Biomedical subjects
Publications and source records attributed to M Dinner.
Long-term ventricular cerebrospinal fluid shunting can prove difficult in the neonatal population, particularly in those neonates who have had previous abdominal and vascular procedures. This article presents a technique of providing vascular access for ventriculoatrial shunting via the azygos vein for patients with limited vascular access and in whom ventriculoperitoneal shunting is not feasible.
To determine the induction and maintenance characteristics of desflurane in pediatric patients, the authors anesthetized 206 infants and children aged 1 month to 12 yr with nitrous oxide plus desflurane and/or halothane in oxygen. Patients were assigned to one of four groups: anesthesia was 1) induced and maintained with desflurane after premedication with an oral combination of meperidine, diazepam, and atropine; 2) induced and maintained with desflurane; 3) induced with halothane and maintained with desflurane; or 4) induced and maintained with halothane. An unblinded observer recorded time to loss of consciousness (lid reflex), time to intubation, and clinical characteristics of the induction and maintenance of anesthesia. Moderate-to-severe laryngospasm (49%) and moderate-to-severe coughing (58%) occurred frequently during induction of anesthesia with desflurane; the incidence of these was not altered by premedication. In contrast, laryngospasm and coughing were rare during induction of anesthesia with halothane. In unpremedicated patients, time to loss of lid reflex (mean +/- SD) was similar for desflurane (2.4 +/- 1.2 min) and halothane (2.1 +/- 0.8 min). During induction of anesthesia, before laryngoscopy and intubation, mean arterial pressure less than 80% of baseline was more common with halothane; heart rate and mean arterial pressure greater than 120% of baseline were more common with desflurane. Intraoperatively, heart rate greater than 120% of baseline was more common with desflurane; blood pressures were similar for the two anesthetics. The authors conclude that the high incidence of airway complications during induction of anesthesia with desflurane limits its utility for inhalation induction in pediatric patients. Anesthesia can be safely maintained with desflurane if induced with a different anesthetic.
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Children with intra-abdominal testes comprise a small group presenting for surgical management of the undescended testicle. During the last 4 years 6 children with 8 intra-abdominal testes have undergone testicular surgery. In 7 testicles the technique involved high intraperitoneal division of the testicular pedicle with reanastomosis of the distal spermatic artery and vein to the inferior epigastric artery and vein using the operating room microscope. Microsurgery on the 7 intra-abdominal testicles led to good results in 6 cases. In 1 testicle venous infarction occurred secondary to venous congestion. Although many children with intra-abdominal testes have been managed using the standard Stephens-Fowler technique, we believe that microsurgical reanastomosis will improve the previously reported results.
The use of the operating room microscope to accomplish microscopic anastomosis is gaining wider application. The technique to accomplish autotransplantation of the intra-abdominal testes involves division of the spermatic artery and vein with reanastomosis to the inferior epigastric vessels under the operating room microscope. The over-all success rate cannot be assessed without long term follow-up study, but this procedure offers more potential success than vascular pedicle division alone and will eliminate staged orchiopexy.
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The use of a rhomboid flap in segmented breast resection is described. This reconstructive technique allows large areas of the breast to be resected with minimal deformity and nipple-areola displacement.
Hirschsprung's disease is one of the most common causes of intestinal obstruction in the neonatal period. In Hirschsprung's disease the aganglionic segment extends for a variable distance along the bowel, and there are three types: (i) short-segment, (ii) long-segment, (iii) total aganglionosis of the bowel. The long-segment group forms +/- 20% of the total group. In approximately 5%, however, the entire colon and even the small bowel may be involved; one such case is described together with its management, some of the problems encountered, and the operation of choice.
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We describe the use of the extensor pollicis longus tendon as an extension of the motor unit in an opponens transfer. Its advantages, and its successful application in 4 cases, are illustrated. To the best of our knowledge, this method has not been described before. We believe it to be a satisfactory addition to the other methods described.
Four patients with homozygous hyperbetalipoproteinaemia who had proved resistant to intensive medical therapy have undergone portacaval shunt. During 3 weeks of total parenteral alimentation before the operation, the serum-cholesterol decreased significantly in each of the four patients. During the fat-emulsion phase of hyperalimentation, one patient experienced a rise in cholesterol. Postoperatively, the size of xanthomas decreased in all cases; serum-cholesterol levels rose above those achieved during hyperalimentation, and this rise continued for as long as 3 months before a further reduction was recorded. In patients with angina, this improved considerably; and in most cases bruits decreased in itensity. The results at this stage do not, however, suggest portacaval shunt for all patients with homozygous hypercholesterolaemia.
A protocol for the management of children with neuroblastoma is described. The appearance of peri-orbital ecchymosis and radiologically demonstrable skeletal metastases are of poor prognostic significance. The relatively infrequent occurrence of neuroblastoma in the Black population of Johannesburg is stressed.
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