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Biomedical subjects

M M Ziegler

Publications and source records attributed to M M Ziegler.

At least 109 records · Page 6Linked to original sources
PubMed1982

Surgical management of reflux strictures of the esophagus in childhood.

The etiology of gastroesophageal reflux (GER) in infancy is related to developmental factors, and there is a high incidence of associated conditions such as neurologic syndromes and esophageal atresia (60%). This is different from the situation in adults. Experience with 18 consecutive children with peptic esophageal strictures is reviewed to determine if conservative surgical management is effective. Eighteen children 14 months to 13 years (mean 6.3 years) of age took an average of 3.5 years from the time of onset of symptoms of GER to develop tight strictures diagnosed by esophagography and esophagoscopy. The incidence of stricture in patients with GER was approximately 15%. Preoperative dilation or direct surgical management prior to correction of reflux is ineffective. All 18 children were managed by intraoperative dilatation, Nissen fundoplication, and guided dilatation after operation. More aggressive surgical procedures were not required nor were associated operations such as pyloroplasty; they are rarely necessary. An average three-year follow-up indicates that this conservative surgical approach is effective in the management of peptic esophageal strictures in childhood with relief of symptoms and gratifying improvement in growth.

Adolescent↗
PubMed1982

Gastrointestinal bleeding: an accessory spleen causing a false-positive Tc-99m-sulfur colloid study.

A Tc-99m-sulfur colloid abdominal scan was performed on a 12-year-old girl to localize the site of gastrointestinal bleeding. The study was normal. When bleeding recurred two weeks later, a repeat study revealed a focal abnormality in the upper abdomen. This was thought to be compatible with a small bleed. However, at surgery an accessory spleen was found, accounting for the abnormal scan.

Child↗
PubMed1982

Nutritional care of the pediatric athlete.

In summary, nutritional analysis and nutritional support of the youngster participating as an athlete remain an important aspect of any organized competition program. It is not only critical to recognize the greater caloric, protein, and water requirements of children and their lesser energy stores, but it is equally important to adequately advise and formulate a safe and logical dietary regimen for these athletic children. The physician caring for such competing children needs to be fully aware of the nutritional ramifications of athletic competition, especially as they apply to the growing child.

Adolescent↗
PubMed1981

Nutritional assessment: an integral part of the preoperative pediatric surgical evaluation.

Comprehensive nutritional assessment in adults has revealed that 50% of hospitalized patients suffer from acute protein calorie malnutrition (PCM), a state which correlates with increased surgical morbidity and mortality. We report our results examining the same question in children, and on the basis of these data suggest that nutritional assessment be a routine part of the preoperative evaluation of all pediatric surgical patients. We studied 198 children and found that the overall prevalence of acute PCM was 54%; but if premature and term infants less than three months of age are selected, the prevalence of acute PCM was a striking 63%. If only surgical patients are considered, the prevalence of acute PCM among patients hospitalized for trauma or burns was 31% for elective operation 39%, and for acute but complex operative procedures 64%. These data demonstrate that a remarkably high prevalence of acute PCM exists among hospitalized pediatric and pediatric surgical patients. Whether aggressive perioperative nutritional support can reverse such acute PCM and favorably influence morbidity and mortality is currently speculation, but that acute protein calorie malnutrition is far more prevalent among hospitalized pediatric patients that is generally realized, and that comprehensive nutritional assessment is essential to identify the "at risk" nutritionally deprived pediatric surgical patient, have now been proven.

Adolescent↗
PubMed1981

The liver and immunoregulation of neuroblastoma growth.

C1300 neuroblastoma, like human neuroblastoma, elicits an immune response in its host and as a result provides an animal model in which to study the enigmatic behavior of this common childhood tumor. Since the liver is a favored site for neuroblastoma metastasis, especially the favorably regressing IV-S stage, and since the liver is a known producer of immunoregulatory factors, this study report a systematic assessment of liver cell tumor cell interaction, the effect on tumor immunogenicity, and the potential for tumor growth control. Immunization-excision-challenge assays in 120 A/J mice with C1300 demonstrate the tumor to be antigenic; but in a second experimental sequence with 120 mice, normal whole liver cells were admixed with C1300 tumor cells in vitro and incubated for one hour prior to animal innoculation. The immunogenicity is dramatically minimized in the admixture group when compared with controls (antigenic ratio = 1.67 versus 3.07, p less than .02). However, if prior to such liver cell-tumor cell admixture the liver cells are sonicated and the lysate ultracentrifuged, a contrasting result is obtained. In 4 additional experiments utilizing 120 mice, the tumor cell is rendered a more potent immunogen following soluble fraction admixture (antigenic ratio = 1.99 versus 1.56, p less than .05). These data suggest that such whole cell and subcellular soluble factor immunoregulatory interactions are operative in determining immunogenicity of a tumor innoculation. We speculate that the progression or regression of clinical neuroblastoma within the liver may be similarly influenced since a host-tumor interaction depends on eliciting an antitumor response to an antigenic stimulus.

Animals↗
PubMed1981

Splenic-gonadal fusion: identification by radionuclide scanning.

Splenic-gonadal fusion is an unusual congenital anomaly resulting from the fusion of the splenic and gonadal anlagen at approximately the sixth week of gestation. A 14-mo-old male presenting with signs and symptoms of testicular torsion underwent scrotal exploration, and ectopic splenic tissue was found adjacent to the left testis. The operative diagnosis of splenic-gonadal fusion prompted abdominal scanning with 99mTc-sulfur colloid. The radionuclide image demonstrated an unusual pattern of activity that was consistent with surgical description of the intraabdominal appearance of this disorder. It is suggested that 99mTc-sulfur colloid scanning may prove to be a useful adjunct in the evaluation of patients with this anomaly.

