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Biomedical subjects

R R Ricketts

Publications and source records attributed to R R Ricketts.

At least 55 records · Page 3Linked to original sources
PubMed1988

Intramural duodenal hematoma in children: reappraisal of current management.

In children, intramural duodenal hematomas resulting from blunt abdominal trauma are generally managed nonoperatively with nasogastric suction and parenteral nutrition. Experience with three cases in which this form of treatment failed caused us to reappraise its benefits and results. Consequently, we now recommend surgical evacuation of intramural duodenal hematomas for children in whom there is no evidence of partial resolution of the obstruction after five days or of complete resolution after ten days of conservative management.

Child↗
PubMed1987

Enterostomy in necrotizing enterocolitis: an analysis of techniques and timing of closure.

Resection and enterostomy are the standard operative procedures for necrotizing enterocolitis (NEC). In order to compare the results of two different methods of enterostomy, a study was carried out in 100 infants with NEC who underwent enterostomy formation and closure. A single surgeon at each of the two collaborating institutions conducted the majority of operations. Level of enterostomy was jejunum in 10, ileum in 75, and colon in 15. Type of enterostomy was separate stomas (usually brought out side by side) in 50, Mikulicz enterostomy in 39, single stoma with Hartmann's pouch in 10, and loop colostomy in 1. Complications of enterostomy formation occurred in 24 infants (24%). When infants with separate stomas were compared with those with the Mikulicz enterostomy, there was no difference in the rate of stomal or wound complications. The separate stomas had a higher rate of stricture formation in the distal bowel (36% v 18%), which may be accounted for by earlier reestablishment of intestinal continuity in the Mikulicz group. Both methods exteriorized the bowel ends close to one another, which was advantageous because subsequent closure was usually performed without a formal laparotomy. After enterostomy closure, 17 (17%) infants had complications. There was no difference in complication rate between early (before 3 months or under 2.5 kg) v late closure, or between closure of the Mikulicz enterostomy v separate stomas (although the Mikulicz enterostomy closure was accomplished more rapidly than closure of separate stomas). Morbidity was unrelated to level of enterostomy, type of enterostomy, maturing the stoma, bringing it through a separate incision, or age or weight of the infant at closure.(ABSTRACT TRUNCATED AT 250 WORDS)

Colostomy↗
PubMed1987

Pneumoperitoneum in the newborn infant.

Fifty-three newborns with pneumoperitoneum were treated between July 1980 and July 1985. The birth weights of these infants ranged from 600 to 4350 grams; nearly 75 per cent weighed less than 1500 grams. The etiology of the pneumoperitoneum and the hospital survival were reviewed. All operative patients had exploratory surgery through an upper abdominal transverse incision extending across both rectus muscles. All gastric and duodenal perforations were closed primarily; the perforations in the remaining gastrointestinal tract were generally exteriorized through the lateral edge of the wound. The single leading cause of pneumoperitoneum in the newborn is necrotizing enterocolitis, accounting for 60 per cent of the patients in this series; 78 per cent of these infants survived. All infants with ("spontaneous") ileal perforations survived. The two patients with colon perforations (from meconium plug obstruction) died, one of congenital heart disease associated with Down's syndrome and the other of hyaline membrane disease. One patient who had mild hyaline membrane disease, who was not ventilated, and who did not have mediastinal emphysema also had pneumoperitoneum for which no cause was found at laparotomy ("spontaneous"). He survived. In six critically ill infants (11% of the series) pneumoperitoneum developed secondary to mediastinal dissection of air from ventilators. None of these infants was operated on because an intestinal perforation as a source of the pneumoperitoneum could reliably be excluded by the presence of pneumomediastinum and/or a negative paracentesis. This group of infants warrants special attention, because in them "negative" laparotomies performed in search of an intestinal perforation would certainly compromise their already precarious conditions.

Enterocolitis, Pseudomembranous↗
PubMed1987

The significance of portal vein gas in necrotizing enterocolitis.

To assess the significance of the presence of portal vein gas (PVG) in necrotizing enterocolitis (NEC), a retrospective study of all cases of NEC seen at Grady Memorial Hospital between July 1980 and June 1984 was conducted. Infants with PVG were compared with those without PVG with respect to clinical presentation, treatment, and outcome. There was no significant difference between the two groups in birth weight, Apgar scores, or the age of onset of NEC. All patients received standard medical therapy unless they developed pneumoperitoneum, had a positive paracentesis, or deteriorated in spite of maximal medical treatment, in which case they had surgery. Of 97 infants with "definite" NEC, 55 (56%) required surgery. Twenty-one patients (22% of the total) had PVG and 17 (81%) of them required surgery. Seventy-six patients (78% of total) did not have PVG and only 38 (50%) of them required surgery (P = 0.011). Five (29%) of 17 infants with PVG had nearly total intestinal necrosis compared with only five (13%, P = 0.25) of 38 infants without PVG. Patients with PVG had a lower overall survival rate (62% vs 88%, P = 0.009), medical survival rate (75% vs 97%, P = 0.184), and surgical survival rate (59% vs 79%, P = 0.19) than patients without PVG. Infants weighing less than 1000 grams fared worse regardless of the presence or absence of PVG. Portal vein gas is an ominous prognostic sign. It signals a greater likelihood for surgical intervention, a more extensive bowel involvement, and a significantly lower survival when compared to patients with NEC who do not have PVG.

