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Developmental chest wall defects
601
I N T E R N A T I O N A L ABSTRACTS OF PEDIATRIC SURGERY
brous band up to the mandible (with resection of an exostosis, when present) is essential.--V. Kafka CARCINOMA OF THE THYROID IN CHILDREN AND YOUNG ADULT: IATROGENIC RELATION TO PREVIOUS Imua.DIATION, S. Hag-
ler, P. Rosenblum, and A. Rosenblum. Pediatrics 38:77-81, July, 1966. The literature concerning the irradiation of the head, neck and chest and the subsequent development of carcinoma of the thyroid gland is reviewed. The danger level is believed to be a dosage of over 180 r. The interval between radiation and the development of carcinoma of the thyroid may be as short as 3 years or as long as 27 years. While as few as 16 per cent to as many as 10O per cent of patients in this adolescent age group have a history of irradiation, the largest collected series suggests that this is true in 50 to 80 per cent. Of those patients followed after therapeutic irradiation, 1 in 150 to as few as 1 in 867 subsequently developed carcinoma of the thyroid gland. The authors have observed 15 children with thyroid carcinoma--14 of whom had radiation therapy. All 4 children with thyroid adenomas had radiation therapy. The interval between radiation and diagnosis was 5 ~ to 17 years. It is concluded that carcinoma of the thyroid in children is related to radiation therapy and such therapy to the head, neck,' or chest of infants and children should therefore be avoided whenever possible.---William K. Sieber. TRACIq[EOSTOMY: AND SEQUELAE
SURGICAL TECHNIQUE I N 50 CARDIOVASCULAR
PATIENTS. Alan S. Trimble, and James Yao. Thor. & Cardiovasc. 569-574, April 1966. A technic of tracheostomy is described, involving a short vertical incision slightly larger than the cuffed tube to b e used. Light general anesthesia and an endotracheal tube are recommended. More than half of the 50 patients had had open heart surgery, and 49 of them required mechanical respiratory support for from 1 to 19 days postoperatively. In 18 patients the procedure was done elective]y at the termina-
tion of surgery. In the 27 patients surviving the incidence of infection was reduced and the degree of scarring minimized.--William L. Riker
THORAX INTRADUCTAL PAPILLOMATOSIS OF THE BREAST. REPORT OF A CASE IN A TEN
YEAR OLD GIRL. Edward B. Diethrieh, Walter W. Hammond, Jr., and Fred Holtz. Amer. J. Surg. 112:80-82, July, 1966. A 10 year old girl presented with a small crescentic mass around the lateral side of the right nipple accompanied by intermittent bloody discharge from the nipple for a 6 month period. Biopsy proved this to be intraductal papillomatosis and the mass was excised. There was no evidence of malignancy. Two and half years later the breast on this side showed marked underdevelopmerit when compared with the breast on the left side. This is believed to be the youngest ease of intraduetal papillomatosis of the breast reported. The presence of a mass and bloody discharge are considered typical of this condition.--Neville K. Connolly. DEVELOPMENTAL
CHEST
WALL
DEFECTS.
I. L. Ehrenha#, N. P. Possi and M. S, Lawrence. Ann. Thoracic Surg. 2:384-395, May 1966. Five types of chest wall defects are described with embryological and developmental explanations of their etiology. Defects in vertebrae and ribs are illustrated by 2 cases of bizarre rib and spine deformities. The second series of 7 patients had chest wall defects secondary to absence of the pectoralis major and minor muscles on one side. Three of these had faulty development of the limb buds on the affected side. The third and largest group were patients with peetus excavatum. Total correction, which is briefly described, was carried out on 82 patients. Simple release of diaphragmatic attachment in infants was found to be unsatisfactory. Peetus carinatum was corrected in 3 patients with an operative technic similar to that used in repair of peetus excavatum. The last condition involved changes in
602
INTERNATIONAL ABSTRACTS OF PEDIATRIC SURGERY
the posterior chest wall secondary to scoliosis, although this is usually an orthopedic problem; but one ease is presented in which reshaping and resecting of ribs was necessary to improve the "razorback" deformity. --William L. Riker ATYPICAL DEFORlV~ITIES O2
THE CHEST
WALL-----ABSENCE AND DEFORMITIES o2 THE RIBS AND COSTAL CARTILAGES. M.
M. Ravitch. Surgery 59:438-449, March 1966. Deformities of the ribs and costal cartilages without associated sternal deformities are discussed. Absence of the peetoralis major, absence or hypoplasia of the pectoralis minor, absence of costal cartilages, and mammary hypoplasia constitutes a syndrome 6 eases of which are described. Absence or separation of the bony ribs in association with hemivertebrae is presented as a more serious syndrome. Excellent illustrations present the complexities and meticulous surgical repair of the various cases presented. It is likely that suitable corrective measures can be instituted for even the most bizarre type of deformities.--Daniel T. Cloud.
