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K P Schropp

Publications and source records attributed to K P Schropp.

At least 19 recordsLinked to original sources
PubMed2001

The association of elevated percent bands on admission with failure and complications of interval appendectomy.

BACKGROUND/PURPOSE: The routine use of interval appendectomy for the treatment of perforated appendicitis, with or without abscess, remains controversial. The purpose of this study is to confirm the efficacy of this approach and to identify factors associated with failures and complications. METHODS: All patients (n = 101) with their clinical diagnosis of perforated appendicitis confirmed with imaging were treated prospectively with fluids and intravenous antibiotics (clindamycin, ceftazidime) and were discharged home on oral fluids and analgesics regardless of fever. Intravenous antibiotics were continued at home until the patients were afebrile for 48 hours, and their white blood cell and differential counts were normal. Patients were readmitted at 8 to 12 weeks for an interval appendectomy. Failure to improve by 72 hours of antibiotic therapy mandated an early appendectomy. P values were determined by chi(2) analysis and Student's t test. RESULTS: The 79 patients (78%) successfully treated with interval appendectomy had an overall 6.3% complication rate, and total hospitalization averaged 5.2 days. The treatment in 21 of 22 patients (22%) requiring early appendectomy failed because of a clinical picture suggesting small bowel obstruction. The patients with the failed procedures had a complication rate of 50% and were hospitalized an average of 12.8 days. The overall complication rate for the 101 patients was 15.8%, and the overall total hospitalization was 6.9 days. Patients requiring early appendectomy had a more frequent finding resembling a small bowel obstruction on their initial x-ray (50% v 13%, P = .004) and a higher percent band count on their initial differential blood cell count (22.6% v 7.6%, P<0.0001) than did those successfully treated with interval appendectomy. An initial band count <15% was predictive of an uncomplicated course (84% positive predictive value). CONCLUSIONS: Interval appendectomy without complications is successful in the majority of patients with perforated appendicitis. An elevated initial band count > or =15% is associated with an increased likelihood of failure and complications.

Adolescent↗
PubMed2000

Sentinel lymph node biopsy for melanoma in young children.

Lymphoscintigraphy and sentinel lymph node biopsy techniques can be applied successfully to young children with melanoma to detect nodal disease. The authors describe their methods of lymphoscintigraphy and sentinel node biopsy and its application in 2 young children with malignant melanoma of the head and neck.

Biopsy↗
PubMed1999

Early definitive intervention by thoracoscopy in pediatric empyema.

PURPOSE: Nineteen children had early thoracoscopic intervention for empyema between 1992 and 1997 at the LeBonheur Children's Medical Center. The authors have evaluated the results of this treatment. METHODS: Thoracoscopic intervention was performed at the fibrinopurulent state of empyema. An irrigating laparoendoscope was inserted, loculi were disrupted, debris was evacuated, and a chest tube was passed through the port site. RESULTS: The patients were aged between 11 months and 16 years (mean, 6.5 years). The etiology of the empyema was parapneumonic in 17, and there was one case each of perforated appendicitis and mediastinal histoplasmosis. They underwent thoracoscopy at a mean of 4.6 days after hospital admission (range, 1 to 12 days). Chest tubes were removed at 1 to 5 days (mean, 2.9 days) after operation, and resolution of fever occurred at 1 to 9 days (mean, 3.8 days) postoperatively. Patients were discharged home between 4 and 10 days (mean, 6.1 days) postoperatively, and the mean hospital stay was 10.3 days (range, 5 to 21). There were no complications. The surgical technique was simple and well tolerated, requiring few disposable items, and the mean operating time was 77 minutes. CONCLUSIONS: Thoracoscopy eliminated the morbidity of thoracotomy and the discomfort and expense of prolonged chest tube drainage. Thoracoscopy may be used as early first-line therapy in a majority of pediatric patients with fibrinopurulent empyema.

Adolescent↗
PubMed1998

Laparoscopic pyloromyotomy: a safer technique.

A modified technique of laparoscopic pyloromyotomy was used to treat infantile hypertrophic pyloric stenosis. Introducing a 5-mm periumbilical port for visualization, two stab wounds are made on either side laterally to directly insert 2.7-mm instruments for manipulation. From the left, the stomach is grasped - not the duodenum! From the right, an inexpensive disposable arthroscopy knife is used to incise the serosa and begin the myotomy, which is completed with a laparoscopic spreader until the muscle is separated sufficiently to relieve the obstruction. Twenty-nine children treated with laparoscopic pyloromyotomy were compared to 125 children treated with the conventional open Ramstedt pyloromyotomy. There were no statistically significant differences in the presentation or results between groups, suggesting that the laparoscopic technique is a safe and equal alternative.