Enterocolitis, Pseudomembranous↗
PubMed1986

Fatal graft v host disease in a child with neuroblastoma following a blood transfusion.

A 2-year-old girl being prepared for a bone marrow transplant for treatment of stage IV neuroblastoma suffered a fatal graft v host (GVH) reaction following a transfusion on nonirradiated packed RBC. GVH disease is a recognized complication of transfusion in patients with leukemia and lymphoma and is a frequent complication following bone marrow transplantation. GVH disease has also been reported in pediatric patients with solid tumors who have received sufficient chemotherapy to render them immunocompromised. GVH disease can be prevented by irradiating all blood products with at least 1,500 rad for patients having total lymphocyte counts less than 1,000/microL or for those who have received greater than 30 mg/kg/d of Cytoxan.

Bile Duct Neoplasms↗
PubMed1986

The role of paracentesis in the management of infants with necrotizing enterocolitis.

Necrotizing enterocolitis (NEC) is the single most common surgical emergency of the newborn. Yet the indications for surgery in NEC are still not clearly established. Pneumoperitoneum is an absolute indication for surgery. A paracentesis indicative of intestinal gangrene, prior to intestinal perforation, has also been proposed as an indication for surgery. A prospective study was conducted to answer two questions: 1) How accurate and safe is paracentesis in detecting bowel necrosis in neonates with NEC? and 2) Do infants with NEC who are operated on for a positive paracentesis have a decreased morbidity and mortality over those operated on for pneumoperitoneum? Between July 1980 through June 1984, 39 infants with definite NEC and without pneumoperitoneum underwent a paracentesis because of suspected bowel necrosis. There were no false "positive" taps. There were 34 "positive" taps in 36 infants who were proven to have bowel necrosis, for an accuracy of 94 per cent. There were two false "negative" taps (40%) and three true "negative" taps (60%). There were no complications related to the procedure. During this same time period, 68 infants with NEC were operated upon. The indication for surgery was pneumoperitoneum in 29, a "positive" paracentesis in 34, and other reasons in 5. A comparison was made between those operated upon for pneumoperitoneum and those operated upon for a "positive" paracentesis. There was no significant difference in survival between the two groups (76% versus 71%). The early and late complications and the causes of death in each group were similar. A positive paracentesis is a valid objective indication for operation in infants with NEC.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdomen↗
PubMed1986

Peritoneal dialysis in infants and children.

Pediatric renal failure patients can be restored to health with peritoneal dialysis more easily, more comfortably, and more safely than with hemodialysis. During the past 3.5 years, we have treated 22 children with either acute (less than 30 days) or chronic (greater than 30 days) peritoneal dialysis (PD) at Henrietta Egleston Hospital for Children. They ranged in age from 2 weeks to 15 1/6 years, mean 5.2 years. The indications for acute dialysis were renal failure following cardiac surgery (4); hemolytic-uremic syndrome (4); and renal failure associated with bromide intoxication (1), congenital urethral stricture (1), or bronchopulmonary dysplasia (1). Chronic dialysis was utilized for end-stage renal disease caused by glomerulonephritis (5), chronic infection (2), hemolytic-uremic syndrome (1), cystinosis (1), congenital renal artery stenosis (1), and unknown etiology (1). Thirty-four adult or pediatric Tenckhoff catheters were utilized to deliver PD for from 6 to 551 days (18 months). Pediatric Tenckhoff catheters must be pre-measured in order to have the Dacron cuffs glued to the appropriate position on the catheter (7-12 cm from the end) to fit the child. There were seven catheter-related infections in four patients; three required catheter revision and four were treated medically. There were eight catheter-related mechanical problems, all of which required re-operation. All of those on chronic PD and seven of those on acute PD survived for an overall survival of 82 per cent. All surviving patients have been restored to health either by recovery of renal function (6 patients), renal transplantation (8 patients), or maintenance of chronic ambulatory peritoneal dialysis (4 patients).

Acute Kidney Injury↗
PubMed1985

Wilms tumor arising in horseshoe kidney.

Tumors originating in horseshoe kidneys are rare; only 21 cases of Wilms tumor reported in horseshoe kidneys. A seven-month-old girl with Wilms tumor arising from the isthmus of a horseshoe kidney is reported. The literature is reviewed, and surgical considerations are discussed.

Female↗
PubMed1985

Epididymal melanotic neuroectodermal tumor of infancy.

