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A new hemostatic clip: Two-year review of 1,007 cases
593
INTERNATIONAL ABSTRAC'I'S OF PEDIATRIC SURGERY
standing study and is recommended to all pediatric surgeons interested in accident prevention. The investigators have done the essential piece of work--establishing a control group (no educational program) against which to compare the study group (intensive educational programing ). The basic conclusion--simply stated--is that there was no demonstrable difference in the rate, type or degree of injury between both
groups.--Robert J. lzant, Jr,
This study emphasizes the inaccuracy of utilizing the inferior vena caval pressure as a measure of effective central venous filling in the presence of abdominal distention. The importance of cannulating the superior cava has been demonstrated in laboratory animals and in a 3 year old boy.--George W. Hol-
comb. CLINICAL USE
OF
TRANSILLUMINATION.
D. B. Shurtleff, E. L. Foltz and D. Fry. Arch. Dis. Child. 41:183, April 1966.
STATISTICAL INVESTIGATION OF MORTALITY AND MORBIDITY DUE TO ACCIDENTS IN CHILDHOOD (PossIBILITIES OF PREVENTION). M. Vest. Schweiz. Med. Wchnschr.
96:687-694, 1966. In Switzerland 45 per cent of all deaths between the ages of 1 and 19 years are due to accidents; half of them are traffic accidents. In decreasing order of incidence, the other most frequent causes of accidental death are drowning, falls, burns, poisoning and suffocation with variations according to age group. Girls are less subject to accidents than boys. For every accidental death there are 100 to 200 nonfatal accidents. Every year 10 per cent of all children are victim of accidents which may result in permanent disability. Prevention of accidents is twofold: education of children and parents, on the one hand, elimination of sources of danger, especially in the household, on the other hand.--M. Bettex
An apparatus for photographic recording of translucent lesions is described in which standardization of light source, time of exposure and recording device obviate the variable results obtained by other methods. Four cases (hydrocephalus, cystic b r a i n disease, subdural hydroma, subdural hematoma) are reported which illustrate the use of cranial transillumination in the detection of fluid--containing lesions in the silent neopallium of infants. One case (congenital stenosis of the mesenteric vein) is described to illustrate the use of abdominal transillumination to define organ size in an abdomen tensely distended by ascites. Other conditions in which the naethod is of value are cited.--Irene M. Irving. A NEW HEMOSTATIC CLIP: Two-YEAR RE-
VIEW OF 1,007 CASES. Peter B. Samuels,
Herbert Roedling, Robert Katz and John J. Cineotti. Ann. Surg. 163:427-431, March 1966.
TIlE OPTIMAL SITE FOR CENTRAL VENOUS MEASUREMENT IN NEWBORN INFANTS.
J. L. Tolbert and J. A. Haller, Jr. J. Surg. Res. 6:168, April 1966. A comparison of superior and inferior vena caval pressures was made in 2 adult dogs and an 8 week old puppy. Following injection of intraperitoneal air there was an associated elevation of inferior caval pressure in each instance. These fluctuation were not observed in the superior vena caval pressures. Employing similar monitoring technics, intraperitoneal air was injected into a 3 year old boy in preparation for a staged repair of an omphalocele. As in dogs, the increased abdominal pressure resulted in elevation of inferior vena caval pressure with no significant alterations in superior vena caval pressure.