Female↗
PubMed1998

Interval appendectomy for perforated appendicitis in children.

To determine the efficacy, safety, and cost of managing perforated appendicitis with intravenous antibiotics followed by an interval appendectomy, the charts of 87 children with ruptured appendicitis were retrospectively reviewed. These patients were treated with intravenous fluid resuscitation and antibiotics (consisting of clindamycin and ceftazidime) and underwent appendectomy, either on that admission (n = 46) or as a delayed interval procedure (n = 41). Antibiotics in all cases were discontinued either at home or in the hospital after the child was a febrile for 48 hours with normal white and differential blood cell counts, and the two groups were compared. Seven patients (17%) "failed" the interval appendectomy protocol. All but one "failure" was due to the development or persistence for >72 hours of a bowel obstruction. The data are described below as percent or mean +/- 1 standard deviation. [table: see text] We conclude that antibiotics and interval appendectomy is a safe effective alternative for the management of perforated appendicitis. When successful, hospitalization, charges, and morbidity are less with this approach. A persistent bowel obstruction for 72 hours is an indication to proceed with appendectomy on admission.

Adolescent↗
PubMed1998

Laparoscopic appendectomy in children.

Laparoscopic appendectomy is a common surgery in most pediatric surgical centers. Many studies, mostly retrospective reviews in adults, show the advantages of the laparoscopic approach to be less wound infections, shortened postoperative recovery, and faster return to normal activities. In addition, less analgesic medication is required postoperatively. Potential disadvantages of laparoscopic appendectomy include an increased operative time, elevated costs when disposable instruments are used, and possibly more infectious complications when performed for complicated appendicitis. There are no prospective, randomized trials comparing laparoscopic versus open appendectomy in children. Until these studies are completed, questions will persist regarding the benefits of laparoscopic appendectomy in children.

Adult↗
PubMed1996

Complications of minimal-access surgery in children.

Minimal-access surgery (MAS) is rapidly becoming the surgical approach of choice for a variety of surgical disorders in adults, but its use in children remains a relative novelty. Most pediatric surgeons continue to harbor justifiable concerns about the morbidity of this modality owing to the cumbersome nature of the instruments and the technical difficulty associated with two-dimensional views. The purpose of this study was to determine the complication rate and the lessons learned from the use of MAS in performing a variety of procedures in a large series of children. To determine complications, the authors reviewed the medical records of all children (n = 636; age range, 1 month to 19 years) who underwent laparoscopy (LAP) or thoracoscopy (THO) during a 5-year period (January 1, 1990 through December 31, 1994). The follow-up ranged from 1 week to 45 months. THO was performed in 62 children. Conversion to thoracotomy occurred in eight children (13%), because of inability to localize the lesion (3), unresectibility (2), inadequate tissue sample (1), unsafe access (1), hypoxemia (1), or inadvertent esophagotomy (1). Postoperatively, two ventilator-dependent children had tension pneumothorax after lung resection and required chest tubes. LAP was performed on 574 children, with conversion to laparotomy occurring in 15 (2.6%), because of technical reasons (10) or intraoperative complications (5). The complication rate of LAP was 2% (12 of 574). Early in the experience, intraoperative complications that led to laparotomy included hemorrhage during appendectomy (2), cholecystectomy (1), and splenectomy (1); and esophagotomy during a fundoplication (1). Other technical problems in the postoperative period were a malpositioned Nissen fundoplication and a gastric volvulus after gastrostomy and Nissen fundoplication owing to improper gastrostomy tube position. In addition, two children had a hernia at the umbilical trocar site that had been used for contralateral inguinal exploration, and cellulitis developed in three patients when a gastrostomy tube was brought out through a trocar site. Other complications not specific to MAS included pelvic abscess after appendectomy (5); small bowel obstruction after jejunostomy catheter placement (1) and combined cholecystectomy/appendectomy (1); enterocolitis (1) and severe hyponatremia (1) after pull-through for Hirschsprung's disease; and pneumonia after splenectomy (1). The overall complication rate of MAS was 4% (26 of 626), and there were no deaths. The initial use of MAS was associated with technical errors, which decreased with experience. Based on this study, the authors recommend (1) routine placement of a thoracostomy tube in children after THO if they require postoperative ventilator support; (2) using the open hernia sac to place a 70 degrees telescope for contralateral inguinal exploration; and (3) not using a trocar site for gastrostomy tube placement in immune-suppressed patients. With appropriate training and experience, MAS can be used safely in children, for a wide variety of diseases, with minimal morbidity and mortality.

