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Biomedical subjects

E W Fonkalsrud

Publications and source records attributed to E W Fonkalsrud.

At least 19 recordsLinked to original sources
PubMed1979

Gastroesophageal fundoplication for reflux following repair of esophageal atresia. Experience with nine patients.

Esophageal dysmotility and gastroesophageal reflux (GER) are common sequelae that may persist for many years in infants and children who have undergone repair of esophageal atresia and tracheoesophageal fistula (TEF). The slow clearance of refluxed gastric contents appears to cause a high incidence of aspiration, a high incidence of esophageal anastomotic stricture or leak, and a slow response to dilation of esophageal anastomotic strictures. Nissen transabdominal gastroesophageal fundoplication was performed in nine children (seven who were less than 4 months of age) subsequent to repair of esophageal atresia because of recurrent severe symptoms due to regurgitation. On the basis of this favorable experience with nine infants and children, we believe that an aggressive surgical approach should be taken in the management of symptomatic GER in patients at a young age following repair of esophageal atresia and TEF who fail to respond to an adequate trial of medical treatment.

Child↗
PubMed1979

Surgical management of congenital lymphedema in infants and children.

Of 67 children and infants with lymphedema, 28 had the congenital type. Congenital lymphedema appears during the first few weeks of life, frequently involves more than one extremity, and enlarges at a slower rate than general body growth. The swelling usually becomes less pronounced with age, and no specific therapy is required in two thirds of the patients. Seven of the 28 children had swelling of the upper extremities and a generalized lymphangiopathy syndrome. Subcutaneous lymphangiectomy was performed on ten of 28 patients who had moderate to severe swelling. Those with hand and arm involvement were particularly benefited; however, operations on the dorsum of the foot produced hypertrophic scars in one third of the cases. The operation is deferred until after age 2 years to permit optimal technical repair and to identify those patients whose conditions will improve spontaneously.

Adolescent↗
PubMed1979

Recurrent pulmonary disease in children: a complication of gastroesophageal reflux.

To evaluate the role of gastroesophageal reflux (GER) as a possible cause of recurrent pulmonary disease, 30 children, aged 1 to 18 years, were studied prospectively with esophageal function tests. These included esophagram (30 patients), esophageal manometry (29 patients), pH probe (Tuttle) test (29 patients), and esophagoscopy with esophageal biopsy (23 patients). The patients studied had either chronic asthma or two or more documented pneumonias within a one-year period. Nineteen (63%) had GER based on two or more positive tests. Eighteen had positive Tuttle tests; 13 had abnormal manometry studies; nine had esophagitis on biopsy; six had esophagitis on esophagoscopy; and five had reflux on esophagram. Of those with GER, 17 had a history of nocturnal cough and eight vomited during infancy. Children with recurrent pulmonary disease should have esophageal function testing to exclude GER as the cause.

Adolescent↗
PubMed1979

Clinical experience with total colectomy and endorectal mucosal resection for inflammatory bowel disease.

During the past 3 yr, 17 patients with chronic ulcerative colitis and 6 with Crohn's disease who had severe rectal and colonic involvement underwent excision of the rectal mucosa without removal of the rectal muscle in combination with total colectomy and cutaneous ileostomy as a 1- or 2-stage procedure. This operative technique has cured each of the patients of their primary colonic and rectal disease and has obviated many of the unpleasant complications that often occur after total proctectomy, such as impotence, prolonged perineal drainage, and bladder dysfunction. The operation has the further advantages of lower operative blood loss, shorter operative time, and earlier safe ambulation. On the basis of the favorable experience with mucosal proctectomy, sphincterotomy, and perineal drainage in 23 patients, none of whom experienced major complications, we believe that this operation warrants further clinical trial in patients with inflammatory bowel disease involving the rectum, which is refractory to medical therapy. Total proctectomy might eventually find scant application in patients with inflammatory bowel disease.

Adolescent↗
PubMed1978

Complete obstruction of the gastric antrum in children following acid ingestion.

We report on two children who experienced delayed complete obstruction of the gastric antrum following concentrated acid ingestion. Both patients required initial tube gastrostomy and subsequent antrectomy with intestinal reconstruction. Unlike the more common alkaline corrosives, ingested acids tend to spare the esophagus and gastric fundus. While gastric perforation and vascular collapse may occur immediately following overwhelming acid ingestion, the more common course is chronic gastric antral inflammation with subsequent fibrosis and, in some cases, complete stricture. Delayed surgical reconstruction is recommended to permit the acute inflammation and edema to subside.

Adolescent↗
PubMed1978

Pectus excavatum repair using autologous perichondrium for sternal support.

