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Biomedical subjects

S S Rothenberg

Publications and source records attributed to S S Rothenberg.

33 records · Page 2Linked to original sources
PubMed1997

Anterior exposure of spinal deformities and tumors: a 20-year experience.

Data from 505 patients (1976 through 1995) who underwent anterior spinal exposure were retrospectively analyzed. There were 222 boys and 283 girls with a mean age of 14.5 years; 166 had thoracic exposure (T), 300 thoracoabdominal (TA), 44 retroperitoneal (R), and 7 transperitoneal (TP); 17 had repeat exposure (5 had initial exposure elsewhere); 70% had scoliosis, 25% kyphosis, 27% a neuromuscular disorder (NMD) and 6.7% a tumor. Average intensive-care-unit stay was 2.5 days, 6.2 days for NMD (P < .05); average ileus was 3.4 days, 4.1 days for NMD (P < .05); and average length of stay was 15.4 days for all patients, 19.3 days for NMD (P < .05). Mechanical ventilation over 96 hours was required in 31 patients, 66% had an NMD (P < .05). The morbidity rate was 9.8%, 10.1% for NMD; the morbidity rate was zero for tumor and repeat exposures. Mortality was zero. Over half of the vessel injuries (57%) and the urinary tract infections (60%) occurred in NMD patients. Differences between the 1976 through 1985 period and the 1986 through 1995 period were a shorter length of stay and a majority of one-stage combined exposures in the latter period. The authors conclude that anterior exposure of spinal deformities is well tolerated by most pediatric patients, and that this technique is easily adaptable to the resection of retroperitoneal and thoracolumbar tumors.

Adolescent↗
PubMed1997

Laparoscopic pull-through procedures using the harmonic scalpel in infants and children with Hirschsprung's disease.

Hirschsprung's disease in infants has routinely been treated by a three- or four-stage process requiring a rectal biopsy, diverting colostomy, pull-through procedure, and then colostomy takedown. This algorithm requires multiple hospitalizations and surgeries over several months. The authors have adopted a laparoscopic approach that allows the surgery to be performed in one stage with a marked decrease in morbidity and hospital stay. From March 1995 to May 1996, 15 infants and children, ages 7 days to 8 years and weighing 2.3 kg to 40 kg, underwent laparoscopic pull-through procedures. Eleven underwent primary pull-through, while four underwent a previous diverting colostomy. The laparoscopic portion of the pull-through was performed using three or four ports, size 3.5 mm or 5 mm and an ultrasonic dissector. The final submucosal dissection was performed transrectally starting 1 cm above the pectinate line. The rectal anastomosis was hand sewn, and no patient was left with a diverting colostomy. Operative time averaged 2 hours and 50 minutes. Average time to feeds was 1.3 days and the average days to discharge was 3.4. There was one intraoperative pathology misdiagnosis and one patient with an anastomotic stricture. All patients are excreting stools spontaneously at least daily and there have been no episodes of colitis. This preliminary report shows that the one-stage laparoscopic pull-through is safe and effective.

Anastomosis, Surgical↗
PubMed1997

Diagnostic value of transbronchial, thoracoscopic, and open lung biopsy in immunocompetent children with chronic interstitial lung disease.

