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1.
Heart Lung Circ ; 22(3): 161-70, 2013 Mar.
Article in English | MEDLINE | ID: mdl-23102694

ABSTRACT

Coronary artery bypass grafting (CABG) remains the standard of care for multi-vessel coronary disease. However, the increased rate of peri-operative stroke reported after surgery compared to percutaneous coronary intervention (PCI) remains of concern. Anaortic, total-arterial, off-pump coronary artery bypass (OPCAB) grafting is a technique that offers the main advantages of surgical revascularisation with a rate of stroke that is equivalent to that of PCI. Some recent trials comparing conventional on-pump CABG with OPCAB have questioned the efficacy of the off-pump technique - these are most often performed with manipulation of the ascending aorta. We review the potential benefits of the anaortic, total-arterial OPCAB technique to explain why it is being employed by an increasing number of surgeons.


Subject(s)
Coronary Artery Bypass, Off-Pump/adverse effects , Coronary Artery Bypass, Off-Pump/methods , Stroke/etiology , Aorta/surgery , Humans , Mammary Arteries/transplantation , Radial Artery/transplantation , Vascular Patency
2.
J Pediatr Surg ; 34(6): 1021-4, 1999 Jun.
Article in English | MEDLINE | ID: mdl-10392927

ABSTRACT

BACKGROUND: Duodenal diaphragms generally are treated by either a duodeno-duodenostomy or excision. The former is a bypass procedure that involves a major anastomosis with its inherent postoperative problems, whereas the latter may result in inadvertent damage to the biliary and pancreatic ducts. To circumvent these problems, the authors used the technique of incision of the diaphragm on its lateral aspect. METHODS: Medical records of five children who underwent surgery for a perforate duodenal diaphragm during the period of 1992 through 1994 were reviewed retrospectively. All patients underwent a similar procedure. A longitudinal duodenotomy was made and the diaphragm incised on its anterolateral aspect. The cut edges of the diaphragm were oversewn, and the duodenotomy closed in "Heineke-Mikulicz" fashion. RESULTS: At a follow-up ranging from 1 to 3 years, all patients are growing normally and remain free of any obstructive symptoms. CONCLUSIONS: This simplified approach is a safe and physiological way of restoring the duodenal continuity and is associated with a highly satisfactory outcome.


Subject(s)
Duodenum/abnormalities , Intestinal Obstruction/surgery , Intestinal Perforation/surgery , Child, Preschool , Digestive System Surgical Procedures/methods , Humans , Infant , Infant, Newborn , Intestinal Obstruction/etiology , Intestinal Perforation/etiology , Retrospective Studies
3.
Pediatr Surg Int ; 13(5-6): 437-9, 1998 Jul.
Article in English | MEDLINE | ID: mdl-9639640

ABSTRACT

A 6-year-old girl presented with intractable constipation. On investigation, she was found to have an association of anorectal stenosis, anterior sacral defect, and anterior meningocoele (Currarino's triad). The meningocoele was excised and a Duhamel pull-through procedure performed after resection of a massively distended rectosigmoid. Post-operatively, she started having spontaneous bowel action. Early diagnosis and management is recommended to avoid the high mortality and morbidity associated with this condition.


Subject(s)
Abnormalities, Multiple , Constipation/etiology , Meningocele/complications , Rectum/abnormalities , Sacrum/abnormalities , Anal Canal/abnormalities , Colostomy , Constipation/diagnostic imaging , Constipation/surgery , Constriction, Pathologic/complications , Constriction, Pathologic/congenital , Constriction, Pathologic/diagnostic imaging , Female , Follow-Up Studies , Humans , Infant, Newborn , Meningocele/diagnostic imaging , Sacrum/diagnostic imaging , Tomography, X-Ray Computed
4.
J Pediatr Surg ; 32(4): 621-3, 1997 Apr.
Article in English | MEDLINE | ID: mdl-9126769

ABSTRACT

Rectal ectasia may be associated with anorectal anomalies. If not recognized at the time of surgical reconstruction it may lead to megarectosigmoid, resulting in severe constipation and overflow incontinence postoperatively. The authors treated four patients presenting with this condition. One patient born with a low anorectal anomaly and two with high anorectal anomalies experienced intractable constipation caused by megarectum despite otherwise adequate primary reconstructive procedures. A fourth patient had rectal stenosis in association with megarectosigmoid. The ectatic megarectum had to be resected in all the patients to achieve normal bowel actions. The authors feel that resection or tailoring of the ectatic segment should be an integral part of the primary reconstructive procedure.


