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Biomedical subjects

S Teich

Publications and source records attributed to S Teich.

At least 19 recordsLinked to original sources
PubMed2002

Streamlining the care of patients with hypertrophic pyloric stenosis: application of a clinical pathway.

PURPOSE: The purpose of this study was to evaluate the impact of a clinical pathway on infants admitted to a pediatric tertiary care center with the diagnosis of hypertrophic pyloric stenosis (HPS). METHODS: The records of 132 HPS patients were evaluated before and after implementation of a clinical pathway. Infants were excluded for prematurity, admission to nonsurgical services, or multiple diagnoses requiring prolonged hospitalization, resulting in 83 patients for analysis. Group I (prepathway, n = 40) and group II (postpathway, n = 43) infants were analyzed for time from admission to operation, operation to first feeding, operation to discharge, total length of stay, hospital charges, metabolic status at time of admission, and postoperative complications. The Mann-Whitney test was performed (statistical significance at P <.05). RESULTS: There was no significant difference between group I and group II patients in the length of preoperative hospitalization or metabolic status at the time of hospital admission. In comparison with group I patients, there was a significant reduction in time to resumption of oral feedings (4.6 +/- 1.9 hours v 7.5 +/- 3.2 hours; P <.001) for group II infants and a significantly earlier discharge (26.7 +/- 6.8 hours v 38.0 +/- 11.7 hours; P <.001). This resulted in a shortened length of stay (41.8 +/- 9.7 hours v 57.8 +/- 14.3 hours; P <.001) with an associated decrease in hospital charges ($4,555 +/- $464 v $5,400 +/- $1,017; P <.001). CONCLUSIONS: Elimination of practice variability by the use of a clinical pathway for HPS resulted in significant reduction of hospital stay and related charges. The impact of the pathway occurred in the postoperative period and is a consequence of a rapid and systematic return to oral feedings.

Breast Feeding↗
PubMed1999

The duodenal dimple: a specific fluoroscopic correlate to the duodenal web.

PURPOSE: We describe a new fluoroscopic sign to aid in the diagnosis of an obstructing duodenal web and its attachment site. MATERIALS AND METHODS: During an upper GI series of a neonate, a nasogastric tube was passed into an obstructed duodenum and barium injected. The tube, pressing on an obstructing web, caused dimpling of the duodenal contour at the attachment point of the web to the duodenal wall. The same maneuver at surgery caused identical dimpling. DISCUSSION: While the maneuver is described in surgical textbooks, there has been no radiologic correlate. The "duodenal dimple" is a new fluoroscopic sign of a duodenal web and its attachment point to the duodenal wall.

Diagnosis, Differential↗
PubMed1999

Preoperative diagnosis of extralobar pulmonary sequestration with unusual vasculature: a case report.

Pulmonary sequestrations are uncommon congenital malformations of the lung. Vascular supply to pulmonary sequestrations is variable, with many unusual combinations. Adequate preoperative evaluation is hence advisable to avoid intraoperative complications. Magnetic resonance imaging (MRI) allows accurate diagnosis of extralobar pulmonary sequestration (ELPS), including definition of vascular supply. This may obviate the need for more invasive investigations that were suggested in the past. Presented here is a case of ELPS with its vascular attachments to the intercostal vessels.

Bronchopulmonary Sequestration↗
PubMed1999

Primary intrathoracic gastric volvulus in a newborn.

Primary gastric volvulus in the neonatal period is extremely rare, with only 18 cases reported in the literature. The authors describe the case of a newborn with intrathoracic gastric volvulus and discuss its management.

Female↗
PubMed1997

Prognostic classification for esophageal atresia and tracheoesophageal fistula: Waterston versus Montreal.

