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Hepatic mesenchymal hamartoma in infancy: Diagnostic and therapeutic problems
496
ated for thalasscmia, histiocytosis, Wiscott-Aldrich syndrome, and portal hypertension. To the group of low risk patients belong all children with spherocytosis, idiopathic thrombocytopenia, purpura and posttraumatic lacerations. Eighty to ninty percent of these fulminant and lethal infections occur between 2 to 3 yr after splenectomy. The report describes the clinical course of a 21/2-yr-old boy who died of septicemia after splenectomy performed 18 me ago. The blood cultures showed a diplococcus infection. Typically pneumococci grow in these cultures, rarely meningococci, streptococci, and others. It is stressed that an exorbitant massive bactcremia is often seen to produce shock and disseminated intravascular clotting with a hemorrhagic diathesis. Prophylactic treatment with penicillin over a period of 2 yr cannot be advised as a routine m e a s u r e . Karl-Ludwig Waag
ABSTRACTS
authors' experience with nine patients who had hereditary pancreatitis yielded five surgically documented pseudocysts and three additional patients with radiographically proven mass effects. Recent studies have shown a 20% spontaneous regression rate for pancreatic pseudocysts of all etiologies when evaluated by B-mode ultrasonography, suggesting that the incidence of pseudocyst formation in hereditary pancreatitis is considerably higher than previously suspected. Ultrasonography is thought to be an excellent method for diagnosing this entity, of evaluating mass effects identified on radiographic studies, and of providing sequential evaluation of pseudocysts treated surgically or conservatively.--George Holcomb, Jr. Tolerance of the Human Liver to Prolonged Normothermic Ischemia. Claude Huget, Bernard Nordlinger, Patric Bloch,
et al. Arch Surg 113:1448-1451, (December), 1978. Modalities of Preservation of the Traumatized Spleen.
H. G. Mishalany, G. H. Mahour, R. J. Andrassy, et al. Am J. Surg 136:697-700, (December), 1978. The authors site evidence of an increased mortality from infection in both adults and pediatric patients who have undergone splenectomy. They propose preservation of as much of the traumatized spleen as is possible and report four cases as examples of alternatives to splenectomy. In one instance the injured spleen was not actively bleed'ing at the time of operation and was left in situ. In another instance a spleen with four large, widely gaping lacerations was managed by the technique of capsular repair. In a third instance fractured spleen was managed by resectional debridement, controlling hemorrhage with sutures, and covering the raw areas of the two segments with omentum. In the fourth patient a documented superior pole injury of the spleen was managed nonoperatively, and her course followed with serial splenic scars and hematocrit determinations. Recovery was uneventful in all four instances. The authors advocate evaluation for "total body injuries" after trauma with appropriate steps at resuscitation. In the event that splenic injury is considered and/or the peritoneal lavage demonstrates blood, a liver-spleen scan is obtained. If there is no suspicion of associated organ injuries based on clinical and laboratory evaluation the decision to explore the abdomen for splenic tear is based on local abdominal findings. If the patient stops bleeding, he is followed with serial hematocrit and hemoglobin determinations as well as general clinical abdominal evaluations. Patients with evidence of continued bleeding arc explored. At the time of exploration an effort is made to retain as much spleen as is possible using debridement, suture repair, partial splenectomy, and simple hemostatic materials. Discussants from Dallas, Texas, Houston, Texas, and Omaha, Nebraska all commented that associated injuries are not uncommon with splenic injury and cautioned the authors against an excess of conservatism.-Carey P. Page Pseudocyst Formation in Hereditary Pancreatitis. A. M.
