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Biomedical subjects

R Soper

Publications and source records attributed to R Soper.

16 recordsLinked to original sources
PubMed2001

Nonanatomic hepatic resection with a pledgetted suturing technique.

BACKGROUND/PURPOSE: Anatomic hepatic resection is dependent on the segmental infrastructure of the liver, whereas nonanatomic resection is independent of structural planes and is often fraught with excessive bleeding. The authors describe their experience with a novel technique using pledgetted suturing for extensive liver resection in patients with benign or malignant hepatic tumors. METHODS: Four children, (mean age, 24.7 +/- 12.5 months) underwent liver resection for the following hepatic lesions: hepatoblastoma, invasive Wilms' tumor, Caroli's disease, and infantile hemangioendothelioma. In the child with hepatoblastoma, the lesion was considered unresectable by segmental anatomy. A surgical technique was designed in which nonabsorbable 2-0 Teflon felt pledgetted sutures were placed through the liver parenchyma in a nonanatomic resection plane. The mattress sutures were sequentially tied until the resection plane was defined. The resection was sharply completed with a scalpel along the line of pledgetted sutures, independent of hepatic segmental anatomy. RESULTS: Complete surgical resections of the hepatic lesions were obtained in all cases. Estimated blood loss was minimal with a mean of 5.3 +/- 0.9 mL/kg. No patient received a blood transfusion as a result of the hepatic resection. There were no postoperative hepatic complications resulting from the resection. The child with hepatoblastoma had a delayed recovery, resulting in reexploration that ruled out a subphrenic abscess. CONCLUSIONS: The pledgetted suturing technique for hepatic resection is relatively bloodless, safe, easy to perform, and may enable a complete surgical resection of otherwise unresectable lesions. We advocate this technique when approaching a large hepatic lesion that would entail a difficult or incomplete anatomic resection in infants. J Pediatr Surg 36:209-212.

Child, Preschool↗
PubMed2000

The modified Puestow procedure for complicated hereditary pancreatitis in children.

PURPOSE: The aim of this study was to evaluate the role of longitudinal pancreaticojejunostomy (modified Puestow procedure) in the treatment of complicated hereditary pancreatitis (HP) in children. METHODS: The authors reviewed their experience with the modified Puestow procedure for complicated HP in patients less than 18 years of age at a single tertiary care facility between 1973 and 1998. Main study outcomes included surgical morbidity and mortality, pre- and postoperative pancreatic function, number of hospitalizations, and percentile ideal body weight (IBW). RESULTS: Twelve patients (6 boys and 6 girls) with a mean age of 9.3 years were identified. Presenting diagnoses were abdominal pain (n = 10), failure to thrive (n = 4), pancreatic pleural effusion (n = 2), and pancreatic ascites (n = 1). Blood loss was greater in patients who underwent distal pancreatectomy to localize the duct (n = 6) than in those who underwent direct transpancreatic duct localization (n = 6; 29.1+/-6.8 v. 8.3+/-3.7 mL/kg; P = .03). Other complications in patients who underwent distal pancreatectomy included splenic devascularization requiring splenectomy (n = 1) and postoperative intraabdominal bleeding with subsequent left subphrenic abscess (n = 1). There was no surgical mortality. Five patients had steatorrhea preoperatively that resolved in 4 patients postoperatively and was well controlled in the fifth. Mean number of hospitalizations for pancreatitis in the 5 years after surgery were markedly less than in the 5 years preceding surgery (0.4+/-0.2 v. 3.5+/-0.5; P = .01, n = 9). Percentile ideal body weight tended to increase within the first postoperative year (24.6+/-6.8 v. 45.0+/-8.3; P = .07, n = 9), and by the third year this trend was clearly significant (27.0+/-7.2 v. 60.9+/-9.5; P = .01, n = 8). CONCLUSIONS: In children with complicated HP, the modified Puestow procedure improves the quality of life by improving pancreatic function, decreasing hospitalizations, and increasing the percentile ideal body weight. Direct pancreatic duct localization during the procedure had a lower morbidity rate than localization via distal pancreatectomy. It is our impression that surgery performed in the early stage of complicated disease may preserve pancreatic function.

