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Biomedical subjects

J L Talbert

Publications and source records attributed to J L Talbert.

At least 19 recordsLinked to original sources
PubMed1992

Pseudomembranous colitis following resection for Hirschsprung's disease.

Enterocolitis is the most common cause of significant morbidity and death in Hirschsprung's disease. Although most cases respond to nasogastric decompression, antibiotics, and colonic evacuation, some children have an unusually fulminant or protracted clinical course. Four cases are reported of pseudomembranous colitis (PMC) that developed 1 to 18 months (mean, 8 months) after definitive surgery for Hirschsprung's disease (Soave endorectal pull-though, 2; Duhamel procedure, 2). While all children presented with fever, abdominal distention, and diarrhea, indistinguishable from typical Hirschsprung's enterocolitis, the clinical course was fulminant in two cases, both of whom died of septic shock. Postmortem examination in both showed extensive colonic pseudomembranes despite identification of Clostridium difficile toxin and subsequent vancomycin therapy (initiated late in the clinical course). Two children in the series had protracted hospitalizations and eventually required diverting enterostomy despite recognition of C difficile toxin and treatment with enteral vancomycin, in one child necessitating multiple courses of antibiotic therapy. Awareness of the virulence of PMC associated with Hirschsprung's disease (even after definitive resection) should prompt submission of stool specimens from any child who presents with enterocolitis for both C difficile culture and toxin levels. On the basis of our experience it is our policy to initiate a prompt course of vancomycin by rectal lavage or nasogastric tube in all children with Hirschsprung's enterocolitis, pending culture results, in view of the significant morbidity and mortality exemplified by cases in this review.

Administration, Rectal↗
PubMed1979

Use of Teflon mesh for repair of abdominal wall defects in neonates.

Since 1975, we have employed Teflon mesh sutured to the fascial rim in four newborns with giant omphaloceles, with approximation of skin flaps over the mesh. By stabilizing the anterior abdominal wall, the Teflon mesh has prevented formation of large ventral hernias. The mesh has been retained in place for a year or longer, until the growth of the child permits excision of the prosthesis and fascial approximation without difficulty. A similar technique has been successfully employed in a fifth neonate following transabdominal correction of congenital bilateral eventration of the diaphragm to avoid unacceptable increase in intra-abdominal pressure with primary closure of the abdominal wall. The Teflon mesh appears ideally suited for this technique. It is well incorporated into the fascial rim with minimal foreign body reaction. At the time of secondary repair, the mesh can easily excised from the smooth underlying pseudomembrane covering the bowel. All infants achieved stable abdominal walls by this technique. Three patients have undergone excision of the Teflon mesh and fascial repair at 12, 15, and 36 mo of age without difficulty.

Abdominal Muscles↗
PubMed1979

Distal spleno-renal shunt for portal decompression in childhood.

Successful portal decompression presents a unique challenge in children. The meso-caval shunt, utilizing the large caliber iliac vein in constructing the anastomosis, has been accepted as the standard operative procedure for treating these patients. Technical and anatomic difficulties, however, often prevent the successful performance of this shunt. The proximal spleno-renal shunt, advocated by many as an alternative in children, incurs the penalty of splenectomy. Furthermore, in both techniques, portal venous blood is preferentially shunted from the liver, posing a potential for subsequent development of hepatic encephalopathy as the patients mature. The distal spleno-renal shunt avoids these problems by selectively decompressing the esophageal venous plexus through the spleen. With this procedure, the majority of portal venous blood flow is maintained and the spleen is preserved. The present report describes three children in whom the distal spleno-renal shunt has been successfully employed for portal decompression. The youngest of these patients was 2 1/2 yr of age at the time of operation and has a patent portal-systemic shunt 18 mo postoperatively. This experience confirms the effectiveness of the distal spleno-renal shunt as an alternative to the meso-caval shunt, especially in children with inflammatory involvement of the superior mesenteric vein.

