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Biomedical subjects

H C Filston

Publications and source records attributed to H C Filston.

At least 37 records · Page 2Linked to original sources
PubMed1989

Common lumps and bumps of the head and neck in infants and children.

The majority of lesions in the neck of children will prove to be benign and of congenital origin arising from such structures as the thyroglossal duct and the branchial clefts in addition to hemangiomas and lymphangiomas. However, it is essential that lymphadenopathy be proven infectious and any asymptomatic lymph node enlargement must be considered Hodgkin's disease until proven otherwise. The occasional neuroblastoma or rhabdomyosarcoma presenting in the neck can usually be identified as solid by sonography, leading to early investigation and biopsy. Because of the abundance of important structures that course through the neck, surgery should be conducted in an operating suite with sophisticated, modern anesthetic techniques and with a surgeon experienced in dealing with the full array of lesions that occur.

Branchioma↗
PubMed1988

Childhood hepatic mesenchymoma: successful treatment with surgery and multiple-agent chemotherapy.

Malignant undifferentiated sarcoma (mesenchymoma) of the liver is a rare tumor of childhood, with fewer than 100 cases reported in the literature. The overall prognosis for patients with this malignancy is poor. In this report, two children with hepatic mesenchymoma underwent surgical excision followed by 2 years of adjuvant chemotherapy. Rotating cycles of cisplatinum, vincristine/doxorubicin, vincristine/cyclophosphamide, and vincristine/actinomycin D were given with minimal toxicity. Both patients are alive, with no evidence of disease at least 5 years from diagnosis. Previous reports of treatment are reviewed.

Adolescent↗
PubMed1988

Elective cholecystectomy in children with sickle hemoglobinopathies. Successful outcome using a preoperative transfusion regimen.

Twenty-seven children with major sickle hemoglobinopathies underwent elective cholecystectomy for cholelithiasis. All were managed with a preoperative transfusion regimen to achieve a hemoglobin concentration of 11-14 g/dl with greater than 65% hemoglobin A. Intraoperative cholangiography revealed common bile duct stones in five patients, although only one case was diagnosed by preoperative ultrasonographic examination. Twenty-four children underwent incidental appendectomy by total intussusception. There were no vaso-occlusive events nor any other perioperative morbidity or mortality. Four months after cholecystectomy, one boy had a small bowel obstruction requiring surgical re-exploration. No patients had transfusion-acquired infection, although one boy had erythrocyte allosensitization to Lewis A antigen. This preoperative transfusion regimen and careful perioperative management permits safe elective cholecystectomy in children with sickle cell disease.

Adolescent↗
PubMed1987

Juvenile secretory carcinoma and juvenile papillomatosis: diagnosis and treatment.

Carcinoma of the breast in the child is a rare pathologic entity, constitutes less than 1% of all breast lesions in this age group. The case of a girl with a left breast mass first noticed at 4.5 years of age is presented. An eccentric subareolar mass was excised at 6 years of age, sparing her breast bud. This biopsy contained juvenile secretory carcinoma, with additional pathologic changes characteristic of juvenile papillomatosis. Both the juvenile papillomatosis component as well as the juvenile secretory carcinoma component were devoid of estrogen and progesterone receptors in contrast to nondiseased breast tissue. The assay for these receptors was performed using a new antireceptor monoclonal antibody technique. Simple mastectomy was performed after completion excision demonstrated tumor at the pectoralis major fascia.

Antibodies, Monoclonal↗
PubMed1987

Giant cutaneous hemangioma associated with axillary arteriovenous fistula causing congestive heart failure in the newborn infant.

Although histopathologically benign, cutaneous hemangiomas may be pathophysiologically malignant if they are associated with significant arteriovenous malformation that is hemodynamically compromising. Rapid surgical intervention may be required to prevent clinical deterioration from congestive heart failure as in the case reported here. Angiography may directly influence the surgical approach to the lesion.

Arteriovenous Fistula↗
PubMed1987

Airway obstruction by vascular anomalies. Importance of telescopic bronchoscopy.

This review of 28 cases of airway obstruction by vascular anomalies in the past 6 years emphasizes the importance of these anomalies as causes of obstruction, stridor, and apnea in infants as well as the important contribution of telescopic bronchoscopy to the recognition of these lesions, especially compression of the trachea by the innominate artery. There were 20 patients with compression by the innominate artery; four were surgically corrected. Seven vascular ring anomalies were all corrected by operation as was an enlarged left atrium and malformed mitral valve in one patient. Vascular anomalies caused 26% of the obstructive airway lesions in a series of infants who had bronchoscopy for obstruction, stridor, or apnea. Failure to diagnose and treat these entities may result in progressive respiratory embarrassment and even death. Barium esophagogram and aortic arch arteriogram, the traditional modalities for diagnosing vascular rings, may fail to identify tracheal compression by enlarged cardiac chambers or the more common "anomalous" innominate artery. Telescopic bronchoscopy will identify tracheal compression by the innominate artery; furthermore, it will identify the area of compression by the vascular ring. Observation of the compressed area during corrective surgery ensures that the operative manipulations are appropriate and successful in relieving the obstruction. This observation can be facilitated by televised monitoring and videotaping.

Airway Obstruction↗
PubMed1985

The association of neuroblastoma and myoclonic encephalopathy: an imaging approach.

Myoclonic encephalopathy is a unique clinical syndrome of infants and children that is associated with a neurogenic tumor of ganglion-cell origin in approximately half of cases. A review of the literature as well as our personal experience with two recent infants suggests an imaging approach that includes chest radiography and abdominal computed tomography (CT). Ultrasonography, neck CT, and chest CT myelography may be required in selected patients. An expedient clinical and imaging evaluation of infants and children with opsomyoclonus is important to detect those patients with neurogenic tumors.

