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Biomedical subjects

K C Pringle

Publications and source records attributed to K C Pringle.

At least 19 recordsLinked to original sources
PubMed1994

Management and outcome of inoperable Wilms tumor. A report of National Wilms Tumor Study-3.

METHODS: The authors reviewed 131 children enrolled in National Wilms Tumor Study-3 (NWTS-3) who received preoperative treatment for tumors unable to be resected at surgery or judged inoperable by imaging evaluation. Preoperative biopsies were performed on 103 patients. Patients were assigned a pretreatment stage: stage II (11 patients), stage III (39 patients), stage IV (66 patients), and unknown (15 patients). The chemotherapy regimen included dactinomycin and vincristine (81 patients), dactinomycin, vincristine, and doxorubicin (30 patients), dactinomycin, vincristine, doxorubicin, and cyclophosphamide (10 patients), and other (8 patients). Preoperative radiation therapy was started concurrently with chemotherapy (27 patients) or because of lack of response (14 patients). Two patients were given preoperative irradiation without chemotherapy. RESULTS: Response to therapy was assessed after the first trial of chemotherapy. Partial responses were noted in 110 patients (85%), 3 had complete responses, 13 had no response or progression of disease, and 5 patients were not able to be evaluated. There were no significant differences in preoperative response to the different chemotherapy regimens. Median time interval from diagnosis to nephrectomy was 58.5 days. When compared with NWTS-3 patients not receiving preoperative treatment, survival was reduced for patients treated preoperatively (88% vs. 74%, respectively, 4-year survival), which was only partially explained by differences in stage distribution. Median duration of follow-up was 5.9 years. Lack of response to the preoperative treatment was associated with a poor prognosis. Eight children died before removal of the primary tumor. All eight had either progressive disease or no response to the preoperative treatment. CONCLUSIONS: The use of preoperative treatment can facilitate subsequent surgical resection in selected patients with inoperable Wilms tumors. Although these very large tumors--judged unable to be resected--have a somewhat worse prognosis, nephrectomy was completed in 93% of patients after preoperative treatment. However, preoperative treatment will lead to less accurate surgical and pathologic staging, and undertreatment should be avoided in these high-risk patients.

Child, Preschool↗
PubMed1992

An evaluation of abdominal staging procedures performed in pediatric patients with advanced Hodgkin's disease: a report from the Childrens Cancer Study Group.

Forty-nine children and adolescents underwent staging laparotomy in the course of a cooperative group (CCG) study of advanced Hodgkin's disease (HD). The purpose of the study was to evaluate the toxicity of a regimen of 12 cycles of doxorubicin, bleomycin, vinblastine, and imidazole carboxamide (ABVD) plus 2,100 cGy regional irradiation in patients with stage III-IV disease. Review of the biopsies and specimens from these 49 laparotomies identified distinct patterns of abdominal involvement and permitted an evaluation of the importance of different aspects of the staging procedure and an assessment of the value of non-invasive techniques in determining the extent of abdominal disease. The major observations from these studies were: (1) computed tomography (CT) and gallium 67 scans (GA) were specific (few false positives), but not sensitive, indicators of abdominal disease; (2) negative findings at laparotomy in 29 patients permitted a contraction of the abdominal radiation fields with no subsequent abdominal recurrence in these patients; (3) in five patients, stage IV status was established only by laparotomy and open hepatic biopsy; (4) all patients with lower abdominal or pelvic involvement also had upper abdominal node or splenic involvement; (5) involvement of splenic hilar nodes was a sensitive predictor of splenic involvement; (6) disease in the inferior paraaortic nodes accurately predicted the presence of more distal disease, ie, in the iliac or pelvic node groups; and (7) in a limited experience, transposition of the ovaries protected ovarian function from the effects of pelvic irradiation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

The effect of preoperative therapy on the histologic features of Wilms' tumor. An analysis of cases from the Third National Wilms' Tumor Study.

