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Biomedical subjects

M W Harrison

Publications and source records attributed to M W Harrison.

At least 37 records · Page 2Linked to original sources
PubMed1989

Pyloroplasty in association with Nissen fundoplication in children with neurologic disorders.

Previous studies have suggested that delayed gastric emptying occurs in severely mentally retarded patients with gastroesophageal reflux. Based on this data, pyloroplasty was employed in such patients. A retrospective analysis of 99 consecutive patients who underwent primary fundoplication for GER was performed. Gastric emptying, as measured by successful removal of the nasogastric tube or elevation of the gastrostomy tube, was studied. Children with neurologic disorders had no clinically significant difference in gastric emptying after fundoplication (3.31 days) when compared with neurologically normal patients (2.21 days). When added to Nissen fundoplication, pyloroplasty did not hasten the return of gastrointestinal function in the severely impaired patients (4.91 days). A prospective study employing gastric isotope bolus feedings before and after Nissen fundoplication will determine if pyloroplasty improves gastric emptying when used in conjunction with Nissen fundoplication for patients with severe neurologic disorders.

Esophagus↗
PubMed1988

Characterization of 26K globular domain of a new basement membrane collagen.

In continuing our earlier studies (Biochem. Biophys. Res. Comm. 130, 1-8, 1985) on a new collagenous component (Type XIII) from lens capsule basement membrane, we report here the isolation and characterization of a 26K protein from the 4.5 M guanidine-HCl extracts of lens capsules. The 26K protein was purified by molecular sieve and DEAE-cellulose chromatography. The protein has been characterized by amino acid composition, NaDodSO4-polyacrylamide gel electrophoresis and by immunochemical analyses. On rotary shadowing, the 26K protein appears as a globule. The available information suggests its location at the terminal end of the collagenous component. The presented data show clearly that the 26K protein is a distinct new protein, different from the earlier reported NC-1 domain of type IV collagen.

Amino Acids↗
PubMed1987

Effects of E. coli endotoxin on rat plasma angiotensin converting enzyme activity in vitro and in vivo.

Angiotensin converting enzyme (ACE), a glycoprotein, is found in high concentration in pulmonary capillary endothelial cells. Several investigators have studied the relationship between various direct and indirect pulmonary insults and ACE activity and in some cases have found conflict. In an attempt to clarify this relationship we have examined the effect of endotoxin on rat plasma ACE activity in vitro and in vivo. We used the synthetic ACE substrate 3H-BPAP and the assay described by Catravas and Gillis [J Pharmacol Exp Ther 217:263-270, 1981]. In vitro, a statistically significant concentration-dependent reduction in ACE activity was demonstrated (p less than .005). In vivo an intravenous dose of endotoxin (20 mg/kg) alone resulted in no significant change in plasma ACE activity. However, the combination of intravenous endotoxin (20mg/kg) and mild hemorrhage (5-10% of blood volume) caused a statistically significant reduction in plasma ACE activity by 15 min as compared to control rats with hemorrhage only (39% vs. 66%, p less than .005). This reduction persisted at 30 and 60 min. However, by 180 min ACE activity was no longer statistically different from control values. We have demonstrated an acute reduction of plasma ACE activity in the endotoxemic rat that appears to be dependent on the amount of circulating endotoxin and the presence of mild blood loss.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1986

Diagnosis and management of Hirschsprung's disease. A 25 year perspective.

The demographic data and the distribution of the extent of involved bowel in Hirschsprung's disease have remained unchanged over the past 25 years and are similar to those reported by others. The age at which the diagnosis was established decreased initially but increased in the last 10 year period. This increase has been accompanied by an increase in the number of breast-fed infants. Definitive operation for Hirschsprung's disease is now usually performed in children less than 18 months of age. The procedures used were selectively applied in the most recent 10 years. Arbitrary dependence on a single procedure is no longer appropriate and individualized judgment should be used in the application of specific treatment alternatives in the surgical management of Hirschsprung's disease. Mortality after definitive operation is now confined to problems other than Hirschsprung's disease. The patient with undiagnosed Hirschsprung's disease may not survive enterocolitis despite aggressive contemporary resuscitative treatment.

Abnormalities, Multiple↗
PubMed1986

Long-term follow-up of patients with gastroschisis.

Long-term follow-up of children with gastroschisis has been made possible by the increased survival of these infants over the past 20 years. We have observed that children with isolated gastroschisis defects exhibit normal growth and development beyond 5 years of age without significant bowel sequelae. Infants with gastroschisis with concomitant bowel atresia or complications who require small bowel resection are at a greatly increased risk for long-term bowel problems and abdominal complaints.

Abdominal Muscles↗
PubMed1986

Juvenile aponeurotic fibroma with disseminated fibrosarcoma.

Juvenile aponeurotic fibromas, although locally recurrent, generally do not metastasize. This observation supports the practice of incomplete excision of the tumor to preserve the function of the involved extremity. We report on a patient with a juvenile aponeurotic fibroma of the palm, who returned 5 years after the second local surgical excision with metastatic fibrosarcoma of the lungs and bones.

Adipose Tissue↗
PubMed1986

Selective management of gastroschisis.

