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Congenital diaphragmatic hernia: Pathophysiology and pharmacologic support
ABSTRACTS
1043 HEAD A N D NECK
Cancer of the Thyroid in Youth. J. ,4. Buckwalter, N. J.
Gurll, and C. G. Thomas, Jr. World J Surg 5:15-25, (January), 1981. This retrospective, computer review of 68 patients less than 20 yr of age presenting at two hospitals since 1935 yielded two striking results. Only one patient in the group succumbed to his disease and a high incidence of follicular tumors (68%) in patients less than 15 yr of age was noted. In well-constructed tables, comparison of multiple factors in relationship to patient age are presented. The authors recommend tailoring the operation to the extent and biologic aggressiveness of the tumor. Lobectomy and isthmusectomy is reserved for unilateral lesions less than 2 cm in size and without lymph node metastases. Near-total thyroidectomy is recommended for more extensive unilateral disease and ipsilateral nodal metastases. Multifocal disease, bilateral lymph node metastases and follicular carcinoma warrants total thyroidectomy. The authors utilize radioactive iodine to treat pulmonary metastases and unresectable cervical disease. They recommend postoperative thyroid s u p p r e s s i o n . Randall W. Powell
was also hypertelorism and malformation of the urinary tract indicating a G-Syndrome first described by Opitz in 1969. First a Heller's operation with fundoplication and gastrostomy was performed. The cleft was closed 4 mo later by interposition of a flap of the sternocleidomastoid muscle between trachea and esophagus. Esophageal stenosis was treated by dilatation. The girl is well 2 yr following surgery.--Thomas A. Angerpointner THORAX Pectus Excavation From Chronic Upper Airway Obstruction. Leland Fan and Shirley Murphy. Am J Dis Child
135:550-552, (June), 1981. Two patients with enlarged adenoids and tonsils had cardiopulmonary distress and pectus excavatum. In both patients the cardiorespiratory difficulty and the pectus deformity were relieved by removing the obstructive adenoids and tonsils. This observation supports the hypothesis that upper airway obstruCtion can cause a chest wall deformity. In a patient with cardiorespiratory distress and pectus excavatum, upper airway obstruction should be considered.--J. J. Tepas
Tracheostomy in Neonates and Small Infants: Problems and Pitfalls. J. J. Tepas, J. H. Heroy, D. W. Shermeta, and
Complete Cleft Sternum. R. K. Firmin, L. S. Fragomeni,
J. A. Hailer. Surgery 89:635, 1981.
and S. C. Lennox. Thorax 35:303-306, (April), 1980.
Seventy-four infants under 24 mo of age required tracheostomy during a 13-yr period. Forty-eight neonates included 34 babies with RDS and 14 with various other congenital anomalies. All neonatal tracheostomies were performed under local anesthesia over an endotracheal tube in the infant special care unit. There were no mortalities related to tracheostomy. One neonate sustained single vocal cord paralysis during an emergency tracheostomy revision. Twenty-six children, one 24 mo of age, required tracheostomy for croup in 16 and multiple cardiac lesion in 10. All of these children had tracheostomy performed in the operating room usually over an endotracheal tube. While the tracheostomies performed for croup were usually short lived (7.5 days), 12 of the 16 sustained significant tracheostomy related morbidity such as airway obstruction secondary to granulations at the stoma, bilateral tension pneumothorax, postoperative bleeding and thyroid injury. None of the cardiac group sustained tracheostomy-related complications. The authors describe their present techniques of operation and decannulation and present suggestions to avoid the complications of tracheostomy in this age group.--E. S. Wiener
This report from the Brompton Hospital concerns a 10day-old female Arab infant weighing 3.4 kg with a spontaneous vertex delivery at term following uncomplicated pregnancy. The parents and all three siblings were well. There was a complete vertical cleft of the sternum. The central ellipse of the skin cover was abnormally pink and partly ulcerated. Urgent operation involved excision of the abnormal skin and closure of the bony and soft tissue defect with nylon sutures. Unremarkable recovery was followed by good health to the time of review, 5 yr later.--John F. R. Bentley
Laryngo-Tracheo-Esophageal Cleft and G-Syndrome-Interposition of a Flap From the Starnocleidomastoid Muscle. H.
Sauer, R. Kurz, and M. HOllwarth. Z Kinderchir 32:29-37, 1981. Esophagolaryngeal and tracheal clefts result from a disturbed separation of foregut and lungs during the fourth week of gestation. The authors describe a case of an extended laryngotracheoesophageal cleft presenting with recurrent infections of the airways and septicemia complicated by an associated achalasia of the cardia in a 7-mo-old girl. There
Congenital Diaphragmatic Hernia: Pathophysiology and Pharmacologic Support. R. S. Bloss, J. V. Aranda, and
H. E. Beardmore. Surgery 89:518, 1981. This is an excellent comprehensive historic, anatomic, physiologic, and pharmacologic review of the problem of congenital diaphragmatic hernia as it occurs in infants operated upon in the first 24 hr of life. While the authors do not present personal clinical data, their discussion serves as a basis for present management of these infants.--E. S. Wiener Congenital Diaphragmatic Hernia in the Newborn: Postoperative CPAP Treatment. T. L. Vereb~ly, E. J. Kontor, and
B. Bfiky. Acta Paediatr Acad Sci Hung 22:131-135, 1981. Between 1973 and 1980, 28 newborn infants were operated on for congenital diaphragmatic hernia. In 20 cases the defect was of the Bochdalek type, and in 2 cases of the Morgagni type on the right side. In six patients, the defect was a total absence of diaphragmatic muscle. All patients needed postoperative respiratory treatment. The CPAP (continuous positive airway pressure), technique was used. The airway pressure never exceeded 2 4 cm H20. Eight patients
1043 HEAD A N D NECK
Cancer of the Thyroid in Youth. J. ,4. Buckwalter, N. J.
