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Biomedical subjects

G H Mahour

Publications and source records attributed to G H Mahour.

At least 19 recordsLinked to original sources
PubMed1992

Neuroblastoma masquerading as a retroperitoneal Salmonella abscess.

Symptomatic Salmonella infections usually manifest as self-limited gastrointestinal distress. Patients with chronic systemic illnesses or those who are immunosuppressed may rarely present with Salmonella infection as distant suppurative abscesses. We present a previously healthy Armenian boy who came to medical attention with abdominal pain, fever, and anemia. Abdominal computed tomography (CT) scan showed a cystic suprarenal mass that was surgically explored and found to be a retroperitoneal Salmonella abscess. Postoperative CT scan showed resolving inflammation. A 6-month follow-up CT showed a large suprarenal tumor, which at exploration was found to be neuroblastoma. To our knowledge, Salmonella has never been reported presenting as a solitary retroperitoneal abscess, and neuroblastoma has not been described presenting as a Salmonella abscess. The patient is also unusual because the abscess contained a species unusual for suppurative salmonellosis.

Abscess↗
PubMed1992

Treatment of bilateral Wilms' tumor: comparison of initial biopsy and chemotherapy to initial surgical resection in the preservation of renal mass and function.

The National Wilms' Tumor Study 3 (NWTS-3) recommended treatment of bilateral Wilms' tumor with initial biopsy followed by chemotherapy with subsequent operation to resect the remaining tumor. This study was performed to determine if this approach preserves renal mass and function when compared with initial surgical resection followed by chemotherapy. Over a 20-year period (1970 to 1990), 15 patients with synchronous bilateral Wilms' tumor were treated at the Childrens Hospital of Los Angeles. Eight patients in the surgical group underwent initial unilateral nephrectomy with contralateral biopsy, wedge resection, or partial nephrectomy and subsequent chemotherapy. The seven patients in the chemotherapy group underwent bilateral tumor biopsy, followed by chemotherapy and subsequent tumor resection. Patients were assigned to each group in a nonrandomized manner according to the preference of the attending oncologist and surgeon. Comparison of the two groups showed no significant differences in sex distribution, initial renal function, tumor histology, dose and field of radiotherapy, presence or absence of positive surgical margins, and local recurrence rates. Patients in the surgery group were slightly older than those in the chemotherapy group: 3.6 +/- 2.2 versus 2.3 +/- 2.2 years. The percent of renal mass involved by tumor for the surgery group was 52 +/- 12 versus 73 +/- 16 for the chemotherapy group (P = .03). The percent of renal mass preserved following all operations, local recurrence rates, incidence of metastases, and survival was nearly identical between the two groups. There were three cases of renal failure in the surgery group and one case of renal failure in the chemotherapy group.(ABSTRACT TRUNCATED AT 250 WORDS)

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1992

Communicating bronchopulmonary foregut malformations: classification and embryogenesis.

Communicating bronchopulmonary foregut malformations (CBPFMs) are characterized by a fistula between an isolated portion of respiratory tissue (ie, a lung, a lung lobe, or a segment) and esophagus or stomach. We combine our 30-year (1959 to 1989) experience of 6 cases with 51 reported patients to propose a CBPFM classification supported by a proposed embryogenesis theory. Group I (16%): anomaly is associated with esophageal atresia and tracheoesophageal fistula. Group II (33%): one lung originates from the lower esophagus. Group III (46%): an isolated anatomic lung lobe or segment communicates with the esophagus or stomach. Group IV (5%): A portion of the normal bronchial system communicates with the esophagus. The portion of the lung served by the communicating bronchus receives systemic blood supply. The right and left lung sacs curve dorsally to embrace the lower esophagus during normal lung development. At this stage a part of the lung bud joins the esophagus. This segment then breaks away from the main pulmonary anlage to form a CBPFM. CBPFMs should be considered in the workup of infants with respiratory distress and/or recurrent pneumonias. Patients with suspected pulmonary sequestration should undergo contrast studies to exclude a gastrointestinal communication.

