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Biomedical subjects

D Poenaru

Publications and source records attributed to D Poenaru.

At least 37 records · Page 2Linked to original sources
PubMed1998

Impact of magnetic resonance imaging on the surgical management of cystic hygromas.

BACKGROUND: The surgical management of cystic hygromas can be challenging, and accurate diagnosis and anatomic localization is essential. The literature on the use of magnetic resonance imaging (MRI) in pediatric cystic hygromas is sparse and mostly limited to radiological descriptions. METHODS: The authors present five cases of cystic hygromas in children ranging in age from 1 to 13 years. The preoperative MRI scans and patient charts were reviewed with attention to the clinical, radiological, surgical, and histological findings. RESULTS: MRI produced highly detailed multiplanar renderings of the cystic hygromas that were both diagnostic and predictive of the subsequent intraoperative findings. This modality helped specifically in some cases to identify lesion extensions that required specific surgical attention. There were no recurrences or complications at a mean follow-up of 18 months. CONCLUSION: The use of MRI in cystic hygromas can facilitate accurate diagnosis and assist in the preoperative planning, thereby contributing to the successful treatment of these lesions.

Adolescent↗
PubMed1998

Undergraduate pediatric surgery objectives: goal and reality.

BACKGROUND/PURPOSE: Educational objectives can be used both in the standardization of curricula and in their evaluation. Surveys of subspecialty objectives can clarify educational priorities and identify areas of proficiency and deficiency. METHODS: Fifty-one third-year and 56 fourth-year medical students were surveyed on their perceived mastery level of 60 pediatric surgery cognitive objectives. The same objectives were also used to survey 34 pediatric surgeons and 126 practicing family physicians. Physicians' expected and students' self-reported proficiency was scored for each objective from 0 (not required/unaware of condition) to 3 (confident with diagnosis and management of condition). Information regarding pediatric surgery instruction was also obtained from the undergraduate deans of 12 Canadian medical schools. Data were analyzed using descriptive methods and one-way analysis of variance (ANOVA) and were compared with existing objectives listings in the subspecialty. RESULTS: Students' familiarity scores increased significantly from third-year to fourth-year (P < .05), and approximated in fourth year the expected proficiency levels. Family physicians' and pediatric surgeons' expectations were remarkably similar. Eleven items were identified by both physician groups as nonessential (mean score < 1.5), whereas 29 were perceived as essential (score > 2.0). The fourth-year students' perceived knowledge of all but 3 of these 29 objectives was adequate. Comparison of the data with previous objectives listings showed similar expected competencies. Deans' data showed varied but mostly limited exposure to pediatric surgery in the undergraduate curriculum. CONCLUSIONS: The current study has allowed a revision of undergraduate objectives in pediatric surgery based on broad stakeholder input. It has also clarified both the expected and the perceived student mastery of these objectives, and identified areas of specific stress required. The results can be used toward establishing a unified, reliable, undergraduate curriculum for pediatric general surgery.

Adult↗
PubMed1998

Torsion of vermiform appendix: value of ultrasonographic findings.

A case of torsion of the vermiform appendix is described in a five-year-old boy with a two-day history of right-sided abdominal pain. No associated abdominal tenderness was reported, no vomiting nor fever. The pain was localized in the same place for 24 hours and became more severe and constant. Blood film showed a normal white cell count. After two ultrasonographic examinations in the course of 24 hours, the sign of a distended intestinal loop became constant. With the diagnosis of mucous-producing appendicular lesions or appendicular torsion, a laparotomy was performed. The appendix was severely congested and gangrenous; there was a 360-degree anticlockwise twist in its base. The related literature is reviewed and the value of the ultrasound scanner images and the possible mechanism involved is discussed.

Appendix↗
PubMed1998

Ventriculoperitoneal shunt knot: a rare cause of bowel obstruction and ischemia.

Small-bowel obstruction caused by knotting of a peritoneal shunt catheter is an extremely rare and severe complication of a ventriculoperitoneal (VP) shunt. In the 1-week-old female infant reported here who had a VP shunt, inability to remove the peritoneal catheter was followed by small-bowel obstruction and necrosis due to intestinal strangulation in a tight loop of the catheter. An uncomplicated primary resection of the necrotic segment was followed by placement of a temporary ventriculoatrial shunt. The authors suggest that when withdrawal of the peritoneal part of a VP shunt meets with resistance, an intraoperative radiograph should be obtained to assess the position of the remaining catheter. If knotting is observed, an attempt to straighten the catheter with a guide wire is worthwhile. Should this fail, immediate laparoscopy or laparotomy is indicated.

