Delayed splenic rupture following low impact activity.
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Abdominal Injuries↗
Biomedical subjects
M A Helikson
Publications and source records attributed to M A Helikson.
Presentation and management of epigastric hernias in children.
BACKGROUND/PURPOSE: Although epigastric hernias are common, there are no reports that describe the presentation and treatment of these defects in children. The authors reviewed their experience with these hernias to develop recommendations for their management in this age group. METHODS: Medical records were reviewed for all children younger than 18 years who presented for evaluation of an epigastric hernia at our institution over 14 years. Data on presentation, operative findings, and postoperative results were obtained. RESULTS: Forty children were evaluated for an epigastric hernia, representing 4% of all pediatric patients seen for treatment of a hernia. An epigastric hernia was first observed at birth in 12 patients (30%). All children presented with a mass in the epigastrium. The hernia was observed to be either symptomatic (abdominal wall pain or tenderness) or enlarging in 22 patients (55%). Thirty-eight children underwent repair, and 2 were lost to follow-up. There was no recurrence or morbidity associated with surgical repair of these defects. CONCLUSIONS: Epigastric hernias are common in children and frequently present in infancy. Because most are either symptomatic or enlarging, the authors recommend repair of these defects at the time of presentation.
Child↗
Anesthetic care for the child with congenital central alveolar hypoventilation syndrome (Ondine's curse).
Idiopathic congenital central alveolar hypoventilation syndrome, otherwise known as Ondine's curse, is a rare neuropathologic syndrome characterized by an inadequate respiratory drive with hypoventilation and periods of prolonged apnea resulting in hypercarbia and hypoxemia. Although no definite pathologic abnormality has been identified to account for the disorder, it is thought to represent a primary defect related to altered function of central chemoreceptors resulting in defective control of minute ventilation. Associated problems related to neural crest cell migration, including neuroblastoma formation and Hirschsprung's disease, suggest that the primary defect is defective neural crest cell migration and function. Problems that may impact on perioperative care include the defective central control of ventilation and defective control of upper respiratory musculature, which may lead to upper airway obstruction. Although many patients will have previously undergone tracheostomy and chronic mechanical ventilation, problems in other organ systems can impact on perioperative care. Cardiovascular issues include the possible presence of cor pulmonale and autonomic nervous system dysfunction. Central nervous system issues include the frequent occurrence of seizures and mental retardation. The preoperative work-up, premedication, and the intraoperative/postoperative care and monitoring of these patients is reviewed.
Anesthesia↗
Monitoring of pH and PCO2 in children using the Paratrend 7 in a peripheral vein.
PURPOSE: To determine the accuracy of the Paratrend 7 monitor inserted into a peripheral vein in providing continuous measurements of PCO2 and pH in children with respiratory failure. METHODS: In a prospective, case series at a University based PICU in a tertiary referral hospital and following informed consent, the Paratrend 7 intra-arterial blood gas monitoring system was inserted through a peripheral intravenous cannula. When clinically indicated, an arterial blood gas (ABG) was obtained. The values of pH and PCO2 from the Paratrend 7 and the ABG were compared using linear regression analysis and Bland-Altman analysis. RESULTS: Seventeen ABGs were obtained in the 4 patients. PaCO2 ranged from 29 to 51 mmHg and the pH values from 7.16 to 7.50. Linear regression analysis for the: Paratrend 7 pH vs the ABG pH resulted in an r = 0.9678 and an r2 = 0.9367 (P < 0.0001). Linear regression analysis for the Paratrend 7 CO2 vs ABG CO2 resulted in an r = 0.8273 and an r2 = 0.6845 (P = 0.01). Using a Bland and Altman analysis, the bias +/- precision of the PCO2 values was 3 +/- 1.4 and 0.036 +/- 0.02 for the pH values. CONCLUSION: The pH and PCO2 values obtained from the Paratrend 7 monitor provide a clinically acceptable correlation with arterial values.
Adolescent↗
Apnea following spinal anaesthesia in two former pre-term infants.
PURPOSE: To report the occurrence of apnea and bradycardia in two former pre-term infants who received spinal anaesthesia without inhalational or intravenous anaesthetic agents during inguinal herniorrhaphy. CLINICAL FEATURES: Two former pre-term infants who had no recent history of apnea or bradycardia and who had been discharged from the hospital presented for anaesthetic care during inguinal herniorrhaphy. Spinal anaesthesia using 1 mg.kg-1 tetracaine in dextrose 10% was performed. A sensory level of T4-6 was obtained in both infants. Neither infant received intravenous, oral, or inhalational agents for sedation. Five to ten minutes after placement of the spinal block, the two infants had frequent episodes of apnea and bradycardia. No change in the sensory level of spinal anaesthesia was noted. The apnea and bradycardia continued for a variable time into the postoperative period. Caffeine benzoate 10 mg.kg-1 was administered to one infant. Other than the apnea and bradycardia, both infants had uncomplicated postoperative courses. CONCLUSION: Apnea can occur when spinal anaesthesia is used as the sole anaesthetic technique in the former pre-term infant. Appropriate monitoring for such problems based on the infant's post-conceptual age is suggested.
