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Biomedical subjects

R G Azizkhan

Publications and source records attributed to R G Azizkhan.

At least 55 records · Page 3Linked to original sources
PubMed1995

Mycotic infections in pediatric surgical patients.

Mycotic infections have become an increasingly common problem in immunosuppressed pediatric patients. The management of fungal infections requires not only the recognition of the potential for infection, but also of the types of organisms that can cause infection. The identification of the organ system(s) affected is important in directing therapy. The immature immune system of neonates is partially responsible for some specific diseases and unique management problems. These infants are increasingly stressed to degrees not previously seen in intensive care nurseries and may be on long-term antibiotic therapy for other illnesses. Chemotherapy for malignancy, bone marrow transplants, trauma, and chronic illness increase the risk of immunocompromise and systemic fungal infections. The frequent use of long-term intravascular catheters contributes to the potential for fungal infection in the pediatric population. Therapy now includes administration of topical and/or parenteral antifungal agents and supportive care to the patients. New therapies may well include more potent and safer antifungal agents as well as new ways to enhance the immune response in immunosuppressed patients.

Antifungal Agents↗
PubMed1994

Chronic lung disease is the leading risk factor correlating with the failure (wrap disruption) of antireflux procedures in children.

Recurrent gastroesophageal reflux (GER) after antireflux procedures (ARP) has been correlated with significant neurological impairment (NI). Other major risk factors for recurrent GER have not been extensively characterized. The authors reviewed their experience with ARPs in children to better characterize the risk factors for recurrent GER and identify successful management strategies for these patients. The charts of 281 consecutively treated children who had an ARP at our institution (1985 to 1992) were reviewed. The neurological status of each child was assessed as normal or impaired (cerebral palsy, seizures, mental retardation, spasticity), and other medical diagnoses such as chronic pulmonary disorders (eg, interstitial disease, cystic fibrosis, bronchopulmonary dysplasia, asthma, etc), and congenital malformations and syndromes were identified. The average follow-up period was 3 years (range, 1 to 7.5 years). Patients with symptoms of recurrent GER were evaluated with an upper gastrointestinal study. Patients with a radiologically intact fundoplication and suspected GER were further evaluated with a 24-hour pH probe. Statistical analyses were performed using the Fisher's Exact Test. Of the 281 patients who underwent ARP, 39 had documented recurrent GER (average, 16 months after surgery). Twenty-five (64%) of these children had chronic pulmonary disease (CPD). Thirty-two percent of all children with CPD had recurrent GER after ARP, versus 7% of those without CPD (P < .0001). For children with NI and CPD there was an increased risk (P < .0001) of failure when compared with the risk in the normal subgroup (children without CPD or NI) who underwent ARP.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

Mice with hemangiomas induced by transgenic endothelial cells. A model for the Kasabach-Merritt syndrome.

Inoculation of an established endothelial cell line from transgenic mouse hemangiomas (Py-4-1) into histocompatible mice induced vascular tumor formation at the site of infection with 100% frequency. Histological and hematological studies revealed that the mice developed hemangiomas with hematological changes similar to those found in the Kasabach-Merritt syndrome in humans, including hemolytic anemia and thrombocytopenic purpura. Modifications in the red blood cell count, hemoglobin concentration, hematocrit, and platelet count were directly correlated with the size of the hemangioma. Thus transgenic endothelial cell injection into histocompatible mice provides an in vivo model system to study the pathobiology of hemangiomas as well as the investigation of angiogenesis inhibitors.

Anemia, Hemolytic↗
PubMed1993

Prospective analysis of urokinase in the treatment of catheter sepsis in pediatric hematology-oncology patients.

