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Biomedical subjects

R M Arensman

Publications and source records attributed to R M Arensman.

At least 19 recordsLinked to original sources
PubMed1992

Calculous disease of the biliary tract in infants after neonatal extracorporeal membrane oxygenation.

Extracorporeal membrane oxygenation (ECMO) can be lifesaving support for neonates with fulminant respiratory failure. In the 121 patients that we have placed on ECMO since 1983, bleeding, infection, and intracranial hemorrhage have constituted most of the major complications. We have also encountered two cases of biliary calculi in post-ECMO infants. The hemolysis, total parenteral nutrition, diuretics, and prolonged fasting associated with ECMO may predispose neonates to early calculous disease of the biliary tract and may require surgical intervention. Evaluation of abdominal pain or jaundice in infants and children who have been supported with ECMO should include examination of the biliary tree. Cholecystectomy should be seriously considered for infants with cholelithiasis.

Cholelithiasis↗
PubMed1991

Pediatric extracorporeal membrane oxygenation in posttraumatic respiratory failure.

The leading cause of death in the pediatric population in the United States is trauma. A retrospective review of patients treated with extracorporeal membrane oxygenation (ECMO) for traumatic respiratory failure was performed. Eight children were treated at the Ochsner Medical Foundation and additional data on six children were available from the National Registry. Six children developed respiratory failure as a result of blunt trauma and eight as a result of near drowning. Standard venoarterial ECMO was used with a circuit very similar to that used in neonatal ECMO. Vascular access was via the common carotid artery and the internal jugular vein. Ventilatory support was weaned to minimal settings during ECMO. Central hyperalimentation and systemic antibiotics were used in all of the cases. Four of six children survived in the blunt trauma group; three of eight children survived in the near drowning group. Although significant conclusions cannot be drawn from a small group of patients the average pre-ECMO PO2 for survivors was 87 mm Hg, whereas for nonsurvivors the average PO2 was only 46 mm Hg. Ventilatory support for both groups was not remarkably different, and the average PCO2 was lower in the nonsurvivor group. The cause of death in this group of patients is usually multisystem organ failure. In the four patients treated at Ochsner who did not survive, all had positive blood cultures and presumed systemic sepsis. ECMO has been demonstrated to be very successful in neonatal respiratory failure. Predicting mortality and morbidity in pediatric respiratory failure has been more difficult.(ABSTRACT TRUNCATED AT 250 WORDS)

Child, Preschool↗
PubMed1991

Thymic enlargement in children.

The presence of an anterior mediastinal mass in an infant or child is a diagnostic and therapeutic challenge. Few papers in the literature specifically address subtypes of thymic tumors in the pediatric population and their treatment. Our purpose was to determine which children are at significant risk of having a malignant thymic tumor. Four children were younger than 18 months old. Of these, two (50%) had respiratory distress from tracheal compression although all four had benign tumors. Of the 14 older children, only two were symptomatic, both of these from myasthenia gravis rather than the size of the mass compressing surrounding structures. Four of the 14 masses (29%) were malignant although none of the four were symptomatic. Children with benign tumors lived significantly longer than those with malignant tumors. The significant incidence of malignancy in thymic tumors when the patient is 18 months or older necessitates surgical exploration with complete removal of the mass. Children younger than 18 months require close follow-up and a trial of corticosteroids. Surgery is necessary if the mass enlarges or becomes symptomatic.

Adolescent↗
PubMed1991

Is primary repair of gastroschisis and omphalocele always the best operation?

Optimal surgical management of neonates with gastroschisis and omphalocele remains controversial. Suggested benefits of primary fascial closure include earlier return of gastrointestinal function, decreased hospital stay, less sepsis, less risk of postoperative intestinal obstruction and fistulae, and lower mortality. Between 1978 and 1989, 40 neonates with gastroschisis or omphalocele underwent repair. Primary fascial repair was performed in 30 children, 18 of whom had a gastroschisis and 12 of whom had an omphalocele. Ten children had staged repair with the use of a silastic silo; seven of these had a gastroschisis and three an omphalocele. Comparison between the groups was made regarding birth weight, days on the ventilator before and after surgery, days to first feeding, days in the hospital after surgery, postoperative complications, and survival. There was no significant difference in birth weight, days on the ventilator, days to first feeding, and postoperative days in the hospital. There were nine complications in nine patients (30%) with primary repair and four complications in two patients (20%) with staged repair. Two infants died after primary repair (6.7%), and one (10%) died after staged closure. It was concluded that silastic silo repair and primary fascial closure are both acceptable alternatives. Primary closure is attractive whenever possible to avoid additional operations.

Abnormalities, Multiple↗
PubMed1990

Congenital bronchoesophageal fistula.

Congenital bronchoesophageal fistula is a rare anomaly that normally appears in adult life. Because of a recent case, we reviewed the literature on this lesion. There have been several reviews in the past but none has included all cases. The largest review included only two thirds of the cases (1966). Including our case, the number of reported cases is 100.

