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Biomedical subjects

J J Doski

Publications and source records attributed to J J Doski.

7 recordsLinked to original sources
PubMed2000

Management of parapneumonic collections in infants and children.

BACKGROUND/PURPOSE: Video-assisted thoracoscopic surgery (VATS) has a recognized role in treatment of empyema thoracis. The purpose of this report is to show the value of initial VATS as the primary treatment of parapneumonic collections. METHODS: A retrospective review was done of 139 children who required surgical consultation for parapneumonic collections between January 1992 and July 1998. Management options were (M1) thoracentesis, chest tube drainage, or fibrinolytic therapy and delayed thoracotomy for unresolved collections; (M2) thoracentesis, chest tube drainage, fibrinolytic therapy with delayed VATS if the child remained ill; or (M3) primary VATS. Comparative data included age, duration of prehospital illness, oxygen requirements, white blood cell count, bacterial culture results, number of procedures performed per patient, duration of chest tube drainage, complications, and length of stay. Kruskal-Wallis 1-way analysis was used, with significance at P less than .05. RESULTS: A total of 60 children were treated by M1, 38 by M2, and 41 by M3. Age, duration of prehospital illness, oxygen requirements, white blood cell count, bacterial culture results, and complication rates were comparable. The median length of stay was 12 days for M1, 11 days for M2, and 7 days for M3, with M3 significantly shorter at P<.001. The number of procedures was a median of 2 in M1, 2 in M2, and 1 in M3, with M3 significantly fewer at P<.001. Duration of chest tube drainage was a median 5 days for M1 and 3 days for M2 and M3, with M1 significantly longer at P<.001. There were 9 thoracotomies in the M1 group, 3 in the M2 group, and none in the M3 group. One child in M3 required a second VATS. CONCLUSIONS: Primary VATS has significantly decreased the number of procedures, duration of chest tube drainage and length of stay for children with parapneumonic effusions. Primary VATS appears to be of value in management of bacterial pneumonia with effusion.

Chest Tubes↗
PubMed1998

Pediatric wound infections: a prospective multicenter study.

OBJECTIVE: Surgical wound infections remain a significant source of postoperative morbidity. This study was undertaken to determine prospectively the incidence of postoperative wound infections in children in a multi-institutional fashion and to identify the risk factors associated with the development of a wound infection in this population. SUMMARY BACKGROUND DATA: Despite a large body of literature in adults, there have been only two reports from North America concerning postoperative wound infections in children. METHODS: All infants and children undergoing operation on the pediatric surgical services of three institutions during a 17-month period were prospectively followed for 30 days after surgery for the development of a wound infection. RESULTS: A total of 846 of 1021 patients were followed for 30 days. The overall incidence of wound infection was 4.4%. Factors found to be significantly associated with a postoperative wound infection were the amount of contamination at operation (p = 0.006) and the duration of the operation (p = 0.03). Comparing children who developed a wound infection with those who did not, there were no significant differences in age, sex, American Society of Anesthesiologists (ASA) preoperative assessment score, length of preoperative hospitalization, location of operation (intensive care unit vs. operating room), presence of a coexisting disease or remote infection, or the use of perioperative antibiotics. CONCLUSIONS: Our results suggest that wound infections in children are related more to the factors at operation than to the overall physiologic status. Procedures can be performed in the intensive care unit without any increase in the incidence of wound infection.

Child↗
PubMed1997

Heparin-associated thrombocytopenia and thrombosis as the cause of a fatal thrombus on extracorporeal membrane oxygenation.

A rare state of acquired hypercoagulability known as heparin-associated or heparin-induced thrombocytopenia and thrombosis (HATT, HITT) exists. It appears to be caused by an antibody reaction with heparin-platelet factor 4 complexes. A mild and severe form exist, but both varieties occur after exposure to heparin. The authors describe a fatal neonatal case of hypercoagulability on extracorporeal membrane oxygenation, and their evaluation that determined the etiology as type II HATT. They discuss the pathophysiology of HATT as well as possible alternative anticoagulation approaches.

Anticoagulants↗
PubMed1997

Outcome of infants requiring cardiopulmonary resuscitation before extracorporeal membrane oxygenation.

BACKGROUND/PURPOSE: Cardiopulmonary resuscitation (CPR) is reported to be used in a significant number of neonates before initiation of extracorporeal membrane oxygenation (ECMO). This report establishes the incidence of infants who require CPR before initiation of ECMO and elucidates survival rates and long-term neurological outcomes. In addition, the authors sought prognostic factors that could reliably predict survival or long-term neurological outcome before initiating ECMO support. METHODS: The Extracorporeal Life Support Organization (ELSO) registry provided data on 839 neonates who received CPR before ECMO from January 1989 to April 1995. Supplemental questionnaires on 414 infants were returned from 64 ECMO centers regarding details of the CPR event and subsequent neurological development. One-year neurological evaluations were provided on 112 infants. Data were analyzed for statistical significance using chi2, multiple logistic regression, and Kruskal Wallis one-way analysis of variance as applicable, with significance set at P < .05. RESULTS: The incidence of infants requiring pre-ECMO CPR was 13.1%. Infants who received pre-ECMO CPR had a survival rate of 60.8% versus 81.6% survival for infants who did not require CPR (P < .00001). Analysis of ELSO registry data showed survival was significantly associated with primary diagnosis, location of CPR, last pH level before ECMO, and the presence of intraventricular hemorrhage. Questionnaire data on 12-month neurological assessment showed 63% had no impairment and 4% were graded as severely impaired. Twelve-month neurological outcome was significantly associated only with primary diagnosis. CONCLUSION: A survival rate of 60.8% with good neurological outcome at 12 months in 63.4% of infants suggests that CPR alone should not be a contraindication to placing a neonate on ECMO.

Analysis of Variance↗
PubMed1997

Successful separation of ischiopagus tripus conjoined twins with comparative analysis of methods for abdominal wall closure and use of the tripus limb.

The authors report the successful delivery, preoperative management, and postoperative courses of ischiopagus tripus twin girls successfully separated at 5 months of age. Surgical objectives were predicated on survival and optimum postseparation reconstructive potential for both girls. Each twin has subsequently undergone additional procedures, and both are doing well 2 years after separation. The authors reviewed 17 known cases of ischiopagus tripus separation, comparing anatomic findings, use of the tripus limb, operative strategies, and attainment of abdominal closure. This 18th case includes the first report of splitting the tripus limb and giving each girl a femur. The authors found that detailed systemic investigation, advanced coordinated teamwork with appropriate technical support, applications of new technologies or reapplication of existing technologies, meticulous planning, and favorable anatomy were vital in yielding favorable outcomes.

Abdominal Muscles↗
PubMed1995

Duodenal trichobezoar caused by compression of the superior mesenteric artery.

Trichobezoars can occur in young women who have a history of trichotillomania, trichophagia, gastric dysmotility, and psychiatric dysfunction. A 6-year-old anorexic girl presented with a fixed right-upper-quadrant abdominal mass. Exploratory celiotomy for a duodenal trichobezoar led to removal of the large foreign body, via a duodenotomy, and prompted a Ladd procedure, in which the duodenum was moved from beneath the compressing superior mesenteric artery to relieve underlying duodenal narrowing.

Bezoars↗