- Email: [email protected]
Omphalocele: Results of surgical treatment
432
INTERNATIONAL
Preoperative preparation included 2 mg. vitamin K and 1 ml. gammaglobulin, daily phisohex baths, and ampicillin from the time of the umbilical vein catheterization. A full description of the technical aspects of the surgical procedure and the postoperative course is presented in detail.-Howard Cooperman. OMPHALOCELE: RESULTS OF SURGICAL TREATMENT. T. E. Simpson and H. B. Lynn. Mayo Ciin. Proc. 43:65, January 1968. This review is based on 21 patients seen at the Mayo Clinic since 1950 with an omphalocele. Ten (48 per cent) of these patients died. Additional anomalies, however, were a significant factor in the death of 6 of the patients. Eight of the 21 patients had a ruptured sac at the time of surgery and 5 died. At the time of diagnosis, the sac was covered with sterile saline or hexachlorophene sponges, a nasogastric tube was placed to suction, and a venous cutdown was done preoperatively. The type of surgical closure depended on the size of the omphalocele and the size of the fascial defect. A one-staged layered closure was performed in 7 infants with 3 resulting deaths. The other 14 patients, including 4 who had their initial operation elsewhere, were treated by a staged technic involving mobilization of skin and subsequent repair of the fascial defect. Seven of these 14 patients died. The author stresses the importance of preservation of the sac when primary closure is unfeasible, even though 3 of these cases who eventually died had major intra-abdominal anomalies. Not including incomplete rotation and fixations, 12 of the 21 patients in this series had significant anomalies (3 with atresia or stenosis of small bowel, 3 others with atresia or stenosis of the large bowel, 2 with duodenal bands, 2 with cardiac anomalies, 1 with exstrophy of bladder, cloaca, and short gastrointestina1 tract) .-MicheE Gilbert. UNILATERAL PARALYSIS OF THE DIAPHRAGM FOLLOWING BIRTH INJURY: SURGICAL TREATMENT. A. Bonelli and A. Fiocchi. Riv. Chir. Pediatr. 9:234-243, July-Sept. 1967. Hemiparalysis of the diaphragm following injury of the phrenic nerve at birth is not common. Two cases are described in this paper. Surgical treatment consisted of plicating the distended diaphragm and was performed at 3 and 2 months of age, respectively. Results were good. Injury of the phrenic nerve at birth was more common in breech presentation and forceps application. Brachial plexus injury was often present
ABSTRACXS
OF PEDL4TRIC
SURGERY
(53 out of 74 cases). Sudden and severe episodes of dyspnea and cyanosis are the major symptoms and may be followed by recurrent and severe pulmonary infection. Mortality rate in untreated cases is high (15 in 74 cases, 10 of which were lost to follow-up). In all cases with severe respiratory symptoms and infection, waiting for spontaneous recovery may be dangerous and early surgery is definitely indicated and beneficial-c. A. Montagnani. BILATERAL DIAPIIRAGMATIC EVENTRATION: DEMONSTRATION BY PNEU~IOPERITONEOGRAPHY.F. N. Firestone and H. Taybi. Surgery 62:954957, November 1967. Diagnostic pneumoperitoneum can be helpful in the diagnosis of diseases of the diaphragm. Supraumbilical injection of air through the linea alba, 7 to 10 cc. of gas per Kg. of body weight is recommended. Subumbilical injection may penetrate the bladder. In the newborn with respiratory distress, nitrous oxide is used because it is absorbed sixteen times more rapidly than air or oxygen. A case is presented with representative striking x-rays showing the clear demonstration of bilateral anterior eventration of the diaphragm.-Daniel T. cloud. DIAPHRAGMATIC HERNIA IN INFAXCY: FACTORS AFFECTING THE MORTALITY RATE. D. G. Johnson, R. M. Deaner, and C. E. Koop. Surgery 62: 1082-1091, December 1967. The authors report 75 patients with diaphragmatic hernia treated over a 1Cyear period. Those patients less than 3 days of age were the high-risk group having a mortality rate of 47 per cent. In patients 4 to 7 days of age the mortality rate was 25 per cent. Associated pulmonary hypoplasia was a major factor in the high mortality rate; lung weights in 7 nonsurvivors thought to have pulmonary hypoplasia were much below normal. The presence of a hernia sac and associated anomalies had no special correlation with survival in this series. All patients were operated upon transthoracically and the presence of intestinal mahotation was not therefore determined. This did not seem to be a disadvantage. Complications included two recurrences-bowel trauma and significant pneumothorax. The survival rate in this series compares to that in series using abdominal repairs-Daniel T. cloud. FORAMEN OF MORGAGNI HERNIAS IN CHILDREN. E. M. Baran, H. E. Houston, H. B. Lynn, and E. J. O’Connell. Surgery 62:10761081, 1967.
