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Biomedical subjects

S Z Rubin

Publications and source records attributed to S Z Rubin.

At least 19 recordsLinked to original sources
PubMed2001

Combined posterior sagittal and three-flap anoplasty in the repair of anorectal anomalies.

PURPOSE: The aim of this study was to describe a new technique for the repair of high and intermediate imperforate anus. METHODS: From 1989 to 1999, 22 children with high and intermediate imperforate anus (17 boys, 5 girls) were operated on with a combination of a posterior sagittal and 3-flap perineal anoplasty. Long-term clinical follow up (to a maximum of 10 years) was done in all patients as well as a recent phone interview with a questionnaire regarding bowel function and degree of satisfaction with the result of the surgical correction. A continence ratio (CR, patient score/maximum possible score) was obtained by a blinded interviewer. RESULTS: A continence survey was obtained in 19 patients. The average CR was 0.68. The CR for high anomalies was 0.62 and for intermediate anomalies was 0.78 (0.84 for girls and 0.64 for boys). Patients with sacral anomalies had a CR of 0.58. Two patients with Trisomy 21 had associated Hirschsprung's disease and were excluded from analysis. CONCLUSIONS: Advantages of this combined surgical approach are excellent anatomic exposure, the ability to limit rectal mobilization to a minimum, reduction of the incidence of mucosal prolapse, the new skin-lined anal canal may assist attainment of continence by providing a "sensory warning zone," and, finally, the cosmetic appearance is satisfactory.

Abnormalities, Multiple↗
PubMed1996

Does laparoscopy adversely affect gas exchange and pulmonary mechanics in the newborn? An experimental study.

Notwithstanding the clinical acceptability of pediatric laparoscopy, the physiological consequences of carbon dioxide (CO(2)) peritoneal insufflation on lung mechanics and gas exchange are not established. This study seeks to establish the affects of increased intraabdominal pressure (P ABD) from CO(2) insufflation on lung mechanics, the compliance of the respiratory system (CRS stat), and gas exchange. Ten anesthetized tracheostomized, and paralyzed rabbits (2.5-3.1 kg) were examined. Mechanical ventilation was established to produce normal ventilation (PaCO(2) 35-45 Torr). Continuous pulse, blood pressure (BP), and serial arterial blood gas measurements were obtained by femoral arteriotomy. The animals were examined at baseline conditions (P ABD = 0 mm Hg), at 2 levels of external compression (P ABD = 6 and 12 mm Hg, respectively), and at two levels of intraperitoneal CO(2) insufflation (P ABD=6 and 12 mm Hg, respectively). Increased P ABD, whether applied externally or by intraperitoneal insufflation, did not alter the CRS stat (ANOVA p = 0.557), nor systematically change the pH, PaCO(2) or PaO(2) (ANOVA p = 0.541, p = 0.545, p = 0.446, respectively). Neither BP nor pulse rate showed any change. Under conditions encountered during laparoscopy, P ABD of 0-12 mm Hg did not have a deleterious effect on ventilation and gas exchange in the ventilated and paralyzed small animal.

Animals↗
PubMed1994

Use of human dura in pediatric chest wall reconstruction after tumor resection.

The most difficult aspect of the surgical treatment of chest wall tumors is reconstruction of the large residual defect. Materials that have been used include Marlex, Goretex, Vicryl, bone, metal, and fascia. The authors' successful experience with dehydrated human dura (Tutoplast) for moderate-size defects is described. A large Askin's tumor in a 13-year-old boy required resection of the right posterior aspect of the 9th to 11th ribs and the transverse process of T-10, the 12- x 12-cm thoracic defect was closed with dura. Partial soft-tissue coverage was obtained with the latissimus dorsi muscle. Although a scoliosis secondary to paraspinal muscle resection has developed, the chest wall is stable, without evidence of a flail chest, at 18 months of follow-up. A 6-year-old girl underwent left anterior chest wall resection of three ribs for an epithelioid sarcoma. Human dura and a myocutaneous flap were used for reconstruction, with good functional and cosmetic results at 16 months of follow-up. Dura is simple to use, has low antigenicity, and in experimental studies appears to be incorporated into the tissues, acting as a collagen matrix. For moderate-size chest wall defects, it appears to be an excellent alternative to synthetic prosthesis.