Use of right atrial catheters (RACs) in children with cancer improves the comfort and efficacy of therapy. However, catheter-related infections are responsible for significant morbidity leading to the removal of approximately 20% of implanted RACs. Sepsis has been linked to thrombus and fibrin sheath formation within the RAC. Gram-negative and fungal infections appear to be particularly resistant to antibiotic therapy alone and most of these infections have required catheter removal. Urokinase has been effectively used for reopening thrombus occluded RACs. Theoretically, thrombolytic agents could improve the treatment of catheter-related infections by removing luminal sites of bacterial/fungal colonization. We prospectively monitored the use of urokinase and antibiotics for catheter-related sepsis in our pediatric hematology/oncology population from 1985 to 1991. Sepsis episodes were treated with 2 doses of urokinase and antibiotics (10 to 42 days) infused through the RAC. One to 2 mL of urokinase (5,000 U/mL) was instilled in the RAC for 1 hour, then removed and repeated 24 hours later. During the study, 224 RACs were placed in 177 children. RACs were in place for a total of 71,134 days (median, 274 days). There were 67 blood culture-positive sepsis episodes occurring in 50 RACs. Fifty-nine sepsis episodes were treated with urokinase and antibiotics and all responded by clearance of organisms from the blood. Three patients (5.1% of urokinase treated) had recurrent sepsis with the same organism within 2 months, were considered treatment failures and had RACs removed. Only 1 of 16 episodes of multiple organism/Candida sepsis led to RAC removal due to inability to cure the infection.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

Munchausen syndrome by proxy: patterns of presentation to pediatric surgeons.

Munchausen syndrome by proxy is an increasingly reported insidious disorder in which illness in a child is fabricated and/or induced by the parent. Over a 5-year period at North Carolina Children's Hospital 10 such children were identified after having presented to the Pediatric Surgical Service. In reviewing this experience, we have identified two patterns of presentation. Apnea, seizures, and cyanosis comprised the pattern most frequently seen in infants. A history of persistent diarrhea and vomiting, although seen in two infants, was the more common pattern in older children. As they got older, four of the infants subsequently were noted to have the childhood pattern of symptoms. The mother was the perpetrator in all cases with the child's illnesses being induced by a number of different mechanisms. The most useful diagnostic tool proved to be isolation of the child from the parent. Resolution of symptoms in parental absence was a consistent finding especially in fabrication cases and was the key to diagnosis. Video telemetry confirmed the diagnosis in two infants and screens for toxins were diagnostic in three others. Awareness of patterns of presentation and parental behavior is critical to establishing an early diagnosis and avoiding needless diagnostic and operative procedures.

Adolescent↗
PubMed1993

Epidural fentanyl infusion with patient-controlled epidural analgesia for postoperative analgesia in children.

The use of epidural fentanyl infusion with patient-controlled epidural analgesia (PCEA) is becoming popular for postoperative analgesia in adults. Its use has not been reported in the pediatric population. We report our initial experience with this technique in pediatric patients. The charts of all children who received epidural fentanyl infusions for postoperative analgesia between June 1991 and February 1992, were reviewed. Thirty-one patients, ages 6 to 17 years (mean +/- SD, 13.2 +/- 2.7) received epidural fentanyl infusion with PCEA for 36 operative procedures. Epidural catheters were either inserted in the lumbar (n = 14) or thoracic (n = 22) epidural space at a level based on the surgery. A fentanyl bolus of 1.38 +/- 0.43 micrograms/kg was delivered via epidural catheter just prior to the conclusion of surgery. A continuous infusion of fentanyl (0.56 +/- 0.18 micrograms/kg/h) with a PCEA bolus (0.53 +/- 0.17 micrograms/kg) available every 15 minutes was initiated in the recovery room and was utilized for 8 to 110 hours (59 +/- 27 hours). Pain and sedation were assessed by verbal descriptive scales, and side effects were noted. Alterations in dosing regimen were made for inadequate analgesia or side effects. Analgesia was assessed as excellent or good in 78% of the patients, 91% in the thoracic catheter group and 57% in the lumbar catheter group (P < .02). Patients with thoracic catheters were more likely to need their infusion and PCEA doses decreased, whereas those with lumbar catheters more often needed their doses increased (P < .05). No patient had respiratory depression.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

Anterior cricoid suspension and tracheal stomal closure for children with cricoid collapse and peristomal tracheomalacia following tracheostomy.