INTERNATIONAL
Preoperative preparation included 2 mg. vitamin K and 1 ml. gammaglobulin, daily phisohex baths, and ampicillin from the time of the umbilical vein catheterization. A full description of the technical aspects of the surgical procedure and the postoperative course is presented in detail.-Howard Cooperman. OMPHALOCELE: RESULTS OF SURGICAL TREATMENT. T. E. Simpson and H. B. Lynn. Mayo Ciin. Proc. 43:65, January 1968. This review is based on 21 patients seen at the Mayo Clinic since 1950 with an omphalocele. Ten (48 per cent) of these patients died. Additional anomalies, however, were a significant factor in the death of 6 of the patients. Eight of the 21 patients had a ruptured sac at the time of surgery and 5 died. At the time of diagnosis, the sac was covered with sterile saline or hexachlorophene sponges, a nasogastric tube was placed to suction, and a venous cutdown was done preoperatively. The type of surgical closure depended on the size of the omphalocele and the size of the fascial defect. A one-staged layered closure was performed in 7 infants with 3 resulting deaths. The other 14 patients, including 4 who had their initial operation elsewhere, were treated by a staged technic involving mobilization of skin and subsequent repair of the fascial defect. Seven of these 14 patients died. The author stresses the importance of preservation of the sac when primary closure is unfeasible, even though 3 of these cases who eventually died had major intra-abdominal anomalies. Not including incomplete rotation and fixations, 12 of the 21 patients in this series had significant anomalies (3 with atresia or stenosis of small bowel, 3 others with atresia or stenosis of the large bowel, 2 with duodenal bands, 2 with cardiac anomalies, 1 with exstrophy of bladder, cloaca, and short gastrointestina1 tract) .-MicheE Gilbert. UNILATERAL PARALYSIS OF THE DIAPHRAGM FOLLOWING BIRTH INJURY: SURGICAL TREATMENT. A. Bonelli and A. Fiocchi. Riv. Chir. Pediatr. 9:234-243, July-Sept. 1967. Hemiparalysis of the diaphragm following injury of the phrenic nerve at birth is not common. Two cases are described in this paper. Surgical treatment consisted of plicating the distended diaphragm and was performed at 3 and 2 months of age, respectively. Results were good. Injury of the phrenic nerve at birth was more common in breech presentation and forceps application. Brachial plexus injury was often present
ABSTRACXS
OF PEDL4TRIC
SURGERY
(53 out of 74 cases). Sudden and severe episodes of dyspnea and cyanosis are the major symptoms and may be followed by recurrent and severe pulmonary infection. Mortality rate in untreated cases is high (15 in 74 cases, 10 of which were lost to follow-up). In all cases with severe respiratory symptoms and infection, waiting for spontaneous recovery may be dangerous and early surgery is definitely indicated and beneficial-c. A. Montagnani. BILATERAL DIAPIIRAGMATIC EVENTRATION: DEMONSTRATION BY PNEU~IOPERITONEOGRAPHY.F. N. Firestone and H. Taybi. Surgery 62:954957, November 1967. Diagnostic pneumoperitoneum can be helpful in the diagnosis of diseases of the diaphragm. Supraumbilical injection of air through the linea alba, 7 to 10 cc. of gas per Kg. of body weight is recommended. Subumbilical injection may penetrate the bladder. In the newborn with respiratory distress, nitrous oxide is used because it is absorbed sixteen times more rapidly than air or oxygen. A case is presented with representative striking x-rays showing the clear demonstration of bilateral anterior eventration of the diaphragm.-Daniel T. cloud. DIAPHRAGMATIC HERNIA IN INFAXCY: FACTORS AFFECTING THE MORTALITY RATE. D. G. Johnson, R. M. Deaner, and C. E. Koop. Surgery 62: 1082-1091, December 1967. The authors report 75 patients with diaphragmatic hernia treated over a 1Cyear period. Those patients less than 3 days of age were the high-risk group having a mortality rate of 47 per cent. In patients 4 to 7 days of age the mortality rate was 25 per cent. Associated pulmonary hypoplasia was a major factor in the high mortality rate; lung weights in 7 nonsurvivors thought to have pulmonary hypoplasia were much below normal. The presence of a hernia sac and associated anomalies had no special correlation with survival in this series. All patients were operated upon transthoracically and the presence of intestinal mahotation was not therefore determined. This did not seem to be a disadvantage. Complications included two recurrences-bowel trauma and significant pneumothorax. The survival rate in this series compares to that in series using abdominal repairs-Daniel T. cloud. FORAMEN OF MORGAGNI HERNIAS IN CHILDREN. E. M. Baran, H. E. Houston, H. B. Lynn, and E. J. O’Connell. Surgery 62:10761081, 1967.