This article reports the experience and the design of the first new hemostatic clip since Cushing's original deseription in 1911. The present clip, manufactured by Edward Week & Co., Inc., has been used in a large variety of eases including eholeeystectomy, vagotomy, varicose vein surgery, retroperitoneal dissection, but also used in various head and neck, chest, abdominal and arterial surgery. There have been no early or late complications. The clip is designed so that it completely encircles the structure involved before the sides close down. The ctip has longitudinal as well as transverse groves in it to prevent necrosis. The clip comes in one size (.2 inches when closed). The reviewer has had no personal experience with this clip but concurs with the
594
INTERNATIONAL ABSTRACTS OF PEDIATRIC SURGERY
disadvantages of the Cushing clips as sighted by the authors.--Robert 1. Izant, Jr. THE ROLE OF ORGAN TRANSPLANTATIONIN PEDIATRICS. T. E. Starzl, T. L. Marchioro,
K. A. Porter, T. D. Faris and T. A. Carey. Pediat. Clin. North Amer. 13:38, May 1966.
Renal Transplantation. Twenty-two patients had renal transplantation at the University of Colorado Medical Center in the past 3 years. Eighteen of these were for chronic glomerulonephritis. In all but one case resuscitation with the artificial kidney was necessary before transplantation. Most of the kidneys were obtained from parents. Tissue transfer between donors and recipients of different blood types should conform to the general rules which apply for unmatched blood transfusions. Thus O to non-O is considered safe, RH-- to R H + is safe, R H + to RH-- is relatively safe; A to non-A, B to non-B and AB to non-AB are dangerous. The principle risk with the use of unacceptable donor-recipient blood type incompatibilities seems to be an acute one due to an immunological reaction possibly distinct from rejection. After a suitable donor is found relative to blood type, a careful examination is conducted including renal function studies, multiple urine cultures, intravenous pyelography and, finally, retrograde aortography. Kidneys with double arterial supply are not used. Better methods of determining histoeompatibility are needed. Terasaki of UCLA in a retrospective study found the best results tended to be in patients who had the greatest antigen similarity to their donors. Because of these findings a prospective study was undertaken in October, 1964, using Terasakiselected donors. Although the follow-up is short all 6 of these patients are alive. Ethical issues are discussed and it is observed that knowledge as to the ultimate fate of donor and recipient would simplify the eonsiderations; nevertheless, these are still complex. The easiest way to minimize anoxic injury to the donor kidney is by perfusing immediately after removal with cold lactated Ringer's solution (15 C.) containing 50 mg. of heparin and 1 Gin. of procaine chloride/L. The kidney is cooled by this method
and revaseularized within the host within 40 minutes. In children 12 years old or more the donor kidney is placed in the opposite iliae fossa attaching renal to external iliae vein. The ureter is implanted directly into the bladder or attached with an end-to-end anastomosis; alternatively a ureteropelvie anastomosis may be used. In children under 12 anastoniosis may be made to iliaes or aorta and inferior vena eava. An acute post-transplant diuresis can be expected for 24-48 hours. Repeated plasma and urine electrolyte determinations are required. A remarkable general improvement in the patient occurs. Early convalescence is more rapid in patients than in donors with diet started the morning after operation and ambulation that evening. Unless immunosuppression is practiced, good early function ceases within a few days or weeks in all but the exceptional ease. To accomplish imnmnosuppression azathioprine and prednisone are used and the dose of the latter is increased at the onset of clinical rejection. At the peak of the rejection crisis Aetinomyein C and local homograft irradiation are also used. In addition to the danger of early rejection, there is the problem of late rejection possible even years after transplantation. There were 4 deaths in this series. Late azathioprine toxicity is a danger. Therapy with prednisone is a matter of concern causing a multitude of problems--including arrest of growth. All patients had spleneetomy and 6 had thymectomy, although the value of these ad~'uvant procedures is not certain. Biopsies of 8 of the homografts from 21 to 26 months after operation revealed that only one of the kidneys was normal. The others showed narrowing of the interlobular arteries by fibrous intimal thickening and interstitial infiltration by large lymphoid cells. In 2 homografts there were ehanges resemblin~ membranous glomerulonephritis. Juxta glomerular hyperplasia was present in 6 of the 8 homografts. Liver Transplantation. Orthotopie transplantation wherein a recipient dog's own liver is removed and replaced with the liver from an unrelated mongrel animal gives an immediate mortality of 10 per cent or less. Azathioprine is given. In the authors labora-
INTERNATIONAL ABSTRAC'I'S OF PEDIATRIC SURGERY
standing study and is recommended to all pediatric surgeons interested in accident prevention. The investigators have done the essential piece of work--establishing a control group (no educational program) against which to compare the study group (intensive educational programing ). The basic conclusion--simply stated--is that there was no demonstrable difference in the rate, type or degree of injury between both
groups.--Robert J. lzant, Jr,
This study emphasizes the inaccuracy of utilizing the inferior vena caval pressure as a measure of effective central venous filling in the presence of abdominal distention. The importance of cannulating the superior cava has been demonstrated in laboratory animals and in a 3 year old boy.--George W. Hol-
comb. CLINICAL USE
OF
TRANSILLUMINATION.