Preoperative chemotherapy is being used with increasing frequency in the US for the management of selected children with Wilms' tumor, despite relatively limited knowledge as to the effects of such therapy on tumor histologic features. The authors reviewed pathologic material from all preoperatively treated unilateral Wilms' tumors registered on the third National Wilms' Tumor Study. Preoperative therapy was associated with increased ambiguity of tumor stage. The prevalence of anaplasia in the 83 evaluable specimens was similar to, although slightly increased over, that in comparable high-stage untreated Wilms' tumors (11% versus 5% to 8%), and it appeared to retain its adverse connotations. These data also suggest that alterations of tumor character and distribution by therapy provide useful prognostic information. All 17 children whose residual viable tumor was limited to intrarenal sites at the time of resection were alive and disease-free at last follow-up. Extensive (greater than 90%) tumor necrosis, low mitotic activity, and high degrees of differentiation of residual tumor were also associated with favorable outcomes. Although careful utilization of preoperative chemotherapy can be of value in children with otherwise difficult-to-manage Wilms' tumors, the potential benefits of preoperative tumor bulk reduction must be weighed against the risk of overtreatment or undertreatment as a result of increased ambiguity of tumor stage.

Anaplasia↗
PubMed1990

Wilms' tumour: a 30 year experience at Wellington Hospital.

Over the 30 year period from 1958-88, 20 cases of Wilms' tumour have been treated at Wellington Hospital. All eight patients presenting prior to 1976 have died. The 12 patients presenting after 1976 were treated according to the guidelines of the National Wilms' Tumour Study Group and ten of these are alive (mean follow up seven years). Four of the patients received preoperative chemotherapy and this was found to facilitate surgical removal of the tumour. The concept of partial nephrectomy in the management of Wilms' tumour is discussed. Retrospective analysis of this series has shown that this would have been a feasible management option in four of the cases reviewed.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1990

Solitary intrahepatic biliary cyst: diagnostic and therapeutic strategy.

This paper describes a newborn infant in whom an intrahepatic biliary cyst was successfully demonstrated by antenatal ultrasound. Postnatally, percutaneous cyst aspiration and computed tomography enhanced with intravenous cholangiographic contrast proved extremely helpful in the selection of surgical procedure. The lesion was completely removed at 12 weeks of age without complications.

Bile Duct Diseases↗
PubMed1990

Fetal gastroschisis complicated by bowel dilation: an indication for imminent delivery?

Antenatal diagnosis of fetal gastroschisis permits study of bowel appearance throughout gestation. Fetal bowel dilation has been regarded as a 'high-risk' condition requiring imminent cesarean delivery. We report 2 cases of gastroschisis with onset of bowel dilation in the third trimester. At surgery, the bowel was patent. Neither fetus had evidence of acute bowel damage following expectant management and vaginal delivery. Both underwent a one-stage repair. We conclude that antenatal bowel dilation does not necessarily reflect bowel injury or a poorer neonatal prognosis. In our experience, bowel dilation in fetal gastroschisis does not represent a separate indication for cesarean delivery and can be associated with a good outcome following vaginal delivery.

Abdominal Muscles↗
PubMed1989

Similar efficacy of 6 and 18 months of therapy with four drugs (COMP) for localized non-Hodgkin's lymphoma of children: a report from the Childrens Cancer Study Group.

Successful treatment of localized non-Hodgkin's lymphoma (NHL) in childhood with 18 months of cyclophosphamide, vincristine, methotrexate (MTX), and prednisone (COMP) prompted a randomized clinical trial to determine whether a 6-month course of the same therapy was as effective as an 18-month course when combined with local irradiation. Two successive Childrens Cancer Study Group (CCSG) protocols (CCG 551 and CCG 501) entered 232 eligible patients from October 1979 until April 1986. Initially, all children with localized disease were considered eligible, but by a subsequent amendment, those with lymphoblastic (LB) histology were excluded. Hence, the study population consisted of 211 patients with nonlymphoblastic (NLB) and 21 with LB disease. Early relapses (before 6 months) occurred in 13 patients with NLB histology. Late relapses were seen in seven patients, three with LB histology. Among the 104 randomized patients who followed the prescribed therapy, there were four recurrences and no differences between 6-month and 18-month therapy. The overall survival for NLB disease was 91% on CCG 551 and 98% on CCG 501. We conclude that 6 months of COMP is excellent therapy for children with localized NLB NHL.

Adolescent↗
PubMed1989

Fetal diagnosis and fetal surgery.