Subject(s)
Anal Canal/abnormalities , Rectum/abnormalities , Anal Canal/surgery , Congenital Abnormalities/surgery , Constipation/etiology , Dilatation, Pathologic , Humans , Infant, Newborn , Male , Rectum/pathology , Rectum/surgery
6.
J Pediatr Gastroenterol Nutr ; 22(4): 351-8, 1996 May.
Article in English | MEDLINE | ID: mdl-8732897

ABSTRACT

Most studies of neural cell adhesion molecule (NCAM) in human musculature are devoted to either developing or adult skeletal and cardiac muscle. The aim of this study was to determine the pattern of NCAM expression in the intestinal musculature of the developing human large bowel. In specimens of large bowel from foetuses (gestational age 8-20 weeks), we examined the immunohistochemical localisation of NCAM in parallel to those of alpha-smooth muscle actin and desmin. Within the developing neural complex, NCAM was expressed at all stages investigated. In intestinal muscle at 8 weeks, immunoreactivity for all antisera was restricted to the muscularis propria. The differentiating muscularis mucosae was demonstrated first at 15 weeks by immunostaining for alpha-smooth muscle actin, and this expression was followed by that of NCAM and desmin at 17 and 19 weeks, respectively. At 20 weeks, NCAM immunoreactivity in the external muscle was intense at the inner border of the circular muscle, with its concentration decreasing towards the outer margin of the muscular wall, whereas alpha-smooth muscle actin and desmin were uniformly distributed in all muscle layers. NCAM is expressed by nerves and muscle of developing human large intestine. Its appearance follows a predetermined pattern, which implies its relevance to the differentiation of intestinal muscle layers.


Subject(s)
Intestine, Large/chemistry , Muscle, Smooth/chemistry , Muscle, Smooth/innervation , Neural Cell Adhesion Molecules/analysis , Actins/analysis , Aging , Desmin/analysis , Female , Gestational Age , Humans , Immunohistochemistry , Infant , Intestinal Mucosa/chemistry , Intestine, Large/embryology , Intestine, Large/growth & development , Male , Muscle Development , Muscle, Smooth/growth & development , Nerve Fibers/chemistry , Neurons/chemistry , Pregnancy , Tissue Distribution
7.
Pediatr Surg Int ; 11(2-3): 203-5, 1996 Mar.
Article in English | MEDLINE | ID: mdl-24057562

ABSTRACT

Oronasopharyngeal teratomas are rare tumours that usually present in the neonatal period with airway obstruction. Management should include prompt establishment of the airway and early excision. Complete excision is recommended, which may require more than one operation, but multilating surgery should be avoided as the malignant potential of these tumours is extremely low. We describe our experience with three patients along with a literature review.

8.
J Pediatr Surg ; 30(11): 1546-50, 1995 Nov.
Article in English | MEDLINE | ID: mdl-8583321

ABSTRACT

Rectal atresia and stenosis are rare and peculiar anorectal malformations for which many and varied surgical procedures have been described, ranging from simple perforation of the atresia to extensive sacro-abdomino-perineal pull-through operations. The results of the operations have been generally unsatisfactory, chronic constipation being a common postoperative feature. In the authors' experience, the Duhamel pull-through is the operation of choice for this problem.


Subject(s)
Intestinal Obstruction/congenital , Rectal Diseases/congenital , Rectum/abnormalities , Colectomy/methods , Colostomy/adverse effects , Dilatation/adverse effects , Embryonic and Fetal Development , Female , Humans , Infant , Infant, Newborn , Intestinal Obstruction/complications , Intestinal Obstruction/diagnosis , Intestinal Obstruction/surgery , Male , Rectal Diseases/complications , Rectal Diseases/diagnosis , Rectal Diseases/surgery , Rectum/embryology
9.
Eur J Pediatr Surg ; 5(5): 286-7, 1995 Oct.
Article in English | MEDLINE | ID: mdl-8555132

ABSTRACT

We studied the doses of "scattered" received by neonates in a Neonatal Surgical Unit by placing thermoluminescent dosemeters in various positions expect the direct beam. Doses of "scattered" radiation received by neonates as a results of exposure of their neighbours to X-ray examinations were found to be negligible. Sick neonates need not be moved from their neighbours undergoing exposure to X-rays.


