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Bronchoscopic removal of aspirated foreign bodies in children
ABSTRACTS
285
Cat Scratch D i s e a s e . A. l~. Margileth, D.J. Wear, T.L. Hadfield, et
al. JAMA 252:928-931, (August 17), 1984. The authors of this paper have demonstrated recently that lymph nodes infected with cat scratch disease when stained with the Warthin-Starry technique contain small pleomorphic bacilli rather than the virus that had been supposed previously. They have now gone on to demonstrate that the same bacteria can also be found in the primary skin lesions of cat scratch disease. They point out the desirability of diagnosing cat scratch disease clinically and by means of the skin test when possible since the skin test is quite specific and accurate. They next suggest a punch biopsy of a primary skin lesion if present. They recommend biopsy of the affected lymph nodes only as a last resort since the condition is self-limited.--David L. Collins
THORAX
patients. Complications were wound infection in 4 cases and breakage of implanted metal splints in 3 cases.-- Thomas A. Angerpointner Bilateral Diaphragmatic Hernia. R. Gonzalez and W. It. Heiss. Z
Kinderchir 39:339-340, (October), 1984. The authors report a newborn with bilateral Bochdalek diaphragmatic hernias. Severe respiratory insufficiency necessitated emergency repair of the left hernia. Although the right diaphragm appeared also to be elevated, no defect could initially be seen. A few days later the diaphragmatic elevation on the right side increased. At relaparotomy, which was necessary on the 12th postoperative day due to bowel obstruction, the right diaphragmatic hernia was also repaired. The patient was discharged from the hospital in the 1lth postoperative week. Reports on bilateral diaphragmatic hernia are very rare.--Thomas A. Angerpointner
Bronchoscopic Removal of Aspirated Foreign Bodies in Children.
R.E. Black, K.J. Choi, W.C. Syrne, et al. Am J Surg 148:778-781, (December), 1984. During a thirteen-year period, 262 children aged 4 months to 13 years were suspected of having aspirated a foreign body. Rigid bronchoscopy under general anesthesia using 0~ and 30~ telescopes was uniformly applied. Postoperatively, all patients received aerosolized bronchodilators, cool mist, chest physiotherapy, and antibiotics. Eight-five percent of the procedures revealed a foreign body that could be removed. There were no deaths. Complications occurred in 8%, including atelectasis (9), pneumonia (2), retained fragments (3), bronchospasm (1), laryngospasm (1), and pneumomediastinum (1) without apparent perforation.--Thomas V. Whalen, Jr Tracheoplasty with Pericardial Patch for Extensive Tracheal Sten o s i s in Infants and Children. F.S. ldriss, S. Y. Deleon, M.N. llbawi,
et al. J Thorac Cardiovasc Surg 88:527-536, (October), 1984. A pericardial patch tracheoplasty was used to correct long tracheal stenoses in 5 children. Four were due to complete tracheal rings and one was secondary to tracheal trauma. Preoperative computed axial tomography and bronchoscopy were useful in delineating the extent of luminal narrowing. Median sternotomy was used for extensive exposure of the trachea, cardiopulmonary bypass, and harvesting of the pericardial patch. Intraoperative bronchoscopy assured appropriate length of tracheal repair and allowed for accurate placement of the endotracheal tube beyond the patch postoperatively. Internal stenting was required in only one patient and was necessary because of compression on the trachea by vascular structures. Use of the pericardium as a tracheal patch in children with tracheal stenosis avoided tracheal resection and a circular anastomoses that might affect tracheal growth.--Marleta Reynolds Conservative and Operative Treatment of the Funnel Chest. R.
