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Pediatric orthotopic liver transplantation: Potential source of intraoperative blood loss and coagulation status monitoring
INTERNATIONAL
453
ABSTRACTS
In the fibrous septa of IHC, fibrinogenesis was apparently lower than in EHBA, because collagen deposition and myofibroblast proliferation were not as prominent as in EHBA. Serum type IV collagen, laminin, and pH increased in IHC, although not as markedly as in EHBA, and returned to normal within 5 weeks after successful LRLT.-G.H. Willital
Pediatric Orthotopic Liver Transplantation: of lntraoperative Blood Loss and Coagulation ing. S.A. Stayer, R.E. Schwartz, C.A. Pasquatiello,
Potential Source Status Monitoret al. Pediatr Surg
Int 10~317-321, (July), 1995. Significant intraoperative blood loss is a major consideration in pediatric liver transplantation. The authors studied 14 parameters to assess whether these potential risk factors correlated with intraoperative blood loss. Seventy transplantations performed between August 1987 and December 1992 (all by the same surgeon) form the database of this study. The parameters include age, weight, gender, ASA physical status, preoperative diagnosis, preoperative ascites, use of veno-veno bypass, need for ICU admission before transplantation, history of previous major abdominal surgery, preoperative prothrombin time, preoperative partial thromboplastin time, preoperative platelet count, use of aminocaproic acid, and whole versus segmental liver transplantation. The only factor that appeared to have statistical significance for determining the amount of blood loss was the age of the patient. Younger age was found to be associated with a lower volume of blood loss. However, the authors note that the variability was too great for this to be of clinical value. This is in variance with findings of others, who have determined that smaller children have a greater volume of blood loss. The authors discuss the findings of other workers with respect to this aspect of liver transplantation. In the final analysis, it appears that prediction of blood loss volume for children who undergo liver transplantation is difficult.-P. Pun’
Trans-Scrotal R.J. Schwarzand
Intra-Abdominal G.K. Blair.
Injuries:
Two
Case
Reports.
Can J Surg 38:374-376, (August), 1995.
Penetrating scrotal injuries are seen infrequently by general and pediatric surgeons. Although such injuries usually are not significant, they may be associated with other more serious ones. The authors present two cases (15 and 45 years of age) of penetrating scrotal trauma with unexpected associated injuries. A 15-year-old boy was involved in a tobogganing accident, and a large piece of wood penetrated his left scrotum, the anterior abdominal wall, and the rectus sheath one third of the way from the umbilicus to the xiphisternum. There was liver laceration as well. Removal of wood and closure of the wounds with drainage resulted in a successful recovery. A 45-year-old man sustained a penetrating straddle-type injury from a broom handle. The handle penetrated Dartos fascia, but there was no testicular injury. It also perforated the rectus sheath 6 cm inferior to the costal margin, and both the anterior and posterior gastric walls. The tract of the handle extended along the base of the transverse mesocolon and posterior to the pancreas. The perforations were debrided and repaired. The patient recovered fully. As a result of their experience with these two patients the authors recommend that when there is penetration of Dartos fascia, the testicle and cord should be inspected, lavage and debridement should be performed, and the injuries should be repaired. Antibiotics should be given perioperatively. In all cases, the entire puncture tract should be explored to its terminus, and a search made for other injuries. Lumbar flexion in association with scrotal penetration in a cranial direction can incur involvement of upper abdominal structures.--Sigmund Ein
Peritoneal Pseudocyst-Ventriculo-Peritoneal cations. R. Besson, J.P. Hladky, P. Dhellemmes,
Shunt Compliet al. Eur J Pediatr
Surg 5:195-197, (August), 1995. Pseudocyst formation is a rare complication of ventriculoperitoneal shunt. It occurred in only 22 of the 1,300 shunt cases managed by the authors. The most common presentation was that of abdominal signs rather than neurological or infectious signs. Diagnosis was achieved easily, using ultrasonography. Treatment of the cysts was by aspiration (21 cases) and for excision (7 cases). The therapeutic choice was made according to the ultrasound findings. When the cyst was infected, an external ventricular shunt was used temporarily. Three patients died.-ThomasA. Angepointner
GENITOURINARY Shortcomings of Testicular
of Color Doppler Torsion. T.D. Allen
TRACT
Sonography in the Diagnosis and J.S. Elder. J Urol 154:1508-
1510, (October), 1995. Five cases of testicular torsion were reviewed in which findings on color Doppler sonography were inconsistent with surgical findings. Color Doppler sonography showed blood flow in two patients who were found to have necrotic testes at the time of surgery. Of the three other patients with normal blood flow by color Doppler sonography, two were treated for epididymitis, with subsequent loss of the testes, and one underwent salvage by immediate exploration. The authors conclude that testicular torsion is a clinical diagnosis that requires consideration of many variables. Color Doppler sonography is helpful but should not be regarded as the definitive discriminator.-Gear W Holcomb, Jr Adolescent Successful
Varicocele: Correction.
