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Biomedical subjects

J D Burrington

Publications and source records attributed to J D Burrington.

At least 19 recordsLinked to original sources
PubMed1993

Hirschsprung's disease complicating colon atresia.

An infant with the rare association of colon atresia, total colonic Hirschsprung's disease, and tetralogy of Fallot is presented. While Hirschsprung's disease associated with atresia of the colon has been reported five times previously, this is the first case with associated congenital cardiac disease. As in previous reports, initial operations to relieve obstruction due to the colon atresia failed because of the unrecognized aganglionosis. This infant initially had an ileostomy performed as a newborn and then two failed attempts at closure of the ileostomy. In this case, as in four previously reported cases, histological examinations of resected colon from the initial operations were first reported as normal and only under the pressure of increasing clinical evidence was the pathology reviewed and the absence of ganglion cells appreciated. We stress the importance of suspecting the coexistence of Hirschsprung's disease and colon atresia when a functional obstruction is present after repair of the atresia.

Colon↗
PubMed1989

A standard of comparison for acute surgical necrotizing enterocolitis.

We reviewed 187 cases of documented neonatal necrotizing enterocolitis (NEC) from 1976 to 1988. Of these patients, 111 infants underwent celiotomy for acute surgical complications. The following protocol of operative indications was employed: pneumoperitoneum, localized mass, abdominal wall erythema, portal venous air, and clinical deterioration, singly or in any combination. Clinical deterioration was defined as falling platelet count, rising or falling white blood cell count, left shift in the myeloid series, persistently or progressively low pH, and increasing frequency of apnea or bradycardia. Overall mortality was 15% (28 of 187). For the patients who underwent celiotomy, all had histologic confirmation of NEC. Ninety-five had localized disease, and 16 had diffuse disease. All of the former had resection and diverting enterostomy with 85 (89.5%) surviving; none with diffuse disease survived, P less than 0.0001. Forty-one infants with NEC weighed less than 1,000 g; 25 underwent surgery and 15 (60%) survived. Fifty-one of the 159 surviving neonates (32%) developed intestinal strictures. All neonates with strictures have had resection and successful reconstruction of their gastrointestinal tract. These indications and surgical principles resulted in a high degree of diagnostic accuracy and a low degree of surgical mortality.

Clostridium↗
PubMed1988

Complications of the Martin procedure for total colonic aganglionosis.

From 1976 to 1986 inclusive, 122 patients were cared for with Hirschsprung's disease. Sixteen of these were treated for total colonic aganglionosis, with or without small bowel involvement. The male to female ratio was 2.2:1. Two children died prior to definitive surgical therapy and two others were transferred following initial therapy. Twelve children underwent Martin's procedure with a 0% mortality rate and an 81.8% morbidity rate. This study would indicate, as do others, that even though the Martin procedure can safely be performed, the long-term results require close scrutiny. A re-evaluation of this procedure and its alternatives is necessary in order to improve long-term results.

Anastomosis, Surgical↗
PubMed1988

Extensive tumor resection under deep hypothermia and circulatory arrest.

The risk of fatal hemorrhage may limit the completeness of resection in hepatic malignancies and in vascular extensions of Wilms' tumors. We have used Ein's technique of deep hypothermia (average 17 degrees C) with cardiac arrest (average 39 minutes) and exsanguination in performing five hepatic and two intravenous Wilms' tumor resections. The initial hepatic resection takes less than 15 minutes to perform in a bloodless field and the specimen is immediately examined by frozen section for determination of adequacy of margin. Additional resection is easily performed. Of four trisegmentectomies and one left lobectomy, two required additional resections. Mattress sutures were used to control hemorrhage during recirculation. One patient died from bleeding and cardiac decompensation and another from recurrence of tumor. The Wilms' tumors extended from the iliac vein into the right atrium in one child and from the right renal vein to the right atrium with extensions into the hepatic and lumbar veins in another. After nephrectomy, the atria and inferior vena cava were opened and the tumor extracted under direct vision. Both patients are well.

Carcinoma, Hepatocellular↗
PubMed1988

Comparison of totally implanted reservoirs with external catheters as venous access devices in pediatric oncologic patients.