Merger. Z Kinderchir 39:302-304, (October), 1984. The author reports on his results in 50 conservatively and 171 surgically treated children with funnel chest. According to his opinion, conservative treatment consisting of intense physiotherapy is promising only in early childhood. Since funnel chest might be enhanced by respiratory obstruction, early adenoectomy or tonsillectomy is recommended. The favorable age periods for surgical correction, which is performed according to Rehbein's technique are between 6 and 8 and after 12 years of age. Children under 6 years and between 9 and 12 years of age are prone to recurrences. Surgical risk is low, and the author did not encounter serious problems in 171
HEART AND GREAT VESSELS Assessment of Percutaneous Balloon Pulmonary and Aortic ValvuIoplasty. J. Walls, Z. Lababidi, J.J. Curtis, et al. J Thorac Cardio-
vasc Surg 88:352-356, (September), 1984. Percutaneous balloon valvuloplasty has been used to relieve congenital pulmonary and aortic valve stenosis in 66 children. The transvalvular gradient was reduced from 85 • 35 to 27 _+ 15 mm Hg, P < 0.01, in 33 patients with isolated valvular pulmonary stenosis. Seven were later evaluated intraoperatively and the mechanism of injury was found to be commisseral splitting, tearing of cusp tissue, and avulsion of cusp tissue from the annulus. When associated with infundibular stenosis, the risk of cusp avulsion was high, and balloon valvuloplasty is not recommended in these patients. In 27 patients, the aortic valve gradients were reduced from 108 • 46 to 32 • 16 mm Hg (p < 0.01). Mild aortic regurgitation resulted in 17 patients, and a residual gradient prompted surgical valvuloplasty in 2 patients. Balloon valvuloplasty is not recommended for patients with critical aortic stenosis and cardiomyopathy, preexisting moderate aortic regurgitation, pressure gradients less than 55 mm Hg, or calcified aortic valves. This technique may result in long-term relief of congenital pulmonic stenosis. Palliation of congenital aortic stenosis should reduce the number of reoperative procedures that will become necessary in the child's future.--Marleta Reynolds Rupture of a Congenital Aneurysm of Valsalva's Sinus. P. Cartier,
J.R. Boudreault, J.D. Jean, et al. Chir P&liatr 25:83-86, (March, April), 1984. The authors describe a particular form of ruptured aneurysm. This incidence is rare. Diagnosis was by clinical and angiographic findings in a girl of 9. The fistula arose from the right coronary sinus and resulted in a 6 cm aneurysm that dissected the interatrial septum and the posterolateral wall of the right atrium. The embryological theory proposed by Sakakikoa is summarized. The surgical approach was through the right atrium, and hypothermia was necessary due to the 30% left-right shunt and in order to inspect the sigmoid valves. The postoperative result was good.--J.M. Guys Surgical Treatment of Truncus Arteriosus in the First Six Months of Life. P.A. Ebert, K. Turley, P. Stanger, el al. Ann Surg
200:451 4 5 6 , (October), 1984. One hundred and six infants under 6 months of age presented with a clinical diagnosis of truncus arteriosus between 1975 and 1981. All of these infants had either Collett and Edwards type I or II lesions. The ages ranged from 6 days to 6 months. The majority of the infants presented with congestive heart failure. One hundred and
285
Cat Scratch D i s e a s e . A. l~. Margileth, D.J. Wear, T.L. Hadfield, et
al. JAMA 252:928-931, (August 17), 1984. The authors of this paper have demonstrated recently that lymph nodes infected with cat scratch disease when stained with the Warthin-Starry technique contain small pleomorphic bacilli rather than the virus that had been supposed previously. They have now gone on to demonstrate that the same bacteria can also be found in the primary skin lesions of cat scratch disease. They point out the desirability of diagnosing cat scratch disease clinically and by means of the skin test when possible since the skin test is quite specific and accurate. They next suggest a punch biopsy of a primary skin lesion if present. They recommend biopsy of the affected lymph nodes only as a last resort since the condition is self-limited.--David L. Collins
THORAX
patients. Complications were wound infection in 4 cases and breakage of implanted metal splints in 3 cases.-- Thomas A. Angerpointner Bilateral Diaphragmatic Hernia. R. Gonzalez and W. It. Heiss. Z
Kinderchir 39:339-340, (October), 1984. The authors report a newborn with bilateral Bochdalek diaphragmatic hernias. Severe respiratory insufficiency necessitated emergency repair of the left hernia. Although the right diaphragm appeared also to be elevated, no defect could initially be seen. A few days later the diaphragmatic elevation on the right side increased. At relaparotomy, which was necessary on the 12th postoperative day due to bowel obstruction, the right diaphragmatic hernia was also repaired. The patient was discharged from the hospital in the 1lth postoperative week. Reports on bilateral diaphragmatic hernia are very rare.--Thomas A. Angerpointner
Bronchoscopic Removal of Aspirated Foreign Bodies in Children.