Adolescent↗
PubMed1993

Fetal tumors associated with hydrops: the role of the pediatric surgeon.

Fetal tumors are being diagnosed with increasing frequency and great accuracy by antenatal ultrasound. High-output cardiac failure and hydrops indicate fetal distress. Management may be limited by the gestational age of the fetus. Our experience with three fetal tumors demonstrates the dilemma with respect to timing of delivery and prognosis. Following the diagnosis of a large sacrococcygeal tumor, a 22-week-gestation fetus became hydropic and died. Another fetus with a rapidly growing posterolateral chest wall mass required cesarean section delivery at 29 weeks gestation. Postnatal course was complicated by pulmonary hypoplasia, intratumoral hemorrhage, and death. The third fetus had an enlarging tumor in the right lobe of the liver. Poor biophysical profile and mild hydrops necessitated cesarean section delivery at 34 weeks. Right hepatic lobectomy was performed and the infant was subsequently discharged home at one month of age. The deleterious effects of the fetal tumor and the need for its removal have to be carefully weighed against the ability of the fetus to survive postnatally.

Adult↗
PubMed1993

Routine use of the nitric oxide stain in the differential diagnosis of Hirschsprung's disease.

Hirschsprung's disease (HD) is defined as a congenital absence of ganglion cells in the distal bowel. Functionally, there is a loss of enteric neuromuscular inhibition. Inhibitory intestinal innervation includes extrinsic nonadrenergic, noncholinergic (NANC) nerves. Nitric oxide (NO) is proposed to be a NANC neurotransmitter. Sites of NO synthesis can be localized using a NO-dependent nicotinamide adenine dinucleotide phosphate (NADPH) diaphorase histochemical assay. We present a study of the distribution of NO neural elements in patients with HD. Routine hematoxylin-eosin (HE) histology as well as histochemical localization of NO synthase activity was carried out on fixed laminae and sectioned tissue of infant colon. NO synthase positive nerve cells and fibers were found throughout the wall of the proximal ganglionated colon. In the myenteric plexus disposition of these nerves parallels the known NANC innervation. "Aganglionic" distal colon displayed disrupted ganglia and increased nerve fibers. Selective preservation of NO synthesizing neurons was also seen. Punctate labeling of an apparent nonneuronal origin was also noted on the surface of arterioles. NO stain simplifies the pathological diagnosis of HD. The presence of NO positive nerve cells in HD suggests that aganglionosis is a misnomer. The lack of characteristic HE findings in other forms of neuronal intestinal dysplasia indicates the need for routine simple, more sensitive neural staining of colonic biopsies in selected infants with constipation.

Amino Acid Oxidoreductases↗
PubMed1990

Ultrasonography in the management of possible appendicitis in childhood.

One hundred thirty-four children referred to the pediatric surgical service with the diagnosis of possible acute appendicitis underwent abdominal ultrasonography within 24 hours of admission. A final diagnosis of appendicitis was made in 45, and of gynecological disease in 11 children. One child had pancreatitis, another jejunal perforation, and a third gross mesenteric lymphadenopathy. In 75 children the clinical picture completely resolved without a definitive diagnosis being made. Clinical diagnosis of gynecological disease showed two false-negatives, and three false-positives, whereas the ultrasonographic diagnosis was accurate in all patients. The sensitivity of the pediatric surgical diagnosis at the time of admission for acute appendicitis was 49% (23 false-negatives) and the specificity was 95% (three false-positives). Ultrasonographic diagnosis of appendicitis had a sensitivity of 89% (five false-negatives) and a specificity of 92% (five false-positives). There was a negative laparotomy rate of 0.7% (one patient) using both clinical evaluation and ultrasonography. These data suggest that abdominal ultrasonography in the child with possible appendicitis is an important diagnostic adjunct.

