Lewis Spitz - Independent Researcher (original) (raw)

Papers by Lewis Spitz

Gastric Transposition for Esophageal Replacement in Children

Annals of Surgery, 2002

ABSTRACT Objective: To evaluate the authors’ experience with gastric transposition as a method of... more ABSTRACT Objective: To evaluate the authors’ experience with gastric transposition as a method of esophageal replacement in children with congenital or acquired abnormalities of the esophagus. Summary Background Data: Esophageal replacement in children is almost always done for benign disease and thus requires a conduit that will last more than 70 years. The organ most commonly used in the past has been colon; however, most series have been fraught with major complications and conduit loss. For these reasons, in 1985 the authors switched from using colon interpositions to gastric transpositions for esophageal replacement in infants and children. Methods: The authors retrospectively reviewed the records of 41 patients with the diagnoses of esophageal atresia (n = 26), corrosive injury (n = 8), leiomyomatosis (n = 5), and refractory gastroesophageal reflux (n = 2) who underwent gastric transposition for esophageal replacement. Results: Mean ± SE age at the time of gastric transposition was 3.3 ± 0.6 years. All but two transpositions were performed through the posterior mediastinum without mortality or loss of the gastric conduit despite previous surgery on the gastric fundus in 8 (20%), previous esophageal operations in 15 (37%), and previous esophageal perforations in 6 (15%) patients. Complications included esophagogastric anastomotic leak (n = 15, 36%), which uniformly resolved without intervention; stricture formation (n = 20, 49%), all of which no longer require dilation; and feeding intolerance necessitating jejunal feeding (n = 8, 20%) due to delayed gastric emptying (n = 3), feeding aversion related to the underlying anomaly (n = 1), or severe neurological impairment (n = 4). No redo anastomoses were required. Conclusions: Gastric transposition reestablishes effective gastrointestinal continuity with few complications. Oral feeding and appropriate weight gain are achieved in most children. Therefore, gastric transposition is an appropriate alternative for esophageal replacement in infants and children.

Chronic intestinal pseudo-obstruction: treatment and long term follow up of 44 patients

Archives of Disease in Childhood, 1999

Archives of Disease in Childhood, 1984

The bacteriological findings of a study of intestinal colonisation in 24 neonates with oesophagea... more The bacteriological findings of a study of intestinal colonisation in 24 neonates with oesophageal atresia are reported. Only five of the patients received antibiotics. When compared with published findings in healthy neonates, the rate of intestinal colonisation in our series was prolonged, with Staphylococcus albus predominating in the first week. Anaerobic colonisation was delayed and bacteroides spp were present in only five patients by the third week. Bifidobacteria were almost completely absent. The onset of intestinal colonisation seemed to be related temporally to enteral feeding. The use of antibiotics in five patients resulted in colonisation by candida in four and clinical thrush in three.

Mesenchymal hamartoma of the liver

Indian Journal of …, 1974

... Hamar-toma of the liver. Surgery, 29, 593. Benson, CD and Penberthy, GC (1942). Surgical exci... more ... Hamar-toma of the liver. Surgery, 29, 593. Benson, CD and Penberthy, GC (1942). Surgical excision of a primary tumour of liver (hamartoma) in an infant with recovery. Surgery, 12, 881. ... Med. Trop. (Mareille), 24, 310. Gerding, W.Jo, Popp. MF and Fartineau, PC (1951). ...

Archives of Disease in Childhood, 1979

An analysis of the factors which may predispose towards postoperative vomiting after pyloromyotom... more An analysis of the factors which may predispose towards postoperative vomiting after pyloromyotomy for hypertrophic pyloric stenosis was carried out in 72 infants at this hospital. 26 (36%) infants experienced moderate to severe postoperative vomiting of sufficient intensity to cause the postoperative feeding regimen to be modified or interrupted. Only two parameters were found to be of statistical significance. These were the state of the oesophageal mucous membrane on endoscopical examination and the presence of haematemesis in the preoperative period. No evidence for a gastric mucosal lesion could be found. An advanced oesophageal mucosal lesion was found in 30% of patients, and this was the source of the haemorrhage in all 11 in whom haematemesis was noted preoperatively. The stay in hospital was prolonged (8 days) in those infants with troublesome vomiting postoperatively compared with those with lesser problems (3 days).