OBJECTIVES: To evaluate the diagnostic value of transbronchial biopsy (TBB), video-assisted thoracoscopy (VAT), and open lung biopsy (OLB) in immunocompetent children with chronic, diffuse infiltrates; to identify factors that may predict diagnosis in children requiring biopsy; to determine whether age, number of biopsies, or type of procedure are associated with diagnostic yield in children undergoing transthoracic biopsy; and to compare morbidity of VAT with that of OLB. STUDY DESIGN: As part of a prospective, descriptive study to define the clinical spectrum of pediatric interstitial lung disease, 30 immunocompetent children required TBB, VAT, and/or OLB for diagnosis of diffuse infiltrates. We reviewed and analyzed the following clinical variables: age; preoperative diagnosis; type of procedure; number of lobes undergoing biopsies; durations of surgery, chest tube insertion, and hospitalization; tissue diagnosis; and complications. RESULTS: Specific diagnoses were made in 50%, 60%, and 53% of patients undergoing TBB, VAT, and OLB, respectively. A variety of rare disorders was found, and tissue diagnosis confirmed the preoperative diagnosis in 25% of all procedures. For patients who underwent transthoracic biopsy, patient age of greater than 24 months was significantly associated with increased diagnostic yield, but the number of lobes biopsied and type of procedure were not. VAT was associated with shorter operating time, chest tube placement, and hospitalization when compared with OLB. The complications of VAT and OLB were comparable. CONCLUSION: Lung biopsy is an important tool for the diagnosis of interstitial lung disease in immunocompetent children, but the diagnosis of many children, particularly those aged 2 years or younger, remains uncertain.

Adolescent↗
PubMed1996

The safety and efficacy of thoracoscopic lung biopsy for diagnosis and treatment in infants and children.

Thoracoscopic techniques were used to perform lung biopsies and limited resections in 36 consecutively treated cases. Biopsies were performed for interstitial lung disease in 27 cases, presumed metastatic lesions in 5, and cavitary lesions in 4. Histological diagnosis was obtained in 35 of the 36 cases, and therapy was directly affected by the results in 30 of 36 cases. There were no postoperative complications, and the average hospital stay for patients admitted the morning of surgery was less than 2 days. Limited thoracoscopic resection provides a safe and effective means for diagnosing and treating parenchymal disease of the lung.

Adolescent↗
PubMed1996

Laparoscopic splenectomy using the harmonic scalpel.

Laparoscopic splenectomy is an accepted technique in the treatment of various pediatric autoimmune and hematologic disorders. We have employed the use of the harmonic scalpel and a posterolateral approach to improve hemostasis, ease of dissection, and decrease operative time. Four patients underwent laparoscopic splenectomy using the harmonic scalpel. Operative time averaged 1 h and 40 mm and average blood loss was less than 10 ml. Hospital stay averaged 2 days. Use of the harmonic scalpel has considerably cut our operative time and improved our patient outcomes.

Adolescent↗
PubMed1995

Thoracoscopic closure of patent ductus arteriosus: a less traumatic and more cost-effective technique.

The authors have developed a technique of thoracoscopic closure of patent ductus arteriosus (PDA) that significantly reduces the surgical morbidity, recovery time, and hospital costs traditionally associated with the standard open procedure. Ten patients have undergone the procedure, with nine completed successfully. One patient required conversion to an open thoracotomy. There were no operative complications, and closure of the ductus was confirmed in all cases with a postoperative echocardiogram. Eight of ten patients were discharged in under 24 hours, and hospital charges were on the average 30% to 40% less.

Child, Preschool↗
PubMed1994

Use of argon beam ablation and sclerotherapy in the treatment of a case of life-threatening total abdominal lymphangiomatosis.

Congenital peritoneal and retroperitoneal lymphangiomas are rare lesions, which are often difficult to treat. This is the case of a 15 year old who had life-threatening complications from diffuse abdominal lymphagiomatosis after failure of accepted medical and surgical therapies. The authors describe the use of the argon beam coagulator in the treatment of this disease.

Adolescent↗
PubMed1994

Thoracoscopy in infants and children.

Thoracoscopy is a rapidly advancing technique in the diagnosis and treatment of children. Miniaturization of instrumentation and improved optics now allow extensive intrathoracic procedures to be performed in infants as small as 2 kg. Procedures such as lung biopsy and resection, biopsy or removal of mediastinal masses, esophageal surgery, and even patent ductus arteriosus closure can now be performed safely with minimally invasive techniques.

Anesthesia, General↗
PubMed1993

Emergency center arteriography in the evaluation of suspected peripheral vascular injuries in children.

