscitated for meconium aspiration, four were being treated for respiratory distress syndrome (RDS), and one had received only routine postpartum suctioning and gastric aspiration. In five infants, esophageal perforation was suspected following traumatic intubation of difficulty in the passage of a catheter or tube. Three neonates passed formula from chest tubes placed for pneumothorax and one child presented with persistent pneumothorax. Esophageal perforation was documented in each case by direct visualization and/or radiographic studies. Three infants were treated with antibiotics and placement of a silastic nasogastric feeding tube. An additional two infants were treated with a silastic tube, antibiotics and chest tube drainage. Four children underwent operation: gastrostomy and drainage (2), gastrostomy and closure of perforation (1), gastrostomy only (1). There were no complications of deaths. Management of iatrogenic perforation of the esophagus depends upon the extent and location of the injury. A nonoperative approach can be successful in those infants with limited injury of short duration. Operation is required in cases with extensive extravasation or delay in diagnosis.

Anti-Bacterial Agents↗
PubMed1981

Experience with the Belt-Fuqua hypospadias repair.

From 1977 through 1979, 30 patients underwent complete repair of hypospadias using a modification of the Belt-Fuqua technique. Only those patients with distal and mid shaft hypospadias and chordee were included in this series. Three patients had undergone previous attempts at repair by other methods. The mean age at the time of repair was 6.4 years, with a range of 1 to 18 years. The over-all complication rate was 10 per cent (3 of 30), with 2 fistulas (6.6 per cent) and 1 distal stricture (3 per cent). All patients had an excellent functional result. The absence of midline scars and the glandular meatus resulted in a superior cosmetic appearance. The reliability of this technique, as well as the functional and cosmetic results, warrant consideration in the selection of a procedure for hypospadias repair.

Adolescent↗
PubMed1981

Neonatal necrotizing enterocolitis. Survival, management, and complications: a 25-year study.

One hundred sixteen infants with neonatal necrotizing enterocolitis (NEC) have been seen during a 25-year period (1955 through 1979). Prior to 1972, the survival rate was 17%; subsequently, it has been 68%. This increased survival is attributed to (1) improved physiologic care of the critically ill infant, (2) the institution of a standard management protocol, and (3) early diagnosis and treatment. Survival following neonatal NEC is attended by a significant incidence of intestinal stricture (21%); however, physical development has been normal and there have been few long-term gastrointestinal tract problems.

Birth Weight↗
PubMed1980

Colostomy complications in children. An analysis of 146 cases.

This report analyzes the course of 146 pediatric patients with colostomies in reference to problems with colostomy formation, management, and subsequent closure. Colostomy was performed predominantly for Hirschsprung's disease (70 cases) and imperforate anus (46 cases). A transverse colostomy was done in 120 patients (82%), and a sigmoid colostomy in the remaining patients. Loop colostomies were five times more frequent than divided colostomies. Early major complications occurred in 24 patients (16%). Stomal complications occurred in 69 patients and were more frequent after loop colostomies. Colostomy revision was required in 24 cases. Sigmoid colostomy had a significantly lower complication rate (P less than .01). One hundred nine patients underwent colostomy closure. Major complications occurred in 16 cases (15%). There were no deaths related to colostomy closure. The use of a sigmoid colostomy when possible and close attention to technical details, principles of stomal care, and proper parental instruction should minimize morbidity.

Adolescent↗
PubMed1980

Jejuno-renal injury following traumatic hyperextension.

A 4-year-old boy suffered hyperextension injury with small-bowel obstruction and renal injuries. This unusual constellation of findings is discussed in light of the pathophysiologic mechanisms of the injury. Hyperextension of the spine resulted in rupture of the anterior longitudinal ligament and avulsion of the L1-L2 disc; a loop of bowel was then drawn into the disc space. There also was an internal tear of the renal artery. Two years after uretero-ureterostomy with nephrostomy tube, the child is normotensive with adequate renal function and with normal growth and development.

Accidents, Traffic↗
PubMed1978

Bedside monitoring of heparin therapy.

Continuous infusion heparin therapy was monitored in twenty-five patients with simultaneously performed activated partial thromboplastin times and activated clotting times. These data were then compared by means of the coefficient of correlation. Significant correlation is demonstrated between the APTT and ACT in 88 per cent of cases.

Blood Coagulation Tests↗