The support of the lower sternum following repair of pectus excavatum using autologous perichondrium from the lower costal cartilages to supplement the standard Ravitch's repair has been used effectively in 29 children during the past 14 years. This technique helps prevent recurrent sternal depression, particularly when the operation is performed in preadolescent children. Most adolescents and adults with pectus deformities as well as patients requiring reoperation will benefit from an internal prosthesis for the sternum that supplements the perichondrial support to reduce the frequency of subsequent sternal depression. Using the described operative technique, an excellent cosmetic and functional result was obtained in 27 children. Recurrent sternal depression of mild degree that occurred in two patients in the first four months postoperatively was related to trauma and possibly to decreased vascular supply to the lower sternum but neither required additional therapy. The internal mammary vessels should be preserved with the lower sternum whenever feasible.

Adolescent↗
PubMed1978

Endorectal ileal pullthrough operation with ileal reservoir after total colectomy.

Ileonal anastomosis through an extramucosal rectal muscular tube with construction of a proximal S-shaped ileal reservoir was performed on seven dogs in an attempt to reestablish fecal continence. Five of the dogs survived more than four weeks and experienced fecal continence, although they had frequent stools. The use of Lomotil and Metamucil has assisted in decreasing the frequency of defecation, and also in developing semisolid stools. None of the dogs developed perianal excoriation or ulceration. The ileal reservoir volume averaged 250 ml in the longterm surviving dogs. It is anticipated that this operative technic may have clinical application in selected patients with ulcerative colitis and other diseases primarily involving the rectal mucosa, since the neurogenic and muscular sphincteric mechanism necessary for continence can be preserved. Clinical experience with the ileal reservoir and endorectal pullthrough in one patient has been encouraging.

Adolescent↗
PubMed1978

Endorectal mucosal resection without proctectomy as an adjunct to abdominoperineal resection for nonmalignant conditions: clinical experience with five patients.

Five patients with chronic ulcerative colitis underwent endorectal excision of the rectal mucosa without removing the rectal muscle in combination with total colectomy and cutaneous ileostomy. This operative technique will cure the patient of the primary disease and obviates many of the usual unpleasant complications following total proctectomy, such as prolonged perineal drainage and sexual and bladder dysfunction. It has the further advantages of lower operative blood loss and earlier safe ambulation. On the basis of favorable clinical experience with these patients, we believe that the operation warrants further clinical trial in patients who have biopsy-proven ulcerative colitis without severe rectal ulcerations as well as in certain other nonmalignant conditions originating in the rectal mucosa.

Adolescent↗
PubMed1978

Home parenteral nutrition: results in 34 pediatric patients.

Although home parenteral nutrition (HPN) has been used successfully for adult patients, no extensive experience with children has been reported. During the past three years, we have managed 34 patients, ages 1 1/2 months to 20 1/2 years, on a HPN program for periods ranging from 23 to 786 days. Silastic Broviac catheters were inserted into the superior vena cava through the jugular or cephalic veins or into the inferior vena cava through the saphenous vein. The catheters were brought out onto the chest or lower abdominal wall through a subcutaneous tunnel. Solutions were infused over a 10--14-hour period each day, using a volumetric pump system. All patients improved their nutritional status. Twenty-three of 29 on the program for more than two months showed an increase in height. All patients evidenced a significant decrease in symptomatology. All resumed per group activities while on HPN and were able to continue their education or work. At present 24 patients including 15 with Crohn's disease no longer receive HPN. Administration of HPN through a Broviac catheter is a safe, successful technique for maintaining an optimal nutritional status in children with severe digestive disorders, and permits resumption of a more normal daily lifestyle. Following HPN, bowel adaptation and initiation of full oral alimentation become possible in many patients.

Adolescent↗
PubMed1978

Gastroesophageal fundoplication for the management of reflux in infants and children.

Gastroesophageal reflux (GER) has been recognized with increasing frequency as the source of a wide variety of symptoms in infants and children. During the past 8 years at the UCLA Hospital, 74 patients under 18 years of age have been identified as having sufficiently severe symptomatic reflux to warrant gastroesophageal fundoplication. Although repeated emesis was the most common primary symptom, failure to thrive was a major symptom in 20 patients, repeated pneumonia in 18, asthma in five, and dysphagia owing to stricture in 12. Nine patients with previously repaired esophageal atresia had severe reflux. Serious neurologic disorders were present in 14 children. The diagnosis of reflux in the majority of symptomatic children was established by combining the findings of an abnormal esophagogram, Tuttle test, esophageal manometry, and esophagoscopy with biopsy. Six infants experienced repeated symptomatic GER although results of all diagnostic studies were normal. Each of the patients had undergone an unsuccessful trial of medical management before the decision to operate was made. Transabdominal Nissen fundoplication with gastrostomy was performed on each of the 74 children (28 under 1 year of age). Each of the strictures was successfully managed by postoperative dilatations. No death and no major complications occurred, but six patients experienced transient dysphagia and four had delayed gastric emptying. Every patient has been relieved of clinical reflux, and the pulmonary status in each, including the asthmatic children, has been markedly improved. On the basis of this favorable experience with 74 patients, we believe that an aggressive surgical approach should be taken in the management of symptomatic GER in infants and children who fail to respond to an adequate trial of medical management.

Adolescent↗