Dandy-Walker Syndrome↗
PubMed1997

Running an objective structured clinical examination on a shoestring budget.

BACKGROUND: A major obstacle in the wide implementation of objective clinical structured examinations (OSCEs) is their high cost, averaging $200 to $300 (Canadian dollars, CDN) per candidate and estimated at up to CDN$900 per candidate if all "hidden" administrative costs are included. METHODS: A detailed cost analysis of preparing and administering OSCEs at 1 institution was undertaken over 2 years. An 18-station, 6-minute-per-station OSCE was given to a 72-student third-year medical class. RESULTS: The total cost of the OSCE was CDN$5,010, or $70 per student. The key factors in reaching this significantly lower per-student OSCE cost included: judicious use of standardized patients, use of academic faculty for preparing and marking the stations, and decreased secretarial and other administrative costs. CONCLUSIONS: Data suggest that OSCEs can be set up with reasonable cost and limited resources even in smaller institutions. Cost should not be considered a major obstacle in implementing this excellent examination type in undergraduate medical education.

Canada↗
PubMed1997

The Pediatric Bowel Management Clinic: initial results of a multidisciplinary approach to functional constipation in children.

The multifactorial nature of functional constipation in children suggests that a multidisciplinary management approach may be effective. The authors tested this hypothesis in a newly created pediatric Bowel Management Clinic (BMC). Detailed data were collected prospectively on all patients seen in the clinic over the first 16 months. Both quantitative and qualitative analyses were performed to describe the index population and to demonstrate the impact of the intervention. Satisfaction with care in the clinic was measured using the Measure of Processes of Care tool, then compared with a normative sample. One hundred fourteen patients, all previously treated unsuccessfully for constipation, were referred to a team comprised of a physician, nurse practitioner, nurse educator, dietitian, and psychosocial nurse specialist. The mean age was 5.4 years with equal gender distribution. Between the first and last visits recorded, several variables including stool consistency and frequency, soiling frequency, abdominal pain, rectal pain, and rectal bleeding all showed statistically significant (P < .05) improvement. Qualitative data analysis showed the significant psychosocial impact of constipation on patients and their families. In the Measures of Processes of Care questionnaire, scores for the BMC were higher than normal on all scales except in provision of information. A multidisciplinary approach to functional constipation leads to both patient and parent satisfaction and significant short-term improvement. Further studies will examine the long-term impact of the clinic.

Adolescent↗
PubMed1996

Traumatic gastric transection: a case report.

This report documents the first known pediatric survivor of seat-belt-associated gastric transection. An 11-year-old boy presented with abdominal ecchymoses after a motor vehicle accident. Physical and radiological examination determined the need for abdominal exploration. During the operation, a near-complete transection of the stomach was found, which was repaired by primary anastomosis. After an initially unremarkable recovery period, gastric stasis and pyloric obstruction developed. Radiologically and endoscopically, this was determined to be secondary to a traumatic distal vagotomy. Neither gastric transection nor traumatic vagotomy had been reported previously in the pediatric population with abdominal seat-belt injuries. This report demonstrates an exceptionally rare seat-belt-related injury, and its unusual postoperative complication. It also emphasizes the significance of the "seat-belt sign" in the assessment of motor vehicle-related blunt abdominal trauma, and outlines potential problems associated with the wearing of adult-designed lap belts by pediatric passengers.

Anastomosis, Surgical↗
PubMed1996

Acute cholecystitis and cholangitis caused by Echinococcus granulosus.

We report for the first time in the recent North American literature, the case of a patient with rupture of a hepatic hydatid cyst into the gallbladder, with subsequent obstruction of the cystic duct by a daughter cyst acting as a ball-valve and causing acute acalculous cholecystitis.

Acute Disease↗
PubMed1995

Imperforate anus, malrotation and Hirschsprung's disease: a rare association.

