Medical management of Candida-infected thrombosis in a pediatric oncology patient.
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Biomedical subjects
Publications and source records attributed to T J Baesl.
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A simplified technique for the repair of gastroschisis without the need to excise the umbilicus or make a fascial incision has been developed. First, the abdominal wall is stretched and the viscera are reduced. Next, the skin and subcutaneous tissue are elevated from the fascia for 1.5 cm around the defect and the fascia is closed transversely with interrupted sutures. The skin is also closed transversely. The umbilical stump is left intact. Eight of nine consecutive patients with gastroschisis were able to undergo repair by this technique. The average hospital stay was 35.6 days. There were no cases of omphalitis or cellulitis of the abdominal wall, but one child has a small umbilical hernia. All have a near normal-appearing umbilicus. This simpler technique for the repair of gastroschisis is quicker and less traumatic, and gives a better cosmetic result than the conventional method.
Recognition of the spleen's important immune function has led to a more conservative surgical approach to the spleen. This has proved to be both safe and beneficial to the patient.
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The effect of total and partial splenectomy on the blood stream clearance of type 23B Streptococcus pneumoniae was studied in chinchillas 2 wk and 2 mo following surgery to determine the amount of splenic tissue necessary for protection against overwhelming sepsis. Significantly more pneumococci were found in the blood of totally splenectomized chinchillas than in the blood of sham-operated animals throughout the 6-hr sampling period after intravenous inoculation of pneumococci. Animals that had two-thirds of their spleen removed demonstrated a significant delay in clearance of pneumococci compared with sham-operated and hemisplenectomized animals. The rate of pneumococcal clearance was similar for the sham-operated and the hemisplenectomized group, and was significantly prolonged but similar among totally splenectomized and two-thirds splenectomized animals. Pneumococcal opsonic activity was reduced only in the sera of totally splenectomized chinchillas 2 mo after surgery. There was no positive relationship between pneumococcal clearance and change in pneumococcal opsonic activity. These results suggest that the impaired clearance of circulating pneumococci in splenectomized animals is due to the loss of splenic reticuloendothelial cells as a mechanical filter, rather than deficient serum opsonic activity. There appears to be a critical splenic mass required for optimal bacterial clearance, and hemisplenectomy may protect against overwhelming postsplenectomy sepsis.
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