Fried and .4. C. Selke. J Pediatr 93:950-953, (December), 1978. The previously estimated incidence of pseudocyst formation in hereditary pancreatitis is approximately 10%. The
Twenty patients submitted to extensive hepatectomy were divided into two groups. Group 1 (11 patients) performed with short hepatic inflow occlusion (7 [mean] _+ 2 [SEM] minutes), and group 2 (nine patients) operated with use of complete hepatic vascular exclusion and prolonged warm liver ischemia (38 [mean] _+ 5 [SEM] minutes). In one patient the warm ischem was 65 min. It is concluded that warm ischemia may be used well beyond the classical 15 min limit.--Edward J. Berman Hepatic Mesenchymal Hamartoma in Infancy: Diagnostic and Therapeutic Problems. L. Perrelli, A. Calisti, R.
Mastrangelo, et al. Rass Ital Chit Ped 19:330, 1977. A mass connected with a large pedicle to the inferior surface of the right hepatic lobe, weighing 1070 g was excised in a 4-me-old male baby. Histologic diagnosis was: hamartoma with predominance of fibrous tissue. A child aged 1 yr and 7 me was admitted because of hepatomegaly. Palpation failed to clarify the differential diagnosis between a renal and hepatic mass. An IVP showed scarse dye excretion from the right kidney and medial displacement of the proximal ureter, the arteriography showed the presence of an hepatic artery branching from the superior mesenteric artery which fed a large vascular circulation in the hepatic right lobe. A very large capsulated hepatic mass invading practically the whole right lobe was excised through a right hepatectomy. The tumor was nodular, 15 cm in diameter, weighing 700 g with ill-defined limits. Histologic diagnosis: fibro-cholangiomatous hamartoma. The follow up was very favorable in both cases. Histologic peculiarities are discussed.--C. A. Montagnani Pharmacological Versus Mechanical Reduction in Portal Pressure: A Comparative Study. R. J. Gorszmann, A. T.
Blei, E. H. Storer, et al. Surgery 84:679-685, (November), 1978. The portal venous pressure was reduced equally effectively (to I/2 of base line level) by intra-arterial vasopressin in the superior mesenteric artery or by partial mechanical obstruction by a balloon catheter, the mechanism of action decreasing the superior mesenteric artery blood flow. Each study was done in a group of 6 anesthetized dogs. All animals survived. Partial balloon catheter obstruction was main-
ated for thalasscmia, histiocytosis, Wiscott-Aldrich syndrome, and portal hypertension. To the group of low risk patients belong all children with spherocytosis, idiopathic thrombocytopenia, purpura and posttraumatic lacerations. Eighty to ninty percent of these fulminant and lethal infections occur between 2 to 3 yr after splenectomy. The report describes the clinical course of a 21/2-yr-old boy who died of septicemia after splenectomy performed 18 me ago. The blood cultures showed a diplococcus infection. Typically pneumococci grow in these cultures, rarely meningococci, streptococci, and others. It is stressed that an exorbitant massive bactcremia is often seen to produce shock and disseminated intravascular clotting with a hemorrhagic diathesis. Prophylactic treatment with penicillin over a period of 2 yr cannot be advised as a routine m e a s u r e . Karl-Ludwig Waag
ABSTRACTS
authors' experience with nine patients who had hereditary pancreatitis yielded five surgically documented pseudocysts and three additional patients with radiographically proven mass effects. Recent studies have shown a 20% spontaneous regression rate for pancreatic pseudocysts of all etiologies when evaluated by B-mode ultrasonography, suggesting that the incidence of pseudocyst formation in hereditary pancreatitis is considerably higher than previously suspected. Ultrasonography is thought to be an excellent method for diagnosing this entity, of evaluating mass effects identified on radiographic studies, and of providing sequential evaluation of pseudocysts treated surgically or conservatively.--George Holcomb, Jr. Tolerance of the Human Liver to Prolonged Normothermic Ischemia. Claude Huget, Bernard Nordlinger, Patric Bloch,
et al. Arch Surg 113:1448-1451, (December), 1978. Modalities of Preservation of the Traumatized Spleen.
