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Biomedical subjects

J P Canarelli

Publications and source records attributed to J P Canarelli.

At least 19 recordsLinked to original sources
PubMed2001

The effects of mesenteric ischemia on ileal colonization, intestinal integrity, and bacterial translocation in newborn piglets.

The effects of mesenteric ischemia on ileal colonization, intestinal integrity, and bacterial translocation (BT) in newborn piglets were investigated in 362-day-old Pietrain piglets. Group I, controls were not operated upon; group II underwent a sham laparotomy; and group III underwent ligation of the mesenteric vessels in the distal ileum. After 3 days, the kidneys, spleens, livers, and ileal segments were harvested for microbial and histologic analyses. Two piglets in the ischemic group died; microscopic examination showed severe histologic lesions of the ischemic area. Escherichia coli counts were increased in the ischemic segment compared to the upper loop (P < 0.05). Ischemia favoured staphylococcal colonization, whereas in the sham group a drastic reduction of these organisms was observed (P < 0.005). BT to the kidneys, spleen, and liver occurred normally in the control group. Ischemia significantly increased the total microflora in the spleen and liver (P < 0.05) and furthered dissemination of Clostridium perfringens in the kidneys (P < 0.05); 50% of ischemic animals had proteolytic clostridia in this organ (P < 0.05). Moreover, the incidence of E. coli in the kidneys, spleen, and liver was significantly higher in the sham and ischemic groups than in the controls (P < 0.05). Ileal ischemia thus induced significant histologic lesions, and surgery rather than gut microflora controls translocation.

Animals↗
PubMed2001

Metformin retention independent of renal failure in intestinal occlusion.

Metformin is eliminated by the kidneys, and metformin accumulation has always been noticed in oligo-anuric patients. We have reported an exception to the rule with the case of a metformin-treated patient having metformin accumulation contrasting with a mild increase in serum creatinine in the context of a volvulus of the sigmoid colon. This case prompted us to examine the association between intestinal occlusion and plasma metformin concentrations. For this purpose, we developed an experimental animal model of mechanical obstruction of the intestine. Rats were pre-treated during 3 weeks via drinking solution at a dose of approximately 100 mg/kg/day of metformin. They underwent at day 0 either sham-operation (n=7) or operation (n=8) to place a plastic tube around the ileum near the ileocaecal valve. Metformin administration was pursued on days 1, 2, and 3 giving a single dose of 100 mg/kg by intragastric gavage. Four days after the surgery, i.e. 24 h after the last metformin administration, the surviving intestinal obstructed rats (n=8) developed overt intestinal dilation but no biochemical abnormality compared to sham-operated animals (n=7; arterial lactate concentrations respectively 4.87 +/- 0.63 mmol/l and 3.97 +/- 0.30 mmol/l, NS, and serum creatinine concentrations 69.0 +/- 1.7 micromol/l and 68.7 +/- 1.9 micromol/l, NS). By contrast, there was a striking difference with regard to metformin concentrations, decreasing from 2.95 +/- 0.94 mg/l at day 0 to 0.12 +/- 0.03 mg/l at day 4 (p<0.001) in the sham-operated group but remaining unchanged (1.65 +/- 0.76 mg/l and 1.61 +/- 0.51 mg/l) in the operation group. In conclusion, this is the first experiment showing that intestinal occlusion may be responsible for metformin retention in the absence of renal failure. Whether this observation may be relevant to other drugs remains to be established.

Acute Kidney Injury↗
PubMed2000

Management of pancreatic and duodenal injuries in pediatric patients.

