Two patients with nesidioblastosis, one with persistent hypoglycemia and another who was asymptom... more Two patients with nesidioblastosis, one with persistent hypoglycemia and another who was asymptomatic, underwent pancreatic resection. Dispersed pancreatic islets were prepared from each patient. Insulin secretion from cultured islet cells was increased and somatostatin decreased in the symptomatic patient compared with the asymptomatic patient. Immunocytochemistry showed increased somatostatin-containing cells in the asymptomatic patient. We hypothesize that this may be the mechanism by which some patients with nesidioblastosis maintain normal serum glucose levels.
1. We recommend that every dialysis session in every patient be monitored for hypotension, with s... more 1. We recommend that every dialysis session in every patient be monitored for hypotension, with special attention to patients at higher risk. 2. It is one of the most common complications seen in 25%–60% (depending on the definition) of treatment sessions and can range from asymptomatic-to-severe drop in BP. 3. It is more common in females, elderly, and those with CVD and neuropathy. 4. Often related to excessive UF (patients with excessive weight gain or erroneous target weight). 5. It is accompanied by symptoms such as abdominal discomfort, yawning, sighing, nausea, vomiting, muscle cramps, restlessness, dizziness, syncope, or simply as extreme anxiety. It can precipitate cardiac or cerebral ischemia.
This is a review of a child who developed symptomatic anemia secondary to a huge Meckel's Div... more This is a review of a child who developed symptomatic anemia secondary to a huge Meckel's Diverticulum (MD). The patient presented with multiple complications, such as: neoplasia, occult chronic bleeding, giant size MD, partial intestinal obstruction and severe symptomatic anemia. There was complete resolution of the condition after resection and ileo-ileal anastomosis. After revision of the literature, this case is the first report of MD occurring concomitantly with such a myriad of signs and symptoms.
This report describes the diagnosis and management of a "giant cystic malformation of th... more This report describes the diagnosis and management of a "giant cystic malformation of the gallbladder," in a child with multiple congenital anomalies.
Prior experience with the rare combination of horseshoe kidney and significant atherosclerotic va... more Prior experience with the rare combination of horseshoe kidney and significant atherosclerotic vascular disease suggests difficulty in intraoperative management, often requiring division of the renal isthmus or sacrifice of some renal tissue. Seven patients have been managed successfully over the past ten years at The Ohio State University Hospital. There were six men and one woman, ranging in age from 39 to 66 years. Of the five patients with abdominal aortic aneurysm, four had a pulsatile abdominal mass, three had abdominal pain, and one had back pain. The other two patients had progressively symptomatic aortoiliac disease. All seven patients had hypertension, easily controlled by medication. Critical diagnostic procedures are preoperative intravenous pyelogram (IVP) and abdominal aortic arteriogram. The IVP detected the previously unsuspected diagnosis in 100% of the cases. The arteriogram accurately located the aneurysm in relation to the renal vascular supply, and disclosed aberrant blood supply in three of four patients with aberrant vessels. All seven horseshoe kidneys were fused at the lower pole. The operative approach involves meticulous dissection of the aberrant blood supply to the kidneys, and mobilization of the isthmus for adequate retrorenal aortic exposure. In six of the seven patients, the grafts were placed posterior to the isthmus. There were no deaths, and there were no complications related to the presence of the horseshoe kidney. In three of the seven patients, hypertension improved. Patients with horseshoe kidney and aortic disease may be safely operated upon without damage to the kidney. IVP and selective angiography are essential to provide preoperative information.
This study was designed to estimate the partial and complete response rates (CR and PR) of two no... more This study was designed to estimate the partial and complete response rates (CR and PR) of two novel drug pairs (vincristine and melphalan vs. ifosfamide and etoposide) and to improve overall survival of previously untreated patients with metastatic rhabdomyosarcoma. One hundred twenty-eight patients were randomly assigned to phase II window therapy consisting of vincristine and melphalan (VM-containing regimen) or ifosfamide and etoposide (IE-containing regimen). Brief window therapy (12 wks) was immediately followed-up by vincristine, dactinomycin, and cyclophosphamide (VAC), chemotherapy, surgery, and irradiation, with continuation of either VM or IE in patients with initial response. Major endpoints were initial CR and PR rates after the phase II window phase of therapy, failure-free survival (FFS), and survival. Patients who received the VM-containing regimen experienced significantly more anemia, neutropenia, thrombocytopenia, and had more cyclophosphamide dose reductions. The...
