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Biomedical subjects

G Stringel

Publications and source records attributed to G Stringel.

At least 19 recordsLinked to original sources
PubMed1990

Gastrostomy with antireflux properties.

The need for feeding gastrostomy seems to be increasing in children with neurological impairment and swallowing incoordination. Because gastrostomy can cause or increase gastroesophageal reflux, an antireflux procedure has been advocated at the time of gastrostomy placement in neurologically impaired children. A gastrostomy in the lesser gastric curvature with antirefluxing properties was performed in nine neurologically impaired children. All had severe swallowing incoordination with aspiration and malnutrition. Postoperatively none of the nine patients have demonstrated clinical evidence of vomiting or gastroesophageal reflux. This type of gastrostomy prevents the developement of gastroesophageal reflux by increasing the length of the intraabdominal esophagus and by increasing the acuity of the gastroesophageal angle of His. When compared with an antireflux procedure, it has less complications, shorter postoperative recovery, and is more economical.

Adolescent↗
PubMed1990

Effect of dietary nucleosides on growth and maturation of the developing gut in the rat.

Dietary nucleoside (DN) as a precursor for nucleic acid synthesis may be important for rapidly dividing cells, since gut epithelial cells have limited capacity for de novo purine and pyrimidine synthesis. We evaluated in a controlled blinded study the effect of added nucleosides, 0.8% by weight, given for 2 weeks, on gut growth and maturation in 20 weanling rats. Mucosal protein and DNA in the proximal intestinal segment were 50% and 77% higher, respectively, in the DN-supplemented group (n = 10; p less than 0.05). Villus height based on cell count was 25% greater in the DN group (p less than 0.05). Maltase activity was significantly greater in proximal, middle, and distal intestinal segments, and the largest increase, 87%, was seen in the proximal gut mucosa. The maltase/lactase ratio was also higher in this segment. Increases in sucrase were less prominent. Lactase was minimally affected. The pattern of change in disaccharidase activity suggests that DN may enhance gut growth and maturation of the intestine in the weanling rat, the effects being more pronounced in the proximal segment. Diets free of nucleosides and nitrogenous bases may have adverse effects on the gut.

Animals↗
PubMed1989

Topical and systemic antibiotics in the prevention of wound infection.

We evaluated under controlled conditions the efficacy of topical and systemic antibiotics, alone and in combination, in the prevention of wound infection and measured serum and tissue antibiotic levels in the wound and distant tissue after administration of antibiotics topically, systemically, and in combination. Adult Sprague-Dawley rats were contaminated on the dorsal paravertebral muscles with a preset standardized inoculum of Staphylococcus aureus, Escherichia coli, and Bacteroides fragilis. A second-generation cephalosporin was used; systemic administration was given intramuscularly and topically in powder form. Wound infection was confirmed by the recovery of the organism by culture. Prophylactic antibiotics were effective in preventing wound infection in all groups. Topical antibiotic and a combination (topical/systemic) antibiotic were significantly more effective than was systemic antibiotic alone in preventing wound infection. Adequate levels of antibiotic were achieved in serum and tissue with both topical and systemic antibiotics. Wound tissue concentration of antibiotic was significantly higher when topical antibiotic was used.

Administration, Topical↗
PubMed1989

Gastrostomy and Nissen fundoplication in neurologically impaired children.

We report our experience with 90 neurologically impaired children treated with gastrostomy and Nissen fundoplication. Malnutrition was the main problem, followed by aspiration, recurrent pneumonia, and vomiting. The symptomatology was caused by swallowing incoordination and gastroesophageal reflux. The diagnosis of gastroesophageal reflux was confirmed by upper gastrointestinal series and pH probe. Nissen fundoplication was performed following a standard technique with preservation of the vagus nerves and its branches, repair of the diaphragmatic crura, reconstruction of the angle of His, and a 360 degree wrap. A gastrostomy and pyloroplasty or pyloric dilatation were part of the operative procedure. There were no deaths and few complications related to the surgical procedure. Marked nutritional improvement was seen in most cases with an average weight gain of 3.2 kg/patient 3 months following surgery. There was also improvement in milestones and seizure control. The majority of parents were very satisfied and would recommend the procedure to other parents with similar problems.

Adolescent↗
PubMed1989

The effect of intestinal anastomosis on gut growth and maturation.

We evaluated the effect of intestinal anastomosis without resection on gut morphometry (muscle thickness, villus height, and crypt depth), growth indices (DNA, protein, and protein:DNA ratio), and disaccharidase activity (maltase, sucrase, and lactase) in the growing animal. A group of 10 weanling Sprague-Dawley rats at 21 days of age was subjected to intestinal transection and anastomosis in the upper jejunum, 10 cm distal to the ligament of Treitz. A second group of 10 similar rats was used as a control group. All rats were fed a regular diet and kept under the same conditions. They were sacrificed 2 weeks later. Body weight, intestinal weight, and intestinal length measurements were obtained. The intestine was divided into two sections: preanastomotic (section A) and postanastomotic (section B) in the surgery group and equivalent sections A and B in the control group. Specimens were subjected to morphometric evaluation and mucosal scrapings for biochemical analysis. Despite significant weight gain in the control group, there were no differences in intestinal length, intestinal weight, and mucosal weight between the two groups. Muscle thickness, villus height, and crypt depth were significantly increased in the preanastomotic segment. Protein and DNA were also higher in the preanastomotic segment, but the protein:DNA ratio was less affected. There was significantly decreased enzymatic activity in the preanastomotic segment. Intestinal anastomosis has a significant effect on gut growth and maturation in the growing animal and may have important implications in the postoperative management of newborns and infants following intestinal surgery.

