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Emergency separation of newborn xypho-omphalopagus conjoined twins
INTERNATIONAL
injuries. The authors emphasize the preventative nature of these injuries.-Purn’ciu M. Davidson
ABSTRACTS
Inherited Hypercoagulable Statea in Children. J. Whitlock. R.L. Janco, and J. Phillips III. Am J Pediatr Hematol Oncol 11:170- 173,
(Summer), 1989. Paediatric Bicycle Injuries. T. Cuss and A.J. Gray.
59:719-724,
Aust N Z J Surg
(September), 1989.
The authors review a subgroup of 251 (13%) children who were injured while riding a bicycle during a 3-year period (1985-1988) from a total of 1,919 pediatric trauma admissions. Boys were predominant (72%). with a mean age of 9.8 years. The accidents happened mostly during the afternoon. Eighty-five percent were minor injuries (injury severity scale less than 16). and 15% were severe (injury severity scale greater than 16). The latter often occurred as a result of a collision with a motor vehicle. One patient died in the hospital, but the other deaths occurred at the scene of the accident before transfer. Only 10% of the patients and none in the seriously injured group were wearing helmets. The authors emphasize the need to separate cyclists from motor vehicle traffic and the importance of educational programs to encourage helmet wearing.-
Pediatr
Surg Int 4:408-411, (October), 1989. The case histories of 36 patients treated for peripheral gangrene between 1973 and 1987 were reviewed. The most common causes of gangrene were disseminated intravascular coagulation due to bacterial septicemia (15) and dehydration due to gastrointestinal fluid loss (8). In only two patients was gangrene of truly iatrogenic origin. In four no apparent cause could be found. Secondary or contributing factors were recognizable in the majority of cases. The overall mortality rate was 30%. Major lower limb amputation was necessary in five patients (bilateral in three). Therefore, the causes of peripheral gangrene were multifactorial in most patients and idiopathic in only a small number. Delay before amputation allows both adequate stabilization of severely ill patients and clear demarcation of gangrenous tissue.-Prem Puri Aortic Thrombosis in Neonates and Infants. G.K. Lqfland,
Russo, B. Seth@
Emergency Separation of Newborn Xypho-Omphalopagus joined Twins. B.M. Vre, A.M. Holschneider,
Con-
M. Gharib, et al. Z
Kinderchir 44:176-180, (June), 1989.
Patricia M. Davidson Peripheral Gangrene in Children. D.H. Bass and S. Cywes.
Thrombotic events are uncommon in children, and this excellent review from Vanderbilt University, Department of Pediatrics, suggests that when they occur a prompt and thorough work-up for an underlying disease is essential. One set of disorders that must be entertained are the heritable hypercoagulable states, such as abnormalities of antithrombin III, protein S, protein C, fibrinogen, and plasminogen. Arterial thrombosis may result from endothelial damage, abnormal vascular flow, or increased platelet aggregation. The review of these disorders is informative and complete and should be read by any pediatric surgeon who might be called upon to evaluate the vascular complications that a child suffering from such a-disorder might experience.-Michael P. Hirsh and Ian T. Cohen
P.
et al. Ann Surg 208:743-745, (December), 1988.