Since 1962, the Waterston classification has been used to stratify neonates who have esophageal atresia (EA) and/or tracheoesophageal fistula (TEF) into prognostic categories based on birth weight, the presence of pneumonia, and the identification of other congenital anomalies. In response to advances in neonatal care, the surgeons from the Montreal Children's Hospital proposed a new categorization system in 1993 in an attempt to define the current risk factors for patients who have EA/TEF. In the Montreal experience only two characteristics independently affected survival: preoperative ventilator dependence and associated major anomalies. The goal of this study was to determine which system had the greatest validity for the evaluation of prognosis in our patients with EA/TEF. The charts of 94 patients who had EA/TEF treated between 1972 and 1991 were reviewed. Patients were classified using both the Waterston and Montreal systems. Groups were compared with Fisher's Exact test using a 95% confidence level for statistical significance. Eleven infants were ventilator dependent preoperatively; 62 children had major associated anomalies, 8 of which were considered life threatening. Sixteen children died within 4 years, eight during their initial hospital stay. Five of the eight early postoperative deaths occurred in the highest-risk patients (Waterston C or Montreal II). Analysis was performed for multiple risk factors and mortality. As in the Montreal study, the presence of life-threatening and major congenital anomalies represented significant risk factors for death. Pulmonary disease as delineated by ventilator dependence appeared to be more accurate than pneumonia. This study confirms the accuracy of the Montreal classification in defining prognosis for EA/TEF. The Montreal system more accurately identifies children at highest risk than the Waterston classification.

Abnormalities, Multiple↗
PubMed1996

Dicephalus dipus dibrachius: an unusual case of conjoined twins.

Conjoined twinning is a rare anomaly, occurring in one of every 50,000 births. Dicephalus dipus dibrachius is an extremely rare form of conjoined twinning in which the infant has two arms, two legs, one trunk, but two heads. These infants are often stillborn or die shortly after birth. The authors describe a case of dicephalus twinning with 11-day survival. A thorough investigation using multiple imaging modalities (plain radiographs, contrast studies, ultrasonography, and magnetic resonance imaging) demonstrated that these twins had separate spinal columns but shared multiple internal organs including heart, liver, pancreas, intestine and bladder. Based on the anatomy of this case, the authors conclude that separation of dicephalus dipus dibrachius twins should not be attempted.

Abnormalities, Multiple↗
PubMed1995

High-dose-rate brachytherapy in childhood sarcomas: a local control strategy preserving bone growth and function.

The administration of external beam radiation therapy (EBRT) has been an integral part of the successful treatment of childhood sarcomas. However, EBRT has severe late morbidity in the developing child. In an attempt to deliver adequate tumoricidal radiation while preserving bone growth and organ function, 13 children with diverse sarcomas were treated with high dose rate brachytherapy (HDR). Seven patients had rhabdomyosarcoma and six patients had other soft tissue sarcoma variants. All patients were treated with disease-appropriate chemotherapy, usually according to the intergroup Rhabdomyosarcoma Study. Eleven patients received fractionated 36 Gy HDR alone at a mean of 3.5 months from diagnosis. Two patients received 10-12.5 Gy intraoperative HDR brachytherapy and additional 27 Gy EBRT. Nine of 11 patients in first remission have had no recurrences. One died of recurrent pulmonary metastases. The other patient that did recur is disease-free 21 months post-recurrence. Two additional patients were treated with HDR after tumor recurrence. One patient with recurrent Ewing's sarcoma, relapsed and died. The second is disease free 3 months after autologous bone marrow transplant. Grade 1 morbidity occurred in 46%, Grade 2 in 15%, and Grade 3 in 8% of the children, while relatively good bone and organ growth was maintained. The combination of conservative surgery, chemotherapy, and HDR offers the potential for disease control in young children while preserving bone growth and organ function.

Brachytherapy↗
PubMed1995

Intraoperative detection and resection of occult neuroblastoma: a technique exploiting somatostatin receptor expression.

