Biomedical subjects

J M Giacomantonio

Publications and source records attributed to J M Giacomantonio.

10 recordsLinked to original sources

PubMed1999

Primary Swenson pull-through compared with multiple-stage pull-through in the neonate.

BACKGROUND: In Hirschsprung's disease, the trend has been for earlier performance of definitive surgery. In our institution, primary Swenson pull-through has become the preferred procedure. METHODS: Retrospective review of the patients treated for Hirschsprung's disease from January 1988 through March 1998 was performed. Sixty-five patients were identified. Median values, analysis of variance and x2 were used for comparisons. RESULTS: The multiple-stage group (M, n = 47) was similar to the primary group (P, n = 18) for gestational age (40 v 39 weeks), time to meconium passage (37.9 v 35.5 hours), and age at diagnosis (median, M 27 vP 3.5 days). Age (median, M 268 vP 5 days) and weight (mean, M 9.4 v P 3.7 kg; P < .001) at pull-through were lower in the primary group. Length of stay (LOS) was lower in the primary group (mean, M 40.8 vP 20.3 days; P < .05). Operating time for pull-through was decreased in P (mean, M 305.2 v P 272.2 minutes; P = .02). Total complications were lower in the primary group (P = .03), with no differences in mortality or enterocolitis rates. CONCLUSIONS: At our institution there were no increases in total complications or enterocolitis in the group undergoing primary Swenson. Primary pull-through is a viable option for the treatment of Hirschsprung's disease.

Analysis of Variance↗

PubMed1997

Acute epididymitis in boys: are antibiotics indicated?

OBJECTIVES: To report the results of using supportive therapy only, rather than antibiotics, in managing boys with acute sterile epididymitis. PATIENTS AND METHODS: From 1991 to 1995, 48 boys presented with acute epididymitis. The diagnosis was confirmed by radionuclide scan in 43 cases, ultrasonography in one, surgical exploration in one and physical examination in three. Urine was collected for microscopy and culture: if pyuria was detected, antibiotics were prescribed. If the urine analysis was normal, the patient was advised to minimize physical activity and analgesics were prescribed. RESULTS: Of the 48 boys, five (10%) had pyuria; seven patients with either no urine tested or negative urine culture were given antibiotics. The remaining 36 were managed with supportive therapy only. The mean follow-up was 87 days (with three patients lost to follow-up). No boys showed any evidence of testicular atrophy or other complications. CONCLUSION: Only a minority of boys with acute epididymitis, as defined by increased flow on radionuclide scanning of the scrotum, have a bacterial aetiology. For those without pyuria or positive urine culture, the condition is self-limiting and does not lead to testicular atrophy. We recommend that for boys with acute epididymitis who have no urinary abnormalities, antibiotics are not indicated. The aetiology of acute sterile epididymitis in boys remains obscure.

Acute Disease↗

PubMed1996

Helicobacter pylori is not associated with nonspecific abdominal pain in children.

Nonspecific abdominal pain is a significant problem in the pediatric population, and there has been much recent interest in the role that Helicobacter pylori (HP) might play in this disorder. A retrospective review was conducted at our center to determine its prevalence among children with otherwise undiagnosed abdominal pain. The study was conducted over a 45-month period during which 47 patients underwent gastroscopy and antral biopsies in the workup of this problem. Of the 37 patients who did not have a history of acid-pepsin disease (APD), only one (2.7%) tested positive for HP. In contrast, of the 10 who had a history of APD, three (30%) tested positive (P < .03). There were no distinguishing features among the HP-positive patients except for the presence of associated antral gastritis. Based on the current endoscopic results, of the nine patients with current evidence of APD, four (44%) were positive for HP; of the other 38 patients, none was positive for HP. Therefore, HP appears to be associated with antral gastritis, and HP does not play a role in nonspecific abdominal pain in this population.

Abdominal Pain↗

PubMed1996

Roux-en-Y jejunostomy in the pediatric population.

Surgical access for nutrition is required in a variety of pediatric disorders. In some, the presence of gastroesophageal reflux, poor gastric emptying, and risks for fundoplication favor the use of a jejunostomy. The significant problems associated with the simple loop jejunostomy can be avoided by using the Roux-en-Y configuration. The stoma can be fashioned either Brook-style (intubatable) or Stamm-style (modified Maydl, permanently intubated). Both types are used at the authors' institution and are compared in this retrospective review. During a 27-month period, 22 Roux-en-Y jejunostomies were performed; nine of them had the Brook-style stoma and 13 had the modified Maydl stoma. Significant complications requiring reoperation occurred in three (33%) patients with a Brook-style jejunostomy: prolapse, leakage, and perforation of the stoma. None of the patients with modified Maydl jejunostomies required reoperation; problems were encountered more with the care of the permanently intubated stoma. Therefore, our preferred choice for a feeding jejunostomy is the modified Maydl approach.

Adolescent↗

PubMed1994

Thrombotic complications of saphenous central venous lines.