when the disease was not diagnosed preoperatively. This crisis responds, however, to adequate antimyasthenic therapy. In view of this possible complication, it is not advisable to use curare or curare-like agents during anesthesia of patients with thymoma. The indication for operation in all cases was the tunaor itself and the possibility of malignancy, and not because of a concomitant myasthenia.--E. A. Kole. ACUTE RESPIRATORY DISTRESS IN INFANTS AND YOUNG CHILDREN, F, Kuffer, and
G. Duc. Padiat. Fortbildungskurse 17:5468, 1966. The authors review the surgical causes of respiratory distress in infants and young children such as staphylococcal pneumonia with pneumatoceles, abscess of the lung, congenital lobar emphysema, congenital cystic disease of the lung, intralobar sequestration, diaphragmatic hernias, mediastinal tumors, agenesis of the hmg and tumors of the lung. They report illustrative cases.--M. Better. CONGENITAL LOBAR EMPHYSEMA: LONGTERM
OBSERVATIONS ON DIAGNOSIS, AND PATHOLOGY O2 THYMIC
THERAPY TUMORS.
]. WedeU and F. Zaborsky. Zbl. Chir. 91:341-355, March 1966. Primary tumors of the thymus are rare. About 3 to 10 per cent of all mediastinal tumors originate in the thymus. The symptoms caused by thymie tumors are not specific, only the result of their position. The diagnosis can be made by chest x-ray. No other new growths are located so close behind the sternum high in the mediastinum. The authors operated upon 5 patients with a thymic tumor. All tumors were benign. There was no operative mortality. In 3 patients myasthenia gravis was present. The relation between this disease and thymoma is not clear. Recently, myasthenia gravis has been classified as an auto-imInune disease. The thynms, and thymoma too, may be of importance in the genesis of these diseases. The effect of removal of a thymie tumor on myasthenia gravis is not predictable. A feared postoperative complication is the myasthenie crisis, especially
EFFECTS
AND
SEQUELAE
IN
TREATED CASES. George R. DeMuth and Herbert Sloan. Surgery 59:601-607, April 1966. Six cases of congenital lobar emphysema treated with pulmonary resection were followed 5 to 14 years postoperative. The cases were evaluated clinically with special regard to growth and development and respiratory problems, and were subjected to detailed pulmonary function studies. In 3 cases, the right middle lobe was involved, in 2 cases the left upper lobe was involved, and in one case segments of the right upper and right lower lobes were involved. All 6 cases showed relatively normal growth and development, and although respiratory infections were fairly frequent during childhood after the original surgery, they diminished with aging. The pulmonary function studies revealed generally reduced vital capacity with normal residual volumes. This was thought to suggest no compensatory regeneration of lung tissue, but rather overdistention of the remaining lung. --Daniel T. Cloud.
I N T E R N A T I O N A L ABSTRACTS OF PEDIATRIC SURGERY
brous band up to the mandible (with resection of an exostosis, when present) is essential.--V. Kafka CARCINOMA OF THE THYROID IN CHILDREN AND YOUNG ADULT: IATROGENIC RELATION TO PREVIOUS Imua.DIATION, S. Hag-
ler, P. Rosenblum, and A. Rosenblum. Pediatrics 38:77-81, July, 1966. The literature concerning the irradiation of the head, neck and chest and the subsequent development of carcinoma of the thyroid gland is reviewed. The danger level is believed to be a dosage of over 180 r. The interval between radiation and the development of carcinoma of the thyroid may be as short as 3 years or as long as 27 years. While as few as 16 per cent to as many as 10O per cent of patients in this adolescent age group have a history of irradiation, the largest collected series suggests that this is true in 50 to 80 per cent. Of those patients followed after therapeutic irradiation, 1 in 150 to as few as 1 in 867 subsequently developed carcinoma of the thyroid gland. The authors have observed 15 children with thyroid carcinoma--14 of whom had radiation therapy. All 4 children with thyroid adenomas had radiation therapy. The interval between radiation and diagnosis was 5 ~ to 17 years. It is concluded that carcinoma of the thyroid in children is related to radiation therapy and such therapy to the head, neck,' or chest of infants and children should therefore be avoided whenever possible.---William K. Sieber. TRACIq[EOSTOMY: AND SEQUELAE
SURGICAL TECHNIQUE I N 50 CARDIOVASCULAR
PATIENTS. Alan S. Trimble, and James Yao. Thor. & Cardiovasc. 569-574, April 1966. A technic of tracheostomy is described, involving a short vertical incision slightly larger than the cuffed tube to b e used. Light general anesthesia and an endotracheal tube are recommended. More than half of the 50 patients had had open heart surgery, and 49 of them required mechanical respiratory support for from 1 to 19 days postoperatively. In 18 patients the procedure was done elective]y at the termina-
tion of surgery. In the 27 patients surviving the incidence of infection was reduced and the degree of scarring minimized.--William L. Riker
THORAX INTRADUCTAL PAPILLOMATOSIS OF THE BREAST. REPORT OF A CASE IN A TEN
YEAR OLD GIRL. Edward B. Diethrieh, Walter W. Hammond, Jr., and Fred Holtz. Amer. J. Surg. 112:80-82, July, 1966. A 10 year old girl presented with a small crescentic mass around the lateral side of the right nipple accompanied by intermittent bloody discharge from the nipple for a 6 month period. Biopsy proved this to be intraductal papillomatosis and the mass was excised. There was no evidence of malignancy. Two and half years later the breast on this side showed marked underdevelopmerit when compared with the breast on the left side. This is believed to be the youngest ease of intraduetal papillomatosis of the breast reported. The presence of a mass and bloody discharge are considered typical of this condition.--Neville K. Connolly. DEVELOPMENTAL
CHEST
WALL
DEFECTS.
