Biomedical subjects

V Gardner

Publications and source records attributed to V Gardner.

9 recordsLinked to original sources

PubMed1999

Mucous fistula refeeding in neonates with short bowel syndrome.

BACKGROUND/PURPOSE: Neonates with enterostomies commonly suffer from a functional short bowel syndrome (SBS) and have a greater risk of electrolyte and fluid loss with poor weight gain. The authors describe their experience with refeeding stoma effluent into the mucous fistula in neonates. METHODS: A 5-year (1993 to 1997) chart review of neonates with stoma effluent refeeding was undertaken. Demographics, medical history, surgical procedures, timing, and duration of refeedings were reviewed. Enteral and total parenteral nutritional (TPN) requirements, electrolyte, and acid-base disturbances were recorded. RESULTS: Six neonates (gestational ages of 27 to 38 weeks, birth weights of 533 to 3400 g) were identified with nutritional or electrolyte complications before the commencement of refeeding. Enterostomy indications included necrotizing enterocolitis (n = 2), intestinal atresia type 3b (n = 1), complications from ruptured omphalocoele (n = 1), congenital adhesive band obstruction (n = 1), and midgut volvulus after congenital diaphragmatic hernia repair (n = 1). Weight gain during refeeding ranged from 5 to 25 g/kg/d with duration of refeeding lasting 16 to 169 days (two neonates were refed at home) until reanastomoses were done 6 to 44 weeks after the original surgery. There were no complications, and TPN requirements were diminished or eliminated. CONCLUSION: This technique represents a simple and safe method, which lessens the need for TPN and electrolyte supplementation in neonates with enterostomies and SBS before reanastomosis.

Enteral Nutrition↗

PubMed1995

Management of metastatic tumors to the spine using simple plate fixation.

Frequency of metastasis to the spine in the population of patients suffering from malignant disease is a significant clinical problem, as these patients present with intractable pain and neurologic impairment. The sequelae of metastatic tumors to the spinal column significantly decrease the quality of the patient's life. With the advent of modern chemotherapeutic regimens in metastatic disease, patients with metastatic tumors are living longer and more productive lives. The goal of surgical management of this problem is to increase the quality of the patient's life, and not longevity. The immediate technical goals are resection of the pathological segment, restoration of load bearing capacity for mobilization of the patient, and decompression of compromised neural structures, as well as maintenance of spinal stability to decrease pain and increase the patient's quality of life during the terminal stages. This is a series of 28 patients with metastatic tumors to the spine, with an average age of 61.5 years, ranging from 25-81 years of age. Within this population there were 11 different tumor types. The postoperative survivorship was an average of 6.4 months. Twenty patients in this series had an anterior procedure alone using a combination of Methylmethacrylate and inexpensive plate fixation. Six patients required an anterior/posterior procedure for circumferential spinal compression and instability. These techniques provide immediate spinal stability for rapid mobilization of the patient. Twenty-four patients in the series had significant pain relief, and 17 experienced neurologic improvement.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1993

Epidural hematomas. An unusual complication of minor blunt force injury due to seizures in a patient with sickle cell disease.

Multiple subacute epidural hematomas in a patient with sickle cell disease (HbSS) are reported. The patient was a 22-year-old Black man with a history of strokes and seizures, who was unexpectedly found dead at his foster home. Scene investigation disclosed no foul play or any indication of violent activities. Autopsy findings included subgaleal contusions and bilateral epidural hematomas, but no calvarial fractures. The epidural hematomas were subacute and closely patterned to the headboard knots of the bed in which the decedent had slept. The etiology of the hematomas is minor blunt force injury secondary to the head striking against the headboard during seizures. The immediate cause of death was determined to be pneumonia and sepsis secondary to HbSS.

Adult↗

PubMed1992

Sudden death in children due to mesenteric defect and mesenteric cyst.

Two cases of sudden death in young female children due to small intestinal volvulus are reported, which involved a mesenteric defect and a mesenteric cyst. Death due to small intestinal volvulus is uncommon, especially when complicated by either a mesenteric defect or cyst.

Child, Preschool↗

PubMed1991

Reconstruction of failed lumbar surgery with narrow AO DCP plates for spinal arthrodesis.