Mortality of patients with gastroschisis has decreased from nearly 90% to 13% (14 of 106) during the period from 1967 to 1984. Coincident with advances in perioperative management, including parenteral nutrition and mechanical ventilation, has been the introduction of staged reduction of the viscera using prosthetic material. To assess the relative merits of primary closure, skin flap coverage, and silo reduction, operative treatment of 106 consecutive infants with gastroschisis was reviewed. Primary fascial closure was accomplished in 54 patients (52%). When fascial approximation resulted in excessive intra-abdominal pressure, the viscera were covered with lateral skin flaps in 10 infants (10%), or the defect was closed after staged reduction with a prosthetic silo in 40 infants (38%). Detailed analysis of the hospital records revealed no significant differences between the primary closure, skin flap, and silo groups with regard to duration of ileus (22 +/- 25, 30 +/- 27, 31 +/- 30 days), length of hospitalization (39 +/- 36, 54 +/- 37, 53 +/- 39 days), or mortality (6, 20, 18%). Respiratory, septic, hemorrhagic, renal, and wound complications occurred in significantly fewer patients with primary closure (36%) and skin flap coverage (30%) than in those with silos (68%) (p less than 0.05). Postoperative mortality was 12% (12/104) and was most often due to respiratory insufficiency (35%) or nonviable small bowel (19%). Primary fascial closure may be accomplished safely in a majority of patients with gastroschisis. However, no single operative strategy is ideal for all patients with gastroschisis, and initial treatment of individual defects should be tailored to the degree of visceroabdominal disproportion.

Abdominal Muscles↗
PubMed1985

Isolation and partial characterization of a novel basement membrane collagen.

A guanidine-HCl extraction of lens capsule basement membrane dissolves collagenous material. This material was fractionated on an Agarose A-5M column. Fractions 1, 2 and 3 were further purified and partially characterized immunochemically and by amino acid analysis. Fraction 3 has a molecular weight of 55,000 when compared with collagen type I standard. The CNBr peptide pattern and composition of fraction 3 are different from those of alpha 1 (IV) 95K and alpha 2 (IV) 95K chains. The results described suggest the presence of a new chain in lens capsule basement membrane.

Amino Acids↗
PubMed1985

Ventral hernia in the treatment of omphalocele and gastroschisis.

Twenty-three patients with gastroschisis or omphalocele undergoing delayed ventral herniorrhaphy were reviewed. The ventral defects resulted from elective skin flap coverage in 15 patients, prosthetic silo failure in five, and nonoperative management using escharotic agents in three. Herniorrhaphy was performed at 2 months to 15 years of age. Fascial closure was achieved in a single procedure in 15 patients (65%) and with multiple operations involving prosthetic material in five patients (22%). Three patients (13%) had prosthetic material left in their defects without sequelae. There was no operative mortality from interval herniorrhaphy, and complications were minor. We conclude that conversion of a gastroschisis or an omphalocele to a ventral hernia is strategically useful in an infant with a giant defect, prosthetic silo failure, or when associated anomalies preclude early definitive surgery.

Abdominal Muscles↗
PubMed1984

The role of apoptosis in atrophy of the small gut mucosa produced by repeated administration of cytosine arabinoside.

Progressive atrophy of ileal crypts and villi following daily administration of cytosine arabinoside to mice was found to be the result of suppression of mitosis and marked enhancement of apoptosis in the crypt epithelium. The amount of apoptosis produced by each dose decreased as the atrophy advanced. Mucosal regeneration after cessation of administration of the drug was due to increased mitosis in the crypts, and was associated with complete restoration of susceptibility of the crypt cells to further doses. During early regeneration, the wave of increased mitosis was accompanied by a wave of mildly increased apoptosis.

Animals↗
PubMed1984

Acute appendicitis in children: factors affecting morbidity.

Appendicitis is a disease that continues to be characterized by a high morbidity rate that has changed little over the past 50 years. A significant proportion of patients (39 percent in this study) still present with advanced disease (gangrene, perforation, or abscess), as determined at operation. Duration of symptoms was the factor most closely associated with advanced disease. Patients with advanced disease had 88 percent of the morbidity. Primary care physicians referred patients who had symptoms for a longer period of time and who ultimately were found to have a more advanced stage of disease compared with patients who were referred from emergency rooms. This difference did not correlate with third party insurance coverage, as both referral groups exhibited a similar profile of coverage. In this study, the number of normal appendices removed was 5 percent. Early intervention remains the most promising means to reduce morbidity, mortality, and discomfort for the child and expense to the family or insurance carrier of a child with suspected appendicitis.

Acute Disease↗
PubMed1983

Treatment of hypoglycemia in infants and children. Surgical considerations.

Pancreatic resection was required in 11 pediatric patients over a 14 year period for control of persistent hypoglycemia. A standard surgical approach based on pathologic considerations was utilized. A subtotal distal pancreatectomy, liver biopsy, and removal of additional adenomatous tissue when found was performed in each patient. This approach precluded the need for routine preoperative visceral angiography, which is currently reserved for patients who require a second exploration. Surgery was curative in patients with adenomatous disease, although patients with diffuse pancreatic lesions usually required continued pharmacologic therapy postoperatively. Two patients thus far have had a total pancreatectomy performed at a second laparatomy due to persistent intractable disease. Seizure disorders, mental retardation, and behavioral problems frequently were unresponsive to improved control of hypoglycemia. An aggressive approach to management of this disorder is required if permanent neurologic damage is to be minimized.

Adenoma, Islet Cell↗
PubMed1983

Surgical treatment of myasthenia gravis in childhood.

Myasthenia gravis is considered to be an autoimmune disorder of neuromuscular transmission. Thymectomy is an effective mode of treatment which produces either remission or stabilization of symptoms especially in young female patients with short duration of disease. The present study, records the experience in ten pediatric patients with early thymectomy done via the transcervical approach. There were no operative deaths or serious complications. Follow-up for a mean of 37 months has shown one to be in complete remission requiring no medication and eight to have improved or stable symptoms. Thymectomy via the transcervical approach is an effective mode of treatment for patients with myasthenia gravis. Since this approach involves a small dissection and avoids sternotomy, the transcervical approach results in a very short postoperative recovery period. It is ideal for those patients not in respiratory failure. It can also be safely done in patients requiring intubation for acute respiratory failure preoperatively.

Adolescent↗