I. L. Ehrenha#, N. P. Possi and M. S, Lawrence. Ann. Thoracic Surg. 2:384-395, May 1966. Five types of chest wall defects are described with embryological and developmental explanations of their etiology. Defects in vertebrae and ribs are illustrated by 2 cases of bizarre rib and spine deformities. The second series of 7 patients had chest wall defects secondary to absence of the pectoralis major and minor muscles on one side. Three of these had faulty development of the limb buds on the affected side. The third and largest group were patients with peetus excavatum. Total correction, which is briefly described, was carried out on 82 patients. Simple release of diaphragmatic attachment in infants was found to be unsatisfactory. Peetus carinatum was corrected in 3 patients with an operative technic similar to that used in repair of peetus excavatum. The last condition involved changes in
602
INTERNATIONAL ABSTRACTS OF PEDIATRIC SURGERY
the posterior chest wall secondary to scoliosis, although this is usually an orthopedic problem; but one ease is presented in which reshaping and resecting of ribs was necessary to improve the "razorback" deformity. --William L. Riker ATYPICAL DEFORlV~ITIES O2
THE CHEST
WALL-----ABSENCE AND DEFORMITIES o2 THE RIBS AND COSTAL CARTILAGES. M.
M. Ravitch. Surgery 59:438-449, March 1966. Deformities of the ribs and costal cartilages without associated sternal deformities are discussed. Absence of the peetoralis major, absence or hypoplasia of the pectoralis minor, absence of costal cartilages, and mammary hypoplasia constitutes a syndrome 6 eases of which are described. Absence or separation of the bony ribs in association with hemivertebrae is presented as a more serious syndrome. Excellent illustrations present the complexities and meticulous surgical repair of the various cases presented. It is likely that suitable corrective measures can be instituted for even the most bizarre type of deformities.--Daniel T. Cloud.
when the disease was not diagnosed preoperatively. This crisis responds, however, to adequate antimyasthenic therapy. In view of this possible complication, it is not advisable to use curare or curare-like agents during anesthesia of patients with thymoma. The indication for operation in all cases was the tunaor itself and the possibility of malignancy, and not because of a concomitant myasthenia.--E. A. Kole. ACUTE RESPIRATORY DISTRESS IN INFANTS AND YOUNG CHILDREN, F, Kuffer, and
G. Duc. Padiat. Fortbildungskurse 17:5468, 1966. The authors review the surgical causes of respiratory distress in infants and young children such as staphylococcal pneumonia with pneumatoceles, abscess of the lung, congenital lobar emphysema, congenital cystic disease of the lung, intralobar sequestration, diaphragmatic hernias, mediastinal tumors, agenesis of the hmg and tumors of the lung. They report illustrative cases.--M. Better. CONGENITAL LOBAR EMPHYSEMA: LONGTERM
OBSERVATIONS ON DIAGNOSIS, AND PATHOLOGY O2 THYMIC
THERAPY TUMORS.
]. WedeU and F. Zaborsky. Zbl. Chir. 91:341-355, March 1966. Primary tumors of the thymus are rare. About 3 to 10 per cent of all mediastinal tumors originate in the thymus. The symptoms caused by thymie tumors are not specific, only the result of their position. The diagnosis can be made by chest x-ray. No other new growths are located so close behind the sternum high in the mediastinum. The authors operated upon 5 patients with a thymic tumor. All tumors were benign. There was no operative mortality. In 3 patients myasthenia gravis was present. The relation between this disease and thymoma is not clear. Recently, myasthenia gravis has been classified as an auto-imInune disease. The thynms, and thymoma too, may be of importance in the genesis of these diseases. The effect of removal of a thymie tumor on myasthenia gravis is not predictable. A feared postoperative complication is the myasthenie crisis, especially
EFFECTS
AND
SEQUELAE
IN
TREATED CASES. George R. DeMuth and Herbert Sloan. Surgery 59:601-607, April 1966. Six cases of congenital lobar emphysema treated with pulmonary resection were followed 5 to 14 years postoperative. The cases were evaluated clinically with special regard to growth and development and respiratory problems, and were subjected to detailed pulmonary function studies. In 3 cases, the right middle lobe was involved, in 2 cases the left upper lobe was involved, and in one case segments of the right upper and right lower lobes were involved. All 6 cases showed relatively normal growth and development, and although respiratory infections were fairly frequent during childhood after the original surgery, they diminished with aging. The pulmonary function studies revealed generally reduced vital capacity with normal residual volumes. This was thought to suggest no compensatory regeneration of lung tissue, but rather overdistention of the remaining lung. --Daniel T. Cloud.