Age Factors↗
Splenic torsion in the presence of renal agenesis.
A 14-year-old male with left renal agenesis presented with a history of intermittent abdominal pain for over 1 year. At laparotomy, the cause was found to be splenic torsion. The case is presented with a literature review. A theory of the cause is also presented based on the regional anatomy and embryology.
Adolescent↗
Hypocalcemia and hyperphosphatemia after phosphate enema use in a child.
The authors present a 3-year-old girl in whom severe hyperphosphatemia and hypocalcemia developed after the administration of three adult-sized hypertonic phosphate enemas. The commonly held notion that these enemas are not absorbed and therefore are systemically inactive is incorrect. With early intervention and treatment, the child survived without sequelae despite a serum phosphate level (74.7 mg/dL) that is greater than those previously reported. The treatment of hyperphosphatemia is reviewed as well as underlying pathology such as altered gastrointestinal motility and renal insufficiency, which may predispose the patient to this problem. Physicians should be aware of the possible adverse effects that can be caused by hypertonic phosphate enemas.
Calcium Gluconate↗
Fracture of the scapula with intrathoracic penetration. A case report.
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Adolescent↗
Intrathecal morphine for postoperative analgesia in an infant with bronchopulmonary dysplasia following upper abdominal surgery.
We present a case of severe bronchopulmonary dysplasia in which intrathecal morphine was successfully used for analgesia after a Nissen fundoplication and gastrostomy. Various options for anaesthesia are discussed with the knowledge that two previous procedures had been complicated by congestive cardiac failure and increased respiratory failure.
Analgesics, Opioid↗
Intrathecal morphine (ITM) for postoperative pain control in children: a comparison with nalbuphine patient controlled analgesia (PCA).
This is a retrospective study covering the ten-year period 1984-1993. Single shot spinal morphine (ITM) is compared with PCA nalbuphine for postoperative pain relief in children having abdominal or thoracic procedures. The records of 52 patients meeting selection criteria were examined. Nursing and physician notations were reviewed for hourly pain assessments, evidence of associated complications, respiratory depression, nausea and or vomiting, pruritus, and urinary retention. ITM provided significantly better pain relief (2.2 h in pain) during the first 24 h postoperatively than PCA nalbuphine (9.2 h in pain). With the exception of urinary retention which was significantly more frequent following ITM (58.6%) compared to PCA nalbuphine (8.7%), narcotic related complications were not different between the two groups. No difference in duration of hospital stay or ICU stay could be demonstrated. We conclude that ITM provides better pain relief, without more serious complications, than PCA nalbuphine. We recommend it as a safe, effective technique to treat postoperative pain in children following thoracic or upper abdominal procedures.
Abdomen↗
Echinococcosis (hydatid disease) in Missouri: diagnosis by fine-needle aspiration of a lung cyst.
Echinococcus granulosus was diagnosed by fine-needle aspiration cytology of a lung cyst in a 6-yr-old white female in central Missouri. No adverse reaction occurred following the aspiration. The cytologic sample yielded clear fluid containing numerous clearly identifiable protoscoleces diagnostic for echinococcosis using routine PAP staining. Since hydatid disease is extremely uncommon in the Midwest, it had not initially been considered in the differential diagnosis. The infection was probably not indigenous to Missouri, since the patient lived the first 3 1/2 yr of life in Alaska, where the organism is endemic. This can only be speculative, however, since echinococcal organisms are found in wildlife in the Midwest.
Biopsy, Needle↗
B-cell precursors in normal pediatric bone marrow.
A number of studies have been published pertaining to "normal" lymphocyte subsets in bone marrow. However, these studies are based on normal adult marrow or marrows of children with leukemia in remission or other systemic illness. Data on hematologically normal children are lacking. This study demonstrates that, compared with that of adults, bone marrow of hematologically normal children has an increased percentage of B cells and B-cell precursors. Dual-parameter flow cytometric methods demonstrated subpopulations of B cells at various stages of differentiation; the percentage of cells in these subsets is highest in the very young and decreases with increasing age. Caution must be exercised when searching for early leukemic relapse in pediatric marrows because these normal immature B-cell precursors immunophenotypically resemble leukemic blasts.