Gurll, and C. G. Thomas, Jr. World J Surg 5:15-25, (January), 1981. This retrospective, computer review of 68 patients less than 20 yr of age presenting at two hospitals since 1935 yielded two striking results. Only one patient in the group succumbed to his disease and a high incidence of follicular tumors (68%) in patients less than 15 yr of age was noted. In well-constructed tables, comparison of multiple factors in relationship to patient age are presented. The authors recommend tailoring the operation to the extent and biologic aggressiveness of the tumor. Lobectomy and isthmusectomy is reserved for unilateral lesions less than 2 cm in size and without lymph node metastases. Near-total thyroidectomy is recommended for more extensive unilateral disease and ipsilateral nodal metastases. Multifocal disease, bilateral lymph node metastases and follicular carcinoma warrants total thyroidectomy. The authors utilize radioactive iodine to treat pulmonary metastases and unresectable cervical disease. They recommend postoperative thyroid s u p p r e s s i o n . Randall W. Powell
was also hypertelorism and malformation of the urinary tract indicating a G-Syndrome first described by Opitz in 1969. First a Heller's operation with fundoplication and gastrostomy was performed. The cleft was closed 4 mo later by interposition of a flap of the sternocleidomastoid muscle between trachea and esophagus. Esophageal stenosis was treated by dilatation. The girl is well 2 yr following surgery.--Thomas A. Angerpointner THORAX Pectus Excavation From Chronic Upper Airway Obstruction. Leland Fan and Shirley Murphy. Am J Dis Child
135:550-552, (June), 1981. Two patients with enlarged adenoids and tonsils had cardiopulmonary distress and pectus excavatum. In both patients the cardiorespiratory difficulty and the pectus deformity were relieved by removing the obstructive adenoids and tonsils. This observation supports the hypothesis that upper airway obstruCtion can cause a chest wall deformity. In a patient with cardiorespiratory distress and pectus excavatum, upper airway obstruction should be considered.--J. J. Tepas
Tracheostomy in Neonates and Small Infants: Problems and Pitfalls. J. J. Tepas, J. H. Heroy, D. W. Shermeta, and
Complete Cleft Sternum. R. K. Firmin, L. S. Fragomeni,
J. A. Hailer. Surgery 89:635, 1981.
and S. C. Lennox. Thorax 35:303-306, (April), 1980.
Seventy-four infants under 24 mo of age required tracheostomy during a 13-yr period. Forty-eight neonates included 34 babies with RDS and 14 with various other congenital anomalies. All neonatal tracheostomies were performed under local anesthesia over an endotracheal tube in the infant special care unit. There were no mortalities related to tracheostomy. One neonate sustained single vocal cord paralysis during an emergency tracheostomy revision. Twenty-six children, one 24 mo of age, required tracheostomy for croup in 16 and multiple cardiac lesion in 10. All of these children had tracheostomy performed in the operating room usually over an endotracheal tube. While the tracheostomies performed for croup were usually short lived (7.5 days), 12 of the 16 sustained significant tracheostomy related morbidity such as airway obstruction secondary to granulations at the stoma, bilateral tension pneumothorax, postoperative bleeding and thyroid injury. None of the cardiac group sustained tracheostomy-related complications. The authors describe their present techniques of operation and decannulation and present suggestions to avoid the complications of tracheostomy in this age group.--E. S. Wiener
This report from the Brompton Hospital concerns a 10day-old female Arab infant weighing 3.4 kg with a spontaneous vertex delivery at term following uncomplicated pregnancy. The parents and all three siblings were well. There was a complete vertical cleft of the sternum. The central ellipse of the skin cover was abnormally pink and partly ulcerated. Urgent operation involved excision of the abnormal skin and closure of the bony and soft tissue defect with nylon sutures. Unremarkable recovery was followed by good health to the time of review, 5 yr later.--John F. R. Bentley
Laryngo-Tracheo-Esophageal Cleft and G-Syndrome-Interposition of a Flap From the Starnocleidomastoid Muscle. H.
Sauer, R. Kurz, and M. HOllwarth. Z Kinderchir 32:29-37, 1981. Esophagolaryngeal and tracheal clefts result from a disturbed separation of foregut and lungs during the fourth week of gestation. The authors describe a case of an extended laryngotracheoesophageal cleft presenting with recurrent infections of the airways and septicemia complicated by an associated achalasia of the cardia in a 7-mo-old girl. There
Congenital Diaphragmatic Hernia: Pathophysiology and Pharmacologic Support. R. S. Bloss, J. V. Aranda, and
H. E. Beardmore. Surgery 89:518, 1981. This is an excellent comprehensive historic, anatomic, physiologic, and pharmacologic review of the problem of congenital diaphragmatic hernia as it occurs in infants operated upon in the first 24 hr of life. While the authors do not present personal clinical data, their discussion serves as a basis for present management of these infants.--E. S. Wiener Congenital Diaphragmatic Hernia in the Newborn: Postoperative CPAP Treatment. T. L. Vereb~ly, E. J. Kontor, and
B. Bfiky. Acta Paediatr Acad Sci Hung 22:131-135, 1981. Between 1973 and 1980, 28 newborn infants were operated on for congenital diaphragmatic hernia. In 20 cases the defect was of the Bochdalek type, and in 2 cases of the Morgagni type on the right side. In six patients, the defect was a total absence of diaphragmatic muscle. All patients needed postoperative respiratory treatment. The CPAP (continuous positive airway pressure), technique was used. The airway pressure never exceeded 2 4 cm H20. Eight patients