Forty-five patients underwent surgical reconstruction with transpedicular fixation of the lumbar spine with narrow AO DCP plates. Preoperatively, all patients underwent spinal imaging with either magnetic resonance imaging, computed tomography, or myelogram as well as provocative discography to determine the location and the number of symptomatic segments. The minimum follow-up in this series was 2 years. The determination of solid posterior fusion in the presence of plate instrumentation was difficult. The patients in the series were classified as having 1) solid fusion; 2) radiographic flaws within the posterolateral fusion without implant failure; or 3) frank pseudarthrosis with implant failure. Thirty-six (80%) of the patients had a solid fusion, 9 of whom required an additional anterior interbody fusion to obtain symptom control. Twenty percent of the patients in the series had radiographic evidence of reabsorption without implant failure. Four patients in the series (8.8%) had screw breakage, three of which required anterior interbody fusions. The highest rate of reabsorption and pseudarthrosis implant failure was in the 12 patients who had three-level instrumentation; 33% of these patients required anterior interbody fusion to obtain a solid arthrodesis. The average preoperative pain scale was 8.9, and the average postoperative pain scale was a 3.3. Twenty-two patients in the series were cigarette smokers and had a slightly lower fusion rate than non-smokers. They did, however, have a higher use of narcotics after surgery. Forty percent of the patients in this series continued to have radiculopathy after their reconstruction. This study demonstrates the utility of transpedicular fixation in salvage lumbar surgery in obtaining a solid arthrodesis with a beneficial clinical result. Anterior interbody fusions are highly successful in the management of pseudarthrosis and implant failure after transpedicular instrumentation.

Adult↗

PubMed1991

Postoperative infections in spinal implants. Classification and analysis--a multicenter study.

A multicenter study was undertaken to analyze postoperative wound infections after posterior spinal instrumentation and fusion. The infection rate of these procedures has been documented in multiple reports. From these results, a classification scheme was developed that can guide therapy and determine the populations at risk. The patients were categorized according to two parameters, the first being the severity or type of infection, and the second being the host response or physiologic classification of the patient. This classification scheme is based on the clinical staging system for adult osteomyelitis developed by Cierny. The severity of infection is divided into three groups. Group 1 is a single-organism infection, either superficial or deep. Group 2 is a multiple-organism, deep infection. Group 3 is multiple organisms with myonecrosis. The host response, likewise, is divided into three classes. Class A is a host with normal systemic defenses, metabolic capabilities, and vascularity. Class B patients demonstrate local or multiple systemic diseases, including cigarette smoking. Class C requires an immunocompromised or severely malnourished host. Our data have demonstrated that single organisms, Group 1, generally can be dealt with by single irrigation and debridement, and closure over suction drainage tubes without the use of an inflow-irrigation system. The Group 2 patients, with multiple organisms and deep infection, required an average of three irrigation debridements. They have a higher percentage of successful closures with closed inflow-outflow suction irrigation systems when compared to simple suction drainage systems without constant inflow irrigation. Multiple-organism infections with myonecrosis, Group 3, are exceedingly difficult to manage, and portend a poor outcome. Patients without normal host defenses, Classes B and C, are at high risk for developing postoperative wound infection. Specifically, this study demonstrated that cigarette smoking may be a significant risk factor.

Bacterial Infections↗

PubMed1988

Treatment of tumors of the thoracic and lumbar spinal column.

From December 1981 to February 1986, 33 patients with tumorous conditions of the spine were treated with anterior, posterior, or combined anterior and posterior surgical techniques. Breast metastases were by far the most common condition, accounting for more than 51% of patients with metastatic spinal disease. The surgeon treating tumorous conditions of the spine must be aware that, to date, the treatment is palliative only. The goals of the surgery and treatment are to reduce pain, preserve or improve neurologic function, and allow early mobilization. Survival overall averaged 9.1 months. Of the 14 patients who had anterior decompression alone, average survival time was 9.9 months. The 14 patients who had posterior procedures had an average survival time of 11.9 months. Five patients treated with combined anterior and posterior procedures survived 9.6 months. Fifteen patients with multiple-level spinal involvement survived 7.9 months, compared with 12.9 months for the 18 patients with single-level spinal involvement. Aggressive surgical treatment definitely improves the quality of life of patients with cord compression or unstable spinal segments secondary to bony destruction. An aggressive approach is indicated because it permits most patients to spend the remainder of their lives relatively pain-free and with intact spinal cord function.

Adult↗

PubMed1985

The effect of alignment on results in arthroscopic debridement of the degenerative knee.

Fifty-two patients with severe degenerative joint disease of the knees were treated by arthroscopic debridement. The results of arthroscopic debridement on normally aligned degenerative knees are encouraging. A combination of arthroscopic debridement and high tibial osteotomy could be an appealing alternative to total knee arthroplasty in the young patients. Patients with varus angular deformity in the degenerative knee had a poor result and should be excluded from consideration for arthroscopic debridement.

Arthroscopy↗

PubMedDate not supplied

Neu-Laxova syndrome: pathological evaluation of a fetus and review of the literature.

Neu-Laxova syndrome is a rare autosomal recessive disorder characterized by ichthyosis, intrauterine growth retardation, microcephaly, short neck, central nervous system abnormalities, hypoplastic or atelectatic lungs, limb deformities, edema, polyhydramnios, and short umbilical cord. Abnormal facial features include sloping forehead, hypertelorism, severe ectropion, proptosis, malformed ears, flat nose, and micrognathia. A necropsy study of a male infant with Neu-Laxova syndrome is described. Cleft palate and ambiguous external genitalia were present in addition to anomalies characteristic of Neu-Laxova syndrome. The clinical manifestations are compared with those of the 40 previously reported cases.

Abnormalities, Multiple↗