The association of imperforate anus with anomalies of rectal innervation is very rare. Moreover, malrotation only rarely accompanies these malformations. We report 2 patients with this unusual triple association and its impact on their management. Retrospectively both patients presented at birth with the same radiological picture of distended distal colon and right-sided small bowel location. We discuss the importance of a systematic search for associated intestinal malformations in cases of imperforate anus in order to avoid serious complications and to choose the optimal operative strategy.

Anastomosis, Surgical↗
PubMed1995

Selective splenic artery embolization or use of polyglycolic acid mesh in children with severe splenic trauma.

Children with splenic trauma are managed conservatively in most circumstances, and the need for surgical intervention is very rare. When surgical exploration in mandatory, splenic preservation is a worthwhile objective, using various suture methods, biomaterials, or resorbable prostheses. We present our experience over the past year with 5 severe splenic injuries. Three of these patients were treated operatively with a resorbable mesh, while the other two were managed percutaneously by selective embolization of the splenic artery under fluoroscopic control. We describe the embolization technique with its advantages, good outcome with low morbidity, and low economic and social cost.

Adolescent↗
PubMed1995

Perinatal management of nasopharyngeal teratoma.

Nasopharyngeal teratoma is a rare benign entity, with most of the published literature represented by sporadic case reports. We present a recent case of a 23-year-old woman found to have elevated maternal serum alpha-fetoprotein and ultrasound findings of a fetal cystic mass in the mandibular region. The infant had a large nasopharyngeal teratoma protruding from the oral cavity making airway access extremely difficult. The presence of severe coexisting cardiac anomalies and respiratory disease led to death in the neonatal period. This report and the review of the literature stress the importance of recognizing suggestive prenatal data and preparing for perinatal management including maintenance of fetal oxygenation and aggressive early provision of an adequate airway.

Abnormalities, Multiple↗
PubMed1994

Primary spontaneous pneumothorax in children.

In the absence of pediatric data, spontaneous pneumothorax is managed according to adult guidelines. Fifty-eight patients with primary spontaneous pneumothorax (PSP) were treated in our center over the last 20 years. The median age was 16.7 years, and the male:female ratio was 1.9:1. A total of 102 PSP were treated; 63% were left-sided. The risk of recurrence was 51% after one PSP and 56% after two. There were four metachronous bilateral PSP. Nonoperative management included tube drainage in 57% of the cases (mean extent of PSP, 53%). Forty percent of patients were treated by supplemental oxygen and observation, without drainage (mean extent of PSP, 23%). Eleven patients were treated as outpatients, with Heimlich valves (mean extent of PSP, 64%). Fourteen patients (28%) underwent bullectomy, with or without pleurodesis. Thirteen of the surgically treated patient had experienced at least two episodes of PSP. Primary spontaneous pneumothorax in children has male predominance. The risk of recurrence after one episode is greater than that for adults. Operative management by bullectomy, with or without pleurodesis, carries little morbidity, has a high success rate, and is recommended after the first recurrence. It is safe to manage younger children conservatively because the chance of recurrence is lower; thoracotomy was not necessary in children under 9 years of age.

Adolescent↗
PubMed1994

Minimally conjoined omphalopagi: a consistent spectrum of anomalies.

Omphalapagus twins constitute less than one third of all siamese twins. Most omphalopagi are attached by a skin bridge that often contains hepatic tissue. Only four cases of omphalopagi attached by an intestinal bridge have been reported. The authors present two additional cases of conjoined twins minimally attached by a small bowel and bladder bridge. In both instances, the spectrum of anomalies included a ruptured omphalocele and imperforate anus with cloacal anomalies. The attachment consisted of an open urachal remnant joining the two bladders, and the short small bowel of twin A attached to the terminal ileum of twin B. Separation was uneventful. For one set of twins, the case part of the proximal colon of twin B was used to lengthen the bowel of twin A. Three of the twins survived and underwent additional procedures for repair of the cloacal anomalies. All four previously reported cases of minimally conjoined omphalopagi presented with a remarkably similar spectrum of anomalies. All had ruptured omphaloceles, imperforate anus with cloacal anomalies, and urachal anomalies. Intestinal connection was consistently at a point corresponding to the Meckel diverticulum site of twin B, with blood supply to the small bowel of twin A, probably via the vitelline artery. The consistent spectrum of anomalies encountered with minimally conjoined omphalopagi allows planning of separation. Caution is required to avoid overlooking the patent urachus, and intestinal lengthening procedures based on the vitelline artery become an important consideration.

