Evaluating Appendix Tumors

Pediatric surgeon Brian Gilchrist, MD, has held medical appointments at Saint Vincent’s Hospital and the Floating Hospital for Children at Tufts University. Brian Gilchrist, MD, focuses on minimally-invasive procedures addressing congenital conditions and has written extensively on internal diseases, including appendiceal tumors.

While appendiceal cancers are rare, tumors found in the appendix are often evaluated through an examination and biopsy. Since malignant appendix tumors can appear as ovarian or gastrointestinal cancers, they can be difficult to diagnose. The most prevalent tumors are carcinoid and measure fewer than two centimeters in size. Patients with this condition may not experience symptoms until the disorder has impacted the liver. Most appendiceal tumors are uncovered during screenings for other conditions.

Non-carcinoid tumors are more aggressive and can cause a buildup in biological substances that can lead to digestive problems. Tumors that have the ability to spread to the lymph nodes and other organs as well as very large masses are usually removed. Small, benign tumors may be monitored.

Hemangiomas – The Most Common Type of Vascular Lesions

Pediatric surgeon Brian Gilchrist, MD, graduated from the Tufts School of Medicine in Boston, Massachusetts, after which he completed his pediatric fellowship at St. Jude’s Children’s Hospital. Possessing more than 30 years’ experience in pediatric surgery practice, research, and teaching, Brian Gilchrist, MD, has published over 80 peer-reviewed papers relating to medical conditions like vascular lesions.

Vascular lesions are skin and tissue abnormalities present at birth that are often referred to as birthmarks. The three types of vascular lesions are: hemangiomas, pyogenic granulomas, and vascular malformations. Hemangiomas are by far the most prevalent type in children.

Hemangiomas are benign (non-cancerous) tumors forming on the cells lining blood vessels. They appear as faint red patches on the skin of a baby after birth. With time, they grow in size and darken in color. In severe cases, they can grow outward, leaving an ulcer on the skin and causing bleeding which, can lead to infection.

In many cases, hemangiomas grow for six to 12 months before hitting a peak, stabilizing, and then going into involution (shrinking). After this final stage, the lesions become small and faded.

Doctors often monitor hemangiomas as they go through the phases of growth, stabilization, and involution without treatment. However, some hemangiomas ulcerate, prompting medical intervention. Others grow in sensitive areas such as the eyelid or ear canal, interfering with eyesight and hearing, similarly prompting intervention. Treatment usually takes the form of medication and surgery.

APSA Guidelines on Opioid Medication for Children after Surgery

A New York City Police Department honorary surgeon, Brian Gilchrist, MD, has more than 30 years of experience as a pediatric surgeon, developing pediatric trauma systems in leading hospitals. A widely published medical researcher, Brian Gilchrist, MD, belongs to the American Pediatric Surgical Association (APSA) and serves on the association’s publications committee.

APSA is dedicated to saving lives by developing and sharing surgical standards and quality of care guidelines. It partnered with the American College of Surgeons to create resources to help parents caring for children who have undergone surgery. One of these is a guide on effective pain control.

Safe pain control entails using medication and other effective therapies to limit pain while having as few side effects as possible. After simple procedures, children can experience mild to moderate pain. After complex surgeries, children may experience severe pain. Parents can help in their children’s healing by monitoring them to identify signs of pain.

A child with mild pain does not exhibit signs of discomfort. The child notices the pain but he or she can still do normal activities like sitting up, standing, walking, and playing. With moderate pain, the child notices the pain and it interferes with his or her activities. The child may moan, squirm, or frown.

With severe pain, the child cannot engage in normal activities and finds it hard to sleep. The pain takes all of his or her focus. He or she has a rigid body, tenses or kicks his or her legs, and cries continuously.

For mild and moderate pain, doctors prescribe non-medication therapies (ice, rest, elevation, and physical therapy) and non-opioid oral medications (ibuprofen and acetaminophen). For severe pain, they can prescribe short-acting opioids on top of the above two. The opioids block pain receptors in the brain and spinal cord.

