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An international survey of gastroschisis and omphalocele (490 cases). II. Relative incidence, pregnancy and environmental factors
INTERNATIONAL ABSTRACTS mortality (85%) in noniatrogenic cases. Three major unanswered questions regarding the etiology of the gas, how it enters the portal vein, and whether it is itself lethal are discussed. The conclusion is that portal vein gas is not merely an incidental radiological feature. It is probably a major contributing factor to the development of septicaemia and eventual death.--Tony Sparnon
Use of ERCP to Identify the Site of Traumatic Injuries of the Main Pancreatic Duct in Children. R.L Hall, M.I. Lavelle, and C.W.
Venables. Br J Surg 73:411-412, (May), 1986. Four children with delayed recognition of blunt pancreatic trauma are described. In each case the presence of pancreatic injury was identified by hyperamylasaemia. Ultrasound and CT scanning were helpful in locating pseudocysts in three of the four patients, although one was wrongly located and the actual site of injury was not demonstrated. In contrast, ERCP correctly identified the presence of ductal rupture and its location in all four patients. Surgical treatment involved a full exploration of the lesser sac with drainage of the cyst contents and identification of the site of extravasation. Two patients with proximal duct lacerations were treated by internal drainage into a Roux-en-Y loop with the addition of a distal pancreatectomy and oversowing of the remnant. All four patients recovered and were well at follow-up. It is concluded that early ERCP should be considered in all children with blunt pancreatic trauma as it is the only reliable method of identifying duct injuries that require urgent surgery.--Tony Sparnon An International Survey of Gastroschisis and Omphalocele (490 cases). II. Relative Incidence, Pregnancy and Environmental Factors. T.C. Moore and Khalid Nur. Pediatr Surg lnt 1:105-109,
(June), 1986. The present international survey by questionnaire of 490 cases of gastroschisis and omphalocele from 16 pediatric surgery centers on four continents reveals a marked spurt in the incidence of gastroschisis in 1972 and after. The gastroschisis-to-omphalocele ratio is highest in Scandinavia, northern Europe, and the United States. The mothers of gastroschisis patients were found to be significantly younger (21.6 v 26.7 years) than omphalocele mothers ( P < .0001). Gastroschisis patients were more frequently premature by birth weight (58% v 23%) and period of gestation (49% v 16%). The rural-to-urban ratio of omphalocele was fairly uniform in all parts of the world reviewed, whereas that of gastroschisis varied widely from area to area with a range of 13% to 61%. Twinning and a family history of congenital disorders were more frequent in the omphalocele group. There was no evidence, from limited data, of the involvement of legal drugs in the etiology of either gastroschisis or omphalocele. The data presented suggests that omphalocele is more likely due to genetic etiology, and that gastroschisis more likely results from environmental (drug and pollutant) factors of fairly recent appearance. The need for a continuing and ongoing worldwide study of environmental and other factors in the etiology of both gastroschisis and omphalocele is stressed.--Prem Purl Femoral Herniae in Children. K. Zaman, J.D. Taylor and D.P.
293 A Broader Spectrum of Abnormalities in the Prune Belly Syndrome. D.F. Gear)), I.B. MacLusky, B.M. Churchill, et al. J Urol
135:324-326, (February), 1986. The clinical course of 25 children with the prune belly syndrome was reviewed retrospectively to assess the overall morbidity associated with the disorder. There were three neonatal deaths from renal or pulmonary disease. Chronic renal insufficiency or end-stage renal disease developed in five survivors, all of whom had impaired kidney function in early infancy. An additional 17 patients survived with only mild renal insufficiency. Growth retardation, which correlated poorly with renal function, was present in a third of the patients. Clinically significant pulmonary and orthopedic problems were noted in 55% of the survivors. Chronic constipation was another common, although less serious, feature. This report emphasizes the severity of the extrarenal problems associated with the prune belly syndrome.--George Holcomb, Jr Layered Versus Mass Closure of Abdominal Wounds in Infants and Children. E.M. Kelly and L. Spitz. Br J Surg 72:739 740, (Septem-
ber), 1985. Five hundred seven patients under 16 years of age, including 108 neonates, were entered into a trial of continuous layered v interrupted mass closure of abdominal wounds using polyglycolic acid sutures. All patients were followed up for a minimum of 2 years. The single wound dehiscence was in the layered closure group. Four incisional hernias occurred. All were in babies under 12 weeks of age following transverse incisions and within 6 weeks of surgery. Three of these patients were in the layered and one in the mass closure groups. This difference was not statistically significant. Unexpectedly, all these hernias resolved spontaneously. The importance of including wide margins of tissue in the sutures and keeping suture tension to a minimum is stressed.--N.P. Madden
