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Bedside assessment of phrenic nerve function in infants and children
1250
INTERNATIONAL
Bedside Assessment of Phrenic Nerve Function in Infants and Children. R.I.R. Russell, D. Mulvey, C. Laroche, et al. J Thorac
Cardiovasc Surg 101:143-147, (January), 1991. Phrenic nerve damage, which may occur after cardiac or mediastinal operation, is associated with an increased morbidity and mortality. This report shows a simplified method of direct phrenic nerve stimulation that can be performed at the bedside of infants and children. For this method, electrical stimulus at (1 Hz) is applied over the phrenic nerve in the neck and a diaphragmatic electromyogram from the seventh and eighth intercostal spaces is obtained. Thirty-seven children were studied with this apparatus before and after cardiac operations. Mean phrenic nerve latency was 5.4 2 1 milliseconds prior to the procedures, and prolongation of this latency was found in 7 of 66 postoperative measurements. The authors believe that the technique is an important addition to the assessment of postoperative phrenic nerve damage.--Thomas F. Tracy, Jr
HEART AND GREAT VESSELS Neonatal Repair of Tetralogy of Fallot With and Without Pulmonary Atresia. R.M. Di Donate, R.A. Jonas, P. Lang, et al. J
Thorac Cardiovasc Surg 101:126-137, (January), 1991. This report stimulates further consideration of early repair of congenital heart anomalies in order to minimize secondary damage to other organ systems. The review assesses the results of nonelective neonatal correction of tetrology of Fallot (TOF) in 27 neonates with either symptomatic TOF or symptomatic TOF with a valvular pulmonary atresia. The mean age at repair was 88 rt 8.4 days, and mean weight was 3.0 + .7 kg. Twenty-five transannular patches and two conduits were used for reconstruction of the right ventricular outflow tract. Three of the five in-hospital deaths were due to avoidable technical problems. Nineteen of 22 hospital survivors had no complications. There were two late deaths in this series, and two patients developed aneurysms of the pericardial transannular patch. Five other patients had residual or recurrent right ventricular outflow tract obstruction. Actuarial survival at 5 years was 74%, and there was a single rapidly declining hazard phase for death, with the hazard approaching zero at 1% years after repair. Actuarial freedom from need for reoperation was 76% at 5 years. The authors conclude that their experience with neonates who are symptomatic from TOF prompts the consideration of elective repair of TOF, which could be reasonably undertaken during the first months of life.--l”homas F. Tracy, Jr Long-Term Follow-Up Comparing Subclavian Flap Angioplasty to Resection With Modified Oblique End-to-End Anastomosis. C. Sciolaro, .I. Copeland, R Cork, et al. J Thorac Cardio-
vast Surg lOl:l-13, (January), 1991. This is a retrospective report of 56 children less than 4 years of age who underwent repair of aortic coarctation. Thirty-four patients had subclavian flap angioplasty and 22 had resection with an oblique end-to-end anastomosis. The only deaths were in two infants under 3 months of age. The overall prevalence of recurrent coarctation varied according to age at operation and to the type of repair. For patients undergoing repair at less than 3 months of age, the prevalence of recoarctation was 7% for subclavian flap angioplasty and 38% for end-to-end anastomosis. This trend was reversed when the age at operation was greater than 3 months with an 11% and 7% prevalence of recoarctation, respectively. The report delineates a recurrence through actuarial and hazard function analyses. Hypertension was a postoperative complication independent of recoarctation. There was a statistically greater prevalence of hypertension in those patients greater than 3 years of age
ABSTRACTS
with end-to-end anastomosis rather than flap angioplasty. The authors conclude that flap angioplasty is the procedure of choice in infants less than 3 months of age. In older children, either technique of repair is useful, yielding similar results.-Thomas F. Tracy, Jr
ALIMENTARY
TRACT
The Use of Nasogastric lntubation in the Radiological Diagnosis of Oesophageal Atresia. M&W.&. Davies. Afr Med J 78:670-
672, (December), 1990. This report emphasizes the role of radiography in the diagnosis of esophageal atresia using a thin infant feeding tube after obstruction has been confirmed by inability to pass a thin nasogastric tube. The thin tube is seen curled up in the proximal pouch, outlining its walls (the hoop sign). Sixteen of 31 infants with esophageal atresia had the diagnosis confirmed in this manner. Two cases of posterior pharyngeal rupture (a diagnostic pitfall) where the thin nasogastric tube was seen in the right thorax and mediastinum, respectively, are reported. Contrast studies are indicated only if primary esophageal repair is to be delayed because endoscopic assessment of the trachea prior to surgery is the investigation of choice to exclude a proximal pouch fistula.-Alastair Millar Membranous Atresia of the Intra-Abdominal Oesophagus: A Case Report. G.P. Hadley and R. Wiersma. S Afr Med J 77:210-
