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Anaemia and hiatus hernia
384
INTONATIONAL
and only one fourth were adults. The tumor was associated with pericardial effusion in 22 patients and this finding, usually an acute effusion with tamponade in those under 3 months of age, appeared to be the most important clinical clue to diagnosis. Only 2 of the 37 tumors were malignant. Operative removal of the tumor was attempted in 20 patients and successfully accomplished in 14. Technical problems in removal of such tumors may arise from the close attachment of the tumor to the adventitia of the aorta and other great vessels. Next to rhabdomyoma, the intrapericardial teratoma is the most common cardiac tumor of childhood.-W. K. Sieber. AN UNUSUAL AORTIC COARCTATION. I?. T. Le Roux and M. A. Williums. Thorax 23: 640-644 ( November ), 1968. This article reports an unusual variety of aortic coarctation in an ISyear-old boy in which the left common carotid, left subclavian, and aberrant right subclavian arteries arose distal to the coarcted segment. Pertinent literature is also reviewed.-W. K. Sieber.
ALIMENTARY
TRACT
THE STORY OF ESOPHAGEAL ATRESM AND THACHEOESOPHAGEAL FISTULA. K. W. Ashcraft and T. M. Holder. Surgery 65: 332340 ( February ) , 1969. This is a compelling narrative of the early history of esophageal atresia and tracheoesophageal fistula. It begins with the first description of this lesion published by Thomas Gibson in 1697 and traces the early world literature. The notable contributions of Richter, Lanman, Leven, Ladd, and Haight are described in detail. Interesting photographs and diagrams are included.D. T. Cloud. ANAEMIA AND HIATUS HERNN. C. W. 0. Windsor and J, Leigh Collis. Proc. Roy. Sot. Med. 61:213-215 (March), 1968. A review of 450 cases of hiatus hernia showed that anemia was three times more common in para-esophageal hernia than in reducible sliding hernia. In the reducible sliding hernias anemia tended to occur in those patients who were subsequently found at operation to have a large hernia and a small hiatus. It is suggested as a hypothesis that anemia in hiatus hernia, which is known
ABSTRACTS
0~ PEDIATRIC
SURGERY
to have no direct co-relation to esophagitis, may be due to trauma to gastric mucosa at the point at which the stomach rides backward and forward over the crural edge.Margaret J. Mayell. CONGENITAL ATFLESIA OF R. Sailer and E. Muller. 6:328-333, 1968.
THE PYLONS. 2. Kinderchir.
Three cases of atresia of the pylorus are reported. These include one case of membrane obstruction, one of atresia, and one of aplasia of the pylorus and the proximal duodenum. In one child the membrane was excised and in the other 2 patients a gastroduodenostomy was carried out.-S. Hofmann and H. B. Eckstein. INFANTILE PYLORIC STENOSIS: A 10 YEAR SURVEY. B. J. Cremin. S. Afr. Med. J. 42: 1056-1060 (October), 1968. One hundred and sixty-five surgically proven cases of pyloric stenosis were studied. In I38 of these pyloric enlargement was identified by palpation. The remaining 27 had contrast studies. Three cases were erroneously diagnosed: pyloric stenosis was diagnosed in a case of pyloric membrane, pyloric stenosis was diagnosed in a case found at surgery not to have a pyloric tumor, and stenosis was missed in one case. The method of examination used entaih the use of a warmed 50 per cent barium solution. Small amounts are used and the baby positioned so that small amounts only present in the antrum and the pylorus may be seen through the air-filled fundus. Gastric dilatation may or may not be present. Peristalsis is often hyperactive but in the neglected case may he absent. Pyloric opening often is delayed for 20-30 minutes or occasionally up to an hour. The important features of the pyloric canal at examination are elongation and a bent curve upwards. Other features are described but these may he present with pylorospasm. The constancy of the narrowing and the absence of peristalsis in the canal are the important distinguishing features-.I. H. Louw and H. V. Firor. MEDICAL MANAGEMENT OF PYLORK STENOSIS. L. R. Day. J.A.M.A. 207:948-950 (Feb. 3), 1969. Sixteen patients were treated medically for pyloric stenosis. An initial gastrointestinal examination was done. A string sign, bulging
INTONATIONAL
and only one fourth were adults. The tumor was associated with pericardial effusion in 22 patients and this finding, usually an acute effusion with tamponade in those under 3 months of age, appeared to be the most important clinical clue to diagnosis. Only 2 of the 37 tumors were malignant. Operative removal of the tumor was attempted in 20 patients and successfully accomplished in 14. Technical problems in removal of such tumors may arise from the close attachment of the tumor to the adventitia of the aorta and other great vessels. Next to rhabdomyoma, the intrapericardial teratoma is the most common cardiac tumor of childhood.-W. K. Sieber. AN UNUSUAL AORTIC COARCTATION. I?. T. Le Roux and M. A. Williums. Thorax 23: 640-644 ( November ), 1968. This article reports an unusual variety of aortic coarctation in an ISyear-old boy in which the left common carotid, left subclavian, and aberrant right subclavian arteries arose distal to the coarcted segment. Pertinent literature is also reviewed.-W. K. Sieber.