D. B. Shurtleff, E. L. Foltz and D. Fry. Arch. Dis. Child. 41:183, April 1966.
STATISTICAL INVESTIGATION OF MORTALITY AND MORBIDITY DUE TO ACCIDENTS IN CHILDHOOD (PossIBILITIES OF PREVENTION). M. Vest. Schweiz. Med. Wchnschr.
96:687-694, 1966. In Switzerland 45 per cent of all deaths between the ages of 1 and 19 years are due to accidents; half of them are traffic accidents. In decreasing order of incidence, the other most frequent causes of accidental death are drowning, falls, burns, poisoning and suffocation with variations according to age group. Girls are less subject to accidents than boys. For every accidental death there are 100 to 200 nonfatal accidents. Every year 10 per cent of all children are victim of accidents which may result in permanent disability. Prevention of accidents is twofold: education of children and parents, on the one hand, elimination of sources of danger, especially in the household, on the other hand.--M. Bettex
An apparatus for photographic recording of translucent lesions is described in which standardization of light source, time of exposure and recording device obviate the variable results obtained by other methods. Four cases (hydrocephalus, cystic b r a i n disease, subdural hydroma, subdural hematoma) are reported which illustrate the use of cranial transillumination in the detection of fluid--containing lesions in the silent neopallium of infants. One case (congenital stenosis of the mesenteric vein) is described to illustrate the use of abdominal transillumination to define organ size in an abdomen tensely distended by ascites. Other conditions in which the naethod is of value are cited.--Irene M. Irving. A NEW HEMOSTATIC CLIP: Two-YEAR RE-
VIEW OF 1,007 CASES. Peter B. Samuels,
Herbert Roedling, Robert Katz and John J. Cineotti. Ann. Surg. 163:427-431, March 1966.
TIlE OPTIMAL SITE FOR CENTRAL VENOUS MEASUREMENT IN NEWBORN INFANTS.
J. L. Tolbert and J. A. Haller, Jr. J. Surg. Res. 6:168, April 1966. A comparison of superior and inferior vena caval pressures was made in 2 adult dogs and an 8 week old puppy. Following injection of intraperitoneal air there was an associated elevation of inferior caval pressure in each instance. These fluctuation were not observed in the superior vena caval pressures. Employing similar monitoring technics, intraperitoneal air was injected into a 3 year old boy in preparation for a staged repair of an omphalocele. As in dogs, the increased abdominal pressure resulted in elevation of inferior vena caval pressure with no significant alterations in superior vena caval pressure.
This article reports the experience and the design of the first new hemostatic clip since Cushing's original deseription in 1911. The present clip, manufactured by Edward Week & Co., Inc., has been used in a large variety of eases including eholeeystectomy, vagotomy, varicose vein surgery, retroperitoneal dissection, but also used in various head and neck, chest, abdominal and arterial surgery. There have been no early or late complications. The clip is designed so that it completely encircles the structure involved before the sides close down. The ctip has longitudinal as well as transverse groves in it to prevent necrosis. The clip comes in one size (.2 inches when closed). The reviewer has had no personal experience with this clip but concurs with the
594
INTERNATIONAL ABSTRACTS OF PEDIATRIC SURGERY
disadvantages of the Cushing clips as sighted by the authors.--Robert 1. Izant, Jr. THE ROLE OF ORGAN TRANSPLANTATIONIN PEDIATRICS. T. E. Starzl, T. L. Marchioro,
