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Biomedical subjects

J S Janik

Publications and source records attributed to J S Janik.

At least 19 recordsLinked to original sources
PubMed1989

A standard of comparison for acute surgical necrotizing enterocolitis.

We reviewed 187 cases of documented neonatal necrotizing enterocolitis (NEC) from 1976 to 1988. Of these patients, 111 infants underwent celiotomy for acute surgical complications. The following protocol of operative indications was employed: pneumoperitoneum, localized mass, abdominal wall erythema, portal venous air, and clinical deterioration, singly or in any combination. Clinical deterioration was defined as falling platelet count, rising or falling white blood cell count, left shift in the myeloid series, persistently or progressively low pH, and increasing frequency of apnea or bradycardia. Overall mortality was 15% (28 of 187). For the patients who underwent celiotomy, all had histologic confirmation of NEC. Ninety-five had localized disease, and 16 had diffuse disease. All of the former had resection and diverting enterostomy with 85 (89.5%) surviving; none with diffuse disease survived, P less than 0.0001. Forty-one infants with NEC weighed less than 1,000 g; 25 underwent surgery and 15 (60%) survived. Fifty-one of the 159 surviving neonates (32%) developed intestinal strictures. All neonates with strictures have had resection and successful reconstruction of their gastrointestinal tract. These indications and surgical principles resulted in a high degree of diagnostic accuracy and a low degree of surgical mortality.

Clostridium↗
PubMed1988

Colon esophagoplasty in the orthotopic position.

Three cases of long-gap esophageal atresia were repaired using a technique that included a right extrapleural thoracotomy, preservation of the entire esophagus available, both anastomoses in the mediastinum, use of a short segment of colon, and preservation of the ileocecal valve. This approach, not previously described, combines multiple features aimed at decreasing complications related to traditional techniques. Successful early results are promising.

Child↗
PubMed1988

Complications of the Martin procedure for total colonic aganglionosis.

From 1976 to 1986 inclusive, 122 patients were cared for with Hirschsprung's disease. Sixteen of these were treated for total colonic aganglionosis, with or without small bowel involvement. The male to female ratio was 2.2:1. Two children died prior to definitive surgical therapy and two others were transferred following initial therapy. Twelve children underwent Martin's procedure with a 0% mortality rate and an 81.8% morbidity rate. This study would indicate, as do others, that even though the Martin procedure can safely be performed, the long-term results require close scrutiny. A re-evaluation of this procedure and its alternatives is necessary in order to improve long-term results.

Anastomosis, Surgical↗
PubMed1988

Extensive tumor resection under deep hypothermia and circulatory arrest.

The risk of fatal hemorrhage may limit the completeness of resection in hepatic malignancies and in vascular extensions of Wilms' tumors. We have used Ein's technique of deep hypothermia (average 17 degrees C) with cardiac arrest (average 39 minutes) and exsanguination in performing five hepatic and two intravenous Wilms' tumor resections. The initial hepatic resection takes less than 15 minutes to perform in a bloodless field and the specimen is immediately examined by frozen section for determination of adequacy of margin. Additional resection is easily performed. Of four trisegmentectomies and one left lobectomy, two required additional resections. Mattress sutures were used to control hemorrhage during recirculation. One patient died from bleeding and cardiac decompensation and another from recurrence of tumor. The Wilms' tumors extended from the iliac vein into the right atrium in one child and from the right renal vein to the right atrium with extensions into the hepatic and lumbar veins in another. After nephrectomy, the atria and inferior vena cava were opened and the tumor extracted under direct vision. Both patients are well.

Carcinoma, Hepatocellular↗
PubMed1986

Occult coin perforation of the esophagus.

Only a small number of ingested foreign bodies perforate the esophagus and even a smaller fraction migrate extraluminally with no symptoms. Both of these events are even rarer after coin ingestion. Between 1972 and 1984, three children (16 months to 5 years), who had unabating upper respiratory symptoms, were found to have ingested coins. In only one child could the time interval between ingestion and appearance of symptoms (3 years) be established, and in this child the diagnosis was delayed because of failure to x-ray the chest after an ingestion episode. Surgical evaluation included chest/neck films: tracheal and esophageal shadows were separated by the object and a soft tissue mass; esphagogram: deviation of the esophagus, irregularity of the lumen, and no leak or tracheoesophageal fistula (TEF) and esophagoscopy: mucosa was intact with no direct visualization of the coin. Treatment consisted of exploration: cervical, one; thoracic, two; localization: coin in extraluminal granulomatous soft tissue; removal: without resection of the soft tissue mass or esophagus, and drainage: penrose, one; chest tube, two. There was no morbidity or mortality from 1 to 13 years later. Though generally harmless, ingested coins are capable of penetrating the esophagus. Sporadic literature reports confirm that the clinical findings and operative results are typical of this seemingly intermediate stage between perforation with mediastinitis and perforation with TEF.

Child, Preschool↗
PubMed1982

Prevention of postoperative peritoneal adhesions: efficacy of povidone.