During the 6-year period from 1983 to 1989, 109 children aged 3 to 18 years (mean, 16) with suspected peripheral vascular injuries underwent 113 emergency center arteriograms (ECA) performed by hand injection of contrast material using a single roentgenographic film. The most common indication for ECA was the proximity of the injury in 93 (82.3%) of the cases as penetrating injury accounted for 106 (94%) of the cases. There were 89 true-negative, 14 true-positive, 1 false-negative, and no false-positive arteriograms. The remaining 9 arteriograms were either equivocal or technically inadequate. The sensitivity, specificity, and diagnostic accuracy of this procedure were 98.9%, 100%, and 91.2%, respectively. Operative intervention was required for 9 (64.2%) injuries detected by emergency arteriography. The remaining 5 injuries were considered minor and were observed with no complications during a period of 21 months. Sixty-eight children (76.4%) with negative ECA were followed for a mean of 12 months with no vascular complications or growth abnormalities noted. ECA is a rapid, accurate, and cost-effective technique. It is of particular value in detecting the presence of occult arterial injuries that might have deleterious effects in the growing child.

Adolescent↗
PubMed1992

Experience with a total muscle-sparing approach for thoracotomies in neonates, infants, and children.

We have adopted a total muscle-sparing technique for thoracotomies in infants and children. The technique preserves the latissimus dorsi and serratus anterior muscles and provides excellent exposure for most thoracic and mediastinal operations. Thirty-two such procedures have been performed with only one complication, a small wound seroma. Use of this technique may not only decrease postoperative pain and splinting, but may decrease the incidence of scoliosis and muscle dysfunction found in children having undergone thoracotomies as infants.

Child↗
PubMed1989

Cholangitis after the Kasai operation for biliary atresia.

One hundred seventy-nine episodes of cholangitis in 28 consecutive patients having a Kasai operation for biliary atresia during the past 3 1/2 years were analyzed. The diagnosis was made primarily on the basis of unexplained fever (greater than 38.0 degrees C). An increase in serum bilirubin or a decrease in bile volume and in bile bilirubin concentration were often confirmatory, but other laboratory data including serum hepatic enzymes and blood and bile culture data were of little or inconsistent value. All patients were treated with systemic antibiotics. The best results were obtained with third-generation cephalosporins or imipenemcilastatin with the addition of aminoglycosides in recalcitrant cases. Antibiotic therapy was modified if defervescence did not occur within the first 24 hours. Cholangitis refractory to antibiotics was aggressively treated with pulse steroid therapy, and in some cases, operative intervention, both with good clinical success (60% and 73%, respectively).

Anti-Bacterial Agents↗
PubMed1989

Emergency Department thoracotomy in children--a critical analysis.

Recent clinical reviews have helped to clarify the role of Emergency Department (E.D.) thoracotomy in critically injured adults. However, guidelines in the pediatric population remain ill defined. The purpose of this report is to examine the yield of E.D. thoracotomy in patients less than or equal to 18 years of age to allow for a more cost-effective application of this heroic measure. From an 11-year experience of 689 consecutive E.D. thoracotomies, 83 patients (12%) were less than or equal to 18 years old. Mechanism of injury was blunt trauma in 57%, gunshot wound in 30%, and stab wound in 13%. Mean age was 15 years and 71% were male. Survival by injury mechanism was 9% (1/11) for stab wound, 4% (1/25) for gunshot wound, and 2% (1/47) for blunt trauma. Sixty-nine patients presented to the E.D. without vital signs and only one, a 16-year-old with stab wounds to the chest and abdomen, survived. In contrast, two (14%) among 14 patients presenting with vital signs were salvaged. As in adults, outcome was largely determined by injury mechanism and physiologic status on E.D. presentation. Blunt trauma, the predominant mechanism of lethal injuries in children, had a dismal outcome, with only 2% salvage and no survivors when vital signs were absent. This study demonstrates a similar outcome for E.D. thoracotomy in children compared to adults, and supports a selective policy of liberal use in penetrating injury irrespective of physiologic status but limited in those arriving lifeless following blunt trauma.

Adolescent↗