Operative G. Belloli,
Anatomy S. D’Agostino,
and Tricks for L. Musi, et al.
Eur J Pediatr Surg 5:219-221, (August), 1995. Conventional varicocelectomy is often complicated by a high recurrence rate, ranging from 6% to 25%, the persistence being usually related to residual venous communications. The authors report their experience with variocelectomy, using three different techniques in 389 adolescents. In the first years (120 patients), an Ivanissevich operation was performed, with a recurrence rate of 18%. During the following years (63 patients), preoperative venography was carried out regularly, and a surgical procedure via inguinal approach was performed with high retroperitoneal and inguinal ligations of the internal spermatic vein(s) and cremasteric vein(s). The recurrence rate was 8%. In the last 5 years a personally modified technique was used, characterized by (1) unique accessto all venous areas in the retroperitoneum and in the inguinal canal with systematic ligation of the internal and external spermatic veins and the deferential vein (if dilated), and (2) intraoperative identification of residual collaterals after venous ligation, by injection of a small amount of methylene blue solution. With this procedure, there were only two recurrences (1%) among 206 consecutively treated patients.-Thomas A. Angerpointner Antegrade Scrotal Sclerotherapy for the Treatment cele in Childhood and Adolescence. A.M. Mottrie, Baerf, et al. Br J Urol76:21-24, (July), 1995.
of VaricoY Matani, +?
Thirty-eight boys (aged 12 to 18 years) with left varicocele, most detected during routine screening, underwent sclerotherapy. Under local anaesthesia the spermatic cord was delivered through a small scrotal neck incision. An isolated vein from the pampiniform plexus was ligated distally and cannulated for on table venography to confirm that the vein was not draining directly into the large
453
ABSTRACTS
In the fibrous septa of IHC, fibrinogenesis was apparently lower than in EHBA, because collagen deposition and myofibroblast proliferation were not as prominent as in EHBA. Serum type IV collagen, laminin, and pH increased in IHC, although not as markedly as in EHBA, and returned to normal within 5 weeks after successful LRLT.-G.H. Willital
Pediatric Orthotopic Liver Transplantation: of lntraoperative Blood Loss and Coagulation ing. S.A. Stayer, R.E. Schwartz, C.A. Pasquatiello,
Potential Source Status Monitoret al. Pediatr Surg
Int 10~317-321, (July), 1995. Significant intraoperative blood loss is a major consideration in pediatric liver transplantation. The authors studied 14 parameters to assess whether these potential risk factors correlated with intraoperative blood loss. Seventy transplantations performed between August 1987 and December 1992 (all by the same surgeon) form the database of this study. The parameters include age, weight, gender, ASA physical status, preoperative diagnosis, preoperative ascites, use of veno-veno bypass, need for ICU admission before transplantation, history of previous major abdominal surgery, preoperative prothrombin time, preoperative partial thromboplastin time, preoperative platelet count, use of aminocaproic acid, and whole versus segmental liver transplantation. The only factor that appeared to have statistical significance for determining the amount of blood loss was the age of the patient. Younger age was found to be associated with a lower volume of blood loss. However, the authors note that the variability was too great for this to be of clinical value. This is in variance with findings of others, who have determined that smaller children have a greater volume of blood loss. The authors discuss the findings of other workers with respect to this aspect of liver transplantation. In the final analysis, it appears that prediction of blood loss volume for children who undergo liver transplantation is difficult.-P. Pun’
Trans-Scrotal R.J. Schwarzand
Intra-Abdominal G.K. Blair.
Injuries:
Two
Case
Reports.
Can J Surg 38:374-376, (August), 1995.
