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Acetabular development in congenital dislocation of the hip
986 leukemia accounted for 8.5?; of the disorders. In 291), of cases infection alone was responsible for stone formation. In 22~;I no cause could be found. The overall recurrence rate after treatment was 7~;, but this was reduced to 3.5~ if patients with cystinuria were excluded. The chemistry of the water supplies was studied, and the authors suggest, tentatively, that hard water with an alkaline pH may be a causative factor.--J. H. Johnston Bilateral Pelvi-Ureteric Avulsion Following Closed Trauma. V. E. Boston and B. T. Smyth. Br J Urol 47:149-151 (April), 1975. A 9-yr-old girl was involved in a traffic accident and received multiple injuries. Following a period of anuria an IVP showed bilateral pelviureteric rupture. At operation the ureters were found to be avulsed about 4 m m below the pelvis. The kidneys were uninjured. Introoperative collapse of the patient prevented reconstruction and bilateral nephrostomies were performed. Ultimately continuity was restored o n each side by pyeloureterostomy. One year after injury the child was well and IVP showed no hydronephrosis. The pathogenesis of the injury is discussed. As a unilateral lesion it m a y be due to extreme lateral flexion and hyperextension of the spine. Alternatively, a wheel crossing the a b d o m e n m a y displace one or both kidneys u p w a r d s . - - J . H. Johnston The Congenital Refluxing Megaureter: Experiences with Surgical Reconstruction. J. H. Johnston and A. Farkas. Br J Urol 47:153-159 (April), 1975. The primary refluxing megaureter is usually a bilateral lesion and is associated with congenital atrophic and sometimes dysplastic changes in the kidney parenchyma. The affected patient usually presents in early childhood with azotemia or infection or both, Surgical tailoring and reimplantation was performed in 29 such megaureters in 17 patients; with three ureters in two patients, pyeloureteroplasty was required in addition because of secondary obstructive kinks at the pelviureteric junction. The results were not satisfactory. Reflux persisted after surgery in ten ureters and three ureters were partially obstructed; most of these cases needed reoperation. I m p r o v e m e n t in drainage of the upper tract was apparent mainly in those cases with secondary pelviureteric kinks. This is in marked contrast to the obstructed megaureter where a good result following surgery is to be expected, Most children with bilateral refluxing
ABSTRACTS megaureters are in incipient or actual renal failure and are of stunted growth. The authors suggest that the mere existence of refluxing megaureters is not of itself an indication for surgery. Operation should be performed only when there is an obstructive element consequent on the reflux or if infection, uncontrollable by chemotherapy, is producing further damage to the already congenitally defective kidney parenchyma. External urinary diversion is contraindicated. It produces the burden of a stoma but does not prolong survival nor delay the onset of overt renal insufficiency.--J. H. Johnston MUSCULOSKELETAL
SYSTEM
The Transarticular Graft for Infantile Pseudarthrosis of Tibia. San Bow. J Bone Joint Surg 57B: 63-68 (Feb), 1975. This paper deals with 14 cases of tibial psuedarthrosis in surgical practice in Burma. Because of conditions in the country where villages are remote and c o m m u n i c a t i o n s are poor, all cases were far advanced and were characterized by severe deformity and shortening of the affected limbs. For these reasons and because a m p u t a tion was always refused this operation was devised in the hope of achieving rapid and early union even with the possibility of reduced ankle joint mobility. The ages o f the patients ranged from I mo to 17 yr. Nine o f them were treated by the insertion of a pointed bone graft driven into the medullary cavity of the distal tibial fragment across the joint and into the body of the talus. The upper end was then fixed to the proximal tibial fragment. The bone grafts were cadaveric in four, d o n o r in four, and a n t o g e n o u s in one. Firm union was secured in six patients. There was no subsequent growth deformity due to perforation of the epiphysial plate. The transarticular part of the graft absorbed in due course and apparently the function of the ankle joints was not affected. Of the other five cases, three had onlay grafts and were lost to followup, their grafts having absorbed. One refused all treatment and one aged 3 m o is still under observation. John Aitken Acetabular Development in Congenital Dislocation of the Hip. N. H. Harris, G. C. Lloyd-Roberts, and R. Gallien. J Bone Joint Surg 57B:46-52 (Feb), 1975. In this paper the authors hope to help solve the problem o f whether acetabuloplasty should
