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Biomedical subjects

T Pittman

Publications and source records attributed to T Pittman.

29 records · Page 2Linked to original sources
PubMed1992

The risk of abdominal operations in children with ventriculoperitoneal shunts.

Ventriculoperitoneal (VP) shunts are the operations of choice for patients with hydrocephalus in most pediatric hospitals. Children with VP shunts frequently undergo abdominal operations unrelated to their shunts, which might lead to shunt infections or to malfunctions related to adhesions. Although prophylactic antibiotics are usually used in this setting, there are few data to support their use, or to assess other risks to the shunt from the abdominal procedures. Consequently, we reviewed the records of 37 children with VP shunts who underwent a total of 44 abdominal operations. In 8 cases, the genitourinary (GU) tract was opened (ureteral reimplantation, bladder augmentation, nephrectomy), whereas in 18 patients the gastrointestinal (GI) tract was opened (appendectomy, gastrostomy, small/large bowel resection). In 18 operations neither GI nor GU tract was opened (lysis of adhesions, herniorrhaphy, orchiopexy). Antibiotic coverage was highly variable: 9 received no antibiotics, 9 received antibiotics only postoperatively, 4 were given antibiotics only preoperatively, and in 22 cases antibiotics were given both preoperatively and postoperatively. One shunt that was involved in a periappendiceal abscess was exteriorized and later successfully replaced. In the remaining cases, no episodes of shunt infection or malfunction occurred in 1 to 10 years of follow-up. Likewise, no abdominal cerebrospinal fluid pseudocysts formed as a result of abdominal adhesions. These data demonstrate that children with VP shunts can safely undergo abdominal operations, even when the GI or GU systems are opened, with minimal risk of shunt infection or malfunction. Rigid protocols of prophylactic antibiotics cannot be supported by this series.

Abdomen↗
PubMed1992

Ventriculo-ureteral shunt without nephrectomy.

Some patients with hydrocephalus cannot be adequately treated with either ventriculo-peritoneal or ventriculo-atrial shunts. Ventriculo-ureteral (VU) shunts are seldom considered in this group of patients because of the belief that nephrectomy is an essential part of the procedure. We report a case in which a VU shunt was performed with direct ureteral re-implantation and we suggest that a VU shunt is a reasonable alternative for the treatment of a patient with difficult-to-manage hydrocephalus.

Cerebrospinal Fluid Shunts↗
PubMed1992

Current imaging concepts of thoracic intervertebral disks.

This article reviews the current concepts of thoracic herniated disks using the radiologic literature as well as our own experience with more than 100 thoracic HNPs. The relative frequency of asymptomatic thoracic HNPs is documented. Points of interest include the optimal technique, criteria for interpretation, strengths and weaknesses of various imaging modalities, including water-soluble myelography, CT myelography, and magnetic resonance imaging. Additionally, the protean clinical manifestations of thoracic HNPs and current operative management are briefly addressed.

Artifacts↗
PubMed1991

Endoscopic coagulation of the choroid plexus using the Nd:YAG laser: initial experience and proposal for management.

Although most patients with hydrocephalus are treated effectively with ventriculoperitoneal shunts, a small group fails to respond to diversion procedures. In some patients within this group, hydrocephalus may be caused in part by the overproduction of the cerebrospinal fluid (CSF). In other patients, previous shunt infections may limit the ability of the peritoneum to absorb fluid, and patient response to a ventriculoperitoneal shunt may be improved by reducing CSF production. We discuss a case of a 29-month-old hydrocephalic infant with a ventriculoperitoneal shunt who had ascites. Computed tomography showed bilateral symmetrical enlargement of the choroid plexus. Repeated cultures of the CSF and shunt tubing were sterile, and the daily production of the CSF exceeded 1000 ml. Therapy with acetazolamide decreased the CSF output temporarily, but it was discontinued after serious electrolyte abnormalities occurred. The endoscopic coagulation of the choroid plexus with a neodymium:YAG laser transmitted through a flexible quartz fiber decreased CSF production effectively. This procedure may be useful in a variety of clinical conditions associated with hydrocephalus or with other intraventricular lesions.