Anastomosis, Surgical↗
PubMed1988

A model to study the direct effect of diet on early intestinal growth and maturation using Thiry-Vella loops.

Thiry-Vella loops (TVL) are neurovascular intact intestinal segments isolated from the normal flow of chyme. TVL have been used to assess the effects of local and systemic factors in the intestine of adult animal models. To assess the direct effect of diet in growth and maturation of the intestine in the growing animal, the authors developed a similar model in the weanling rat. The surgical technique is described. Results include weight gain, morphometry of the intestine, dissacharidases, total proteins, and nucleic acid in both TVLs and intestine in continuity. This model is inexpensive, easy to handle, and ideal for studying the effect of dietary factors on intestinal growth and maturation, separating the direct effect of diet on the intestine from systemic effects.

Animals↗
PubMed1987

Appendicitis in children: a systematic approach for a low incidence of complications.

Four hundred fourteen appendectomies in children have been described. Acute nonperforated appendicitis was seen in 57.1 percent of the patients and perforated appendicitis in 18.6 percent. A histologically normal appendix was seen in 14.3 percent of the patients. In 31 of these patients, other pathologic abnormalities were found to account for the symptoms, thus the number of negative explorations was reduced to 7 percent. The average length of hospitalization was 5.3 days for patients with acute nonperforated appendicitis and 7.3 days for patients with perforated appendicitis. A protocol was followed which consisted of fluid resuscitation, preoperative and postoperative administration of antibiotics, and surgical exploration with appendectomy in all patients. No interval appendectomies were performed. The peritoneal cavity was not irrigated and the use of drains was avoided as much as possible. All wounds were closed primarily without wound drains. Topical cefamandole powder was used in all cases. Aerobic and anaerobic culture specimens were obtained in all cases from the peritoneal cavity and appendiceal stump. Twenty-eight different organisms were recovered, B. fragilis being the most common followed by E. coli. Excellent results were obtained without mortality and a less than 1 percent complication rate. There was a shorter period of hospitalization for patients with perforated appendicitis and a shorter period of antibiotic treatment.

Acute Disease↗
PubMed1987

Giant hemangioma: treatment with intermittent pneumatic compression.

Giant cavernous hemangiomas in newborns and infants can present with life-threatening complications. Although some modes of therapy are effective, there is a significant associated morbidity and mortality. The author reports two cases of complicated giant cavernous hemangiomas treated successfully with intermittent pneumatic compression. This mode of therapy is effective in the treatment of accessible giant hemangiomas. It is safe, simple, and inexpensive and, when possible, should be used as a primary mode of treatment in complicated cases.

Abdominal Muscles↗
PubMed1986

Omphalocele closure: surgical technique with preservation of the amniotic sac.

The ideal surgical closure for large omphaloceles remains controversial. Most techniques described advocate removal of the amniotic sac prior to repair of the abdominal wall defect. Herein, the authors describe a surgical technique preserving the amniotic sac, which has distinct advantages in achieving safe and rapid closure of the omphalocele by primary or secondary means in selected patients.

Amnion↗
PubMed1986

Extensive intestinal aganglionosis including the ileum: a new surgical technique.

Extensive aganglionosis including the ileum occurs in less than 5% of children with Hirschsprung's disease; in these cases nutrition, fluid, and electrolyte balance are a problem. The author reports an infant with extensive aganglionosis including the ileum in whom an endorectal pull-through of the Soave type as modified by Boley was performed with a longitudinal side-to-side anastomosis between the aganglionic and normal intestine, preserving terminal ileum and ileocecal valve. At two and one-half years of age the infant is well. He is toilet trained and has 1 to 4 soft bowel movements per day as he is in the 50th percentile for weight. When extensive aganglionosis involves the small intestine, saving the important function of the terminal ileum and the ileocecal valve is possible and highly desirable.

Female↗
PubMed1986

Infantile mammary duct ectasia: a cause of bloody nipple discharge.

Bloody nipple discharge in infancy has been rarely reported in the medical literature. Its cause is unknown. We report a three-year-old male infant and a five-month-old female infant with bloody nipple discharge. Because of persistent bloody discharge, a subcutaneous mastectomy was performed in the boy; the problem resolved in the girl after a period of observation. The specimen showed histologic changes identical to those seen in adult mammary duct ectasia. All the endocrinologic work-up was normal. We suspect that bloody nipple discharge in infancy is underreported. This is a benign condition with histologic changes similar to adult mammary duct ectasia and if persistent, should be properly investigated; biopsy or excision are not indicated.