Abnormalities, Multiple↗
PubMed1981

Primary nonspecific ileal ulceration as a cause of massive rectal bleeding.

A case of primary ulceration of the ileum in the absence of a Meckel's diverticulum or ectopic gastric tissue is described. Although this condition is infrequently observed, it should be considered as a potential cause of massive rectal bleeding, iron deficiency anemia of unknown cause, perforation, or partial small bowel obstruction. The diagnosis is normally made at surgery. Segmental resection with end-to-end anastomosis is the treatment of choice. Recurrence following surgery is rare.

Child↗
PubMed1980

Multiple congenital anomalies associated with infantile achalasia.

Achalasia is rare in the pediatric age group, particularly in the neonate and young infant. The symptoms are often nonspecific and may not even suggest a primary esophageal disorder. This is a report of two cases of achalasia seen in neonates, both of whom has other unusual and exceedingly uncommon congenital abnormalities.

Abnormalities, Multiple↗
PubMed1980

Electrocoagulation induced immunity--an explanation for regression of neuroblastoma.

Electrocoagulation of tumor potentiates the host's antitumor immune response. Utilizing a murine neuroblastoma system and comparing surgical excision versus electrocoagulation we have demonstrated that electrocoagulation potentiates the immunogenicity of the neuroblastoma, potentiates the host antitumor immune response to residual primary tumor, and potentiates the host antitumor immune response to distant autochthonous neuroblastoma. These data suggest that such a heightened antitumor response might account for spontaneous regression of massive clinical neuroblastomas treated by electrocoagulation, and they suggest that electrococoagulation may be useful as a treatment modality for cytoreductive neuroblastoma surgery.

Animals↗
PubMed1979

Sequelae of prolonged ventilatory support for pediatric surgical patients.

The evolution of intensive prolonged respiratory support has been a major development in improving survival in the critically-ill child. That intensive respiratory support can be maintained for prolonged periods of time even in the home with survival of good babies is the subject of this report. In a 3-yr period, 2112 surgical patients were admitted to intensive care facilities with an over-all survival of 95%. Ventilatory support was required in 368 (17.4%) of these children, and survival in this group was 75.3%. Prolonged mechanical ventilation was necessary in 13 of the 368 children (3.5%) for a mean support time of 359 days (range 101 to 1095). Of these 13 children, 4 died while hospitalized (30.8%), and 3 died subsequently after being discharged (23.1%) for a total mortality of 53.8%. However, 6 children (46.2%) survive, 3 free of ventilatory support and 3 being weaned from their machine at home. The greatest cost in this expensive program was delivered to the survivors and psycho-social and developmental data confirm that these children are good babies with favorable long-term prognoses.

Child↗
PubMed1979

Covalent structure of subunits of bacterial luciferase: NH2-terminal sequence demonstrates subunit homology.

The heterodimeric subunit structure of bacterial luciferase was demonstrated more than 10 years ago. The enzymes from both Beneckea harveyi and Photobacterium fischeri have since been studied in detail; they each consist of two nonidentical subunits, designated alpha and beta. Both are required for bioluminescence activity, with the active center apparently confined to the alpha subunit. Amino acid sequence analysis of the NH2 termini of the alpha and beta subunits of the B. harveyi and P. fischeri luciferases not only confirms the earlier observation that the alpha subunits are homologous but also demonstrates that the NH2-terminal sequences of the beta subunits of the luciferases from the two genera are homologous. Furthermore, within each luciferase, the NH2-terminal sequences of the alpha and beta subunits are similar, suggesting the possibility that the genes coding, for alpha and beta may have arisen by gene duplication, presumably prior to divergence of the lines leading to present-day luminous bacteria.

Amino Acid Sequence↗
PubMed1978

Mesenchymal hamartoma of the liver in infants.

Mesenchymal hamartoma of the liver is a rare benign tumor of childhood which has been confused with various other benign liver lesions, particularly vascular hamartomas which are mesodermal but not mesenchymal. The mass, frequently cystic, is characterized by an admixture of epithelial structures in a loose connective tissue stroma with fluid accumulation suggestive of lymphangiomatous channels. Four patients are presented and reviewed with 25 previously reported cases. The patients, usually asymptomatic, present during the first two years of life with progressive abdominal distention, which may be rapid because of increasing fluid content in the connective tissue stroma and cysts. Exploration and biopsy may be necessary before definitive excision. The present cases include a newborn, the youngest known, and a case in which radiation resulted in hyalinization of the mesenchyme, decrease in fluid content, and easlier resection. Respiratory distress and signs of vena caval obstruction due to intra-abdominal pressure were noted. Prognosis after extirpation is very good.

Diagnosis, Differential↗
PubMed1977

Surgical manifestations of eosinophilic gastroenteritis in the pediatric patient.

Eosinophilic gastroenteritis, an inflammatory bowel disease of unknown etiology, occurs in one of 10,000 admissions to this Children's Hospital. We had added 4 cases to the 11 retrieved from a literature review. The inflammation is characterized by mature eosinophils predominating a transmural process which may produce pain, obstruction, perforation, bleeding, or fistulae. All levels of the gastrointestinal tract are involved, but stomach (25.9%) and small bowel (66.7%) lesions are most common. Eosinophilia occurs in 61% of children and allergy in 13%. X-rays may demonstrate a diffuse or localized process. Operative intervention may be necessary to exclude tumors or regional enteritis, and at times to extirpate complications of local disease, but conservative therapy is the treatment of choice for this exacerbating-remitting disease.

Adolescent↗