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Dilute elemental diet and continuous infusiontechnique for management of short bowel syndrome
598
This is a reasonably comprehensive and upto-date review of the problem of corrosive ingestions of an accidental nature, covering, it appeared, most of the possibilities having to do with various types of caustics ingested. The a u t h o r s do not attach any importance to early esophagectomy in cases of massive liquid alkaline ingestion which some surgeons feel is of importance in preventing destruction of the mediastinum and acute aortoesophageal fistula formation. Keith W. Ashcraft Replacement of the Cervical Esophagus With an Ileal Autotransplant in the Dog. H. Pull ter Gunne. Thesis Rotterdam Erasmus University 1975 (Dutch with a summary in English). A n experimental study in replacement of parts of the cervical e s o p h a g u s in the dog with an ileal autotransplant. The excellent results were studied with esophagoscopy, cinematography, angiography, and histology in all of the 15 used dogs, except three of them that died in the immediate postoperative period. To get a segment of a b o u t 41 cm of ileal transplant, an average of 112 cm ileum had to be resected which was a m e a n of 38.5~ of the total small bowel length. In conclusion it is stated that cervical esophageal replacement with a revascularised ileal autotransplant is feasible. J.C. Molenaar Mortality in Neonatal Duodenal Obstruction. L. Perreli and A. W. Wilkinson. J Roy Coil Surg
Edinb 20:365-373 (November), 1975.
Seventy-six babies with congenital obstruction of the d u o d e n u m who were treated at the Hospital for Sick Children, Great O r m o n d Street, L o n d o n in 1966-1973 inclusive are reviewed. They are compared with another series of 132 treated in the same place and reported in 1966. Particulars are given of the following: type of obstruction, age on admission, pregnancy, sex distribution, birth weight, method of feeding, and mortality. A fall in the n u m b e r of patients with other severe anomalies in addition to duodenal obstruction from 3 0 ~ in the early series to 15~ in the present series is considered to be the main reason why the operative mortality r a t e fell from 35.6~ in the first series to 17.3~ in the second. Case reports are given for all 14 patients who died and include autopsy reports on all except two. A soft transanastomotic feeding tube was used on 42 occasions and no complications en-
ABSTRACTS
sued. The a u t h o r s firmly believe that this was of value but because of other changes in treatment which have taken place at the same time, admit that there is no hard evidence to support this claim. Eleven per cent of the babies suffered also from D o w n ' s s y n d r o m e , which is a m u c h lower percentage than reported in several other series. Possible reasons for this are discussed. A . J . Dougall Gastrointestinal Manifestations of Cystic Fibrosis. Harry Shwachman. Pediatr Clin North Am 22:787-805 (November), 1975 Approximately 15~ of babies with cystic fibrosis have m e c o n i u m ileus. Lactase or other disaccharidase deficiencies are also associated with cystic fibrosis, but whereas m e c o n i u m ileus is usually manifest within the first 48 hr of life, disaccharide deficiencies usually appear at about the age of 4 yr. W h e n intestinal obstruction from impaction occurs after the newborn period, the term m e c o n i u m ileus equivalent is used. One per cent o f patients with cystic fibrosis have intussusception. The average age is 9 yr and the intussusception is usually ileocecal. Only 2 5 ~ have blood in the stool. Surgery was required for reduction in 19 of 22 "episodes." Between the ages of 9 m o and 5 yr, 2 2 ~ of cystics m a y have rectal prolapse. Cirrhosis will occur in 4 - 6 ~ . For bleeding varices, portacaval shunting is presently preferred. Shunting may also be done for hypersplenism without varices. The sweat test is indicated in: (1) Patients with growth failure. (2) Patients with chronic diarrhea, steatorrhea, or abnormal stools. (3) Patients suspected of having celiac disease. (4) Patients with rectal prolapse. (5) Patients with idiopathic hypoproteinemia. (6) Patients with cirrhosis and portal hypertension. (7) Patients with recurrent episodes of abdominal pain and fecal impaction. (8) All siblings of known patients with cystic fibrosis. (9) All offspring of mothers with cystic fibrosis. (10) Patients with heat stroke. (11) Infants with salty taste. (12) Patients with chronic cough, recurrent pneumonia, or recurrent episodes of asthmatic bronchitis, bronchiolitis, nasal polyps, or x-ray evidence of chronic obstructive disease. (13) Children with pancreatitis. EdwardJ. Berman Dilute Elemental Diet and Continuous Infusion Technique for Management of Short Bowel Syndrome. Dennis L. Christie and Marvin E. Ament. J Pediatr 87:705-708 (November), 1975. Two infants with short bowel syndrome were successfully weaned from total parenteral
This is a reasonably comprehensive and upto-date review of the problem of corrosive ingestions of an accidental nature, covering, it appeared, most of the possibilities having to do with various types of caustics ingested. The a u t h o r s do not attach any importance to early esophagectomy in cases of massive liquid alkaline ingestion which some surgeons feel is of importance in preventing destruction of the mediastinum and acute aortoesophageal fistula formation. Keith W. Ashcraft Replacement of the Cervical Esophagus With an Ileal Autotransplant in the Dog. H. Pull ter Gunne. Thesis Rotterdam Erasmus University 1975 (Dutch with a summary in English). A n experimental study in replacement of parts of the cervical e s o p h a g u s in the dog with an ileal autotransplant. The excellent results were studied with esophagoscopy, cinematography, angiography, and histology in all of the 15 used dogs, except three of them that died in the immediate postoperative period. To get a segment of a b o u t 41 cm of ileal transplant, an average of 112 cm ileum had to be resected which was a m e a n of 38.5~ of the total small bowel length. In conclusion it is stated that cervical esophageal replacement with a revascularised ileal autotransplant is feasible. J.C. Molenaar Mortality in Neonatal Duodenal Obstruction. L. Perreli and A. W. Wilkinson. J Roy Coil Surg
Edinb 20:365-373 (November), 1975.