R.E. Black, K.J. Choi, W.C. Syrne, et al. Am J Surg 148:778-781, (December), 1984. During a thirteen-year period, 262 children aged 4 months to 13 years were suspected of having aspirated a foreign body. Rigid bronchoscopy under general anesthesia using 0~ and 30~ telescopes was uniformly applied. Postoperatively, all patients received aerosolized bronchodilators, cool mist, chest physiotherapy, and antibiotics. Eight-five percent of the procedures revealed a foreign body that could be removed. There were no deaths. Complications occurred in 8%, including atelectasis (9), pneumonia (2), retained fragments (3), bronchospasm (1), laryngospasm (1), and pneumomediastinum (1) without apparent perforation.--Thomas V. Whalen, Jr Tracheoplasty with Pericardial Patch for Extensive Tracheal Sten o s i s in Infants and Children. F.S. ldriss, S. Y. Deleon, M.N. llbawi,
et al. J Thorac Cardiovasc Surg 88:527-536, (October), 1984. A pericardial patch tracheoplasty was used to correct long tracheal stenoses in 5 children. Four were due to complete tracheal rings and one was secondary to tracheal trauma. Preoperative computed axial tomography and bronchoscopy were useful in delineating the extent of luminal narrowing. Median sternotomy was used for extensive exposure of the trachea, cardiopulmonary bypass, and harvesting of the pericardial patch. Intraoperative bronchoscopy assured appropriate length of tracheal repair and allowed for accurate placement of the endotracheal tube beyond the patch postoperatively. Internal stenting was required in only one patient and was necessary because of compression on the trachea by vascular structures. Use of the pericardium as a tracheal patch in children with tracheal stenosis avoided tracheal resection and a circular anastomoses that might affect tracheal growth.--Marleta Reynolds Conservative and Operative Treatment of the Funnel Chest. R.
Merger. Z Kinderchir 39:302-304, (October), 1984. The author reports on his results in 50 conservatively and 171 surgically treated children with funnel chest. According to his opinion, conservative treatment consisting of intense physiotherapy is promising only in early childhood. Since funnel chest might be enhanced by respiratory obstruction, early adenoectomy or tonsillectomy is recommended. The favorable age periods for surgical correction, which is performed according to Rehbein's technique are between 6 and 8 and after 12 years of age. Children under 6 years and between 9 and 12 years of age are prone to recurrences. Surgical risk is low, and the author did not encounter serious problems in 171
HEART AND GREAT VESSELS Assessment of Percutaneous Balloon Pulmonary and Aortic ValvuIoplasty. J. Walls, Z. Lababidi, J.J. Curtis, et al. J Thorac Cardio-
vasc Surg 88:352-356, (September), 1984. Percutaneous balloon valvuloplasty has been used to relieve congenital pulmonary and aortic valve stenosis in 66 children. The transvalvular gradient was reduced from 85 • 35 to 27 _+ 15 mm Hg, P < 0.01, in 33 patients with isolated valvular pulmonary stenosis. Seven were later evaluated intraoperatively and the mechanism of injury was found to be commisseral splitting, tearing of cusp tissue, and avulsion of cusp tissue from the annulus. When associated with infundibular stenosis, the risk of cusp avulsion was high, and balloon valvuloplasty is not recommended in these patients. In 27 patients, the aortic valve gradients were reduced from 108 • 46 to 32 • 16 mm Hg (p < 0.01). Mild aortic regurgitation resulted in 17 patients, and a residual gradient prompted surgical valvuloplasty in 2 patients. Balloon valvuloplasty is not recommended for patients with critical aortic stenosis and cardiomyopathy, preexisting moderate aortic regurgitation, pressure gradients less than 55 mm Hg, or calcified aortic valves. This technique may result in long-term relief of congenital pulmonic stenosis. Palliation of congenital aortic stenosis should reduce the number of reoperative procedures that will become necessary in the child's future.--Marleta Reynolds Rupture of a Congenital Aneurysm of Valsalva's Sinus. P. Cartier,
J.R. Boudreault, J.D. Jean, et al. Chir P&liatr 25:83-86, (March, April), 1984. The authors describe a particular form of ruptured aneurysm. This incidence is rare. Diagnosis was by clinical and angiographic findings in a girl of 9. The fistula arose from the right coronary sinus and resulted in a 6 cm aneurysm that dissected the interatrial septum and the posterolateral wall of the right atrium. The embryological theory proposed by Sakakikoa is summarized. The surgical approach was through the right atrium, and hypothermia was necessary due to the 30% left-right shunt and in order to inspect the sigmoid valves. The postoperative result was good.--J.M. Guys Surgical Treatment of Truncus Arteriosus in the First Six Months of Life. P.A. Ebert, K. Turley, P. Stanger, el al. Ann Surg
200:451 4 5 6 , (October), 1984. One hundred and six infants under 6 months of age presented with a clinical diagnosis of truncus arteriosus between 1975 and 1981. All of these infants had either Collett and Edwards type I or II lesions. The ages ranged from 6 days to 6 months. The majority of the infants presented with congestive heart failure. One hundred and