Abdominal Pain↗
PubMed1989

Occurrence of contralateral inguinal hernia following unilateral repair in a pediatric hospital.

A review of 904 unilateral hernia repairs was conducted at the Children's Hospital of Eastern Ontario over the period of January 1985 to December 1987. Repairs were done in 758 boys and 89 girls. Repairs of 57 contralateral inguinal hernias were completed following prior unilateral repair (52 boys, 5 girls). Occurrence of contralateral hernias was 5.6% (5.7% for boys, 4.7% for girls). The relative risk in boys with right hernia following left hernia was 8.5%, whereas left hernia following right hernia was 4.3%. Neither sex nor laterality should be considered as an indicator for contralateral exploration in children with a clinical diagnosis of unilateral hernia repair.

Child↗
PubMed1988

Diffuse necrotizing tracheobronchitis: an acute and chronic disease.

Necrotizing tracheobronchitis (NTB) is characterized by acute episodes of airway obstruction, hypercarbia, and lack of chest movement in mechanically ventilated neonates. Emergency bronchoscopic removal of necrotic tissue is essential for survival. Although postmortem lesions extend into smaller bronchi, survivors have not demonstrated residual tracheobronchial abnormalities. Two infants were treated successfully for NTB but succumbed to diffuse tracheobronchial strictures with progressive pulmonary hyperinflation. A third neonate with esophageal atresia and left pulmonary agenesis developed NTB. Despite initial postbronchoscopic improvement, the infant died at age 6 weeks with diffuse obstructing NTB. All three infants required endotracheal intubation and mechanical ventilation. High-frequency jet ventilation was not used. Tracheal cultures for fungi, bacteria and viruses were negative. Successful treatment of NTB may be followed acutely by recurrence of NTB and chronically by diffuse tracheobronchial strictures and emphysema.

Acute Disease↗
PubMed1988

Acute scrotal abnormalities in children: diagnosis by combined sonography and scintigraphy.

Both scintigraphy and real-time sonography have been used to assess acute symptoms involving the scrotum. However, because of its high sensitivity and ability to document physiologic abnormalities, scintigraphy has been the procedure of choice. Scintigraphy, however, lacks specificity; its value lies mainly in serving to distinguish torsion from nontorsion. The purpose of this study was to supplement scrotal scintigraphy with sonography to determine if the combination improves diagnosis and management compared with scintigraphy alone. Forty-three scrotal scintigrams and sonograms were performed on 40 consecutive patients with acute scrotal symptoms. The interpretation of the scintigram was altered by sonography in six (14%) of the combined scans, directly affecting clinical management. In three patients with acute hydroceles diagnosed by sonography, exploratory surgery was avoided despite scintigraphic findings suggesting testicular torsion. Scintigraphy was normal in two patients with spontaneous testicular detorsion, whereas sonography showed recent spermatic-cord torsion that required subsequent orchiopexy. In a patient with epididymitis and orchitis, sonography showed a complicating scrotal abscess, which was not apparent on scintigraphy and which required antibiotic treatment. The addition of sonography to the scintigraphic evaluations of children with acute scrotal abnormalities changed the diagnosis and clinical management in 14% of the patients studied.

Acute Disease↗
PubMed1987

Removal of esophageal foreign bodies with a Foley balloon catheter under fluoroscopic control.

Between 1982 and 1985 removal of a nonorganic, smooth, radiopaque foreign body in the esophagus with a Foley balloon catheter under fluoroscopic control without sedation was attempted in 38 children. An ultra-low-dose fluoroscopic unit was used. In 35 children the foreign body (a coin) was either easily removed (in 29 cases) or advanced into the stomach (in 6). No complications of the procedure were observed. In three children the foreign body could not be removed by this means; it was subsequently removed by endoscopy (in two cases, both of coins) or esophagotomy (in two cases, both of coins) or esophagotomy (in one, of a stone). When carefully performed, removal of blunt, recently ingested esophageal foreign bodies with a Foley catheter under fluoroscopic control is a safe mode of treatment.

