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Biomedical subjects

G Shoshani

Publications and source records attributed to G Shoshani.

6 recordsLinked to original sources
PubMed2001

Abdominal compartment syndrome in children.

OBJECTIVE: To investigate the frequency, predisposing factors, clinical presentation, and outcome of abdominal compartment syndrome (ACS) in critically ill pediatric patients. DESIGN: A prospective study over a 5-yr period. SETTING: Pediatric intensive care unit of a tertiary care, university hospital. PATIENTS: All patients admitted to the pediatric intensive care unit were screened for the presence of ACS and were treated with a uniform protocol. ACS was defined as abdominal distention with intra-abdominal pressure (IAP) > 15 mm Hg, accompanied by at least two of the following: oliguria or anuria; respiratory decompensation; hypotension or shock; metabolic acidosis. MEASUREMENTS AND MAIN RESULTS: Of 1762 patients admitted over 5 yrs, ten patients (0.6%) had a total of 15 episodes of ACS. Of 406 trauma cases, three had ACS (0.7%). Three of the ten patients had primary abdominal conditions (mesenteric vein thrombosis, intussusception, enterocolitis), three had abdominal surgery (trauma, Kasai operation, esophageal perforation and peritonitis), three had primary central nervous system involvement, and one had meningococcemia. At laparotomy, bowel ischemia or necrosis was found in four episodes of ACS (27%). Mean IAP at diagnosis of ACS was 23.9 +/- 3.8 (range 17-31) mm Hg. Physiologic parameters were compared during 4 hrs before the development of ACS, during ACS, and after abdominal decompression. Mean arterial pressure, Pao(2), Pao(2)/Fio(2) ratio, and urinary output decreased significantly, whereas Paco(2), peak inspiratory pressures, positive end-expiratory pressures, and base deficit increased significantly after the development of ACS. After decompressive laparotomy, the condition of the patients improved promptly and these variables returned to pre-ACS values. Overall mortality rate in this group was 60%. CONCLUSIONS: Although relatively infrequent compared with adults, ACS occurs in critically ill children. Timely decompression of the abdomen results in uniform improvement, but overall mortality is still high. In contrast with adults, children with ACS have diverse primary diagnoses, with a significant number of primary extra-abdominal-mainly central nervous system-conditions. Ischemia and reperfusion injury appear to be the major mechanisms for development of ACS in children. Clinical presentation is similar to adults, but children may develop ACS at a lower IAP (as low as 16 mm Hg).

Journal Article↗
PubMed1992

Intraoperative assessment of blood flow to strangulated stomach by pulse oximetry.

A pulse oximeter was used to detect safe margins for resection of a strangulated stomach. The sensor probe was placed intraoperatively on various portions of the stomach, which herniated through a left lateral diaphragmatic defect. Failure to detect blood flow by this device in equivocally compromised tissue helped in the assessment of safe viable margins for resection.

Female↗
PubMed1986

Unconjugated hyperbilirubinaemia in hypertrophic pyloric stenosis, an enigma.

In a search of features that might be relevant to the understanding of the hyperbilirubinaemia of infants with hypertrophic pyloric stenosis (HPS), we examined the duodenal fluid in 11 infants with this condition. Four (36%) had an unconjugated bilirubin level above 2.5 mg/dl in the serum. Levels of electrolytes, bicarbonate, liver function tests and cholesterol were similar in the jaundiced and the non-icteric infants. Examination of duodenal fluid for pH, concentration of bilirubin, bile salts, electrolytes and beta-glucuronidase levels also did not disclose any significant differences between the HPS patients and the controls. Bacterial culture of the fluid yielded similar results in both groups. We may conclude that the unconjugated hyperbilirubinaemia observed in some patients with HPS is not associated with overgrowth of bacteria, changes in glucuronidase levels, pH, electrolytes or biliary obstruction.

Bilirubin↗