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Biomedical subjects

I Vinograd

Publications and source records attributed to I Vinograd.

At least 37 records · Page 2Linked to original sources
PubMed1994

Acute scrotal pain complicating familial Mediterranean fever in children.

Twenty-nine children with familial Mediterranean fever presented with 39 attacks of acute scrotal pain. Of these, 25 patients had an acute scrotum complicating familial Mediterranean fever and only four had testicular torsion. Scrotal pain was the only manifestation of a familial Mediterranean fever crisis in 36 episodes and in 15 boys scrotal involvement was the first manifestation of the condition. Fourteen patients were treated medically. Of 15 patients who underwent scrotal exploration there were no definite diagnostic findings in 11 and four had testicular torsion. Three cardinal features strongly suggest the diagnosis of acute scrotum in familial Mediterranean fever in a boy of Mediterranean origin with a relevant family history: recurrent scrotal pain or swelling; body temperature above 37.5 degrees C; and gradual onset of pain, usually of more than 12 h duration. Conservative management can safely be undertaken in these boys without fear of losing a salvageable testis.

Acute Disease↗
PubMed1994

Continuous esophageal pH monitoring during laparoscopic cholecystectomy.

Gastro-esophageal regurgitation (GER) and eventual aspiration is considered a major risk during general anesthesia. High intraperitoneal pressure produced during laparoscopic cholecystectomy (LC) is a possible source of increased GER. We investigated the incidence of GER using continuous esophageal pH monitoring in 14 patients undergoing elective LC. Only two brief episodes of acid reflux (pH < 4) occurred during LC. Apparently the high intraperitoneal pressure during LC carries no increased risk of regurgitation and aspiration.

Adult↗
PubMed1994

General peritonitis induced by rectal examination: an unusual complication of primary psoas abscess.

Primary psoas abscess is a relatively rare disease with highest incidence in children and adolescents. It usually presents with fever, abdominal pain and limp. Limping tends to incriminate musculoskeletal problems below the pelvis, but movement of the hip involves the psoas muscle which is mostly retroperitoneal and intimately related to pelvic and intraperitoneal organs. Although the current tendency is to use abdominal sonography, rectal examination is still a valuable step in clinical examination, and may help to assess a pelvic mass or abscess. The following case report describes the elusive nature of psoas abscess and a rare occurrence of abscess rupture and peritonitis, immediately after rectal examination.

Child, Preschool↗
PubMed1994

Peritoneal ventilation: an animal model of extrapulmonary ventilation in experimental adult respiratory distress syndrome.

Adult respiratory distress syndrome (ARDS) is a critical medical problem in which severe arterial hypoxemia is often poorly responsive to conventional modes of mechanical ventilation. We studied the efficiency of mechanical ventilation of the peritoneal cavity in rabbits with experimental ARDS caused by lung lavage. The study shows that peritoneal ventilation is significantly effective in oxygenation of hypoxemic animals with ARDS and is also effective for carbon dioxide elimination. Peritoneal ventilation may be considered as an investigational method for extrapulmonary oxygenation in severe intractable hypoxemia caused by ARDS.

Animals↗
PubMed1994

Airway obstruction in neonates and children: surgical treatment.

OBJECTIVE: This review of 54 infants and children with airway obstruction who were treated surgically emphasizes the importance of the surgical indications with respect to various anomalies causing airway obstruction and the surgical approach to their management. PATIENTS: There were 4 etiologic groups of airway obstruction. Group A comprised 12 infants with subglottic stenosis; Group B--20 infants with tracheomalacia; 21 patients (Group C) with anatomic narrowing of the trachea; and 1 infant (Group D) with laceration of a main bronchus. METHODS: The surgical procedures performed included anterior laryngotracheal decompression in 12 infants, aortopexy in 19; 1 pulmonary arteriopexy; tracheal stenting with an autologous rib graft in 3 and with Marlex mesh in 1. Tracheal widening, using a free tibia autologous graft, was performed in 3 patients; transbronchoscopic excision in 12; anterior tracheal wedge resection in 4, and segmental tracheal resection and anastomosis in 1 patient. The lacerated bronchus was repaired with fine Dexon sutures. RESULTS: There were no operative deaths. With respect to the original indications for surgery, there were 3 failures--2 in Group A and 1 in Group C. Two patients died from causes unrelated to the procedures--one 10 days postoperatively, and the other 3 months after surgery. CONCLUSIONS: The surgical approach to tracheal obstruction in infants and children offers effective treatment, with no operative mortality, a low complication rate, and good long term survival.

Age Factors↗
PubMed1994

A new intratracheal stent made from nitinol, an alloy with "shape memory effect".