This study was designed to estimate the partial and complete response rates (CR and PR) of two no... more This study was designed to estimate the partial and complete response rates (CR and PR) of two novel drug pairs (vincristine and melphalan vs. ifosfamide and etoposide) and to improve overall survival of previously untreated patients with metastatic rhabdomyosarcoma. One hundred twenty-eight patients were randomly assigned to phase II window therapy consisting of vincristine and melphalan (VM-containing regimen) or ifosfamide and etoposide (IE-containing regimen). Brief window therapy (12 wks) was immediately followed-up by vincristine, dactinomycin, and cyclophosphamide (VAC), chemotherapy, surgery, and irradiation, with continuation of either VM or IE in patients with initial response. Major endpoints were initial CR and PR rates after the phase II window phase of therapy, failure-free survival (FFS), and survival. Patients who received the VM-containing regimen experienced significantly more anemia, neutropenia, thrombocytopenia, and had more cyclophosphamide dose reductions. The...
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, Jan 15, 2001
The study goal was to improve outcome in children with rhabdomyosarcoma by comparing risk-based r... more The study goal was to improve outcome in children with rhabdomyosarcoma by comparing risk-based regimens of surgery, radiotherapy (RT) and chemotherapy. Eight hundred eighty-three previously untreated eligible patients with nonmetastatic rhabdomyosarcoma entered the Intergroup Rhabdomyosarcoma Study-IV (IRS-IV) (1991 to 1997) after surgery and were randomized treatment by primary tumor site, group (1 to 3), and stage (I to III). Failure-free survival (FFS) rates and survival were the end points used in comparisons between randomized groups and between patient subgroups treated on IRS-III and IRS-IV. Most patients were randomized to receive vincristine and dactinomycin (VA) and cyclophosphamide (VAC, n = 235), or VA and ifosfamide (VAI, n = 222), or vincristine, ifosfamide, and etoposide (VIE, n = 236). Patients with group 3 tumors were randomized to receive conventional RT (C-RT) versus hyperfractionated RT (HF-RT). Overall 3-year FFS and survival were 77% and 86%, respectively. Thr...
Lung resections in children are performed for a variety of reasons including congenital malformat... more Lung resections in children are performed for a variety of reasons including congenital malformations, infections, bronchiectasis, and tumors. There are no long-term reports on pneumonectomy alone in children, but those on lung resection as a group state that children tolerate these operations well, with mild sequelae if any, and that the majority of them in adulthood can perform non-physically demanding jobs adequately. The authors' findings concur with the reports that younger patients can endure pulmonary resections with minimal functional limitations.
The realm of laparoscopic surgery has extended to include the neonate as well as the pediatric pa... more The realm of laparoscopic surgery has extended to include the neonate as well as the pediatric patient. The advent of new and smaller instrumentation has facilitated this goal. Previous procedures exclusively relegated to laparotomy can now be accomplished as outpatient procedures. Removal of the acute appendix, correction of torsion of an adnexa, as well as the appropriate diagnosis and initial treatment of acute pelvic inflammatory disease are now well established laparoscopic procedures. This article provides insight into the laparoscopic evaluation and management of a number of challenging clinical problems for the endoscopic surgeon, thus providing a minimally invasive approach for patients ranging from neonates to adults.
Recent technological innovations have improved our ability to perform thoracoscopy in children. V... more Recent technological innovations have improved our ability to perform thoracoscopy in children. Video imaging improves thoracoscopic visualization and enhances the role of the surgical assistant. The placement of multiple access ports improves the thoracoscopic manipulation of tissue. The laser permits the application of thermal energy to intrathoracic tissue for hemostasis without the risk of cardiac fibrillation. The endoscopic stapler allows hemostatic, airtight lung resection which obviates the need for routine tube thoracostomy. Our initial experience with these innovations applied to thoracoscopy was successful in 9 of 12 patients, ages 5 months to 17 years. For diagnostic cases, adequate tissue for histologic evaluation was always obtained. Complications of successful thoracoscopy included suspected air embolus on establishing the initial pneumothorax and persistent air leak requiring tube thoracostomy after resection of a bronchogenic cyst. There were no perioperative deaths...