Child, Preschool↗
PubMed1989

Efficacy of barbiturates in the treatment of resistant intracranial hypertension in severely head-injured children.

Cerebral perfusion pressures (CPP) of less than 50 torr are associated with marginal cerebral blood flow and poor outcome. We report our experience with a group of 7 children who survived long period with CPP of less than 50 torr during treatment with pentobarbital. The study group was identified through a retrospective review of all head-injured patients admitted to Cardinal Glennon Memorial Hospital for Children between 1984 and 1986. All of the patients presented had sustained intracranial pressure of greater than 20 torr which was resistant to conventional therapy. All patients received pentobarbital for at least 24 h and all had documented CPP of less than 50 torr for more than 30 min during that time. Of these 7 children: 3 made good recoveries; 2 are moderately disabled, and 2 are vegetative. Neither the CPP nor the length of pentobarbital coma was an accurate predictor of outcome. It seems likely that these children are a subset of those previously defined as having resistant intracranial hypertension and that, as a group, they may have benefited from pentobarbital administration. It is also apparent that, in this group, low CPP was not indicative of irreversible brain damage or brain death.

Adolescent↗
PubMed1988

Organization of transient projections from the primary somatosensory cortex to the cerebellar nuclei in kittens.

The organization of transient projections from the primary somatosensory cortex (SI) to the cerebellar nuclei was studied in neonatal cats. Tritiated amino acids were injected into the face, forelimb, or hindlimb areas of SI in 4 to 6-day-old kittens. The animals were killed 3 to 6 days later and their brains processed for autoradiography. Labeled axons were found bilaterally in the cerebellar nuclei, but, although the distribution of label was similar on both sides, the label was always much denser on the side of the injection. Each area of SI demonstrated a characteristic pattern of projection to the cerebellar nuclei. Neurons in the hindlimb area projected to the rostral part of the anterior interpositus nucleus, the caudal part of the posterior interpositus nucleus, and the medial quadrant of the dentate nucleus. Fibers from the forelimb area were directed to the caudal part of the anterior interpositus and the rostral part of the posterior interpositus. Projections from the face area terminated principally in the caudal pole of the posterior interpositus. A small transitional area between the interpositus and fastigial nuclei was labeled with all injections. These data indicate that transient neocortical projections to the deep nuclei are organized and that the somatotopy of these projections is similar to that of other cerebellar nuclear connections.

Amino Acids↗
PubMed1982

Effect of converting enzyme inhibition on pulmonary edema after microembolization.

We examined the effect of converting enzyme inhibition with captopril (SQ 14,225) on pulmonary hemodynamics and on accumulation of extravascular lung water after microembolization in dogs. Pulmonary microembolization, induced with glass beads (200 microns diam), increased the mean pulmonary arterial pressure to approximately 40 Torr in both control and captopril-treated animals. The increase in pulmonary vascular resistance (PVR) in control animals was sustained during the 75 min of study and was associated with an increase in the extravascular lung water content-to-bloodless dry lung weight ratio (W/D) from a normal value of 2.84 +/- 0.22 to 4.53 +/- 0.24 ml/g (P less than 0.01) after embolization. In the captopril-treated group, the PVR increased gradually, such that the value at 75 min postembolization was greater than in controls (P less than 0.05). The W/D in the captopril-treated group of 4.62 +/- 0.19 ml/g was greater than the value of 2.83 +/- 0.10 ml/g in nonembolized captopril-treated animals, but the degrees of edema in the control and captopril-treated animals were not different. A similar degree of embolization induced during infusion of 5 micrograms X kg-1 X h-1 of bradykinin also did not enhance the pulmonary edema, and there was also a greater increase in PVR than in control animals after embolization. These findings suggest that bradykinin does not contribute to the degree of pulmonary edema after microembolization.

Angiotensin-Converting Enzyme Inhibitors↗