Penetrating scrotal injuries are seen infrequently by general and pediatric surgeons. Although such injuries usually are not significant, they may be associated with other more serious ones. The authors present two cases (15 and 45 years of age) of penetrating scrotal trauma with unexpected associated injuries. A 15-year-old boy was involved in a tobogganing accident, and a large piece of wood penetrated his left scrotum, the anterior abdominal wall, and the rectus sheath one third of the way from the umbilicus to the xiphisternum. There was liver laceration as well. Removal of wood and closure of the wounds with drainage resulted in a successful recovery. A 45-year-old man sustained a penetrating straddle-type injury from a broom handle. The handle penetrated Dartos fascia, but there was no testicular injury. It also perforated the rectus sheath 6 cm inferior to the costal margin, and both the anterior and posterior gastric walls. The tract of the handle extended along the base of the transverse mesocolon and posterior to the pancreas. The perforations were debrided and repaired. The patient recovered fully. As a result of their experience with these two patients the authors recommend that when there is penetration of Dartos fascia, the testicle and cord should be inspected, lavage and debridement should be performed, and the injuries should be repaired. Antibiotics should be given perioperatively. In all cases, the entire puncture tract should be explored to its terminus, and a search made for other injuries. Lumbar flexion in association with scrotal penetration in a cranial direction can incur involvement of upper abdominal structures.--Sigmund Ein
Peritoneal Pseudocyst-Ventriculo-Peritoneal cations. R. Besson, J.P. Hladky, P. Dhellemmes,
Shunt Compliet al. Eur J Pediatr
Surg 5:195-197, (August), 1995. Pseudocyst formation is a rare complication of ventriculoperitoneal shunt. It occurred in only 22 of the 1,300 shunt cases managed by the authors. The most common presentation was that of abdominal signs rather than neurological or infectious signs. Diagnosis was achieved easily, using ultrasonography. Treatment of the cysts was by aspiration (21 cases) and for excision (7 cases). The therapeutic choice was made according to the ultrasound findings. When the cyst was infected, an external ventricular shunt was used temporarily. Three patients died.-ThomasA. Angepointner
GENITOURINARY Shortcomings of Testicular
of Color Doppler Torsion. T.D. Allen
TRACT
Sonography in the Diagnosis and J.S. Elder. J Urol 154:1508-
1510, (October), 1995. Five cases of testicular torsion were reviewed in which findings on color Doppler sonography were inconsistent with surgical findings. Color Doppler sonography showed blood flow in two patients who were found to have necrotic testes at the time of surgery. Of the three other patients with normal blood flow by color Doppler sonography, two were treated for epididymitis, with subsequent loss of the testes, and one underwent salvage by immediate exploration. The authors conclude that testicular torsion is a clinical diagnosis that requires consideration of many variables. Color Doppler sonography is helpful but should not be regarded as the definitive discriminator.-Gear W Holcomb, Jr Adolescent Successful
Varicocele: Correction.
Operative G. Belloli,
Anatomy S. D’Agostino,
and Tricks for L. Musi, et al.
Eur J Pediatr Surg 5:219-221, (August), 1995. Conventional varicocelectomy is often complicated by a high recurrence rate, ranging from 6% to 25%, the persistence being usually related to residual venous communications. The authors report their experience with variocelectomy, using three different techniques in 389 adolescents. In the first years (120 patients), an Ivanissevich operation was performed, with a recurrence rate of 18%. During the following years (63 patients), preoperative venography was carried out regularly, and a surgical procedure via inguinal approach was performed with high retroperitoneal and inguinal ligations of the internal spermatic vein(s) and cremasteric vein(s). The recurrence rate was 8%. In the last 5 years a personally modified technique was used, characterized by (1) unique accessto all venous areas in the retroperitoneum and in the inguinal canal with systematic ligation of the internal and external spermatic veins and the deferential vein (if dilated), and (2) intraoperative identification of residual collaterals after venous ligation, by injection of a small amount of methylene blue solution. With this procedure, there were only two recurrences (1%) among 206 consecutively treated patients.-Thomas A. Angerpointner Antegrade Scrotal Sclerotherapy for the Treatment cele in Childhood and Adolescence. A.M. Mottrie, Baerf, et al. Br J Urol76:21-24, (July), 1995.
of VaricoY Matani, +?
Thirty-eight boys (aged 12 to 18 years) with left varicocele, most detected during routine screening, underwent sclerotherapy. Under local anaesthesia the spermatic cord was delivered through a small scrotal neck incision. An isolated vein from the pampiniform plexus was ligated distally and cannulated for on table venography to confirm that the vein was not draining directly into the large