Two patients with aortic thrombosis are presented. Case 1 is a 4.6 kg infant girl who developed respiratory distress and was monitored with an umbilical artery catheter. The patient subsequently developed renal failure. Subtraction aortogram demonstrated thrombotic occlusion of the descending aorta. The patient was taken to surgery, where she underwent an aortic thrombectomy via midline abdominal approach. The postoperative course was complicated by leakage of peritoneal dialysis fluid, abdominal wound dehiscence, and a rquirement for hemodialysis. Renal function slowly improved, and she was discharged 3 months after admission. The second patient is a 3.3 kg baby girl with meconium aspiration syndrome who also was monitored with an umbilical artery catheter. On routine examination, prior to discharge, the patient was found not to have femoral pulses. Angiography showed complete aortic obstruction 1 cm below the renal arteries. The patient underwent aortoiliac thrombectomy via flank incision and a retroperitoneal approach with restoration of good blood flow. The postoperative course was complicated by necrotizing enterocolitis. Predischarge digital subtraction angiography showed her abdominal aorta and iliac arteries to be patent. The authors review the controversial literature that both advocates for and counsels against aortic thrombectomy in infants with aortic thrombosis. The case presentations are used to support an aggressive surgical treatment regimen for aortoiliac thrombosis with tbe preferred approach being retroperitoneal.-Edward G. Ford
The emergency separation of xyphoomphalopagus conjoined twins is reported. The twins were delivered by cesarean section in the 35th week of gestation. They were conjoined between the omphalus and xyphoid process and had a common liver. All remaining organs including the peritoneal cavities were separate. One twin looked normal, whereas the other was multiply malformed, presenting with microcephalus, complicated congenital heart disease, microintestine, and malformations of the extremities. Due to the extremely poor condition of the deformed twin immediate emergency separation was mandatory, even before complete diagntis of vessel and liver formation. The deformed twin died intraoperatively and the fully developed twin died on the 7th postoperative day of cerebral hemorrhage with hemorrhagic diathesis. The report gives a detailed description of the specific fetal circulation and of a postoperatively occurring partial liver necrosis.--Thomas A. Angerpointner Experience With Minimal Complications in Implanted Catheters in Children. M.J. Hockenberry,
W.H. Schultz, B. Bennett, et al. Am J
Pediatr Hematol Oncol 11:295-299, (Fall), 1989. This excellent review of Duke University’s Pediatric Hematology/ Oncology Department’s experience with implantable catheters is a tribute to both implantable catheters and the care plans this group has established for them. Eighty-two patients with a mean catheter life of 168 days had minimmal complication rate, with only 5% removed for infection, infiltration, or tissue breakdown. Bacteremia was demonstrated in four patients. In three the infection was cleared by agressive intravenous antibiotic therapy. The catheters required minimal home maintenance, Rushing every 4 to 6 weeks only, did not alter the patients body image, and were reliable in administration of chemotherapy, blood products, medications, or for blood drawing. A rigorous inservice. procedure for all practitioners and caretakers involved with these catheters was established, as well as a catheter-care team that administered this in-house education. Implantable catheters were a definite improvement over the rates of complications of the Hickman or Broviac type of catheters and should be considered an important option for the pediatric hematology/oncology patient.-Michael P. Hirsh and ion T. Cohen Percutaneous Insertion of Subclavian Venous Catheters in Infants and Children. E. V. Bonventre, K.P. Lully. W.J. Chwals, et al.
Surg
Gynecol Obstet 169:203-205, (September), 1989. All attempts at subclavian venous catheterization by the Pediatric Surgery Service during a l&year period were prospectively studied.
injuries. The authors emphasize the preventative nature of these injuries.-Purn’ciu M. Davidson
ABSTRACTS
Inherited Hypercoagulable Statea in Children. J. Whitlock. R.L. Janco, and J. Phillips III. Am J Pediatr Hematol Oncol 11:170- 173,
(Summer), 1989. Paediatric Bicycle Injuries. T. Cuss and A.J. Gray.
59:719-724,
Aust N Z J Surg
(September), 1989.
The authors review a subgroup of 251 (13%) children who were injured while riding a bicycle during a 3-year period (1985-1988) from a total of 1,919 pediatric trauma admissions. Boys were predominant (72%). with a mean age of 9.8 years. The accidents happened mostly during the afternoon. Eighty-five percent were minor injuries (injury severity scale less than 16). and 15% were severe (injury severity scale greater than 16). The latter often occurred as a result of a collision with a motor vehicle. One patient died in the hospital, but the other deaths occurred at the scene of the accident before transfer. Only 10% of the patients and none in the seriously injured group were wearing helmets. The authors emphasize the need to separate cyclists from motor vehicle traffic and the importance of educational programs to encourage helmet wearing.-
Pediatr
Surg Int 4:408-411, (October), 1989. The case histories of 36 patients treated for peripheral gangrene between 1973 and 1987 were reviewed. The most common causes of gangrene were disseminated intravascular coagulation due to bacterial septicemia (15) and dehydration due to gastrointestinal fluid loss (8). In only two patients was gangrene of truly iatrogenic origin. In four no apparent cause could be found. Secondary or contributing factors were recognizable in the majority of cases. The overall mortality rate was 30%. Major lower limb amputation was necessary in five patients (bilateral in three). Therefore, the causes of peripheral gangrene were multifactorial in most patients and idiopathic in only a small number. Delay before amputation allows both adequate stabilization of severely ill patients and clear demarcation of gangrenous tissue.-Prem Puri Aortic Thrombosis in Neonates and Infants. G.K. Lqfland,
Russo, B. Seth@
Emergency Separation of Newborn Xypho-Omphalopagus joined Twins. B.M. Vre, A.M. Holschneider,
Con-
M. Gharib, et al. Z
Kinderchir 44:176-180, (June), 1989.