Bronchial Fistula↗
PubMed1990

Mesenchymal hamartoma of the liver. A 35-year review.

Mesenchymal hamartoma of the liver occurs almost exclusively in infancy and childhood, with approximately 140 total cases reported. We report the experience with 18 patients at the Childrens Hospital of Los Angeles (Calif) during the past 35 years. The charts of all patients with mesenchymal hamartoma were retrospectively reviewed. The mean age at presentation was 16 months. Thirteen patients were symptomatic, presenting with increasing abdominal distention. Physical examination revealed an abdominal mass or hepatomegaly. Ultrasonography and computed tomography were the most useful diagnostic tests. Fourteen patients underwent resection; 9 underwent hepatic resection and 5 underwent excision of the tumor only. One patient had marsupialization, 1 underwent a biopsy only, and 2 died of unrelated causes and the hamartoma was found incidentally at autopsy. In all instances, a large cystic mass with well-demarcated margins was found. Three patients were unavailable for follow-up and 13 patients were alive and well 1 month to 24 years (mean, 5 years) after diagnosis. Recurrence or malignant transformation was not noted. A presumptive diagnosis can be made preoperatively by normal laboratory values and a combination of ultrasonography and computed tomography. We recommend excision of the tumor in all patients once the diagnosis is made, with the expectation of complete recovery.

California↗
PubMed1990

Surgical implications of Henoch-Schönlein purpura.

Intestinal intussusception, perforation, necrosis, and massive gastrointestinal bleeding are the surgical conditions most often seen in Henoch-Schönlein purpura (HSP). We reviewed the charts of 183 patients who were diagnosed with HSP at two children's hospitals over a 17-year period. Ten patients underwent laparotomy. Intussusception was the most common surgical lesion. Sequential barium enema and upper gastrointestinal series established the diagnosis of intussusception preoperatively in five of six patients. Two patients developed jejunal perforation and segmental ileal ischemia. Although gastrointestinal bleeding occurred in 52% of patients, the bleeding was self-limiting and no blood transfusion was required. Laboratory data were not helpful in differentiating patients with and without surgical problems.

Adolescent↗
PubMed1990

Germ cell tumors in infancy and childhood: a 45-year experience.

The clinical and pathologic features of germ cell tumors in 188 patients seen at the Childrens Hospital of Los Angeles from 1941 to 1986 are reviewed. There were 129 females and 59 males 19 years of age or younger. Tumors were seen in the ovary (73, 39%), sacrococcygeal region (67, 36%), testis (13, 7%), pineal region (10, 5%), mediastinum (8, 4%), and other sites (17, 9%). The mean age at diagnosis of patients with sacrococcygeal tumors was 11 months, and for those with ovarian tumors it was 9.3 years. Histologically, 56% of the tumors were benign, 15% had immature tissues, and 29% had frankly malignant tumors. Patients with immature tumors and elevated serum alpha-fetoprotein levels at diagnosis had a higher incidence of tumor relapse (p = .004). The histology of the recurrent tumors in these patients was embryonal carcinoma. Of 54 patients with malignant tumors, 27 are alive with no evidence of recurrence, 5 died of non-disease-related causes, and 22 (41%) had tumor recurrence within 3 years of initial diagnosis and eventually died of tumor progression. The 5-year survival rate for patients with benign tumors was 96%; for those with immature tumors, 83%; and for those with malignant tumors, 42%.

Child↗
PubMed1990

Emergency center laboratory evaluation of pediatric trauma victims.

