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Contrast media in intussusception
INTERNATIONALABSTRACTS
364 were no operative deaths and no major surgical complications. There were no recurrent aspiration pneumonias. Eighty-eight percent of infants with unexplained apneic episodes showed marked benefit, and 83% of those with bronchopulmonary dysplasia had clinical improvement. There were no late problems attributed to the operation. There were eight late deaths, due to associated congenital anomalies or acquired problems (3), sepsis (3) and sudden infant death syndrome (2). Fundoplication is recommended for patients, 2 years of age or younger, who have a persistent pulmonary problem attributed to gastroesophageal reflux that does not respond to medical therapy.-John N. Schullinger Changes in Pyloric Tumor of Infantile Hypertrophie Pyloric Stenosis Before and After Pyforomyotomy. Z. Shen. Y. She, W. Ding, et al. Pediatr Surg Int 4:322-325, (August), 1989.
Sixteen of 24 infants with vomiting were examined by real-time sonography, which established the diagnosis of hypertrophic pyloric stenosis (HPS). Twe>e underwent surgery. Of the three parameters measured, pyIoric muscle wall thickness was the most reliable and accurate for the diagnosis of HPS. The authors suggest that a muscle wall thickness of 4 mm or more and a stenosis index greater than 50% are standard findings in patients with HPS. Serial real-time sonography following pyloromyotomy showed that the pyloric tumor changed significantly during the 1st postoperative week and returned to normal size by the end of the 4th week.-Prem Puri Acute Duodenal Ulcer. H.Y. Hsu, M.H. Chang, T.H. Want, et al. Arch Dis Child 64:774-779, (June), 1989.
Thirty-one infants and children, all of whom had an acute duodenal ulcer verified by endoscopy, were studied over an &year period. The main presenting symptoms were gastrointestinal bleeding, vomiting, and abdominal pain. Ninety-four percent of patients had a preceeding illness characterised by diarrhea, upper respiratory infection, or fever; only 35% had been treated with antipyretics. The authors conclude that acute duodenal ulceration is a cause of gastrointestinal bleeding after viral illnesses, even in the absence of antipyretic treatment, that these ulcers heal quickly and, at variance with other reports, may be multiple, irregularly shaped, and may extend to the second part of the duodenum.-D.&f. Burge Contrast Media in Intussusception.
J.B. Campbell. Pediatr Radio1
19:293-296, (June), 1989. Pediatric radiologists in 40 children’s hospitals in North America were interviewed to determine their choice of contrast media in the diagnosis and treatment of intussusception. The respondents indicated that barium was used in the vast majority of instances. Almost all indicated that they would proceed with barium enema even if there is unequivocal evidence of small bowel obstruction on the.plain film examination. In over 14,000 cases of intussusception, there were 55 perforations, an incidence of approximately 1 in 250. The perforations, in general, were well tolerated, although there wasone death.Prem Puri Gas Reduction of Intussusception.
J.F. de Camp0 and E. PheIan. Pediatr Radio1 19:297-298, (June), 1989. Efforts to improve the nonsurgical management of childhood intussusception center around (I) reassessment of selection criteria used to ensure that as many children as possible have the advantage of hydrostatic reduction, and (2) improvements and modifications of enema technique to ensure successful and safe reductions without increased morbidity. Reports that pneumatic reduction was highly successful in treating childhood intussusception prompted the au-
thors to evaluate this technique over an 18-month period using the authors’ previously reported technique of oxygen at 2 L per minute and a pressure of 80 mmHg. Pneumatic reduction was attempted in 114 of 129 consecutive cases of intussusception, and was successful in 85 (75%). Fifteen patients (8.6%) were considered unacceptable risks Ear gas reduction, using the authors current selection criteria, and had primary surgery. The overall success rate, considering all cases of intussusception managed at the authors’ institution over this period, was 66% (85/129). As with any form of hydrostatic reduction, pneumatic reduction of intussusception requires careful selection of patients, meticulous technique, and awareness of comphcations and their appropriate management. Because of its simplicity and improved success rate, pneumatic reduction hasreplaced traditional barium reduction at the authors’ institution. It may be that with further evaluation of selection criteria, higher pressures, and prolonged attempts, that results will improve further.-Prem Pun’ Postoperative Intussurception in Children.