Bronchial Fistula↗
PubMed1990

The perioperative management of neonates with congenital oropharyngeal teratomas.

Oropharyngeal teratomas are rare congenital neoplasms that distort orofacial anatomy and often cause respiratory embarrassment at birth. Immediate management of such lesions should include establishment of a secure upper airway, radiographic exclusion of midline central nervous system anomalies, and early surgical excision to prevent asphyxia or permanent disfigurement. Perioperative assessment and surgical management are reported for three oropharyngeal teratomas.

Female↗
PubMed1990

Retrohepatic vena cava reconstruction with polytetrafluoroethylene graft.

The case of an 18-month-old male who underwent a right hepatic lobectomy for hepatoblastoma with extensive involvement of the retrohepatic vena cava is presented. The retrohepatic vena cava was replaced with an expanded polytetrafluoroethylene graft. This graft was proved patent by ultrasonography 2 years after operation. The child has no evidence of recurrent hepatoblastoma. The results of grafting the retrohepatic vena cava have been notoriously poor. It is widely believed that a prosthetic vena cava graft cannot be expected to remain patent. Our experience with polytetrafluoroethylene and previous reports using Dacron and polytetrafluoroethylene have shown that long-term patency of retrohepatic vena cava replacement with synthetic graft can be successful.

Blood Vessel Prosthesis↗
PubMed1990

Wilms' tumor with metastasis to the left testis.

Wilms' tumors account for the vast majority of renal neoplasms in infants and children. Common areas for metastases include the lung, liver, and contralateral kidney. Less common sites include the bone, skin, brain, and orbit. We report a case of Wilms' tumor in a 13-month-old boy who, after radical left nephrectomy, developed a left testicular mass that turned out to be metastatic Wilms' tumor. The epidemiology, case history, review of the literature, and possible etiology of this rare site of metastatic Wilms' tumor are discussed.

Combined Modality Therapy↗
PubMed1990

Ventilatory management casebook. Congenital diaphragmatic hernia meeting criteria for extracorporeal membrane oxygenation.

Respiratory distress in newborns with CDH is the result of the interaction of pulmonary hypertension and pulmonary hypoplasia. Many patients will demonstrate adequate pulmonary parenchyma after repair as evidenced by adequate oxygenation and ventilation. Patients should be classified into groups of predicted mortality using Bohn's criteria. Patients in groups A, B, and D may be managed conventionally if blood gases can be kept in the normal range. These patients should be supported with ECMO if unresponsive to conventional management. In those patients with adequate gas exchange who fall into the C group, transfer to an ECMO center should be undertaken early, since mortality with continued conventional management is predictable. Some patients never demonstrate a "honeymoon" period, and mortality can be reliably predicted in this group as well by using Bohn's criteria. Because the relative significance of pulmonary hypoplasia compared with pulmonary hypertension in an individual patient cannot be reliably determined, any patient who has respiratory failure after repair of CDH should be supported with ECMO when conventional techniques fail as long as no contraindications exist. At least one institution will withhold ECMO therapy if lung parenchyma is judged inadequate as predicted by the inability to achieve a preductal PaO2 greater than 100 mm Hg and PaCO2 less than 50 mm Hg with maximal conventional therapy. In our experience, however, some patients can survive with ECMO support when all other indicators would suggest hypoplasia incompatible with life. Therefore, we do not believe any patient should be refused ECMO support when conventional measures fail.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Tracheoesophageal compression syndromes related to vascular ring.

Seventeen cases of vascular ring have been encountered at Ochsner Clinic over the past 22 years. Anatomic configurations consisted of double aortic arch in 11 cases, right aortic arch with left ligamentum arteriosum in five cases, and aberrant right subclavian artery in one case. In four cases chest x-ray films revealed air block or hyperinflation and led to further diagnostic tests. The definitive diagnostic methods included esophagogram in 15 cases, aortography in 14 cases, two-dimensional echocardiography in one case, and esophagoscopy/bronchoscopy in eight cases. Presenting symptoms were respiratory in 13 cases and feeding difficulties in three; one asymptomatic case was found incidentally. Four cases of air block syndrome were observed as an early and unusual presentation of vascular ring in infants. Hyperinflation of the lung fields on chest x-ray film should spur suspicion of a possible vascular ring. Two case reports are included to demonstrate air block in relation to vascular rings in neonates.

Adolescent↗
PubMed1989

Extracorporeal membrane oxygenation as treatment of severe meconium aspiration syndrome.

