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Biomedical subjects

J S Janik

Publications and source records attributed to J S Janik.

At least 37 records · Page 2Linked to original sources
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↗
PubMed1981

The well-nourished infant with intussusception. Fact or fallacy?

To assess the nutritional status of children with intussusception, the weight, length, and weight-for-length percentiles of 100 children with intussusception and 100 children admitted to the hospital for elective surgery was determined and compared with the National Center for Health Statistics standards. Of the children with intussusception, 26% were found to have a weight-for-length ratio below the fifth percentile while only 11% of the children admitted for elective surgery had ratios below the fifth percentile. This difference could not be explained by duration of symptoms, vomiting, or diarrhea. Therefore, although children with intussusception may appear "well nourished" they are no better nourished than the general population and, in fact, a significant number exhibit anthropometric data suggestive of malnourishment.

Body Height↗
PubMed1981

Bronchoscopy in childhood.

One hundred and seventeen patients underwent 183 bronchoscopies with no fatalities. Thirteen patients had complications related to their bronchoscopy and not the underlying disease state. Only the 33 patients with a diagnosis of foreign body aspiration had a high (88%) correlation of the preoperative diagnosis or condition and the postoperative findings. Fifty-one of the 117 patients had normal bronchoscopies and the number of normal bronchoscopies in patients who had wheezing, croup, hoarseness, stridor, and chronic cough was high. Assessing justification for bronchoscopies despite the negative correlation of pre- and postoperative diagnosis is difficult due to many factors, including pediatrician and parental anxiety, and the recognized consequences of missing a foreign body or other lesion in the airway of a child. Using liberal criteria for justification. fewer than 10% of the patients in this series had an unwarranted bronchoscopy, and the safety of the procedure would indicate that bronchoscopy in a pediatric medical center should be performed with minimal clinical justification.

Bronchoscopy↗
PubMed1981

Intestinal stricture after necrotizing enterocolitis.

Between 1974 and 1979 inclusive, 20 of 175 neonates with previous necrotizing enterocolitis (NEC) developed obstruction from intestinal stricture 1-20 mo after the diagnosis of NEC. Seven were found in the small bowel, 19 in the colon. Treatment included proximal decompressive enterostomy with subsequent resection in 6 and primary resection in 11. Two died during attempts to restore GI continuity and one died from cardiac disease before any GI surgery. Morbidity occurred in six. Various stages of wound healing from acute inflammation to dense fibrosis were found in pathologic specimens. Fibrosis was most marked in the submucosa and most consistently found in specimens resected 3 mo after the acute episode of NEC. Intestinal stricture develops in 6%-33% of the infants with previous NEC. Eighty percent of these strictures are colonic, 30% are left sided, and 15% are multiple. Multiple lesions are exclusively colonic. Histology varies with age of lesion. The predominant feature of stricture is submucosal fibrosis. Strictures less than 3 mo old still have acute inflammatory disease, older strictures are mature and fibrotic. The best diagnostic tools are a high index of suspicion and a barium enema. An intestinal stricture should be suspected in any infant with a past history of NEC and: (1) symptoms of obstruction or failure to thrive; (2) previous exteriorization or proximal diversion of acute or chronic NEC lesions; or (3) peritoneal drainage under local anesthesia for NEC perforation. Treatment should be tailored to the infant's condition and the time elapsed since the acute NEC episode. Resection of the stricture must be complete otherwise recurrence or leak is unlikely. Intestinal diversion with a 3-6-mo delay before reconstruction appears safer in the child with little margin for error. Earlier restoration of blood flow and cessation of intestinal function during the acute episode of NEC might reduce the incidence of stricture.

Colonic Diseases↗
PubMed1981

The vulnerability of the vas deferens.

Transection of the vas deferens is considered a disaster, but other manipulations may have unpredictable and hitherto undocumented effects. In order to delineate the structural changes in the vas deferens after operative manipulation, 40 Wistar rats (300-500 g) were divided into four groups and subjected to four different operative manipulations (grasping with fingers, nontoothed Adson forceps, bulldog vascular clamp, clamping with "mosquito" hemostat). Histologic studies performed at 6 wk postmanipulation demonstrated a variable intra- and transmural inflammatory reaction in all groups. Thirty percent of the specimens grasped by the forceps showed disruption of the muscle wall. One-hundred percent of the specimens clamped by the hemostat showed mural disruption and marked inflammatory reaction; in addition 30% had an associated abscess. Therefore all manipulation of the vas deferens should be minimized to avoid triggering inflammation and secondary obstruction. Grasping with a nontoothed forceps results in appreciable damage. Clamping with a hemostat is as serious as complete transection.

Animals↗
PubMed1981

An assessment of the surgical treatment of adhesive small bowel obstruction in infants and children.

At The Hospital for Sick Children, Toronto, Canada, adhesive small bowel obstruction (SBO) ranks seventh as a cause of pediatric bowel obstruction. Between January 1968 and December 1979, 131 infants and children had adhesive SBO proven at laparotomy or autopsy: 123 had 1; 7 had 16 adhesiotomies; 1 died without surgery; 100 had 1 prior operation; and 31 had multiple operations. Over 80% of the SBOs developed within 2 yr of the prior operations. Appendectomy and subtotal colectomy were the most common prior operation. Postoperative morbidity occurred in 29 children; 20 were observed longer than 24 hr before laparotomy. The rate of wound infection ranged from 4% to 50%; it was lowest for those children who had lysis of adhesions only, and highest for those who had lysis and decompressive enterotomy or perforation repair. Results indicate that delaying adhesiotomy and entering the GI tract during adhesiotomy are associated with increased morbidity (p less than 0.01), and therefore should be avoided. Prophylactic antibiotics may have a protective role during anterolysis.