Diagnosis of duodenal and pancreatic injuries is frequently delayed, and optimal treatment is often controversial. Fourteen children with duodenal and/or pancreatic injuries secondary to blunt trauma were treated between 1980 and 1997. The pancreas was injured in all but 1 child. An associated duodenal injury was present in 4. The preoperative diagnosis was suspected in only 6 patients based on clinical signs and ultrasonography. One patient was treated successfully conservatively; all the others required surgical management. At operation, three procedures were used: peripancreatic drainage, suture of the gland or duodenum with drainage, and primary distal pancreatic resection without splenectomy. A duodenal resection with reconstruction by duodeno-duodenostomy was performed in 1 case. The overall complication rate was 14%: 1 fistula and 1 pseudocyst. Pancreatic ductal transection was recognized 3 days after the initial laparotomy by endoscopic retrograde cholangiopancreatography (ERCP). The mortality was 7%; 1 patient died from septic and neurologic complications. When the diagnosis of pancreatic ductal injuries is a major problem, ERCP may be a useful diagnostic procedure. Pancreatic injuries without a transected duct may often be treated conservatively. The surgical or conservative management of duodenal hematomas is still controversial; other duodenal injuries often need surgical treatment.

Adolescent↗
PubMed2000

[Thoracic injuries in children].

Chest trauma in children is rare but shows that trauma is severe and the mortality rate is high (30%). Multidisciplinary management of children includes an initial evaluation of respiratory distress, freeing the airways, placing an intercostal tube, stabilizing the chest wall, and analgesia. When vital signs are stable, secondary evaluation includes an etiologic, radiologic and biologic check-up, ending with the therapeutic strategy. Thoracotomy is rarely required, and for most children, only monitoring will be necessary, though this is important because of the risk of secondary decompensation and late diagnosis of potentially fatal lesions.

Age Factors↗
PubMed1997

Human recombinant growth hormone increases small bowel lengthening after massive small bowel resection in piglets.

BACKGROUND/PURPOSE: Dramatic improvement in small bowel lengthening and in weight gain has been demonstrated in newborn rats treated with human growth hormone (GH) after massive small bowel resection. The aim of this study was to confirm these results in another animal model and to specify the part food intake plays in small bowel lengthening induced by GH. METHODS: Twenty-five piglets underwent laparotomy at day 28 of life. Intestinal length was measured under general anesthesia, and animals had an 80% resection of small bowel, leaving a similar length of jejunum and ileon. There were no perioperative deaths. One animal died 3 days after surgery. Animals were assigned to five groups: (1) S (n = 4): sham, mere laparotomy; (2) GH-S (n = 4): sham and GH treatment (0.1 IU/kg/d subcutaneously); (3) R (n = 7): intestinal resection; (4) GH-R (n = 6); and (5) GH-R AdL (n = 4): intestinal resection and GH treatment. S, GH-R, and GH-R AdL had a free diet; GH-S and GH-R were pair-fed with S and R, respectively. Animals were killed 28 days later. RESULTS: Weight gain was not different in the two nonresected groups (S, 144 +/- 6% of initial weight; GH-S, 150 +/- 3%) and was significantly higher than in the resected groups (R, 67 +/- 28%; GH-R, 74 +/- 16%; GH-R AdL, 55 +/- 16%; NS). GH did not enhance small bowel lengthening in the nonresected groups; S, 41.9 +/- 23% and GH-S, 36.9 +/- 9%, in sharp contrast with the resected groups; R, 28 +/- 9 cm versus GH-R, 96 +/- 39 cm (P = .0008) and versus GH-R AdL, 89 +/- 41 cm (P = .003). Compared with initial length, the increase was R, 16.2 +/- 5%; GH-R, 56.5 +/- 24%; GH-R AdL, 51 +/- 25%. Villus height and diameter, average number of mitosis per field, intestinal muscular layer, wall thickness, and crypt ratio were higher in resected groups than in unresected ones, with no difference observed between resected groups. CONCLUSIONS: GH improves the postoperative intestinal adaptation process after massive small bowel resection in newborn piglets in terms of small bowel lengthening. In contrast to rats, GH did not improve weight gain. In addition, no difference was observed whether animals were on a free or a controlled diet.

Adaptation, Physiological↗
PubMed1996

Effect of BN 50727 on pathological findings and tissue platelet activating factor levels during ileal ischemia in newborn piglets.