Authors of recent publications advocate central venous access by saphenous vein cutdown in the thigh. Even relatively inert SILASTIC catheters are recognized to convey a risk of large vein thrombosis when maintained for long periods. Thrombosis of the inferior vena cava (IVC) and tributaries place the patient at risk for a spectrum of problems not associated with superior vena cava (SVC) cannulation. The authors describe 46 neonatal intensive care patients with central venous cannulation of more than 2 weeks' duration. Prospective monitoring by ultrasound yielded a thrombosis rate of 16.6% for SVC cannulation and 28.5% for IVC cannulation. Complete occlusion of the IVC was clinically apparent and confirmed radiographically in four patients. In another patient, bilateral renal vein thrombosis developed, which contributed to her death. The authors compare their data for IVC and SVC cannulation and question whether the saphenous vein should be a primary route.

Catheterization, Central Venous↗

PubMed1991

The absence of clinically significant tracheomalacia in patients having esophageal atresia without tracheoesophageal fistula.

The association of tracheomalacia (TM) with esophageal atresia (EA) has been well described. This study attempted to find a correlation between the severity of TM and the presence or absence of an associated tracheoesophageal fistula (TEF) in patients with EA. A review of all patients presenting at this institution with EA through the years 1970 to 1990 was carried out. Six patients with EA without fistula (type A) and 61 patients having EA with fistula (types B, C, D, and E) were analyzed. Five of the six type A patients required esophageal dilatations and antireflux procedures; none had clinically significant TM. Thirty-five of the 61 patients with fistula required esophageal dilatation, and 8 had an antireflux procedure; 11 (18%) required either long-tube tracheostomy or aortopexy for TM. This small study supports a recent hypothesis of different embryological events resulting in different types of esophageal and tracheal anomalies. When EA occurs without fistula, it appears that no significant alteration in tracheal development occurs.

Abnormalities, Multiple↗

PubMed1991

Emergency separation of conjoined twins.

Female omphalopagus conjoined twins were successfully delivered vaginally and required emergency surgical separation shortly after birth for gastroschisis. Shared tissue included conjoined bowel; one twin also had a complex cloacal abnormality and patent urachus. A 2-year follow-up is presented. A review of the relevant literature confirms that this is the first example of gastroschisis conjoining omphalopagus twins.

Abdominal Muscles↗

PubMed1990

Balloon catheter dilatation for hypertrophic pyloric stenosis.

Balloon dilating catheters (BDC) have provided a non-operative means of managing obstructive lesions within the gastrointestinal tract. Its potential utility in infants with hypertrophic pyloric stenosis (HPS) was studied. Six patients with HPS underwent balloon catheter dilatation of the pylorus under the direct observation of the surgeon. The pylorus was exposed using a standard right upper quadrant incision. The BDC was passed transorally into the stomach and manipulated into the pyloric canal by the surgeon. The balloon was inflated with saline to a maximum pressure of 50 psi for 2 minutes. Four patients were dilated with a 10-mm diameter balloon catheter, and in two patients, a 15-mm balloon was used. Success was defined as the complete and longitudinal disruption of the seromuscular ring without violation of mucosal integrity. Using this criterion, none had successful pyloric dilatation. No disruption occurred in three patients, partial disruption in two. These patients subsequently underwent a Ramstedt pyloromyotomy. Complete disruption was observed in one; however, a breach of the mucosa was evident. This was repaired without incident. All seromuscular breaks occurred at the point of vascular entry along the lesser curve, presumably the weakest point of the ring. Pyloric dilatation using BDC does not reliably disrupt the muscular ring. This preliminary report recognizes that major refinements must occur before this method will supplant the time-honored surgical pyloromyotomy for HPS.

Catheterization↗

PubMed1989

Acute scrotal pain in children: prospective study of diagnosis and management.

Forty-eight boys were assessed for an acutely painful scrotum. Thirty-six (75%) of them underwent radionuclide scanning of the scrotum; the average age of this group was 11 years. The scan revealed epididymitis in 19 cases, spermatic cord torsion in 9, appendix testis torsion in 7 and acute hernia-hydrocele in 1. The diagnosis was confirmed at operation in all nine cases of spermatic cord torsion. Boys who had epididymitis received antibiotics only; all were available for short-term follow-up, and 16 were also assessed at a mean of 6 months after infection. Only one boy had testicular atrophy; he had undergone repair of an inguinal hernia, which could not be ruled out as a cause. Bacteriuric epididymitis occurred in three boys; two had known predisposing genitourinary anomalies, the third had no abnormalities. Boys who had nonbacteriuric epididymitis were investigated by renal and pelvic ultrasonography or voiding cystourethrography; no important abnormalities were detected. This prospective study indicates that radionuclide scanning can reliably differentiate spermatic cord torsion from other acute scrotal disease.

Acute Disease↗

PubMed1985

The acutely painful scrotum in children: review of 113 consecutive cases.

A young boy who presents with an acutely painful scrotum can be a diagnostic challenge to his physician. It is important to differentiate the various causes of this symptom and to institute prompt management. Failure to do so could jeopardize the patient's future fertility. In a review of 113 consecutive cases of a painful scrotum at a children's hospital, torsion of the testicle was found in 51 patients (45%). Torsion of the appendix testis was found in 40 patients (35%) and acute epididymitis, once considered rare in children, was diagnosed in 17 (15%). The importance of prompt diagnosis of torsion is emphasized. The clinical diagnosis of the acutely painful scrotum is notoriously difficult, and in this series of cases surgical exploration was required in 92%. Only 2 of the 17 cases of epididymitis were associated with a bacterial urinary tract infection.

Adolescent↗