Long term venous access devices have become an important part of the standard care for children with malignant diseases requiring chemotherapy. A prospective nonrandomized study was conducted between January 1985 and January 1987 examining complications, child and parental acceptance and costs between totally implantable venous access devices (ports) and externally exiting catheters. Fifty ports were placed in 49 patients who had a median age of ten years; median implant time was 350 days. Forty-one catheters were placed in 39 patients who had a median age of eight years; median implant time was 365 days. Both devices provided equivalent venous access. Although catheters were initially less expensive, the cost for both devices was comparable by the six month point. Beyond this time, an increasing savings was realized when the port was used. Catheter device complications occurred 14 times compared with seven with ports (p less than 0.02). There were 15 infectious complications with catheters compared with seven with ports (p less than 0.01). Child and parental acceptance questionnaires indicated that the ports were easier to care for and more readily accepted in children older than 11 years than were catheters (p less than 0.001). Totally implanted reservoirs are effective alternatives to external catheters for venous access in children with cancer.

Adolescent↗
PubMed1987

Anesthesia for intraoperative radiation therapy in children.

Intraoperative radiation therapy (IORT) is a relatively new mode of cancer treatment which is being used with increasing frequency. IORT presents several challenges to the anesthesiologist, including patients who are debilitated from their disease or chemotherapy, operations involving major tumor resections, intraoperative interdepartmental transport of patients, and remote monitoring of patients during electron beam therapy. This report discusses the anesthetic management of ten children undergoing IORT. With adequate preparation and interdepartmental communication, complications can be avoided during these challenging cases.

Adolescent↗
PubMed1986

Occult coin perforation of the esophagus.

Only a small number of ingested foreign bodies perforate the esophagus and even a smaller fraction migrate extraluminally with no symptoms. Both of these events are even rarer after coin ingestion. Between 1972 and 1984, three children (16 months to 5 years), who had unabating upper respiratory symptoms, were found to have ingested coins. In only one child could the time interval between ingestion and appearance of symptoms (3 years) be established, and in this child the diagnosis was delayed because of failure to x-ray the chest after an ingestion episode. Surgical evaluation included chest/neck films: tracheal and esophageal shadows were separated by the object and a soft tissue mass; esphagogram: deviation of the esophagus, irregularity of the lumen, and no leak or tracheoesophageal fistula (TEF) and esophagoscopy: mucosa was intact with no direct visualization of the coin. Treatment consisted of exploration: cervical, one; thoracic, two; localization: coin in extraluminal granulomatous soft tissue; removal: without resection of the soft tissue mass or esophagus, and drainage: penrose, one; chest tube, two. There was no morbidity or mortality from 1 to 13 years later. Though generally harmless, ingested coins are capable of penetrating the esophagus. Sporadic literature reports confirm that the clinical findings and operative results are typical of this seemingly intermediate stage between perforation with mediastinitis and perforation with TEF.

Child, Preschool↗
PubMed1985

Modified fundoplication technique for correction of gastroesophageal reflux in children.

A modification of the Nissen fundoplication for correcting GER in children is described. This method involves creating a reinforced fundoplication below the diaphragm at the gastroesophageal junction. Two additional lateral rows of sutures are used to reinforce the conventional Nissen fundoplication. This modified technique prevents symptomatic recurrence by lessening the chance of disruption of fundoplication sutures, and it prevents formation of paraesophageal hiatal hernia. We conclude that the modified fundoplication technique is both safe and effective for use in treating children with GER.

Age Factors↗
PubMed1984

Surgery of acquired lobar emphysema in the neonate.

Surgical treatment for pulmonary interstitial emphysema (PIE) has been reported with increasing frequency. We have done pulmonary lobectomies in 14 neonates with the localized form of PIE. This type of treatment was successful in 11 patients. Two patients expired in the hospital and one showed no improvement. Another six very compromised patients with diffuse PIE were treated during the same period with multiple visceral pleurotomies. Only one survived. Infants with diffuse PIE are usually poor surgical candidates, while those with acquired lobar emphysema (ALE) have been treated successfully with lobectomies.

Female↗
PubMed1984

Chest injuries in children.