Child↗
PubMed1979

Thoracoscopy in children.

Dissatisfied with standard techniques for pulmonary diagnosis in children, we have evaluated the usefulness of thoracoscopy for diagnosis of intrathoracic pathology. Between July 1, 1975, and May 1, 1978, 65 thoracoscopy procedures have been performed in 57 children at the University of Florida. Thirty-four procedures were performed in immunosuppressed patients to rule out Pneumocystis carinii pneumonia. Twenty of these patients were proven to have Pneumocystis pneumonia, a diagnostic accuracy of 100%. Twelve nonimmunosuppressed patients underwent thoracoscopy for the diagnosis of persistent pulmonary infiltrates with a 100% diagnostic accuracy. Fifteen procedures were performed for the diagnosis of intrathoracic tumors. In two patients, previously unsuspected areas of involvement were encountered while in two patients false-negative biopsies were obtained. Four patients underwent therapeutic thoracoscopy. In three small infants, unsuccessful attempts were made to unroof pulmonary cysts through the thoracoscope and one patient underwent a talc poudrage. Thoracoscopy has proven to be a safe and rapid procedure which may be performed under local anesthesia without need for endotracheal intubation. In patients with pulmonary infiltrates, the accuracy has been 100%. The capability of viewing the entire hemithorax has proven valuable in evaluating children with intrathoracic tumors. Complications have included pneumothorax in six patients and bleeding in two.

Adolescent↗
PubMed1979

Thoracoscopy. Early diagnosis of interstitial pneumonitis in the immunologically suppressed child.

Interstitial pneumonitis in immunosuppressed patients demands prompt diagnosis and treatment. In an effort to achieve a simple yet highly accurate method of diagnosis, we have evaluated the usefulness of thoracoscopic examination. Twenty-seven procedures have been performed in 24 patients between the ages of 17 months and 18 years. All patients were immunosuppressed, most for treatment of malignant processes. All procedures have been performed under anesthesia with intravenously administered ketamine, without endotracheal intubation. A definitive diagnosis has been made in every case, with pneumonia due to Pneumocystis carinii being identified in 18 instances. Complications have been minimal and include four minor pneumothoraces, two instances of bleeding, and two instances of prolonged air leak. Mortality attributable to the procedure has been nil, although five patients have died due to their underlying diseases within 30 days of the thoracoscopic procedure. Thoracoscopy has proven to be a rapid and safe technique for providing accurate histologic and bacteriologic diagnoses in these critically ill children.

Adolescent↗
PubMed1979

Morphologic and functional effects of esophageal cryotherapy.

With advances in equipment design, cryotherapy has been applied increasingly in the management of various integumentary disorders. Recently, endobronchial cryotherapy has been utilized in the treatment of acquired tracheal strictures. To evaluate the effects of cryotherapy upon the esophagus, we cooled the distal esophagus of 12 cats to -70 degrees to -80 degrees C. for 2 minutes with a specially constructed cryoprobe. The animals were put to death in pairs 90 minutes, 4 days, 10 days, 14 days, 28 days, and 42 days following cryotherapy. Immediately prior to sacrifice, all animals were studied with esophageal cinefluoroscopy and esophageal manometrics. All animals tolerated this degree of cryotherapy and gained weight on an ad libitum diet. Manometric studies demonstrated diminished amplitude of peristalsis immediately following cryotherapy, but prompt return to a normal manometric pattern. There was no evidence of esophageal dysfunction on esophageal cinefluoroscopy. Morphologic examination demonstrated superficial ulceration between 4 and 10 days following cryotherapy, with subsequent healing. The esophagus in animals put to death 28 and 42 days following cryotherapy appeared histologically normal. These studies demonstrate the safety of cryotherapy to -70 to -80 degrees C. upon the esophageal wall and suggest investigation of the usefulness of this modality in the treatment of local esophageal webs and strictures.

Animals↗
PubMed1978

Clinical application of endotracheal cryotherapy.

