331 research outputs found
A Technique for Tunneling Central Venous Catheters
Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141663/1/jpen0521.pd
New surgical approaches to ulcerative colitis in children and adults
Ulcerative colitis continues to be a devastating disease for the child and the young adult. In spite of intensive medical therapy with sulfasalazine and corticosteroids, the majority of patients with universal ulcerative colitis will ultimately require a total colectomy. The standard operation of a total proctocolectomy and a permanent end ileostomy is probably still the best procedure for the definitive management of this disease because all diseased tissue is removed with this operation; however, the resultant abdominal stoma can create significant psychological trauma in many of these patients. For that reason, sphincter-saving operations were introduced in 1933 but were only marginally successful until 1977, when renewed interest in the endorectal pull-through occurred. Since that time, several centers around the world have gained significant experience with the endorectal procedure, with or without the use of an ileal reservoir. Although the ileal reservoir appears to have certain advantages over the straight endorectal pull-through, the procedure also is associated with a significant number of complications and is a far more complicated technical exercise . The experience at the University of Michigan with the straight endorectal pullthrough procedure in patients with ulcerative colitis and familial polyposis during the period from 1977 to 1984 is herein reported. All of the patients in our series are continent and experience a median stool frequency of 6 per 24 hours 1 year after the procedure. Patient satisfaction has been excellent with the majority of patients preferring their lifestyle without an ileostomy to that experienced with an ileostomy. At the present time, we can strongly recommend the endorectal pullthrough procedure to all patients with ulcerative colitis . La colite ulcĂ©reuse reste une affection redoutable chez l'enfant et le jeune adulte. MalgrĂ© un traitement mĂ©dical intense par la sulfasalazine et les corticoĂŻdes la majoritĂ© des malades atteints de colite ulcĂ©reuse diffuse devront subir une colectomie totale. L'opĂ©ration standard, la coloprotectomie avec ilĂ©ostomie terminale permanente reste probablement la meilleure mĂ©thode de traitement de cette affection car elle permet l'exĂ©rèse totale des lĂ©sions; cependant l'ilĂ©ostomie peut ĂŞtre Ă l'origine d'un sĂ©vère traumatisme psychologique. Pour l'Ă©viter les opĂ©rations respectant l'appareil sphinctĂ©rien ont Ă©tĂ© tentĂ©es dès 1933 mais avec un succès relatif jusqu'en 1977 moment ou se manifeste un nouvel intĂ©rĂŞt pour l'abaissement endorectal de l'ilĂ©on. Depuis cette Ă©poque de multiples centres dans le monde lui ont donnĂ© la prĂ©fĂ©rence que l'abaissement transanal s'accompagne ou non de la constitution d'un rĂ©servoir ilĂ©al. Bien que le rĂ©servoir ilĂ©al prĂ©sente certains avantages sa constitution dĂ©licate s'accompagne de nombreuses complications. L'expĂ©rience de l'UniversitĂ© de Michigan concernant l'abaissement ilĂ©al transanal appliquĂ© au traitement de la colite ulcĂ©reuse et de la polypose familiale pendant la pĂ©riode s'Ă©tendant de 1977 Ă 1984 est rapportĂ©e par les auteurs. Tous les malades ainsi traitĂ©s sont continents, le nombre moyen des selles par 24 heures s'Ă©levant Ă 6. La satisfaction Ă©prouvĂ©e par la majoritĂ© des opĂ©rĂ©s est supĂ©rieure Ă celle des malades qui ont subi une coloprotectomie totale avec ilĂ©ostomie classique. A partir de ces faits, il est possible d'affirmer que l'exĂ©rèse globale du rectum et du colon avec abaissement transanal de l'ilĂ©on est l'opĂ©ration de choix. La colitis ulcerativa sigue siendo una enfermedad devastadora para el niño y el adulto joven. A pesar de terapia mĂ©dica intensa con sulfasalazina y corticosteroides, la mayorĂa de los pacientes con colitis ulcerativa universal, a la larga, requieren colectomĂa total. La operaciĂłn estandar de proctocolectomĂa total e ileostomĂa permanente todavĂa es, probablemente, el mejor procedimiento para el manejo definitivo de esta enfermedad en virtud de que la totalidad del tejido enfermo puede ser removido mediante la operaciĂłn; sinembargo, el estoma abdominal resultante puede crear un trauma psicolĂłgico significativo en muchos de estos pacientes. Para resolver este problema, en 1933 fueron introducidos los procedimientos de conservaciĂłn de esfĂnter, los cuales apenas fueron marginalmente exitosos hasta 1977, cuando se desarrollĂł un renovado interĂ©s en los procedimientos endorrectales de “pullthrough.” Desde tal Ă©poca algunos centros de diversos lugares del mundo han llegado a tener suficiente experiencia con el procedimiento endorrectal, con o sin el uso de reservorio ileal. Aun cuando el reservorio ileal parece poseer ciertas ventajas sobre el simple procedimiento de “pullthrough,” la operaciĂłn tambiĂ©n se halla asociada con un nĂşmero importante de complicaciones y significa un ejercicio quirĂşrgico tĂ©cnicamente bastante más complicado.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/41317/1/268_2005_Article_BF01656313.pd
Hirschsprung's disease
Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/47144/1/383_2004_Article_BF00166864.pd
Pediatric trauma
Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/47184/1/383_2004_Article_BF00177094.pd
Commentary
Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/47179/1/383_2004_Article_BF00182790.pd
Circumcision in the United States: medical and nonmedical attitudes
Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/47182/1/383_2004_Article_BF00177486.pd
Pediatric TPN: Efficacy and Toxicity of a New Fat Emulsion
Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141693/1/jpen0384.pd
Studies on the Toxicity and Efficacy of a New Amino Acid Solution in Pediatric Parenteral Nutrition
Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/142223/1/jpen0368.pd
Comparison of a New 10% and 20% safflower Oil Fat Emulsion in Pediatric Parenteral Nutrition
Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141546/1/jpen0236.pd
Studies on the Efficacy of a New 20% Fat Emulsion in Pediatric Parenteral Nutrition
Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141878/1/jpen0222.pd
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