Parents whose children have been prescribed opioids should ensure their children take the lowest doses possible. In addition, they should never crush the pills or give them with antihistamines, sleep aids, muscle relaxers, and anti-anxiety medication.

About Iatrogenic Injuries

Brian Gilchrist, MD is a member of the American Pediatric Surgical Association publication committee. Extensively involved in research, Brian Gilchrist, MD dedicates his experience to improving the treatment modalities for various conditions, including necrotizing enterocolitis, iatrogenic vascular lesions, and rectal prolapse.

Derived from a combination of two Greek words, the term “iatrogenic” refers to a consequence of medical action. Any injury from a medical procedure is an iatrogenic injury. These injuries may result from lack of medical ethics, negligence or careless practice, inadequate medical knowledge, or use of a high-risk procedure when a lower-risk alternative is available.

About 50 percent of pediatric vascular trauma are iatrogenic injuries. With frequencies that follow inverse proportion with age, iatrogenic pediatric injuries occur mostly among neonates (80 percent), declining to an average of 50 percent among children in the two to six-year-old group and 33 percent in older children. Arterial injuries are rare but can mandate surgery in severe or worsening cases. Iatrogenic pediatric vascular injuries account for most thromboembolism cases (blood clots forming in vessels), especially in the lower extremities. Treatment modalities for these injuries in pediatrics vary from those of adult counterparts.

Necrotizing Enterocolitis – Symptoms and Causes

With an MD from Tufts University School of Medicine, Dr. Brian Gilchrist is a consultant surgeon for the government of Grenada. Well-versed in congenital diseases, Brian Gilchrist, MD edited a well-referenced book on necrotizing enterocolitis (NEC), which subsequently became widely received throughout the country.

A disease that affects young infants’ abdomen, necrotizing enterocolitis occurs when bacteria invade the intestinal wall and cause inflammation. This inflammation creates a gap through which nasty germs leak out to invade the abdomen. If left untreated, necrotizing enterocolitis worsens and may result in death. It often happens to babies fed baby formula instead of breast milk within their first two weeks after birth.

While symptoms of NEC vary from child to child, some symptoms occur within the first two weeks after birth in almost every child. These include bloody poop, swollen or bloated belly, low heart rate, sluggishness, and trouble breathing. Intestinal inflammation can also block food from moving from the stomach to the small intestine.

At present, the cause of NEC is not yet certain. Premature infants, for instance, may develop the condition as a result of their immature digestive system. An immature digestive system may lack an adequate structural barrier to microbial infection and fail to secrete appropriate biochemical defenses. Dangerous bacteria can take advantage of this and infect compromised parts. These shortcomings make premature infants more susceptible to the kinds of inflammations that result in NEC.

In most cases, full-term infants with NEC develop the condition as a result of sickness. Undergoing some procedures – such as vascular bypass surgery – can potentially disrupt the intestines’ blood supply.

Iatrogenic Vascular Lesions – Wounds Related to Medical Treatment

Based in New York City, Brian Gilchrist, MD, has an extensive leadership background in pediatric medicine and has published widely on pediatric and neonatal surgical topics. One area in which Brian Gilchrist, MD, has worked extensively is iatrogenic vascular lesions, a type of wound involving organ or tissue damage resulting from necessary medical treatment.

As the number of minimally invasive therapeutic and diagnostic procedures increases, iatrogenic complications have occurred more frequently. When it comes to vascular procedures, the common femoral artery represents the most common arterial access point, with complication rates in the 6 percent range. Iatrogenic vascular lesions also may occur include at access points in the wrist, elbow, and knee.

There are multiple ways to manage injuries related to iatrogenic lesions at femoral artery access points. One such procedure involves catheter embolization, with clotting agents or devices transmitted into the blood vessel. This limits blood flow to the region, addresses issues of abnormal bleeding, and gives the body an opportunity to heal.

