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Congenital mesoblastic nephroma: Treatment options
508
INTERNATIONAL ABSTRACTS
exercise treatment are not provided in 19 children. These may represent a group of patients in whom physiotherapy failed. Of the 88 infants, follow-up was available in 87 children (median 9 months, range 1 month to 12 years). None of these patients required surgery. This study shows a successful outcome in 88 infants with torticollis treated with passive stretching exercises. In the absence of the details of the severity of torticoUis in infancy in patients belonging to the late group, it is difficult to compare these two groups. A prospective randomized studY is necessary to confirm or refute Jones' statement, "The value of passive manipulation (for CMT) has not been proved." --R. Surana
and without placing a tape around it during surgery. Application of papaverine hydrochloride (40 mg/mL) around the artery and the administration of prostaglandin E1 0.1 mg/kg/min may be helpful. The authors state that these measures have helped to prevent these complications but do not state whether papaverine or prostaglandin was used in their patients or not, and if so, how many patients were treated in this manner. --P. Puri
Fixation After Fractures of the Sternum and Lumbar Spine in Children and Adolescents. G. MOllemhoff, M. Walz, and G. Muhr. Chirurg 64:948-952, 1993.
Forty-five patients with hepatic tumor in childhood during the past 35 years underwent clinical analysis. Thirty-six cases were malignant, and all 9 patients who did not undergo hepatic resection died. Fifteen of 27 (55.6%) patients who received hepatic resection survived. Among 22 patients with hepatoblastoma and hepatocellular carcinoma, 13 patients (59.1%) survived, 3 developed local recurrence, and 8 developed pulmonary metastasis. The longest survival was obtained in an 8-month-old boy treated with right trisegmentectomy followed by resection of pulmonary metastasis twice. He is now disease-free at the age of 20 years. The improved prognosis of hepatic tumors in childhood is mainly due to (1) the introduction of modern diagnostic imaging procedures, ie, angiography, ultras0nography, computed tomography, and magnetic resonance imaging, (2) improved technique of hepatic resection, ie, ultrasonic dissection, Pringle's method, and argon beam coagulator, and (3) the introduction of adjuvant chemotherapy (adriamycin and cisplatinum). --Takesh Miyano
Spinal column trauma with fractures of the breast and lumbar spine (2% to 3%) is relatively uncommon in the pediatric patient population (from birth to 16 years). The treatment of 22 patient s between 1978 and 1988 is reviewed. The purpose of the study was to describe the indications for operative versus nonoperative treatment, and to determine the course of treatment depending upon the age of the patient. Follow-up studies after approximately 8 years showed an improvement in the neurological status of 8 patients and a spontaneous correction of kyphotic angulation from 21 ° to 3°. The authors conclude that treatment must be individualized and depends on the age of the patient. ~ u n t e r H . WilIital NEOPLASMS
Bone Metastasis in Wilms' Tumour--Report of Three Cases and Rev,ew I . of the Literature. S. Gururangan, J.A. Wiliiams, and B.D. Fletcher. Pediatr Radio124:85-87, (April), 1994. This is a report of 3 patients (0.8% of all Wilms' tumor patients) who were found to have bone metastasis. One patient was found to have bone metastasis at diagnosis and two at relapse. The patient with a favorable histology received further chemotherapy and local radiotherapy with evidence of healing of the metastasis on computed tomography and bone scintigraphy. This patient remains disease-free 30 months from relapse. Two other patients with primary anaplastic tumors died of uncontrollable disease. --P. Puri Congenital Mesoblastic Nephroma: Treatment Options. V. Kalisdasan, A. Mammon, ].M. Hutson, et al. Pediatr Surg Int 9:524-525, (August), 1994. Five patients with congenital mesoblastic nephroma are reported. Three were treated within the first week of life. Two other patients had a cellular variant and presented at 5 and 18 months of age. Four patients were treated by nephrectomy. One newborn, who had an exophytic lesion from the lower pole, underwent partial nephrectomy. --R. Surana Renal Atrophy Following Removal of a Neuroblastoma. L Yarnagiwa, K. Obata, H. Saito, et al. Pediatr Surg Int 9:387-390, (June), 1994. The authors report 3 of 18 patients with abdominal neuroblastoma treated between 1987 and 1993 who developed "renal atrophy" or deterioration in renal function after kidney preserving surgery. The probable reason in 2 patients was impaired renal peffusion during surgery, whereas in 1 patient with pelvic neuroblastoma, the ureter was occluded by periureteral fibrosis secondary to silver clips. The authors believe that the decreased renal perfusion may be caused by either renal spasm or endothelial damage. They therefore believe that the renal artery should be handled gently
Surgical Treatment of Hepatic Tumors in Childhood. ThirtyFive Years' Experience.A. Okada, S. Kamata, M. Fukuzawa, et al. J Jpn Soc Pediatr Surg 30:35-42, 1994.