The appearance and severity of peritoneal adhesions after simple laparotomy and after adhesiolysis were studied in a rabbit model. Adhesions were induced by direct abrasion with latex glove and dry gauze; control rabbits had abrasion only. Study groups had abrasion and treatment with 10% or 25% povidone. Results showed a significant reduction in the number of adhesions and in the severity of adhesions after treatment with povidone. This study supports the further investigation of the efficacy of povidone in preventing postoperative peritoneal adhesions.

Animals↗
PubMed1982

Effect of indomethacin on mesenteric circulation in mongrel dogs.

Necrotizing enterocolitis has been attributed to the use of indomethacin (INDO) for medical closure of patent ductus arteriosus. To study the effect of INDO on cardiac output and mesenteric circulation, INDO was given by rectum (0.25 mg/kg, 0.5 mg/kg, 1.25 mg/kg--3 dogs in each group) and the control group received none. The cardiac output and organ blood flow were measured before and 1 hr after INDO with radioactive microspheres using 4 isotopes (Cr53, Ni95, Co57, Sn113). The blood flow to different parts of the GI tract was measured as percent of cardiac output using a gamma counter. Paired t test was used to calculate percent reduction in organ blood flow. During the experiment, there was no reduction in cardiac output in the entire group. Anesthesia had no effect on the control group. In the three INDO treated groups, percent reduction of mucosal blood flow of the stomach (63%, 32%, 68%, p less than 0.01), mid ileum (19%, 59%, 57%, p less than 0.05) and terminal ileum (57%, 35%, 54%, p less than 0.015) was significant. A strong trend in reduction of organ blood flow was noted in other regions. There was no significant change due to different dosages of INDO. The area of ischemia in this dog model corresponds to clinical pathology noted in necrotizing enterocolitis.

Animals↗
PubMed1982

The vulnerability of the vas deferens (II): the case against routine bilateral inguinal exploration.

The results of operative manipulation of the vas deferens have unknown results. In order to document early and late structural changes in the vas after simple operative manipulations, the vasa deferentia of 120 Wistar rats were subjected to 4 different manipulations. Subsequently, they were removed at intervals (up to 6 mo) and examined after appropriate staining. Finger or vascular clamp grasping resulted in mild inflammation at 6 wk, which resolved thereafter. Forceps grasping disrupted the muscle layers in 30%-40% of the vasa. Hemostat clamping damaged muscle layers in 100% of the vasa and resulted in abscess formation in 30%. Healing in forceps grasped and hemostat clamped specimens was negligible and haphazard with minimal evidence of normal collagen or elastin at 6 mo. All differences were significant (p less than 0.05). These results suggest that operative manipulations of the vas should be minimized and limited to digital maneuvers. Damage from other manipulations is appreciable, long-term, and only minimally repaired at 6 mo.

Animals↗
PubMed1982

Thoracoscopic evaluation of intrathoracic lesions in children.

In the last 3 years, we have used transthorascopic biopsy for the diagnosis of intrathoracic pulmonary lesions in 17 children ranging in age from 5 months to 17 years. The procedure is performed under a variety of anesthetic conditions ranging from local infiltrative to general endotracheal anesthesia. A fiberoptic rod lens system with cautery is utilized for direct observation and biopsy of intrathoracic pulmonary lesions. Biopsy specimens have been adequate for diagnosis in each child. Death and morbidity have not occurred. This technique is a safe, direct means under minimal anesthesia for the diagnosis of diffuse or localized intrathoracic disease in children.

Adolescent↗
PubMed1982

An ultrastructural study of enteric serosa after surgical management.

The surface topography of rabbit enteric serosa was studied with a scanning electron microscope before and after surgical manipulation and after pretreatment with polyvinylpyrrolidone, an experimental antiadhesion agent. Results indicated that the serosal surface is characterized by an intertwined three-dimensional lattice of collagen like material which was remarkably altered by simple handling. Pretreatment with polyvinylpyrrolidone reduced this alteration, but polyvinylpyrrolidone itself has an adverse effect upon serosal topography. This study has provided novel insight into the fine structure of the intestinal serosa and has demonstrated alterations in this structure after simple operative handling. It has been shown that polyvinylpyrrolidone, although offering some protection, altered the fine latticework that covers the serosal surface. In addition, this study has demonstrated the usefulness of the scanning electron microscope in defining serosal damage and evaluating new therapeutic antiadhesion agents.

Animals↗
PubMed1982

Congenital funnel-shaped tracheal stenosis: an asymptomatic lethal anomaly of early infancy.

Two infants with an unusual variant of congenital tracheal stenosis (funnel-shaped distal trachea) are described. Six other reports have appeared in the literature. This anomaly is asymptomatic from 1 to 3 months after birth, despite nearly complete tracheal obstruction. Staged surgical repair and/or definitive correction have been hampered by the size of the tracheal lumen, length of the deformity, and nondistensibility of the complete cartilaginous rings in the distal trachea.

Female↗