GENITOURINARY TRACT Successful Reconstruction Following Circumcision W i t h Diathermy. A. Azmy, S.A. Boddy, and P.G. Ransley. Br J Urol
57:587-588, (October), 1985. A child, who had extensive burns to his penis as a neonate at circumcision, was left with the glans attached by a narrow stalk. At 3 years of age the two adjacent surfaces were denuded and sutured with a satisfactory resutt.--Ray Fitzgerald Ascent of the Testis: Fact or Fiction. J.D. Atwell. Br J Urol
57:474-477, (August), 1985. Ascent of the testis from a normal to an undescended position was observed and documented in ten patients. In nine of them there was a complete hernial sac, and it is suggested that the acquired malposition of the testis is due to partial absorption of the processus vaginalis into the parietal peritoneum. Alteration in the length of the inguinal canal with growth may be an additional contributing factor. The hypothesis is neatly schematised in diagrams. The mean late orehiopexy age was 9.4 years.--Ray Fitzgerald
Fossard. Ann R Coil Surg Engl 67:249-250, (July), 1985. Of 772 patients who had femoral hernial repairs in the Leicester Hospitals between 1972 and 1984, 12 (1.6%) were under the age of 15 years. There were seven males and five females, and the herniae were equally distributed between the right and left sides. In nine patients the hernia was reducible. The correct preoperative diagnosis was made in only three patients. All but one were treated by herniorrhaphy, and in the nine patients followed up there were no recurrences.--B.A. Madarikan
Double-blind, Placebo-Controlled Study of Luteinising-HormoneReleasing-Hormone Nasal Spray in the T r e a t m e n t of Undescended Testes. S.M.P.F. De Muinck Keizer-Schrama, F.W.J. Hazebroek,
A.W. Matroos, et al. Lancet i:876-879, (April 19), 1986. In a double-blind, placebo-controled study, 252 prepubertal boys with 301 undescended testes were treated with luteinizinghormone-releasing-hormone (LHRH), 1.2 m g / d intranasally. After the 8-week double-blind period ten placebo-treated (8%) and 14
Use of ERCP to Identify the Site of Traumatic Injuries of the Main Pancreatic Duct in Children. R.L Hall, M.I. Lavelle, and C.W.
Venables. Br J Surg 73:411-412, (May), 1986. Four children with delayed recognition of blunt pancreatic trauma are described. In each case the presence of pancreatic injury was identified by hyperamylasaemia. Ultrasound and CT scanning were helpful in locating pseudocysts in three of the four patients, although one was wrongly located and the actual site of injury was not demonstrated. In contrast, ERCP correctly identified the presence of ductal rupture and its location in all four patients. Surgical treatment involved a full exploration of the lesser sac with drainage of the cyst contents and identification of the site of extravasation. Two patients with proximal duct lacerations were treated by internal drainage into a Roux-en-Y loop with the addition of a distal pancreatectomy and oversowing of the remnant. All four patients recovered and were well at follow-up. It is concluded that early ERCP should be considered in all children with blunt pancreatic trauma as it is the only reliable method of identifying duct injuries that require urgent surgery.--Tony Sparnon An International Survey of Gastroschisis and Omphalocele (490 cases). II. Relative Incidence, Pregnancy and Environmental Factors. T.C. Moore and Khalid Nur. Pediatr Surg lnt 1:105-109,
(June), 1986. The present international survey by questionnaire of 490 cases of gastroschisis and omphalocele from 16 pediatric surgery centers on four continents reveals a marked spurt in the incidence of gastroschisis in 1972 and after. The gastroschisis-to-omphalocele ratio is highest in Scandinavia, northern Europe, and the United States. The mothers of gastroschisis patients were found to be significantly younger (21.6 v 26.7 years) than omphalocele mothers ( P < .0001). Gastroschisis patients were more frequently premature by birth weight (58% v 23%) and period of gestation (49% v 16%). The rural-to-urban ratio of omphalocele was fairly uniform in all parts of the world reviewed, whereas that of gastroschisis varied widely from area to area with a range of 13% to 61%. Twinning and a family history of congenital disorders were more frequent in the omphalocele group. There was no evidence, from limited data, of the involvement of legal drugs in the etiology of either gastroschisis or omphalocele. The data presented suggests that omphalocele is more likely due to genetic etiology, and that gastroschisis more likely results from environmental (drug and pollutant) factors of fairly recent appearance. The need for a continuing and ongoing worldwide study of environmental and other factors in the etiology of both gastroschisis and omphalocele is stressed.--Prem Purl Femoral Herniae in Children. K. Zaman, J.D. Taylor and D.P.