Subject(s)
Intensive Care Units, Neonatal , Radiography/adverse effects , Humans , Infant, Newborn , Radiometry , Scattering, Radiation
10.
Postgrad Med J ; 71(835): 309-12, 1995 May.
Article in English | MEDLINE | ID: mdl-7596943

ABSTRACT

Many problems may arise within the gastrointestinal tract of patients with cystic fibrosis. We report a new cause of subacute intestinal obstruction due to a fibrotic stricture of the ascending colon in a child with cystic fibrosis. Treatment was with a right hemicolectomy. There has been no recurrence after nine months follow-up. Recent similar cases suggest that this new pathology is linked to the use of enteric-coated high-strength pancreatin microspheres.


Subject(s)
Colonic Diseases/etiology , Cystic Fibrosis/complications , Intestinal Obstruction/etiology , Pancreatic Hormones/administration & dosage , Tablets, Enteric-Coated/adverse effects , Child, Preschool , Colonic Diseases/pathology , Cystic Fibrosis/pathology , Humans , Intestinal Obstruction/pathology , Intestines/pathology , Male , Microspheres
11.
Br J Surg ; 82(1): 74-8, 1995 Jan.
Article in English | MEDLINE | ID: mdl-7881964

ABSTRACT

Duplication of the alimentary tract is rare but potentially dangerous. Five of 72 children with alimentary tract duplication treated between 1973 and 1992 died from postoperative complications; a further ten required more than one operation. Ileal duplications were the commonest, occurring in 16 patients (22 per cent). Thoracoabdominal duplications were the most complicated and responsible for much of the overall morbidity and mortality. Surgical complications were related to the size and location of the duplication, communication with the gastrointestinal tract or vertebral canal, presence of heterotopic gastric mucosa and involvement of mesenteric vessels. Complete excision of the duplication should be possible in most cases.


Subject(s)
Digestive System Abnormalities , Adolescent , Child , Child, Preschool , Colon/abnormalities , Colon/surgery , Duodenum/abnormalities , Esophagus/abnormalities , Esophagus/surgery , Female , Humans , Infant , Infant, Newborn , Intestine, Small/abnormalities , Intestine, Small/surgery , Male , Mediastinal Cyst/etiology , Rectum/abnormalities , Rectum/surgery , Stomach/abnormalities , Stomach/surgery , Thoracotomy
12.
J Pediatr Surg ; 29(4): 501-3, 1994 Apr.
Article in English | MEDLINE | ID: mdl-8014803

ABSTRACT

Seven full-term infants with aganglionosis extending into the small bowel presented with clinical, radiological, and operative features of meconium ileus. Misdiagnosis resulted in inappropriate treatment. The correct diagnosis was eventually established by rectal suction biopsy, mostly after either recurrent intestinal obstruction or stomal dysfunction, and after cystic fibrosis had been excluded. For two patients, the results of rectal suction biopsies were initially misleading. Two infants died. Extensive intestinal aganglionosis should be considered a rare possibility in all infants with meconium ileus. In such cases, histological examination of the appendix may avoid this potential pitfall.


Subject(s)
Hirschsprung Disease/complications , Intestinal Obstruction/etiology , Meconium , Biopsy, Needle , Female , Hirschsprung Disease/pathology , Humans , Infant, Newborn , Intestine, Small/pathology , Male , Rectum/pathology
14.
J Med Assoc Thai ; 76(12): 683-7, 1993 Dec.
Article in English | MEDLINE | ID: mdl-7798820

ABSTRACT

The repair of esophageal atresia, preserving the patient's own esophagus is the surgical procedure of choice. In "long-gap" type or in "tension anastomosis" cases, anastomotic complications were known to be higher than in usual cases. From this report, postoperative elective ventilation for 5 days together with neck flexion position reduced such complications with minimal subsequent complications related to the mechanical ventilation.