Catheterization↗
PubMed1987

Esophageal function following Livaditis repair of long gap esophageal atresia.

Proximal pouch esophagomyotomy (Livaditis) allows for repair of long gap esophageal atresia (EA). Postoperative esophageal functional studies in these patients are lacking. Six such infants were followed for up to 42 months. Esophageal function was assessed clinically and by barium swallow, manometry, 24 hr pH monitoring, esophagoscopy, and biopsy. Operative complications included two minor anastomotic leaks and two asymptomatic diverticula at the myotomy site. All patients had dysmotility on barium swallow. Gastroesophageal reflux (GER) was seen in four. Manometry showed a variable aperistaltic segment in each infant but lower esophageal sphincter pressures and relaxation were retained. Twenty-four hour pH monitoring showed an increase in frequency and duration of GER. All four patients biopsied had esophagitis. Five of the six patients showed normal growth velocity. Livaditis modified repair of EA was not associated with significant surgical complications. Esophageal motility showed abnormalities similar to those reported after the standard repair of EA. Myotomy did not adversely affect the esophageal function.

Biopsy↗
PubMed1987

Neuroblastoma: a specific sonographic tissue pattern.

Previous attempts to determine a sonographic appearance characteristic of neuroblastoma have had diverse results. Sonograms of 53 abdominal tumors, including 10 neuroblastomas, imaged during 1982-1986 were reviewed. Four of the patients with neuroblastoma had a distinctive sonographic "lobule" of increased echogenicity in a part of the larger tumor mass. This sonographic appearance was secondary to the growth pattern of the tumor and was not cell specific. Correlative CT scans in two of the four patients did not differentiate this lobule. Histologically, the lobule was an aggregate of uniform neuroblastoma cells (marginated by reticulin and collagen) without hemorrhage, necrosis, or calcification. This tissue pattern was not seen in any of the other 43 neoplasms, including 12 Wilms' tumors. When identified sonographically, the lobule identified in this study seems specific for neuroblastoma and is a valuable diagnostic sign in children with an abdominal mass.

Abdominal Neoplasms↗
PubMed1986

Ultrasonography and the impalpable testis.

The accuracy of inguinal ultrasonography in the pre-operative localization of the maldescended testis was assessed in 51 patients with 57 maldescended testes. Pre-operative sonographic results were compared with the clinical assessment and the operative findings. Testes located in the inguinal canal or at the internal ring, which were occasionally impalpable, were readily demonstrated by sonography. The management of children with an impalpable maldescended testis should include a sonographic examination as the investigative procedure of choice.

Adolescent↗
PubMed1985

A fluorochromic stain for nucleic acids to demonstrate submucosal and myenteric neurons in Hirschsprung's disease.

Acridine orange, a rapid and technically simple fluorochromic stain of nucleic acids, was applied to sections of 18 specimens of resected distal colon in infants with Hirschsprung's disease. Neurons were readily identified in the submucosal and myenteric plexuses of normal ganglionic segments because of their intense orange cytoplasmic fluorescence of ribonucleic acid (RNA) that contrasted with the pale green of the smooth muscle and connective tissue. This technic, which may be applied to both frozen and paraffin-embedded sections, is a useful adjunct in the confirmation of aganglionic segments of bowel wall.

Acridine Orange↗
PubMed1985

Sacrococcygeal teratoma.

Eight cases of sacrococcygeal teratoma are described. Seven patients were diagnosed at birth, and one presented at 3 1/2 months of age with urinary retention. Two patients had associated congenital anomalies (arachnoid cyst, external angular dermoid and bifid sacrum), while one had a family history of sacrococcygeal teratoma. All had the tumour removed together with the coccyx as soon as the diagnosis was made. None had recurrence of the tumour.

Female↗