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Biomedical subjects

W L Buntain

Publications and source records attributed to W L Buntain.

At least 19 recordsLinked to original sources
PubMed1988

Predictability of splenic salvage by computed tomography.

The recognition of overwhelming post-splenectomy infection (OPSI) has led to greater efforts to conserve splenic tissue in patients sustaining blunt torso trauma. Nonoperative management of splenic trauma has emerged as a means to enhance splenic salvage yet criteria to assure the safety of such an approach remain ill defined and controversial. Since severity of injury directly influences outcome, a need exists for identification of splenic injuries that require early operation and repair or removal. Using our recently reported classification of splenic trauma, 46 patients with blunt splenic trauma were evaluated preoperatively with computed tomography (CT). Injuries were graded I through IV and were described as capsular or subcapsular disruptions without parenchymal injury (four); capsular and parenchymal injuries not involving the major vessels or hilum (24); injuries involving major vessels and/or the hilum (17); and fragmentation/devascularizing injuries (one). Additional modifiers were added for associated intra-abdominal and/or extra-abdominal injuries. Sixteen patients had their splenic injuries managed nonoperatively and the remainder underwent operation for the splenic injury or associated injuries. The CT classification was confirmed in all patients and we believe early operation optimized splenic salvage. We conclude that: 1) CT is an accurate technique to determine the extent of splenic injury; 2) CT classification of splenic trauma has a high correlation with anatomic findings and need for operation; 3) early operation in patients with severe class II and all class III injuries affords optimal conditions for splenic salvage; and 4) early definitive management of splenic trauma significantly reduces late splenectomy and shortens hospitalization.

Adolescent↗
PubMed1986

Beneficial use of an evocative test in chronic relapsing pancreatitis in children.

The true incidence and cause of chronic recurrent pancreatitis in children remains enigmatic because little is known about its early natural history, it is considered only infrequently, and diagnosis is difficult. Chronic recurrent abdominal pain in children continues to be common. To help evaluate the possibility that such pain is related to chronic recurrent pancreatitis, this study used the morphine-prostigmine pancreatic evocative test with the recent addition of concomitant pancreatic ultrasonography to evaluate ductal activity. Fourteen of 67 children studied had positive results and 13 underwent operation, which included 2 partial pancreatectomies and 12 sphincteroplasties in 12 patients. At last follow-up seven were asymptomatic, five were significantly improved, and one who had pancreatography only continued to have pain. The remaining patient, who has not yet operated on, continues to have pain. This series supports the use of the morphine-prostigmine test to determine which patients have abdominal pain that is potentially related to pancreatitis and which patients would benefit from operation.

Abdomen↗
PubMed1986

Posterior sagittal anoplasty combined with ventricular peritoneal shunting: an unusual complication.

This report is intended to point out the potential difficulties in patients with the combined abnormalities of anorectal agenesis and central nervous system disorders requiring diversion of CSF. The potential accumulation of this diverted fluid in and around meticulously approximated pelvic musculature so important to continence was a real concern and prompted immediate reexploration and shunt conversion. It is recommended that future cases with these coexisting abnormalities should be carefully considered for shunt conversion prior to or at the time of posterior sagittal anorectoplasty, particularly if the peritoneum is inadvertantly entered.

Anal Canal↗
PubMed1985

Chronic relapsing pancreatitis in childhood.

Chronic intermittent abdominal pain in childhood, reported to afflict nine to 12 per cent of all children, is an enigma of such magnitude that more than 30 per cent of these patients reach adulthood with persistent problems and no definitive diagnosis. This report discusses 20 children with such pain (9 girls and 11 boys) in whom routine diagnostic evaluation failed to identify the etiology. Selected special diagnostic studies and considerable suspicion for chronic pancreatitis prompted surgical intervention in three patients. Two were unsuspected and identified at celiotomy as having pancreatitis. The morphine-neostigmine evocative test, modified in some cases to confirm its usefulness, was helpful, accurate, and definitive in all 13 patients on whom it was used. Eighteen patients were confirmed surgically to have pancreatic disease, and two patients are unoperated with continued pancreatic pain. Ductal pathology was believed present in all. Of 18 patients operated, 11 patients are asymptomatic, five patients are improved, and two patients are considered failures 6 months to 10 years following surgery.

Abdomen↗
PubMed1985

A new technique for the placement of continuous ambulatory peritoneal dialysis catheters in infants and small children.

The technique described herein is simple and straightforward. Strict attention to detail should result in a peritoneal catheter which will function indefinitely. Using this method of catheter placement, patients have not only had the renal disease controlled but have experienced improved dietary and caloric intake orally and, through the dialysate, increased protein utilization and subsequent accelerated weight gain and improved height velocity in centimeters per year. Patients and their parents have enhanced social and psychologic experiences at home with a reduction in therapy costs and eventual successful transplantation has been achieved.

Catheterization↗
PubMed1979

Bilateral Wilms tumor presenting with acute renal failure and clinical findings mimicking cardiac failure.

