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Biomedical subjects

N J Sherman

Publications and source records attributed to N J Sherman.

At least 19 recordsLinked to original sources
PubMed1994

Hamartomas of the chest wall in infants.

Chest wall hamartomas in infancy are rare lesions with distinct clinical, radiologic, and pathologic characteristics. Four cases treated at Children's Hospital of Los Angeles are presented and previously reported cases are reviewed. Chest wall hamartomas arise antenatally and present as hard, immobile masses, which may cause respiratory insufficiency. An extrapleural mass arising from the ribs can be seen radiographically. Histologically, these lesions are hypercellular and consist of a disorganized array of mesenchymal tissues endogenous to the chest wall. Rapid growth may occur, but usually is self-limited. Chest wall hamartomas are usually benign. This series includes the malignant transformation of one of these lesions. En bloc resection is curative, but the large residual chest wall defect frequently results in scoliosis.

Biopsy↗
PubMed1994

Diamond flap anoplasty in infants and children with an intractable anal stricture.

After posterior sagittal anorectoplasty for imperforate anus a prolonged course of anal dilatations is necessary until the scar softens. Although rare, severe stricture after this procedure is difficult to resolve. Y-V plasty is not entirely satisfactory because the pedicle advanced into the anus has some tension, which tends to retract producing recurrent stricture. The authors performed a diamond-shaped island anoplasty in eight children with postoperative and strictures (one after an unsuccessful Y-V plasty), with prompt resolution of the stricture in five. The island flap anoplasty consists of a diamond-shaped flap of skin formed laterally, with complete separation of skin and subcutaneous attachments around the periphery of the flap. The skin island is supplied with blood from the deep tissue. An incision is made through the scarred anal ring and into the mucosa, a distance of half the length of the diamond, which is then advanced into the mucosal defect. The defect lateral to the advanced flap is sutured closed. The island of skin descends naturally into the anus, under no tension. The procedure can be performed simultaneously in the 3 o'clock and 9 o'clock positions, and can later be repeated anteriorly and posteriorly, although this has not been necessary. Two of the eight children have required no dilatation postoperatively, a distinct advantage in the 4-year-old patient. One segment in one child sloughed, resulting in repeat stricture that is responding to dilatation. The other seven children are doing well with their colostomies closed.

Anus, Imperforate↗
PubMed1987

Use of a subclavian venous catheter for short- and long-term hemodialysis in children.

Vascular access for hemodialysis in children poses problems not encountered in adults because of the small size of the vessels available. The increasing use of peritoneal dialysis has created a large number of patients who need prompt access for hemodialysis for days to weeks during episodes of peritonitis. There are also occasional patients who have exhausted available fistula sites and still require hemodialysis. To address these problems, we designed a series of catheters for insertion in the subclavian vein. The catheters are stiffer than the Hickman type catheter to allow for higher flow rates without collapse. Seventy-five catheters were implanted in 58 patients with a mean age of 14 years. Twelve catheters were inserted in ten children for long-term (over 3 months) access; they have been in place for a mean of 259 days and used for a mean of 64 dialyses. In two children, the catheter has been the sole site for hemodialysis for over a year. Fifty-eight catheters were implanted in 43 patients for short-term hemodialysis. They were in place for a mean of 29 days and used for a mean of 13 dialyses. The major complications encountered were clotting of the catheter and migration out of position. Four catheters were removed because of infection. These new catheters provide effective hemodialysis for children as small as 7 kg with an acceptable morbidity rate and may be used for extended periods of time if necessary.

Adolescent↗
PubMed1987

Iliac artery pseudoaneurysm following umbilical artery catheterization.

We report a case of a large iliac artery pseudoaneurysm in a newborn infant following umbilical artery catheterization. The aneurysm was excised and a primary repair was performed with limb salvage and reestablishment of normal blood flow to the foot. While these aneurysms are rare, prompt surgical repair should be performed as soon as the diagnosis is made because the associated mortality is high.

Aneurysm↗
PubMed1983

The surgeon's role in chronic peritoneal dialysis.

Hemodialysis has been the mainstay for children with end-stage renal disease until a successful renal transplant is accomplished. Chronic peritoneal dialysis has been a second choice and, in special circumstances such as for small infants, children without vascular access, or patients unstable on hemodialysis, it is the only alternative. Recent refinements in peritoneal catheters and dialysis have added to the many medical, psychological, and economic advantages, resulting in the displacement of hemodialysis by peritoneal dialysis as the most frequently used modality. Forty-six patients were followed for 593 catheter months on peritoneal dialysis. A total of 74 procedures were performed, and 56 catheters were implanted. Complications included infection and mechanical occlusion of the catheter. Peritonitis occurred in 13 of the 46 patients on 56 separate occasions. There were 5 episodes of subcutaneous catheter infection. The peritonitis was treated with medical therapy alone in 50 of the 56 episodes of peritonitis. Mechanical occlusion in 10 patients and remedial surgery was required in 9. Of the total series, 4 patients were returned to hemodialysis and 5 patients died. Based on this experience we have developed guidelines to assist the surgeon in preventing and treating the various complications associated with chronic peritoneal dialysis.

Adolescent↗
PubMed1979

Traumatic splenic injury: splenectomy vs. repair.

Splenectomy has been the standard treatment during this century for traumatic splenic injuries. Because of the association between asplenia and overwhelming sepsis, recent attempts have been made to repair injured spleens. Details of splenic anatomy and blood supply allow prediction of the usual type of splenic injury that can be repaired. By utilizing a topical hemostatic agent, capsular sutures, and arterial ligation, severely traumatized spleens have been repaired. Postoperative splenic scanning is available in assessing remaining splenic tissue. The present and future ramifications of reparative splenic surgery are presented.

Adult↗
PubMed1978

A triple duplication of the alimentary tract.

Duplications of the alimentary tract occur infrequently, and are usually isolated anomalies. In the infant described below, a complex clinical picture was the result of three distinct duplication in widely separated portions of the alimentary tract (esophagus, duodenum, ileum). Details of the clinical course and technical management of an extremely long ileal duplication form the basis for this report.

Abnormalities, Multiple↗
PubMed1978

Conservative surgery for splenic injuries.

Splenectomy for traumatic injury of the spleen has recently been questioned, due to the occurrence of postsplenectomy sepsis. During the past year we have operated on six children with splenic injuries and, by utilizing different surgical manuevers, have successfully reserved all or part of the spleen. The following report describes the management of these children and the operative techniques that allow the injured spleen to be salvaged.

Child↗
PubMed1977

Gastric volvulus in children: report of two cases.

Two cases of gastric volvulus in children are reported, one acute and one chronic. The diagnosis should be suspected as an unusual cause of chronic recurring upper abdominal pain or in acute gastric obstruction. The radiographic appearances of these patients are presented. Anterior gastropexy has produced good results in both the patients described.

Child↗
PubMed1977

Cryptorchidism and abdominal pain.

In this case report, abdominal symptoms simulating acute appendicitis were due to recurrent torsion of an intra-abdominal testicle. Cryptorchidism frequently goes unnoted. Most undescended testicles are in the groin and easily palpable. If not, they can be absent, retroperitoneal or intra-abdominal. An intra-abdominal testicle is more likely to occur on the right than the left.

Abdomen↗