V.J. Kiesling, Jr and ES. Tank. Urology 33:387-389, (May), 1989. Intussusception in the postoperative period is an unusual, yet potentially fatal, surgical complication. The authors have encountered seven postoperative cases in children, and describe three of those patients. The symptoms, characteristics, diagnosis, and treatment of this postoperative problem are reviewed and contrasted with the more familiar, and more common, classic childhood intussuscep tion-George W. Holcomb III High Incidence of Upper Gastrointestinal Tract Involvement in Children With Crohn’s Disease. C.
Lenaerrs, C.C. Roy, M. Vaillancourf, et al. Pediatrics 83:777-781, (May), 1989. The authors reviewed the records of 230 patients collected over 15 years. At the time of diagnosis, three patients (1.3%) had involvement limited to the esophagus, stomach, and/or duodenum; thirtyseven had involvement of the small bowel alone (16.1 W). Both small and large intestine were involved in 169 patients (73.5%). The colon and/or rectum were the only sites in the remaining 21 (9.1%). Upper gastrointestinal disease was defined as radiologic, endoscopic, or surgical evidence of disease of the esophagus, stomach, and/or duodenum. A total of 69 patients (30%) qualified as having upper gastrointestinal disease. A significantly higher number of these patients presented with disease of both small and large bowel. Patients with upper gastrointestinal involvement had. significantly higher incidences of dysphagia, epigastric pain, nausea and vomiting, weight loss at the time of diagnosis, apthous ulcers of the mouth, and hypoalbuminemia. The incidence of patients subsequently requiring surgery did not differ between those patients who had involvement and those who did not. The authors suggest that upper gastrointestinal examination may allow for earlier diagnosis in some patients with Crohn’s disease.-Jeflrey L. Zitsman Lavege Treatment of Distal Intestinal Obstruction Syndrome in Children With Cystic Fibrosis. S.
Koletzko, D.A. Stringer, G.J. Cleghorn. et al. Pediatrics 83:727-733, (May), 1989. Twenty-two patients having meconium ileus equivalent were treated by intestinal lavage using Golytely, a balanced electrolyte solution. The solution was given orally in 14, and by nasogastric tube in eight. An average of 5.6 + 1.9 L were given. Bloating, nausea, chills, and vomiting were common but minor side effects. There were no serious side effects. Twenty-one patients experienced dramatic relief of symptoms for an average of 3 months. Approximately one half of the patients required additional treatments, most of which were carried out at home.-Je&ey L. Zitsman
364 were no operative deaths and no major surgical complications. There were no recurrent aspiration pneumonias. Eighty-eight percent of infants with unexplained apneic episodes showed marked benefit, and 83% of those with bronchopulmonary dysplasia had clinical improvement. There were no late problems attributed to the operation. There were eight late deaths, due to associated congenital anomalies or acquired problems (3), sepsis (3) and sudden infant death syndrome (2). Fundoplication is recommended for patients, 2 years of age or younger, who have a persistent pulmonary problem attributed to gastroesophageal reflux that does not respond to medical therapy.-John N. Schullinger Changes in Pyloric Tumor of Infantile Hypertrophie Pyloric Stenosis Before and After Pyforomyotomy. Z. Shen. Y. She, W. Ding, et al. Pediatr Surg Int 4:322-325, (August), 1989.
Sixteen of 24 infants with vomiting were examined by real-time sonography, which established the diagnosis of hypertrophic pyloric stenosis (HPS). Twe>e underwent surgery. Of the three parameters measured, pyIoric muscle wall thickness was the most reliable and accurate for the diagnosis of HPS. The authors suggest that a muscle wall thickness of 4 mm or more and a stenosis index greater than 50% are standard findings in patients with HPS. Serial real-time sonography following pyloromyotomy showed that the pyloric tumor changed significantly during the 1st postoperative week and returned to normal size by the end of the 4th week.-Prem Puri Acute Duodenal Ulcer. H.Y. Hsu, M.H. Chang, T.H. Want, et al. Arch Dis Child 64:774-779, (June), 1989.
Thirty-one infants and children, all of whom had an acute duodenal ulcer verified by endoscopy, were studied over an &year period. The main presenting symptoms were gastrointestinal bleeding, vomiting, and abdominal pain. Ninety-four percent of patients had a preceeding illness characterised by diarrhea, upper respiratory infection, or fever; only 35% had been treated with antipyretics. The authors conclude that acute duodenal ulceration is a cause of gastrointestinal bleeding after viral illnesses, even in the absence of antipyretic treatment, that these ulcers heal quickly and, at variance with other reports, may be multiple, irregularly shaped, and may extend to the second part of the duodenum.-D.&f. Burge Contrast Media in Intussusception.