217, (February), 1990. A case of membranous atresia of the intraabdominal esophagus occuring in a preterm neonate who presented on day 3 of life with nonbilious vomiting is described. Esophagram identified the level of obstruction. A membrane was identified via gastrotomy and was excised over a nasogastric tube passed to the level of obstruction. No subsequent stenosis or reflux was apparent on follow-up. This anomaly has only rarely been described.-Alastair Millar Reproducibility of 24 Hour Oesophageal pH Studies in Infants. F.J. Hampton, U.M. MacFadyen, and H. Simpson. Arch Dis
Child 65:1249-1254, (November), 1990. As part of a larger study to assess the incidence of gastroesophageal reflux in infants presenting with a variety of problems, 13 infants had two 24-hour esophageal pH studies performed. In 11 these were on consecutive days and the other 2 after 4 and 6 weeks. Ages of the infants ranged from 7 days to 11 months and most had presented with apnea as their clinical problem. Appreciable differences were found between the two recordings, and the authors conclude that these were largely due to biological rather than technical variability. The authors comment that these findings should be taken into account in interpreting the results of 24-hour pH studies.-D.M. Rurge Abdominal Wall Dehiscence Following Ramstedt’s Operation: A Review of 170 Cases of Infantile Hypertrophic Pyloric Stenosis. M.H. Harvey, G. Humphrey, N. Fieldman, et al. Br J Surg
78:81-82, (January), 1991. The authors report their experience in treating 170 cases of infantile hypertrophic pyloric stenosis over a lo-year period with particular reference to the incidence of wound infection and wound dehiscence. The wound infection rate appeared high at 15.5% for no apparent reason. The rate of abdominal wall dehiscence was 6.7%. It was noted that when mass closure was used, dehiscence occurred in nearly 15% of cases, compared with 5% after layered closure. It was suggested that technical error might
INTERNATIONAL
Bedside Assessment of Phrenic Nerve Function in Infants and Children. R.I.R. Russell, D. Mulvey, C. Laroche, et al. J Thorac
Cardiovasc Surg 101:143-147, (January), 1991. Phrenic nerve damage, which may occur after cardiac or mediastinal operation, is associated with an increased morbidity and mortality. This report shows a simplified method of direct phrenic nerve stimulation that can be performed at the bedside of infants and children. For this method, electrical stimulus at (1 Hz) is applied over the phrenic nerve in the neck and a diaphragmatic electromyogram from the seventh and eighth intercostal spaces is obtained. Thirty-seven children were studied with this apparatus before and after cardiac operations. Mean phrenic nerve latency was 5.4 2 1 milliseconds prior to the procedures, and prolongation of this latency was found in 7 of 66 postoperative measurements. The authors believe that the technique is an important addition to the assessment of postoperative phrenic nerve damage.--Thomas F. Tracy, Jr
HEART AND GREAT VESSELS Neonatal Repair of Tetralogy of Fallot With and Without Pulmonary Atresia. R.M. Di Donate, R.A. Jonas, P. Lang, et al. J
Thorac Cardiovasc Surg 101:126-137, (January), 1991. This report stimulates further consideration of early repair of congenital heart anomalies in order to minimize secondary damage to other organ systems. The review assesses the results of nonelective neonatal correction of tetrology of Fallot (TOF) in 27 neonates with either symptomatic TOF or symptomatic TOF with a valvular pulmonary atresia. The mean age at repair was 88 rt 8.4 days, and mean weight was 3.0 + .7 kg. Twenty-five transannular patches and two conduits were used for reconstruction of the right ventricular outflow tract. Three of the five in-hospital deaths were due to avoidable technical problems. Nineteen of 22 hospital survivors had no complications. There were two late deaths in this series, and two patients developed aneurysms of the pericardial transannular patch. Five other patients had residual or recurrent right ventricular outflow tract obstruction. Actuarial survival at 5 years was 74%, and there was a single rapidly declining hazard phase for death, with the hazard approaching zero at 1% years after repair. Actuarial freedom from need for reoperation was 76% at 5 years. The authors conclude that their experience with neonates who are symptomatic from TOF prompts the consideration of elective repair of TOF, which could be reasonably undertaken during the first months of life.--l”homas F. Tracy, Jr Long-Term Follow-Up Comparing Subclavian Flap Angioplasty to Resection With Modified Oblique End-to-End Anastomosis. C. Sciolaro, .I. Copeland, R Cork, et al. J Thorac Cardio-