Long-Term Complications of Laparotomy in Hodgkin's Disease. M. Jackovich, N.P. Mendenhall, M.D. Sombeck, et al. Ann Surg 219:615-524, (June), 1994. The authors review the complications in 133 patients who underwent staging laparotomy and splenectomy for Hodgkin's disease (stages I to IV). Mean follow-up was 15.7 years; age range 2.5 to 28 years. There were 10 episodes of overwhelming postsplenectomy infection (OPSI) in 9 patients (6.8%), 5 of whom developed their infection within 5 years after operation. Patients with stage III and IV or recurrent disease were at greater risk; also those receiving combined modality intensive oncologic therapy. None of 25 patients who received preoperative pneumococcal vaccination developed OPSI. Surgical complications included small bowel obstruction (13), atelectasis (17), subdiaphragmatic abscess (1), and wound dehiscence (1). There were no deaths as a result of surgical complications. The authors conclude that with presplenectomy vaccination, the risks of a staging procedure are acceptable if knowledge of the pathological extent of the abdominal disease would alter treatment. John N. Schullinger Fibrous Hamartoma of Infancy in the Genital Region: Findings in 15 Cases, EJ. Popek, E.A. Montgomery, andJ.L. Fourcroy. J Urol 152:990-993, (September), 1994. Fibrous hamartoma of infancy is a benign myofibroblastic proliferation that typically occurs in the axillary or shoulder region of male infants. Fifteen cases of this condition are reported that involved the inguinal region (5), scrotum (5), spermatic cord (1), perineum (1), labium majus (1), suprapubic region (1), and pubic area (1). Patient median and mean ages were 10 and 6.7 months, respectively (range 2 to 24 months). No case was reported to be congenital. Median and mean tumor size was 3 em (range 0.5 to 6 cm). The microscopic features were identical to those seen in fibrous hamartoma of infancy occurring in more typical sites and
INTERNATIONAL ABSTRACTS
exercise treatment are not provided in 19 children. These may represent a group of patients in whom physiotherapy failed. Of the 88 infants, follow-up was available in 87 children (median 9 months, range 1 month to 12 years). None of these patients required surgery. This study shows a successful outcome in 88 infants with torticollis treated with passive stretching exercises. In the absence of the details of the severity of torticoUis in infancy in patients belonging to the late group, it is difficult to compare these two groups. A prospective randomized studY is necessary to confirm or refute Jones' statement, "The value of passive manipulation (for CMT) has not been proved." --R. Surana
and without placing a tape around it during surgery. Application of papaverine hydrochloride (40 mg/mL) around the artery and the administration of prostaglandin E1 0.1 mg/kg/min may be helpful. The authors state that these measures have helped to prevent these complications but do not state whether papaverine or prostaglandin was used in their patients or not, and if so, how many patients were treated in this manner. --P. Puri
Fixation After Fractures of the Sternum and Lumbar Spine in Children and Adolescents. G. MOllemhoff, M. Walz, and G. Muhr. Chirurg 64:948-952, 1993.