Abdominal Neoplasms↗
PubMed1984

The Currarino triad: complex of anorectal malformation, sacral bony abnormality, and presacral mass.

The Currarino triad is a unique complex of congenital caudal anomalies including anorectal malformation, sacral bony abnormality, and presacral mass. The usual symptomatology is constipation due to anorectal stenosis. Contrast enema and computed tomographic myelography are the imaging modalities of choice for diagnostic confirmation and clarification of the anomalies. The clinical features, unique radiologic appearance, and importance of a correct diagnosis of the Currarino triad are reviewed.

Abnormalities, Multiple↗
PubMed1984

Esophageal atresia. Prognostic factors and contribution of preoperative telescopic endoscopy.

In recent years, the surgical correction of esophageal atresia with distal tracheoesophageal fistula (TEF) has become increasingly successful. However, there remains a group of high-risk patients with specific anatomical abnormalities in whom the mortality remains appreciable. These associated disorders include cardiac, renal, and chromosomal anomalies as well as severe respiratory distress syndrome. These factors, rather than low birth weight or early gestational age, are primarily responsible for surgical mortality. Preoperative telescopic bronchoscopy has been a useful adjuvant confirming the diagnosis, identifying unusual variants, and permitting the proper anatomic placement of the endotracheal tube. A Fogarty balloon catheter can be passed bronchoscopically into the distal TEF in patients with severe respiratory distress syndrome to occlude the fistula and facilitate effective positive pressure ventilation. Thirty-two patients were treated for esophageal atresia among whom 28 had esophageal atresia with distal TEF, three had esophageal atresia alone, and one had esophageal atresia with proximal TEF. The higher-risk group comprised those with severe respiratory insufficiency as evidenced by a room air paO2 of less than 60 mmHg; this group accounted for nine of the ten deaths in the total series. There was one late death following surgical correction. In summary, in the absence of severe respiratory insufficiency or associated life-threatening congenital anomalies, the results of surgical correction for esophageal atresia are remarkably good and survival in this group approximates 100%.

Abnormalities, Multiple↗
PubMed1984

An imaging approach to persistent neonatal jaundice.

Fifteen patients with persistent neonatal jaundice were evaluated by sonography and radionuclide scintigraphy. The sonographic features of both neonatal hepatitis and biliary atresia are nonspecific. Hepatobiliary scintigraphy after phenobarbital pretreatment in patients with neonatal hepatitis demonstrates normal hepatic extraction and delayed tracer excretion into the gastrointestinal tract. If there is neonatal hepatitis with severe hepatocellular damage, the hepatic extraction of tracer activity is decreased and excretion may be delayed or absent. Patients under 3 months of age with biliary atresia have normal hepatic extraction of tracer with no excretion into the gastrointestinal tract. Sonography in patients with a choledochal cyst shows a cystic mass in the porta hepatis with associated bile-duct dilatation. Hepatobiliary scintigraphy confirms that the choledochal cyst communicates with the biliary system. Initial sonography demonstrates hepatobiliary anatomy; subsequent phenobarbital-enhanced radionuclide scintigraphy determines hepatobiliary function. An expedient diagnostic approach is recommended for the evaluation of persistent neonatal jaundice.

Bile Ducts↗
PubMed1983

Localized pulmonary interstitial emphysema: treatment by bronchial occlusion.

Selective bronchial occlusion for the treatment of localized cystic pulmonary interstitial emphysema (PIE) offers a means to facilitate weaning from ventilatory support and to preserve potentially functional lung parenchyma. We employed a commercially manufactured balloon catheter, placed under direct visualization to occlude a left mainstem bronchus in two cases of localized PIE. This is the safest method for selective bronchial occlusion so far reported. Therapeutic success was achieved with either continuous or intermittent bronchial occlusion. Evaluation of pulmonary function with nuclear scintigraphy aids in determining the most appropriate position for the occluding catheter and permits assessment of the resultant improvements in pulmonary function.

Bronchi↗
PubMed1983

Gastroschisis--primary fascial closure. The goal for optimal management.

Since Raffensperger and Jona reported an 80% success rate with primary skin closure including a 16% rate of complete fascial closure in 24 patients with gastroschisis in 1974, primary fascial closure has been the author's preferred method. It has been possible to achieve complete fascial and skin closure in 17 of the last 21 patients (81%). Four infants in this series, one of whom was initially managed by another surgeon, were treated with brief application of a silon prosthesis with subsequent reduction and closure. The two keys to success of this method are thorough wash out of the meconium from the entire intestine and vigorous stretching of the abdominal wall. Assisted ventilation may be needed for 24 to 48 hours after operation and has been well tolerated. Transposition of an umbilical artery for cannulation and blood gas monitoring has been an important adjunct. The one death (5% mortality) resulted from prolonged bowel dysfunction and liver failure three months after operation. Other complications have been few and mild. Since some recent reports have indicated that primary closure is not being widely used in the treatment of gastroschisis, this series is presented to emphasize that this method can be used in most infants and with a very low complication rate.

Abdominal Muscles↗
PubMed1982

The association of malrotation and Hirschsprung's disease.

malrotation and Hirschsprung's disease are common gastrointestinal abnormalities in neonates and infants. Four patients with the association of malrotation and Hirschsprung's disease are reported. A delay in diagnosis may be complicated by midgut volvulus or enterocolitis. The diagnostic and therapeutic implications of this important association are discussed.

Barium Sulfate↗