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Biomedical subjects

Michael G Caty

Publications and source records attributed to Michael G Caty.

11 recordsLinked to original sources
PubMed2007

Current management of hernias and hydroceles.

The repair of inguinal hernia and hydrocele is one of the most common operations in a pediatric surgery practice. This work reviews current concepts in the management of the inguinal hernia and hydrocele. The authors describe current concepts of anesthetic management of children undergoing repair of inguinal hernia. The authors also discuss current management of the contralateral hernia, hernias in premature infants, and the management of an incarcerated hernia. In addition, the authors discuss the role of laparoscopy in the surgical treatment of an inguinal hernia and its application for investigation of the contralateral inguinal canal.

Anesthesia↗
PubMed2006

Lawnmower injuries in children: a 10-year experience.

Approximately 77,800 annual lawnmower-related injuries are treated in the USA, with 9,300 involving children. This work reviews the literature and reports our 10-year experience with lawnmower injuries. We retrospectively reviewed patients with lawnmower injuries admitted to the Women and Children's Hospital of Buffalo from 1995 to 2005 and reviewed the literature. Sixteen patients with mower-related injuries were admitted to our institution, with three due to walk-behind mowers and 13 due to riding mowers. The mean age was 7.5 years. Riding mower injuries had a higher average injury severity score (14.3 vs. 9) and a longer average length of hospital stay (15 vs. 2 days). All of the walk-behind mower injuries were extremity injuries, with two requiring amputations. Eleven of the riding mower injuries had extremity injuries alone, one had isolated torso injuries, and one had both extremity and torso injuries. Three required amputations, and the two patients with torso injuries required extensive surgical reconstructions. Pediatric lawnmower injuries, particularly due to riding mowers, are a highly preventable cause of morbidity and mortality. Increased public safety awareness and further manufacturer safety modifications should be strongly encouraged in order to limit this cause of pediatric trauma.

Accidents, Home↗
PubMed2005

Renal arteriovenous aneurysm in a 4-year-old patient.

We report a case of a symptomatic renal arteriovenous aneurysm in a 4-year-old pediatric patient. We were able to diagnose the lesion by means of a Doppler renal sonogram with color duplex interrogation. The diagnosis was confirmed by digital subtraction angiography. On the basis of the angiographic findings, the aneurysm was resected, and the renal arteriovenous fistula was repaired.

Angiography, Digital Subtraction↗
PubMed2004

Hepatoblastoma in low birth weight infants: an institutional review.

The association between hepatoblastoma and low birth weight documented recently in the literature has yet to be well explained, in particular the suggestion that these patients may have a more aggressive form of the disease. From 1989 to 2003, our institution treated four patients for hepatoblastoma who had birth weights of less than 1,500 g. Notable was 100% patient survival despite bilateral and, in one case, recurrent disease. Speculation regarding the etiology of this subset of hepatoblastoma has included damage to developing hepatocytes induced by oxygen free radicals. Our patients universally had pulmonary disease requiring prolonged supplemental oxygen and ventilatory support. However, our review supports no changes in the standard care of low birth weight infants or in managing those who develop hepatoblastoma.

Bronchopulmonary Dysplasia↗
PubMed2004

Reduced social morbidity of laparoscopic appendectomy in children.

Laparoscopic appendectomy has not been uniformly adopted by pediatric surgeons. Our children's hospital adopted laparoscopic appendectomy due to perceived benefits to patients and their families. We hypothesized that laparoscopic appendectomy in children resulted in less social morbidity than those undergoing open appendectomy. A questionnaire focused on a set of postoperative variables affecting the patient's and the family's return to normal activities. Families expressed their answers as a range of days. Five different ranges were assigned a numerical value for 10 different social morbidity variables. The numerical values were analyzed using Pearson chi2 test; statistical significance was defined as P < 0.05. The response rate was 55 per cent (134 of 244). Seventy-four had open and 47 laparoscopic appendectomy with a comparable incidence of acute and perforated appendicitis. Children undergoing laparoscopic appendectomy had shorter hospital stays and earlier resumption of feeding, return to school, return to pain-free walking and stair climbing, and resumption of normal activities including gym. Additionally, they had fewer wound problems, shorter duration of oral pain medication usage, and their parents returned to work quicker than the open group. All these were statistically significant. Laparoscopic appendectomy results in significantly reduced social morbidity for children and their families.

Activities of Daily Living↗
PubMed2003

The respiratory advantage of laparoscopic Nissen fundoplication.

BACKGROUND/PURPOSE: Laparoscopic Nissen fundoplication is replacing the open approach in the treatment of children with gastroesophageal reflux. The postoperative respiratory advantages seem obvious but remain unproven. The authors hypothesized that laparoscopic Nissen fundoplication provides postoperative respiratory advantages in neurologically normal children as well as those with mental retardation or profound neurologic impairment. METHODS: The charts of all laparoscopic Nissen fundoplications over a 4-year period were reviewed. Sixty-one laparoscopic procedures were compared with the most recent 61 consecutive open Nissen fundoplications. The following variables were reviewed: age, weight, gender, preexisting comorbidities, operating time, postoperative pulmonary complications, and length of stay. Categorical data were compared for significance utilizing chi2 cross tabulation. Variables representing numerical data were compared by t test. RESULTS: Although there appeared to be a trend toward sicker patients in the open group, the laparoscopic group showed significantly improved rates of extubation, shorter recovery room stays, shorter durations of chest physiotherapy, fewer intensive care unit admissions, more rapid resumption of baseline feedings, and overall decreased length of stay (P < 0.05). Pulmonary benefits also were noted in the neurologically impaired population when analyzed separately. CONCLUSIONS: Laparoscopic Nissen fundoplication confers a definable benefit with a significant pulmonary advantage in both neurologically normal children and those with neurologic impairment.