Temporary or permanent tracheal splinting in pediatric patients may be indicated in tracheomalacia or bronchomalacia, repair of congenital tracheal stenosis, and after tracheal resection. This study presents the results of the development of a new intraluminal airway stent made from titanium alloy, a metal with "shape memory effect". At low temperatures (martensitic state) the titanium alloy stent can be fashioned into a specific shape; then when heated to a higher temperature (austenitic state) the stent alters its shape, only to regain its original shape when recooled to the lower temperature. The stent, connected to a small electric power supply, was introduced into 20 young rabbits with the use of a 2.5 cm rigid bronchoscope. After implantation in the martensitic state the stent was warmed to 40 degrees C, the austenitic state, by an electric current of 1.5 to 3 ampere for 1 to 2 seconds. After a period of 8 to 10 weeks the stent was removed (in its martensitic state) through the same-sized bronchoscope after being cooled with 3 to 4 ml of 80% alcohol solution at 6 degrees C. No signs of airway obstruction developed in any of the animals after implantation or extraction of the stent. The biomechanical properties of the trachea, as shown by strain measurements with the use of incremental forces, showed significant differences between the stented and unstented segments (p < 0.005). The titanium alloy intratracheal stent adequately fulfilled the requirements of a temporary intraluminal airway splint, and because of its unique feature of shape memory effect the stent could be inserted, fixed, and removed easily, even in very small airways.

Alloys↗
PubMed1993

[Surgical treatment of tracheal obstruction in children].

47 infants and children with tracheobronchial obstruction requiring surgical treatment are reported. 10 had subglottic stenosis; 17 severe tracheomalacia; 19 intraluminal tracheal stenosis (in 2 of whom it was congenital); 12 granulation tissue or webs; 4 both tracheal stenosis and tracheal fistula; and 1 had a tear of the right main bronchus. The anterior cricoid splitting procedure for the management of severe acquired subglottic stenosis was performed in 10, in 2 of whom it failed and tracheostomy was required. Aortopexy was performed in 14 cases and pulmonary arteriopexy in 1. A rib cartilage graft and a prosthetic splint fabricated from Marlex mesh were applied in 2 cases after failed aortopexy. The 19 patients with tracheal stenosis were treated as follows: tracheal splitting with autologous free tibial periosteal graft was used in 2 infants; transbronchoscopic resection was successful in 12 children; wedge resection of the tracheal fistula and anterior anastomosis was done in 4; segmental tracheal resection with end-to-end anastomosis in 1; and suture of a bronchial tear was performed in 1. There was no operative mortality; 2 patients died; but the deaths were not directly related to surgery. In our experience, the surgical approach is both safe and expedient in relieving tracheal obstruction in most infants and children.

Child↗
PubMed1993

Chronic diffuse varioliform gastritis in a child. Total gastrectomy for acute massive bleeding.

Chronic diffuse varioliform gastritis is an uncommon, subacute, inflammatory gastric mucosal disease characterized by swollen congested rugae and disseminated mucosal erosions. The entity is exceptionally rare in children. The spectrum of reported symptoms is broad; frank hematemesis has never been reported in childhood. We present a child in whom the disease had a remarkably unusual clinical course. Because many caretakers were unaware of the existence of the disease in children, the patient had numerous hospitalizations and surgical procedures, until massive gastric bleeding resulted in unavoidable emergency total gastrectomy. Microscopical examination and immunofluorescent staining of the gastric mucosa confirmed the diagnosis of chronic diffuse varioliform gastritis.

Child↗
PubMed1993

Familial thyroglossal duct cyst.

Thyroglossal duct cysts are common congenital abnormalities or developmental field defects, usually detected in early childhood. Despite their frequent occurrence, familial patterns are rare. We report on two new families with thyroglossal duct cysts. In the first family three siblings were involved, while in the second one, father and son were affected. This trait may be autosomal recessive or possibly multifactorial, as the first family would indicate, and also autosomal dominant, as the second family would suggest.

Adult↗
PubMed1993

Oral blast injury caused by an accident.

Blast trauma within the oropharyngeal cavity may be associated with superficial or deep injuries. Superficial injury generally needs only observation; deeper injury that violates the retropharyngeal space may produce dissecting emphysema into the neck and mediastinum followed by prevertebral soft tissue infections and mediastinitis. Injury involving the parapharyngeal space might damage vital cervical vessels. Life-threatening complications may result unless treatment is adequate. Three children who sustained oropharyngeal blast injury are presented. The direct cause was the blast effect of a new, spoiled, orange-flavor beverage just released on the market. The bottle cap of the soft drink and its effervescent liquid "exploded" into their mouths while they were trying to open the bottle with their teeth. Obviously, the failure to observe due precautions, as frequently happens among children, contributed to the occurrence of the accidents. This paper describes the diagnosis, management, and relevant educational and preventive measures of the problem.

