The records of 253 children with congenital diaphragmatic hernia admitted to The Hospital for Sick Children, Great Ormond Street, between 1961 and 1980 were analysed. The overall mortality of 37 per cent is greater than that reported in the preceding 13 years from the same institution, and showed no improvement over the 20 years. While there was no significant increase in the number of admissions over the study period, the proportion of children who underwent surgery within the first 6 h of life steadily increased from 13 per cent in the first five years to 39 per cent in the last five years. The mortality of this group (65 per cent) did not improve over the study period and this would account for the lack of improvement in the overall survival figures. However, analysis of birth weights, onset and severity of signs and lung weights indicates that the increasing number of early admissions was due to speedier transfer rather than to referral of more severely affected children in the later years.

Bei 144 Kindern wurde eine Harnableitung über ein Ileum-Conduit durchgeführt. Das Alter der Patienten lag zwischen 2 Monaten und 16 Jahren (Mittel 5,5 Jahre), 120 Mädchen und 24 Knaben wurden operiert. Mit einer Ausnahme lag als Grunderkrankung eine neurogene Blasenentleerungsstörung vor (meist Meningomyelozele), die Indikation zur Harnableitung wurde aufgrund einer progressiven Dilatation des oberen Harntraktes bei 90 und aufgrund einer Inkontinenz bei 54 Kindern gestellt. Frühe und späte Komplikationen traten insgesamt bei ⅓ der Patienten auf und betrafen hauptsächlich das Stoma und das Ileumsegment.

Journal Article Colonic stricture and enterocolic fistulae following necrotizing enterocolitis Get access E Kiely, E Kiely The Hospital for Sick Children, Great Ormond Street, London WC1, UK Correspondence to: Mr E. Kiely Search for other works by this author on: Oxford Academic Google Scholar H B Eckstein H B Eckstein The Hospital for Sick Children, Great Ormond Street, London WC1, UK Search for other works by this author on: Oxford Academic Google Scholar British Journal of Surgery, Volume 71, Issue 8, August 1984, Page 613, https://doi.org/10.1002/bjs.1800710816 Published: 07 December 2005 Article history Accepted: 02 March 1983 Published: 07 December 2005

In recent years ileal conduit diversion for children with neuropathic bladders secondary to myelomeningocele has been performed less frequently than previously, mainly because of reports of long term upper tract deterioration in these patients. The results of this series of 144 ileal conduit urinary diversions show that in the 85 children diverted for more than ten years, there has been improvement or preservation of their upper tracts in 80%. This compares favourably with the results of a recently reported series of colonic conduit diversions and consequently we feel that there is still a place for ileal conduit diversion in this group of patients. The early and late complications are described and means of minimising these are discussed.

Our experience of intussusception in 75 patients has been reviewed. The average duration of symptoms from onset to diagnosis was 40 hours. Barium enema was performed in 34 patients and in only six was the intussusception reduced successfully by hydrostatic pressure. Seventy-one laparotomies were performed with no mortality. Resection was carried out in seven patients for gangrenous bowel or presence of a leading point. The main complication was that of wound infection which occurred in eight patients. Incidental appendicectomy was safe and did not increase the complication rate.

A series of 282 children subjected to pyloromyotomy for congenital hypertrophic pyloric stenosis seen in the years 1961--1980 is presented. The various features relating to presentation, diagnosis and treatment are compared and contrasted in those treated in the first decade, 1961--1970 (series A) with those treated in the second decade, 1971--1980 (series B). It is noteworthy that there was an increased demand for radiological investigation in the second decade, and the fact that the number of patients diagnosed by radiological means only has doubled (from 9% to 19%) in the two series is probably a reflection of medical training and attitude. There was a marked decrease in the amount of post-operative vomiting during the second decade of this study and there was a slight tendency to earlier discharge from hospital in the latter years. The series confirms that congenital hypertrophic pyloric stenosis treated by pyloromyotomy has no mortality and only a minimal morbidity.

Two infants with very large, rapidly growing vascular tumours of the back are presented, one in the occipital region and one in region of the lumbo sacral spine. In both, malignant soft tissue tumours were diagnosed on clinical grounds. Histological examination of both tumours showed them to be benign and the difficulty of histopathological assessment is discussed. Both tumours were totally excised, with difficulty, and the follow-up studies confirm the benign nature of the tumours.

Diaphragmatic paralysis caused by phrenic nerve injury at thoracotomy for primary anastomosis of oesophageal atresia and tracheo-oesophageal fistula is rare. A case is reported of reversible paralysis of the right hemidiaphragm and its management discussed.

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.

A series of 93 children with 136 megaureters treated by re-implantation is presented. Successful re-implantation was achieved in 85 % of those who had refluxing and 68 % of those with stenotic megaureter. Recurrent reflux and uretero-vesical stenosis are the two major complications and the relatively high success rate is probably related more to careful patient selection for re-implantation than to operative technique.

60 patients with neuropathic bladder are presented in whom intermittent catheterisation was attempted as a form of therapy for incontinence over an 18 months period. The treatment was successful in 70% of the patients who presented essentially in an unselected group. It is recommended that this type of treatment is eminently satisfactory for many forms of neuropathic incontinence of urine and patients should be screened and selected for their suitability for such treatment.

Myositis ossificans progressiva is a rare inherited disease characterized by progressive ectopic ossifications associated with thumb and big toe anomalies. Ossification usually progresses from central to the peripheral, proximal to distal, cranial to caudal, and from dorsal to ventral directions and leading to activity limitation, significant eating disability, recurrent pulmonary infection, and atelectasis. In this report, we present a 7-year-old boy with a total spine stiffness (wooden spine) seriously limited his activity of daily living.

A case in which orchioblastoma metastasised to a lymph node at the left renal hilum is described. The metastasis was not detected by bipedal lymphography, but was associated with a rise in the serum level of the alpha1-fetoprotein. The metastasis responded to combination chemotherapy, including adriamycin, and residual tumour was excised at laparotomy. Tumour regression was associated with a fall in serum alpha1-fetoprotein which may be of value as a tumour marker substance in the diagnosis and monitoring of therapy in this tumour.

In a review of 113 paediatric patients followed for an average of 5 years, the ileal conduit has been very effective in preventing infection and loss of renal function. The incidence of early and late complications can be minimised by proper patient selection, attention to surgical details and diligent postoperative follow-up.