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Ileocecal resection in infancy. Indication and results
263
ABSTRACTS
teric artery are described. There were 19 patients in all. Selective infusion of the superior mesenteric artery was impossible in two. There were 18 trials of treatment in the remaining 17 patients. Initially, vasopressin 0.2 u n i t s / m l / m i n was infused. If bleeding continued the dose was increased, the m a x i m u m dose used being 0.8 u n i t s / m i n . In ten treatments by infusion alone bleeding was completely controlled in two. In the remaining eight treatments, a Sengstaken tube was also used for the first one or two days. There was no i m p r o v e m e n t in the results. The complications of the selective infusion, e.g., groin h e m a t o m a , catheter occlusion, nonocclusive arterial thrombosis, are described by the authors, who no longer feel justified in using it, as " b o t h n u m e r o u s and s e r i o u s . " - - & J.
Corkery The Leucocyte C o u n t in Acute Appendicitis. P. W. R. Lee. Br. J. Surg. 60:618 (August), 1973. The leukocyte count was estimated in 100 consecutive cases of appendicitis in patients aged 8-70 yrs. The white cell count was more than 10,000 in 82 cases. It is concluded that although a white cell count below 10,000 does not exclude the diagnosis of acute appendicitis, such a result should p r o m p t further review and consideration of the d i a g n o s i s , - - J . Lari The Surgical M a n a g e m e n t of Amoebiasis in Children, L. Spitz. Br. J. Surg. 60:623-625 (August), 1973. Five children with severe complications o f acute amebic dysentery in the form of colonic perforation or intestinal obstruction due to severe involvement of colon had defunctioning ileostomy or colostomy performed. All are alive and well. Prior anti-amebic therapy and postoperative intensive medical" care are m a n d a tory for a successful outcome. J. Lari M a n a g e m e n t of Intussusception in Infants and Children: A Survey Based on 288 Consecutive Cases. J. Gierup, H. Jorulf. and A. Livaditis. Pediatrics 50:535-546 (October), 1972. The cardinal signs of intussception include a b d o m i n a l pain, vomiting, and bloody stools, with intermittent pain the most c o m m o n sign (91~o), vomiting second most c o m m o n (63~), and bloody stools least c o m m o n (16~). This
study encompasses an 18-yr period and stresses the importance of early radiologic e x a m i n a tion to establish the diagnosis. T h e r a p y by barium e n e m a reduction was the m e t h o d of choice, was attempted in 308 cases with success in 249 (81~) with a far higher success in the past 10 yr (87~o). The following results were drawn: (1) Reduction rate was 987o when pain was the only s y m p t o m , 82~o when associated with vomiting, and 5 7 ~ with bloody stools. (2) lleo-colic intussception, the m o s t c o m m o n type, was reduced in 8 5 ~ of the c a s e s b u t only 18~o ileoileocolic. (3) The apex of intussuception was more easily reduced in the right colon than if the apex was in the left. (4) The longer the duration of intussusception, the more chance of bowel obstruction, and the m o r e difficult the reduction. Finally, the a u t h o r s conclude that the diagnosis in the early stage is n o t always obvious and clinical findings alone do not establish the diagnosis. Therefore barium e n e m a and survey films of the a b d o m e n should be m a d e when the diagnosis is entertained. They feel that barium e n e m a reduction is a simple and safe m e t h o d with low morbidity, and the only contraindications to barium e n e m a reduction are peritonitis or intestinal o b s t r u c t i o n . -
Clifford Rubin
lleocecal Resection in Infancy. Indication and Results. G. Brandesky. Wien. Med. Wschr. 123:439 442 (June), 1973. A series of 25 ileocecal resections in neonates and infants is analyzed. There were eight neonates suffering from cecal or colonic perforation, seven of t h e m died postoperatively. The rest of the series (17 cases) comprises malformations, intussusception, strangulated hernia, volvulus, a n d a perforation due to foreign body ingestion. There were four fatalities, all of them presenting with severe peritonitis preoperatively. The high mortality in these cases, especially in the neonatal period, suggest a more conservative approach in these children preferring operations such as Mikulicz's resection or enterostomies. Eleven of the 14 survivors were followed 189 to 12 yr, an average 7 yr postoperatively. All children were free, of s y m p t o m s a n d physical development was normal. In 9 of the 11 cases there was free reflux to the ileum, t h o u g h all of these children were a s y m p t o m a t i c . T w o children who underwent hernicolectomy presented with a some-
264
