Pancreatitis of unusual origin

ABSTRACTS T h e score test was of great value for differentiation of biliary atresia from neonatal hepatitis in both patient-groups of older age and those y o u n g e r than 10 wk of a g e . - - M . Kasai Prognosis After Portocaval Anastomosis: A 15yr Follow-up. R. Windle and J. H. Peacock. Br J Surg 62:701-706, 1975. This is a long-term review of 57 patients who h a d portocaval anastomosis for cirrhosis. The youngest patient was 7 yr of age and only ten were under the age of 20. The prognosis is best in the y o u n g patients, particularly those without evidence of hepatic decompensation. Jaundice and low serum a l b u m i n were also contraindications to surgery. In the 15 yr of follow-up there was a recurrence of bleeding in 12~o of 48 patients investigated. This compares very favourably with the recurrence of bleeding in 6 3 ~ of adults who bleed in the first year without operation. R. B. Zachary Pancreatitis of Unusual Origin. L. Traverse, P. Damus and W. Longmire. Surg Gynecol Obstet 141: 383-386 (September), 1975. This report concerns a developmental foregut defect that ultimately led to pancreatitis in a 32-yr-old lady. A n aberrant duct with an accessory pancreatic lobe c o m m u n i c a t e d with a gastric duplication in the antral wall. F o u r patients with this rare condition previously have been reported. In a period of 4 yr this patient required nineteen hospital admissions for pancreatitis. A distal pancreatectomy and resection of the duplication were performed. Her convalescence was uneventful.--George Holcomb Operative Management of Pancreatic Pseudocysts in Infants and Children: A Review of 75 Cases. D. R. Cooney and J. L. Grosfeld. Ann Surg 182:590 (November), 1975. This report combines the findings and treatm e n t in 15 infants and children with pancreatic pseudocysts with 60 additional cases from a literature review: The mean age of the patients was 7.5 yr with a range of 5 m o to 17 yr. Pseudocysts in 44 children were the result of blunt a b d o m i n a l t r a u m a , whereas in adults, over 80~o o f pseudocysts are due to complications of alcoholic pancreatitis. The time interval between injury and diagnosis ranged from 15 to 712 days. T h e most c o m m o n s y m p t o m was a b d o m i n a l pain followed by vomiting. A n abdominal mass was palpable in 64~o of patients. M o s t useful diagnostic studies were the serum

487 amylase and the upper gastrointestinal series. Despite suggestive physical, laboratory, and x-ray findings, the diagnosis of pancreatic pseudocyst was frequently not considered prior to operation. Operative treatment included external drainage in 25 children, cyst gastrostomy or cyst-jejunostomy in 34, excision in ten, and miscellaneous procedures in six. All of the 75 patients in this review survived. The a u t h o r s suggested that the appropriate operation is determined by the location and duration of pseudocysts. T h e low recurrence rates and a zero mortality rate m a k e s operative treatment highly acceptable therapy.--Frank G. DeLuca Acute Pyogenic Psoas Abscess. S. S. Narasangai. Indian J Surg 37:242-243 (June-July), 1975. A u t h o r has collected 85 cases of abscesses in the psoas sheath in children during the period of 8 yr in a large general hospital in India. These are quite apart from tubercular psoas abscesses which are even m o r e c o m m o n . A u t h o r believes that poor nutrition and preceding infections like measles and gastroenteritis predispose these children to such abscesses.--Vasant Talwalker

G E N I T O U R I N A R Y TRACT Nephrocalcinosis In Infancy And Childhood. R. S. Malek and T. P. Kelalis. J Urol 114:441 (Sep-

tember), 1975. Eleven children (six girls, 5 boys), ranging in age from 2 to 15 yr are studied. Seven of 11 were symptomatic; the other four were investigated for unrelated causes (rickets, steroid treatment, and convulsions). The etiology included renal tubular acidosis (six), hyperoxaluria (two), hyperparathyroidism (one), exogenous hyperadrenocorticism (one), and idiopathic infantile hypercalcemia (one). All demonstrated nephrocalcinosis and in addition, three had renal calculi and one had bilateral ureteral calculi. Nephrocalcinosis involved both kidneys in all cases. Surgical treatment, when indicated, included ureterolithotomy, parathyroid adenectomy, a n d open renal biopsy. Results show that six children (five with R T A and one with hyperparathyroidism) have done well on medical treatment supplemented by surgery. Three of the remaining five have died a n d the remaining two have progressive renal failure. Renal transplantation should be considered in those cases with significantly diminished renal function.