Accurate fetal diagnosis became possible by the steadily increasingly complex techniques of amniocentesis, ultrasound, and ultrasound-guided fetal blood sampling and chorion villous sampling. A high degree of diagnostic accuracy for a wide variety of structural and metabolic anomalies is required. The field of fetal diagnosis has been extended to the point that a journal dedicated to this subject alone is a viable proposition. It is becoming apparent, however, that lesions that were well known and well understood when recognized in neonatal life appear in general to have a worse prognosis if the lesion is diagnosed in utero. Fetal surgery began with attempts to perform in utero transfusions for babies with erythroblastosis fetalis. For a while, there was competition between open surgical procedures and the percutaneous placement of blood through catheters introduced into the fetal peritoneal cavity from outside the mother's abdomen. For fetal transfusion, closed techniques proved far safer and just as efficacious. There has been a worldwide interest in shunting of hydrocephalus and obstructive uropathy. The results of shunting hydrocephalus have been disappointing, with most of the patients surviving, but most of the survivors being severely handicapped. The results of shunting obstructive uropathy were that only about 50 per cent of the babies survived, but it appeared that those that did survive did well. Other lesions that have been shunted have been hydrothoraces or fetal ascites. A limited number of open procedures have been carried out in the last few years in San Francisco, and it may well be that diaphragmatic hernia (in appropriately selected patients) will be a lesion that can be corrected by in utero surgery. The future of this field is exciting, but before this form of treatment becomes routine, the ethical implications of the possibility of fetal surgery must be defined much more clearly than is currently the case.

Female↗
PubMed1988

Sodium deficit causing decreased weight gain and metabolic acidosis in infants with ileostomy.

The records of 11 infants, 25 to 38 weeks' gestation, with metabolic abnormalities induced by ileostomy fluid losses were reviewed. At operation for necrotizing enterocolitis (NEC) (9) or meconium ileus (MI) (2), they weighed between 1,100 and 3,100 g and were from one to 41 days old. All developed total body sodium depletion and metabolic acidosis from ileostomy bicarbonate loss. In seven, sodium depletion was severe enough to require supplementation; six initially lost or failed to gain weight despite being fed adequate diet and calories. However, after receiving sodium supplementation (three with NaCl and three with NaHCO3), these six patients gained weight and improved their metabolic acidosis. The other five subjects did not initially receive sodium supplementation. Four gained weight; one of these later received supplemental NaHCO3 for a metabolic acidosis. The fifth patient failed to thrive until his ileostomy was closed. All infants initially had urine Na less than 10 mEq/L and normal serum Na. All infants whose urine Na rose above 10 mEq/L and had serum HCO3- greater than or equal to 20 mEq/L grew adequately. A direct relationship existed between ileostomy output and sodium intake required for growth. This expressed mathematically (Na intake = 1.2 + [0.13 x ileostomy output] shows a basal sodium need (with no ileostomy output) of 1.2 mEq/kg/d and an additional requirement of 0.13 mEq/kg/d of sodium for each mL/kg/d of ileostomy output. We conclude that infants with ileostomies are at extreme risk of total body sodium depletion with resultant metabolic acidosis and inadequate weight gain. These infants require sodium supplementation with a combination of NaCl and NaHCO3.(ABSTRACT TRUNCATED AT 250 WORDS)

Acid-Base Equilibrium↗
PubMed1988

Congenital anorectal anomalies: MR imaging.

Twenty-one patients with anorectal anomalies were evaluated with magnetic resonance (MR) imaging. In seven preoperative patients, MR imaging demonstrated the level of atresia correctly by showing the rectal pouch and sphincter muscles. The exact location and development of the sphincter muscles were estimated and associated anomalies involving the kidneys and the spine and its contents were evaluated. In 14 postoperative patients, the location of the pulled-through intestine was examined in relation to the sphincter muscles. MR imaging demonstrated operative complications affecting rectal continence--such as a misplaced neorectum, inadvertently pulled-through mesenteric fat, and an implantation mucous retention cyst--and provided objective data for individuals with persistent incontinence after surgery who were under consideration for repeat surgery. The authors recommend MR imaging in all patients being considered for repeat procedures and in any patient without prior surgery who is suspected of having a high anomaly; any degree of sacral agenesis; or spinal, genito-urinary tract, or cloacal anomalies.