Patricia M. Davidson Peripheral Gangrene in Children. D.H. Bass and S. Cywes.
Thrombotic events are uncommon in children, and this excellent review from Vanderbilt University, Department of Pediatrics, suggests that when they occur a prompt and thorough work-up for an underlying disease is essential. One set of disorders that must be entertained are the heritable hypercoagulable states, such as abnormalities of antithrombin III, protein S, protein C, fibrinogen, and plasminogen. Arterial thrombosis may result from endothelial damage, abnormal vascular flow, or increased platelet aggregation. The review of these disorders is informative and complete and should be read by any pediatric surgeon who might be called upon to evaluate the vascular complications that a child suffering from such a-disorder might experience.-Michael P. Hirsh and Ian T. Cohen
P.
et al. Ann Surg 208:743-745, (December), 1988.
Two patients with aortic thrombosis are presented. Case 1 is a 4.6 kg infant girl who developed respiratory distress and was monitored with an umbilical artery catheter. The patient subsequently developed renal failure. Subtraction aortogram demonstrated thrombotic occlusion of the descending aorta. The patient was taken to surgery, where she underwent an aortic thrombectomy via midline abdominal approach. The postoperative course was complicated by leakage of peritoneal dialysis fluid, abdominal wound dehiscence, and a rquirement for hemodialysis. Renal function slowly improved, and she was discharged 3 months after admission. The second patient is a 3.3 kg baby girl with meconium aspiration syndrome who also was monitored with an umbilical artery catheter. On routine examination, prior to discharge, the patient was found not to have femoral pulses. Angiography showed complete aortic obstruction 1 cm below the renal arteries. The patient underwent aortoiliac thrombectomy via flank incision and a retroperitoneal approach with restoration of good blood flow. The postoperative course was complicated by necrotizing enterocolitis. Predischarge digital subtraction angiography showed her abdominal aorta and iliac arteries to be patent. The authors review the controversial literature that both advocates for and counsels against aortic thrombectomy in infants with aortic thrombosis. The case presentations are used to support an aggressive surgical treatment regimen for aortoiliac thrombosis with tbe preferred approach being retroperitoneal.-Edward G. Ford
The emergency separation of xyphoomphalopagus conjoined twins is reported. The twins were delivered by cesarean section in the 35th week of gestation. They were conjoined between the omphalus and xyphoid process and had a common liver. All remaining organs including the peritoneal cavities were separate. One twin looked normal, whereas the other was multiply malformed, presenting with microcephalus, complicated congenital heart disease, microintestine, and malformations of the extremities. Due to the extremely poor condition of the deformed twin immediate emergency separation was mandatory, even before complete diagntis of vessel and liver formation. The deformed twin died intraoperatively and the fully developed twin died on the 7th postoperative day of cerebral hemorrhage with hemorrhagic diathesis. The report gives a detailed description of the specific fetal circulation and of a postoperatively occurring partial liver necrosis.--Thomas A. Angerpointner Experience With Minimal Complications in Implanted Catheters in Children. M.J. Hockenberry,
W.H. Schultz, B. Bennett, et al. Am J
Pediatr Hematol Oncol 11:295-299, (Fall), 1989. This excellent review of Duke University’s Pediatric Hematology/ Oncology Department’s experience with implantable catheters is a tribute to both implantable catheters and the care plans this group has established for them. Eighty-two patients with a mean catheter life of 168 days had minimmal complication rate, with only 5% removed for infection, infiltration, or tissue breakdown. Bacteremia was demonstrated in four patients. In three the infection was cleared by agressive intravenous antibiotic therapy. The catheters required minimal home maintenance, Rushing every 4 to 6 weeks only, did not alter the patients body image, and were reliable in administration of chemotherapy, blood products, medications, or for blood drawing. A rigorous inservice. procedure for all practitioners and caretakers involved with these catheters was established, as well as a catheter-care team that administered this in-house education. Implantable catheters were a definite improvement over the rates of complications of the Hickman or Broviac type of catheters and should be considered an important option for the pediatric hematology/oncology patient.-Michael P. Hirsh and ion T. Cohen Percutaneous Insertion of Subclavian Venous Catheters in Infants and Children. E. V. Bonventre, K.P. Lully. W.J. Chwals, et al.
Surg
Gynecol Obstet 169:203-205, (September), 1989. All attempts at subclavian venous catheterization by the Pediatric Surgery Service during a l&year period were prospectively studied.