Chest injuries of varying severity occur commonly in children, much more as a result of motor vehicle accidents and falls from a height than from penetration. The author reviews the injuries that occur with reference to mechanism, immediate and late treatment and monitoring. The differences between the injuries of children and those of adults stem from the greater resilience of most structures in children; bony injuries are not necessarily extensive even when disruptions of the lung and blood vessels are serious. Pneumothorax may occur alone or with other injuries. A chest tube should be inserted early. Persistence of the pneumothorax may indicate the presence of a tracheobronchial tear which must be repaired by thoracotomy. A flail chest may be treated without intubation if blood-gas levels are normal. In the presence of paradoxical motion and increased carbon dioxide pressure, intubation and positive-pressure ventilation are required for a few days. Penetrating wounds require the same care as in adults. Diaphragmatic tears occur from falls from excessive heights or direct passage of vehicle wheels over the chest or abdomen. Ventilation becomes progressively more inefficient. Esophageal tears occur from irregular foreign bodies. Great-vessel injuries occur by penetration. The author establishes priorities in management to assure adequate oxygen utilization, arrest of hemorrhage and restoration of circulation. Following stabilization efforts, monitoring procedures are instituted. These include insertion of central venous pressure and arterial lines to measure pH, carbon dioxide and cardiac output as well as for other biochemical and hematologic measurements.

Bronchi↗
PubMed1984

Primary hyperparathyroidism, pregnancy, and neonatal hypocalcemia.

Primary hyperparathyroidism in the mother during pregnancy is known to result in a high rate of fetal complications; spontaneous abortions, still births, and neonatal tetany occur in excessive incidence. To understand the pathophysiology of neonatal hypocalcemia that accompanies this disorder, transplacental calcium dynamics were studied in female sheep during the last trimester of pregnancy and in their fetal lambs after hysterotomy. Calcium ion was shown to move rapidly across the placenta. However, this organ blocked the passage of both parathyroid hormone and calcitonin from the maternal and to the fetal circulations. Our studies support the hypothesis that in primary hyperparathyroidism maternal hypercalcemia results in fetal hypercalcemia, which leads to suppression of fetal parathyroid gland function. In such a situation, neonatal hypocalcemia would occur after birth when maternal calcium flow is interrupted. Parathyroidectomy performed in the mother, especially during the second trimester of pregnancy when operation is safest, would break this cycle and permit normal serum calcium homeostasis in the fetus.

Animals↗
PubMed1980

Immunologic response in splenectomized and partially splenectomized rats.

One of the following procedures was carried out in 112, 200-gr, Sprague-Dawley rats: (A) sham operation, (B) hemisplenectomy, (C) 90% splenectomy, (D) total splenectomy and autologous spleen transplants in either omental, muscle, or subcutaneous pouch after total splenectomy, and (E) homologous splenic transplants after splenectomy. The rats were challenged intravenously with sheep, cat and guinea pig erythrocytes 6 wk, 3 mo, and 6 mo postoperative. All totally splenectomized rats had significantly reduced primary responses, regardless of whether fragments of splenic tissue had been grafted or not. There was initial lowering of primary response in partially splenectomized animals but they responded significantly better than totally splenectomized rats. After 6 mo the primary response in the hemisplenectomy group was not significantly different from the nonoperated control group. The primary response in the 90% splenectomy group had improved significantly when compared to the total splenectomy group and normal controls. Total splenectomy and partial splenectomy did not appreciably reduce the ability to mount secondary and teritary responses.

Animals↗
PubMed1980

Exercise and children.

Children are naturally active and enjoy many forms of physical activity. Each community, family, and physician owes the children in his care the opportunity to exercise and compete to the limits of their ability under supervised programs that will encourage a life-long participation.

Adolescent↗
PubMed1979

Familial nesidioblastosis: severe neonatal hypoglycemia in two families.

Severe neonatal hypoglycemia with pathologic findings of diffuse nesidoblastosis of the pancreas is described in five children of both sexes from two families with unaffected parents. This appears to represent an autosomal recessive disorder of pancreatic development. Despite extensive testing, the diagnosis of hyperinsulinism was difficult in the index case of each family and delayed definitive treatment. Medical therapy with steroids and diazoxide was unsuccessful; pancreatectomy was required to treat persistent hypoglycemia. An abnormality of circulating glucagon found in one child with this disorder suggested that hyperinsulinism may not be the sole hormonal imbalance present, but rather that this disease is one of generalized disturbance of islet cell function. The history of severe, persistent neonatal hypoglycemia in an older sibling should lead the physician to investigate subsequent children for the presence of asymptomatic hypoglycemia.

Chromosome Aberrations↗