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Adrenocortical function in the first week of life
420
INTERNATIONAL
A NEW TECHNIQUE OF MICROSUTURE FOR BLOODVESSEL ANASTOMOSIS. Peter A. Salmon. Brit. J. Surg. 55:58-63,
1968.
In a series of 60 gastric homotransplants performed in dogs nearly half of the anastomoses thrombosed in the postoperative period. The arteries measured between 2 and 4 mm.; the veins between 4 and 6 mm. in diameter. To try to overcome this high technical failure rate a new technic of anastomosis was adopted. A Zeiss binocular operating microscope was obtained. Using this in conjunction with conventional needle holders, it soon became apparent that the necessity of rotating the forearm or rotating an asymmetrical handgrip between thumb and forefingers, together with manipulation of the ratchet, imposed insurmountable problems to the stability of the needle-holder tip. Therefore, a needle-holder which could be held in a fountain pen grip was designed. The jaws were controlled by a foot pedal using compressed gas as the activating mechanism. Firm support for the arm, hand, and fingers, close to the operative field, is the basis for fine controlled movements in the operative field. All rotational movements are performed by the fingers gripping the instrument. If the suture length is kept short (34 cm.), the entire anastomosis can often be performed without removing the gaze from the eyepiece. The adventitia is removed from the cut end of the vessel which is not handled if possible. The vessel lumen is irrigated with heparinized saline. The stitches should be placed as close as possible to the vessel edge with as little inversion as possible. Four untied stay-sutures are used and in this way it is never necessary to stitch around a comer. The suture of 5-O or 6-O cardiovascular silk is tied only once, i.e., when the anastomosis is completed. As a result of adopting this technic in a further series of 100 gastric homotransplants in dogs, only 4 grafts were lost due to causes attributable to failure of the vascular anastomosis-J. Corkery and R. B. Zachary. ADRENOCORTICAL FUNCTION IN THE FIRST WEEK OF LIFE. H. N. Hugen, T. Brinck-Johnsen? and 0. Knutrud. Kinderchir. Vol. 2; No. 5, 1967. Preliminary results of investigations of the 17 hydroxycorticosteriod levels in the plasma and urine in the first week of life are presented without however giving the total number of children investigated. The levels immediately after birth
ABSTRACTS OF PEDIATRIC SURGERY
are similar to those found in adults. There are decreases in blood and urine levels, which rise to normal at the end of the first week. The relevance of surgical interventions is discussed.--% Hofmann and H. B. Eckstein. SCREENING FOR CYSTIC FIBROSISBY MEASUREMENT OF UNSTIMULATED PAROTID SALIVA SODIUM LEVELS. D. Lawson, B. A. Saggers, and M. J. Chapman. Arch. Dis. Child. 42:689, 1967. The
authors
give a preliminary
communication
on measurement of the sodium concentration of unstimulated parotid saliva in early infancy. Fifty neonates aged 1 to 7 days, 50 infants at 6 weeks, and 50 infants at 3 to 4 months were tested, together with 5 cases of cystic fibrosis homozygotes. In the neonates, the range of parotid saliva sodium concentration was 6.2-30.0 mEq./L.; at 6 weeks the level dropped to 5.0-18.0 mEq./L. and at 3 to 4 months the levels were within the reported adult range-being 5.0-11.5 mEq./L. The 5 proven cases of cystic fibrosis aged 3 to 4 months showed saliva sodium levels of 16.5-49.5 mEq./L. The scatter of results in the neonate at 6 weeks is undesirably wide, but the authors suggest that by 3 to 4 months the range has narrowed to adult levels and therefore, it provides a feasible screening test for infant welfare clinics.-James Lbter. LINCO~L~YCININ THE TREAT~~ENT OF PENICILLINRESISTANT STAPEMXE~CCAL INFECTIONS IN CHILDREN. J. F. R. Bentley and D. Pollock. Arch. Dis. Child. 43:58-61, 1968. Over a period of 2 years all children in the author’s unit who had an infection due to a penicillinase-producing staphylococcus pyogenes, which is sensitive to lincomycin in vitro, and in whom toxicity, cellulitis, or septicaemia was present, such that operative treatment unsupported by antibiotic therapy was unlikely to produce a rapid response, were treated by lincomycin. There were 20 patients varying in age from 3 months to 12 months in a group suffering from such lesions as wound sepsis, bums, osteitis, and cervical abscess, with duration of treatment ranging from 542 days. The drug was administered by mouth in a dose of 30 mg./Kg. per day, the total dose being divided into three equal parts and given at intervals of 8 hours. All patients were observed for side effects, and liver function tests were carried out. In all patients improvement was rapid and the infection was eradicated. There were no side effects or evidence of serious toxicity and no resistant strains emerged.-James Lister.
