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Biomedical subjects

J L Cahill

Publications and source records attributed to J L Cahill.

18 recordsLinked to original sources
PubMed2001

Omphalocele, colonic atresia, and Hirschsprung's disease: an unusual cluster of malformations in a single patient.

Omphalocele, colonic atresia (CA), and Hirschsprung's disease (HD) are individually rare congenital malformations. An association between CA and HD has been described, but the co-occurrence of all three malformations has not been previously reported. We present an infant born with all three malformations and review the management issues relevant to this case, with an emphasis on the importance of considering co-existent HD in any infant born with CA.

Abnormalities, Multiple↗
PubMed1998

Elective transplant pneumonectomy.

The use of a single lung transplant, modified with removal of the middle lobe of the donor right lung, has been described for a term neonate with respiratory distress secondary to right-sided congenital diaphragmatic hernia. The successful transplant allowed the patient to be successfully weaned from extracorporeal membrane oxygenation. Because of the early age of the patient at transplantation (3 weeks), it was unclear how the patient's left lung would develop, and there was uncertainty regarding the risk of life-time immunosuppression. By the age of 4 years, 10 months, she was demonstrating some failure to thrive, hypertension, and hirsutism, obvious side effects of chronic immunosuppression. The question was raised as to the potential for transplant pneumonectomy. A ventilation-perfusion scan demonstrated a decrease of right lung ventilation compared with the immediate postoperative period (27% versus 43%); right heart catheterization with balloon occlusion of the right main pulmonary artery suggested that the patient would tolerate right pneumonectomy. After discussion with the family, the patient underwent transplant pneumonectomy via a right posterolateral approach. Findings at the time of operation included mild to moderate adhesions as well as recurrence of the diaphragmatic hernia. She tolerated the procedure well and was discharged home on the fifth postoperative day with cessation of her immunosuppression. The immediate and medium-term success of this procedure suggests the potential for temporizing transplantation as a palliation to promote survival until the remaining native lung can provide sufficient ventilation.

Child, Preschool↗
PubMed1998

Outcome of Nissen fundoplication using intraoperative manometry in children.

BACKGROUND: Intraoperative manometry is useful in performing Nissen fundoplication (NF) in children. Long-term clinical outcome information after use of this method is lacking. METHODS: A retrospective review of the outcomes of 62 consecutive NFs using intraoperative manometry was performed. The follow-up period was 3.4 years. Approximately half of the patients were neurologically normal (NN) and half were neurologically impaired (NI). All patients with gastroesophageal reflux disease (GERD) did not respond to an adequate trial of medical treatment. RESULTS: The NF was tailored to result in a twofold increase in the lower esophageal sphincter pressure (LESP) and a 75% increase in the LES length (LESL). An accelerated growth rate in 40% of "failure to thrive" (FTT) patients was demonstrated. Eighty-four percent of caregivers reported improved quality of life after NF. There was a twofold reduction in the number of hospital admissions and a sixfold reduction in total inpatient days for both NI and NN children. The early and late mortality rate was 13%, and the complication rate was similar to other series reported in the literature, with more complications occurring in NI patients. There was a 2% incidence of wrap herniation. An improvement in long-term outcomes after NF was seen in 89% of NN children and over half of NI patients. CONCLUSIONS: Intraoperative manometry is useful in standardizing the tightness of the wrap in NF. There was a low incidence of complications, dysphagia, recurrent emesis, and GERD in this series. Long-term outcomes using this technique were deemed very good based on caregivers' responses.

Adolescent↗
PubMed1994

Symptomatic brachial artery aneurysm in a child.

The authors present the case of a 3-year-old boy who had transient ischemic symptoms secondary to thromboembolism from a left brachial artery aneurysm not associated with trauma or an autoimmune or connective tissue disorder. He underwent emergency resection of a brachial artery aneurysm and interposition grafting. Two months later he was found to have a right brachial artery aneurysm and underwent elective aneurysm resection and interposition grafting. He was well at the 3-year follow-up and had no other arterial aneurysms. The risk of limb threat or loss can be avoided by prompt diagnosis and early surgery. The authors advocate brachial artery aneurysm resection when it becomes technically feasible and/or when thrombus is present. Patients with upper extremity aneurysms should have continuous follow-up with serial examinations to detect concomitant or subsequent aneurysm formation.

Aneurysm↗
PubMed1991

Bronchioloalveolar carcinoma of the lung and congenital cystic adenomatoid malformation.

A case of bronchioloalveolar carcinoma of the lung is described in a 19-year-old man who had had a lobectomy in infancy, for removal of a congenital cystic adenomatoid malformation. It is suggested that congenital cystic adenomatoid malformation may predispose a patient to development of epithelial malignancies of the lung, whereas mesenchymal hamartomas usually are associated with nonepithelial neoplasms.

Adenocarcinoma, Bronchiolo-Alveolar↗
PubMed1985

Results after posterior sagittal anorectoplasty: a new approach to high imperforate anus.

Six patients, 3 to 12 months of age have undergone posterior sagittal anorectoplasty for high imperforate anus. A rectourethral fistula was present in all patients. The operative procedure performed was the method of de Vries and Pena, utilizing electrostimulation and identification of the external sphincter muscles. One patient required an abdominal operation as well as the perineal approach. There were no complications. Serial assessment was carried out over a period of 4 months to 2 1/2 years. Normal continence was achieved in three patients. Anorectal manometry was performed in five patients. Four of five patients had normal rectal sensation and normal mean anal canal pressures. These results suggest that this procedure is applicable to the young infant with high imperforate anus, and a satisfactory result can be anticipated.

