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Gut blood flow velocities in the newborn: Effects of patent ductus arteriosus and parenteral indomethacin
INTERNATIONAL
1351
ABSTRACTS
clinical results were good to excellent in 44 cases (92%) and fair in four cases (8%). In these four patients, two had residual dysphagia and two had gastroesophageal reflux. Barium studies showed a decrease in esophageal diameter and disappearance of distal narrowing, but normal esophageal emptying did not occur. Postoperative manometric studies (29 patients) showed a significant decrease in lower esophageal sphincter pressure and a significant increase in the length of the infradiaphragmatic segment. In the esophageal body a recovery of peristaltic waves in the proximal third was seen in 10 of the patients (34%). Twenty-four-hour pH monitoring showed pathological reflux in only 3 of 25 patients studied, and 1 of these was asymptomatic. The authors believe that this technique is effective, improving esophageal symptoms and controlling longterm reflux.-Lewis Spitz Results of Fundoplication in a UK Paediatric Centre. D. Parikh and P.K.H. Tam. Br J Surg 78:347-348, (March), 1991.
This is a retrospective study of 55 children undergoing fundoplication in childhood. Major complications (paraesophageal hernia, prolonged ileus, recurrent gastroesophageal reflux, and accidental perforation) occurred in 9 cases. The omission of a crural repair was the most important factor resulting in these complications. Four patients required repeat fundoplication for recurrent symptoms. Of the 13 patients with a stricture prior to surgery, 6 resolved after the fundoplication and 6 responded to dilatation. The authors’ preliminary experience with balloon dilatation was encouraging, with 3 patients responding to only one dilatation. They conclude that surgery is effective in controlling reflux in 89% of patients on l- to 6-year follow-up. Routine crural repair is an essential part of the antireflux operation.--John D. Orr Management of Disc Battery Ingestion in Children. Barghuuty Br J Surg 78:247, (February), 1991.
N. EI-
The author describes a protocol used to manage five children admitted with battery ingestion in a single year. The type of battery is determined and x-rays of the chest and abdomen are performed to determine its position. If in the esophagus, immediate endoscopic removal is indicated. If in the stomach and intact, the patient is admitted, given oral cimetidine, and the passage of the battery followed by daily x-rays. If the battery remains in the stomach for more than 24 hours or there is radiological evidence of leakage, endoscopic or surgical removal is performed. Blood mercury levels are measured in the latter case. If elevated, the patient is treated with a mercury-chelating agent such as dimercaprol. The majority of patients will pass the battery spontaneously, and only a small percentage develop symptoms.--John D. Orr Familial Superior Mesenteric Artery Syndrome. C. Ortiz, R.H. Cleveland, J.G. Blickman, et al. Pediatr Radio1 20:588-589, (Octo-
ber), 1990. The authors describe a family in which a father and his four daughters presented with symptoms of the superior mesenteric artery syndrome. The four sisters had radiological findings consistent with the diagnosis of superior mesenteric artery syndrome. The authors suggest that this familial clustering, involving five members of a family of eight, poses the probability of a genetic predisposition to this symptom and radiographic complex.-Prem PUn’ Gut Blood Flow Velocities in the Newborn: Effects of Patent Ductus Arteriosus and Parenteral Indomethacin. R.C. Coombs, M.E.I. Morgan, G.M. Durbin, et al. Arch Dis Child 65:1067-1071,
(October), 1990 (Fetal and Neonatal Ed). The effects of parenteral indomethacin on gut blood flow velocity in infants with patent ductus arteriosus were studied using
Doppler ultrasound of the superior mesenteric artery and celiac axis. The data suggest that there is a profound disturbance in midgut perfusion in infants with patent ductus that is exacerbated by indomethacin when it is given rapidly by intravenous bolus. The effects are reduced if the indomethacin is given slowly by infusion without loss of efficacy in closure of the ductus.-D.M. Burge Abdominal Complications of Ascaris Lumbricoides in Children. H. Rode, S. Cullis, A. Millar, et al. Pediatr Surg Int 5:397-401,