INTERNATIONAL
A NEW TECHNIQUE OF MICROSUTURE FOR BLOODVESSEL ANASTOMOSIS. Peter A. Salmon. Brit. J. Surg. 55:58-63,
1968.
In a series of 60 gastric homotransplants performed in dogs nearly half of the anastomoses thrombosed in the postoperative period. The arteries measured between 2 and 4 mm.; the veins between 4 and 6 mm. in diameter. To try to overcome this high technical failure rate a new technic of anastomosis was adopted. A Zeiss binocular operating microscope was obtained. Using this in conjunction with conventional needle holders, it soon became apparent that the necessity of rotating the forearm or rotating an asymmetrical handgrip between thumb and forefingers, together with manipulation of the ratchet, imposed insurmountable problems to the stability of the needle-holder tip. Therefore, a needle-holder which could be held in a fountain pen grip was designed. The jaws were controlled by a foot pedal using compressed gas as the activating mechanism. Firm support for the arm, hand, and fingers, close to the operative field, is the basis for fine controlled movements in the operative field. All rotational movements are performed by the fingers gripping the instrument. If the suture length is kept short (34 cm.), the entire anastomosis can often be performed without removing the gaze from the eyepiece. The adventitia is removed from the cut end of the vessel which is not handled if possible. The vessel lumen is irrigated with heparinized saline. The stitches should be placed as close as possible to the vessel edge with as little inversion as possible. Four untied stay-sutures are used and in this way it is never necessary to stitch around a comer. The suture of 5-O or 6-O cardiovascular silk is tied only once, i.e., when the anastomosis is completed. As a result of adopting this technic in a further series of 100 gastric homotransplants in dogs, only 4 grafts were lost due to causes attributable to failure of the vascular anastomosis-J. Corkery and R. B. Zachary. ADRENOCORTICAL FUNCTION IN THE FIRST WEEK OF LIFE. H. N. Hugen, T. Brinck-Johnsen? and 0. Knutrud. Kinderchir. Vol. 2; No. 5, 1967. Preliminary results of investigations of the 17 hydroxycorticosteriod levels in the plasma and urine in the first week of life are presented without however giving the total number of children investigated. The levels immediately after birth
ABSTRACTS OF PEDIATRIC SURGERY
are similar to those found in adults. There are decreases in blood and urine levels, which rise to normal at the end of the first week. The relevance of surgical interventions is discussed.--% Hofmann and H. B. Eckstein. SCREENING FOR CYSTIC FIBROSISBY MEASUREMENT OF UNSTIMULATED PAROTID SALIVA SODIUM LEVELS. D. Lawson, B. A. Saggers, and M. J. Chapman. Arch. Dis. Child. 42:689, 1967. The
authors
give a preliminary
communication
on measurement of the sodium concentration of unstimulated parotid saliva in early infancy. Fifty neonates aged 1 to 7 days, 50 infants at 6 weeks, and 50 infants at 3 to 4 months were tested, together with 5 cases of cystic fibrosis homozygotes. In the neonates, the range of parotid saliva sodium concentration was 6.2-30.0 mEq./L.; at 6 weeks the level dropped to 5.0-18.0 mEq./L. and at 3 to 4 months the levels were within the reported adult range-being 5.0-11.5 mEq./L. The 5 proven cases of cystic fibrosis aged 3 to 4 months showed saliva sodium levels of 16.5-49.5 mEq./L. The scatter of results in the neonate at 6 weeks is undesirably wide, but the authors suggest that by 3 to 4 months the range has narrowed to adult levels and therefore, it provides a feasible screening test for infant welfare clinics.-James Lbter. LINCO~L~YCININ THE TREAT~~ENT OF PENICILLINRESISTANT STAPEMXE~CCAL INFECTIONS IN CHILDREN. J. F. R. Bentley and D. Pollock. Arch. Dis. Child. 43:58-61, 1968. Over a period of 2 years all children in the author’s unit who had an infection due to a penicillinase-producing staphylococcus pyogenes, which is sensitive to lincomycin in vitro, and in whom toxicity, cellulitis, or septicaemia was present, such that operative treatment unsupported by antibiotic therapy was unlikely to produce a rapid response, were treated by lincomycin. There were 20 patients varying in age from 3 months to 12 months in a group suffering from such lesions as wound sepsis, bums, osteitis, and cervical abscess, with duration of treatment ranging from 542 days. The drug was administered by mouth in a dose of 30 mg./Kg. per day, the total dose being divided into three equal parts and given at intervals of 8 hours. All patients were observed for side effects, and liver function tests were carried out. In all patients improvement was rapid and the infection was eradicated. There were no side effects or evidence of serious toxicity and no resistant strains emerged.-James Lister.