A nitrous oxide cryoprobe has been developed that may be used through the infant bronchoscope. A total of 19 discrete airway lesions have been treated in 17 patients ranging in age from 2 mo to 30 yr. Three patients with periglottic lesions have had complete eradication of these lesions without the need for tracheostomy. Six patients with subglottic stenoses have been treated, with one successful extubation and one patient approaching extubation. Five patients have been treated for distal tracheal strictures, with two successful extubations and a third pending extubation. Five patients have been treated for endotracheal granulation tissue, and 3 patients have been successfully extubated. Cryotherapy allows bloodless resection of these lesions with rapid tissue healing not accompanied by residual scarring.

Adolescent↗
PubMed1978

Fasting and postprandial serum gastrin in normal human neonates.

Serum gastrin determinations were performed in 32 normal-term infants to determine the level of this hormone in normal infants at birth and its response to normal feeding. Significant differences were noted between newborn cord blood and maternal blood at birth. Further significant elevations in fasting serum gastrins were noted in these infants over the first 72 hr of life. Pre- and postprandial determinations with normal feeding failed to demonstrate a significant elevation in serum gastrin levels following ingestion of protein-containing formulas. These data suggest a relative insensitivity of the release of gastrin from the gastric antrum in response to protein, a powerful mediator of gastrin release in the adult.

Fasting↗
PubMed1978

Functional and metabolic evaluation of colon replacement of the esophagus in children.

Thirteen children with esophageal replacement with colon interposition have been followed at the University of Florida Medical Center between 1962 and 1976. Eight of these patients were evaluated with a detailed functional and metabolic protocol, four requiring colon interposition for esophageal atresia and four for esophageal strictures. Growth was noted to be somewhat delayed in the patients with esophageal atresia, especially those with associated congenital anomalies. Otherwise, excellent functional results were obtained. Significant anemia with depressed serum iron concentrations was noted in four patients, and three patients had abnormal vitamin B12 absorption. This abnormality correlated with length of terminal ileum employed with the interposed segment. Serum parameters of intestinal absorption were normal in each patient. Manometric evaluation revealed absence of peristalsis within the colonic segment, but progressive peristalsis within interposed ileal segments. Radiologic evaluation demonstrated delay in passage of thick material from mouth to stomach and wide variability in overall intestinal transit time.

Anemia↗
PubMed1978

Bilateral granulosa cell tumors of the ovaries in infancy.

A case of bilateral cystic granulosa cell tumors of the ovaries in an 11-wk-old infant is described. The patient presented with a large abdominal mass, but without sexual precocity. Treatment consisted of bilateral salpingo-oophorectomy without subsequent chemotherapy or radiation, and 2 yr follow-up has shown no evidence of recurrence of this tumor.

Female↗
PubMed1978

Laparoscopy in the diagnosis and treatment of malfunctioning ventriculo-peritoneal shunts in children.

Abdominal complications following ventriculo-peritoneal shunting for hydrocephalus are not uncommon. One of the complications that has heretofore required abandonment of the peritoneal shunt has been entrapment or encystation of the peritoneal limb of the catheter system. Four infants have been identified with malfunction of the peritoneal limb of the system by characteristic physical findings of increasing head size and dissection of fluid along the shunt track. Abdominal radiographs in multiple views revealed the tip of the peritoneal catheter to be fixed in position in each patient and sonography aided in identification of encysted catheters. These infants underwent six laparoscopic procedures to define the cause of shunt malfunction and to reposition the catheter. Cerebrospinal fluid cysts were encountered in three infants and entrapment by the falciform ligament in the fourth. All catheters were easily repositioned within the abdominal cavity with laparoscopy forceps and three of the infants presently have normally functioning shunt systems.

Cerebrospinal Fluid Shunts↗
PubMed1978

Fasting and postprandial serum gastrin levels in infants with congenital hypertrophic pyloric stenosis.