H. G. Mishalany, G. H. Mahour, R. J. Andrassy, et al. Am J. Surg 136:697-700, (December), 1978. The authors site evidence of an increased mortality from infection in both adults and pediatric patients who have undergone splenectomy. They propose preservation of as much of the traumatized spleen as is possible and report four cases as examples of alternatives to splenectomy. In one instance the injured spleen was not actively bleed'ing at the time of operation and was left in situ. In another instance a spleen with four large, widely gaping lacerations was managed by the technique of capsular repair. In a third instance fractured spleen was managed by resectional debridement, controlling hemorrhage with sutures, and covering the raw areas of the two segments with omentum. In the fourth patient a documented superior pole injury of the spleen was managed nonoperatively, and her course followed with serial splenic scars and hematocrit determinations. Recovery was uneventful in all four instances. The authors advocate evaluation for "total body injuries" after trauma with appropriate steps at resuscitation. In the event that splenic injury is considered and/or the peritoneal lavage demonstrates blood, a liver-spleen scan is obtained. If there is no suspicion of associated organ injuries based on clinical and laboratory evaluation the decision to explore the abdomen for splenic tear is based on local abdominal findings. If the patient stops bleeding, he is followed with serial hematocrit and hemoglobin determinations as well as general clinical abdominal evaluations. Patients with evidence of continued bleeding arc explored. At the time of exploration an effort is made to retain as much spleen as is possible using debridement, suture repair, partial splenectomy, and simple hemostatic materials. Discussants from Dallas, Texas, Houston, Texas, and Omaha, Nebraska all commented that associated injuries are not uncommon with splenic injury and cautioned the authors against an excess of conservatism.-Carey P. Page Pseudocyst Formation in Hereditary Pancreatitis. A. M.
Fried and .4. C. Selke. J Pediatr 93:950-953, (December), 1978. The previously estimated incidence of pseudocyst formation in hereditary pancreatitis is approximately 10%. The
Twenty patients submitted to extensive hepatectomy were divided into two groups. Group 1 (11 patients) performed with short hepatic inflow occlusion (7 [mean] _+ 2 [SEM] minutes), and group 2 (nine patients) operated with use of complete hepatic vascular exclusion and prolonged warm liver ischemia (38 [mean] _+ 5 [SEM] minutes). In one patient the warm ischem was 65 min. It is concluded that warm ischemia may be used well beyond the classical 15 min limit.--Edward J. Berman Hepatic Mesenchymal Hamartoma in Infancy: Diagnostic and Therapeutic Problems. L. Perrelli, A. Calisti, R.
Mastrangelo, et al. Rass Ital Chit Ped 19:330, 1977. A mass connected with a large pedicle to the inferior surface of the right hepatic lobe, weighing 1070 g was excised in a 4-me-old male baby. Histologic diagnosis was: hamartoma with predominance of fibrous tissue. A child aged 1 yr and 7 me was admitted because of hepatomegaly. Palpation failed to clarify the differential diagnosis between a renal and hepatic mass. An IVP showed scarse dye excretion from the right kidney and medial displacement of the proximal ureter, the arteriography showed the presence of an hepatic artery branching from the superior mesenteric artery which fed a large vascular circulation in the hepatic right lobe. A very large capsulated hepatic mass invading practically the whole right lobe was excised through a right hepatectomy. The tumor was nodular, 15 cm in diameter, weighing 700 g with ill-defined limits. Histologic diagnosis: fibro-cholangiomatous hamartoma. The follow up was very favorable in both cases. Histologic peculiarities are discussed.--C. A. Montagnani Pharmacological Versus Mechanical Reduction in Portal Pressure: A Comparative Study. R. J. Gorszmann, A. T.
Blei, E. H. Storer, et al. Surgery 84:679-685, (November), 1978. The portal venous pressure was reduced equally effectively (to I/2 of base line level) by intra-arterial vasopressin in the superior mesenteric artery or by partial mechanical obstruction by a balloon catheter, the mechanism of action decreasing the superior mesenteric artery blood flow. Each study was done in a group of 6 anesthetized dogs. All animals survived. Partial balloon catheter obstruction was main-