Subject(s)
Esophageal Atresia/surgery , Esophagus/surgery , Respiration, Artificial , Anastomosis, Surgical , Humans , Infant , Postoperative Care , Retrospective Studies
15.
Eur J Pediatr Surg ; 3(5): 264-6, 1993 Oct.
Article in English | MEDLINE | ID: mdl-8292576

ABSTRACT

Forty-eight patients with repaired congenital oesophageal anomaly underwent aortopexy for significant tracheomalacia between 1980 and 1990. Indications for aortopexy included recurrent apnoea/cyanosis in 31, near fatal episodes in 16, recurrent respiratory distress and infection in 20 and worsening stridor in 15. Gastro-oesophageal reflux was noted in 30 patients, recurrent fistula in 6 and oesophageal stricture in 14. Aortopexy cured near fatal episodes in all patients and resulted in improvement of airway obstruction in 95%. The procedure failed in 2 patients due to unrecognised bronchomalacia and phrenic nerve palsy respectively. Aortopexy is the primary procedure of choice for significant tracheomalacia when associated with near fatal episodes and significant airway obstruction.


Subject(s)
Airway Obstruction/surgery , Aorta, Thoracic/surgery , Esophageal Atresia/surgery , Tracheal Stenosis/surgery , Tracheoesophageal Fistula/surgery , Airway Obstruction/congenital , Airway Obstruction/mortality , Cause of Death , Child , Child, Preschool , Esophageal Atresia/mortality , Female , Follow-Up Studies , Humans , Infant , Male , Postoperative Complications/mortality , Sternum/surgery , Tracheal Stenosis/congenital , Tracheal Stenosis/mortality , Tracheoesophageal Fistula/congenital , Tracheoesophageal Fistula/mortality , Treatment Outcome
16.
Gastroenterology ; 105(4): 1104-9, 1993 Oct.
Article in English | MEDLINE | ID: mdl-8405855

ABSTRACT

BACKGROUND: Neural cell adhesion molecule (NCAM) is down regulated during morphogenesis and innervation of cardiac and skeletal muscle. In mature muscle, its reexpression over the entire sarcolemma occurs in response to denervation or paralysis of muscle and in some myopathies. No information is available regarding NCAM expression in human enteric muscle either in health or in disease. Our aim was to test whether NCAM is present in nerves and muscle of normal infant bowel and to determine how its expression is altered in congenital aganglionosis. METHODS: Using immunocytochemistry for light microscopy, we compared the pattern of distribution of NCAM in congenitally aganglionic colon with that in colon from age-matched controls. RESULTS: In normal colon, NCAM immunoreactivity was seen in ganglion cells and nerve fibers throughout the gut wall and, more weakly, on the inner border of the circular muscle. In aganglionic bowel, there was a marked increase in NCAM expression in muscle, particularly that of the muscularis mucosac and characteristic hypertrophied nerve bundles of the intermuscular zone and submucosa displayed immunoreactivity for NCAM. CONCLUSIONS: Abnormal expression of NCAM is, thus, a feature of congenital aganglionosis and is likely to be associated with neuromuscular dysfunction within the affected colon.


Subject(s)
Cell Adhesion Molecules, Neuronal/analysis , Hirschsprung Disease , Intestines/chemistry , Muscles/chemistry , Child , Child, Preschool , Female , Ganglia/chemistry , Ganglia/pathology , Hirschsprung Disease/pathology , Histocytochemistry , Humans , Infant , Intestines/pathology , Male , Muscle, Smooth/chemistry , Muscle, Smooth/pathology , Muscles/pathology , Nerve Fibers/chemistry , Nerve Fibers/pathology , Thiolester Hydrolases/analysis , Ubiquitin Thiolesterase
17.
J Pediatr Surg ; 28(8): 979-81, 1993 Aug.
Article in English | MEDLINE | ID: mdl-8229602