Tumor cell expression of specific high-affinity somatostatin receptors has been associated with a favorable prognosis in children with neuroblastoma. The purpose of this study was (1) to document intraoperatively the in vivo binding of the somatostatin analogue 125I-tyr3-octreotide to high-affinity somatostatin receptors expressed on human neuroblastoma, using a hand-held gamma detector; (2) to determine whether gamma-probe detection of radioligand binding to tumor receptors could identify occult malignancy; and (3) to determine the safety and biodistribution of 125I-tyr3-octreotide in children. Six children with stage III or IV neuroblastoma received an intravenous injection of 125I-tyr3-octreotide and underwent operative exploration using gamma-probe detection of radioligand binding to tumor somatostatin receptors. Tissue that demonstrated in vivo binding of 125I-tyr3-octreotide, or that was suspicious for tumor, was extirpated and analyzed by histopathology, immunohistochemistry, and microautoradiography. The biodistribution of 125I-tyr3-octreotide was recorded intraoperatively over time. Tumor tissue from each child also was assayed in vitro for somatostatin receptor expression by competitive binding studies using 125I-tyr3-octreotide. In vivo binding of 125I-tyr3-octreotide to malignant tissue was documented in the five children with a known tumor burden. Seventeen sites of radioreceptor binding were amenable to resection. Histopathological analysis confirmed neuroblastoma in 15 of these specimens. Four of the 15 proven tumor foci were occult malignancies. Every site of histologically proven neuroblastoma demonstrated in vivo binding of 125I-tyr3-octreotide. Five of seven sites histologically negative for neuroblastoma also were negative for in vivo radioreceptor binding. Microautoradiography confirmed in vivo binding of 125I-tyr3-octreotide to tumor cells. Uptake of 125I-tyr3-octreotide in abdominal organs occurred within 15 minutes of injection, was highest in the liver and gallbladder, and decreased over 24 hours. The conclusions were as follows. (1) 125I-tyr3-octreotide binds, in vivo, to somatostatin receptors on neuroblastoma, with 100% sensitivity and 71% specificity. (2) Occult neuroblastoma is found through gamma-probe detection of radioligand binding to receptors. (2) The biodistribution of 125I-tyr3-octreotide reflects the hepatobiliary clearance of this radionuclide. (4) Radioreceptor-guided surgery may safely provide more complete operative staging and cytoreduction of neuroblastoma.

Biomarkers, Tumor↗
PubMed1995

Congenital diaphragmatic hernia and profound prematurity: report of a survivor.

Congenital diaphragmatic hernia (CDH) continues to be one of the most challenging problems in pediatric surgery. The overall mortality rate remains at 40%, and death is caused by pulmonary hypoplasia and persistent pulmonary hypertension. It has been suggested that in utero repair of the defect should be performed to allow the lungs to grow and develop, in the hope of preventing fatal pulmonary insufficiency. The authors report the survival of a 960-g premature infant with CDH, suggesting that ex utero repair is possible in a very low birth weight infant.

Female↗
PubMed1994

Highly vascularized sacrococcygeal teratoma: description of this atypical variant and its operative management.

The authors report on three infants who had an unusual variant of sacrococcygeal teratoma--a highly vascularized tumor. All three patients had major problems perioperatively, which resulted in cardiac arrest in all three and the death of one. Several suggestions are made concerning diagnosis as well as preoperative and intraoperative management of this rare tumor variant.

Female↗
PubMed1991

Serum endorphin levels in injured children.

Plasma beta-endorphin levels (PBEL) are known to be elevated in acutely injured adults, but this has not been studied in pediatric patients with trauma. We measured PBEL in 46 children who sustained blunt injury. The mean acute PBEL was significantly elevated compared with the mean convalescent PBEL (40.5 +/- 29.0 versus 5.4 +/- 2.1 picomoles per liter, p less than 0.05). PBEL were highest in patients with multiple injuries (60.5 +/- 33.2 picomoles per liter, n = 16). PBEL were also elevated with isolated injuries of the head, face or limbs, and even with less severe injuries, namely multiple abrasions. PBEL were low in patients with abdominal (two patients) or spinal (two patients) injuries. Convalescent PBEL were consistently low. Severely injured patients (Injury Severity Score [ISS] of more than ten) had significantly elevated PBEL compared with patients with minor injuries (ISS less than 10), but some children with low ISS had elevated PBEL. The presence of head injury did not influence PBEL and there was no correlation between PBEL and systolic blood pressure. We have demonstrated that the PBEL is elevated in pediatric patients with trauma.