K. A. Porter, T. D. Faris and T. A. Carey. Pediat. Clin. North Amer. 13:38, May 1966.
Renal Transplantation. Twenty-two patients had renal transplantation at the University of Colorado Medical Center in the past 3 years. Eighteen of these were for chronic glomerulonephritis. In all but one case resuscitation with the artificial kidney was necessary before transplantation. Most of the kidneys were obtained from parents. Tissue transfer between donors and recipients of different blood types should conform to the general rules which apply for unmatched blood transfusions. Thus O to non-O is considered safe, RH-- to R H + is safe, R H + to RH-- is relatively safe; A to non-A, B to non-B and AB to non-AB are dangerous. The principle risk with the use of unacceptable donor-recipient blood type incompatibilities seems to be an acute one due to an immunological reaction possibly distinct from rejection. After a suitable donor is found relative to blood type, a careful examination is conducted including renal function studies, multiple urine cultures, intravenous pyelography and, finally, retrograde aortography. Kidneys with double arterial supply are not used. Better methods of determining histoeompatibility are needed. Terasaki of UCLA in a retrospective study found the best results tended to be in patients who had the greatest antigen similarity to their donors. Because of these findings a prospective study was undertaken in October, 1964, using Terasakiselected donors. Although the follow-up is short all 6 of these patients are alive. Ethical issues are discussed and it is observed that knowledge as to the ultimate fate of donor and recipient would simplify the eonsiderations; nevertheless, these are still complex. The easiest way to minimize anoxic injury to the donor kidney is by perfusing immediately after removal with cold lactated Ringer's solution (15 C.) containing 50 mg. of heparin and 1 Gin. of procaine chloride/L. The kidney is cooled by this method
and revaseularized within the host within 40 minutes. In children 12 years old or more the donor kidney is placed in the opposite iliae fossa attaching renal to external iliae vein. The ureter is implanted directly into the bladder or attached with an end-to-end anastomosis; alternatively a ureteropelvie anastomosis may be used. In children under 12 anastoniosis may be made to iliaes or aorta and inferior vena eava. An acute post-transplant diuresis can be expected for 24-48 hours. Repeated plasma and urine electrolyte determinations are required. A remarkable general improvement in the patient occurs. Early convalescence is more rapid in patients than in donors with diet started the morning after operation and ambulation that evening. Unless immunosuppression is practiced, good early function ceases within a few days or weeks in all but the exceptional ease. To accomplish imnmnosuppression azathioprine and prednisone are used and the dose of the latter is increased at the onset of clinical rejection. At the peak of the rejection crisis Aetinomyein C and local homograft irradiation are also used. In addition to the danger of early rejection, there is the problem of late rejection possible even years after transplantation. There were 4 deaths in this series. Late azathioprine toxicity is a danger. Therapy with prednisone is a matter of concern causing a multitude of problems--including arrest of growth. All patients had spleneetomy and 6 had thymectomy, although the value of these ad~'uvant procedures is not certain. Biopsies of 8 of the homografts from 21 to 26 months after operation revealed that only one of the kidneys was normal. The others showed narrowing of the interlobular arteries by fibrous intimal thickening and interstitial infiltration by large lymphoid cells. In 2 homografts there were ehanges resemblin~ membranous glomerulonephritis. Juxta glomerular hyperplasia was present in 6 of the 8 homografts. Liver Transplantation. Orthotopie transplantation wherein a recipient dog's own liver is removed and replaced with the liver from an unrelated mongrel animal gives an immediate mortality of 10 per cent or less. Azathioprine is given. In the authors labora-