Journal of Pediatric Surgery, 1972

T HE TRAUMATIC EFFECTS of various types of vascular clamps on the arterial wall has been extensiv... more T HE TRAUMATIC EFFECTS of various types of vascular clamps on the arterial wall has been extensively reported,rs5 and histological changes described in detail.8 Varying degrees of intimal damage have been found to occur with all instruments, with the possible exception of the Fogarty hydragrip clamp. A similar effect on the mucosa of the intestinal wall from occlusive "noncrushing" clamps might be expected and so a comparative study has been carried out into the effects on the intestinal wall of the various clamps commonly used in pediatric intestinal surgery. MATERIALS AND METHODS Rabbits of mixed stock, 6-6 wk old, were used in these experiments and were anesthetized with i.v. nembutal supplemented by ether inhalation. Clamps were applied to the small intestine for a period of 30 min. Adjustable clamps were applied with a minimum of holding power compatible with an acceptable degree of occlusion. The animals were sacrificed at 1, 6, 24, 72, and 168 hr. The clamps used were a straight Potts vascular clamp, a bulldog clamp with cloth covers, Doyens clamps with and without rubber covers, a Fogarty hydragrip clamp using two opposing hydrajaws, an Edslab parallel jaw spring clip, and an Edslab regular handleless clamp. RESULTS Macroscopic Appearances The effect on the mucosal surface produced by the various clamps used is shown in Table 1. The bulldog clamp caused severe mucosal damage in all specimens examined in the first 24 hrs (Fig. 1A). The Potts (Fig. 1B) and Fogarty hydragrip (Fig. 1C) clamps were moderately traumatic. A Doyen-type clamp without protective covering and the Edslab spring clip and handleless clamps produced little or no detectable change. Microscopic Examination Histological examination of material from two animals in each group sacrificed at 1, 6, 24, and 72 hrs was carried out. The absence of changes in the latter two groups made examination at 168 hrs superfluous. The results are shown in Table 2. Damage was confined largely to the mucosa with epithelial necrosis, congestion of the lamina propria with fibrin exudation, and edema

Archives of Disease in Childhood, 1986

We report 37 patients ranging in age from 1 month to 14 years treated for intestinal malrotation ... more We report 37 patients ranging in age from 1 month to 14 years treated for intestinal malrotation during a five year period. The main presenting features consisted of intermittent attacks of vomiting (15 patients), failure to thrive (seven), and recurrent colicky abdominal pain (seven). The diagnosis was confirmed by gastrointestinal contrast studies in all but three patients. A standard Ladd's procedure comprised the definitive surgical treatment. We emphasise the poor nutritional state at the time of operation (49% of the cases were on or below the third centile). In contrast with neonatal presentation, volvulus of the midgut occurred in only five patients (14%) compared with 68% in neonates with malrotation. There were two deaths in the series. Ninety four per cent of the remaining patients responded favourably to the operative procedure. Malrotation should be considered in the differential diagnosis of a wide variety of symptoms and should be treated promptly once the diagnosis has been confirmed.

Journal of Pediatric Surgery, 2003

Background/Purpose: A small proportion of infants born with oesophageal atresia in which the gap ... more Background/Purpose: A small proportion of infants born with oesophageal atresia in which the gap between the 2 ends of the oesophagus is too great for an end-to-end anastomosis will require oesophageal replacement. Since 1981 the author's procedure of choice for oesophageal replacement has been gastric transposition. The long-term functional outcome appears to be satisfactory, but the quality of life of these patients has not been investigated formally. This report assesses the health-related quality of life (QOL) of 2 groups of patients born with oesophageal atresia who have undergone gastric transposition. Methods: The study group comprised 28 patients aged 2 to 22 years who resided in England. Group 1 (n ϭ 13), comprised patients who had undergone cervical oesophagostomy and gastrostomy without attempt at oesophageal anastomosis; group 2 (n ϭ 15), comprised patients who had undergone previous attempts at reconstruction or replacement. QOL was assessed using modified versions of the Gastrointestinal Quality Of Life Index (GIQLI). Results: QOL scores based on patients' responses showed no significant differences between the groups (124 v 119). However, the disease-specific symptom scores showed that patients in group 1 experienced fewer symptoms compared with those in group 2. Additionally, based on parental responses, patients in group 1 had higher QOL scores than those in group 2. QOL scores for patients aged 2 to 4 years (n ϭ 5) did not differ between the groups (81 v 92, not significant). Conclusions: The quality of life for patients with oesophageal atresia undergoing gastric transposition was generally unimpaired by any side effects of gastric transposition. Patients undergoing gastric transposition as a primary procedure experienced fewer disease-specific symptoms in the medium term compared with patients who had undergone previous unsuccessful attempts at reconstruction or replacement of their oesophagus.

Archives of Disease in Childhood, 1989

9 Thirty full-term infants born with surgically correctable life-threatening abnormalities who un... more 9 Thirty full-term infants born with surgically correctable life-threatening abnormalities who underwent emergency neonatal surgery were followed up from birth to 3 years of age. Comparable data were obtained on a matched group of healthy newborn babies. At 3 years the cognitive functioning of children whose condition had been resolved in the early months of life was similar to the controls. Those children who required further medical or surgical treatment were functioning at lower levels than the controls, with language development being most affected. Number of operations, defined as all procedures under general anesthetic, was the medical factor most strongly associated with poorer outcome at 3 years. Family factors-higher maternal IQ and nonmanual social class-were also positively correlated with language development.

Duodenal Atresia Associated With Midgut Deletion in Cloacal Exstrophy: A New Association?

The Journal of Urology, 2001