47 patients with functional chronic constipation associated with an achalasia of the anal sphincter were treated with the alpha blocking agent Phenoxybenzamin. Dosages were used according to the manufacturers' instructions. 29 of the children were completely cured. There was significant improvement in a further 13 children and only 5 patients showed no improvement. Treatment failures were associated with additional severe psychological disturbances for which psycho-therapeutic management was required.
The various forms of congenital abnormality of the femur usually require combined conservative and operative procedures over a long period of time. Operative treatment depends essentially on the morphological findings. The literature is discussed. The authors present a case in whom the pseudoarthrosis can be utilised to obtain femoral lengthening and the operative detail is discussed.
Early complications of Hirschsprung's disease are anastomosis leakage, mucosal ulcers in the region of the anastomosis, early ileus and early stenosis. On the basis of these criteria, we analysed 85 cases of children who underwent resection of the aganglionic segment in the years from 1969-1978 in the paediatric surgical units of the University Clinics in Mainz and Göteborg. Of 19 cases, 2 showed anastomosis leakage, 9 anastomotic ulcers, 5 early ileus, 2 early stenosis, 7 general disturbances independent from Hirschsprung's disease. Extensive aganglionosis did not produce problems in the immediate postoperative period, with the exception of the risk of secondary healing of the wound. Possible influencing factors could be: age and general condition of the child at the time of operation, operative method, experience of the operator and prophylactic administration of antibiotics.
The key factor in malignant hyperthermia does not seem to be a defect in the calcium-storing membrane of the skeletal and cardiac muscle cells. The primary cause would appear to be deficiency of adenylate kinase.
A 3 1/2-month-old girl with external endometriosis is presented. Bloody cyst formation was seen in the lower abdominal cavity. Endometriosis is a very rare disease in early infancy.
Clinical and electromanometrical studies were performed in 439 children suffering from Hirschsprung's disease, who had been operated upon between 1 to 24 years ago by Rehbein's rectosigmoidectomy 40,1 %, State's anterior resection 0,5 %, Swenson's technique 18,2 %, Soave's endorectal pull-through 24,1 % and Duhamel's operation in 14,8 %.
A two month old female infant presented with inflammation of the Bartholinian gland. A congenital ano-vestibular fistula was found without malformation of the anus. The possible pathoembryology is discussed. A protecting colostomy is advised to prevent recurrence of the fistula.
l'ulminam epSl J. Clat d Hanmur, I coliti , with mark d b w I wall thickening und ob HucrlOn f he colon. a p ar ro b a rar arly infan F r thi r a on, ir ha ecmed de irable ro reporr ,n lInu ual ca f tran mural c liri in n infant ~ ith mark inflammaror' thick nin of the b wcl \ all nd wirh ob rrucrion < t th ur-off p 1m f inflammari n In ehe tran ver ein. Th di ca e pr ces oro Iy w. limit d th ri ht c I n.
17 children with burn contractures (21 hands) were treated at Princess Margaret Hospital, Hong Kong, with release and flap repair. The age of these children varied from 11/2 to 13 years. The overall result of hand functions was gratifying although a high complication rate was observed. When indicated, flap repair in children is certainly a worthwhile consideration.
Between 1966-1977 the authors operated on 920 children with appendicitis, including 162 children with peritonitis. In the latter cases the peritoneum was washed out with normal saline. It decidedly decreased the amount of postoperative complications. No deaths occurred among children operated on.
Neonatal gastric perforation (N.G.P.) has been attributed to various causes, perforation of an ulcer similar to that encountered in adults, gastric over distension complicating resuscitative measures, positive pressure ventilation, blunt abdominal trauma, and excessive vomiting. Distal obstruction, especially when accompanied by a congenital muscular defect in the wall of the stomach, or the muscular defect alone, have also accounted for gastric perforation in the neonatal period.
The combination of severe chordee with extreme torsion of the penis is rare. 3 such cases are reported. One of these had hypospadias, the other two did not. They were treated by a modified Spence-Allen procedure and the post-operative result between 6 and 12 months later was satisfactory. The aetiology of this malformation is briefly discussed and the operative technique is described in detail. Eck
A case study of a new born affected by jejunal atresia, with parenteral feeding by central venous catheter is presented.
The necrotizing enterocolitis (NEC) is marked by three stages, each of which has characteristic clinical symptoms and radiological findings. The management and prognosis are different in each stage. The experiences we got from 27 patients, seen in 5 years, are demonstrated and the typical postoperative complications are analysed. The conclusion can be reached that NEC has the best prognosis by a conservative treatment in stages I and II, and that a surgical approach is indicated when stage III turns into stage IV.
An experimental investigation was undertaken to assess the survival and functional capacities of splenic autotransplants. A total of 75 individual implants were created following splenectomy in 24 rabbits. Twelve implants consisted of the entire spleen and 63 of small pieces of splenic tissue. The former were implanted in the posterior peritoneum of the upper abdominal cavity and the latter in the omentum. Progressive degeneration of the implant was consistently found in the group with implantation of the entire spleen. Conversely, the small implants survived and were histologically compatible with normal splenic tissue. The functional status of such implants was assessed in terms of phagocytic ability, proliferative activity and response to immunization. Phagocytic and proliferative activities were significant, while the magnitude of the specific response to immunization could not be evaluated with certainty. The results of this study indicate that small splenic autotransplants are functionally far from inert and may be of potential benefit in children undergoing splenectomy for trauma.
Intrathoracic end-to-end oesophageal anastomoses were performed in three series of young pigs each containing 10 animals. In one series (series M), the divided oesophagus was anastomosed with interrupted ultrafine (10/0) monofilament supramid sutures. In another series (series MR), the same ultrafine suture material was used but following a segmental oesophageal resection of 15 mm. In the third series (control series S), interrupted 6/0 black braided silk sutures were used following oesophageal division.
A 2-year-old child is presented with irregular frequent vomiting leading to a very severe marasmus. Only repeated radiological investigations revealed the hepatodiaphragmatic interposition of the colon. Two years after surgery she has nearly doubled her body-weight.
An adrenal hematoma in a newborn, with unusual presentation having motivated surgical exploration, was confirmed and followed by ultrasonographic examination. Ultrasonography represents an important advance in the investigation of intra-abdominal neonatal masses. It is a non-invasive technique, and often is much more precise than the more classical methods.
Serious acute complications can occur in relation to anastomotic insufficiency or re-opening of the fistula in patients with tracheo-oesophageal fistula and atresia, even if the repair has been carried out extra-pleurally. For this reason the patient should not be nursed flat and the important life-threatening signs to watch for are increasing tachypnoea and dyspnoea with respiratory acidosis and a central air shadow in the mediastinum.