The role of platelet activating factor (PAF), a potent ulcerogen mediator in the digestive tract, is thought to be important in the genesis of necrotizing enterocolitis. The aim of this study was to evaluate the role of PAF in the perpetuation and aggravation of gastrointestinal damage resulting from limited ischemia in the 2-day-old piglet using a natural PAF antagonist (BN 50727). Animals were separated into six groups: U4, controls; S, sham operated animals undergoing laparotomy; I4 and I9, ligation of the mesenteric vessels in the last ileal loop; IT4 and IT9, same procedure together with treatment with BN 50727 (50 mg/kg) orally before and after surgery and intraperitoneally during surgery. Animals were killed at day 4 in groups U4, S, I4 and IT4 and at day 9 in groups I9 and IT9, with histological studies and mediator measurements taken. Macroscopic and histological lesions of intestinal wall in groups I4, I9, IT4 and IT9 were similar to those of human neonatal necrotizing enterocolitis and did not vary according to the absence or the presence of BN 50727 treatment (P = .7, I4 v IT4 and P = .9, I9 v IT9). Peritoneal bands were significantly reduced in treated groups IT4 and IT9 as compared with untreated ones I4 and I9 (P = .003). Mucosal PAF levels in the terminal ileum were higher in group I4 than in groups U4 or I9. In the upper loop, mucosal PAF levels were comparable in all groups. An increase in stool PAF levels was observed only in group I9 (26.4 ng/g v 4.7 ng/g, I9 v U4 + S, P < .05), whereas values comparable to those observed in controls were detected in other groups (I4, 7.2 ng/g; IT4, 4.5 ng/g; IT9, 6.8 ng/g). Tumor necrosis factor alpha (TNF alpha) measurements did not exhibit any difference between groups. Using a PAF antagonist, the role of PAF in the aggravation of intestinal damage after ischemia was not remarkable because treatment did not induce any modifications of parietal intestinal lesions. PAF antagonists appeared to reduce significantly the local peritoneal consequences of local inflammation.

Animals↗
PubMed1996

Evaluation of a hydrocolloid dressing.

A hydrocolloid dressing was compared to adhesive skin tapes on children's postoperative wounds. A total of 170 children of varying ages were randomised in two parallel groups, in nine centres of plastic, thoracic, gastrointestinal, urogenital and orthopaedic surgery. Skin closure was satisfactory in both groups, with 76 (89.4%) healthy closures without dehiscence in the hydrocolloid group and 81 (95.3%) in the control group; a relationship was found between partial closures/dehiscence and the type of surgical procedure. No product-related maceration, infection or adverse event was reported during the study and both groups showed very satisfactory cosmetic results.

Adhesives↗
PubMed1994

Stimulation by recombinant human growth hormone of growth and development of remaining bowel after subtotal ileojejunectomy in rats.

The impact of human recombinant growth hormone (GH) after massive small bowel resection was studied in 38 weaning female Wistar rats (65 +/- 5 days old; 193 +/- 26 g). Animals underwent a 80% small bowel resection, leaving in place similar lengths of jejunum and ileum. Animals were assigned to four groups: group A (n = 9), small bowel resection only; group B (n = 10), resection and treatment with 0.2 GH units (GHU) s.c. every other day; group C (n = 9), resection and 0.4 GHU; and group D (n = 10), laparotomy without intestinal resection. Twenty-eight days later, weight gain (percentage of initial weight) was 1 +/- 3 in group A, 12 +/- 8 in group B, 12 +/- 9 in group C, and 16 +/- 7 in group D; p < 0.001, groups B-D. Time to recover initial weight was 26.2 +/- 3.3 days in group A; 11.7 +/- 5.4 days in group B (p < 0.001); and 16 +/- 6.1 days in group C (p < 0.001 vs. A). The size of the intestinal remnant after the rats were killed was 1.3 +/- 0.6 cm (13 +/- 10% of initial length) in A; 5.15 +/- 2.4 cm (37 +/- 18%) in B (p < 0.01); 4.2 +/- 2.3 cm (33 +/- 20%) in C (p < 0.01 vs. A); and 4.4 +/- 3.5 cm (5.8 +/- 4.9%) in D (p < 0.001 vs A). Villus height and diameter, average number of mitosis per field, and muscular layer and wall thickness were greater in groups A, B, and C than in group D (p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1994

[Lesions of the renal pedicle in blunt abdominal trauma in children. 7 cases].

