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A case of congenital biliary dilatation associated with portal hypertension
INTERNATIONAL ABSTRACTS tive weeks. In 18 patients bile flow ceased and was resistant to steroid therapy. Prompt reoperation permanently restored bile excretion in 14. Portal hypertension developed in 21 of 72 patients with sustained bile flow. Bleeding was controlled with endosclerosis in 12. Nine patients with hypersplenism had splenic embolization. Six patients who did not have Kasai's procedure died at 2 to 19 months. There were no operative deaths following Kasai's procedure. Sixty-eight of 125 children who underwent Kasai's procedure died at an average of 25 months from liver disease. Twelve patients died after liver transplantation. Fifty-six patients are living, 13 with transplants. Long-term survival was 46% in those operated on younger than the median age (66 days) and 24% when operated on older than the median age.--Edward G. Ford A Case of Congenital Biliary Dilatation Associated With Portal Hypertension. T. Kitamura, K. Ohama, S. Asano, e/ al. Jpn J
Pediatr Surg 21:1165-1170, (October), 1989. The case of a 13-year-old girl with portal hypertension secondary to congenital biliary dilatation is reported and combined with 21 others previously reported in the literature. She appeared to be a healthy teenage girl, but physical examination showed splenomegaly, abdominal mass, and mild icterus. Corrected wedge hepatic vein pressure measured 320 mm HzO. A Roux-en-Y hepaticojejunostomy and liver biopsy were performed. Liver biopsy demonstrated chronic cholangitis. Three months later portal pressure was 210 mm H20. Ten months later serum bilirubin, SGOT, and SGPT had returned to normal. Chronic cholangitis with extrahepatic biliary obstruction may cause peripheral portal embolism and lead to portal hypertension.--Takeshi Miyano Congenital Absence of the Portal Vein. H. Nakasaki, Y. Tanaka,
829 article tests the hypothesis that children with severe neurological impairment are at higher risk for intraabdominal injury than those who have little or no neurological impairment. In a 3-year period, 515 consecutive children underwent abdominal CT evaluation following blunt trauma (aged 1 month to 18 years; mean, 7.7 years). Seventy-eight percent were injured in motor vehicle accidents, 5% during assaults, 2% had bicycle injuries, and the remaining sustained miscellaneous injuries. The children were divided into two groups: (1) those considered neurologically impaired (Glasgow Coma Scale [GCS] < 8, n = 90) and (2) those with little neurological impairment (GCS _> 8, n = 369). Children with GCS less than 8 and physical signs suggestive of underlying abdominal injury were at higher risk for abdominal injury than children with GCS greater than 8. Neurological impairment alone was a low yield indication for abdominal CT. Eleven children with GCS less than 8 underwent CT scan of the abdomen for neurological compromise; all had normal studies. Each child with abdominal injuries had more than one physical indication for CT scan. The authors conclude that CT evaluation of the neurologically impaired child is a low-yield procedure in the absence of physical evidence suggesting intraabdominal injury. The mechanism of injury is an important consideration in the decision to proceed with abdominal CT, regardless of the GCS. Abdominal injuries occur in 37.5% of children with violent assault, with a mortality rate of 12.5%. Abdominal CT scan should be reserved for children in whom there is a high clinical index of suspicion of significant abdominal trauma based on physical examination and mechanism of injury.--Edward G, Ford
GENITOURINARY TRACT
M. Ohta, et al. Ann Surg 210:190-193, (August), 1989.
Intracorporeal Pressure Monitoring During Artificial Penile Erection. J.P. Gearhart andJ.L. Mostwin. J Urol 142:1063-1064, (Octo-
A 14-year-old girl presented with a large hepatic tumor. Preoperative examination showed an absence of the portal vein. However, all serum ammonia studies were normal. Superior mesenteric portography showed the superior mesenteric vein emptying into the left renal vein. The splenic vein also flowed into the left renal vein, and the left renal vein joined the inferior vena cava. The hepatic veins were in normal position. There was no communication from the intestinal tract to the liver via a portal vein. At surgery the portal vein was absent, and the only blood supply to the liver was provided by the hepatic artery. The embryonic development of the portal vein is discussed.--Edward G. Ford
ber), 1989.
