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Accessory diaphragm—Report of a case with complete physiological evaluation and surgical correction
781
ABSTRACTS Intermediate
Deep
Loss of dermis; Healing from hair follicles Healing from sweat ducts
Deep dermal bum
Only scanty epithelial foci left, which may or may not be adequate for epithelialization
Whole skin loss
Healing from edge only
This classification is based on the appearance of healing burned areas under standard treatment (penicillin cream), and their fate. Early diagnosis depends on sensitivity to pinprick, and testing must be done carefully in a standard manner. Erythema burns and superficial partial-loss burns show hyperalgesia. Intermediate areas show normal or reduced algesia. Deep partial-loss burns have reduced or no sensitivity to pinprick. Deeper burns are analgesic. Healing times, treatment, and the texture of the healed skin are related to this classification, The author also indicates the disadvantages of the classification. Deep dermal bums can only be diagnosed in retrospect. Sensitivity tests are difficult in the very young and old, and in the mentally subnormal, and they cannot be relied upon in certain special areas (such as face, palms, and soles).A. Jolleys MULTIPLE CONGENITAL SKIN WEBBING WITH CUTIS LAXA. B. McC. O’Brien, 0. M. Garson, A. G. Baikie, and B. J. DooZey. Brit. J. Plast. Snrg. 23:329-336 (October) 1970. Various types of congenital skin webs are discussed, with particular attention to multiple webs, and familial cases. A patient who had multiple webs and cutis laxa is described. An abnormality was found in number 16 chromosome in the patient and two members of his family.-A. Jolleys LYMPHANCIOMA IN CHILDREN: REPORT OF 32 CASES INCLUDING LESIONS AT RARE SITES. Shiudev Singh, M. L. Baboo, and I. C. Pathak. Surgery 69:947-951 (June) 1971.
six.
It
presented
lymphatic
mesenteric
HEAD AND NECK THF. ORLIQUE FACIAL CLEFT. Khoo Boo-Chai. Brit. J. Plastic Surg. 23:3X?-359 (October) 1970. The two main forms of oblique
facial cleft,
i.e., the naso-ocular and the oro-ocular, are described. A case of each type is described, and a further 39 cases collected from the literature are analyzed. Criteria to distinguish between minor forms of oro-ocular and the common cleft lip deformity are described. -A. Jolleys BILATERAL CONGENITAL CHOANAL ATRESIA ASSOCV~TED WITH ANOMALIES OF THE FOREGUT. P. M. Buckfield, M. D. Holdaway, S. Horowitz, and M. R. Kean. Aust. Paediat. J. 7:3744 (March) 1971. Three patients with bilateral osseous congenital choanal atresia, each with associated anomalies of the foregut, are described. A disturbing feature was the failure to thrive and intellectual retardation in each child; one child finally succumbed. Early diagnosis is a necessity and early surgical removal of the obstruction is advocated, a transnasal approach being selected in the three patients. The embryology is discussed and a molded intraoral airway device is described-J. II. Solomon
CYSTIC
The surgical management of 32 children with cystic lymphangiomas is the basis of this report. Seventeen were boys and I5 were girls. In 14 children the mass was present at birth. The lymphangioma involved the neck in I2 patients, the axilla and chest wall in
as
cysts in five. In nine patients uncommon locations as the scrotum and retroperitoneal area were involved. There were no instances of spontaneous regression of the mass. Surgical treatment of 30 of these 32 patients accomplished total excision of the mass in 23 patients. Two patients died postoperatively. Four unusual cases are reported in greater detail.-W. K. Sieber
THORAX MEDIASTINAL TUMORS AND CYSTS. H. N. Oldham, Jr. Ann. Thorac. Surg. 11:246275 (March) A collective Rosenkrantz
1971. review-133
references.-1.
G.