Accidents↗
PubMed1993

False-positive ultrasonography in agenesis of the gallbladder: a pitfall in the laparoscopic cholecystectomy approach.

We report a case of agenesis of the gallbladder in a 15-year-old girl incorrectly diagnosed as cholelithiasis on preoperative sonography and suspected at laparoscopic surgery. The diagnosis of agenesis was confirmed at open surgery with intraoperative sonography, intraoperative cholangiography, and postoperative radioisotope scan. Difficulties in preoperative diagnosis and the management during laparoscopic and open surgery are discussed.

Adolescent↗
PubMed1993

Miliary Crohn's disease: early or different?

We describe what we take to be the eighth case of miliary Crohn's disease since 1967 with a view to the possibility that miliary Crohn's disease is a disease different from Crohn's disease, and not just an early stage. Miliary Crohn's disease might be a different disease because (a) miliary tubercles are seen so rarely on the serosal surface of the bowel, (b) the 100% chance of finding crowded, typical granulomas in the bowel wall, and (c) the anatomic distribution of the lesion.

Adolescent↗
PubMed1992

Severe tracheomalacia associated with esophageal atresia: results of surgical treatment.

This study reviews our experience from 1977 to 1991 with 32 children born with esophageal atresia and tracheoesophageal fistula (EA-TEF) who later underwent surgery for severe tracheomalacia. Indications for surgery included dying spells (21), inability to extubate the airway (nasotracheal tube 5, tracheotomy 3), and recurrent pneumonia (3). Diagnosis was confirmed by chest x-ray, esophagogram, and bronchoscopy. Aortopexy was performed in 31 of 32 children; a splint without aortopexy was used in one older girl. Splinting was also necessary in two of the 31 at the initial operation, when aortopexy failed to prevent tracheal collapse. There were four initial failures. Currently, 29 children are well (median follow-up, 6.6 years). Two have a tracheostomy in place, and one, who had a vascular ring divided after aortopexy, died at home of unknown cause 1 month later. These findings indicate that aortopexy provides long-term relief of severe symptoms of tracheomalacia associated with EA-TEF in almost all affected children. When aortopexy fails, the insertion of an airway splint may succeed; otherwise, tracheostomy is necessary.

Aorta↗
PubMed1992

Nissen fundoplication in the treatment of children with familial dysautonomia.

Thirty-four children with familial dysautonomia (FD) underwent Nissen fundoplication and gastrostomy. The indications for operation were persistent cyclic vomiting that resulted in repeated aspiration pneumonia (94% of the patients), chronic dehydration (82%), failure to thrive (97%), and frequent hospitalizations (76%). There was no operative or early postoperative mortality. Long-term follow-up for up to 12 years was available. Eight patients died during this period from 7 months to 7.5 years postoperatively. In 5 patients (15% of the operated patients), the fundoplication ceased to function 16 months to 5 years postoperatively, which was attributed mainly to repeated severe dysautonomic crises with vigorous retching. Vomiting ceased in 85% of the symptomatic patients; pulmonary deterioration was halted, and the frequency of aspiration pneumonia was reduced in 68%; nutritional improvement was seen in 44%; the hydration status improved in 88%; and the frequency of hospital admissions decreased in 74%. These long-term findings resulted in a significant improvement in the quality of life for the majority of the patients. The absence of operative mortality and the low postoperative morbidity, together with the long-term beneficial results of this surgical procedure, should encourage early surgical intervention in selected FD patients.

Adolescent↗
PubMed1992

Case report: selective occipital lobe hydrocephalus and agenesis of the left lobe of the liver in congenital myotonic dystrophy.

Myotonic dystrophy (Steinert's disease) is an uncommon familial autosomal dominant disease, characterized by progressive muscular atrophy and myotonia. Mental retardation, frontal baldness, cortical lenticular opacities and testicular atrophy are other prominent features of a disease that involves predominantly striated muscle. There is little information regarding this disease in the radiological literature. The present report introduces two additional findings involving the skull and the liver.

Adolescent↗
PubMed1992

Unilateral hydroureteronephrosis caused by abdominoscrotal hydrocele.

Abdominoscrotal hydrocele is extremely rare in children. A case is presented of an unusually large abdominoscrotal hydrocele in a child, with secondary right hydroureteronephrosis due to contiguous pressure and right cryptorchidism. This entity, although unusual, should be considered in the differential diagnosis of a lower abdominal mass in children, as well as a cause of hydroureteronephrosis. Diagnosis is made with ultrasound, computerized tomography and occasionally excretory urography. Complete surgical excision through a groin incision is recommended, but optional inguinoabdominal or abdominal incisions have been reported. After surgical removal, healing is usually complete, including regression of the hydroureteronephrosis.

Abdomen↗