Meconium aspiration syndrome (MAS) is a common cause of morbidity and mortality in neonates. Chemical pneumonitis can lead to persistent pulmonary hypertension of the newborn (PPHN) with irreversible hypoxia and death. Extracorporeal membrane oxygenation (ECMO) for the treatment of severe PPHN became available at the Ochsner Foundation Hospital in September 1983. We reviewed the first 28 cases in which ECMO was used for the treatment of PPHN due to severe MAS; 26 of the 28 infants survived. During the three years preceding our development of ECMO capability, ten neonates had PPHN due to severe MAS and met the criteria for ECMO; only three survived. The difference in survival demonstrates the efficacy of ECMO for the treatment of severe MAS. We believe that when established criteria are met, ECMO should be instituted without delay.

Combined Modality Therapy↗
PubMed1988

Klippel-Trenaunay syndrome: rarely a surgical disease.

The various combinations of varicose veins, limb hypertrophy, and hemangiomas necessitate diagnostic consideration of the Klippel-Trenaunay syndrome versus Weber's syndrome and cavernous hemangioma. The wide spectrum of this disease has generated diverse approaches, and treatment must be individualized. Whereas the Klippel-Trenaunay syndrome is rarely a surgical disease, the gigantic proportions of our patient's anomaly warranted prompt amputation.

Amputation, Surgical↗
PubMed1988

Persistent pulmonary hypertension in the neonate.

Respiratory failure is the leading cause of death in the neonatal period. The anatomic and functional basis for this, particularly in full-term infants, most often is persistent pulmonary hypertension of the neonate (PPHN). This condition is reversible but can cause very severe and unrelenting respiratory failure and ultimate death when uncontrolled. Recent technologic advances have expanded the scope of therapy available for PPHN, resulting in increasing therapeutic success for these critically ill infants. This article reviews the anatomic and functional anomalies of PPHN, as well as the methods of diagnosis and discusses current treatment.

Adaptation, Physiological↗
PubMed1987

Diagnosis and management of hydrohematometrocolpos syndromes.

Hydrohematometrocolpos anomalies denote the different types of accumulation of fluid and menstrual products in the vagina and the uterus. They are rare conditions due to an intact hymen, vaginal membrane, or vaginal atresia. They may present at different times during development. The method of presentation is variable, and the presence of other genitourinary abnormalities and anorectal anomalies makes prompt diagnosis and treatment necessary. Review of our experiences with these conditions for the last ten years reveals a total of ten cases. This study reports three cases in detail and describes the others in tabular form.

Adolescent↗
PubMed1987

Extracorporeal membrane oxygenation for respiratory and cardiac failure in infants and children.

Fifty-three neonates and seven pediatric patients were treated with extracorporeal membrane oxygenation from September 1983 until April 1986. Venoarterial bypass was achieved by cannulating the right atrium via the right internal jugular vein and the aortic arch via the right common carotid artery. In the neonatal group, 40 infants with acute respiratory failure were treated, and 36 (90%) survived. Five infants with congenital heart disease were treated and three (60%) survived. Among the eight patients with congenital diaphragmatic hernia, there were three (38%) survivors. In the pediatric group, four patients were treated for ventricular failure after cardiac operations. Two were weaned from bypass, with one long-term survivor. Three patients with acute respiratory failure were treated, with one survivor. salvaging high-risk neonates with minimal morbidity and mortality. It has also been useful in the support of infants with congenital heart disease and congenital diaphragmatic hernia. In pediatric patients one cannot expect to get results that are comparable to those found in neonates. Still, this modality can be useful in salvaging some moribund patients with pulmonary or cardiac failure, or both.

Extracorporeal Circulation↗
PubMed1986

Improving survival in the treatment of congenital diaphragmatic hernia.

Thirty-two infants were treated for congenital diaphragmatic hernia at our institution from 1979 to 1984. Eight were in no or minimal distress at birth and had operative intervention when they were more than 24 hours old; survival was 100%. The remaining 24 neonates required immediate intubation and ventilation followed by operation at less than 12 hours of age. Overall survival was 54%; survival was 31% (4 of 13 patients, Group 1) in the first three years of the series and 82% (9 of 11 patients, Group 2) in the last three years (p less than 0.001). Apgar score, gestational age, birth weight, and incidence of associated congenital heart disease were equal for the two groups (all, p greater than 0.05). The two groups also were examined with reference to alveolar-arterial oxygen differences P(A-a)O2 and mean airway pressure (MAP). The best preoperative P(A-a)O2 was greater than 600 mm Hg for 7 neonates in Group 1 and 6 in Group 2, and survival was 0% and 71%, respectively (p less than 0.001). Infants with a postoperative MAP of 13 cm H2O or greater had a higher mortality (100% in Group 1 and 50% in Group 2, p greater than 0.05). Our treatment protocol was studied to determine those methods related to improved survival. Sodium bicarbonate infusion was used earlier in Group 2 as a prophylaxis against persistent fetal circulation (PFC) (p greater than 0.05). The incidence of severe PFC dropped from 85 to 54% (p greater than 0.05). Higher ventilator rates rather than pressures were used to achieve equally effective ventilation.(ABSTRACT TRUNCATED AT 250 WORDS)

Apgar Score↗