Adolescent↗
PubMed1996

A prospective evaluation of an endoscopic ultrasonic probe to detect intraparenchymal malignancy at pediatric thoracoscopy.

Thoracoscopy has been proposed as the procedure of choice for the evaluation of focal, suspected malignant pulmonary lesions in children. One drawback with this approach, however, is the concern that intraparenchymal lesions may go undetected. We prospectively evaluated the ability of an endoscopic ultrasonic probe to detect intraparenchymal nodules. The handheld probe contains a piezoelectric ultrasound emitter and receiver that operates at 7.5 MHz. The axial resolution of the probe is 1.1 cm. Two different probe tips were used. One is a forward viewing tip and the other is angled at 45 degrees relative to the axis of the probe shaft. Both probes image 90 degrees sectors. Twelve thoracoscopies on nine patients were performed using the ultrasound probe. Of seven patients with confirmed metastatic disease, six had thoracoscopy converted to open thoracotomy to assure that no lesion had been missed. The probe was able to accurately assess surrounding bronchovascular structures and the presence and location of previously placed surgical clips. Although deep structures were readily visualized with the probe, lesions within 1.5 cm of the surface of the lung were poorly visualized. No complications occurred. This ultrasound system allows for the distinction of dense lesions from the surrounding pulmonary parenchyma except for those lying near the surface of the lung, which are usually easy to see directly. Furthermore, the images define the broncho vascular structures adjacent to the lesion. This device may enhance thoracoscopy by facilitating the detection of, and ability to resect, pulmonary intraparenchymal lesions.

Endoscopes↗
PubMed1995

The use of minimal access surgery in pediatric trauma: a preliminary report.

Minimal access surgery (MAS) is becoming an accepted modality in the management of adult trauma, but its use in children is rarely reported. Recently, we began using minimal access surgery to evaluate injured children. The purpose of this report is to review our preliminary experience with the use of laparoscopy and thoracoscopy in blunt and penetrating pediatric trauma. Eight children aged 2-14 years old were evaluated using MAS. Two children with blunt injuries had persistent abdominal pain despite normal radiologic studies. Laparoscopy documented a disrupted gallbladder and a small bowel perforation. Laparoscopy was also used to evaluate five hemodynamically stable children with penetrating wounds to the abdominal wall with potential peritoneal penetration. Only one child was converted to a laparotomy. Four were found to have either tangential penetrating wounds or nonbleeding solid organ injuries and were spared an open exploration. Two children with penetrating trauma with potential mediastinal injury were assessed with thoracoscopy. MAS was also used as a therapeutic modality in two children who had diaphragmatic lacerations repaired with an endoscopic "hernia" stapler. MAS accurately identified all injuries. All children were subsequently discharged without complications. We conclude that MAS is a safe and effective way to evaluate and manage hemodynamically stable children with both penetrating and blunt traumatic injuries.

Adolescent↗
PubMed1994

Laparoscopic splenectomy in childhood.

The authors describe their technique for laparoscopic splenectomy in childhood. Five ports, including one 12-mm port for an endoscopic stapler, are placed. With the patient in the supine position, the short gastric vessels are divided between clips. The patient is then placed in the lateral decubitus position for mobilization of the splenic flexure of the colon, division of the posterolateral ligamentous attachments, and en masse transection of the splenic hilum using the EndoGIA stapler. The freed spleen is placed in a nylon reinforced Lap Sac, which is exteriorized at the neck. The spleen is morcellated and the sac removed. Concomitant cholecystectomy is performed in patients with hereditary spherocytosis who have cholelithiasis or sludge. The procedure has been performed without complication in six patients who had hematologic disorders. For another patient, the procedure was converted to an open splenectomy to achieve better hemostasis.

Adolescent↗
PubMed1994

The suitability of automatic tissue morcellation for the endoscopic removal of large specimens in pediatric surgery.

UNLABELLED: Now that endoscopic removal of tumors and other solid structures from the abdomen and chest is possible, it is important to know the suitability of this technique for the removal of solid pediatric malignancies where accurate histological assessment becomes important for prognosis and staging. The authors tested an automatic tissue morcellator on a variety of pediatric tissues to assess the interpretability of the material obtained. The morcellator consists of a rotary blade within a 1-cm sleeve. When suction is applied to the morcellator and the device is activated, the solid material is shaved or morcellated into bits of tissue that are aspirated and collected for analysis. To test the interpretability of morcellated tissue, the device was used on six Wilms' tumors, three hepatoblastomas, a lung resection, a splenectomy, and a bowel resection. The average size of the pieces of tissue was 1.33 x 0.58 x 0.43 cm. In every instance, the histology was as good as the evaluation of sections from the gross tumor. It was difficult to distinguish the edge of tissue procured by the morcellator from an edge cut by the pathologist's knife. CONCLUSIONS: (1) Morcellated pediatric tissues are available by experienced pediatric pathologists. (2) The adoption of this technique should not interfere with proper histological evaluation of solid pediatric tumors.

