The role of surgery in American Burkitt's lymphoma in children

The records of 28 children with the pathological diagnosis of American Burkitt's lymphoma were reviewed. Twenty-three of these children (82%) presented with primary abdominal tumors and 5 with disease located in the head and neck. Twelve required an emergency operation for either intestinal obstruction (3), intussusception (5), or appendicitis (4); the others underwent an elective exploration for tissue diagnosis. Ten patients had disease localized to one particular site. Seven of these 10 children underwent complete resection of the tumor including a right colectomy (4), small bowel segmental resection (1), tonsillectomy (1), and appendectomy (1). Eight children had a subtotal resection of the tumor (P < .05). In those children who had complete resection of their tumor, survival time was greater than 3.7 years. Despite the relatively small number of patients in this series, these results suggest that surgical intervention for either primary control of the tumor or for management of complications occurring during the medical treatment of this disease may be responsible for the increased survival presently seen in children with American Burkitt's lymphoma.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/29120/1/0000159.pd

Magnetic resonance imaging assessment of lipomatous soft-tissue tumors

Aim: To establish the accuracy of magnetic resonance imaging (MRI) in distinguishing between benign and malignant lipomatous tumors; to evaluate the reproducibility of the MRI interpretation assessing the agreement between judgments of two radiologists with the same experience in soft-tissue sarcomas; to identify an association among MRI findings (size, depth, septa, nodules, signal homogeneity) and nature of the lesion. Materials and Methods: A total of 54 patients (28 men and 26 women), with a mean age of 56 (range=27-84) were included years. All subjects followed-up by the Multidisciplinary Sarcoma Group. The following MRI findings were judged in a blind study by two radiologists: Size, localization, septa, nodules and signal homogeneity. A diagnostic indication was then given from among lipoma, atypical lipomatous tumour (ALT) and liposarcoma. Accuracy in distinguishing between benign and malignant lesions, and between lipoma and ALT (Fisher's exact test), inter-operator agreement (Cohen's kappa), association of MRI findings and malignancy of the lesion (Fisher's exact test and odds ratio) were evaluated. Results: The inter-operator agreement was complete (100%). The agreement between diagnostic hypothesis and histological diagnosis was statistically significant (p<0.05). Among the radiological findings taken into account, only septa and signal homogeneity were significantly associated with the malignancy of the lesion (p<0.05). Conclusion: MRI could be helpful in distinguishing lipomatous tumors, allowing biopsy to be avoided in some cases (negative predictive value=100%)

Surgical treatment of thyrotoxicosis in children and adolescents

Forty-one children and adolescents had thyroidectomies for Grave's disease during an 8 yr period. Twenty patients became euthyroid within a short period after treatment with antithyroid drugs and had operations with minimal disruption of their lives. Antithyroid drugs were administered to 20 patients for a longer period of time as a primary form of treatment for Grave's disease. Complications resulting from drug toxicity, poor cooperation by patients, and persistent goiters were indications for thyroidectomies in this group. Permanent remissions, after prolonged antithyroid drug therapy, are rare in children. Because the treatment is associated with significant morbidity, this form of therapy is unacceptable in most cases. Iodine-131 was given to 30 children or adolescents for Grave's disease during the same time period. Iodine-131 is primarily indicated for patients who are resistant or allergic to antithyroid drugs, who have serious systemic diseases, or who have had previous thyroid operations. Hypothyroidism is an inevitable result of effective 131I treatment of Grave's disease in children. Serious consequences from 131I therapy were not observed during the short period of follow-up. Subtotal thyroidectomy continues to be the preferred primary treatment for most patients with Grave's disease in childhood. Total thyroidectomy may be indicated for patients in the first decade of life. Hypothyroidism, which is easily managed in this age group, is the price paid for the prevention of recurrent Grave's disease. Early detection and treatment of hypothyroidism can be achieved only by a careful follow-up of all patients treated by less than total thyroidectomy for Grave's disease.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/22804/1/0000361.pd

The effect of pyloromyotomy on serum and luminal gastrin in infants with hypertrophic pyloric stenosis

Previous studies of the pathogenesis of congenital hypertrophic pyloric stenosis (CHPS) have implicated immunoreactive gastrin, although no consistent relationship has been demonstrated. In this study we have examined the effect which pyloromyotomy has on serum and luminal gastrin concentration after a mechanical and protein stimulus. Seventeen infants were examined preoperatively, and 1 week after pyloromyotomy. On each occasion, samples of serum and gastric contents were collected from fasting infants. Sixty cubic centimeters of water was placed into the stomach and further samples collected 20 min later. The water was then aspirated and replaced by 60 cc of 10% peptone broth and a third set of samples collected after 20 min. All samples from each patient were analyzed for immunoreactive gastrin in the same assay. Pyloromyotomy did not alter fasting serum gastrin (119.3 pg +/- 11.9 preop vs 164.7 +/- 29.9 postop) nor did it alter the gastrin response to water. Pyloromyotomy decreased the incremental serum gastrin response to peptone broth (66.6 +/- 16.9 preop vs 18.9 +/- 11.7 postop). Luminal gastrin concentration was not significantly affected by pyloromyotomy. When the pre- and postoperative serum gastrin increments for water and peptone were plotted against the fasting gastrin levels, an inverse relationship was apparent which was statistically significant by regression analysis. Seen in this way, intragastric water and peptone have a dual effect on serum gastrin; a rise if the fasting serum gastrin concentration is low; a fall or lesser rise if the fasting serum gastrin concentration is high. The data suggest that the direction and magnitude of serum gastrin response to intragastric water or peptone is set by the fasting level, and is independent of pyloromyotomy.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/23236/1/0000169.pd

An Analysis of Factors Contributing to the Development of Total Parenteral Nutrition‐Induced Cholestasis

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141659/1/jpen0586.pd

Long-term radiographic follow-up of the Nissen fundoplication in children

This study examined 46 children 5–9 years (mean 6.7) after Nissen fundoplication surgery for gastroesophageal reflux (GER). Eleven were deceased and ten of the 35 families declined objective evaluation. The remaining 25 children (71%) had a barium swallow examination. In 16 of the 25 patients the fundoplication was intact. In 2 patients a small portion of the fundoplication was displaced above the diaphragm. In 5 patients there was residual esophageal disease. In 3 patients (one with esophageal disease), with a hiatus hernia prior to surgery, despite immediate postoperative reduction, the barium swallow examination done for this study revealed recurrent hiatus hernia but no GER. Long-term results of the Nissen fundoplication reveal success in eliminating clinically significant gastroesophageal reflux. Those patients with esophageal disease prior to the surgery need close interval follow-up to monitor continuing problems.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/46689/1/247_2006_Article_BF02389563.pd

Dermatoglyphic patterns in children with chronic constipation

Analysis of the fine ridge configurations on the digits of the palms and soles (dermatoglyphics) may sometimes help in the diagnoses of certain medical disorders. Dermatoglyphic patterns have been reported to be associated with congenital anomalies, such as congenital heart disease, duodenal ulcer, abdominal pain, and constipation. The palmar dermatoglyphic patterns of 77 children with constipation (39 functional and 38 organic constipation) were recorded. The control group consisted of 84 children with inguinal hernia. Those patients with at least one arch identified on any digit of either hand were termed arch positive. There was no significant correlation between arch positivity and constipation (functional or organic), or inguinal hernia (chi square, P =0.9211). Therefore, the presence of palmar arches cannot be used as a screening device for children with chronic constipation, especially of organic etiology.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/44424/1/10620_2005_Article_BF02285186.pd