Emergency center (ER) trauma evaluations often include leukocyte count (LC), serum amylase (SA), electrolytes (EL), and urine analysis. We reviewed records of 100 pediatric ER patients to determine utility of these tests in management of blunt injury. SA was evaluated in 65 patients and ranged from 30-146 U/L (mean 50.6 U/L); 14 patients with normal CT scans had SA from 30-68 U/L (mean 49.1 U/L). Six patients with intraabdominal or retroperitoneal injuries had SA from 30-130 U/L (mean 64.0 U/L), P = NS. LC was determined in 76 patients and ranged 2.3-28.3 k/ml (mean 13.8 k/ml). Patients with normal abdominal CT (12) had mean LC 14.8 k/ml (range 7.2-19.6 k/ml). Eight patients with injuries on CT had mean LC 14.4 k/ml (range 3.5-27.1 k/ml). ER, SA, and LC did not alter patient management. Thirty-four patients had serum sodium, 36 potassium, and 33 chloride and bicarbonate determinations. Sodium, potassium, and chloride levels were uniformly normal; bicarbonate and leukocyte counts were uniformly abnormal in initial evaluations. These changes are expected in response to severe injury and their determinations did not alter patient care. Combined laboratory urinarlysis (LA) and urine dipstick (DA) analysis for hematuria had sensitivity 75.0 per cent (specificity 81.6%). LA predicted injury with sensitivity 75.0 per cent (specificity 81.6%). DA predicted injury with sensitivity 60.0 per cent (specificity 79.2%). DA accurately represented LA results (sensitivity 100%, specificity of 94.5%). DA is a rapid and effective replacement of LA in evaluation of trauma patients in the emergency center.

Amylases↗
PubMed1990

Partial splenic embolization. An effective alternative to splenectomy for hypersplenism.

Splenectomy for massive splenomegaly and hypersplenism carries a significant morbidity and mortality. We have used partial splenic embolization (PSE) as an effective alternative to splenectomy. Ten PSE procedures were performed on nine patients without mortality and with minimal morbidity. The age of the patients ranged from 8 months to 32 years (mean 14 years). The causes of splenomegaly and hypersplenism included cystic fibrosis with cirrhosis (2), tyrosinemia and cirrhosis (1); thalassemia (1), hemophilia with Human Immune Deficiency Virus infection (2), chronic hepatitis with portal hypertension (1), malignant histiocytosis (1), and Wiskott-Aldrich Syndrome (1). All procedures were performed under local anesthesia with sedation. A percutaneous femoral artery approach to the splenic artery was used to deliver Ivalon sponge particles (280-800 microns) into the spleen. Splenic infarction was assessed by postembolization angiograms. All of the patients except one demonstrated improvement of hematologic parameters. In one patient, however, cytopenia improved only after a second embolization. In the total series, there was an early mean rise of 8,600/mm3 in the leukocyte count (range 2,900-14,900) and 212,000/mm3 in the platelet count (range 30,000-718,000). Follow-up ranged from 4 months to 7 years. Improvement of the blood picture has been persistent in seven of the eight patients who showed initial improvement. Transient procedural complications included fever (5), pleural effusion (2), pneumonia (1), and splenic abscess (1). One patient had paralytic ileus lasting for 10 days and one patient developed a streptococcal peritonitis 3 weeks after embolization. No patient developed pancreatitis or vascular compromise of other abdominal viscera.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

Evolution in the management of splenic injury in children.

To assess the changes in the management of splenic trauma, the charts of all patients with splenic injury, documented either roentgenographically or at operation, treated at the Childrens Hospital of Los Angeles from 1965 through 1985 were reviewed. One hundred and eleven patients with confirmed splenic injury were treated. Forty-one patients were seen during the first decade (1965 to 1975) and 70 during the second decade (1976 to 1985). The majority of patients were boys with a mean age of seven years. All of the patients sustained blunt abdominal trauma. During the first decade, all of the patients who had a recognized splenic injury underwent splenectomy. In the second decade, 44 patients were treated without surgical intervention. Twenty-six of the patients required surgical treatment. Splenorrhaphy was successful in 15; however, splenectomy was required in 11 patients. The patients who required surgical therapy had more complications and required more blood products than those patients who were treated nonsurgically. The overall survival rate was 95 per cent and was similar in both decades. Associated injuries, not the splenic injury, were responsible for the lethal outcome of the nonsurvivors. Although the majority of children with splenic injury can be managed nonoperatively, surgical intervention continues to be necessary in our experience in approximately 38 per cent of the patients with an over-all splenic salvage rate of 85 per cent.