ABSTRACTS
987
be included as a step in early cases of congenital dislocation of the hip. In the authors' view this procedure should not be performed without very good reason. Judging from their results, it appears that acetabular development occurs satisfactorily in a large n u m b e r of instances as long as proper reduction is maintained. Seventy-two patients with 85 affected hips were studied; all had been over 1 yr old when admitted and over 10 at the time o f review. Acetabular development was assessed radiologically by m e a s u r e m e n t of the acetabular angle. Satisfactory development occurred in 80~. The reasons for failure in the others were failure to obtain and maintain congruity and development of ischemic necrosis due to manipulative reductions. When patients in w h o m these errors have occurred were eliminated from the series, satisfactory acetabular development in 9 5 ~ of hips was claimed. The authors appear to have proved their point that acetabuloplasty should not be necessary if the patient is admitted under the age of 4 or congruity obtained in the functional position under 489yr.--John A itken
Posterior Psoas Transfer and Hip Instability in Lumbar Myelomeningocele. Barrie Parker and Geoffrey Walker. J Bone Joint Surg 57B:53-58 (Feb), 1975. In 1959 Sharrard described posterior transfer of the ileopsoas muscle as an operation for the treatment of hip instability in children with myelomeningocele and with neurologic activity below lumbar 1 and 2. This paper deals with 72 patients in w h o m this procedure was carried out in an attempt to assess the value of the operation. Seventy-two posterior ileopsoas transfers were done in 44 children and these were reviewed 1-8 yr after operation. It was found that hip stability had improved in all, 94 being stable at the time of review. Fifty-seven percent of the patients had an acceptable functional result, which depended mainly on the level of neurologic activity. From these results the a u t h o r s think that transfers should be done as soon after the age of 9 mo as possible and if done after the age of 2 yr should be restricted to patients with neurologic activity in lumbar 3 and 4.--John A itken
During the 6-yr period 1967-1973, 173 p a tients were treated by ventriculoatrial s h u n t a n d 43 o f these have been analyzed in detail. All these patients were about 3 yr of age. O f the 27 survivors, 24 were investigated by psychologic tests. Mental development was n o r m a l in 14, while 10 showed mental retardation; of the 10, 8 can still attend school. Grave etiologic factors, like aqueduct occlusion, ventriculitis and occlusion, birth in asphyxia, late surgery, toxemic pregnancy, neonatal subarachnoidal hemorrhage, and p r e m a t u r e birth are considered primarily responsible for the retardation. The functional development that can be achieved by successful surgical treatment is discussed.--A ndrew Pint~r
Postmeningitic Hydrocephalus. B. Zumsteln and H. Zumstein. Schweiz Med Wochenschr 104:799795 (June), 1974.
Twenty-three patients with postmeningitic hydrocephalus have been followed. The a u t h o r s found that postmeningitic hydrocephalus has a tendency to s p o n t a n e o u s resolution but at a time when definitive cerebral d a m a g e has already occurred. Therefore, a s h u n t operation has to be performed as soon as possible, in any case within 6 m o after meningitis.--G. Egli NEOPLASMS
Management of the Acute Abdomen in Children With Leukemia. Philip R. Exelby, Amir Ghandchi, Nicolas Lansigan, and Ira Schwartz. Cancer 35: 826-829 (March), 1975.
Study of Hydrocephalic Patients Three Years After Surgery. E. Paralcz, L. V~kbssy, and Susan
A m o n g 286 children with acute leukemia seen at the Memorial Hospital (NYC) from 1966 to 1971, 16 developed an acute a b d o m i n a l disease entity during their course of therapy. Five o f these conditions were not noted until autopsy. Two were treated without surgery by election and died. A m o n g the nine children m a n a g e d by active surgical intervention, five were long-term survivors. However, three of the latter were in remission at the time of surgery. The pathologic entities in these 16 children were appendicitis, typhlitis (including infarction and perforation), intussusception, intestinal obstruction, pancreatitis, and liver abscess. In addition to supportive care, including broad-spectrum antibiotics, aggressive antileukemic therapy is r e c o m m e n d e d during the postoperative period following abdominal surgery in these children. --Daniel M. Hays
Kovbcs. Acta Paediatr Acad Sci Hung 15:205-209, 1974.