Seventy-six babies with congenital obstruction of the d u o d e n u m who were treated at the Hospital for Sick Children, Great O r m o n d Street, L o n d o n in 1966-1973 inclusive are reviewed. They are compared with another series of 132 treated in the same place and reported in 1966. Particulars are given of the following: type of obstruction, age on admission, pregnancy, sex distribution, birth weight, method of feeding, and mortality. A fall in the n u m b e r of patients with other severe anomalies in addition to duodenal obstruction from 3 0 ~ in the early series to 15~ in the present series is considered to be the main reason why the operative mortality r a t e fell from 35.6~ in the first series to 17.3~ in the second. Case reports are given for all 14 patients who died and include autopsy reports on all except two. A soft transanastomotic feeding tube was used on 42 occasions and no complications en-
ABSTRACTS
sued. The a u t h o r s firmly believe that this was of value but because of other changes in treatment which have taken place at the same time, admit that there is no hard evidence to support this claim. Eleven per cent of the babies suffered also from D o w n ' s s y n d r o m e , which is a m u c h lower percentage than reported in several other series. Possible reasons for this are discussed. A . J . Dougall Gastrointestinal Manifestations of Cystic Fibrosis. Harry Shwachman. Pediatr Clin North Am 22:787-805 (November), 1975 Approximately 15~ of babies with cystic fibrosis have m e c o n i u m ileus. Lactase or other disaccharidase deficiencies are also associated with cystic fibrosis, but whereas m e c o n i u m ileus is usually manifest within the first 48 hr of life, disaccharide deficiencies usually appear at about the age of 4 yr. W h e n intestinal obstruction from impaction occurs after the newborn period, the term m e c o n i u m ileus equivalent is used. One per cent o f patients with cystic fibrosis have intussusception. The average age is 9 yr and the intussusception is usually ileocecal. Only 2 5 ~ have blood in the stool. Surgery was required for reduction in 19 of 22 "episodes." Between the ages of 9 m o and 5 yr, 2 2 ~ of cystics m a y have rectal prolapse. Cirrhosis will occur in 4 - 6 ~ . For bleeding varices, portacaval shunting is presently preferred. Shunting may also be done for hypersplenism without varices. The sweat test is indicated in: (1) Patients with growth failure. (2) Patients with chronic diarrhea, steatorrhea, or abnormal stools. (3) Patients suspected of having celiac disease. (4) Patients with rectal prolapse. (5) Patients with idiopathic hypoproteinemia. (6) Patients with cirrhosis and portal hypertension. (7) Patients with recurrent episodes of abdominal pain and fecal impaction. (8) All siblings of known patients with cystic fibrosis. (9) All offspring of mothers with cystic fibrosis. (10) Patients with heat stroke. (11) Infants with salty taste. (12) Patients with chronic cough, recurrent pneumonia, or recurrent episodes of asthmatic bronchitis, bronchiolitis, nasal polyps, or x-ray evidence of chronic obstructive disease. (13) Children with pancreatitis. EdwardJ. Berman Dilute Elemental Diet and Continuous Infusion Technique for Management of Short Bowel Syndrome. Dennis L. Christie and Marvin E. Ament. J Pediatr 87:705-708 (November), 1975. Two infants with short bowel syndrome were successfully weaned from total parenteral