Biomedical subjects
Publications and source records attributed to M Maksimak.
Intestinal mucosal biopsy has become an invaluable tool for the evaluation of children with abdominal complaints. Multiple techniques and biopsy instruments have each been developed with advantages and limitations. Physicians caring for infants and children must be familiar with indications for tissue sampling, timing of the biopsies, and interpretations of biopsy specimens.
Two children are reported with hemangioendothelioma of the hepatobiliary system. One patient, a 7-month-old girl, presented with classic symptomatology of hepatomegaly and congestive heart failure, but did not have any cutaneous lesions. She was treated with systemic steroids and supportive therapy and did very well. The other patient, a 22-month-old boy, is the first patient reported with exclusive involvement of the extrahepatic biliary tree. His symptoms included hepatomegaly and obstructive jaundice. He was evaluated with an endoscopic retrograde cholangiopancreatogram and a transhepatic cholangiogram. He did very well after resection of the lesion and Roux-en-Y drainage of the proximal biliary tree and remains asymptomatic 2 years after surgery.
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Two No. 3 French silastic central venous catheters designed for infants, a pediatric Broviac catheter, and a standard infant catheter were used in 41 (group I) and 33 infants (group II), respectively, to compare the effectiveness of each in providing access to the central venous circulation. Group I patients used 52 Broviac catheters or 1.2 catheters per patient for an average of 75 days per catheter. Thirty-five patients had one catheter placed. Group II patients had 66 catheters or 2.0 catheters per patient for an average of 45 days per catheter. One episode of sepsis occurred for every 1,950 days of usage in group I, but in group II, one episode occurred every 750 days. Eight of 52 catheter placements in group I were associated with localized infections at the catheter insertion site, but this was the case with only two of 66 catheters in group II. Dislodgement of the catheter occurred four times as frequently in group II as compared with group I. Repair of cracked catheters was successfully completed in 90% of those in group I, but none in group II. The pediatric Broviac catheter proved to be more durable than a standard No. 3 French silastic catheter.
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Four adolescents with achalasia were treated with nifedipine. All the patients' symptoms improved dramatically. On manometric evaluation, following oral nifedipine, the lower esophageal sphincter pressure decreased approximately 50%. No change in esophageal peristaltic activity was noted. Side effects were minimal; two patients had mild headache initially. Nifedipine, which is commonly used in adult patients with achalasia, may be beneficial for short-term symptomatic relief in children until more definitive therapy can be performed.