Adolescent↗
PubMed1999

The role of prophylactic cholecystectomy during splenectomy in children with hereditary spherocytosis.

BACKGROUND/PURPOSE: Hereditary spherocytosis is an autosomal dominant disorder associated with an intrinsic defect in the red blood cell membrane often necessitating splenectomy to prevent sequestration of spherocytes. When cholelithiasis is present, these patients undergo cholecystectomy at the same surgical setting as splenectomy. After splenectomy alone, it is uncertain whether the amount of hemolysis is adequately decreased to prevent subsequent gallstone formation. This study set out to evaluate the frequency in which symptomatic cholelithiasis subsequently develops in children treated by splenectomy alone. METHODS: All patients less than 18 years old with hereditary spherocytosis who underwent splenectomy without cholecystectomy at our institution during the past 27 years were included in this study. A retrospective chart review and telephonic patient follow-up was performed. Gallstones were excluded in these patients either by preoperative ultrasound scan, or by intraoperative palpation of the gallbladder. The main study outcomes of this group included documented cases of cholelithiasis, subsequent need for cholecystectomy secondary to cholelithiasis, and questionnaire to determine the incidence of "subclinical" cholelithiasis (not reported to a physician). RESULTS: Twenty-three subjects were identified who met the inclusion criteria. Complete follow-up data were obtained for 17 of these patients (74%). The mean age at splenectomy was 6.6 +/- 0.69 years, and the mean follow-up was 15.65 +/- 2.03 years (median, 18 years). None of the patients in this series subsequently have undergone cholecystectomy, nor have any had either clinical or subclinical evidence of cholelithiasis since splenectomy. CONCLUSION: Prophylactic cholecystectomy at the time of splenectomy is not indicated in patients with hereditary spherocytosis who do not have gallstones.

Adolescent↗
PubMed1998

The Significance of Umbilical Vein Doppler Changes during Fetal Hiccups

> Objective: The physiology of hiccups is a sharp inspiratory gasp against a closed glottis, causing a sudden sharp fall in intrathoracic pressure. This would be expected to cause an increase in venous return to the chest; however, we noticed that umbilical venous Doppler waveforms indicated a cessation of flow during hiccups. We observed other hiccuping fetuses to ascertain the range of response of the fetal umbilical vein Doppler waveforms and derive an explanation for them. Methods: Fetuses who were hiccuping at the time of their antepartum testing had observations of umbilical vein flow made, and representative recordings of the trace were obtained. Results: Ten Doppler traces were obtained from fetuses during hiccuping. In every case there was a brief fall of the umbilical vein Doppler waveform to base line, indicating an arrest of flow. Conclusions: Fetal hiccups are associated with arrest of flow in the umbilical vein as demonstrated by Doppler waveforms. This is contrary to predictions based on previously demonstrated fetal physiology of hiccups. We speculate that the findings result from obstruction of the venous return by a combination of the contracting diaphragm at the level of the inferior vena cava as it passes through the diaphragm, by raised intra-abdominal pressure from the descending diaphragm, and possibly from kinking of the umbilical vein at the umbilical ring.

Journal Article↗
PubMed1997

Effects of epidermal growth factor and Clostridium difficile toxin B in a model of mucosal injury.

Numerous factors have been advocated as being paramount to the development of necrotizing enterocolitis (NEC) including hypoxia, abnormal bacterial flora, and by products of enteral feedings. In an effort to better understand mechanisms involved at the level of the intestinal mucosal barrier the authors have chosen the CACO-2 cell line to model the neonatal intestinal epithelium. By growing CACO-2 cells in transwell inserts, the authors have investigated the ability of Clostridium difficile toxin B, epidermal growth factor (EGF), and a model of mechanical injury to alter transepithelial resistance of CACO-2 monolayers. The findings show that toxin B diminishes resistance in this setting, and EGF can alter that resistance drop.