ALIMENTARY
TRACT
THE STORY OF ESOPHAGEAL ATRESM AND THACHEOESOPHAGEAL FISTULA. K. W. Ashcraft and T. M. Holder. Surgery 65: 332340 ( February ) , 1969. This is a compelling narrative of the early history of esophageal atresia and tracheoesophageal fistula. It begins with the first description of this lesion published by Thomas Gibson in 1697 and traces the early world literature. The notable contributions of Richter, Lanman, Leven, Ladd, and Haight are described in detail. Interesting photographs and diagrams are included.D. T. Cloud. ANAEMIA AND HIATUS HERNN. C. W. 0. Windsor and J, Leigh Collis. Proc. Roy. Sot. Med. 61:213-215 (March), 1968. A review of 450 cases of hiatus hernia showed that anemia was three times more common in para-esophageal hernia than in reducible sliding hernia. In the reducible sliding hernias anemia tended to occur in those patients who were subsequently found at operation to have a large hernia and a small hiatus. It is suggested as a hypothesis that anemia in hiatus hernia, which is known
ABSTRACTS
0~ PEDIATRIC
SURGERY
to have no direct co-relation to esophagitis, may be due to trauma to gastric mucosa at the point at which the stomach rides backward and forward over the crural edge.Margaret J. Mayell. CONGENITAL ATFLESIA OF R. Sailer and E. Muller. 6:328-333, 1968.
THE PYLONS. 2. Kinderchir.
Three cases of atresia of the pylorus are reported. These include one case of membrane obstruction, one of atresia, and one of aplasia of the pylorus and the proximal duodenum. In one child the membrane was excised and in the other 2 patients a gastroduodenostomy was carried out.-S. Hofmann and H. B. Eckstein. INFANTILE PYLORIC STENOSIS: A 10 YEAR SURVEY. B. J. Cremin. S. Afr. Med. J. 42: 1056-1060 (October), 1968. One hundred and sixty-five surgically proven cases of pyloric stenosis were studied. In I38 of these pyloric enlargement was identified by palpation. The remaining 27 had contrast studies. Three cases were erroneously diagnosed: pyloric stenosis was diagnosed in a case of pyloric membrane, pyloric stenosis was diagnosed in a case found at surgery not to have a pyloric tumor, and stenosis was missed in one case. The method of examination used entaih the use of a warmed 50 per cent barium solution. Small amounts are used and the baby positioned so that small amounts only present in the antrum and the pylorus may be seen through the air-filled fundus. Gastric dilatation may or may not be present. Peristalsis is often hyperactive but in the neglected case may he absent. Pyloric opening often is delayed for 20-30 minutes or occasionally up to an hour. The important features of the pyloric canal at examination are elongation and a bent curve upwards. Other features are described but these may he present with pylorospasm. The constancy of the narrowing and the absence of peristalsis in the canal are the important distinguishing features-.I. H. Louw and H. V. Firor. MEDICAL MANAGEMENT OF PYLORK STENOSIS. L. R. Day. J.A.M.A. 207:948-950 (Feb. 3), 1969. Sixteen patients were treated medically for pyloric stenosis. An initial gastrointestinal examination was done. A string sign, bulging