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Biomedical subjects

L Siplovich

Publications and source records attributed to L Siplovich.

At least 19 recordsLinked to original sources
PubMed2000

Fiberoptic bronchoscopy in children using the laryngeal mask airway.

We describe our experience using the laryngeal mask airway (LMA) in children to facilitate diagnostic procedures in fiberoptic bronchoscopy (FOB). Two cases of stridor, two cases of protracted pneumonia, and one case of laryngotracheomalacia were studied. Intravenous atropine (0.02 mg/kg) was given, and induction was carried out by either inhalation of a mixture of halothane-nitrous oxide-oxygen (n = 3) or IV injection of propofol (n = 2). After an adequate depth of anesthesia was obtained, a LMA was introduced. A 2.7-mm-OD flexible fiberoptic bronchoscope was introduced through the LMA and the diagnostic procedure was performed. Ventilation and oxygenation were maintained, and no serious morbidity was associated with the procedure. We found the use of the LMA to facilitate FOB to be useful, easy to perform, and safe, avoiding nasal trauma and providing a patent airway.

Bronchoscopy↗
PubMed1999

Use of N-butyl-2-cyanoacrylate in elective surgical incisions--longterm outcomes.

BACKGROUND: Histoacryl Blue (N-butyl-2-cyanoacrylate) is a tissue adhesive that has been used clinically for more than 20 years. In the last decade, N-butyl-2-cyanoacrylate has been used for cutaneous closure of low-tension lacerations in children and adults and has become a preferred method for closure of pediatric facial lacerations in many emergency rooms outside the United States. Many pediatric elective surgical procedures are performed in tension-free areas and may be suitable for closure with a tissue adhesive. In order to assess this approach, a retrospective study was conducted to evaluate the cosmetic outcomes and complications of the application of N-butyl-2-cyanoacrylate for the approximation of elective surgical incisions in a pediatric population. STUDY DESIGN: Records of 1,098 patients, ages 1 month to 16 years, who, between January 1995 and December 1996, underwent one of the following: orchidopexy, inguinal hernia, umbilical hernia, or hydrocele repair were analyzed. In all patients, N-butyl-2-cyanoacrylate was applied to close the surgical incision. A 12-item questionnaire was created to assess the presence of complications and to determine shortterm and longterm cosmetic outcomes of the incision. Data were collected by conducting telephone interviews of family members. RESULTS: Among the 1,033 children who were treated, 66% had inguinal hernias, 15% hydroceles, 15% undescended testis, and 4% umbilical hernias. Redness or tenderness at the incision site (5.5%), discharge from the surgical wound (1.9%), and wound dehiscence (1.1%) were the main immediate complications after surgery. Overall satisfaction with the cosmetic outcomes of the surgical scar was high, with an average score of 4.73 out of 5 (94.6%). CONCLUSIONS: Our results demonstrate that administration of N-butyl-2-cyanoacrylate for the closure of small low-tension surgical incisions in the pediatric population is safe, has a low complication rate, and produces excellent cosmetic outcomes.

Adolescent↗
PubMed1998

[Trichobezoars].

Trichobezoars are accumulations of hair casts in the stomach associated with trichophagia. The typical patient is an adolescent female who presents with alopecia and an upper abdominal mass which on moving can cause intermittent gastric outlet obstruction. Only a minority of patients have severe psychiatric disorders. When hair strands extend from the main mass in the stomach, all along the small bowel and reaching the cecum, the condition is termed the Rapunzel syndrome. In about 5% of patients there are separate hair masses in the stomach. The clinical presentation includes abdominal pain, loss of appetite, weight-loss, vomiting, loose stools, pancreatitis, jaundice, anemia and hypoalbuminemia. These signs and symptoms raise the suspicion of malignancy. Complications of bezoars include ulcers, perforation of the bowel, obstruction and intussusception. Diagnosis can be established either by barium swallow or by CT scan. Ultrasound might suggest the diagnosis, but sonographic features are definitely not pathognomonic. Treatment is surgical, as endoscopic removal is usually unsuccessful. We present 2 children in whom trichobezoars were found.

Adolescent↗
PubMed1997

T-tubes in the management of meconium ileus

Fifteen cases of meconium ileus (MI) were treated between 1986 and 1995; 7 responded to conservative treatment. Eight were operated upon, and comprise the study group. Six of the operated babies had no complications; 1 had meconium peritonitis with a pseudocyst and small-bowel atresia, and 1 had a volvulus of a small-bowel segment with necrosis. In all 8 cases a T-tube (TT) was left via an enterotomy; in the complicated cases the enterotomy was pre-anastomotic. The obstruction was relieved in all the babies, without any stoma or bowel resection in the uncomplicated cases. Two complications occurred: 1 patient died of respiratory failure 1 month following surgery and another required a relaparotomy for lysis of adhesions. We conclude that TT ileostomy is an effective and safe procedure for uncomplicated cases of MI that do not respond to conservative therapy, as well as for complicated cases that need an anastomosis.