Adolescent↗
PubMed1988

Abdominal wall defects and obstructive uropathies. Aetiology and management.

Gastroschisis and omphalocele (exomphalos) are embryologically distinct, and for this reason each has its own distinct constellation of associated anomalies. The perinatal management of both gastroschisis and omphalocele addresses the controversy as to the best mode of delivery that has been expressed in the literature with regard to gastroschisis and has exercised many of those involved in antenatal diagnosis in the case of omphalocele. The post-delivery management of both of these defects is briefly discussed. Controversies surrounding the aetiology of renal dysplasia and whether urinary tract obstruction is a cause of dysplasia or an anomaly associated with dysplasia are also discussed. The options for therapy and the indications for an in utero shunting procedure are outlined as well as the controversy centred around the utility of an in utero shunt. The need for a prospective randomised trial is emphasised, together with the difficulty that is raised by the need to choose a limited number of prospective indices on which treatment decisions in such a trial must be based. The need for a long-term follow-up of all patients entered in such a trial is emphasised.

Abdominal Muscles↗
PubMed1988

Development of fetal lamb lung and kidney in obstructive uropathy: a preliminary report.

Oligohydramnios, whatever the cause, results in lungs that are 'hypoplastic' or at least smaller than normal. The fine structure in such lungs has not been reported previously. Three fetal lambs had both ureters ligated at 60, 72 and 58 days of gestation. They were sacrificed at 117, 143 and 142 days of gestation. The lungs were fixed by tracheal perfusion at 15 mm Hg. Individual lobar volumes were determined, and the lungs were sampled for electron microscopy. Total lung volumes for 2 of the lambs were very close to those previously reported for lungs of equivalent gestation with diaphragmatic hernia. The third lamb had a twin that had been unrecognised at the time of the original procedure. This lamb's lung volumes were normal. The morphological appearances of the lungs at the electron microscopy level are not normal but dramatically different from those previously reported in lambs with diaphragmatic hernia, phrenic nerve avulsion, and fetal tracheostomy. The lungs of the lamb with bilateral ureteric ligation and a normal twin were essentially normal. These preliminary findings point to the need for more studies of lung structure in oligohydramnios/obstructive uropathy models. However, the normal lungs in a lamb with grossly dysplastic kidneys and a normal twin argue against any important renal trophic factor in lung development in the fetal lamb. An interesting sidelight to this investigation was the unequivocal demonstration that early ureteric ligation results in true renal dysplasia in the fetal lamb. The kidneys of the lamb sacrificed at 117 days were smaller than normal and grossly dysplastic. The kidneys of the lambs that underwent ureteric ligation at 60 and 72 days were structurally different, with the ureters ligated at 60 days being small and dysplastic, while those with the ureters ligated at 72 days were larger and appeared almost polycystic.

Animals↗
PubMed1988

A reassessment of pregnancy staging.

A system of staging pregnancy that is directly related to normal development is proposed to replace the currently used 'trimester' system. If accepted, this concept of staging could be applied across species without the likelihood of a grossly incorrect assessment of the stage of development. In contrast to this, the division of a pregnancy into trimesters is based upon an accident of mathematics and bears no relationship to human development. The proposal is to divide pregnancy into three stages, termed 'horizons'. First is the 'embryonic horizon' from fertilisation until the end of the 8th week from fertilisation, i.e., 10 weeks from the first day of the last menstrual period (LMP). The 'early fetal horizon' extends from the end of the embryonic phase to the 25th week of gestation (i.e., 25 weeks from the first day of the LMP). This horizon is divided into the 'primitive phase' (up to the 15th week of gestation) and the 'transitional phase' (from the 15th to the 25th week of gestation). The 'late fetal horizon' extends from 25 weeks to beyond term and is divided into the 'premature phase' (from 25 weeks to 36 weeks of gestation), the 'mature phase' (36 weeks to term) and the 'post-mature phase' which extends from term to about 45 weeks of gestation. The importance of this phase is the fact that perinatal morbidity and mortality is proportional to the length of time the gestation continues beyond maturity. It must be stressed that the terms 'horizon' and 'phase' are intentionally imprecise. This is to emphasise that human development is a continuum and not a series of steps.