J.B. Campbell. Pediatr Radio1
19:293-296, (June), 1989. Pediatric radiologists in 40 children’s hospitals in North America were interviewed to determine their choice of contrast media in the diagnosis and treatment of intussusception. The respondents indicated that barium was used in the vast majority of instances. Almost all indicated that they would proceed with barium enema even if there is unequivocal evidence of small bowel obstruction on the.plain film examination. In over 14,000 cases of intussusception, there were 55 perforations, an incidence of approximately 1 in 250. The perforations, in general, were well tolerated, although there wasone death.Prem Puri Gas Reduction of Intussusception.
J.F. de Camp0 and E. PheIan. Pediatr Radio1 19:297-298, (June), 1989. Efforts to improve the nonsurgical management of childhood intussusception center around (I) reassessment of selection criteria used to ensure that as many children as possible have the advantage of hydrostatic reduction, and (2) improvements and modifications of enema technique to ensure successful and safe reductions without increased morbidity. Reports that pneumatic reduction was highly successful in treating childhood intussusception prompted the au-
thors to evaluate this technique over an 18-month period using the authors’ previously reported technique of oxygen at 2 L per minute and a pressure of 80 mmHg. Pneumatic reduction was attempted in 114 of 129 consecutive cases of intussusception, and was successful in 85 (75%). Fifteen patients (8.6%) were considered unacceptable risks Ear gas reduction, using the authors current selection criteria, and had primary surgery. The overall success rate, considering all cases of intussusception managed at the authors’ institution over this period, was 66% (85/129). As with any form of hydrostatic reduction, pneumatic reduction of intussusception requires careful selection of patients, meticulous technique, and awareness of comphcations and their appropriate management. Because of its simplicity and improved success rate, pneumatic reduction hasreplaced traditional barium reduction at the authors’ institution. It may be that with further evaluation of selection criteria, higher pressures, and prolonged attempts, that results will improve further.-Prem Pun’ Postoperative Intussurception in Children.
V.J. Kiesling, Jr and ES. Tank. Urology 33:387-389, (May), 1989. Intussusception in the postoperative period is an unusual, yet potentially fatal, surgical complication. The authors have encountered seven postoperative cases in children, and describe three of those patients. The symptoms, characteristics, diagnosis, and treatment of this postoperative problem are reviewed and contrasted with the more familiar, and more common, classic childhood intussuscep tion-George W. Holcomb III High Incidence of Upper Gastrointestinal Tract Involvement in Children With Crohn’s Disease. C.
Lenaerrs, C.C. Roy, M. Vaillancourf, et al. Pediatrics 83:777-781, (May), 1989. The authors reviewed the records of 230 patients collected over 15 years. At the time of diagnosis, three patients (1.3%) had involvement limited to the esophagus, stomach, and/or duodenum; thirtyseven had involvement of the small bowel alone (16.1 W). Both small and large intestine were involved in 169 patients (73.5%). The colon and/or rectum were the only sites in the remaining 21 (9.1%). Upper gastrointestinal disease was defined as radiologic, endoscopic, or surgical evidence of disease of the esophagus, stomach, and/or duodenum. A total of 69 patients (30%) qualified as having upper gastrointestinal disease. A significantly higher number of these patients presented with disease of both small and large bowel. Patients with upper gastrointestinal involvement had. significantly higher incidences of dysphagia, epigastric pain, nausea and vomiting, weight loss at the time of diagnosis, apthous ulcers of the mouth, and hypoalbuminemia. The incidence of patients subsequently requiring surgery did not differ between those patients who had involvement and those who did not. The authors suggest that upper gastrointestinal examination may allow for earlier diagnosis in some patients with Crohn’s disease.-Jeflrey L. Zitsman Lavege Treatment of Distal Intestinal Obstruction Syndrome in Children With Cystic Fibrosis. S.
Koletzko, D.A. Stringer, G.J. Cleghorn. et al. Pediatrics 83:727-733, (May), 1989. Twenty-two patients having meconium ileus equivalent were treated by intestinal lavage using Golytely, a balanced electrolyte solution. The solution was given orally in 14, and by nasogastric tube in eight. An average of 5.6 + 1.9 L were given. Bloating, nausea, chills, and vomiting were common but minor side effects. There were no serious side effects. Twenty-one patients experienced dramatic relief of symptoms for an average of 3 months. Approximately one half of the patients required additional treatments, most of which were carried out at home.-Je&ey L. Zitsman