ABSTRACT

In the decade 1981 to 1991, 16 infants developed recurrent necrotizing enterocolitis (NEC). They comprised 12 (6%) of 196 neonates referred for further management of NEC and four others referred with major congenital anomalies. Their median gestational age was 32 weeks (range, 27 to 40), median birth weight was 1,260 g (range, 790 to 3,230), and the sex distribution was equal. Recurrent NEC occurred after a median interval of 37 days (range, 11 to 163) from the onset of the initial episode. All but one of the 16 infants were either premature (n = 10) or mature with major congenital anomalies (n = 5). Nine patients had previously undergone surgery for NEC. Medical treatment was successful in 11 patients with recurrent NEC. Two infants died, both of liver failure related to parenteral nutrition; one of whom had suffered four separate episodes of NEC and was found to have a superior mesenteric artery occlusion. There was no consistent association between recurrent NEC and the type or timing of enteral feeds or the anatomical site or method of management of the original attack. The mortality of 12.5% was similar to that for primary NEC.


Subject(s)
Enterocolitis, Pseudomembranous/surgery , Infant, Premature, Diseases/surgery , Postoperative Complications/surgery , Child , Child, Preschool , Enterocolitis, Pseudomembranous/etiology , Female , Follow-Up Studies , Gestational Age , Humans , Infant , Infant, Newborn , Infant, Premature, Diseases/etiology , Intestinal Perforation/etiology , Intestinal Perforation/surgery , Male , Postoperative Complications/etiology , Recurrence , Retrospective Studies
18.
J Pediatr Surg ; 28(8): 1059-62, 1993 Aug.
Article in English | MEDLINE | ID: mdl-7693908

ABSTRACT

Despite technically satisfactory operations, at least 20% of children with Hirschsprung's disease have an unsatisfactory postoperative result. A possible explanation for their symptoms is the retention of ganglionic intestine which has demonstrable abnormalities of the enteric nervous system. The distribution of intestinal neural proteins and peptides in resected colons from patients with Hirschsprung's disease (n = 10) was compared with that in normal controls (n = 5). Immunocytochemistry was performed using antisera against general markers of the enteric nervous system (PGP 9.5, NSE, NFILs, and S-100 protein) and colonic neuropeptides (VIP, GAL, SP, NPY, CGRP, and Met-ENK). The distribution and density of peptide-containing nerve fibers varied greatly from one patient to another and no consistent pattern of neural disturbances could be discerned in aganglionic colon. At the proximal limit of resection, abnormalities of enteric innervation were detected in 8 of 10 studied specimens. Although ganglion cells staining positively for general neuronal markers were present in all cases, normal populations of neural cell bodies immunoreactive for neuropeptides could be found in only 2 specimens. Enlarged submucosal nerve trunks found in the most proximal area of most specimens, displayed immunoreactivity for general nerve markers and VIP, GAL, NPY, and CGRP. The widely practised conventional histopathological assessment of the proximal limit of colonic neural abnormalities may be inadequate.


Subject(s)
Colon/innervation , Hirschsprung Disease/pathology , Neuropeptides/analysis , Calcitonin Gene-Related Peptide/analysis , Child , Child, Preschool , Colon/pathology , Colostomy , Enkephalin, Methionine/analysis , Female , Galanin , Hirschsprung Disease/surgery , Humans , Immunoenzyme Techniques , Infant , Male , Nerve Fibers/pathology , Neuropeptide Y/analysis , Peptides/analysis , Submucous Plexus/pathology , Substance P/analysis , Vasoactive Intestinal Peptide/analysis
19.
BMJ ; 307(6901): 447, 1993 Aug 14.
Article in English | MEDLINE | ID: mdl-8374473
20.
J Pediatr Surg ; 28(5): 720-2, 1993 May.
Article in English | MEDLINE | ID: mdl-8340867

ABSTRACT

The surgical problems encountered in treating three infants with short-bowel syndrome are reported. The two survivors demonstrate many of the problems associated with the very short-bowel syndrome and both are dependent on parenteral nutrition despite undergoing intestinal lengthening.


Subject(s)
Intestines/abnormalities , Intestines/surgery , Female , Humans , Infant, Newborn , Male , Postoperative Care , Postoperative Complications , Short Bowel Syndrome/etiology
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