Journal Article↗
PubMed1997

Changes in the management of pediatric blunt splenic and hepatic injuries.

BACKGROUND/PURPOSE: Intensive care monitoring, blood replacement, and nonoperative treatment of splenic and hepatic injuries in stable patients is the standard practice in pediatric surgery with a success rate of 90% in children's trauma centers. METHODS: During the past 5 years, 55 children under 14 years of age have been treated for laceration of spleen, liver, or both, proven by computed tomography. RESULTS: In 34 (62%), other injuries were identified, and only 21 (38%) presented with isolated injuries. In the 21 children who had isolated injuries, 18 had laceration of spleen, two had liver lacerations, and one had liver and spleen laceration. One patient who had spleen laceration required laparotomy and splenorrhaphy because of hemodynamic instability 4 hours after admission. The other 20 patients were initially closely monitored indiscriminately in the Intensive Care Unit of the pediatric surgical nursing unit. Blood transfusion was given to four children during the first 24 hours of admission despite the fact that, retrospectively, all were hemodynamically stable. There was no morbidity or mortality in all the 55 children. CONCLUSIONS: The results of this study suggest that intensive care monitoring is not mandatory in hemodynamically stable patients who have isolated liver or spleen injuries. Blood replacement should be indicated in patients who have hematocrit levels lower than 20% and signs of continuing blood loss. Because of structural characteristics of the young liver and spleen, early progressive mobilization can be indicated.

Accidents, Home↗
PubMed1997

Varicocele treatment in pubertal boys prevents testicular growth arrest.

PURPOSE: There is evidence that varicocele damage, as reflected by loss of testicular mass, is most striking in the pubertal age group. We attempted to evaluate the long-term effect of early varicocele treatment on testicular growth and sperm count and, thus, determine its prophylactic value. MATERIALS AND METHODS: We compared testicular mass and sperm count in 32 men (mean age 28 years) who underwent surgery for varicocele at 11 to 15 years old (mean age 13) to those in 26 untreated, age matched men (mean age 30 years) with varicocele and 27 male controls (mean age 25 years). Mean followup in the treated group was 14.5 years (range 12 to 20). Testicular volumes were measured by ultrasonography. RESULTS: There was no significant difference between left and right testicular volumes in the treated or control group, in contrast to the untreated group, in which the left testicles were significantly smaller. Comparison of testicular mass showed a striking similarity between the treated and control groups, while there was a significant difference when the untreated group was compared to the control and operated groups. Total sperm counts were significantly less in the untreated than the treated and control groups. CONCLUSIONS: These data support the notion that testicular hypotrophy related to varicocele may be reversed by early intervention and they further strengthen the indication for varicocelectomy in children.

Adolescent↗
PubMed1997

T-tubes in the management of meconium ileus.

Fifteen cases of meconium ileus (MI) were treated between 1986 and 1995; 7 responded to conservative treatment. Eight were operated upon, and comprise the study group. Six of the operated babies had no complications; 1 had meconium peritonitis with a pseudocyst and small-bowel atresia, and 1 had a volvulus of a small-bowel segment with necrosis. In all 8 cases a T-tube (TT) was left via an enterotomy; in the complicated cases the enterotomy was pre-anastomotic. The obstruction was relieved in all the babies, without any stoma or bowel resection in the uncomplicated cases. Two complications occurred: 1 patient died of respiratory failure 1 month following surgery and another required a relaparotomy for lysis of adhesions. We conclude that TT ileostomy is an effective and safe procedure for uncomplicated cases of MI that do not respond to conservative therapy, as well as for complicated cases that need an anastomosis.

Cause of Death↗
PubMed1995

Foreign-body appendicitis.

The authors report the case of a 9-year-old boy who had a needle in his appendix. The contrast between absence of clinical symptoms and clear inflammatory changes of the appendix is noted. The authors recommend appendectomy for patients with pointed foreign bodies in the appendix to avoid inflammation and perforation.

Appendicitis↗
PubMed1995

Gentamicin once-daily versus thrice-daily in children.

