Papers by Michael Gauderer
Enterostomies are key interventions in the management of various surgical and nonsurgical pediatr... more Enterostomies are key interventions in the management of various surgical and nonsurgical pediatric conditions. They are employed for feeding, decompression, or a combination of both. A large palette of options is now available, the choice of procedure depending on the specific indication, the experience of the management team and the available resources. If the access is primarily for long-term feeding, the optimal kind must be carefully chosen, taking into account the patients' specific needs, comorbidities, habitus, and caretakers' experience. Ideally the choice is a team decision. Regular early and long-term follow-up are essential to assure optimal functionality and minimal morbidity.
Springer eBooks, Dec 22, 2005
Springer eBooks, Nov 13, 2017
Enterostomies are key interventions in the management of various surgical and nonsurgical pediatr... more Enterostomies are key interventions in the management of various surgical and nonsurgical pediatric conditions. They are employed for feeding, decompression, or a combination of both. A large palette of options is now available, the choice of procedure depending on the specific indication, the experience of the management team and the available resources. If the access is primarily for long-term feeding, the optimal kind must be carefully chosen, taking into account the patients' specific needs, comorbidities, habitus, and caretakers' experience. Ideally the choice is a team decision. Regular early and long-term follow-up are essential to assure optimal functionality and minimal morbidity.
Journal of Pediatric Surgery, Aug 1, 1981
CRC Press eBooks, Apr 30, 2003
Journal of Pediatric Surgery, Aug 1, 1984
Cleveland, Ohio 9 The outcome of 139 fetuses with anatomical abnormalities diagnosed by ultrasono... more Cleveland, Ohio 9 The outcome of 139 fetuses with anatomical abnormalities diagnosed by ultrasonography (out of 15,180 examinations) at our institution during the last 6 years was reviewed. Of these, 56 were diagnosed before 21 weeks gestational age and 83 thereafter. Fifty-four had anomalies of the central nervous system. Of these 27 were diagnosed early. Twentysix had anomalies of the genitourinary tract, 11 diagnosed early. Four had anomalies of the muscu-Ioskeletal system diagnosed early in 3. Thirty-seven had miscellaneous anomalies and early diagnosis was made in 6. Only the early pregnancies were terminated, 38 in number. The fetal diagnosis was clearly confirmed in 33. Of particular interest were the 18 fetuses with anomalies of the gastrointestinal tract and abdominal wall. There were nine early diagnoses. The pregnancy was interrupted in seven. In all the diagnosis was confirmed. Five of these had associated anomalies. Among the 9 fetuses whose anomalies were diagnosed late, 3 had associated anomalies and died shortly after birth before corrective surgery. In all, two fetuses with abdominal wall defects had no detectable associated anomalies and were potentially correctable but the pregnancies were terminated. With earlier, accurate imaging diagnosis possible, special attention has to be directed toward multidisciplined counseling (including a pediatric surgeon) for ultimately satisfactory fetal-neonatal salvage. Otherwise the spectrum of neonatal surgical pathology could be seriously altered. INDEX WORDS: Ultrasound; antenatal diagnosis. '•/•rITH the rapid strides in technical development of ultrasonic equipment coupled with the increasing expertise of the ultrasonographer, it is now possible to make much earlier and more accurate intrauterine diagnoses of fetal anatomical malformations, l ~0 Since these ana-From the
Journal of Pediatric Surgery, Jul 1, 1989
The presence of a parent in the operating room (OR) during induction of anesthesia is controversi... more The presence of a parent in the operating room (OR) during induction of anesthesia is controversial. In order to assess the feasibility, safety, and acceptance of this practice, we evaluated a near-4-year experience with 3,086 patients <15 years of age, who were operated on at a free-standing ambulatory surgical center. The age distribution was: 1 to 23 months, 790; 2 to 5 years, 1,190; 6 to 10 years, 775; and 10 to 15 years, 331. The distribution of patients by service was: otorhinolaryngology, 1,597; pediatric surgery, pediatric urology, and plastic surgery, 948; ophthalmology, 443; orthopaedics, 72; and dental, 26. No premedlcation was employed. Anesthetic gases were delivered via a mask while the parent held or remained close to the child. Vascular access was established after the induction. Only five patients (tonsillectomy, four; circumcision, one) were admitted to the base hospital and subsequently discharged. Advantages of parental presence in the OR during anesthesia induction are decreased psychological trauma (child), smoother induction (child), and decreased parental anxiety. Possible disadvantages include disruption of OR routine, unpredictability of parental behavior, and increased time and cost. Because of careful preoperative preparation of parents by the nurses and anesthetists, the first three problems rarely occurred. The cost of supplies used by each parent was minimal. Practically all parents chose to accompany the child to the OR. The feedback during follow-up from those parents has been excellent. Nurses, anesthesiologists, and surgeons are enthusiastic about the program. In the examined setting, this approach has proven safe, simple, and effective.
