Biomedical subjects
Publications and source records attributed to P W Cronen.
Delayed pneumothorax may occur after subclavian vein catheterization and results from slow accumulation of air in the pleural space. Thus initial postinsertion chest x-rays may not detect this complication. The addition of positive pressure ventilation for general anaesthesia may make this complication life threatening. We report three cases and the literature is surveyed.
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Ovarian tumors in the pediatric age group, although rare, can be malignant and lethal; the most common is the germ cell tumor. Operation and chemotherapy with multiple drugs is recommended to improve survival. For children with benign ovarian tumors, preservation of ovarian tissue should be a priority. Thirty children with ovarian tumors were treated at Kosair Children's Hospital in Louisville, Kentucky, over the past 19 years. The average patient age was 12 years. Presenting symptoms were acute pain (46%), chronic pain (33%), increased abdominal girth (21%), and a palpable mass (55%). Plain x-ray films of the abdomen, ultrasonography, and intravenous pyelography were helpful in making the diagnosis preoperatively. Emergency laparotomy for an acute abdominal condition was done in ten patients. Twenty-two tumors were benign and eight were malignant. Of the malignant tumors, six (75%) were germ cell tumors, one was a sex cord tumor, and one was a cystadenocarcinoma. Benign tumors were managed by cystectomy or oophorectomy. For malignant tumors, oophorectomy or salpingo-oophorectomy was done initially, followed by chemotherapy and "second look" procedures. Survival ranged from five months to nine years, with an average of 46 months. Four patients died between five and 40 months after diagnosis; the other four have a median survival of 76 months.
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A 3-year retrospective review of 110 consecutive Tenckhoff catheter placements was undertaken. Major complications were found in 3.6 per cent of cases and minor complications occurred in 30 per cent. Analysis of cases in which catheters failed revealed that obesity and prior abdominal surgery occurred in 75 per cent of these patients. Attention to these factors and the use of appropriate techniques of placement and, in special situations, the use of endoscopy and fluoroscopy have reduced the failure rate of these high-risk situations. Management of infective complications are outlined and should include continued antibiotic dialysis and catheter replacement only if persistent peritonitis or fungal peritonitis occur. With these guidelines, improved peritoneal dialysis can be undertaken with less morbidity to the patient.
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I have reported a case of esophageal pseudodiverticulosis, a benign disorder consisting of dysphagia and esophageal stricture. The diagnosis is made by the radiologic findings of multiple outpouchings into the esophageal wall. The disorder appears to be related to abnormal submucosal glands of the esophagus. No coexistent diseases have been found, and except for treatment of the associated esophageal stricture no specific therapy is required.
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Necrotizing enterocolitis has been attributed to the use of indomethacin (INDO) for medical closure of patent ductus arteriosus. To study the effect of INDO on cardiac output and mesenteric circulation, INDO was given by rectum (0.25 mg/kg, 0.5 mg/kg, 1.25 mg/kg--3 dogs in each group) and the control group received none. The cardiac output and organ blood flow were measured before and 1 hr after INDO with radioactive microspheres using 4 isotopes (Cr53, Ni95, Co57, Sn113). The blood flow to different parts of the GI tract was measured as percent of cardiac output using a gamma counter. Paired t test was used to calculate percent reduction in organ blood flow. During the experiment, there was no reduction in cardiac output in the entire group. Anesthesia had no effect on the control group. In the three INDO treated groups, percent reduction of mucosal blood flow of the stomach (63%, 32%, 68%, p less than 0.01), mid ileum (19%, 59%, 57%, p less than 0.05) and terminal ileum (57%, 35%, 54%, p less than 0.015) was significant. A strong trend in reduction of organ blood flow was noted in other regions. There was no significant change due to different dosages of INDO. The area of ischemia in this dog model corresponds to clinical pathology noted in necrotizing enterocolitis.
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Multiple techniques for tunneling right atrial catheters have been described. This is an atraumatic technique which involves using the introducer and sheath needed for venous access.