Abdominal Injuries↗
PubMed1990

Pseudocysts of the pancreas in children.

Sixteen children with pancreatic pseudocysts were treated from 1965-1988. Blunt trauma was the etiology of pseudocyst formation in 69 per cent of children with 50 per cent resulting from the abdomen impacting bicycle handlebars. Chronic pancreatitis is an uncommon cause of pseudocyst formation in children. Medical therapy is directed towards reduction of pancreatic stimulation and nutritional support, which are maintained through pseudocyst resolution or maturation. Pseudocysts spontaneously resolved in 25 per cent of patients. Complications occurred in 25 per cent during nonoperative management. Children may safely undergo internal drainage earlier than adults (3-4 weeks vs 6 weeks). Internal drainage by cystoenterostomy was curative in eight patients. Persistent fistula drainage developed for five weeks in one patient who had surgical external pseudocyst drainage. One patient required distal pancreatectomy for a transected pancreatic duct. Spontaneous resolution of psseudocysts while on medical therapy is more frequent in children than in adults, and major complications (abscess formation, hemorrhage, and fistula formation) are usually not encountered. Pseudocyst rupture is the major complication of conservative management. We had no pseudocyst recurrences and 11 of 12 children treated surgically were discharged home within ten days of operation.

Abdominal Injuries↗
PubMed1989

Immature teratomas: identification of patients at risk for malignant recurrence.

We investigated the significance of immature elements in an otherwise benign teratoma in 28 patients with immature teratomas diagnosed and treated at the Childrens Hospital of Los Angeles from 1941 to 1986. Different characteristics, including age, sex, primary tumor site, type of surgery (complete resection vs. partial resection or biopsy), and preoperative levels of alpha-fetoprotein (AFP) were analyzed to evaluate their association with risk of subsequent local malignant recurrence. After a median follow-up of 6 years, 21 patients are alive with no recurrence of the tumor (72% event-free survival). One patient died from infection after surgery and six patients had local malignant tumor recurrence within 1 year from diagnosis. Of the 28 patients, 12 had AFP levels measured at diagnosis. Eight patients had normal levels with no further evidence of tumor recurrence, and four had elevated levels with three tumor recurrences. Our experience demonstrates that only at the time of diagnosis do AFP levels correlate with a subsequent malignant behavior of these tumors (P = .004). Those patients with immature teratomas and elevated AFP levels at diagnosis should receive adjuvant chemotherapy after the initial surgical resection.

Adolescent↗
PubMed1989

Utility of the cervical spine radiograph in pediatric trauma.

To determine the utility of the routine cervical spine radiograph, we reviewed all cervical spine radiographs obtained in pediatric trauma patients over a 2 1/2-year period at the Childrens Hospital of Los Angeles. Records of patients admitted with a documented cervical spine injury over a 20-year period were also reviewed. One hundred eighty-seven children had at least one cervical spine radiograph. Forty-six patients (25 percent) required at least one repeat study in an attempt to see all 7 vertebrae. Thirty-eight children (20 percent) had a second radiograph and 8 patients had a third study, all of which showed no injury. There was only one fracture seen during the 2 1/2-year time period. Of the 16 children admitted over the 20-year period, only 3 sustained an injury below the fourth cervical vertebra (C4), and all were over 8 years of age. All patients with cervical spine injury were either comatose or had symptoms referable to the neck. We conclude that the routine cervical spine radiograph in pediatric trauma is a very low-yield test.

Adolescent↗
PubMed1988

Measured energy expenditure in critically ill infants and young children.