293 A Broader Spectrum of Abnormalities in the Prune Belly Syndrome. D.F. Gear)), I.B. MacLusky, B.M. Churchill, et al. J Urol
135:324-326, (February), 1986. The clinical course of 25 children with the prune belly syndrome was reviewed retrospectively to assess the overall morbidity associated with the disorder. There were three neonatal deaths from renal or pulmonary disease. Chronic renal insufficiency or end-stage renal disease developed in five survivors, all of whom had impaired kidney function in early infancy. An additional 17 patients survived with only mild renal insufficiency. Growth retardation, which correlated poorly with renal function, was present in a third of the patients. Clinically significant pulmonary and orthopedic problems were noted in 55% of the survivors. Chronic constipation was another common, although less serious, feature. This report emphasizes the severity of the extrarenal problems associated with the prune belly syndrome.--George Holcomb, Jr Layered Versus Mass Closure of Abdominal Wounds in Infants and Children. E.M. Kelly and L. Spitz. Br J Surg 72:739 740, (Septem-
ber), 1985. Five hundred seven patients under 16 years of age, including 108 neonates, were entered into a trial of continuous layered v interrupted mass closure of abdominal wounds using polyglycolic acid sutures. All patients were followed up for a minimum of 2 years. The single wound dehiscence was in the layered closure group. Four incisional hernias occurred. All were in babies under 12 weeks of age following transverse incisions and within 6 weeks of surgery. Three of these patients were in the layered and one in the mass closure groups. This difference was not statistically significant. Unexpectedly, all these hernias resolved spontaneously. The importance of including wide margins of tissue in the sutures and keeping suture tension to a minimum is stressed.--N.P. Madden
GENITOURINARY TRACT Successful Reconstruction Following Circumcision W i t h Diathermy. A. Azmy, S.A. Boddy, and P.G. Ransley. Br J Urol
57:587-588, (October), 1985. A child, who had extensive burns to his penis as a neonate at circumcision, was left with the glans attached by a narrow stalk. At 3 years of age the two adjacent surfaces were denuded and sutured with a satisfactory resutt.--Ray Fitzgerald Ascent of the Testis: Fact or Fiction. J.D. Atwell. Br J Urol
57:474-477, (August), 1985. Ascent of the testis from a normal to an undescended position was observed and documented in ten patients. In nine of them there was a complete hernial sac, and it is suggested that the acquired malposition of the testis is due to partial absorption of the processus vaginalis into the parietal peritoneum. Alteration in the length of the inguinal canal with growth may be an additional contributing factor. The hypothesis is neatly schematised in diagrams. The mean late orehiopexy age was 9.4 years.--Ray Fitzgerald
Fossard. Ann R Coil Surg Engl 67:249-250, (July), 1985. Of 772 patients who had femoral hernial repairs in the Leicester Hospitals between 1972 and 1984, 12 (1.6%) were under the age of 15 years. There were seven males and five females, and the herniae were equally distributed between the right and left sides. In nine patients the hernia was reducible. The correct preoperative diagnosis was made in only three patients. All but one were treated by herniorrhaphy, and in the nine patients followed up there were no recurrences.--B.A. Madarikan
Double-blind, Placebo-Controlled Study of Luteinising-HormoneReleasing-Hormone Nasal Spray in the T r e a t m e n t of Undescended Testes. S.M.P.F. De Muinck Keizer-Schrama, F.W.J. Hazebroek,
A.W. Matroos, et al. Lancet i:876-879, (April 19), 1986. In a double-blind, placebo-controled study, 252 prepubertal boys with 301 undescended testes were treated with luteinizinghormone-releasing-hormone (LHRH), 1.2 m g / d intranasally. After the 8-week double-blind period ten placebo-treated (8%) and 14