Adolescent↗
PubMed1981

Balloon embolization of a bleeding gastroduodenal artery in a 1-year-old child.

Severe stress can produce ulceration and uncontrollable hemorrhage in the pediatric age group. Modern angiographic techniques, using embolization of a Silastic balloon to occlude a visualized bleeding vessel, can successfully control hemorrhage and avoid surgical intervention and its resultant disordered gastric physiology. Recently this technique was used to control hemorrhage from the gastroduodenal artery in a 1-year-old child with severe respiratory sepsis. This is the youngest reported child in whom the technique has been used to control bleeding from this vessel.

Aneurysm↗
PubMed1981

Wide gap esophageal atresia with inaccessible upper pouch.

Circular myotomy of the proximal esophageal pouch has allowed end-to-end esophagoesophagostomy in infants with wide gap esophageal atresia. Occasionally, the proximal pouch ends so high in the thorax that the circular myotomy is technically impossible under conventional means. Exteriorization, mobilization, and myotomy of the proximal esophageal pouch via a separate cervical incision has allowed us to overcome this limitation of an inaccessible upper pouch and has permitted esophagoesophagostomy. This technique has been performed successfully in two infants with good results and no morbidity over a follow-up period of 1 1/2 to 3 1/2 years.

Esophageal Atresia↗
PubMed1980

Long-term follow-up circular myotomy for esophageal atresia.

Between January 1976 and March 1979, esophageal atresia was successfully repaired in six infants with circular myotomy (Livaditis technique) and end-to-end anastomosis. Children were 1 day-6 mo in age and weighed 2.4 to 8.0 kg at the time of repair. Four children required one and two children required two circular myotomies in the proximal esophagus to bridge gaps between esophageal ends, which varied from 1.2-3.0 cm. Follow-up has been 1-4 yr (mean-3 yr). Operative complications included: opening of the mucosa at myotomy (2) and anastomotic leak (2). Subsequently, three children developed anastomotic stricture which required dilatation. Current x-rays show ballooning of the esophagus at the myotomy site during swallowing in all. However, the esophageal diameter at the myotomy site was never more than 2 cm greater than that of the distal esophagus. In the three children with anastomotic stricture, mucosal ballooning was not greater than in the others. During follow-up, weights have ranged from the 3rd to the 50th percentile for age. Swallowing has been good in 4, fair in 1 (dilatation still required), and poor in 1 (oropalatal deformities necessitate gastrostomy feedings). Circular myotomy offers a safe means of esophageal lengthening. Complications directly related to the myotomy are minimal (mucosal tear) and should be recognized at operation. Ballooning of the mucosa at the myotomy site is a common late finding but diverticulum formation has not occurred. Swallowing and esophageal motility are similar to other children who have had esophageal atresia repair.

Esophageal Atresia↗
PubMed1980

Peritoneal drainage under local anesthesia for necrotizing enterocolitis (NEC) perforation: a second look.

Between 1974 and 1979, 15 extremely ill neonates with necrotizing enterocolitis (NEC) were initially treated with peritoneal drainage under local anesthesia for intestinal perforation. They weighed 600 to 3040 g with half less than 1000 g. Most had other serious illnesses (RDS, PDA, jaundice, CNS abnormalities). There were no immediate complications such as hemorrhage or bowel evisceration from the local drainage procedures. Seven of the 15 (46%) survived. Three (20%) died because of unrelated problems (CNS, liver failure) with an intact gastrointestinal tract, while another 8 (34%) died from intestinal sepsis. Seven (87%) of the neonates weighing less than 1000 g had an adequately functioning GI tract after this drainage procedure. Half of the neonates requiring additional surgery within 24 hr of initial peritoneal drainage survived and half of the neonates requiring subsequent surgery survived. Five of 15 infants developed strictures one died before excision. This technique is contrary to standard practice and was employed in less than 10% of the neonates with NEC treated at our institution. These results indicate that this method is effective in possibly temporizing the very ill neonate with NEC. An added bonus, however, is that 40% of the neonates treated in this fashion had complete resolution of their disease without residual scarring of the gastrointestinal tract requiring further surgery. It is our continued conclusion that this form of peritoneal drainage under local anesthesia is warranted in certain carefully selected instances.

Anesthesia, Local↗
PubMed1980

Nonsurgical management of appendiceal mass in late presenting children.

Thirty-seven late presenting children with appendiceal mass were treated between 1965 and 1975 with i.v. fluids, alimentation according to the state of gastrointestinal function, and no antibiotics. They ranged in age from 18 mo to 16 yr and all had had symptoms for at least 5 days (mean 8.7), an abnormal WBC (mean 19.9), and a fixed palpable mass without rebound tenderness. Children were discharged when clinical findings resolved. All returned for interval appendectomy. Eighty-one percent (31 children) had clinical improvement within 5-22 days (mean 10.9). Nineteen percent (7 children) had recurrence or worsening of symptoms and required abscess drainage within 2-10 days after observation began. No child in either group received antibiotics nor did any die. Only one recurrence of symptoms after discharge was recorded before interval appendectomy. Pathologic specimens revealed fibrosis in 46%, subacute inflammation in 35%, and acute inflammation in 19%. Nonoperative management of the appendiceal mass without antibiotics in children is safe as long as diligent observation is maintained. Interval appendectomy can be performed as late as 20 wk after symptom resolution or drainage, however, over 50% of the interval appendectomy specimens reveal acute and subacute inflammation.

Adolescent↗