Technological limitations have impeded accurate energy expenditure assessment in critically ill infants and young children. Instead, a predicted energy expenditure (PEE) is derived based on weight, heat loss, activity, growth requirements, and degree of stress. This study compared actual measured energy expenditure (MEE) with conventional predicted values in 20 critically ill infants and children using a validated metabolic cart designed for use in this age group. All patients were studied either within 4 days of major surgery or during an acute disease process necessitating intensive care. All were severely stressed clinically and were studied while mechanically ventilated in a temperature-controlled environment. The study interval ranged from 1 to 12 hr and averaged 4 hr after a stabilization period of 30 min. The mean MEE was significantly lower than the mean PEE (52.2 +/- 16 kcal/kg/day vs 101.8 +/- 17 kcal/kg/day, P less than 0.001) with a mean MEE/PEE of 52.6 +/- 17% (range 26 to 92%). In a subgroup of 7 paralyzed patients, the mean MEE was significantly lower than in the 13 nonparalyzed patients when compared with PEE and predicted basal metabolic rate (PBMR). The coefficient of variance, conventionally recognized to be approximately 15% for PEE, averaged 6.35% for MEE in this study. These data indicate that if PEE is used as the sole guide for caloric repletion in the stressed infant or child, these patients will be substantially overfed.

Basal Metabolism↗
PubMed1988

Abdominal CT scanning in pediatric blunt trauma.

The use of the emergency IV contrast-enhanced abdominal computed tomography (CT) scanning was evaluated in 90 pediatric patients sustaining blunt abdominal trauma. Medical records, CT scans, and operative and postmortem reports, when applicable, were reviewed retrospectively. By identifying the organs of injury, CT scans of the abdomen, with IV contrast, proved to be useful to the surgeon in deciding whether to operate in the setting of blunt abdominal trauma. The failure rate for conservative, non-operative management (four of 33) in "positive" scans was low, and represented progression of known injuries, not the appearance of unexpected injuries. Similarly, the (unplanned) surgery rate in the "negative" scan cases was low (one of 57). Abdominal CT scans cannot be relied on to consistently diagnose gastrointestinal perforation or pancreatic injury.

Abdominal Injuries↗
PubMed1988

Lipoblastoma and lipoblastomatosis--a report of six cases.

Lipoblastoma and lipoblastomatosis are rare examples of benign mesenchymal tumors that exhibit a tendency to invade locally but not to metastasize. The tumors are found primarily in children less than 5 years of age and can arise almost anywhere within the soft tissues. The rate of growth is variable and has no bearing on prognosis, which is excellent in the majority of cases. The experience at Childrens Hospital of Los Angeles with six children (3 males, 3 females) having these tumors is described. There was no instance of recurrence after surgical removal of the tumors, with follow-up periods ranging from 3 months to 5 years. Histologic appearance and outcome were similar in all patients, and there was no relationship between histologic appearance and prognosis. Complete local excision without radical mutilating resection is the treatment of choice.

Child, Preschool↗
PubMed1987

Broviac catheter insertion: operating room or neonatal intensive care unit.

We reviewed the records of all infants hospitalized in the neonatal intensive care unit (NICU) who underwent insertion of a Broviac catheter from July 1, 1984 through August 30, 1985. Eighty-six catheters were inserted in 81 patients. Thirty-one catheters were inserted in the NICU and the remainder were inserted in the operating room (OR). The patient's average weight at the time of catheter insertion was the same in both groups. Fifty-two of the 55 OR catheters (95%) were inserted in the external or internal jugular vein while only 68% of the NICU catheters were placed in the jugular veins. Six of the NICU catheters (19%) and 11 of the OR catheters (20%) developed catheter-associated sepsis with positive blood cultures. The infection rate per catheter day was similar in both groups as was the incidence of catheter occlusion. The NICU catheters were in place for an average of 51 days, and there was an average 46 day lifespan for the OR inserted catheters. Broviac catheter insertion can safely be performed in the NICU without an increase in morbidity. Broviac catheter insertion in the NICU is less costly and saves transportation of the sick neonate to the operating room.

California↗