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Biomedical subjects

M M Woolley

Publications and source records attributed to M M Woolley.

At least 37 records · Page 2Linked to original sources
PubMed1986

Kasabach-Merritt syndrome treated by therapeutic embolization with polyvinyl alcohol.

The authors describe a 6 1/2-month-old boy with a large hemangioma involving the left buttock associated with a severe consumptive coagulopathy. Cosmetic improvement and resolution of the coagulation defect followed occlusion of the nutrient vessels to the hemangioma with polyvinyl alcohol. This is the first report of successful treatment of this condition with therapeutic embolization.

Blood Coagulation Disorders↗
PubMed1986

Mesenchymal hamartomas of the liver in childhood: sonographic and CT findings.

Mesenchymal hamartomas of the liver usually present within the first 2 years of life. Abdominal enlargement and respiratory distress are the most common presenting features. Pathologically, the lesion is composed of large cysts separated by septations. Review of sonograms and CT scans in nine patients shows that a large, predominantly cystic mass with internal septae is characteristic of the tumor. Angiography shows peripheral hypervascularity with a septated avascular center. A confident preoperative diagnosis of mesenchymal hamartoma based on these features is possible.

Angiography↗
PubMed1985

Sacrococcygeal teratomas in infants and children.

From 1941 through 1983, a total of 66 patients with sacrococcygeal teratoma were seen, representing 41 percent of the total of 162 patients with teratomas from all anatomic sites seen over this period. Forty-six (70 percent) of the patients with sacrococcygeal teratomas were female and 34 (52 percent) were neonates. Younger patients had a significantly better prognosis. Approximately half (48 percent) of the patients had benign tumors. Of the other 34 patients, 19 (29 percent) had frank malignancy, being either a purely malignant tumor or a tumor with malignant mixed with benign elements, and 15 (23 percent) patients had tumors containing embryonic but no malignant components. Patients with tumors containing mature adult or embryonic tissues have a good prognosis. However, malignant sacrococcygeal teratoma portends a bleak prognosis irrespective of therapy (in this series only one patient survived among 19 patients with an average survival of 16 months after diagnosis).

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1985

The prognostic implication of hypercholesterolemia in infants and children with hepatoblastoma.

This paper reports the relationship between serum cholesterol level and hepatoblastoma in nine patients. Four of the nine patients had a high (417-544 mg%) serum cholesterol. All of these patients were less than one year of age and had tumors of the epithelial type. Three of the infants died soon after being diagnosed. Three patients had a moderately elevated serum cholesterol (206-249mg%). One underwent primary hepatic resection. Two had nonresectable tumors that became resectable after chemotherapy. One died secondary to pulmonary metastases. The remaining two patients had a normal serum cholesterol level prior to treatment. Both patients had hepatic resection after chemotherapy and had no evidence of increased cholesterol postoperatively and are alive six years after diagnosis. From these data, it is suggested that the pretreatment level of serum cholesterol may be of prognostic significance in infants and children with hepatoblastoma.

Adolescent↗
PubMed1984

Necrotizing fasciitis. A serious sequela of omphalitis in the newborn.

We reviewed all cases of omphalitis seen at Childrens Hospital of Los Angeles from 1961 to 1981. One hundred and forty patients were seen and, of these, eight had necrotizing fasciitis. All patients with necrotizing fasciitis acquired omphalitis at home, making the incidence of necrotizing fasciitis over 10% in patients with community acquired omphalitis. Most of the infants appeared relatively well on admission with no fever but had a marked leukocytosis. The disease rapidly spread to involve most of the abdominal wall over a period of several hours to days. Seven of the eight patients died (87.5%). Five patients were operated upon but despite extensive resection of involved tissue, four died within 24 hours of surgery. A polymicrobial flora of both gram positive and gram negative bacteria was recovered in all patients cultured. The high incidence of necrotizing fasciitis following omphalitis in the newborn with its attendant morbidity and mortality mandates close observation of these infants with early surgical intervention if there is any question of the diagnosis.

Bacterial Infections↗
PubMed1983

Incidental appendectomy in infants and children. Risk v rationale.

Between January 1977 and December 1979 (three years), 642 appendectomies were performed at the Childrens Hospital of Los Angeles. Two hundred seventy-two of the appendectomies were performed incidentally at the time of another abdominal operative procedure. Using known incidence of appendicitis, approximately 54 cases of acute appendicitis may have been obviated. In three patients, would infections developed. Twenty-four of the appendices were histologically normal and 30 were abnormal in a clinically insignificant respect. If incidental appendectomy is appropriate in the age group, it is of more benefit to the pediatric patient because of the frequency of appendicitis in patients under 20 years of age.

Adolescent↗
PubMed1983

Treatment of esophageal varices by sclerotherapy in children.

Bleeding from esophageal varices may be a serious or lethal complication of portal hypertension in children. The standard therapy over the past 30 years has been to create a portosystemic shunt. In children physiologic complications leading to high rates of perioperative morbidity and early and late thrombosis with recurrence and encephalopathy have been common. Over a 42 month period, we treated six patients aged 5 to 18 years, with endoscopic injection of 3 percent sodium tetradecyl sulfate into the varix. Five patients required only injection, whereas one underwent direct oversewing of gastric varices followed by endoscopic sclerosis of the esophageal varices which remained. A total of 38 endoscopic procedures were performed. There has been complete cessation of bleeding in two patients, minimal subsequent bleeding in two others, and anemia requiring transfusion in the last two treated. These last two patients, although still requiring occasional transfusions, have been free from hypotensive or exsanguinating hemorrhage since beginning sclerotherapy. No deaths or serious complications were encountered in this series. Follow-up has ranged from 18 to 42 months (mean 26 months). The results of this trial suggest that repeated endoscopic sclerotherapy of varices, combined with operative oversewing of gastric varices when necessary, offered a viable alternative therapy for patients with esophageal varices.