The frequency of urinary tract trauma in children is difficult to estimate. Renal pedicle lesions are estimated to represent 10% of all forms of urinary tract trauma. These lesions are difficult to diagnose and may be completely missed. Over a 12 year period, we have treated 7 children with a renal pedicle injury. Haematuria was immediate in 3 cases, delayed in 2 cases and absent in 2 cases. The diagnosis is based on intravenous urography or postcontrast computed tomography. Treatment consisted of disobstruction with intimal suture with a good result, but impaired renal function, an upper pole nephrectomy, functional aorto-renal bypass graft but with altered renal function, total nephrectomy and 3 cases of surveillance with one non-functioning kidney. None of these children are hypertensive. The authors discuss the diagnostic approach, the contribution of imaging and the therapeutic options and results.

Abdominal Injuries↗
PubMed1993

Ligation of the patent ductus arteriosus in premature infants--indications and procedures.

Premature newborns with patent ductus arteriosus can be managed by prostaglandin inhibition, but this medical treatment carries a high risk of renal failure, and other complications such as necrotizing enterocolitis and hematologic disorders have been described. Echocardiography gives an early confirmation of shunt and surgical treatment may be proposed. The aortic arch anatomy in the premature infant may not be as simple to determine as the anatomy of an older child. In the premature infant the use of a clip for patent ductus arterious closure seems the best technique, avoiding circular dissection of the ductus. We report our experience of 68 cases operated upon.

Cause of Death↗
PubMed1993

[Voluminous ovarian cyst in children. Therapeutic strategy].

Ovarian cysts are rare in children but can sometimes become extremely large, leading to difficult therapeutic decisions. There is general agreement that the therapeutic attitude for benign serous cysts less than 5 cm in diameter includes echographic monitoring and possible echo-guided punction. For cysts larger than 5 cm, most authors favour cystectomy via the celioscopic route using either celio-surgery or mini-laparotomy. On the contrary, the clinical manifestations of large cysts greater than 15 cm in diameter may vary greatly, presenting as increased abdominal volume, pain, respiratory impairment. The large size of the cyst should not be allowed to mask an associated torsion of the annexes in cases of paroxysmal abdominal pain. We report our experience of 6 voluminous ovarian cysts with a largest diameter varying between 15 and 40 cm. The children's age varied from 10 to 15 years. There were 3 dermoid cysts, 2 treated by ovariectomy and 1 by celio-surgery, 1 torsion of the annexes on dermoid cyst was treated via laparotomy. There were two cases of mucinous cystadenomas, 1 treated by mini-laparatomy and the other by celio-surgery. Finally one serous cyst with torsion of the annex was treated by annexectomy. The large size of the cysts may impair the surgical approach. Prudent ceilo-surgery should be preferred to wide laparotomy. Introduction should be performed under visual control followed by leak-free punction. The cyst is emptied before exeresis of the ovary via a mini-laparotomy since, in many of these cases of voluminous tumours, cystectomy cannot always be performed and ovariectomy must be preferred.

Adolescent↗
PubMed1993

[Pulmonary embolism in adolescents].