A six-year-old girl presented with clinical signs and symptoms of right-sided heart failure. Cardiac catheterization demonstrated filling defects in both pulmonary arteries felt to represent metastatic lesions or thromboemboli. Intravenous pyelogram revealed bilateral renal masses and intrarenal obstruction. Acute renal failure was unresponsive to standard therapy. An open renal biopsy revealed Wilms tumor with favorable histology. Aggressive chemotherapy and irradiation were undertaken and renal function returned. This case adds to the heterogeneity of presentations described for Wilms tumor, and review of the literature reveals no other cases with similar presenting signs.

Acute Kidney Injury↗
PubMed1979

Transcutaneous oxygen (tcPO2) measurements as an aid to fluid therapy in necrotizing enterocolitis.

Impaired peripheral perfusion is a major problem in necrotizing enterocolitis with delayed recognition and definite documentation being primary factors. While blood pressure and other clinical measurements may improperly estimate the severity of the problem, changes in transcutaneous oxygen measurements and their relationship to arterial oxygen (the tcPO2/PaO2 ratio) potentially afford a sensitive measurement of peripheral perfusion. Experience in our unit confirms a close relationship between tcPO2/ and PaO2 being 0.97 +/- 0.04 (SE). Ten infants with birth weights of 640 to 1380 g, who subsequently developed necrotizing enterocolitis, had strikingly lower ratios initially (0.00, 0.00, 0.00, 0.17, 0.21, 0.43, 0.44, 0.48, and 0.56). Use of the tcPO2/PaO2 ratio to monitor fluid therapy was related to outcome, suggesting that this ratio is important in managing necrotizing enterocolitis.

Enterocolitis, Pseudomembranous↗
PubMed1979

Pulmonary arteriovenous malformations in children.

Pulmonary arteriovenous malformations are a life-threatening, but curable, cause of persistent cyanosis in children. Abnormal communications may be single or multiple and are usually in the lower lobes. Three patients with pulmonary arteriovenous malformations have recently been managed at this hospital. Ranging in age from 2 to 4 yr, all were female, all were from families with Rendu-Osler-Weber syndrome, and all underwent pulmonary angiography with confirmation of diagnosis. All have had uneventful resection, one of the left lower lobe, one the right upper lobe, and the other the right middle and lower lobes.

Arteriovenous Malformations↗
PubMed1979

Christmas bow tragedies.

Two cases of fatal accidents involving plastic buttons from Christmas bows are described. Although accidents are the commonest cause of death in children less than 3 years old, governmental mechanisms, properly enforced, can be instrumental in preventing such catastrophies.

Child, Preschool↗
PubMed1979

Splenorrhaphy: changing concepts for the traumatized spleen.

Established doctrine dictating splenectomy for the traumatized spleen has come under considerable critism since the report of fatal postsplenectomy sepsis by King and Shumacher in 1952. With expanding knowledge of immunologic and physiologic function, splenectomized persons have been proven at risk in different areas, but the most important impetus for splenic preservation has been the observation of overwhelming postsplenectomy sepsis. Several reports have confirmed this concern, with a documented increase in morbidity and death of splenectomized patients of 50 to 200 times the normal. Successful results with surgical repair of traumatized spleens have been reported, experimentally and clinically proving excellent healing capabilities. It is not uncommon to frequently find little if any active bleeding with such injuries; in fact, even significant bleeding can be controlled with splenic salvage. Several different techniques to accomplish this have been reported. These are reviewed, two new successful and previously unreported techniques are outlined in detail, and statistical information supporting the use of these techniques is presented.

Hemostatic Techniques↗
PubMed1978

Pancreatitis in childhood.

Thirty cases of pancreatitis in children are reviewed. Diagnosis is based on the clinical findings of pancreatic inflammation, laboratory confirmation with elevated serum and/or urinary amylase values, and in some cases surgical or postmortem tissue substantiation. Four major classes of pancreatitis are defined in children: (1) traumatic; (2) systemic-disease associated; (3) drug-induced, caused by drug therapy for various life-threatening diseases, and (4) chronic pancreatitis, with or without an anatomic abnormality. If cases of traumatic pancreatitis are excluded, females outnumber males 5 to 1. A high index of suspicion is necessary to make the diagnosis, and this is very important if the mortality for pancreatitis in children is to be lowered. Awareness and consistent early aggressive intervention should increase the salvage rate.

Adolescent↗
PubMed1978

Ventriculoperitoneal (VP) shunt migration causing an acute scrotum: a case report of Doppler evaluation.

The diagnosis and management of a scrotal complication of a ventriculoperitoneal shunt simulating testicular torsion in a neonate is outlined. Radiologic evaluation determined the location of the shunt tube and adequate blood flow to the testicle was confirmed by use of the Doppler stethoscope, allowing for definitive therapy by extraperitoneal shortening of the shunt catheter. Surgery to the scrotum was, thus, avoided.

Cerebrospinal Fluid Shunts↗