- Email: [email protected]
Agenesis of the left lung and total anomalous pulmonary venous connection: Hemodynamic studies before and after complete surgical correction
ABSTRACTS
Agenesis
of the Left Lung and Total Anomalous Pulmonary
Venous Connection: Hemodynamic Studies Before and After Complete Surgical Correction. R. A. Boxer, c. T.
Hayes, A. J. Hordof, and R. B. Mellins. Chest 14:106-109, (July), 1978. A term female infant developed intermittent cyanosis and tachypnea at 2 days of age. Physical examination was normal except for tachypnea. ECG revealed right axis deviation and RVH and her chest x-ray revealed absence of the left lung with overexpansion of the right lung and mediastinal shift. The infant remained asymptomatic and was discharged. At 3% mo of age, she returned in moderate respiratory distress with evidence of bronchiolitis and congestive heart failure. After medical treatment, cardiac catheterization revealed total anomalous venous return to the right atrium, absent left pulmonary artery, and a small patent ductus. Pulmonary pressure was ‘/3 of systemic with low resistance. Surgical correction was performed with good results. At I yr repeat catheterization revealed normal pulmonary pressures and unobstructed pulmonary venous flow. This is the second report of a patient with these two anomalies and the first to survive.-Randall W. Powell Multiple Congenital Aneurysms Br J Surg 65509, 1978.
in Childhood.
D. %‘. Shorr.
This is a case report of a girl who, at the age of 7 yr, presented with a saccular aneurysm of the left brachial artery. Over the following 8 yr, a further I5 aneurysms appeared. Some, but not all, of these aneurysms have been operated upon. Complications included renovascular hypertension due to bilateral intrarenal aneurysms and controlled with antihypertensive drug therapy. She has been followedup for 15yr and has developed no new aneurysms during the past 6 yr. There is no evidence of Ehlers-Danlos syndrome. Three other previously reported cases in the literature are reviewed. It is noteworthy that 3 of the 4 cases presented in early childhood with aneurysms of the brachial or radial arteries. Three of the four patients subsequently developed aortic aneurysms and two also had renal aneurysms. It appears that the disease progresses rapidly during the period of active growth until adolescence, when the condition stabilizes.-Lewis Spitz
ALIMENTARY
TRACT
Esophagitis Due to Adriamycin and Radiation Therapy for Childhood Malignancy. P. E. Newburger, J. R. Cassady, and
N. Jo&
Cancer
42(2):417-23,
(August),
1978.
Several children developed severe esophagitis. with stricture formation in two, following mediastinal radiation therapy and multiple agent chemotherapy including in all cases adriamycin. The radiation doses were low (SO&2500 rad) and the esophagitis was attributed to the synergistic effects of adriamycin and radiation. A form of “recall” esophagitis occurred in three of these patients when adriamycin was administered subsequently. Candida infection was not a significant factor in the esophagitis seen in these patients. The children involved had a variety of different malignancies and there were no factors in the course that would appear to predict the development of this form of esophagitis.-llaniel M. Hays
Late Results of Chemical Esophageal Burns in Childhood.
A. P. Biezins and J. K. Ganjen. Prog Paediatr 23, 1977.
Surg
10:19-
Early and persistent bouginage is recommended on the basis of a review of over 1700 children with chemical esophageal burns treated between 1929 and 1974. Threequarters of children so treated should recover completely. If the start of treatment is delayed, the chance of failure is increased. Retrosternal colonic replacement (that replaced presternal dermatojejunoplasty in the Riga Hospital in 1955) was done in 21 children who had complete obliteration of the esophageal lumen or who failed to respond to bouginage. The risk of malignant change in the damaged esophagus is calculated to be not greater than the surgical risks of esophagectomy.-R. C. M. Cook Long-Term Results Following Esophageal Anastomosis in the Neonate. E. Hrabovsky
Gynecol Obstet
147:30-32.
and E. T. Boles, Jr. Surg (July), 1978.
In an attempt to assess the results of a one-layer versus a two-layer anastomosis, 73 patients who survived long enough to evaluate the status of the anastomosis were reviewed. Twenty-seven had a one-layer repair and forty-three had a two-layer anastomosis. There were 10 leaks and 6 strictures associated with the one-layer anastomosis. The two-layer anastomosis resulted in 13 leaks and 24 strictures. Eleven deaths occurred in these seventy-three patients. There was no significant difference in the leak rate or the mortality between the two groups. However, there was a striking decrease in stricture formation following one-layer anastomosis. The authors advise a one-layer end-to-end anastomosis through an extrapleural approach with good drainage on the basis of this study.-George Holcomb, Jr. Esophageal Atresia With Distal Trachea-Esophageal Fistula-A
Long-Term Follow-Up. N. A. Myers. Prog in Paediatr
Surg 10:5-l?,
1977.
Complete follow-up details were available in 58 of 72 survivors of 132 infants operated on for esophageal atresia with fistula between 13 and 26 yr previously. Most had had a primary anastomosis without a simultaneous gastrostomy. Dysphagia was prominent in small children, but did not cause problems in later years. Eighteen children required dilatations for anastomotic strictures and eleven had resection of strictures and/or closure of recurrent fistulae. Radiologically, disordered esophageal function was evident and problems such as scoliosis (common after the early rib resections) were assessed. Motility disorders, demonstrated by manometry, mainly result from excessive mobilization of the esophagus and damage to vagal nerve fibers. Respiratory tract problems, possibly following aspiration of food, largely disappear in late childhood.-R. C. M. Cook Esophageal Atresia, Duodenal Atresia. and Gastric Distention: Report of Two Cases. T. A. McCook
Felman. Am J Roentgen01
131:167-168.
(July),
and A. H. 1978.