vast Surg lOl:l-13, (January), 1991. This is a retrospective report of 56 children less than 4 years of age who underwent repair of aortic coarctation. Thirty-four patients had subclavian flap angioplasty and 22 had resection with an oblique end-to-end anastomosis. The only deaths were in two infants under 3 months of age. The overall prevalence of recurrent coarctation varied according to age at operation and to the type of repair. For patients undergoing repair at less than 3 months of age, the prevalence of recoarctation was 7% for subclavian flap angioplasty and 38% for end-to-end anastomosis. This trend was reversed when the age at operation was greater than 3 months with an 11% and 7% prevalence of recoarctation, respectively. The report delineates a recurrence through actuarial and hazard function analyses. Hypertension was a postoperative complication independent of recoarctation. There was a statistically greater prevalence of hypertension in those patients greater than 3 years of age
ABSTRACTS
with end-to-end anastomosis rather than flap angioplasty. The authors conclude that flap angioplasty is the procedure of choice in infants less than 3 months of age. In older children, either technique of repair is useful, yielding similar results.-Thomas F. Tracy, Jr
ALIMENTARY
TRACT
The Use of Nasogastric lntubation in the Radiological Diagnosis of Oesophageal Atresia. M&W.&. Davies. Afr Med J 78:670-
672, (December), 1990. This report emphasizes the role of radiography in the diagnosis of esophageal atresia using a thin infant feeding tube after obstruction has been confirmed by inability to pass a thin nasogastric tube. The thin tube is seen curled up in the proximal pouch, outlining its walls (the hoop sign). Sixteen of 31 infants with esophageal atresia had the diagnosis confirmed in this manner. Two cases of posterior pharyngeal rupture (a diagnostic pitfall) where the thin nasogastric tube was seen in the right thorax and mediastinum, respectively, are reported. Contrast studies are indicated only if primary esophageal repair is to be delayed because endoscopic assessment of the trachea prior to surgery is the investigation of choice to exclude a proximal pouch fistula.-Alastair Millar Membranous Atresia of the Intra-Abdominal Oesophagus: A Case Report. G.P. Hadley and R. Wiersma. S Afr Med J 77:210-
217, (February), 1990. A case of membranous atresia of the intraabdominal esophagus occuring in a preterm neonate who presented on day 3 of life with nonbilious vomiting is described. Esophagram identified the level of obstruction. A membrane was identified via gastrotomy and was excised over a nasogastric tube passed to the level of obstruction. No subsequent stenosis or reflux was apparent on follow-up. This anomaly has only rarely been described.-Alastair Millar Reproducibility of 24 Hour Oesophageal pH Studies in Infants. F.J. Hampton, U.M. MacFadyen, and H. Simpson. Arch Dis
Child 65:1249-1254, (November), 1990. As part of a larger study to assess the incidence of gastroesophageal reflux in infants presenting with a variety of problems, 13 infants had two 24-hour esophageal pH studies performed. In 11 these were on consecutive days and the other 2 after 4 and 6 weeks. Ages of the infants ranged from 7 days to 11 months and most had presented with apnea as their clinical problem. Appreciable differences were found between the two recordings, and the authors conclude that these were largely due to biological rather than technical variability. The authors comment that these findings should be taken into account in interpreting the results of 24-hour pH studies.-D.M. Rurge Abdominal Wall Dehiscence Following Ramstedt’s Operation: A Review of 170 Cases of Infantile Hypertrophic Pyloric Stenosis. M.H. Harvey, G. Humphrey, N. Fieldman, et al. Br J Surg
78:81-82, (January), 1991. The authors report their experience in treating 170 cases of infantile hypertrophic pyloric stenosis over a lo-year period with particular reference to the incidence of wound infection and wound dehiscence. The wound infection rate appeared high at 15.5% for no apparent reason. The rate of abdominal wall dehiscence was 6.7%. It was noted that when mass closure was used, dehiscence occurred in nearly 15% of cases, compared with 5% after layered closure. It was suggested that technical error might