Gastrointestinal Duplications Causing Relapsing Pancreatitis in
Children. ,I.E. Lavine, M. Harrison, and M.D. Heyman. Gastroentero197:1556-1558, (December), 1989. The most common pediatric causes of obstructive relapsing pancreatitis are choledochal cysts, strictures of the common duct, congenital stenosis of the ampulla of Vater, and anomalous insertion of the common bile duct. The authors report two pediatric patients with relapsing pancreatitis that was caused by duplications of the antrum in one patient and of the duodenum in the second patient. The diagnosis was made by ERCP or intraoperative cholangiopancreatography. In each case, the cyst was resected and the ectopic duct leading to the common bile duct was ligated. Both patients had an unremarkable recovery.--Richard R. Ricketts Abdominal CT in Children With Neurologic Impairment Following Blunt Trauma. G.A. Taylor and M.R. Eichelberger. Ann Surg
210:229-233, (August), 1989. Computed tomography (CT) of the abdomen is considered routine in the evaluation of children with blunt abdominal trauma. This
In an effort to determine if artificial penile erection has any harmful effect in children, intracorporeal pressures were measured in 12 boys (mean age, 18 months) with midshaft hypospadias. Using a solid state intracompartmental pressure monitoring system, intracorporeal pressures were obtained during full penile erection and after removal of the tourniquet at detumescence. The mean intracorporeal pressure obtained was 85.9 mm Hg during erection and 21.6 mm Hg at detumescence. The systemic arterial pressure obtained was 102 mm Hg at full erection. The pressure studies would suggest that the intracorporeal pressures achieved during full artificial erection would not be harmful to the cavernosal tissue in the hypospadiac child.-G.W. Holcomb, Jr Persistent Cloaca and Phallic Urethra. G. Karlin, W. Brock, M. Rich et al. J Urol 142:1056-1059, (October), 1989.
During the last 8 years, 54 children with a persistent cloaca have been treated. The most common associated anomalies involved the urinary tract, with renal agenesis, renal dysplasia, vesicoureteral reflux, and megaureter encountered most frequently. Four patients demonstrated the rare entity of an opening at the tip of a pseudophallus, and two also had an accessory urethra in association with the cloacal malformation. These children exhibited some form of masculinization of the external genitalia with the accessory urethra or cloacal channel assuming a phallic position in an enlarged clitoris. No adrenal, metabolic, or chromosomal abnormalities were detected, and virilization was limited to the genitalia. These cases illustrate the greater predilection of these patients to more complex congenital malformations than patients with an isolated cloaca. The posterior sagittal approach has been used effectively for repair of these congenital malformations.--G. IF. Holcomb, Jr
Pediatr Surg 21:1165-1170, (October), 1989. The case of a 13-year-old girl with portal hypertension secondary to congenital biliary dilatation is reported and combined with 21 others previously reported in the literature. She appeared to be a healthy teenage girl, but physical examination showed splenomegaly, abdominal mass, and mild icterus. Corrected wedge hepatic vein pressure measured 320 mm HzO. A Roux-en-Y hepaticojejunostomy and liver biopsy were performed. Liver biopsy demonstrated chronic cholangitis. Three months later portal pressure was 210 mm H20. Ten months later serum bilirubin, SGOT, and SGPT had returned to normal. Chronic cholangitis with extrahepatic biliary obstruction may cause peripheral portal embolism and lead to portal hypertension.--Takeshi Miyano Congenital Absence of the Portal Vein. H. Nakasaki, Y. Tanaka,
829 article tests the hypothesis that children with severe neurological impairment are at higher risk for intraabdominal injury than those who have little or no neurological impairment. In a 3-year period, 515 consecutive children underwent abdominal CT evaluation following blunt trauma (aged 1 month to 18 years; mean, 7.7 years). Seventy-eight percent were injured in motor vehicle accidents, 5% during assaults, 2% had bicycle injuries, and the remaining sustained miscellaneous injuries. The children were divided into two groups: (1) those considered neurologically impaired (Glasgow Coma Scale [GCS] < 8, n = 90) and (2) those with little neurological impairment (GCS _> 8, n = 369). Children with GCS less than 8 and physical signs suggestive of underlying abdominal injury were at higher risk for abdominal injury than children with GCS greater than 8. Neurological impairment alone was a low yield indication for abdominal CT. Eleven children with GCS less than 8 underwent CT scan of the abdomen for neurological compromise; all had normal studies. Each child with abdominal injuries had more than one physical indication for CT scan. The authors conclude that CT evaluation of the neurologically impaired child is a low-yield procedure in the absence of physical evidence suggesting intraabdominal injury. The mechanism of injury is an important consideration in the decision to proceed with abdominal CT, regardless of the GCS. Abdominal injuries occur in 37.5% of children with violent assault, with a mortality rate of 12.5%. Abdominal CT scan should be reserved for children in whom there is a high clinical index of suspicion of significant abdominal trauma based on physical examination and mechanism of injury.--Edward G, Ford