what elongated colon showing some sort of right colonic flexure.--G. Brandesky Regional Enteritis and Growth Retardation Without Intestinal Symptoms. J. W. Donald and J. G. Donald. South. Med. J. 66:90% 912 (August), 1973. Severe growth failure associated with regional enteritis can occur even in the absence of intestinal s y m p t o m s . The authors report such a situation in a 16-yr-old boy. This association is more likely when the disease is present in the j e j u n u m or proximal ileum. Accordingly, roentgenographic barium study of the small bowel is essential in the diagnosis of this condition. In the investigation of growth retardation, even in the absence of intestinal s y m p t o m s , a careful search for regional enteritis should be made. Resection of the involved 91cm segment o f mid small bowel was accomplished. Microscopic appearance was typical of regional enteritis. In the first 5 m o following the operation he gained 9.1 kg, and his height increased 3.7 cm. His good health continued until 9 m o later when he developed a b d o m i n a l cramps and diarrhea. Barium studies revealed mild recurrence of the regional enteritis. This responded to a medical program of bland diet and Azulfidine. Since then he has had no intestinal s y m p t o m s with a weight gain of 13.6 kg and height increase of 10.2 cm. The a u t h o r s propose growth retardation as another indication for resection in patients with this d i s e a s e . George Holcomb Lymphocyte T r a n s f o r m a t i o n in the Mesenteric L y m p h Nodes of Patients With C r o h n ' s Disease. P. J. Guillou, T. G. Brennan, and G. R. Giles. Gut:14:20 24, 1973. T h e response, in vitro, of peripheral l y m p h o cytes to phytohemagglutinin (PHA) is compared with the responses obtained in l y m p h o cytes from mesenteric lymph nodes of a group of eight patients with C r o h n ' s disease and another group of seven patients undergoing laparotomy for n o n i n f l a m m a t o r y and n o n m a lignant conditions of the gastrointestinal tract. Following incubation of each culture the n u m ber of lymphocytes demonstrating uptake of radioactive thymidine was determined a n d expressed as a percentage of the total n u m b e r of cells in the culture to give "lymphocyte transformation rate" (L.T.R.~o). In the patients with C r o h n ' s disease the L.T.R. for peripheral lymphocytes was 35.8~o
ABSTRACTS
as against 48.3~,,, in normal subjects. The L.T.R, for " l y m p h node lymphocytes" in C r o h n ' s disease was 22.8'Yo, as against 42.6'~o in controls. It appears that the cause of this depressed response lay within the lymphocyte itself. Attempts to correlate L.T.R. with the histologic appearances of the lymph nodes were not entirely satisfactory, Despite the observed results an i m m u n o l o g i cal basis for C r o h n ' s disease c a n n o t be excluded by this study. It could be that in C r o h n ' s disease most of the lymphocytes in the lymph nodes and peripheral blood are bone m a r r o w derived and therefore do not respond to p h y t o h e m a g glutinin. Techniques which d e m o n s t r a t e imm u n o g l o b u l i n s on the surface of bone marrow derived lymphocytes m a y be able to help clarify the situation f u r t h e r . - - J . J. Corkery Pathology of Ulcerative Colitis in Childhood. B. C. Morson. Proc. Roy Soc Med. 66:1036 (October), 1973. This paper emphasizes that ulcerative colitis can affect persons at any age and the a u t h o r has examined specimens from babies and very y o u n g children; the histology is exactly the same as in adults. The risk of the development of colon carcinoma in children with ulcerative colitis is emphasized.--John E. S. Scott Medical Aspects of Ulcerative Colitis in Childhood. S. C. Truelove. Proc. Roy. Soc. Med. 66:1032 (October), 1973. The present m e t h o d s of medical t r e a t m e n t are outlined indicating the variations required for disease of differing severity, it is pointed o u t that corticosteroids are of no value as m a i n t e n a n c e treatment because they do not prevent recurrence of the disease, whereas sulphasalazine does reduce the risk of recurrence and has become the basis of long term medical treatment and m a y be required for several years. The a u t h o r describes a series o f 57 children with ulcerative colitis collected over a period of 10 yr; children with the more benign h e m o r rhagic proctitis are excluded, 5 6 ~ of the series having evidence of total colitis. There was one death following proctocoleetomy, one child was found to have a c a r c i n o m a in a proctocolectomy specimen, a further eight were subjected to excisional surgery, Thirtyseven patients did not require surgery and all were living n o r m a l lives, t h o u g h s o m e were on m a i n t e n a n c e therapy.--John E. S, Scott
ABSTRACTS
teric artery are described. There were 19 patients in all. Selective infusion of the superior mesenteric artery was impossible in two. There were 18 trials of treatment in the remaining 17 patients. Initially, vasopressin 0.2 u n i t s / m l / m i n was infused. If bleeding continued the dose was increased, the m a x i m u m dose used being 0.8 u n i t s / m i n . In ten treatments by infusion alone bleeding was completely controlled in two. In the remaining eight treatments, a Sengstaken tube was also used for the first one or two days. There was no i m p r o v e m e n t in the results. The complications of the selective infusion, e.g., groin h e m a t o m a , catheter occlusion, nonocclusive arterial thrombosis, are described by the authors, who no longer feel justified in using it, as " b o t h n u m e r o u s and s e r i o u s . " - - & J.
