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Intestinal polyp and associated carcinoma in childhood
202
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the drugs was that of normal colonic muscle. In the contracted segment, the muscle gave a normal response to adrenaline but was less sensitive to acetylcholine. Also, the muscle was contracted by D.M.P.P. and nicotine; the normal colon is inhibited by these drugs. It is suggested that the wall of the aganglionic segment contains a cholinergic system which causes muscle contraction. An adrenergic inhibitory system may be present in a defective sent.-_]. H. Johnston.
form
or may
be
ab-
INTESTINAL POLYP AND ASSOCIATED CARCINOMA IN CHILDHOOD. P&eter K. Kottme&, H. William Clatworthy. Amer. J. Surg.
110:709-716,
1965.
Fifty children with a total of 144 polyps seen between 1950 and 1960 were studied. The youngest was 4 days when first seen and the oldest 13 years with a peak incidence between 3 and 6 years. A distinction is made between “juvenile” polyps and adenomatous polyps. Three patients had adenomatous polyps, one with a solitary lesion and the other 2 with more than 10 lesions. Of these 2, one, reported in detail, developed frank adenocarcinoma. Eighty four of the polyps in these cases within the reach of the sigmoidoscope.
were The
authors recommend excisional biopsy with fulguration of the base to decide whether the polyp is juvenile or adenomatous. If juvenile, they consider these to be benign and for the most part self-limiting and treat only for symptoms. If adenomatous repeated frequent follow-up is required with sigmoidoscopy and barium enema with air contrast. They state that in patients with asymptomatic multipIe polyps, if biopsy shows one to be juvenile, the rest may be assumed to be the same and no further surgery is required. In patients with adenomatous polyps or familial polyposis they recommend subtotal colectomy and fulguration of the rectal polyps or total colectomy and ileostomy. They consider lesser surgery with multiple colotomies to carry a greater morbidity and more possiblity of missing a malignant change. They had 6 patients with multiple symtomatic polyps beyond the reach of the sigmoidoscope, 2 had adenomatous polyps and 4 juvenile. All these cases with more than 10 polyps had recurrences after colotomies and came to
ABSTBACTS
OF
PEDIATRIC
SURGERY
subtotal colectomy. They advocate this as the primary procedure, since colectomy does not impair the growth of children.--2\reville K. Connolly.
MALFORMATIONS Thomas
OF THE ANUS ANDRECTUM.
V. Santulli,
John
N. Schullinger
and Raymond A. Amoury. S. Clin. North America. 45: 1253-1271, 1965. This fication
up-to-date review correlates classiwith surgical treatment, after a re-
view of the embryology Lateral roentgenograms
of these with
anomalies. the hips
flexed and the infant inverted determine the ischial level with relation to the lower end of the bowel. If the lower end of the bowel lies above this level in abdominoperineal procedure is necessary. The position of the terminal
end of the
intestine with reference to the puborectalis sling is emphasized as a major factor in providing continence. Preliminary
colostomy
is the initial
treat-
ment of all high lesions and in those males with suspected urinary tract fistula. Definitive pull-through procedures are deferred until 9 to 12 months of age. Associated anomalies were present in onethird of over 300 patients comprising the clinical material upon which this report is based. Congenital heart disease, esophageal atresia, urologic and spinal anomalies were most frequent. The mortality rate, presently under 5 per cent, is that directly related to these associated anomalies. Follow-up information reveals 54 per cent of these patients in this series to have a near normal functional result, 20 per cent a satisfactory result, and 26 per cent an unsatisfactory result. In general, the first definitive operation is the most important one. Subsequent operations yield progressively poorer results. Final functional result is best in those patients with low anomalies. The functional results improve with time.-William R. Sieber.