(November), 1990. Ascaris infestation is a serious problem in tropical and subtropical areas, and it is responsible for 20% of admissions annually to the surgical wards of the Red Cross Children’s Hospital. The authors reviewed 225 children with symptomatic Ascaris during a 5-year period. The predominant symptoms were abdominal pain (96%) abdominal tenderness (77%), palpable abdominal mass (38%), and vomiting of worms (33%). Sixty-six percent of children presented with intestinal ascaris, 30% with hepatobiliary, and 4% with pancreatic. The vast majority had an uncomplicated course and responded to conservative treatment. Sonography was the method of choice for diagnosing hepatobiliary and pancreatic disease and for monitoring treatment. Indications for surgery were suspicion of ischemic bowel, persistence of common bile duct worms for more than 4 to 6 weeks, liver disease. and persisting pseudocyst of the pancreas.-Prem Puri Intractable Ulcerating Enterocolitis of Infancy. Z.R. Sanderson, R.A. Risdon, and J.A. Walker-Smith. Arch Dis Child 66:295-299,
(March), 1990. A new distinct inherited condition affecting the whole gastrointestinal tract, particularly the colon, is reported in five children who presented in the first year of life. Clinical features included combinations of diarrhea, ulcerating stomatitis, partial villous atrophy of small bowel mucosa, ulcerative colitis, severe perianal disease, and an absence of stool pathogens. Four of the five reported children were from consanguinous marriages. All failed to respond to standard medical management including corticosteroids. In every case the colitis became so severe that subtotal colectomy was required. Although this condition had features similar to those of Crohn’s disease and Behcet’s disease, the authors feel that this is a new distinct entity.-D.M. Burge Ultrasonography in the Diagnosis of Acute Appendicitis. H.WA. Ooms, R.K.J. Koumans. P.J. Ho Kang You, et al. Br J Surg
78:315-318, (March), 1991. Five hundred twenty-five patients with clinical signs of acute appendicitis underwent ultrasonography using a graded compression technique in which intervening fat and bowel were displaced to eliminate disturbing artefacts and to reduce the distance from transducer to the appendix. The use of a high-frequency transducer gave satisfactory image quality. If the diameter of the visualized appendix was greater than 6 mm, it was considered to be inflamed. Eighty-six percent of the 207 patients with surgically proven appendicitis had positive findings on sonography. The score for nonperforated appendicitis (91%) was higher than that for perforated appendicitis (55%). Twenty-four patients in whom an inflamed appendix was seen on ultrasound did not undergo surgery because of resolution of their symptoms. Four of these 24 developed recurring appendicitis resulting in surgery, two underwent elective appendicectomy, and 18 have remained symptom free. One hundred fifty-five patients subsequently had alternative conditions diagnosed. Ultrasound made the correct diagnosis in 140. These
1351
ABSTRACTS
clinical results were good to excellent in 44 cases (92%) and fair in four cases (8%). In these four patients, two had residual dysphagia and two had gastroesophageal reflux. Barium studies showed a decrease in esophageal diameter and disappearance of distal narrowing, but normal esophageal emptying did not occur. Postoperative manometric studies (29 patients) showed a significant decrease in lower esophageal sphincter pressure and a significant increase in the length of the infradiaphragmatic segment. In the esophageal body a recovery of peristaltic waves in the proximal third was seen in 10 of the patients (34%). Twenty-four-hour pH monitoring showed pathological reflux in only 3 of 25 patients studied, and 1 of these was asymptomatic. The authors believe that this technique is effective, improving esophageal symptoms and controlling longterm reflux.-Lewis Spitz Results of Fundoplication in a UK Paediatric Centre. D. Parikh and P.K.H. Tam. Br J Surg 78:347-348, (March), 1991.
This is a retrospective study of 55 children undergoing fundoplication in childhood. Major complications (paraesophageal hernia, prolonged ileus, recurrent gastroesophageal reflux, and accidental perforation) occurred in 9 cases. The omission of a crural repair was the most important factor resulting in these complications. Four patients required repeat fundoplication for recurrent symptoms. Of the 13 patients with a stricture prior to surgery, 6 resolved after the fundoplication and 6 responded to dilatation. The authors’ preliminary experience with balloon dilatation was encouraging, with 3 patients responding to only one dilatation. They conclude that surgery is effective in controlling reflux in 89% of patients on l- to 6-year follow-up. Routine crural repair is an essential part of the antireflux operation.--John D. Orr Management of Disc Battery Ingestion in Children. Barghuuty Br J Surg 78:247, (February), 1991.