Adolescent↗
Complete external iliac artery disruption after percutaneous aortic valvuloplasty in two young children: successful repair with hypogastric artery transposition.
The majority of vascular injuries in young children are iatrogenic. This is a report of two complete external iliac artery disruptions occurring during percutaneous transfemoral balloon aortic valvuloplasty in a 2-year-old and a 5-year-old child. The damaged external iliac artery was bypassed by extensively mobilizing the hypogastric surgery and rotating it upward to anastomose it to the proximal common femoral artery. Normal limb pulses, function, and growth were noted in follow-up.
Anastomosis, Surgical↗
Plasma-cell granuloma producing calcitriol and hypercalcemia.
A teenage boy presented with hypercalcemia and a large intrathoracic mass. Results of an extensive evaluation, including normal findings on parathyroid hormone and urinary 3', 5'-cyclic adenosine monophosphate assays, failed to explain his hypercalcemia. During surgery, a large plasma-cell granuloma of the right middle and lower lobes was resected. Within 2 weeks, serum calcium levels returned to normal. Serum calcitriol (1,25-dihydroxyvitamin D3) levels were elevated before surgery and decreased to normal afterward, correlating with the serum calcium level. Homogenates of the plasma-cell granuloma synthesized a compound indistinguishable from calcitriol.
Adolescent↗
Congenital segmental dilatation of the colon.
Segmental dilatation of the colon with bowel wall muscle hypertrophy has been described in children 6 mo and older presenting with constipation since birth. A case of segmental dilatation of the colon without muscle hypertrophy in a newborn argues for the congenital origin of the dilatation and for the muscle hypertrophy being acquired.
Colonic Diseases↗
Revascularization for bilateral renal artery occlusion after umbilical artery catheterization.
The case of a newborn infant who became hypertensive and oliguric because of bilateral renal artery occlusion following umbilical artery catheterization is presented. Eventual treatment was by microsurgical placement of an aortorenal graft, with subsequent marked improvement in the patient's course. A scan and arteriogram at 1 year showed that the revascularized kidney was responsible for the patient's normal blood urea nitrogen and creatinine concentrations, but the renal artery had recanalized and the graft occluded. The role of umbilical artery catheterization in such catastrophes and the possible future role such microsurgical reconstruction could play in neonatal hypertension are discussed.
Catheterization↗
Continent ileoanal endorectal pull-through.
Five patients with familial polyposis coli, ages 13 through 21 yr, were given the choice of permanent reservoir-type ileostomy or ileoanal endorectal pull-through to prevent cancer of the colon. Total colectomy and an ileoanal endorectal pull-through was uniformly chosen and was performed using the principles described by Boley and Soavè. The post-operative courses were characterized by a transition from 8 to 10 liquid stools per day and up to 3 incontinent nocturnal stools, to a bowel pattern of 2 to 4 continent semi-liquid stools without nocturnal soiling by 1 mo. Defecograms at 1 mo revealed excellent sphincter function and mild reservoir dilatation of the ileum. These observations have convinced us that this is the operative management of choice for familial polyposis.
Adolescent↗
Pelvic fractures in children--review of 120 patients with a new look at general management.
Retrospective analysis of 120 pelvic fractures in children revealed many differences from reports of this injury in adults. Most of the children injured are pedestrians. Ruptured urethra and bladder are less commonly associated with pelvic fractures in children. Associated head injury with residual neurologic deficits are more common in children. Mortality in adults is approximately 10%, while in children it is about 5%. The mortality in our series was 1.4%, the lowest reported in the literature. The rectal examination is a most important part of the physical evaluation, IVP and cystourethogram are necessary in distinguishing serious genitourinary injuries (10%) when hematuria is present (57%) and are also helpful in evaluating retroperitoneal hematoma. Retroperitoneal hemorrhage and secondary infection are the main causes of death in children and adults with pelvic fractures. Although recognizable retroperitoneal hematomas were present in 46% of our patients, only 3% of these children had continuing massive retroperitoneal hemorrhage requiring intervention. Initial arteriography is valuable in management of children with continuing bleeding and large retroperitoneal hematomas. A new technique, silicone balloon embolization, may be combined with selective arteriography to occlude bleeding arteries. This was invaluable in two of our patients; hemorrhage from the hypogastric arteries, was successfully arrested in both cases. We believe this technique deserves more evaluation in the control of massive hemorrhage from pelvic fractures.
Adolescent↗