Age Factors↗
PubMed2003

Beneficial effects of intraluminal nitroglycerin in intestinal ischemia-reperfusion injury in rats.

BACKGROUND: We examined the effects of intraluminal nitroglycerin (NTG) on various physiologic functions and intestinal pathology in intestinal ischemia-reperfusion (IR) injury in rats. MATERIAL AND METHODS: Intraluminal NTG (0.15-3.75 mg/kg) was administered at different doses and stages during the experimental disease, and intestinal permeability and histology, bile flow, and systemic hemodynamics were measured. RESULTS: Prophylactic intraluminal NTG treatment at 0.75 mg/kg, but not at 0.15 mg/kg, significantly attenuated the deleterious changes in intestinal barrier function and mucosal injury caused by IR. However, administration of NTG after ischemia was not effective, even up to 3.75 mg/kg. In vitro intestinal NTG metabolism was significantly decreased following intestinal ischemia. Intraluminal NTG at 0.75 mg/kg significantly attenuated the reduction in bile flow that accompanied IR. Reperfusion induced a precipitous and sustained decrease in mean arterial pressure, which was blunted by intraluminal NTG. CONCLUSIONS: Intraluminal NTG produced several beneficial local and systemic effects in a rat model of intestinal IR. In this disease model, 0.75 mg/kg intraluminal NTG did not exacerbate, but rather reduced, the hypotensive effects induced by IR.

Administration, Topical↗
PubMed2003

Diagnosing Hirschsprung's disease: increasing the odds of a positive rectal biopsy result.

BACKGROUND/PURPOSE: Rectal biopsies are performed as a definitive means of diagnosing Hirschsprung's Disease (HD) in children presenting with constipation. The authors hypothesized that key features in the history, physical examination, and radiographic evaluation would allow us to avoid unnecessary rectal biopsies. METHODS: A retrospective analysis was conducted on patients undergoing rectal biopsy between 1995 and 2001. Patients with HD were identified (n = 50), and a concurrent cohort of patients with idiopathic constipation (IC; n = 50) was selected. Pertinent features in patients with HD versus those with IC were cross tabulated using Pearson Chi2 testing (significance was P <.05). RESULTS: Sixty percent of patients with HD and 15% of patients with IC experienced onset of symptoms in the first week of life. HD patients more frequently experienced delayed passage of meconium (P <.05), abdominal distension (P <.05), vomiting (P <.05), and transition zone on contrast enema (P <.05). All patients with HD had one or more of these significant features. In contrast, only 64% of patients with IC had one or more of these features. The classic triad of symptoms (ie, delayed passage of meconium, vomiting, and abdominal distension) was present in 18%, and one or more of these symptoms was present in 98% of HD patients. In contrast, only 60% of patients with IC had a history of delayed passage of meconium, vomiting, or abdominal distension. CONCLUSIONS: A history of delayed passage of meconium, abdominal distension, vomiting or the results of a contrast enema identified all patients with HD and excluded HD in approximately 36% of patients with idiopathic constipation. The authors have shown that key features in a patient's history, physical examination, and radiologic evaluation can differentiate between HD and IC. In a child presenting with constipation and none of the above features, it is not necessary to perform a rectal biopsy to exclude HD.

Adolescent↗
PubMed2003

One-stage transanal Soave pullthrough for Hirschsprung disease: a multicenter experience with 141 children.

BACKGROUND: The surgical management of Hirschsprung's disease (HD) has evolved from the original 3-stage approach to the recent introduction of minimal-access single-stage techniques. We reviewed the early results of the transanal Soave pullthrough from 6 of the original centers to use it. METHODS: The clinical course of all children with HD undergoing a 1-stage transanal Soave pullthrough between 1995 and 2002 were reviewed. Children with a preliminary stoma or total colonic disease were excluded. RESULTS: There were 141 patients. Mean time between diagnosis and surgery was 32 days, and mean age at surgery was 146 days. Sixty-six (47%) underwent surgery in the first month of life. Forty-seven (33%) had the pathologic transition zone documented laparoscopically or through a small umbilical incision before beginning the anal dissection. Mean blood loss was 16 mL, and no patients required transfusion. Mean time to full feeding was 36 hours, mean postoperative hospital stay was 3.4 days, and 87 patients (62%) required only acetaminophen for pain. Early postoperative complications included perianal excoriation (11%), enterocolitis (6%), and stricture (4%). One patient died of congenital cardiac disease. Mean follow-up was 20 months; 81% had normal bowel function for age, 18% had minor problems, and 1% had major problems. Two patients required a second operation (twisted pullthrough, and residual aganglionosis). One patient developed postoperative adhesive bowel obstruction. CONCLUSION: To date, this report represents the largest series of patients undergoing the 1-stage transanal Soave pullthrough. This approach is safe, permits early feeding, causes minimal pain, facilitates early discharge, and presents a low rate of complications.

Child↗
PubMed2002

Pediatric hernias.

Indirect inguinal hernias, hydroceles, and umbilical hernias are extremely common in infancy and childhood. Less commonly encountered are femoral, direct inguinal, epigastric, and Spigelian hernias. Patient history and physical examination are usually sufficient for the diagnosis of a hernia. If the diagnosis is uncertain, ultrasound examination or herniograms are occasionally employed. Magnetic resonance imaging may be useful in diagnosing abdominal wall hernias in obese patients for whom physical examination is difficult.

Child↗