What You Need to Know about Pilonidal Disease

An experienced pediatric surgeon, Dr. Brian Gilchrist completed pediatric surgery residency training at numerous institutions and hospitals, including the University of Tennessee. Dr. Brian Gilchrist works to provide less painful, minimally-invasive surgical interventions for treating various diseases, including pilonidal disease. Since 2009, he has performed over 250 minimally-invasive procedures for pilonidal disease with no instance of complication or disease recurrence.

Pilonidal disease is a chronic skin infection that affects the crease of the buttocks – anywhere around the area on top of the tailbone to the anus. Often, the disease occurs between the onset of puberty and age 40. It is three to four times more prevalent among males than females.

Symptoms may include a small dimple or large painful mass in the affected area; pain that worsens when a patient sits; and fluid (clear, cloudy, or containing blood) draining from the site. If the area is infected, it may become red and tender, drainage fluid may have a funky order, and patients may also exhibit common symptoms of infectious disease (such as nausea and fever).

In almost all cases, the condition starts with an acute abscess episode when the area becomes tender and swollen. Pus may also drain from it. The abscess may go away naturally over time or with medical care. Once the abscess is gone, the patient may develop a pilonidal sinus. A pilonidal sinus is a cavity or empty space below the skin in the affected area that connects to the skin surface through one or more openings. In the majority of the cases, this needs to be corrected with surgery.

What Is Pilonidal Disease?

Experienced pediatric surgeon Brian Gilchrist, MD, completed a fellowship in pediatric and transplantation surgery at St. Jude Children’s Research Hospital and Harvard Medical School, respectively. With upwards of 30 years of medical experience, Dr. Brian Gilchrist is familiar with a range of congenital diseases, including pilonidal disease.

Pilonidal disease refers to a chronic skin infection that occurs at the crease of the buttocks near the tailbone, or coccyx. It results in at least one cyst that becomes infected or inflamed, creating the appearance of a small dimple in the area. Sometimes hair grows out of this dimple, but this isn’t always the case.

As the infection worsens, it creates a large, painful mass just above the buttocks and can result in the area becoming red and tender and leaking bloody or cloudy fluid. Patients may also present with a fever or feelings of nausea as their body responds to the infection.

To treat the cyst that forms, physicians will either remove it surgically or open and drain it. If a patient experiences a returning infected pilonidal cyst, surgery is the standard treatment option. Once the cyst is removed or drained, a pilonidal sinus will typically form in the area. This cavity below the surface of the skin will either resolve on its own or necessitate surgical removal.

Following treatment of the cyst, patients must keep the surgical site clean and dry as the skin heals. They must also remove hair from the buttocks crease via a hair removal agent or razor. Doing so reduces the risk of developing another cyst.

Risk Factors and Common Age of Infants with NEC

The former chief of pediatric surgery at a New York hospital, Brian Gilchrist, MD, has been practicing medicine for more than three decades. During that time, Dr. Brian Gilchrist has become familiar with a wide range of congenital and pediatric conditions, including necrotizing enterocolitis (NEC).

A serious illness, NEC affects the intestines of infants. Babies with this condition have inflammation in their large intestine, or colon, that damages and kills intestinal tissue. When left untreated, this damage leaves the abdomen open to germs that may lead to death or a serious infection.

A rare condition, NEC affects 1 out of every 2,000 to 4,000 infants. While physicians are unsure of what causes NEC, it occurs most often in premature babies who weigh less than 3.25 pounds. These infants have less mature lungs and intestines that cannot properly move oxygen and blood around. As a result, they struggle with fighting infection and breaking down food — characteristics that physicians believe make them more susceptible to NEC.

In addition to occurring more frequently in premature infants, NEC affects babies who regularly experience other illnesses. These babies may have too many red blood cells, an existing gastrointestinal infection, or received a blood transfusion. Premature babies fed formula are also at greater risk, as are those with reduced oxygen levels.

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