Analysis of Variance↗
PubMed1996

Proton MR spectroscopy of squamous cell carcinoma of the upper aerodigestive tract: in vitro characteristics.

PURPOSE: To determine the ability of in vitro high-field-strength proton MR spectroscopy to differentiate squamous cell carcinoma of the upper aerodigestive tract from uninvolved muscle. METHODS: Surgical specimens of squamous cell carcinoma arising from the upper aerodigestive tract (n = 18) and from muscle (n = 13) were examined in vitro using high-field (11 T) proton MR spectroscopy. The peak heights of choline and creatine were measured for tumor and muscle at echo times of 136 and 272. The choline/creatine (Cho/Cr) ratio was compared between tumor and normal tissue for each echo time. Student's t test was used to determine whether a significant difference existed between proton MR spectroscopic measurements of the Cho/Cr ratio for tumor and muscle. RESULTS: The mean Cho/Cr ratio was consistently higher in tumor than in muscle at all echo times; however, statistically significant differences between tumor and muscle were identified only at longer echo times (136 and 272). CONCLUSION: The Cho/Cr peak height ratio can be used to differentiate tumor from muscle in vitro (at 11 T).

Carcinoma, Squamous Cell↗
PubMed1995

Ischemic stroke and intracranial multifocal cerebral arteriopathy in Williams syndrome.

We describe an otherwise healthy 2-year-old patient with Williams syndrome who had a stroke as a result of intracranial multivessel focal and segmental stenotic disease. The diagnosis of Williams syndrome was confirmed by elastin gene deletion testing. Combined magnetic resonance imaging and magnetic resonance angiography, and transcranial Doppler flow studies, were used in diagnosing and monitoring the course of the disease.

Brain Ischemia↗
PubMed1993

Absorption in the isolated bowel segment.

An isolated bowel segment (IBS) is a viable mesenteric segment of intestine. This study was undertaken to investigate the effects of mesenteric vascular and neural supply on intestinal absorption. Ten rats were used for leucine absorption and another 10 for glucose absorption experiments. L-leucine, 12 ml of 15.0 mM/L, or 3.0 mM/L of D-glucose solution were recirculated through the IBS (n = 5) and rat jejunum that underwent sham operation (n = 5) at 2.56 ml/min for 90 min. Absorption was expressed as millimoles of leucine or glucose per gram of mucosal protein. The Student's t test was used for statistical analysis; a p < or = 0.05 was considered significant. The net absorption of L-leucine was 36.20 +/- 3.31 mM/g of mucosal protein in the IBS and 15.52 +/- 1.48 mM/g of mucosal protein in the control group (p < 0.001). The net absorption of D-glucose was 3.82 +/- 0.26 mM/g of mucosal protein in the experimental group and 4.34 +/- 0.31 mM/g of mucosal protein in the control group (p = 0.02). This study concludes that absorption of leucine and glucose in the IBS is preserved after mesenteric division.

Animals↗
PubMed1975

Acute iron intoxication with intestinal infarction managed in part by small bowel resection.

This report deals with a case of acute iron intoxication in a child in which acute and chronic gastrointestinal abnormalities developed as a consequence of severe intestinal infarction and corrosion. Microscopic examination of resected small bowel revealed prominent iron deposits in areas of necrosis, in basement membranes of lymphatics, capillaries, and venules, and within platelet-fibrin thrombi. The clinical history and microscopic findings are consistent with the hypothesis of a direct action of absorbed iron on vascular walls as the pathophysiologic mechanism for the toxic effects of iron on the gastrointestinal tract. Acute and long-term management of iron intoxication is discussed in the context of the observations in this case.

Deferoxamine↗