ACCESSORYDIAPHRAGM-REPORT OF A CASE WITH COMPLETE PHYSIOLOGICALEVALUA-
782 AND SURCKAL CORRECTION. M. Nazarian, G. Currarino, W. R. Webb, K. W&s, R. J. Kiphart, and H. E. W&son. J. Thorac. Cardiovasc. Surg. 61:293-299 (February) 1971. TION
A 6-yr-old girl with recurrent pneumonia who was found to have a right accessory diaphragm above the right lower pulmonary lobe. The right upper and middle pulmonary lobes were absent. Bronchial, arterial, and venous anatomy of the right lower lobe seemed normal. Following excision of the accessory diaphragm, there was better expansion of the right lower lobe and the child’s symptoms improved over the 3 mo followup reported.-]. G. Rosenkrantz RECENT ADVANCES IN THE SURGERY OF THE DIAPHRAGM IN THE NEWBORN. James Lister. Prog. Ped. Surg. 2:29-39, 1971. The main advances are the earlier recognition and better management of pre- and postoperative respiratory problems. Diaphragmatic hernia is diagnosed earlier, but results in infants diagnosed early is often disappointing. Resuscitation includes prompt nasogastric suction and possibly positive pressure ventilation through an endotracheal tube. Operation may be very urgent and should be done transabdominally in order to corretit the malrotation of the midgut. The diaphragmatic defect is usually easily closed and manual stretching of the abdominal wall is a valuable inovation. Pulmonary hemorrhage from an excessive p0, and ispsilateral and contralateral pneumothorax may complicate treatment. The hypoplasia of both lungs contributes to the often high intrathoracic pressure that the infant may spontaneously produce which may be responsible for the pneumothoraces. Rolling and sliding hiatus hernias may present difficulties in the newborn and the latter may give very early stricture formation.-R. C. M. Cook
HEART AND GREAT VESSELS BRONCHIAL COMPRESSION FROM ENLARGED, HYPERTENSIVE RIGHT PULMONARY ARTERY WITH CORRECTED TRANSPOS~ON OF GRWT ARTERIES, DFXTROCARDIA, AND VENTRICULAR'SEPTAL DEFECT. DIAGNOSIS AND SURGICAL TREATMENT. W. W. Miller, C. D. Park and J. A. Waldhausen. J.
ABSTRACTS Thorac.
Cardiovasc.
Surg.
60:233-236
(August) 1970. A report is given of an extremely rare cardiac anomaly wherein an abnormal course of the right pulmonary artery and hypertension in this artery compressed the right bronchus. The case was managed successfully by revision of the artery and pulmonary arterial banding. The authors make the important point that there are a number of cases with commoner cardiac defects whose dilated, hypertensive pulmonary arteries have compressed the tracheobronchial tree.-J. G. Rosenkrantz PULA~ONARY SLING: ROENTGEN OBSERVATIONS. Marie A. Capitanio, Rafael Ramos, and John A. Kirkpatrick. Amer. J, Roentgen. 112:26-34 (May) 1971. An anomalous left pulmonary artery can arise from the right pulmonary artery when failure of development of the left sixth aortic arch occurs. It causes tracheal deviation and respiratory obstruction as it courses over the proximal right main bronchus and behind the trachea. The vascular anomaly is known as a pulmonary sling, aberrant left pulmonary artery, or anomalous left pulmonary artery. The prognosis in infants with symptoms is poor but the lesion is surgically correctable. Roentgenographic signs include an alteration of lung aeration (right lung more involved than left with obstructive emphysema or atelectasis), a low left hilus, and anterior bowing of the right main bronchus. Diagnostic studies include esophagography, bronchoscopy, and bronchography. A definitive diagnosis by pulmonary angiography can be obtained prior to surgery.-W. L. Schey PATENT DUCTUS ARTERIOSUS IN INFANTS AND CHZ~REN. A REVIEW OF 936 OPERATIONS ( 1946-69). Ph. G. PanagopouZos, C. J. Tatooles, E. Aberdeen, D. J. Waterston, and R. E. Bonhum Carter. Thorax 26: 137-144 (March) 1971. This report from the Hospital for Sick Children, London, concerns consecutive operations undertaken from April 1946 to May 1969 primarily for the closure of patent ductus arteriosus. A further 222 natients in