Embryonic and Fetal Development↗
PubMed1988

Balloon dilatation of esophageal stenosis in children.

Balloon dilatation of benign esophageal strictures is an accepted mode of therapy in adults. This report describes balloon dilatation in 20 consecutive infants and children. The lesions treated include 11 strictures at surgical anastomotic sites, seven restrictive Nissen fundoplications, and three nonanastomotic esophageal strictures. One patient had two lesions. Most dilatations were performed on an outpatient basis without anesthesia. All strictures responded immediately to dilatation. In most cases, long-term resolution occurred after three or fewer procedures. A subgroup of patients was identified in which a prolonged course of treatment was needed. These included patients with long strictures due to esophageal atresia, patients with chronic severe esophagitis, and patients with strictures at the site of esophageal perforation. No significant complications were encountered. Balloon dilatation of esophageal stenosis in children is effective and safe and should be considered before other methods of treatment are used.

Catheterization↗
PubMed1987

Successful treatment of hepatic venocclusive disease in a bone marrow transplant patient with side-to-side portacaval shunt.

Hepatic venocclusive disease developed in a 14-yr-old white girl after allogenic bone marrow transplantation from an HLA-identical sibling donor. Clinical diagnosis of venocclusive disease was based on the development of ascites, hepatomegaly, and jaundice 3 wk after transplantation. Current treatment of hepatic venocclusive disease is ineffective. The pathophysiology of the hepatic lesion suggests that construction of a side-to-side portacaval shunt should be beneficial in relieving the ascites and preventing further hepatic damage. Because the ascites was refractory to medical therapy and she was clinically deteriorating, a side-to-side portacaval shunt was performed. Histologic examination of a liver biopsy specimen obtained at surgery documented the presence of venocclusive disease. Postoperatively, the patient diuresed and returned to her baseline weight. One year after surgery the patient was doing well, her weight was stable, and she was being maintained on salt restriction alone. While the resolution of ascites and improvement of hepatic function in our patient after side-to-side portacaval shunt does not guarantee that such an approach will be uniformly successful, it should serve to encourage others to consider such therapy for this frequently devastating complication of chemoradiation therapy.

Adolescent↗
PubMed1987

Magnetic resonance imaging as an adjunct to planning an anorectal pull-through.

Magnetic resonance imaging (MRI) is a relatively new diagnostic tool that generates images of sections of the body taken in any plane. We report the use of MRI as a tool to plan surgical procedures in patients with imperforate anus, imaging the pelvis and lumbosacral spine in the sagittal, transverse, and coronal planes. MRI clearly reveals the extent of the pelvic musculature even in patients with severe sacral agenesis. MRI is extremely useful in assessing patients under consideration for reoperation, clearly demonstrating the relationship between the pulled through colon and the "striated muscle complex." A very useful addition is the ability, on the same study, to detect previously unsuspected anomalies such as tethered cord, lipoma of the filum terminale, and renal dysplasia. We conclude that MRI is a very useful examination in selected patients with imperforate anus.

Adolescent↗
PubMed1987

Permanent cardiac pacemaker implant in the fetal lamb.

To investigate the feasibility of permanent cardiac pacing in the fetal lamb, we attempted five implants in lambs between 100 and 115 days of gestation. The lambs were approached by a left thoracotomy done through a transverse hysterotomy in the ewe. An epicardial lead was fixed to the left ventricle. Pacing parameters were measured and the lead was connected to an Enertrax implantable pulse generator. A pouch was created for the generator deep to the latissimus dorsi. Documentation of pacing was obtained electrocardiographically; pacing faster than the fetal intrinsic rate. The muscle and the fetal skin were closed. The pacemaker was programmed to a rate of 70 in the ventricular inhibited (VVI) mode and the uterine and abdominal wall incisions were then closed. One lamb was successfully delivered by Cesarean section at term. Pacing parameters were measured at birth and one month later. There were small changes in the pacing lead function parameters as the implant progressed into the chronic phase. They were within the capacity of the generator to pace with a margin of safety. Four lambs died in utero and were delivered 5 to 26 days post-implant. We conclude that permanent cardiac pacemaker implantation is feasible in the fetal lamb and with further development, it may eventually be used in humans in the treatment of fetal congestive heart failure due to bradyarrhythmias.

Animals↗