Clinical Nutrition, Apr 1, 2002
FThis paper is based on the opening lecture of the 23rd Congress of the European Society of Paren... more FThis paper is based on the opening lecture of the 23rd Congress of the European Society of Parenteral and Enteral Nutrition (ESPEN), given on September 9, 200l in Muenchen, Germany. The article relates the story of the origin and the evolution of the percutaneous endoscopic gastrostomy or PEG, based on the then-novel concept of sutureless approximation of a hollow viscus to the abdominal wall. It also provides a perspective of the clinical applications of PEG, in general, and the author's pediatric experience in particular. Additionally, it briefly describes the old and new expanded applications of the PEG concept. In this communication, the author of the procedure encourages young investigators to ask relevant questions in research and in clinical settings aimed at developing new ideas and concepts in the field of nutrition. He also stresses the need to carefully reflect upon the ethical and moral implications of new discoveries. The article contains pertinent illustrations and bibliographic references.
Journal of Pediatric Surgery, 2009
This Robert E. Gross lecture is an analysis of the concept of creativity and how it relates to th... more This Robert E. Gross lecture is an analysis of the concept of creativity and how it relates to the practice of surgery. The questions-why surgery and creativity are closely associated; what influences creativity; why we should be concerned about it; and, finally, what rewards it brings-are discussed. In a personal note, the author describes his approach to creativity, with simplification as a central theme. He presents 6 examples of his work and the lessons learned from this activity. He stresses the importance of fostering creativity in all institutions in which physicians are trained and the need to focus on medical students, residents, and fellows. The critical importance of identifying, nurturing, and protecting innovators, as well as the role of the mentor, is emphasized. Because creativity has a place in many settings and discovery encompasses a wide spectrum, the author provides multiple suggestions aimed at encouraging the participation of those providing surgical care in the fulfilling experience of creative activity and innovation.
European Journal of Pediatric Surgery, Sep 1, 1988
Journal of Pediatric Surgery, Jun 1, 1999
Background/Purpose: Delivery of local anesthesia for surgical office procedures for pediatric pat... more Background/Purpose: Delivery of local anesthesia for surgical office procedures for pediatric patients can be difficult.
Journal of Pediatric Surgery, Apr 1, 1986
During a 52-month span, 14,324 ultrasonographic examinations were performed on 9,453 pregnant pat... more During a 52-month span, 14,324 ultrasonographic examinations were performed on 9,453 pregnant patients. One-hundred and fifty-one anatomical malformations were found in 122 fetuses (1.29%). Our analysis of patients referred to the perinatal center for ultrasonography indicates that the number of high risk patients has increased, and a parallel increase of neonatal surgical anomalies has resulted. An analysis of fetuses concluded that anomalies of the: gastrointestinal tract had improved care, deaths occurred due to associated anomalies or severe prematurity; genitourinary system received earlier diagnosis and treatment; central nervous system/musculoskeletal system/hydrops--no difference in management, treatment or outcome was noted; teratoma/cystic hygroma--did not effect treatment; cardiovascular system--inutero medical treatment by digitalization of the mother was possible. Paradoxically, an increase in the mortality of diaphragmatic hernia patients was noted and concluded to be secondary to the extremely early detection of this anomaly.