Anal Canal↗
PubMed1984

A summary of preoperative and postoperative cardiorespiratory performance in patients undergoing pectus excavatum and carinatum repair.

Preoperative and postoperative pulmonary function tests and progressive work exercise performances were compared for fourteen pectus excavatum and five pectus carinatum patients who underwent operative repair. No changes could be documented in the pectus carinatum patients. The excavatum patients demonstrated a small improvement in total lung capacity (P less than .02) and a significant improvement in maximal voluntary ventilation (P less than .001). In addition, the exercise performances were improved for the excavatum patients postoperatively as quantitated both by the total exercise time and the maximal oxygen consumption (P less than .01). In addition, at any given work rate, the excavatum patient demonstrated a lower heart rate and higher minute ventilation after operation. These findings support the hypothesis that both the restricted cardiac stroke volume and the increased work of breathing that have been described in pectus excavatum patients can be ameliorated by operative intervention.

Adolescent↗
PubMed1983

Experiences with phrenic nerve pacing in children.

We report a series of four spinal cord-injured children with ventilator dependency who were implanted with radiofrequency phrenic nerve pacers. At injury, their ages ranged from 6 to 9 years. Implantation occurred from 15 to 47 months following injury. The longest term of pacing has been 59 months. One patient, who was being paced full-time, died suddenly at 32 months of a viral myocarditis. Two patients underwent bipolar phrenic implantation in the neck, while two other patients underwent bilateral thoracotomy with monopolar electrode implantation in the mediastinum. There have been no complications related to pacer dysfunction in the postoperative course. Selective pacing schedules have been developed to minimize problems related with external mechanical ventilation. Radiofrequency phrenic nerve pacing is of value in the complete rehabilitative management of these severely disabled children.

Adult↗
PubMed1982

Follow-up studies on patients undergoing Nissen fundoplication utilizing intraoperative manometry.

Intraoperative esophageal manometry has been developed for use in children as a guide to optimizing the surgical results of Nissen fundoplication. Eighty-two Nissen fundoplication operations were performed using intraoperative manometry. Follow-up manometry was performed within 6 wk postoperatively in 45 patients and later than 6 wk postoperatively in 33 patients. The mean preoperative lower esophageal sphincter pressure (LESP) was 13 mm Hg. The mean postoperative LESP was 42 mm Hg. LESP was found to drop in the early postoperative period nearly 40%. There was minimal further decline in LESP between the early and late follow-up determinations. Lower esophageal sphincter length (LESL) was measured both pre- and postoperatively in 56 patients with an average increase of 1.4 cm. There was a very mild decline in LESL in the late follow-up period. The clinical course of these patients was correlated with manometric findings. The routine use of gastrostomy has been found to be unnecessary.

Adolescent↗
PubMed1979

Incidence and significance of gastroesophageal reflux following repair of esophageal atresia and tracheoesophageal fistula and the need for anti-reflux procedures.

Patients with esophageal atresia and/or tracheoesophageal fistula are known to have disordered esophageal motility, but the incidence of significant gastroesophageal reflux requiring anti-reflux surgery remains undocumented. We have studied a series of patients from 2 wk to 13 yr post-repair, utilizing manometric motility and acid reflux techniques. All demonstrated abnormalities of esophageal motility, including aperistalsis, low amplitude contraction, and simultaneous contractions. Lower esophageal sphincter pressures ranged from 7 to 50 mm Hg. Fourteen patients demonstrated signifcant reflux and six patients required anti-reflux surgery for recurrent pneumonia or recurrent stricture. The incidence of significant gastroesophageal reflux requiring antireflux surgery appears significant following repair of esophageal atresia and/or tracheoesophageal fistula.

Child↗
PubMed1978

Use of intraoperative esophageal manometrics in surgical treatment of gastroesophageal reflux in pediatric patients.

Intraoperative lower esophageal sphincter (LES) pressures and lenghts were measured in 10 pediatric patients requiring surgery for compications of gastroesophageal reflux. LES pressure changed significantly pre- and post-Nissen fundoplication (9.8 +/- 1.51 mm Hg vs. 32.8 +/- 2.68 mm Hg, p less than 0.001). LES length also showed a significant change (1.3 +/- 0.13 cm vs. 2.8 +/- 0.26 cm, p less than 0.001). One week postoperatively LES pressures were significantly greater than preoperative values (26.4 +/- 1.74 mm Hg vs. 15.6 +/- 2.64 mm Hg, p less than 0.01). Eight of 10 patients have been evaluated 6 mo post fundoplication. None has gastroesophageal reflux by acid reflux testing or water siphon barium esophagram. None of the 10 patients has had gas bloat syndrome during the follow-up period.

Adolescent↗
PubMed1976

The evolution of the concept of the use of surgical castration in the palliation of breast cancer in pre-menopausal females.

The understanding of the association of mammalian ovarian function with lactation was common knowledge to dairy-men early in the 19th century or earlier. This thesis reviews the application of these empiric observations to lactation in humans by Beatson of Glasgow, supported by his preliminary laboratory investigations. Beatson noted the cellular anatomic similarity between pre-gestational breast and carcinoma. This study reviews the progressive development of the successful clinical application of castration for the control of inoperable breast cancer by Beatson in pre-menopausal women in 1895. The review terminates with its leading to the monumental work of Huggins in 1941.

Breast Neoplasms↗