Blood↗
PubMed1985

Esophageal duplication cyst containing a foreign body.

About 10% to 15% of all duplication cysts in the alimentary tract are esophageal. Esophageal duplication cysts are intimately attached to the alimentary tract, are lined by mucous membrane and have smooth muscle. This paper describes a 2-year-old child who presented with symptoms of progressive respiratory distress. A diagnosis of esophageal duplication cyst was made. At surgery a low cervical incision was made and the sternal manubrium split, thereby providing adequate exposure. The cyst was then removed. The most useful investigations were chest roentgenography and barium esophagography. Computerized tomography showed a small, round foreign body in the middle of the cyst that was subsequently found to be a bingo chip. Communication between the cyst and the esophagus was not obvious at the time of surgery and had not been demonstrated by barium esophagography. When complete excision of the cyst is not possible because of inflammatory reaction all the mucosa must be removed to prevent recurrence. Careful postoperative respiratory support and broad-spectrum antibiotic therapy are recommended.

Child, Preschool↗
PubMed1985

Pull-through with isolated jejunal loop for ulcerative colitis.

Total colectomy with endorectal mucosectomy and ileal pull-through to preserve fecal continence is well known for ulcerative colitis. A female patient developed severe ulcerative colitis at 5 years of age and had an emergency subtotal colectomy and ileostomy at 7 years of age. The rectum was preserved. At 9 years of age rectal mucosectomy and a pull-through using isolated jejunal loop were performed. Postoperatively she was treated with ano-rectal physiotherapy and balloon dilatations of the new rectum. Six months later the ileostomy was closed. Two and a half years after her operation she has 2-4 soft bowel movements daily, perfect diurnal control with occasional night soiling. A pull-through using an isolated loop of jejunum leaves intact a good functioning ileostomy. The blood supply to the jejunum is better than the terminal ileum. Bacterial contamination with jejunum is less than with ileum. There is no need for a reservoir; if the pull-through fails valuable terminal ileum is not lost.

Child↗
PubMed1985

The occult insulinoma operative localization by quick insulin radioimmunoassay.

Hypoglycemia secondary to organic hyperinsulinism in children can be caused by diffuse or localized pancreatic lesions. Differentiation between these two types of lesions is of utmost importance since the surgical approach will be different. Some tumors escape detection by all preoperative investigations including ultrasound, scintiscan, arteriography, and computerized tomography. We are reporting on a 12-year-old boy with organic hyperinsulinism in whom we were unable to localize a tumor preoperatively. Peroperative determination of insulin levels from a number of sites on the pancreas enabled us to localize an insulin-producing pancreatic adenoma. This technique can be done easily by catheterizing the splenic and portal vein through a branch of the splenic vein and by serial sampling at 2 cm intervals along the portal and splenic veins. Insulin levels at these sites were determined by quick double-antibody radioimmunoassay, which allows the determination of the insulin levels within 50 minutes after sampling. There was a perfect biochemic and anatomic correlation allowing us to perform a precise distal pancreatectomy. The technique can be used to localize pancreatic adenomas and to decide how much pancreas to remove in diffuse lesions avoiding "blind" pancreatectomies.

Adenoma, Islet Cell↗
PubMed1985

Condyloma acuminata in children.

Condyloma Acuminata (venereal warts) are sexually transmitted involving the human papilloma virus. It has become commoner in adults in the last decade. While infection is most often by sexual intercourse, it can be transmitted at birth and with close contact with infected individuals. It is common in marked sexual promiscuity. Condyloma acuminata in children should alert the physician to the possibility of sexual abuse or early sexual activity. We report 14 cases of condyloma acuminata in children; from 6 months to 17 years. Sex incidence was equal. All had social and family problems in common, except for one who developed perianal condyloma after repeated rectal dilatations because of a pull through procedure for Hirschsprung's Disease. Two cases of sexual abuse were documented. Treatment methods included podophyllin, liquid nitrogen, 5 fluorouracil cream, fulguration and laser therapy. An adequate social history was available only in six cases. Investigations should include VDRL and cultures for Gonococcus, careful medical and social history for neglect or abuse.

Adolescent↗
PubMed1985

Splenic abscess.

Abscess of the spleen is a rare entity. It may develop after generalized infection, hematologic disorders and trauma. The authors report the case of a 7-year-old boy who presented with a 2-month history of spiking fever, anorexia, fatigue and weight loss. He had left subcostal tenderness and a palpable spleen. He had a history of trauma to the left flank 5 months before admission but a splenic scan obtained at that time appeared normal. A splenic abscess was diagnosed by gallium scanning, computerized tomography and ultrasonography. Although splenectomy has been advocated as the treatment of choice for splenic abscess, this patient was treated successfully with appropriate antibiotics and simple drainage, preserving the spleen. Cultures grew Staphylococcus aureus. Of all the diagnostic methods available, ultrasonography is the least invasive study that will make the diagnosis and is less expensive than some methods.

Abscess↗