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Biomedical subjects

T C Jewett

Publications and source records attributed to T C Jewett.

At least 37 records · Page 2Linked to original sources
PubMed1985

Prosthetic materials and muscle flaps in the repair of extensive diaphragmatic defects: an experimental study.

Relative merits of three methods of diaphragmatic hernia repair were evaluated in growing animals. Twenty-five puppies underwent laparotomy. In four controls, the left hemidiaphragm was incised and sutured primarily. In the remaining dogs, it was partially resected sparing the phrenic nerve. The defects were repaired in six with silastic sheeting, in eight with polytetrafluoroethylene (PTFE; trademark, Gore-Tex), and in seven with a thoracoabdominal muscle flap. Dogs were killed at 1, 4, and 7 months for gross and microscopic evaluation of the repair. Diaphragmatic function was evaluated by inspiratory force against a closed airway and by selective phrenic nerve stimulation (PNS). Serial fluoroscopy was used to evaluate diaphragmatic motion. Grossly the diaphragms in all groups showed compensatory growth. Microscopically the silastic was encapsulated without adherence, while PTFE showed tissue ingrowth. Maximal inspiratory force was equivalent in all groups but selective PNS revealed left-sided impairment in all experimental groups. Fluoroscopy showed paradoxical motion of the diaphragm in the muscle flap group for 1 to 2 months, and in the silastic repair group for 2 to 3 weeks, with near normal motion in the PTFE group for the entire postoperative period. These differences disappeared by 6 months. Prosthetic materials or muscle flaps are all safe for repair of large diaphragmatic hernias. Diaphragmatic growth occurs and the prosthesis remains in place. Physiologic impairment is minimal and not of clinical importance. Use of PTFE may be the preferred method as it develops better tissue incorporation and results in more normal diaphragmatic motion in the critical early postoperative period.

Animals↗
PubMed1983

The intercostal vein: an alternate route for central venous alimentation.

During the course of parenteral nutrition in infants, access to the central venous system may become limited due to thrombotic occlusion of the superior and inferior caval venous systems. When this problem arises, central venous access via the intercostal vein into the azygos system can provide a safe, relatively easy solution. A new technique utilizing this approach has been developed at our institution using silicone elastomer tubing joined with a Broviac catheter for long-term use. Thus far, six catheters have successfully been inserted with a mean duration of 52 days; one catheter was in place for as long as 110 days.

Azygos Vein↗
PubMed1983

The nonoperative management of pediatric hepatic trauma.

Although nonoperative therapy is well-accepted for renal and splenic injuries in children, this mode of treatment has not been widely advocated for children with blunt hepatic injury. Surgical repair or excision of the traumatized tissue has been the generally accepted standard of care. In the present series, 17 consecutive children between 2 and 13 years of age with liver trauma were managed by nonoperative means. Patients were carefully selected for treatment based on clinical criteria and initial computed tomography (CT) scan findings. The 17 patients with hepatic trauma identified by CT scan all responded to initial resuscitative measures. The children clinically remained stable and required only a limited number of transfusions. No immediate surgical intervention was necessary for isolated hepatic injuries. However, one patient required exploration due to an associated renal pedicle avulsion. One child required exploration on the fourth post-injury day because of a suspected infected hematoma. The remaining 15 injuries resolved without operation. Healing was documented on follow-up CT scans. The mean time required for resolution of the injury was 4 months. One child developed a late subhepatic hematoma which resolved without drainage. The progression of healing of hepatic parenchymal injuries was observed by serial CT scans. The liver injury progressed through stages of coalescence, resorption, and remodeling prior to final healing. Utilizing proper patient selection, many blunt liver injuries can be managed nonoperatively.

Adolescent↗
PubMed1983

A long-term follow-up on a duplication of the entire small intestine treated by gastroduplication.

Duplication of the entire small intestine resulting in gastrointestinal hemorrhage was managed by excision of the ulcerogenic lesion, ileo-ileostomy, and diversion of the gastric-lined intestinal duplication into the stomach. A 25 yr followup study reveals no evidence of recurrent bleeding or malabsorption secondary to bind-loop syndrome. This operative procedure is worthy of consideration in patients with this congenital anomaly.

Adolescent↗
PubMed1983

The use of different induction and maintenance chemotherapy regimens for the treatment of advanced yolk sac tumors.

Four children with yolk sac tumor were treated with an aggressive combination chemotherapy program. Three children had presacral primary tumors, one having pulmonary metastases, and one had a testicular primary tumor with pulmonary metastases. Three children were treated when they had measurable disease, and one had no measurable disease. The chemotherapy program consisted of a 6-wk induction period with vincristine (VCR), cis-diamminedichloroplatinum (DDP), and bleomycin. Maintenance therapy consisted of VCR, actinomycin D, and cyclophosphamide (cytoxan) every 3-4 wk as tolerated. Treatment was discontinued after 12 mo of complete remission. All three patients with evaluable disease had a partial response (PR) to induction therapy. Two underwent surgical exploration following induction therapy, one a laparotomy and the other a thoracotomy, and were found to have only scar tissue at the sites of presumed residual disease. The third child with measurable disease progressed to a clinical complete response (CR) during maintenance therapy. Two patients have had no evidence of disease (NED) for 42+ and 41+ mo since starting therapy (28+ and 27+ mo since completing treatment). Two patients are NED 11+ and 7+ mo since starting therapy and remain on treatment. We have encountered no significant renal or pulmonary toxicity, and there have been only two hospitalizations during maintenance therapy for fever and neutropenia. These preliminary results employing different induction and maintenance chemotherapy programs and planned second-look surgical intervention appear encouraging.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1983

Chronic relapsing pancreatitis in childhood caused by pancreaticobiliary ductal anomaly.