N. EI-
The author describes a protocol used to manage five children admitted with battery ingestion in a single year. The type of battery is determined and x-rays of the chest and abdomen are performed to determine its position. If in the esophagus, immediate endoscopic removal is indicated. If in the stomach and intact, the patient is admitted, given oral cimetidine, and the passage of the battery followed by daily x-rays. If the battery remains in the stomach for more than 24 hours or there is radiological evidence of leakage, endoscopic or surgical removal is performed. Blood mercury levels are measured in the latter case. If elevated, the patient is treated with a mercury-chelating agent such as dimercaprol. The majority of patients will pass the battery spontaneously, and only a small percentage develop symptoms.--John D. Orr Familial Superior Mesenteric Artery Syndrome. C. Ortiz, R.H. Cleveland, J.G. Blickman, et al. Pediatr Radio1 20:588-589, (Octo-
ber), 1990. The authors describe a family in which a father and his four daughters presented with symptoms of the superior mesenteric artery syndrome. The four sisters had radiological findings consistent with the diagnosis of superior mesenteric artery syndrome. The authors suggest that this familial clustering, involving five members of a family of eight, poses the probability of a genetic predisposition to this symptom and radiographic complex.-Prem PUn’ Gut Blood Flow Velocities in the Newborn: Effects of Patent Ductus Arteriosus and Parenteral Indomethacin. R.C. Coombs, M.E.I. Morgan, G.M. Durbin, et al. Arch Dis Child 65:1067-1071,
(October), 1990 (Fetal and Neonatal Ed). The effects of parenteral indomethacin on gut blood flow velocity in infants with patent ductus arteriosus were studied using
Doppler ultrasound of the superior mesenteric artery and celiac axis. The data suggest that there is a profound disturbance in midgut perfusion in infants with patent ductus that is exacerbated by indomethacin when it is given rapidly by intravenous bolus. The effects are reduced if the indomethacin is given slowly by infusion without loss of efficacy in closure of the ductus.-D.M. Burge Abdominal Complications of Ascaris Lumbricoides in Children. H. Rode, S. Cullis, A. Millar, et al. Pediatr Surg Int 5:397-401,
(November), 1990. Ascaris infestation is a serious problem in tropical and subtropical areas, and it is responsible for 20% of admissions annually to the surgical wards of the Red Cross Children’s Hospital. The authors reviewed 225 children with symptomatic Ascaris during a 5-year period. The predominant symptoms were abdominal pain (96%) abdominal tenderness (77%), palpable abdominal mass (38%), and vomiting of worms (33%). Sixty-six percent of children presented with intestinal ascaris, 30% with hepatobiliary, and 4% with pancreatic. The vast majority had an uncomplicated course and responded to conservative treatment. Sonography was the method of choice for diagnosing hepatobiliary and pancreatic disease and for monitoring treatment. Indications for surgery were suspicion of ischemic bowel, persistence of common bile duct worms for more than 4 to 6 weeks, liver disease. and persisting pseudocyst of the pancreas.-Prem Puri Intractable Ulcerating Enterocolitis of Infancy. Z.R. Sanderson, R.A. Risdon, and J.A. Walker-Smith. Arch Dis Child 66:295-299,
(March), 1990. A new distinct inherited condition affecting the whole gastrointestinal tract, particularly the colon, is reported in five children who presented in the first year of life. Clinical features included combinations of diarrhea, ulcerating stomatitis, partial villous atrophy of small bowel mucosa, ulcerative colitis, severe perianal disease, and an absence of stool pathogens. Four of the five reported children were from consanguinous marriages. All failed to respond to standard medical management including corticosteroids. In every case the colitis became so severe that subtotal colectomy was required. Although this condition had features similar to those of Crohn’s disease and Behcet’s disease, the authors feel that this is a new distinct entity.-D.M. Burge Ultrasonography in the Diagnosis of Acute Appendicitis. H.WA. Ooms, R.K.J. Koumans. P.J. Ho Kang You, et al. Br J Surg
78:315-318, (March), 1991. Five hundred twenty-five patients with clinical signs of acute appendicitis underwent ultrasonography using a graded compression technique in which intervening fat and bowel were displaced to eliminate disturbing artefacts and to reduce the distance from transducer to the appendix. The use of a high-frequency transducer gave satisfactory image quality. If the diameter of the visualized appendix was greater than 6 mm, it was considered to be inflamed. Eighty-six percent of the 207 patients with surgically proven appendicitis had positive findings on sonography. The score for nonperforated appendicitis (91%) was higher than that for perforated appendicitis (55%). Twenty-four patients in whom an inflamed appendix was seen on ultrasound did not undergo surgery because of resolution of their symptoms. Four of these 24 developed recurring appendicitis resulting in surgery, two underwent elective appendicectomy, and 18 have remained symptom free. One hundred fifty-five patients subsequently had alternative conditions diagnosed. Ultrasound made the correct diagnosis in 140. These