Journal of Pediatric Surgery, Aug 1, 2001
Acute appendicitis is common, frequently atypical, challenging, and still associated with signifi... more Acute appendicitis is common, frequently atypical, challenging, and still associated with significant morbidity. Despite major technologic advances, appendicitis remains a primarily clinical diagnosis. Therefore, no relevant anamnestic information should be overlooked. Surprisingly, the relationship between heredity and appendicitis is seldom considered. Because of the potential clinical importance of the family history, the authors addressed this question prospectively over a 52-month period in a practice that includes the majority of pediatric patients with appendicitis in the region. Family histories were obtained in a standardized manner, focusing on first-degree relatives. Children with incomplete family information were excluded. Patients (ages 2(1/2) to 19 years) were divided into 3 groups: group A, children who underwent an appendectomy (n = 166); group B (first control), children who presented with an acute abdomen and suspected appendicitis but did not undergo an appendectomy (n = 117); group C (second control), children who were seen in the practice for unrelated conditions (n = 141). A positive parental history was obtained from 59 patients (36%) in group A, 24 patients (21%) in group B, and 20 patients (14%) in group C, and the odds ratios (ORs) were 2.0 (P =.035) and 2.9 (P &lt;.001) for groups A versus B and A versus C, respectively. Of the 13 patients whose sibling had had acute appendicitis, 9 were in group A versus 2 each in groups B and C, and the OR for any family history (siblings, parents) in groups A versus B was 1.9 (P =.028) and for groups A versus C was 2.9 (P &lt; 0.001). Appendicitis was histologically confirmed in 93% of children in group A. Heredity is a significant factor in pediatric patients who have appendicitis. Children who have appendicitis are twice as likely to have a positive family history than are those with right lower quadrant pain (but no appendicitis) and almost 3 times as likely to have a positive family history than are surgical controls (without abdominal pain). Because of its potential value in changing the threshold for intervention, a careful family history should be obtained for every child in whom acute appendicitis is suspected.
PubMed, Jun 1, 1989
The button jejunostomy provides long term access for jejunal feedings incorporating the benefits ... more The button jejunostomy provides long term access for jejunal feedings incorporating the benefits of the gastrostomy button device. Although this procedure requires a celiotomy, we believe the relative simplicity of the procedure and its advantages over other types of jejunostomies warrant its use in patients with clinically significant gastroesophageal reflux who require long term enteral nutrition.
Gastrointestinal Endoscopy, Aug 1, 2004
To the Editor: We read with great interest the report of Rosemore et al. 1 concerning bilateral t... more To the Editor: We read with great interest the report of Rosemore et al. 1 concerning bilateral temporomandibular joint (TMJ) dislocation after placement of a PEG tube. In addition to the cases cited by Rosemore et al., 1 we also found a further 5 reports of TMJ dislocation related to endoscopic procedures. 2-6 Moreover, we recently encountered a similar case. A 26-year-old woman underwent upper endoscopy with conscious sedation (midazolam, 2 mg intravenously) for dyspeptic symptoms. The only finding was antral erythema. However, immediately after removal of the mouth guard, the patient was unable to close her mouth. The right anterior head of the mandibular bone was noted to be prominent, suggesting right anterior TMJ dislocation. The patient remained calm and attempted to reduce the dislocation herself, which was accomplished with the help of the endoscopist. A detailed history taken subsequently revealed habitual TMJ dislocations, which had occurred nearly 15 times over the previous 10 years, mainly during yawning or retching. The patient had learned to put her chin into place in response to these episodes. Patients with a history of chin dislocation are at risk for TMJ dislocation during endoscopic procedures. Thus, it is prudent and advisable to inquire about such events during the pre-endoscopy evaluation. In addition, as a routine, patients should be evaluated after upper endoscopic procedures for TMJ dislocation. This is easily accomplished by observing the patient during mastication.
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Papers by Michael Gauderer