CLASSIFICATION OF ANO-RECTAL ABNORMALITIES.P. Romualdi. Riv. Cir. Ped. 7: 1965. An extensive and descriptive, more than embryologic classification of the ano-rectal
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the drugs was that of normal colonic muscle. In the contracted segment, the muscle gave a normal response to adrenaline but was less sensitive to acetylcholine. Also, the muscle was contracted by D.M.P.P. and nicotine; the normal colon is inhibited by these drugs. It is suggested that the wall of the aganglionic segment contains a cholinergic system which causes muscle contraction. An adrenergic inhibitory system may be present in a defective sent.-_]. H. Johnston.
form
or may
be
ab-
INTESTINAL POLYP AND ASSOCIATED CARCINOMA IN CHILDHOOD. P&eter K. Kottme&, H. William Clatworthy. Amer. J. Surg.
110:709-716,
1965.
Fifty children with a total of 144 polyps seen between 1950 and 1960 were studied. The youngest was 4 days when first seen and the oldest 13 years with a peak incidence between 3 and 6 years. A distinction is made between “juvenile” polyps and adenomatous polyps. Three patients had adenomatous polyps, one with a solitary lesion and the other 2 with more than 10 lesions. Of these 2, one, reported in detail, developed frank adenocarcinoma. Eighty four of the polyps in these cases within the reach of the sigmoidoscope.
were The
authors recommend excisional biopsy with fulguration of the base to decide whether the polyp is juvenile or adenomatous. If juvenile, they consider these to be benign and for the most part self-limiting and treat only for symptoms. If adenomatous repeated frequent follow-up is required with sigmoidoscopy and barium enema with air contrast. They state that in patients with asymptomatic multipIe polyps, if biopsy shows one to be juvenile, the rest may be assumed to be the same and no further surgery is required. In patients with adenomatous polyps or familial polyposis they recommend subtotal colectomy and fulguration of the rectal polyps or total colectomy and ileostomy. They consider lesser surgery with multiple colotomies to carry a greater morbidity and more possiblity of missing a malignant change. They had 6 patients with multiple symtomatic polyps beyond the reach of the sigmoidoscope, 2 had adenomatous polyps and 4 juvenile. All these cases with more than 10 polyps had recurrences after colotomies and came to
ABSTBACTS
OF
PEDIATRIC
SURGERY
subtotal colectomy. They advocate this as the primary procedure, since colectomy does not impair the growth of children.--2\reville K. Connolly.
MALFORMATIONS Thomas
OF THE ANUS ANDRECTUM.
V. Santulli,
John
N. Schullinger
and Raymond A. Amoury. S. Clin. North America. 45: 1253-1271, 1965. This fication
up-to-date review correlates classiwith surgical treatment, after a re-
view of the embryology Lateral roentgenograms
of these with
anomalies. the hips
flexed and the infant inverted determine the ischial level with relation to the lower end of the bowel. If the lower end of the bowel lies above this level in abdominoperineal procedure is necessary. The position of the terminal
end of the
intestine with reference to the puborectalis sling is emphasized as a major factor in providing continence. Preliminary
colostomy
is the initial
treat-
ment of all high lesions and in those males with suspected urinary tract fistula. Definitive pull-through procedures are deferred until 9 to 12 months of age. Associated anomalies were present in onethird of over 300 patients comprising the clinical material upon which this report is based. Congenital heart disease, esophageal atresia, urologic and spinal anomalies were most frequent. The mortality rate, presently under 5 per cent, is that directly related to these associated anomalies. Follow-up information reveals 54 per cent of these patients in this series to have a near normal functional result, 20 per cent a satisfactory result, and 26 per cent an unsatisfactory result. In general, the first definitive operation is the most important one. Subsequent operations yield progressively poorer results. Final functional result is best in those patients with low anomalies. The functional results improve with time.-William R. Sieber.
CLASSIFICATION OF ANO-RECTAL ABNORMALITIES.P. Romualdi. Riv. Cir. Ped. 7: 1965. An extensive and descriptive, more than embryologic classification of the ano-rectal