Fifty children aged 3 months--16 y with Gram-negative bacterial infections, were evaluated in this open randomized study; 26 received gentamicin 4.5 mg/kg/day, once daily, and 24 received the same daily dosage, in three divided doses. The groups had similar demographic and clinical characteristics. Serum trough gentamicin concentrations were significantly lower in the od group than in the tds group, while peak concentration were significantly higher in the od group. Clinical cure was obtained in 23 of the 26 (88.8%) children who received gentamicin once daily, and in 22/24 (91%) children treated thrice daily. Microbiological cure was obtained in 10/10 (100%) and 12/13 (92%) of the evaluated cases. Nephrotoxicity was not observed but ototoxicity occurred in two children in each group. These results, although obtained from a small number of patients, showed a similar outcome in children receiving gentamicin 4.5 mg/kg/day whether administered once or thrice daily.

Adolescent↗
PubMed1994

Sonographic presentation of Hirschsprung's disease. A case of an entirely aganglionic colon and ileum.

Prenatal sonographic presentation of Hirschsprung's disease has been considered non-specific and uncommon. This report presents a second-trimester fetus with an aganglionic colon and ileum diagnosed by the sonographic presentation of dilated fetal bowel loops, increased abdominal circumference, and mild polyhydramnios. The prenatal sonographic diagnosis of Hirschsprung's disease helped to expedite early neonatal treatment.

Adult↗
PubMed1994

[Pulmonary sequestration detected by ultrasound].

Pulmonary sequestration is part of the spectrum of bronchopulmonary foregut anomaly. It is a rare type of congenital malformation in which a mass of pulmonary tissue is separate from the normal lung and receives its arterial supply directly from the systemic circulation. Angiographic demonstration of a systemic artery leading to the sequestrated lung has usually been used to diagnose this condition. In the past 10 years cases of this rare anomaly have been detected and diagnosed by ultrasonography in the pre- and postnatal period. We describe a very rare case of intraabdominal, extralobar pulmonary sequestration detected in the antenatal period. Ultrasonography showed a hyperechoic subdiaphragmatic mass above the left kidney, near the aorta. In the mass were 2 echo-free vascular structures. 2 arterial branches originating from the abdominal aorta which traversed the subdiaphragmatic mass. The near-diaphragmatic location of many pulmonary sequestrations provides an excellent acoustic window for sonographic detection. MRI can help in the diagnosis when ultrasonographic findings are equivocal. Ultrasound and MRI will soon replace aortic angiography in the diagnosis of this condition in the pre- and postnatal period, pulmonary sequestration should be included in the differential diagnosis of upper abdominal masses identified by ultrasonography.

Aorta, Abdominal↗
PubMed1993

Management of urachal anomalies in children and adults.

During a period of fifteen years, 9 children and 5 adults with a variety of urachal anomalies were treated. Infected urachal cysts were more common in children whereas adults more frequently had infected urachal sinuses. After careful physical examination, a preoperative diagnosis could be made in most patients, with ultrasound examination decisive in doubtful cases. Whenever feasible, complete excision of the umbilicovesical tract is performed, but in very ill patients, a staged treatment becomes necessary. The preoperative injection of methylene blue is helpful in the identification of communicating tracts, all of which should be removed. All affected children should undergo investigation for associated genitourinary anomalies.

Adolescent↗
PubMed1992

[Percutaneous drainage of pancreatic pseudocyst in children].

Pancreatic pseudocysts in children are usually the consequence of blunt abdominal trauma. Spontaneous resolution can be expected in up to 50%, while surgical drainage is required in the others. Percutaneous drainage of these pseudocysts has recently been reported to give good results. We present a 7-year-old boy treated successfully with percutaneous drainage of a traumatic pseudocyst of the pancreas.

Abdominal Injuries↗
PubMed1992

[Idiopathic scrotal edema].

Idiopathic scrotal edema causes painful enlargement of the scrotum, as does torsion of the testis or of a testicular appendage, or epididymo-orchitis. Unilateral edema of the scrotum develops rapidly, the skin becomes pale pink or red, and there is discomfort rather than acute pain. Careful palpation reveals a nontender testis. The condition is usually self-limited, and resolves completely without treatment in 48 hours. It must be differentiated from testicular torsion, for which urgent surgical treatment is mandatory.

Diagnosis, Differential↗
PubMed1992

[Interposition of colon for short bowel syndrome].

Massive small bowel resection causes short bowel syndrome, manifested by signs and symptoms of malabsorption and by short digestion and transient times. A case of the syndrome is presented, in which an infant had massive bowel resection with interposition of the colon performed for volvulus. The signs of volvulus appeared only a few hours after birth.

Colon↗
PubMed1991

[Diagnosis and treatment of Hirschsprung's disease in adolescence].

Hirschsprung's disease is the most frequent cause of large intestinal obstruction in the neonatal period, during which the majority of cases are diagnosed. In about 5 of cases diagnosis is not established until adolescence. We present a 12-year-old boy with Hirschsprung's disease, treated since childhood for constipation. Early diagnosis avoids complications.

Child↗