Corkery The Leucocyte C o u n t in Acute Appendicitis. P. W. R. Lee. Br. J. Surg. 60:618 (August), 1973. The leukocyte count was estimated in 100 consecutive cases of appendicitis in patients aged 8-70 yrs. The white cell count was more than 10,000 in 82 cases. It is concluded that although a white cell count below 10,000 does not exclude the diagnosis of acute appendicitis, such a result should p r o m p t further review and consideration of the d i a g n o s i s , - - J . Lari The Surgical M a n a g e m e n t of Amoebiasis in Children, L. Spitz. Br. J. Surg. 60:623-625 (August), 1973. Five children with severe complications o f acute amebic dysentery in the form of colonic perforation or intestinal obstruction due to severe involvement of colon had defunctioning ileostomy or colostomy performed. All are alive and well. Prior anti-amebic therapy and postoperative intensive medical" care are m a n d a tory for a successful outcome. J. Lari M a n a g e m e n t of Intussusception in Infants and Children: A Survey Based on 288 Consecutive Cases. J. Gierup, H. Jorulf. and A. Livaditis. Pediatrics 50:535-546 (October), 1972. The cardinal signs of intussception include a b d o m i n a l pain, vomiting, and bloody stools, with intermittent pain the most c o m m o n sign (91~o), vomiting second most c o m m o n (63~), and bloody stools least c o m m o n (16~). This
study encompasses an 18-yr period and stresses the importance of early radiologic e x a m i n a tion to establish the diagnosis. T h e r a p y by barium e n e m a reduction was the m e t h o d of choice, was attempted in 308 cases with success in 249 (81~) with a far higher success in the past 10 yr (87~o). The following results were drawn: (1) Reduction rate was 987o when pain was the only s y m p t o m , 82~o when associated with vomiting, and 5 7 ~ with bloody stools. (2) lleo-colic intussception, the m o s t c o m m o n type, was reduced in 8 5 ~ of the c a s e s b u t only 18~o ileoileocolic. (3) The apex of intussuception was more easily reduced in the right colon than if the apex was in the left. (4) The longer the duration of intussusception, the more chance of bowel obstruction, and the m o r e difficult the reduction. Finally, the a u t h o r s conclude that the diagnosis in the early stage is n o t always obvious and clinical findings alone do not establish the diagnosis. Therefore barium e n e m a and survey films of the a b d o m e n should be m a d e when the diagnosis is entertained. They feel that barium e n e m a reduction is a simple and safe m e t h o d with low morbidity, and the only contraindications to barium e n e m a reduction are peritonitis or intestinal o b s t r u c t i o n . -
Clifford Rubin
lleocecal Resection in Infancy. Indication and Results. G. Brandesky. Wien. Med. Wschr. 123:439 442 (June), 1973. A series of 25 ileocecal resections in neonates and infants is analyzed. There were eight neonates suffering from cecal or colonic perforation, seven of t h e m died postoperatively. The rest of the series (17 cases) comprises malformations, intussusception, strangulated hernia, volvulus, a n d a perforation due to foreign body ingestion. There were four fatalities, all of them presenting with severe peritonitis preoperatively. The high mortality in these cases, especially in the neonatal period, suggest a more conservative approach in these children preferring operations such as Mikulicz's resection or enterostomies. Eleven of the 14 survivors were followed 189 to 12 yr, an average 7 yr postoperatively. All children were free, of s y m p t o m s a n d physical development was normal. In 9 of the 11 cases there was free reflux to the ileum, t h o u g h all of these children were a s y m p t o m a t i c . T w o children who underwent hernicolectomy presented with a some-
264