Nearly 10% of infants with long-standing tracheostomies (> 1 year) have severe peristomal tracheomalacia and/or significant cricoid cartilage collapse. Tracheal decannulation in these small children may be complicated by upper airway obstruction, recurring respiratory tract infections, and an unsightly cervical scar. We have developed a simple one-stage method of surgically alleviating severe cricoid collapse and peristomal tracheomalacia that permits immediate extubation. After excising and transversely closing the tracheocutaneous fistula, an anterior cricoid/tracheal suspension is accomplished by suturing the adherent fibromuscular tissue overlying the cricoid and peristomal trachea to the musculofascial insertions of the cervical strap muscles adjacent to the sternum. Once tied, these sutures significantly elevate the anterior cricoid and peristomal trachea by pulling the cervical airway ventrally and inferiorly. The strap muscles cover the tracheal suture line and the skin and soft tissue are closed in a transverse fashion. This procedure has been performed in 9 children (ages 1 to 4 years). All were extubated within 24 to 72 hours. No perioperative or long-term complications were observed with follow-up averaging 20 months (range, 6 months to 4 years). Postoperative endoscopy demonstrated substantial improvement in the airway lumens of all children. The final cosmetic appearance has been excellent. This operative method of dealing with cricoid collapse and peristomal tracheomalacia is simple, safe, and effective.

Bronchoscopy↗
PubMed1993

Bladder pressure monitoring significantly enhances care of infants with abdominal wall defects: a prospective clinical study.

Increased intraabdominal pressure (IAP) has been demonstrated to cause intestinal and renal ischemia in both animals and humans. Neonates undergoing closure of anterior abdominal wall defects are at risk for these complications from markedly increased IAP, which are putatively responsible for a 13% to 20% mortality. In an effort to decrease morbidity and mortality we performed a 4-year prospective clinical study to determine if monitoring IAP using bladder pressure (BdP) measurements would significantly improve perioperative care in infants with abdominal wall defects. Forty-two consecutive infants with gastroschisis (28) and omphalocele (14) were prospectively studied. Intraoperative and serial postoperative measurements of BdP were obtained from an indwelling bladder catheter using a standard pressure transducer. Methods of initial closure, as well as manipulations in sedation, paralysis, and silo reduction, were selected to keep BdP < 20 mm Hg. Bladder pressure monitoring significantly altered the management of 64% of our patients, particularly those with gastroschisis (74%). Thirteen patients with gastroschisis underwent staged closure; in 7 (54%) this decision was based on high BdP even though bowel reduction was mechanically possible. Elevated BdP influenced the closure method and timing of silo reductions in 5 of 14 (42%) infants with omphalocele. There were no episodes of renal failure or refractory oliguria. There were three patients in a single cluster who developed uncomplicated, nonsurgical necrotizing enterocolitis late in their respective courses. One patient whose bowel was placed in a silo had severe hypotension associated with group B streptococcal sepsis and subsequently developed necrotic bowel despite low BdP.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdominal Muscles↗
PubMed1992

Anaesthetic management of infants requiring endobronchial argon laser surgery.

Small infants with endobronchial lesions primarily due to traumatic suction catheter injuries are now undergoing argon laser surgery to remove obstructive tissue. Providing an anaesthetic for these infants can be challenging because of the small airways involved which must be shared by the anaesthetist and the surgeon. We have performed 30 argon laser endobronchial surgeries in nine infants. The lungs of the majority of patients were ventilated through a tracheostomy intraoperatively, while the surgeon passed the argon laser fibre through the suction port of a fibreoptic bronchoscope which was passed trans-nasally. Three infants were too small to allow passage of the fibreoptic bronchoscope past an artificial airway. In these patients surgery and ventilation were accomplished through a rigid bronchoscope. Three larger patients without tracheostomies were managed with a modified nasal airway for intraoperative ventilation in conjunction with the fibreoptic bronchoscope.

Airway Obstruction↗
PubMed1992

Percutaneous translumbar and transhepatic inferior vena caval catheters for prolonged vascular access in children.