Acute Disease↗
PubMed1990

Choroidal lesions in patients with AIDS.

Seven cases of bilateral, scattered, yellow-white choroidal lesions have been seen in AIDS patients since January 1988. One resulted from presumed extension of cryptococcal meningitis into the optic nerve and choroid. All the remaining six patients had pneumocystis pneumonia at some time during the course of the disease and were receiving aerosolised pentamidine therapy. None died quickly of disseminated Pneumocystis carinii infection, unlike previously reported patients. Mycobacterial infection was also present in five of these six patients. The differential diagnosis of this entity in AIDS patients is discussed.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Atropine pharmacokinetics are affected by moderate hemorrhage and hypothyroidism.

Atropine is used both to treat a variety of clinical disorders and as an antidote to cholinesterase poisoning. While various conditions affect the physiologic responses to atropine, little is known of the pharmacokinetics of this drug except under resting conditions. Pharmacokinetic studies were performed in mongrel dogs under two experimental conditions, moderate hemorrhage and hypothyroidism, to determine whether im absorption and elimination of atropine (0.05 mg/kg body weight) were affected by changes in hemodynamic or metabolic status. Using a randomized, crossover experimental design, it was found that during hypovolemia the mean volume of distribution was reduced by 22% (2.50 +/- 0.62 vs. 3.21 +/- 0.63 L/kg), with no changes in peak serum level, total atropine availability, elimination half-life, or whole-body clearance. Hypothyroidism was associated with a significant increase in peak serum atropine concentration (26.4 +/- 3.9 vs. 20.6 +/- 4.9 ng/ml) and drug bioavailability (48.5 +/- 8.8 vs. 30.0 +/- 10.7 ng/ml.h), while the clearance was reduced by 39% (426 +/- 34 vs. 696 +/- 187 ng/ml.min). These results suggest that atropine kinetics are not altered appreciably during moderate hemorrhage. In hypothyroidism, alterations in atropine pharmacokinetics may warrant modification of drug dose and frequency of administration.

Animals↗
PubMed1989

Mycotic aneurysm of the inferior pancreaticoduodenal artery: successful nonoperative management.

Although mycotic aneurysms of small visceral arteries are rare, they have a high morbidity and mortality due to rupture and sepsis. Any patient with abdominal pain and bacterial endocarditis should be suspected of having a mycotic aneurysm. Selective arteriography confirms the diagnosis. In the case we have reported, diagnosis of a mycotic aneurysm of the inferior pancreaticoduodenal artery was established by angiography, and the patient was treated by percutaneous transcatheter embolization. This case demonstrates that mycotic aneurysms of small visceral arteries may be managed nonoperatively with antibiotics and percutaneous transcatheter embolization therapy.

Aneurysm, Infected↗
PubMed1986

Ischemic enterocolitis as a complication of Hirschsprung's disease.

Enterocolitis is a recognized complication of Hirschsprung's disease. However, little distinction has been made in the literature between inflammatory enterocolitis and ischemic (necrotizing) enterocolitis when seen with Hirschsprung's disease. We report on four cases of ischemic enterocolitis complicating Hirschsprung's disease. The characteristics of ischemic enterocolitis are compared to those of inflammatory enterocolitis.

Enterocolitis, Pseudomembranous↗
PubMed1986

Hemorrhagic hypotension increases plasma beta-endorphin concentrations in the nonhuman primate.

The role which beta-endorphin plays in the pathogenesis of hemorrhagic hypotension is controversial. In the present experiment, 20 ml/kg of blood was bled from ten healthy male baboons (Papio anubis) over 60 min and then retransfused over the next 30 min. We found that the mean plasma beta-endorphin level increased 109% above baseline (p less than .05) within 15 min after starting hemorrhage, and rapidly returned to a baseline concentration with retransfusion. We conclude that in a primate species, circulating endogenous opioid peptide concentrations increase rapidly in response to sublethal hemorrhagic hypotension and normalize with restoration of the baseline intravascular volume. These findings support the concept that endogenous opioid peptides may mediate the hypotension of shock states.

Animals↗