Anus, Imperforate↗
PubMed1994

[The value of laparoscopy in the diagnosis and treatment of non-palpable testicular cryptorchism].

Laparoscopy is useful in both the diagnosis and the management of impalpable testes. Intra-abdominal testicles can be removed laparoscopically if atrophic or can be partly devascularized by spermatic vessel clipping if apparently normal. Assessment of testicular revascularization would be desirable prior to subsequent orchidopexy. A second-stage vasal-based orchidopexy can then be performed once adequate testicular reperfusion via the deferential pedicle is believed to have occurred. We have used both diagnostic and therapeutic laparoscopy in the management of 103 non-palpable testes over a period of 6 years. Open procedures following laparoscopy included 57 orchidopexies, 11 orchiectomies and one microvascular testicular autotransplant. Thirteen laparoscopic interventions were performed: 5 orchiectomies for atrophic testes and 8 testicular vessel clippings followed by 6 second stage open inguinal orchidopexies. Color Doppler duplex ultrasonography was not found to be reliable for assessment of testicular revascularization following spermatic vessel clipping. There were 3 complications which were all related to puncture with the Veress needle.

Adolescent↗
PubMed1994

[Intralobar pulmonary sequestration with multiple arterial blood supply].

We report the case of a 4 years old boy, who presented at our institution with reiterative neumonia affecting left basal lobe. Anomalous vascular appearance was detected in the chest x-ray. With the suspicion of pulmonary sequestration we carried on Digital Intravenous Angiography by Substraction (DIVAS) and aortogram. The anomalous systemic arterial supply was formed by 6 vessels coming from the thoracic aorta and going into the left lower lobe basal segment. Lobectomy was performed and previous diagnosis was confirmed pathologically.

Bronchopulmonary Sequestration↗
PubMed1993

Anal fistula in infants: etiology, features, management.

Anal fistulas in infants are poorly understood. A high incidence of recurrence has been attributed to a congenital abnormality of the anal crypts. To verify this hypothesis, we reviewed all anal fistulas seen in children less than 2 years of age and treated between 1980 and 1991. All patients were males with a mean age of 9.5 months, and only 3 had other illnesses. Ninety-two percent have had previous anorectal abscesses. The fistulas were single in 31 patients and double in 5. Their origin in the crypts was clearly identified in 14 cases. When anoscopy was routinely performed, deep thick-walled crypts were found in 47% of the cases. In most instances only one crypt was abnormal. The operative management included fistulotomy in 17 patients and fistulectomy in 9. Cryptotomies besides fistula excision were performed in 9 cases, and concurrent abscess drainage in 6. Follow-up was available in 31 patients for a mean length of 20 months. There were 4 complications (11%): one abscess requiring drainage, one wound infection treated conservatively, one granuloma, and one postoperative laryngitis. No recurrences were observed and none of the patients had fistula-related complaints at the last visit. Anal fistulas in infants are observed exclusively in males and are often related to abnormal crypts. Although 92% of fistulas are preceded by a perianal abscess, only 42% of perianal abscesses will result in fistula formation. Anal fistulas can be treated by either fistulotomy or fistulectomy.(ABSTRACT TRUNCATED AT 250 WORDS)

Follow-Up Studies↗
PubMed1993

Laparoscopic management of the impalpable abdominal testis.

Laparoscopy is useful in both diagnosis and management of impalpable testes. Intra-abdominal testicles can be removed laparoscopically if atrophic or can be partly devascularized by spermatic vessel clipping if apparently normal. Assessment of testicular revascularization would be desirable prior to subsequent orchiopexy. A second-stage vasal-based orchidopexy than can be performed once adequate testicular reperfusion via the deferential pedicle is believed to have occurred. We have used both diagnostic and therapeutic laparoscopy in the management of 103 non-palpable testes over a period of six years. Open procedures following laparoscopy included 57 orchidopexies, 11 orchiectomies, and 1 microvascular testicular autotransplant. Thirteen laparoscopic interventions were performed: 5 orchietomies for atrophic testes and 8 testicular vessel clippings followed by 6 second-stage open inguinal orchidopexies. Color Doppler duplex ultrasonography was not found to be reliable for assessment of testicular revascularization following spermatic vessel clipping. There were 3 complications which were all related to puncture with the Veress needle.

Adolescent↗