Two patients with nesidioblastosis, one with persistent hypoglycemia and another who was asymptom... more Two patients with nesidioblastosis, one with persistent hypoglycemia and another who was asymptomatic, underwent pancreatic resection. Dispersed pancreatic islets were prepared from each patient. Insulin secretion from cultured islet cells was increased and somatostatin decreased in the symptomatic patient compared with the asymptomatic patient. Immunocytochemistry showed increased somatostatin-containing cells in the asymptomatic patient. We hypothesize that this may be the mechanism by which some patients with nesidioblastosis maintain normal serum glucose levels.
1. We recommend that every dialysis session in every patient be monitored for hypotension, with s... more 1. We recommend that every dialysis session in every patient be monitored for hypotension, with special attention to patients at higher risk. 2. It is one of the most common complications seen in 25%–60% (depending on the definition) of treatment sessions and can range from asymptomatic-to-severe drop in BP. 3. It is more common in females, elderly, and those with CVD and neuropathy. 4. Often related to excessive UF (patients with excessive weight gain or erroneous target weight). 5. It is accompanied by symptoms such as abdominal discomfort, yawning, sighing, nausea, vomiting, muscle cramps, restlessness, dizziness, syncope, or simply as extreme anxiety. It can precipitate cardiac or cerebral ischemia.
This is a review of a child who developed symptomatic anemia secondary to a huge Meckel's Div... more This is a review of a child who developed symptomatic anemia secondary to a huge Meckel's Diverticulum (MD). The patient presented with multiple complications, such as: neoplasia, occult chronic bleeding, giant size MD, partial intestinal obstruction and severe symptomatic anemia. There was complete resolution of the condition after resection and ileo-ileal anastomosis. After revision of the literature, this case is the first report of MD occurring concomitantly with such a myriad of signs and symptoms.
This report describes the diagnosis and management of a "giant cystic malformation of th... more This report describes the diagnosis and management of a "giant cystic malformation of the gallbladder," in a child with multiple congenital anomalies.
Prior experience with the rare combination of horseshoe kidney and significant atherosclerotic va... more Prior experience with the rare combination of horseshoe kidney and significant atherosclerotic vascular disease suggests difficulty in intraoperative management, often requiring division of the renal isthmus or sacrifice of some renal tissue. Seven patients have been managed successfully over the past ten years at The Ohio State University Hospital. There were six men and one woman, ranging in age from 39 to 66 years. Of the five patients with abdominal aortic aneurysm, four had a pulsatile abdominal mass, three had abdominal pain, and one had back pain. The other two patients had progressively symptomatic aortoiliac disease. All seven patients had hypertension, easily controlled by medication. Critical diagnostic procedures are preoperative intravenous pyelogram (IVP) and abdominal aortic arteriogram. The IVP detected the previously unsuspected diagnosis in 100% of the cases. The arteriogram accurately located the aneurysm in relation to the renal vascular supply, and disclosed aberrant blood supply in three of four patients with aberrant vessels. All seven horseshoe kidneys were fused at the lower pole. The operative approach involves meticulous dissection of the aberrant blood supply to the kidneys, and mobilization of the isthmus for adequate retrorenal aortic exposure. In six of the seven patients, the grafts were placed posterior to the isthmus. There were no deaths, and there were no complications related to the presence of the horseshoe kidney. In three of the seven patients, hypertension improved. Patients with horseshoe kidney and aortic disease may be safely operated upon without damage to the kidney. IVP and selective angiography are essential to provide preoperative information.
This study was designed to estimate the partial and complete response rates (CR and PR) of two no... more This study was designed to estimate the partial and complete response rates (CR and PR) of two novel drug pairs (vincristine and melphalan vs. ifosfamide and etoposide) and to improve overall survival of previously untreated patients with metastatic rhabdomyosarcoma. One hundred twenty-eight patients were randomly assigned to phase II window therapy consisting of vincristine and melphalan (VM-containing regimen) or ifosfamide and etoposide (IE-containing regimen). Brief window therapy (12 wks) was immediately followed-up by vincristine, dactinomycin, and cyclophosphamide (VAC), chemotherapy, surgery, and irradiation, with continuation of either VM or IE in patients with initial response. Major endpoints were initial CR and PR rates after the phase II window phase of therapy, failure-free survival (FFS), and survival. Patients who received the VM-containing regimen experienced significantly more anemia, neutropenia, thrombocytopenia, and had more cyclophosphamide dose reductions. The...