Forty-five patients with hepatic tumor in childhood during the past 35 years underwent clinical analysis. Thirty-six cases were malignant, and all 9 patients who did not undergo hepatic resection died. Fifteen of 27 (55.6%) patients who received hepatic resection survived. Among 22 patients with hepatoblastoma and hepatocellular carcinoma, 13 patients (59.1%) survived, 3 developed local recurrence, and 8 developed pulmonary metastasis. The longest survival was obtained in an 8-month-old boy treated with right trisegmentectomy followed by resection of pulmonary metastasis twice. He is now disease-free at the age of 20 years. The improved prognosis of hepatic tumors in childhood is mainly due to (1) the introduction of modern diagnostic imaging procedures, ie, angiography, ultras0nography, computed tomography, and magnetic resonance imaging, (2) improved technique of hepatic resection, ie, ultrasonic dissection, Pringle's method, and argon beam coagulator, and (3) the introduction of adjuvant chemotherapy (adriamycin and cisplatinum). --Takesh Miyano
Spinal column trauma with fractures of the breast and lumbar spine (2% to 3%) is relatively uncommon in the pediatric patient population (from birth to 16 years). The treatment of 22 patient s between 1978 and 1988 is reviewed. The purpose of the study was to describe the indications for operative versus nonoperative treatment, and to determine the course of treatment depending upon the age of the patient. Follow-up studies after approximately 8 years showed an improvement in the neurological status of 8 patients and a spontaneous correction of kyphotic angulation from 21 ° to 3°. The authors conclude that treatment must be individualized and depends on the age of the patient. ~ u n t e r H . WilIital NEOPLASMS
Bone Metastasis in Wilms' Tumour--Report of Three Cases and Rev,ew I . of the Literature. S. Gururangan, J.A. Wiliiams, and B.D. Fletcher. Pediatr Radio124:85-87, (April), 1994. This is a report of 3 patients (0.8% of all Wilms' tumor patients) who were found to have bone metastasis. One patient was found to have bone metastasis at diagnosis and two at relapse. The patient with a favorable histology received further chemotherapy and local radiotherapy with evidence of healing of the metastasis on computed tomography and bone scintigraphy. This patient remains disease-free 30 months from relapse. Two other patients with primary anaplastic tumors died of uncontrollable disease. --P. Puri Congenital Mesoblastic Nephroma: Treatment Options. V. Kalisdasan, A. Mammon, ].M. Hutson, et al. Pediatr Surg Int 9:524-525, (August), 1994. Five patients with congenital mesoblastic nephroma are reported. Three were treated within the first week of life. Two other patients had a cellular variant and presented at 5 and 18 months of age. Four patients were treated by nephrectomy. One newborn, who had an exophytic lesion from the lower pole, underwent partial nephrectomy. --R. Surana Renal Atrophy Following Removal of a Neuroblastoma. L Yarnagiwa, K. Obata, H. Saito, et al. Pediatr Surg Int 9:387-390, (June), 1994. The authors report 3 of 18 patients with abdominal neuroblastoma treated between 1987 and 1993 who developed "renal atrophy" or deterioration in renal function after kidney preserving surgery. The probable reason in 2 patients was impaired renal peffusion during surgery, whereas in 1 patient with pelvic neuroblastoma, the ureter was occluded by periureteral fibrosis secondary to silver clips. The authors believe that the decreased renal perfusion may be caused by either renal spasm or endothelial damage. They therefore believe that the renal artery should be handled gently
Surgical Treatment of Hepatic Tumors in Childhood. ThirtyFive Years' Experience.A. Okada, S. Kamata, M. Fukuzawa, et al. J Jpn Soc Pediatr Surg 30:35-42, 1994.
Long-Term Complications of Laparotomy in Hodgkin's Disease. M. Jackovich, N.P. Mendenhall, M.D. Sombeck, et al. Ann Surg 219:615-524, (June), 1994. The authors review the complications in 133 patients who underwent staging laparotomy and splenectomy for Hodgkin's disease (stages I to IV). Mean follow-up was 15.7 years; age range 2.5 to 28 years. There were 10 episodes of overwhelming postsplenectomy infection (OPSI) in 9 patients (6.8%), 5 of whom developed their infection within 5 years after operation. Patients with stage III and IV or recurrent disease were at greater risk; also those receiving combined modality intensive oncologic therapy. None of 25 patients who received preoperative pneumococcal vaccination developed OPSI. Surgical complications included small bowel obstruction (13), atelectasis (17), subdiaphragmatic abscess (1), and wound dehiscence (1). There were no deaths as a result of surgical complications. The authors conclude that with presplenectomy vaccination, the risks of a staging procedure are acceptable if knowledge of the pathological extent of the abdominal disease would alter treatment. John N. Schullinger Fibrous Hamartoma of Infancy in the Genital Region: Findings in 15 Cases, EJ. Popek, E.A. Montgomery, andJ.L. Fourcroy. J Urol 152:990-993, (September), 1994. Fibrous hamartoma of infancy is a benign myofibroblastic proliferation that typically occurs in the axillary or shoulder region of male infants. Fifteen cases of this condition are reported that involved the inguinal region (5), scrotum (5), spermatic cord (1), perineum (1), labium majus (1), suprapubic region (1), and pubic area (1). Patient median and mean ages were 10 and 6.7 months, respectively (range 2 to 24 months). No case was reported to be congenital. Median and mean tumor size was 3 em (range 0.5 to 6 cm). The microscopic features were identical to those seen in fibrous hamartoma of infancy occurring in more typical sites and