ABSTRACTS Intermediate
Deep
Loss of dermis; Healing from hair follicles Healing from sweat ducts
Deep dermal bum
Only scanty epithelial foci left, which may or may not be adequate for epithelialization
Whole skin loss
Healing from edge only
This classification is based on the appearance of healing burned areas under standard treatment (penicillin cream), and their fate. Early diagnosis depends on sensitivity to pinprick, and testing must be done carefully in a standard manner. Erythema burns and superficial partial-loss burns show hyperalgesia. Intermediate areas show normal or reduced algesia. Deep partial-loss burns have reduced or no sensitivity to pinprick. Deeper burns are analgesic. Healing times, treatment, and the texture of the healed skin are related to this classification, The author also indicates the disadvantages of the classification. Deep dermal bums can only be diagnosed in retrospect. Sensitivity tests are difficult in the very young and old, and in the mentally subnormal, and they cannot be relied upon in certain special areas (such as face, palms, and soles).A. Jolleys MULTIPLE CONGENITAL SKIN WEBBING WITH CUTIS LAXA. B. McC. O’Brien, 0. M. Garson, A. G. Baikie, and B. J. DooZey. Brit. J. Plast. Snrg. 23:329-336 (October) 1970. Various types of congenital skin webs are discussed, with particular attention to multiple webs, and familial cases. A patient who had multiple webs and cutis laxa is described. An abnormality was found in number 16 chromosome in the patient and two members of his family.-A. Jolleys LYMPHANCIOMA IN CHILDREN: REPORT OF 32 CASES INCLUDING LESIONS AT RARE SITES. Shiudev Singh, M. L. Baboo, and I. C. Pathak. Surgery 69:947-951 (June) 1971.
six.
It
presented
lymphatic
mesenteric
HEAD AND NECK THF. ORLIQUE FACIAL CLEFT. Khoo Boo-Chai. Brit. J. Plastic Surg. 23:3X?-359 (October) 1970. The two main forms of oblique
facial cleft,
i.e., the naso-ocular and the oro-ocular, are described. A case of each type is described, and a further 39 cases collected from the literature are analyzed. Criteria to distinguish between minor forms of oro-ocular and the common cleft lip deformity are described. -A. Jolleys BILATERAL CONGENITAL CHOANAL ATRESIA ASSOCV~TED WITH ANOMALIES OF THE FOREGUT. P. M. Buckfield, M. D. Holdaway, S. Horowitz, and M. R. Kean. Aust. Paediat. J. 7:3744 (March) 1971. Three patients with bilateral osseous congenital choanal atresia, each with associated anomalies of the foregut, are described. A disturbing feature was the failure to thrive and intellectual retardation in each child; one child finally succumbed. Early diagnosis is a necessity and early surgical removal of the obstruction is advocated, a transnasal approach being selected in the three patients. The embryology is discussed and a molded intraoral airway device is described-J. II. Solomon
CYSTIC
The surgical management of 32 children with cystic lymphangiomas is the basis of this report. Seventeen were boys and I5 were girls. In 14 children the mass was present at birth. The lymphangioma involved the neck in I2 patients, the axilla and chest wall in
as
cysts in five. In nine patients uncommon locations as the scrotum and retroperitoneal area were involved. There were no instances of spontaneous regression of the mass. Surgical treatment of 30 of these 32 patients accomplished total excision of the mass in 23 patients. Two patients died postoperatively. Four unusual cases are reported in greater detail.-W. K. Sieber
THORAX MEDIASTINAL TUMORS AND CYSTS. H. N. Oldham, Jr. Ann. Thorac. Surg. 11:246275 (March) A collective Rosenkrantz
1971. review-133
references.-1.
G.