Biopsy↗
PubMed1994

Primary malignancy of the salivary gland in children.

Seventeen pediatric patients with a major salivary gland malignancy (16 parotid, 1 submaxillary) were reviewed. Eight patients presented with carcinoma. The usual presentation was a mass over the affected gland. Six patients had localized disease, which was treated by excision. This was accomplished by either a total or subtotal parotidectomy or resection of the submaxillary gland. Two patients received adjuvant radiation therapy. All six patients with localized carcinoma are alive, without evidence of disease. Two patients presented with metastatic disease and died of the disease despite treatment with multiagent chemotherapy, and in one case, radiation therapy. Nine patients had rhabdomyosarcoma (RMS). The usual presentation was a mass at the angle of the mandible. Five patients had involvement of one or more cranial nerves, and two had concomitant cervical adenopathy. Eight patients had a biopsy and then were treated according to an existing prospective institutional protocol. The ninth patient initially underwent a superficial parotidectomy. Seven patients received radiation therapy. In one patient, rapid progression of the disease precluded this treatment. Seven patients died of progressive local and distant disease 2 months to 2 years (median, 6 months) from the time of diagnosis. Two patients are alive, without evidence of disease, 3 and 7 years after presentation. We conclude that carcinoma should be managed with complete excision. For RMS of the salivary gland, a biopsy should be performed, and treatment should consist of chemotherapy and radiation therapy.

Adolescent↗
PubMed1994

Breast malignancy in children.

In 25 years, 18 patients with breast cancer were treated at St Jude Children's Research Hospital, 16 were female and 2 were male. The patients presented with primary malignancy (2), metastatic disease (13), or secondary malignancy (3). One of the females with primary breast malignancy had alveolar rhabdomyosarcoma. She was treated with wide excision and is currently receiving chemotherapy. The other patient presented with non-Hodgkin's lymphoma of the right breast. After biopsy, she was treated with chemotherapy. Of 13 patients with metastatic disease, the primary lesion was rhabdomyosarcoma in nine. One patient each had non-Hodgkin's lymphoma, Hodgkin's lymphoma, neuroblastoma, and signet-cell adenocarcinoma. All patients with metastatic disease to the breast died of the disease. Three females presented with invasive ductal carcinoma of the breast after treatment for Hodgkin's disease. Two underwent mastectomy and are alive without evidence of disease. One patient refused therapy and died of the second malignancy. We conclude that (1) breast malignancies had three distinctly different presentations in our patients, (2) the breasts of pediatric oncology patients should be carefully and routinely examined for metastatic disease, and (3) metastatic disease in the breast of a child is a manifestation of disseminated disease and is associated with an extremely poor prognosis.

Adolescent↗
PubMed1994

Fat containing renal mass in childhood: a case report of teratoid Wilms tumor.

Renal masses in childhood rarely contain adipose tissue as a major component. We report a case of teratoid Wilms tumor, an atypical variant of nephroblastoma, in which bilateral renal masses were found on computerized tomography to have a high fat content. Previously reported cases have had clinical characteristics in common with our case. However, our patient died of metastatic disease, which to our knowledge has not been previously described.

Adipose Tissue↗
PubMed1993

Laparoscopic Nissen fundoplication in childhood.

An obese, 10-year-old boy presented with symptoms of pain and apnea due to gastroesophageal reflux that was unresponsive to medication. A laparoscopic Nissen fundoplication was performed, and the child was discharged from the hospital within 36 hours of the operation. The rationale and technique of a laparoscopic Nissen fundoplication for symptomatic gastroesophageal reflux in childhood is described.

Child↗
PubMed1993

A "smart needle" to facilitate difficult vascular access in pediatric patients.

A new Doppler probe inside a needle was evaluated in a group of infants and children to assess its suitability for subclavian venous access. While the efficient use of this device required learning a new technique, we found the device useful to accurately locate the subclavian vein and differentiate it from the artery in all patients weighing more than 3 kg. This device will be most helpful in cases of difficult access, eg, scar from previous access, obesity, or edema.

Catheterization, Central Venous↗
PubMed1993

Thoracoscopy.

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Anesthesia↗