Recently attempts have been made to demonstrate the possible role of hypergastrinemia in the production of congenital hypertrophic pyloric stenosis in infants. Eleven infants with congenital hypertrophic pyloric stenosis, ranging in age from three to 11 weeks, were evaluated for fasting and postprandial serum gastrin levels. Two to ten weeks following successful pyloromyotomy, a similar evaluation was undertaken to demonstrate the possible role of elevated serum gastrin levels in the etiology of congenital hypertrophic pyloric stenosis. The average fasting and postprandial serum gastrin levels in infants with congenital hypertrophic pyloric stenosis did not differ significantly from levels noted in control infants. Similarly, no statistically significant difference was noted between the pre- and postoperative levels of serum gastrin in the affected infants. Several experimental studies have been reported within the past few years describing the production of hypertrophic pyloric stenosis in the offspring of dogs injected with pentagastrin during pregnancy. The results of our study minimize the direct importance of serum gastrin in the production of congenital hypertrophic pyloric stenosis. The role of the hormone secretin in the etiology of this condition is hypothesized.

Female↗
PubMed1977

Wilms' tumor with acute abdominal pain.

Acute abdominal pain is the presenting manifestation in approximately 30% of all patients with Willms' tumor. In a small proportion of these patients this pain is significant enough to engender a diagnosis of an acute surgical abdomen. Six of 38 patients with Wilms' tumors treated between the years 1965 and 1975 at the Shands Teaching Hospital of the University of Florida Medical Center have had significant pain. Our experience with these patients emphasizes the importance of thoroughly palpating the abdomen of any child with a suspected acute surgical condition, following induction of anesthesia and prior to initiating the operation. In the absence of any evidence of an acute surgical problem at the time of the exploratory laparotomy, it is also imperative that a careful intra-abdominal examination be performed to exclude the presence of conditions, such as Wilms tumor of the kidney, that may occasionally present in this manner.

Abdomen, Acute↗
PubMed1977

Endobronchial cryotherapy in the treatment of tracheal strictures.

Modern advances in ventilatory support systems have introduced a patient population requiring long term endotracheal intubation or tracheostomy. The formation of tracheal strictures in such patients remains a very significant clinical problem despite new modifications in endotracheal tube design and materials. Dissatisfied with standard modalities of treatment for these lesions, we have explored the usefulness of endobronchial cryotherapy for the treatment of such stricture. Cervical tracheal strictures were produced in 11 sheep. In six animals a prototype cryosurgical probe was passed through the bronchoscope and these lesions frozen to -80 degrees C. Respiratory epithelial regeneration was complete, but significant reduction in strictures was not noted. Utilizing the cryosurgical probe in conjunction with the endobronchial resection of tracheal strictures in three animals did, however, produce significant reduction in stricture size. Healing following cryonecrosis was associated with minimal fibrosis. Endobronchial cryotherapy is easily performed and has been well tolerated by these animals.

Animals↗
PubMed1977

Surgical management of massive ventral hernias in children.

The management of 7 children with massive abdominal wall hernias is reviewed, utilizing a technique of stabilizing the defect by insertion of a Teflon mesh prosthesis followed by pneumoperitoneum and staged reduction. Teflon mesh has proven ideally suited for this purpose because of its flexibility, elasticity, and relative nonreactivity, allowing it to be applied directly over the surface of exposed bowel without inducing fistula formation. Although the mesh is securely incorporated into the fascial perimeter of the abdominal wall, a pseudomembrane is formed at the point of contact with the bowel surface which allows subsequent dissection and removal of the prosthesis with relative ease. Having limited the size of the defect by insertion of the mesh, an ideal situation is created for use of pneumoperitoneum to expand the peritoneal cavity and stretch the normal tissues of the abdominal wall, thus facilitating subsequent operative reduction of the ventral hernia. Utilizing this approach, excellent cosmetic and functional results have been achieved in all 7 patients.

Abdominal Muscles↗