Biomedical subjects
Publications and source records attributed to J A Borger.
A 15 year old with Duke's C2 adenocarcinoma of the rectum was treated with a sphincter-saving surgical resection and adjuvant chemotherapy and radiation. The patient is alive and has been disease-free for over 5 years. Adenocarcinoma of the colon is a virulent disease in children and has a poor prognosis. The reasons for this are explored, and a literature review is included.
A 15 year old with severe malignant ascites, refractory to medical management, was treated with a venous port. This proved to be an effective way to control the ascites and was easily placed under local anesthesia, with little risk or discomfort to the patient.
Foreign bodies of the esophagus may penetrate the wall and migrate extraluminally, requiring a thoracotomy for removal. We report two children who swallowed coins that went undetected for several months and slowly eroded into the esophageal wall. These coins could not be retrieved by upper endoscopy, because of proximal strictures and granulation tissue at the perforation sites. Following surgical gastrostomy and retrograde flexible endoscopy, the coins were successfully removed. Retrograde endoscopy should be considered for removal of foreign esophageal objects before undertaking a thoracotomy.
Four patients presented with large intra-abdominal masses. Three patients were diagnosed as having hepatoblastomas of the right hepatic lobe, one of the left lobe. Initially these tumors were unresectable, and after biopsy each patient was treated with a standardized chemotherapy protocol. All tumors decreased remarkably in size and were resected successfully. Postoperative chemotherapy was then instituted and, as of this date, three of the children appear to be disease free; the fourth had a pulmonary metastatic lesion completely resected. Contrary to the dismal past history of patients with initially unresectable hepatoblastomas, treatment with preoperative chemotherapy, surgery and postoperative chemotherapy has had most rewarding results.
Carcinoma of a thyroglossal duct cyst is a rare occurrence, first reported by Ucherman in 1910. Less than 100 cases have been reported. most cases have been papillary carcinoma. We report the uncommon occurrence of a mixed papillary-follicular carcinoma in thyroglossal duct cyst in a 12-year-old girl. The controversy regarding surgical management is reviewed.
Two neonates with multiple congenital anomalies presented with contamination of the urinary tract with fecal organisms. Both patients had normal anorectal areas but in both, a work-up of the urinary tract infection including cystogram and barium enema revealed a rectovesical fistula. This is highly unusual and as far as can be determined, no reports similar to this could be found. Patient 1 succumbed from severe cardiovascular disease after colostomy so that no further diagnostic or therapeutic measures could be taken. Patient 2 underwent sigmoid colostomy to divert the fecal contamination of the bladder. He then underwent successful surgical division of the rectovesical fistula from an abdominal approach and subsequently had his colostomy closed. Intraoperatively, a catheter placed in the fistula via the rectum was quite helpful in identification of the fistula. This very unique lesion in this second patient was one of a constellation of anomalies including megalourethra, epispadiac urethral fistula, undescended testes, bilaterally, a floppy lower abdominal wall, and absent left kidney. This patient could be construed as a variant of the prune belly syndrome.
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Nevi over the size of a dime at the time of birth should probably be removed. Nevi this size often cannot be differentiated histologically from the true giant nevus that may cover over 50% of the body. Giant nevi have a 2%-30% malignant potential. In order to avoid the morbidity of split-thickness skin grafts when removing the larger nevi, we have been successful in serially excising many nevi as ambulatory procedures. Most moderately large nevi, regardless of their location, can be managed with this method.
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An 8-week-old infant presented with vomiting and failure to thrive due to small bowel obstruction caused by a diffusely enlarged pancreas. Surgical bypass of the obstruction was followed by secretory diarrhea, hypokalemia, and dehydration. Plasma vasoactive intestinal peptide (VIP) (823pg/ml), pancreatic polypeptide (4,500 pg/ml), and neurotensin (680 pg/ml) concentrations were markedly elevated. No neoplastic process was identified. Therapy with the long-acting somatostatin analogue SMS 201-995 was followed by decline in VIP concentrations (900 to 200-300 pg/ml), decrease in stool frequency, and normalization of serum electrolytes. During 12 months of somatostatin analogue therapy, length and weight progressed along the 3rd percentile on the Tanner growth chart.