BACKGROUND: Pulmonary embolism is rare in children, but its incidence is probably underestimated. While its causes are the same as in adults, the role of clotting factor deficiency and oral contraceptive agents has recently been stressed. CASE REPORTS: Case n. 1: A 15 year-old girl was immobilized for an ankle strain. She developed thrombophlebitis of the deep veins of the right leg. The condition was confirmed by Doppler. A phlebogram showed a clot floating in the inferior vena cava. This required the insertion of a clip around it and further thrombectomy. Despite immediate intravenous heparin therapy, the adolescent died of a massive pulmonary embolization. The girl had a congenital antithrombin III deficiency; she was also taking an oral contraceptive. Case n. 2: A 15 year-old suffered from left thoracic pain radiating to the shoulder. Perfusion scintiphotography showed evidence of pulmonary embolism of the left inferior lobe and a phlebogram showed thrombosis of the hypogastric veins. This adolescent was 4 months pregnant. A filter was placed inside the inferior vena cava to permit therapeutic interruption of the pregnancy. The girl was treated with intravenous heparin, followed by antivitamin K with an uneventful course. She suffered from no clotting factor deficiency. CONCLUSION: Pulmonary embolism remains a severe complication of thrombi in the femoral and pelvic veins. It can occur in adolescents, especially those with a congenital clotting factor deficiency, those on oral contraceptives or those who are pregnant.

Adolescent↗
PubMed1992

[Thymus in posterior mediastinal localization. Apropos of a case in a child].

Posterior and upper mediastinal localization of the thymus gland is uncommon in young children. Presenting symptoms and signs are very variable from incidental diagnosis to bronchopneumonial with atelectasias of the left upper Chest X-Ray and CT Scan are sufficient to make the diagnosis. Treatment of complicated forms with bronchial compression requires thoracotomy and surgical excision.

Humans↗
PubMed1992

[Posterior mediastinal thymus. Apropos of a case in a child].

Posterior and upper mediastinal localization of the thymus gland is uncommon in young children. Presenting symptoms and signs are very variable from incidental diagnosis to bronchopneumonial with atelectasias of the left upper Chest X-Ray and CT Scan are sufficient to make the diagnosis. Treatment of complicated forms with bronchial compression requires thoracotomy and surgical excision.

Bacterial Infections↗
PubMed1991

[Chest injuries in children. Apropos of 93 cases].

UNLABELLED: Ninety-three cases of thoracic trauma (age ranging from 1.1/2 to 15 years) were observed over a 10 year-period (1980-1990): 86 cases of blunt trauma and 7 cases of perforating injuries. Road accidents were the most prevalent (63 cases) followed by home and sport injuries (9), falls (9), perforating trauma (9) and others. Associated lesions were frequent: skeletal (67), abdominal (19), and head injuries (5)--the latter influence the vital prognosis. Rib fractures were observed in 60% of cases of blunt trauma (86). Pulmonary lesions were as follows: pneumothorax (41), hemothorax (21), and lung contusions (29). In 48 cases, several of these pulmonary lesions were associated. Diagnosis and therapy problems were encountered in 21 cases. Results were as follows: 3 deaths, within 24 hours due to hemorrhage (1 case with aortic lesion). FOLLOW-UP: 85 good results, 5 sequelae, without any clinical consequence--either pleural (2), diaphragmatic (2), or lung (1). The treatment was as follows: none (27), pleural aspiration (2), thoraco-synthesis by drain in other cases for 2 to 9 days. Surgery was necessary in 10 cases, with 2 thoracotomies, 1 orthopedic traction, 1 embolization of iliac artery.

Abdominal Injuries↗
PubMed1991

[Pleuro-pericardial cyst in children].

We report the case of 3 1/2 year old child presenting a left pleuropericarditic cyst causing febrile cough and an opacity of the left lower lobe of the lung. We underline the importance of computed tomography of the thorax allows differential diagnosis with encysted effusion. Surgical treatment rarely indicated in pleuropericarditic cysts has stopped respiratory symptoms.

Child, Preschool↗
PubMed1991

[Case report of priapism in a 4 year old child].

The authors report a case of idiopathic priapism in a 4 year old boy. This is an exceptional disease at this age, which was treated urgently by creating a cavernosospongiosum fistula with a rapidly favourable clinical course. The prognosis appears to be related to the rapidity of treatment. Although aetiological treatment can be proposed in the case of priapism due to haematological malignancies, only surgical treatment appears to be truly effective in the other forms.

Biopsy, Needle↗