GENITOURINARY TRACT
M. Ohta, et al. Ann Surg 210:190-193, (August), 1989.
Intracorporeal Pressure Monitoring During Artificial Penile Erection. J.P. Gearhart andJ.L. Mostwin. J Urol 142:1063-1064, (Octo-
A 14-year-old girl presented with a large hepatic tumor. Preoperative examination showed an absence of the portal vein. However, all serum ammonia studies were normal. Superior mesenteric portography showed the superior mesenteric vein emptying into the left renal vein. The splenic vein also flowed into the left renal vein, and the left renal vein joined the inferior vena cava. The hepatic veins were in normal position. There was no communication from the intestinal tract to the liver via a portal vein. At surgery the portal vein was absent, and the only blood supply to the liver was provided by the hepatic artery. The embryonic development of the portal vein is discussed.--Edward G. Ford
ber), 1989.
Gastrointestinal Duplications Causing Relapsing Pancreatitis in
Children. ,I.E. Lavine, M. Harrison, and M.D. Heyman. Gastroentero197:1556-1558, (December), 1989. The most common pediatric causes of obstructive relapsing pancreatitis are choledochal cysts, strictures of the common duct, congenital stenosis of the ampulla of Vater, and anomalous insertion of the common bile duct. The authors report two pediatric patients with relapsing pancreatitis that was caused by duplications of the antrum in one patient and of the duodenum in the second patient. The diagnosis was made by ERCP or intraoperative cholangiopancreatography. In each case, the cyst was resected and the ectopic duct leading to the common bile duct was ligated. Both patients had an unremarkable recovery.--Richard R. Ricketts Abdominal CT in Children With Neurologic Impairment Following Blunt Trauma. G.A. Taylor and M.R. Eichelberger. Ann Surg
210:229-233, (August), 1989. Computed tomography (CT) of the abdomen is considered routine in the evaluation of children with blunt abdominal trauma. This
In an effort to determine if artificial penile erection has any harmful effect in children, intracorporeal pressures were measured in 12 boys (mean age, 18 months) with midshaft hypospadias. Using a solid state intracompartmental pressure monitoring system, intracorporeal pressures were obtained during full penile erection and after removal of the tourniquet at detumescence. The mean intracorporeal pressure obtained was 85.9 mm Hg during erection and 21.6 mm Hg at detumescence. The systemic arterial pressure obtained was 102 mm Hg at full erection. The pressure studies would suggest that the intracorporeal pressures achieved during full artificial erection would not be harmful to the cavernosal tissue in the hypospadiac child.-G.W. Holcomb, Jr Persistent Cloaca and Phallic Urethra. G. Karlin, W. Brock, M. Rich et al. J Urol 142:1056-1059, (October), 1989.
During the last 8 years, 54 children with a persistent cloaca have been treated. The most common associated anomalies involved the urinary tract, with renal agenesis, renal dysplasia, vesicoureteral reflux, and megaureter encountered most frequently. Four patients demonstrated the rare entity of an opening at the tip of a pseudophallus, and two also had an accessory urethra in association with the cloacal malformation. These children exhibited some form of masculinization of the external genitalia with the accessory urethra or cloacal channel assuming a phallic position in an enlarged clitoris. No adrenal, metabolic, or chromosomal abnormalities were detected, and virilization was limited to the genitalia. These cases illustrate the greater predilection of these patients to more complex congenital malformations than patients with an isolated cloaca. The posterior sagittal approach has been used effectively for repair of these congenital malformations.--G. IF. Holcomb, Jr