what elongated colon showing some sort of right colonic flexure.--G. Brandesky Regional Enteritis and Growth Retardation Without Intestinal Symptoms. J. W. Donald and J. G. Donald. South. Med. J. 66:90% 912 (August), 1973. Severe growth failure associated with regional enteritis can occur even in the absence of intestinal s y m p t o m s . The authors report such a situation in a 16-yr-old boy. This association is more likely when the disease is present in the j e j u n u m or proximal ileum. Accordingly, roentgenographic barium study of the small bowel is essential in the diagnosis of this condition. In the investigation of growth retardation, even in the absence of intestinal s y m p t o m s , a careful search for regional enteritis should be made. Resection of the involved 91cm segment o f mid small bowel was accomplished. Microscopic appearance was typical of regional enteritis. In the first 5 m o following the operation he gained 9.1 kg, and his height increased 3.7 cm. His good health continued until 9 m o later when he developed a b d o m i n a l cramps and diarrhea. Barium studies revealed mild recurrence of the regional enteritis. This responded to a medical program of bland diet and Azulfidine. Since then he has had no intestinal s y m p t o m s with a weight gain of 13.6 kg and height increase of 10.2 cm. The a u t h o r s propose growth retardation as another indication for resection in patients with this d i s e a s e . George Holcomb Lymphocyte T r a n s f o r m a t i o n in the Mesenteric L y m p h Nodes of Patients With C r o h n ' s Disease. P. J. Guillou, T. G. Brennan, and G. R. Giles. Gut:14:20 24, 1973. T h e response, in vitro, of peripheral l y m p h o cytes to phytohemagglutinin (PHA) is compared with the responses obtained in l y m p h o cytes from mesenteric lymph nodes of a group of eight patients with C r o h n ' s disease and another group of seven patients undergoing laparotomy for n o n i n f l a m m a t o r y and n o n m a lignant conditions of the gastrointestinal tract. Following incubation of each culture the n u m ber of lymphocytes demonstrating uptake of radioactive thymidine was determined a n d expressed as a percentage of the total n u m b e r of cells in the culture to give "lymphocyte transformation rate" (L.T.R.~o). In the patients with C r o h n ' s disease the L.T.R. for peripheral lymphocytes was 35.8~o
ABSTRACTS
as against 48.3~,,, in normal subjects. The L.T.R, for " l y m p h node lymphocytes" in C r o h n ' s disease was 22.8'Yo, as against 42.6'~o in controls. It appears that the cause of this depressed response lay within the lymphocyte itself. Attempts to correlate L.T.R. with the histologic appearances of the lymph nodes were not entirely satisfactory, Despite the observed results an i m m u n o l o g i cal basis for C r o h n ' s disease c a n n o t be excluded by this study. It could be that in C r o h n ' s disease most of the lymphocytes in the lymph nodes and peripheral blood are bone m a r r o w derived and therefore do not respond to p h y t o h e m a g glutinin. Techniques which d e m o n s t r a t e imm u n o g l o b u l i n s on the surface of bone marrow derived lymphocytes m a y be able to help clarify the situation f u r t h e r . - - J . J. Corkery Pathology of Ulcerative Colitis in Childhood. B. C. Morson. Proc. Roy Soc Med. 66:1036 (October), 1973. This paper emphasizes that ulcerative colitis can affect persons at any age and the a u t h o r has examined specimens from babies and very y o u n g children; the histology is exactly the same as in adults. The risk of the development of colon carcinoma in children with ulcerative colitis is emphasized.--John E. S. Scott Medical Aspects of Ulcerative Colitis in Childhood. S. C. Truelove. Proc. Roy. Soc. Med. 66:1032 (October), 1973. The present m e t h o d s of medical t r e a t m e n t are outlined indicating the variations required for disease of differing severity, it is pointed o u t that corticosteroids are of no value as m a i n t e n a n c e treatment because they do not prevent recurrence of the disease, whereas sulphasalazine does reduce the risk of recurrence and has become the basis of long term medical treatment and m a y be required for several years. The a u t h o r describes a series o f 57 children with ulcerative colitis collected over a period of 10 yr; children with the more benign h e m o r rhagic proctitis are excluded, 5 6 ~ of the series having evidence of total colitis. There was one death following proctocoleetomy, one child was found to have a c a r c i n o m a in a proctocolectomy specimen, a further eight were subjected to excisional surgery, Thirtyseven patients did not require surgery and all were living n o r m a l lives, t h o u g h s o m e were on m a i n t e n a n c e therapy.--John E. S, Scott