Chronic relapsing pancreatitis is a rare childhood disease. Although various obstructive phenomena have been implicated in its etiology, few reports have described the role played by anomalies of the pancreaticobiliary ductal system. Recently, a patient with a complex anomalous ductal communication was treated by us for chronic relapsing pancreatitis. This particular anomaly, and its clinical presentation, has not previously appeared in the literature. The problems associated with the diagnosis and surgical management of this patient have prompted this report.

Child, Preschool↗
PubMed1982

Teratoma of thyroid gland in infancy: review of the literature and two case reports.

Teratomas of the cervical area are relatively rare tumors--only 132 cases have been reported. This paper adds two more cases to the literature and reviews the important clinical aspects of the disease. This tumor commonly presents in early infancy with increasing respiratory distress; polyhydramnios is commonly associated with tumors greater than 10 cm in diameter. They are always benign in infants and are believed to arise from the thyroid gland. Prompt surgical removal is mandatory. Thyroid function studies should be initiated preoperatively, if feasible, and definitely postoperatively to avoid the possible complication of hypothyroidism in the young infant.

Humans↗
PubMed1982

Dental disease masquerading as suppurative lesions of the neck.

Three female patients ages 16, 16, and 12, and an 8-yr-old male presented with neck pathology/2 with abscesses, 1 with a submandibular mass and 1 with a spontaneously draining abscess. In 2 instances, routine oral cavity examinations including percussion of the teeth, failed to reveal significant pathology. A detailed examination by a dentist, intraoral roentgenograms, and in the first child a sinogram, identified the etiology of the lesions as periapical infections. Review of the literature reveals that these patients characteristically receive multiple surgical procedures and courses of antibiotics prior to the recognition of intra-oral disease. Extraction, or root canal, is the definitive therapy that leads to involution of the sinus tract. These four typical cases are reported to illustrate the presentation and pathogenesis of this disease entity, and the importance of an adequate dental examination prior to surgery for a draining sinus of the neck.

Adolescent↗
PubMed1982

The abdominal technetium scan (a decade of experience).

Out of 270 children with gastrointestinal symptoms, the indications for technitium scanning were: gastrointestinal tract bleeding (165 patients), abdominal pain (99 patients) and a history of intussusception (6 patients). Thirty children had abnormal findings, while the remaining 240 patients had "normal" scans. Four of the 30 children with positive scans were not explored, while the others underwent laparotomy. Of the 26 operated patients, 12 (46%) had a Meckel's diverticulum. Nine patients (34%) had other pathologic lesions that were detected by the scan. Five had true "false positives" as no pathologic lesions were found. Of the 240 children with negative scans, 19 were eventually explored because of persistent symptoms or clinical findings. Two of these had a Meckel's diverticulum. Eleven had a negative exploration while six had other surgical lesions. Technitium scan should reliably detect around 80%-90% of Meckel's diverticula. It will also accurately exclude the diagnosis of Meckel's diverticulum in over 90% of patients.

Abdomen↗
PubMed1982

Vasoactive intestinal peptide producing neuroblastoma.

The Verner-Morrison syndrome has been described in 19 previous patients with ganglioneuroma and ganglioneuroblastoma but never neuroblastoma. Its occurrence following treatment of a neuroblastoma with chemotherapy with maturation of the tumor has only been reported on one previous occasion. Our case suggests that vasoactive intestinal polypeptide may be used not only as a diagnostic indicator for the presence of a neural crest tumor but also as a marker to monitor maturation of the tumor and indicate an improving prognosis.

Adenoma, Islet Cell↗
PubMed1982

Ectasia of the rete testis with ipsilateral renal agenesis.

Scrotal masses are a common problem in children. Cystic lesions usually are found to be hydroceles, while solid masses suggest the possibility of neoplasia. A rare cause of a cystic scrotal mass is ectasia of the rete testis. A review of the literature reveals only 1 case similar to the patient herein described. Both patients had agenesis of the ipsilateral kidney, which explained on the basis of the embryologic overlapping of the genitourinary system. Our patient bears clinical similarity to the ACI rat and correlation is made with this animal model system. Excision of the multiloculated rete testis cyst, rather than orchiectomy, appears to be curative.

Child↗
PubMed1979

The incidence of post-splenectomy sepsis and herpes zoster in children and adolescents with Hodgkin disease.

The occurrence of sepsis due to Streptococcus pneumoniae and Hemophilus influenza and of herpes zoster (HZ) was reviewed in a series of 72 consecutive, previously untreated children and adolescents with Hodgkin disease. There was not a statistically significant difference in the risk of developing sepsis within five years of diagnosis between patients who had (16.6%) or had not (6.2%) undergone splenectomy. Sepsis occurred most frequently among patients treated initially with total nodal irradiation and combination chemotherapy. The estimated risk of HZ during the first five years after diagnosis was 34%. Patients treated initially with irradiation and combination chemotherapy had a significantly greater risk of developing HZ than patients treated initially with only irradiation (P less than 0.05). Although trends were present which suggested that splenectomy and the extent of disease at diagnosis may influence the occurrence of HZ, these did not achieve statistical significance. Survival was not influenced by the occurrence of HZ.

Adolescent↗
PubMed1979

The umbilical polyp.

Anomalies of the omphalomesenteric duct (OMD) present a variety of surgical problems. The most readily apparent of these lesions is the umbilical polyp. One-third of patients explored at our hospital and 56% of patients reviewed had an additional OMD anomaly when explored for an umbilical polyp. The preferred treatment for this lesion should be a mini-laparotomy after the presence of intestinal mucosa at the umbilicus is confirmed.

Child, Preschool↗