ACCESSORYDIAPHRAGM-REPORT OF A CASE WITH COMPLETE PHYSIOLOGICALEVALUA-
782 AND SURCKAL CORRECTION. M. Nazarian, G. Currarino, W. R. Webb, K. W&s, R. J. Kiphart, and H. E. W&son. J. Thorac. Cardiovasc. Surg. 61:293-299 (February) 1971. TION
A 6-yr-old girl with recurrent pneumonia who was found to have a right accessory diaphragm above the right lower pulmonary lobe. The right upper and middle pulmonary lobes were absent. Bronchial, arterial, and venous anatomy of the right lower lobe seemed normal. Following excision of the accessory diaphragm, there was better expansion of the right lower lobe and the child’s symptoms improved over the 3 mo followup reported.-]. G. Rosenkrantz RECENT ADVANCES IN THE SURGERY OF THE DIAPHRAGM IN THE NEWBORN. James Lister. Prog. Ped. Surg. 2:29-39, 1971. The main advances are the earlier recognition and better management of pre- and postoperative respiratory problems. Diaphragmatic hernia is diagnosed earlier, but results in infants diagnosed early is often disappointing. Resuscitation includes prompt nasogastric suction and possibly positive pressure ventilation through an endotracheal tube. Operation may be very urgent and should be done transabdominally in order to corretit the malrotation of the midgut. The diaphragmatic defect is usually easily closed and manual stretching of the abdominal wall is a valuable inovation. Pulmonary hemorrhage from an excessive p0, and ispsilateral and contralateral pneumothorax may complicate treatment. The hypoplasia of both lungs contributes to the often high intrathoracic pressure that the infant may spontaneously produce which may be responsible for the pneumothoraces. Rolling and sliding hiatus hernias may present difficulties in the newborn and the latter may give very early stricture formation.-R. C. M. Cook
HEART AND GREAT VESSELS BRONCHIAL COMPRESSION FROM ENLARGED, HYPERTENSIVE RIGHT PULMONARY ARTERY WITH CORRECTED TRANSPOS~ON OF GRWT ARTERIES, DFXTROCARDIA, AND VENTRICULAR'SEPTAL DEFECT. DIAGNOSIS AND SURGICAL TREATMENT. W. W. Miller, C. D. Park and J. A. Waldhausen. J.
ABSTRACTS Thorac.
Cardiovasc.
Surg.
60:233-236
(August) 1970. A report is given of an extremely rare cardiac anomaly wherein an abnormal course of the right pulmonary artery and hypertension in this artery compressed the right bronchus. The case was managed successfully by revision of the artery and pulmonary arterial banding. The authors make the important point that there are a number of cases with commoner cardiac defects whose dilated, hypertensive pulmonary arteries have compressed the tracheobronchial tree.-J. G. Rosenkrantz PULA~ONARY SLING: ROENTGEN OBSERVATIONS. Marie A. Capitanio, Rafael Ramos, and John A. Kirkpatrick. Amer. J, Roentgen. 112:26-34 (May) 1971. An anomalous left pulmonary artery can arise from the right pulmonary artery when failure of development of the left sixth aortic arch occurs. It causes tracheal deviation and respiratory obstruction as it courses over the proximal right main bronchus and behind the trachea. The vascular anomaly is known as a pulmonary sling, aberrant left pulmonary artery, or anomalous left pulmonary artery. The prognosis in infants with symptoms is poor but the lesion is surgically correctable. Roentgenographic signs include an alteration of lung aeration (right lung more involved than left with obstructive emphysema or atelectasis), a low left hilus, and anterior bowing of the right main bronchus. Diagnostic studies include esophagography, bronchoscopy, and bronchography. A definitive diagnosis by pulmonary angiography can be obtained prior to surgery.-W. L. Schey PATENT DUCTUS ARTERIOSUS IN INFANTS AND CHZ~REN. A REVIEW OF 936 OPERATIONS ( 1946-69). Ph. G. PanagopouZos, C. J. Tatooles, E. Aberdeen, D. J. Waterston, and R. E. Bonhum Carter. Thorax 26: 137-144 (March) 1971. This report from the Hospital for Sick Children, London, concerns consecutive operations undertaken from April 1946 to May 1969 primarily for the closure of patent ductus arteriosus. A further 222 natients in