The Management of Pulmonary Metastases in
NERVOUS SYSTEM
ABSTRACTS megaureters are in incipient or actual renal failure and are of stunted growth. The authors suggest that the mere existence of refluxing megaureters is not of itself an indication for surgery. Operation should be performed only when there is an obstructive element consequent on the reflux or if infection, uncontrollable by chemotherapy, is producing further damage to the already congenitally defective kidney parenchyma. External urinary diversion is contraindicated. It produces the burden of a stoma but does not prolong survival nor delay the onset of overt renal insufficiency.--J. H. Johnston MUSCULOSKELETAL
SYSTEM
The Transarticular Graft for Infantile Pseudarthrosis of Tibia. San Bow. J Bone Joint Surg 57B: 63-68 (Feb), 1975. This paper deals with 14 cases of tibial psuedarthrosis in surgical practice in Burma. Because of conditions in the country where villages are remote and c o m m u n i c a t i o n s are poor, all cases were far advanced and were characterized by severe deformity and shortening of the affected limbs. For these reasons and because a m p u t a tion was always refused this operation was devised in the hope of achieving rapid and early union even with the possibility of reduced ankle joint mobility. The ages o f the patients ranged from I mo to 17 yr. Nine o f them were treated by the insertion of a pointed bone graft driven into the medullary cavity of the distal tibial fragment across the joint and into the body of the talus. The upper end was then fixed to the proximal tibial fragment. The bone grafts were cadaveric in four, d o n o r in four, and a n t o g e n o u s in one. Firm union was secured in six patients. There was no subsequent growth deformity due to perforation of the epiphysial plate. The transarticular part of the graft absorbed in due course and apparently the function of the ankle joints was not affected. Of the other five cases, three had onlay grafts and were lost to followup, their grafts having absorbed. One refused all treatment and one aged 3 m o is still under observation. John Aitken Acetabular Development in Congenital Dislocation of the Hip. N. H. Harris, G. C. Lloyd-Roberts, and R. Gallien. J Bone Joint Surg 57B:46-52 (Feb), 1975. In this paper the authors hope to help solve the problem o f whether acetabuloplasty should
ABSTRACTS
987
be included as a step in early cases of congenital dislocation of the hip. In the authors' view this procedure should not be performed without very good reason. Judging from their results, it appears that acetabular development occurs satisfactorily in a large n u m b e r of instances as long as proper reduction is maintained. Seventy-two patients with 85 affected hips were studied; all had been over 1 yr old when admitted and over 10 at the time o f review. Acetabular development was assessed radiologically by m e a s u r e m e n t of the acetabular angle. Satisfactory development occurred in 80~. The reasons for failure in the others were failure to obtain and maintain congruity and development of ischemic necrosis due to manipulative reductions. When patients in w h o m these errors have occurred were eliminated from the series, satisfactory acetabular development in 9 5 ~ of hips was claimed. The authors appear to have proved their point that acetabuloplasty should not be necessary if the patient is admitted under the age of 4 or congruity obtained in the functional position under 489yr.--John A itken
Posterior Psoas Transfer and Hip Instability in Lumbar Myelomeningocele. Barrie Parker and Geoffrey Walker. J Bone Joint Surg 57B:53-58 (Feb), 1975. In 1959 Sharrard described posterior transfer of the ileopsoas muscle as an operation for the treatment of hip instability in children with myelomeningocele and with neurologic activity below lumbar 1 and 2. This paper deals with 72 patients in w h o m this procedure was carried out in an attempt to assess the value of the operation. Seventy-two posterior ileopsoas transfers were done in 44 children and these were reviewed 1-8 yr after operation. It was found that hip stability had improved in all, 94 being stable at the time of review. Fifty-seven percent of the patients had an acceptable functional result, which depended mainly on the level of neurologic activity. From these results the a u t h o r s think that transfers should be done as soon after the age of 9 mo as possible and if done after the age of 2 yr should be restricted to patients with neurologic activity in lumbar 3 and 4.--John A itken
During the 6-yr period 1967-1973, 173 p a tients were treated by ventriculoatrial s h u n t a n d 43 o f these have been analyzed in detail. All these patients were about 3 yr of age. O f the 27 survivors, 24 were investigated by psychologic tests. Mental development was n o r m a l in 14, while 10 showed mental retardation; of the 10, 8 can still attend school. Grave etiologic factors, like aqueduct occlusion, ventriculitis and occlusion, birth in asphyxia, late surgery, toxemic pregnancy, neonatal subarachnoidal hemorrhage, and p r e m a t u r e birth are considered primarily responsible for the retardation. The functional development that can be achieved by successful surgical treatment is discussed.--A ndrew Pint~r
Postmeningitic Hydrocephalus. B. Zumsteln and H. Zumstein. Schweiz Med Wochenschr 104:799795 (June), 1974.
Twenty-three patients with postmeningitic hydrocephalus have been followed. The a u t h o r s found that postmeningitic hydrocephalus has a tendency to s p o n t a n e o u s resolution but at a time when definitive cerebral d a m a g e has already occurred. Therefore, a s h u n t operation has to be performed as soon as possible, in any case within 6 m o after meningitis.--G. Egli NEOPLASMS
Management of the Acute Abdomen in Children With Leukemia. Philip R. Exelby, Amir Ghandchi, Nicolas Lansigan, and Ira Schwartz. Cancer 35: 826-829 (March), 1975.
Study of Hydrocephalic Patients Three Years After Surgery. E. Paralcz, L. V~kbssy, and Susan
A m o n g 286 children with acute leukemia seen at the Memorial Hospital (NYC) from 1966 to 1971, 16 developed an acute a b d o m i n a l disease entity during their course of therapy. Five o f these conditions were not noted until autopsy. Two were treated without surgery by election and died. A m o n g the nine children m a n a g e d by active surgical intervention, five were long-term survivors. However, three of the latter were in remission at the time of surgery. The pathologic entities in these 16 children were appendicitis, typhlitis (including infarction and perforation), intussusception, intestinal obstruction, pancreatitis, and liver abscess. In addition to supportive care, including broad-spectrum antibiotics, aggressive antileukemic therapy is r e c o m m e n d e d during the postoperative period following abdominal surgery in these children. --Daniel M. Hays
Kovbcs. Acta Paediatr Acad Sci Hung 15:205-209, 1974.
The Management of Pulmonary Metastases in
NERVOUS SYSTEM