This study was designed to estimate the partial and complete response rates (CR and PR) of two no... more This study was designed to estimate the partial and complete response rates (CR and PR) of two novel drug pairs (vincristine and melphalan vs. ifosfamide and etoposide) and to improve overall survival of previously untreated patients with metastatic rhabdomyosarcoma. One hundred twenty-eight patients were randomly assigned to phase II window therapy consisting of vincristine and melphalan (VM-containing regimen) or ifosfamide and etoposide (IE-containing regimen). Brief window therapy (12 wks) was immediately followed-up by vincristine, dactinomycin, and cyclophosphamide (VAC), chemotherapy, surgery, and irradiation, with continuation of either VM or IE in patients with initial response. Major endpoints were initial CR and PR rates after the phase II window phase of therapy, failure-free survival (FFS), and survival. Patients who received the VM-containing regimen experienced significantly more anemia, neutropenia, thrombocytopenia, and had more cyclophosphamide dose reductions. The...
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, Jan 15, 2001
The study goal was to improve outcome in children with rhabdomyosarcoma by comparing risk-based r... more The study goal was to improve outcome in children with rhabdomyosarcoma by comparing risk-based regimens of surgery, radiotherapy (RT) and chemotherapy. Eight hundred eighty-three previously untreated eligible patients with nonmetastatic rhabdomyosarcoma entered the Intergroup Rhabdomyosarcoma Study-IV (IRS-IV) (1991 to 1997) after surgery and were randomized treatment by primary tumor site, group (1 to 3), and stage (I to III). Failure-free survival (FFS) rates and survival were the end points used in comparisons between randomized groups and between patient subgroups treated on IRS-III and IRS-IV. Most patients were randomized to receive vincristine and dactinomycin (VA) and cyclophosphamide (VAC, n = 235), or VA and ifosfamide (VAI, n = 222), or vincristine, ifosfamide, and etoposide (VIE, n = 236). Patients with group 3 tumors were randomized to receive conventional RT (C-RT) versus hyperfractionated RT (HF-RT). Overall 3-year FFS and survival were 77% and 86%, respectively. Thr...
Lung resections in children are performed for a variety of reasons including congenital malformat... more Lung resections in children are performed for a variety of reasons including congenital malformations, infections, bronchiectasis, and tumors. There are no long-term reports on pneumonectomy alone in children, but those on lung resection as a group state that children tolerate these operations well, with mild sequelae if any, and that the majority of them in adulthood can perform non-physically demanding jobs adequately. The authors' findings concur with the reports that younger patients can endure pulmonary resections with minimal functional limitations.
The realm of laparoscopic surgery has extended to include the neonate as well as the pediatric pa... more The realm of laparoscopic surgery has extended to include the neonate as well as the pediatric patient. The advent of new and smaller instrumentation has facilitated this goal. Previous procedures exclusively relegated to laparotomy can now be accomplished as outpatient procedures. Removal of the acute appendix, correction of torsion of an adnexa, as well as the appropriate diagnosis and initial treatment of acute pelvic inflammatory disease are now well established laparoscopic procedures. This article provides insight into the laparoscopic evaluation and management of a number of challenging clinical problems for the endoscopic surgeon, thus providing a minimally invasive approach for patients ranging from neonates to adults.
Recent technological innovations have improved our ability to perform thoracoscopy in children. V... more Recent technological innovations have improved our ability to perform thoracoscopy in children. Video imaging improves thoracoscopic visualization and enhances the role of the surgical assistant. The placement of multiple access ports improves the thoracoscopic manipulation of tissue. The laser permits the application of thermal energy to intrathoracic tissue for hemostasis without the risk of cardiac fibrillation. The endoscopic stapler allows hemostatic, airtight lung resection which obviates the need for routine tube thoracostomy. Our initial experience with these innovations applied to thoracoscopy was successful in 9 of 12 patients, ages 5 months to 17 years. For diagnostic cases, adequate tissue for histologic evaluation was always obtained. Complications of successful thoracoscopy included suspected air embolus on establishing the initial pneumothorax and persistent air leak requiring tube thoracostomy after resection of a bronchogenic cyst. There were no perioperative deaths...
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