Adolescent↗
PubMed1982

Radioisotope spleen scan in patients with splenic injury.

The technetium Tc 99m sulfur colloid liver-spleen scan is a valuable aid in diagnosis and treatment of patients with splenic injury. After reviewing the charts of 47 patients who were ill as a result of splenic trauma, we came to the following conclusions: (1) the scan identified the injury, accurately mapped its extent, and indicated the presence or absence of associated liver injuries; (2) the scans were useful in following the extent and rate of healing of the splenic injury; (3) the scan is an indirect measurement of of return of splenic fuction; (4) the procedure can be performed in a reasonable time frame with no serious morbidity; and (5) the indications, contraindications, and timing of scans are now reasonably well established.

Adolescent↗
PubMed1981

Congenital cystic adenomatoid malformation: 1 30-year experience.

A retrospective analysis of 20 patient with congenital cystic adenomatoid malformation admitted to the Childrens Hospital of Los Angeles since 1948 is presented. Symptoms, diagnostic evaluation, and methods of management are reviewed. Based on this experience, we consider this entity a surgical emergency in the neonatal period. Rapid diagnostic evaluation with abdominal and chest roentgenograms and upper gastrointestinal contrast studies is mandatory. Lobectomy is the procedure of choice since segmental resections led to increased complications and prolonged hospitalizations.

Child↗
PubMed1980

Esophageal atresia and tracheoesophageal fistula: 1939 to 1979.

During the past 40 years, the survival of patients with esophageal atresia and tracheoesophageal fistula has increased from zero to approximately 85 percent. With the increased survival rate, the surgeon has the opportunity to follow up the patient into adult life. By so doing, the early and late complications can be anticipated and treated appropriately.

Esophageal Atresia↗
PubMed1980

Multiple surgical problems in two patients with Ehlers-Danlos syndrome.

Ehlers-Danlos syndrome is a genetically determined disorder of connective tissue, the internal manifestations of which carry significant morbidity and mortality rates. During the past 14 years, we have treated multiple life-threatening surgical complications of this disease in two patients. The difficulties encountered at operation require modification of anesthetic and surgical techniques to accommodate the sometimes surrealistic situations that develop with alarming suddenness in patients with the Ehlers-Danlos syndrome. These techniques include handling the extremely friable tissues, dissecting and ligating vessels that disintegrate under the pressure of a hemostat, stemming spontaneous arterial hemorrhage, and special care in harvesting and placing split-thickness skin grafts.

Child↗
PubMed1979

Congenital diaphragmatic hernias: eleven years' experience.

Fifty-five patients with congenital diaphragmatic hernias (1966 to 1976) were studied and compared to 65 similar patients reported previously (1953 to 1963). The mortality was found to be the same in the two groups despite the fact that in the current series, patients were diagnosed and operated on at a younger age. Initial uncorrected pH value was found to be of prognostic importance. All babies whose initial uncorrected pH was greater than 7.0 survived and almost all those whose pH was less than 7.0 died, with the group in-between having a 50% chance of survival. Earlier operation and correction of acidosis did not substantially improve the chance of survival. Hypoplasia of the lungs and major cardiovascular anomalies contributed to death in a number of patients. Pulmonary hypertension causing a right-to-left shunt was responsible for the deaths of others and, therefore, the use of vasodilator drugs deserves further evaluation.

Acid-Base Imbalance↗
PubMed1979

The twin with esophageal atresia.

A retrospective analysis of esophageal atresia occurring in patients who are members of a twin set indicated that twinning does occur more frequently in patients with esophageal atresia. These patients tend to be small for date, but have a similar occurrence of associated anomalies as singletons with esophageal atresia. Applying risk-grouping to the entire series and twins indicated no real difference in survival or additional anomalies by organ system, except more cardiovascular anomalies occurred in twins. Long-term follow-up of five survivors revealed severe growth retardation.

Abnormalities, Multiple↗
PubMed1979

Aarskog syndrome: significance for the surgeon.

A familial syndrome of short stature associated with facial dysplasia and congenital anomalies was reported by Aarskog in 1970. Subsequently, at least 53 patients in 13 affected families have been reported. The family to be described came under investigation following referral of one of the nine siblings to the surgical clinic at Childrens Hospital of Los Angeles for the evaluation of a right inguinal hernia. Recognition of the syndrome and further evaluation of the remaining siblings led to the diagnosis of several genital anomalies requiring surgical correction.

Abnormalities, Multiple↗
PubMed1979

The role and safety of early postoperative feeding in the pediatric surgical patient.

The authors report their experience with early postoperative feedings in a variety of pediatric surgical patients utilizing a needle catheter jejunostomy. A small caliber catheter, similar to that used for antecubital central venous cannulation, is inserted in the antimesenteric border of the jejunum providing a subserosal tunnel. A purse-string suture is placed around the catheter and then it is secured to the abdominal wall, and the catheter is brought out through the abdominal wall via a needle puncture wound. Our experience with 27 insertions in 25 patients ranging in age from 1 day to 17 yr, has demonstrated the ease of placement and feasibility of immediate postoperative feeding. Patients were generally started on a dilute elemental diet through the jejunostomy within 12 hr of the operative procedure. Patients were administered between one and 3.5 g of protein kg/day and between 45 and 100 cal/kg/day depending on age and weight. Duration of treatment with enteral nutrition ranged from 10 to 150 days. There was no catheter-related complications utilizing the technique described. Technical details of catheter placement and protocol for administration of early postoperative feedings are discussed. The ability to provide nutritional support via the gut has obviated the need for total parenteral nutrition in the majority of these patients.

Adolescent↗