Central venous access for children with caval occlusion remains a major challenge to pediatric surgeons. Traditionally, children with superior and inferior vena cava (SVC, IVC) thrombosis have often required a thoracotomy to directly cannulate the azygos system or right atrium (RA). Recently, the possibility of placing tunneled RA catheters (RACs) by a percutaneous translumbar or transhepatic approach has become available. We report our experience of seven children with SVC and IVC obstruction who have received 11 transhepatic and 4 translumbar RACs from 1987 to 1991. All but one child was less than 2.5 years old and all were chronically dependent on parenteral nutrition. All catheters were placed in the angiography suite under general anesthesia using ultrasound guidance and Seldinger technique. This technique was successful in all seven children. Perioperative complications included accidental extubation in one patient and aspiration pneumonia in another. Mechanical complications requiring RAC replacement occurred 5 times in three infants (greater than 2,650 catheter days) and included catheter dislodgement (2) and thrombosis (3). In the patients with catheter thrombosis, the existing tract was successfully wired and the catheter exchanged on three occasions. Thrombolytic therapy was effective in restoring catheter patency on three other occassions. Nine episodes of catheter sepsis occurred in five children. Two late deaths occurred from infection. Of the five remaining children, four are dependent on total parenteral nutrition and have a translumbar or transhepatic catheter in situ and one child has adapted successfully to enteral feedings. Percutaneous translumbar or transhepatic IVC catheters provide excellent alternative routes for prolonged central venous access in those patients whose traditional vascular access sites are no longer available. Complications of the technique itself were minimal and although late catheter complications were not infrequent, they appear to be comparable to the standard approaches reported.

Adolescent↗
PubMed1992

Endoscopic management of large, postresection bronchopleural fistulae with methacrylate adhesive (Super Glue).

Bronchopleural fistulae that occur following pulmonary resection are usually managed by direct, operative closure. In complex cases, in which the risk of repeat thoracotomy is great, other means may be preferable. We report two patients, one with cystic fibrosis and one with extensive radiation fibrosis post-Askin's tumor, in whom the risk of thoracotomy was considered to be prohibitive. Both had a large fistula between the pleural cavity and a segmental bronchus from the right upper lobe. The cystic fibrosis patient had recurrent massive bleeding from the pleural space. A Teflon catheter was passed through a flexible bronchoscope and Super Glue (butyl or methyl methacrylate) was deposited into the fistula. In both cases, the fistula resolved promptly. One patient developed a large, recurrent granuloma at the site of the fistula requiring endoscopic resection. We believe that tissue adhesive may be a reasonable approach to the management of large bronchopleural fistulas when the risk of operative closure is great.

Adolescent↗
PubMed1992

Heterotopic hindgut duplication: a cloacal remnant associated with exstrophy of the bladder.

Lower hindgut duplications, although very rare, usually present as a cystic mass located posterior to the rectum and confined to the pelvis. Hindgut duplications are often associated with genitourinary or spinal anomalies. We describe a neonate with a previously unreported heterotopic colonic duplication presenting as an exophytic perineal mass associated with classic bladder exstrophy. The embryonic significance of these anomalies is discussed.

Abdominal Neoplasms↗
PubMed1992

Acquired lobar emphysema (overinflation): clinical and pathological evaluation of infants requiring lobectomy.