Two infants with esophageal atresia, without tracheoesophageal fistula, and duodenal atresia presented with epigastric masses. The use of ultrasonography in the second
Agenesis
of the Left Lung and Total Anomalous Pulmonary
Venous Connection: Hemodynamic Studies Before and After Complete Surgical Correction. R. A. Boxer, c. T.
Hayes, A. J. Hordof, and R. B. Mellins. Chest 14:106-109, (July), 1978. A term female infant developed intermittent cyanosis and tachypnea at 2 days of age. Physical examination was normal except for tachypnea. ECG revealed right axis deviation and RVH and her chest x-ray revealed absence of the left lung with overexpansion of the right lung and mediastinal shift. The infant remained asymptomatic and was discharged. At 3% mo of age, she returned in moderate respiratory distress with evidence of bronchiolitis and congestive heart failure. After medical treatment, cardiac catheterization revealed total anomalous venous return to the right atrium, absent left pulmonary artery, and a small patent ductus. Pulmonary pressure was ‘/3 of systemic with low resistance. Surgical correction was performed with good results. At I yr repeat catheterization revealed normal pulmonary pressures and unobstructed pulmonary venous flow. This is the second report of a patient with these two anomalies and the first to survive.-Randall W. Powell Multiple Congenital Aneurysms Br J Surg 65509, 1978.
in Childhood.
D. %‘. Shorr.
This is a case report of a girl who, at the age of 7 yr, presented with a saccular aneurysm of the left brachial artery. Over the following 8 yr, a further I5 aneurysms appeared. Some, but not all, of these aneurysms have been operated upon. Complications included renovascular hypertension due to bilateral intrarenal aneurysms and controlled with antihypertensive drug therapy. She has been followedup for 15yr and has developed no new aneurysms during the past 6 yr. There is no evidence of Ehlers-Danlos syndrome. Three other previously reported cases in the literature are reviewed. It is noteworthy that 3 of the 4 cases presented in early childhood with aneurysms of the brachial or radial arteries. Three of the four patients subsequently developed aortic aneurysms and two also had renal aneurysms. It appears that the disease progresses rapidly during the period of active growth until adolescence, when the condition stabilizes.-Lewis Spitz
ALIMENTARY
TRACT
Esophagitis Due to Adriamycin and Radiation Therapy for Childhood Malignancy. P. E. Newburger, J. R. Cassady, and
N. Jo&
Cancer
42(2):417-23,
(August),
1978.
Several children developed severe esophagitis. with stricture formation in two, following mediastinal radiation therapy and multiple agent chemotherapy including in all cases adriamycin. The radiation doses were low (SO&2500 rad) and the esophagitis was attributed to the synergistic effects of adriamycin and radiation. A form of “recall” esophagitis occurred in three of these patients when adriamycin was administered subsequently. Candida infection was not a significant factor in the esophagitis seen in these patients. The children involved had a variety of different malignancies and there were no factors in the course that would appear to predict the development of this form of esophagitis.-llaniel M. Hays
Late Results of Chemical Esophageal Burns in Childhood.
A. P. Biezins and J. K. Ganjen. Prog Paediatr 23, 1977.
Surg
10:19-
Early and persistent bouginage is recommended on the basis of a review of over 1700 children with chemical esophageal burns treated between 1929 and 1974. Threequarters of children so treated should recover completely. If the start of treatment is delayed, the chance of failure is increased. Retrosternal colonic replacement (that replaced presternal dermatojejunoplasty in the Riga Hospital in 1955) was done in 21 children who had complete obliteration of the esophageal lumen or who failed to respond to bouginage. The risk of malignant change in the damaged esophagus is calculated to be not greater than the surgical risks of esophagectomy.-R. C. M. Cook Long-Term Results Following Esophageal Anastomosis in the Neonate. E. Hrabovsky
Gynecol Obstet
147:30-32.
and E. T. Boles, Jr. Surg (July), 1978.
In an attempt to assess the results of a one-layer versus a two-layer anastomosis, 73 patients who survived long enough to evaluate the status of the anastomosis were reviewed. Twenty-seven had a one-layer repair and forty-three had a two-layer anastomosis. There were 10 leaks and 6 strictures associated with the one-layer anastomosis. The two-layer anastomosis resulted in 13 leaks and 24 strictures. Eleven deaths occurred in these seventy-three patients. There was no significant difference in the leak rate or the mortality between the two groups. However, there was a striking decrease in stricture formation following one-layer anastomosis. The authors advise a one-layer end-to-end anastomosis through an extrapleural approach with good drainage on the basis of this study.-George Holcomb, Jr. Esophageal Atresia With Distal Trachea-Esophageal Fistula-A
Long-Term Follow-Up. N. A. Myers. Prog in Paediatr
Surg 10:5-l?,
1977.
Complete follow-up details were available in 58 of 72 survivors of 132 infants operated on for esophageal atresia with fistula between 13 and 26 yr previously. Most had had a primary anastomosis without a simultaneous gastrostomy. Dysphagia was prominent in small children, but did not cause problems in later years. Eighteen children required dilatations for anastomotic strictures and eleven had resection of strictures and/or closure of recurrent fistulae. Radiologically, disordered esophageal function was evident and problems such as scoliosis (common after the early rib resections) were assessed. Motility disorders, demonstrated by manometry, mainly result from excessive mobilization of the esophagus and damage to vagal nerve fibers. Respiratory tract problems, possibly following aspiration of food, largely disappear in late childhood.-R. C. M. Cook Esophageal Atresia, Duodenal Atresia. and Gastric Distention: Report of Two Cases. T. A. McCook
Felman. Am J Roentgen01
131:167-168.
(July),
and A. H. 1978.
Two infants with esophageal atresia, without tracheoesophageal fistula, and duodenal atresia presented with epigastric masses. The use of ultrasonography in the second