Six melanotic neuroectodermal tumors of infancy arising in the epididymis were reported previously. Each followed a benign clinical course. In the seventh case of such a tumor, reported herein, an elevated serum alpha-fetoprotein level returned to normal following excision of the tumor. Urinary and serum tumor markers may be useful for following the course of these tumors in the future.

Chorionic Gonadotropin↗
PubMed1985

Adrenal abscess in the neonate.

Adrenal abscess in the neonate is a rare complication of adrenal hemorrhage. The radiographic and clinical findings of 12 previously published cases and two new cases of adrenal abscess in the newborn are presented. Sonography was the most helpful examination in distinguishing a suprarenal lesion from an intrarenal lesion and in demonstrating the morphology of the abscess.

Abscess↗
PubMed1985

Management and outcome of necrotizing enterocolitis.

A survey of all cases of NEC in the State of Georgia during 1977 and 1978 identified 148 infants with NEC. Fifty-two of these infants were treated surgically, and the survival rate was 48 percent (26/54). The survival rate of medically treated patients was 68 percent (64/94) p less than 0.02. Survival was inversely associated with birthweight, although the survival rate following surgery was similar regardless of size. Age of presentation did not influence frequency of surgery or survival, but if perforation at surgery was present in smaller infants (less than or equal to 1500 g) the survival was less than if operation occurred prior to perforation (78% vs. 39%) p less than 0.05. The type of surgical procedure required also was associated with survival. The survival rate was greatest (90%) if only large bowel was removed and least (27%) if small bowel was resected. These results indicate the influence of birthweight, surgical procedure required, and presence or absence of perforation on survival and particularly surgical survival in NEC. They suggest that reviews of outcome in surgical management must take into account the extent of the surgical procedure that it was necessary to employ.

Birth Weight↗
PubMed1985

Renovascular hypertension complicating neurofibromatosis.

Three patients, ages 13 months, 13 years, and 16 years, with renovascular hypertension complicating neurofibromatosis underwent vascular reconstruction with good results. A review of these patients, plus 47 additional patients from the literature, constitutes the basis of this report. The standard intravenous pyelogram revealed abnormalities in only 46 per cent of the patients. Definitive diagnosis required angiography and selective renal vein renin determinations. Unilateral and bilateral lesions were seen with equal frequency. Associated arterial abnormalities were common. Medical treatment and balloon angioplasty failed to control the blood pressure in all patients. Surgical therapy, either nephrectomy or vascular reconstruction, cured or significantly improved 95 per cent of the patients. Although one primary goal of operation is renal salvage, 40 per cent of the patients in this review underwent nephrectomy to control their hypertension.

Adolescent↗
PubMed1984

Surgical therapy for necrotizing enterocolitis.

Fifty-one infants were treated surgically for necrotizing enterocolitis utilizing a uniform protocol from July 1980 through July 1983. The indications for surgery were pneumoperitoneum or a paracentesis indicative of bowel infarction. Segmental intestinal resection and exteriorization of the bowel ends through the upper abdominal transverse incision was the usual procedure. Intestinal continuity was reestablished when the patient reached 10 pounds, or sooner if he was failing to thrive with his ileostomy. The overall survival was 72.5%, and it was 82% for those patients have a definitive surgical procedure. This survival rate was not adversely affected by the patient's weight or age at the time of operation, nor by the presence of bowel perforation. The 37 survivors endured multiple postoperative complications. The most significant long-term sequela was short-gut syndrome, which occurred in 11% of survivors.

Age Factors↗
PubMed1984

Workup of neonatal intestinal obstruction.

An algorithm for the evaluation of a newborn with an intestinal obstruction was formulated. It is hoped that this will aid the practicing surgeon in rapidly and safely arriving at the proper diagnosis so that appropriate therapy can be promptly instituted.

Duodenal Obstruction↗
PubMed1982

Management of Hemophilus influenza pericarditis.

Hemophilus influenza is the causative organism in only 7%-11% of the cases of pyogenic pericarditis in children. A total of 36 cases have been reported in the literature since 1942. This report analyzes those cases, adds four more (ages 8 mo, 4 yr, 5 yr, and 7 yr), and recommends a plan of management. The diagnosis is suspected in a child with an acute febrile illness of less than seven days' duration who has an enlarged heart shadow on chest x-ray. Most patients have major associated conditions such as pneumonia or meningitis. The echocardiogram is the best modality for establishing the diagnosis. The characteristic feature of the disease is the thick fibropurulent pericardial fluid produced. This cannot be adequately managed with pericardiocentesis or tube peridcardiostomy. Complete anterior pericardiectomy is required to achieve adequate drainage. This must be combined with maximal doses of ampicillin and chloramphenicol. The overall mortality has been 20%, however, when aggressive surgical and medical therapy is used, the mortality rate is reduced to 7.4%. All of our patients treated in this manner survived.

Child↗