Acquired lobar "emphysema" (overinflation) (ALE) is an increasingly recognized complication of advanced bronchopulmonary dysplasia (BPD). To refine current concepts regarding patient management and pathogenesis, we examined clinical and pathological features of six infants with ALE who did not have obstructing intraluminal lesions and who underwent lobectomy after failing nonoperative management. All had severe neonatal respiratory distress and required prolonged ventilatory support (average, 2 months) with peak inspiratory pressures greater than 30 mm Hg and 100% oxygen. ALE developed between 3 weeks and 20 months of age (median, 5 months), with lobar hyperinflation, atelectasis, and mediastinal shift. Selective bronchial intubation provided only transient benefit. Videobronchoscopy demonstrated no intraluminal obstructing lesions in five patients. In one child, ALE became clinically apparent only after laser excision of an endobronchial cicatrix. All infants had bronchomalacia with the involved lobar bronchus being most severely affected. Ventilation-perfusion scans demonstrated severe impairment of both ventilation and perfusion in the involved lobes. The decision to perform lobectomy was based on clinical parameters and failure of non-operative management. After lobectomy, all children dramatically improved. However, only three of six were alive 2 to 3 years later; one infant died of unrelated causes at 6 weeks; and two died of progressive respiratory insufficiency 13 and 24 months postlobectomy. Microscopic evaluation of the lung demonstrated findings of late-stage BPD with peribronchial and interstitial fibrosis, parenchymal overinflation, and alveolar septal disruption.(ABSTRACT TRUNCATED AT 250 WORDS)

Bronchi↗
PubMed1992

Characterization of GRO alpha, beta and gamma expression in human colonic tumours: potential significance of cytokine involvement.

The GRO genes, isolated from transformed fibroblasts, belong to a superfamily of genes such as platelet factor 4 and neutrophil activating peptide/IL-8. Three related GRO genes are described which are closely linked on chromosome 4: GRO alpha, GRO beta, and GRO gamma: GRO beta and GRO gamma share 90 and 86% sequence homology with GRO alpha. The GRO alpha gene product shares homology with, and is melanocyte growth stimulatory activity (MGSA). The MGSA/GRO alpha has potent chemotactic, growth regulatory and transformative functions. The function of GRO beta and gamma is unknown. Expression of GRO alpha is well characterized in vitro; studies in actual human tissues are not reported. We chose to determine the specific expression of GRO alpha, beta and gamma in both normal and transformed human colonic tissues and to assess the role of exogenous cytokines on their induction. Tissues from ten patients with colonic neoplasia were obtained at the time of colectomy. All specimens underwent Northern analysis for GRO gene expression, comparing normal colonic mucosa with neoplastic mucosa. Differential GRO alpha, beta and gamma expressions were determined by polymerase chain reaction (PCR). GRO alpha expression was evaluated in the tumour specimens compared with normal, while there was constitutive expression of GRO gamma in both normal and neoplastic colonic mucosa. Expression of GRO beta was minimal in all tissue specimens. In addition, HT29 colon carcinoma cells stimulated with IL-1 beta and TNF alpha demonstrated induction of GRO alpha and IL-8. Thus, GRO alpha is differently elevated in in vivo colon carcinoma specimens. GRO gamma was constitutively expressed in colonic tissues; GRO beta was not similarly expressed.

Adenoma, Villous↗
PubMed1992

Modified extravesical ureteral reimplantation in pediatric renal transplantation: 5 years of experience.

Numerous surgical procedures have been described to reimplant the ureter into the bladder during renal transplantation. Since November 1985 we have used a modified extravesical technique in 19 children. At the time of transplantation patient age ranged from 2 to 17 years (average age 10 years). Of these patients only 2 received a cadaveric kidney. Postoperative followup ranged from 4 to 54 months (average 32 months). No immediate or delayed urological complications were noted, and all but 1 graft has continued to function. This procedure is not only expeditious and safe but it also eliminates a long cystostomy suture line and requires a short ureteral length. Urinary leakage and ureteral obstruction, 2 of the most common urological complications, have not been observed in our patients. Although further experience and longer followup are required, this technique has become our procedure of choice for ureteral reimplantation in children undergoing renal transplantation.

Adolescent↗
PubMed1992

Lasers in pediatric surgery.

The use of lasers in a variety of surgical disciplines has added new dimensions to operative techniques, allowing increased precision, improved hemostasis, and less tissue injury. Although lasers offer no significant benefit over some conventional pediatric surgical techniques, there are other procedures and disease conditions in which the use of laser technology provides major advances and improves outcome. The physics of laser technology and the unique characteristics and applications of the currently available lasers are discussed along with current and future applications in pediatric surgery.

Animals↗