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Long-term follow-up after inhalation of foreign bodies
342
INTERNATIONAL
Operative Correction of Pectus Excavatum. Experience at the Children’s Hospital of Bremen. G. von der Oelsnitz. Pediatr Surg
Int 5150-155, (May), 1990. The authors report on the Rehbein operation for pectus excavaturn. This procedure has been used at the Children’s Hospital of Bremen for the past 35 years. The operative results have been good in 69.2%, satisfactory in l&3%, and poor in 12.5% of cases. The operation mobilizes the concavity and maintains the raised sternum in a position of overcorrection by steel splints and metal bands, which remain in situ for 3 years. The optimum age for success of this operation in children is between 6 and 8 years or more than 12 years. Surgery is indicated for all severe deformities. Operation for moderate forms is only recommended in cases of ventilation disturbances, cardiac displacement, or psychological disorders.-Prem Puri Sternal Defects. R. C. Shamberger and KJ. Welch. Pediatr Surg Int
5:156-164, (May), 1990. The authors review a broad range of deformities of the sternum, heart, and upper abdominal wall that are classified as sternal defects. In their own series of 16 patients, there were five with thoracic ectopia cordis with a completely naked heart, eight with thoracoabdominal ectopia cordis with a covered heart, and three with a cleft sternum. All patients with thoracic ectopic cordis died. Five of the eight cases of thoracoabdominal ectopic cordis died, primarily due to associated pulmonary hypoplasia or intrinsic cardiac anomalies. In all three cases of bifid sternum successful repair was accomplished.-Prem Pun’ Subcostal Slide for Diaphragmatic Hernia Repair.A.1 and S. Cywes. Pediatr Surg Int 5298-299, (June), 1990.
ABSTRACTS
respiratory disease. Both patients were successfully treated by balloon dilatation. The authors discuss the advantages and disadvantages of this method as an alternative to lobectomy.-Z+em Puri Microbiology of Empyema in Children Brook. Pediatrics 85:722-726, (May), 1990.
and Adolescents.
I.
The author reports his experience over a 13-year period with 72 pediatric patients who were diagnosed with empyema. The patients ranged in age from 3 months to 17 years 8 months. A total of 93 organisms were cultured. Sixty aerobic or facultative bacteria and 33 anaerobic bacteria were recovered. Pure aerobic bacteria were present in 48 (67%), anaerobes only in 17 (24%), and mixed bacteria in 7 (10%). Thus, one third of the patients had anaerobic isolates. The predominant aerobic isolates were H it@uenzae, Spneumoniae, and S aureus. The predominant anaerobes were Bacteroides species, anaerobic cocci, and Fusobucterium. Blood cultures were positive in 11 of 42 cases, 10 of which matched the empyema isolate. Pneumonia was the most common predisposing factor (28 patients). Pneumonia secondary to aspiration accounted for 16 patients. Eight patients had lung abscess. In each of these two groups the empyema cultures grew anaerobes. Spreading infection from an adjacent site (oropharnyx, neck) occurred in seven cases. Suhdiaphragmatic abscess led to empyema in three cases, all of which grew anaerobic bacteria. Prior thoracotomy accounted for two cases. This study reinforces the importance of anaerobic bacteria in pediatric and adolescent empyemas, and places appropriate emphasis on meticulous anaerobic culture technique.Jefiey L. Zitsman
W. Millar
The authors describe a method of closing large congenital diaphragmatic hernial defects without significant tension. The simplicity of the method, the limited negative effects of surgical repair on lung compliance, the preservation of the dome shape of the diaphragm (thereby sparing intra-abdominal volume), and the better cosmetic results are the many advantages of this technique.-Prem Pun’ Long-Term Follow-Up After Inhalation of Foreign Bodies. H. Davies, I. Gordon, D.J. Matthew, et al. Arch Dis Child 65:619-621,
(June), 1990. The authors reviewed two groups of children, one from a district children’s hospital and one from a tertiary referral center. All these children had inhaled foreign bodies, which had been removed endoscopically. Follow-up by chest x-ray and V/Q lung scan was accomplished at a mean of 2 years following removal of the foreign body. The results showed that of the tertiary referral center group of 21 children, eight had abnormal chest x-rays and 14 had ahnormal lung scan on long-term review. Of the district hospital group of 12 children, three had abnormal chest x-rays and four had abnormal scans. The following factors were found to be of prognostic significance: (1) the site of impaction (left lung being more likely to be abnormal than right); (2) initial radiographic appearance; and (3) length of history before removal of the foreign body. These factors should be kept in mind in the follow-up of such children.D. M. Burge Balloon Dilatation of the Lobar Bronchi for Symptomatic Lobar Bronchial Stenosis. L. Morales, J. Roviru, M. Rottermann, et al. Pediatr Surg Int 5:250-252, (June), 1990.
The authors describe two cases of bronchial stenosis secondary to inflammatory processes with the clinical features of chronic
HEART AND GREAT VESSELS Role of Aortopexy in the Management of Primary Tracheomalacia and Tracheobronchomalacia. P.S. Malone and E.M. Kiely.
Arch Dis Child 65:438-440, (April), 1990. In this retrospective study the authors report 12 patients with primary tracheomalacia and five with tracheobronchomalacia treated with aortopexy because of severe stridor associated with apneic episodes or “death” attacks. Gastroesophageal reflux was found in 47% of these patients. Six patients were improved by aortopexy alone and a further five improved with the combination of aortopexy and reflux treatment. The authors found that aortopexy failed if gastroesophageal reflux was present. They discuss the concept that reflux might be the primary pathology requiring treatment in some cases, and they recommend that all children with tracheomalacia be investigated to confirm or exclude reflux. In patients with both conditions in whom aortopexy fails, a fnndoplication should be undertaken without delay.-D.M. Burge Innominate Artery Compression of the Trachea in InfancySurgical Therapy in 30 Cases. T. Schuster, WCh. He&q E. Ring-Mrozik, et al. Z Kinderchir 45:86-91, (April), 1990.
The authors report 30 cases of innominate artery compression of the trachea and its surgical correction by means of an aortotruncopexy. Tracheoscopy is the most important diagnostic tool. Magnetic resonance imaging (MRI) shows the anatomical relationship between the innominate artery, the aortic arch, and the trachea. It also shows the extent of tracheal compression. Surgical intervention is indicated if narrowing of the tracheal lumen is more than 70%. Tracheal compression is relieved by fixation of the aortic arch and the proximal innominate artery to the back of the sternum. There were no operative failures and no mortality in 30 consecutive cases. Temporary phrenic nerve lesions appeared in four cases.Thomas A. Angevointner
INTERNATIONAL
Operative Correction of Pectus Excavatum. Experience at the Children’s Hospital of Bremen. G. von der Oelsnitz. Pediatr Surg
Int 5150-155, (May), 1990. The authors report on the Rehbein operation for pectus excavaturn. This procedure has been used at the Children’s Hospital of Bremen for the past 35 years. The operative results have been good in 69.2%, satisfactory in l&3%, and poor in 12.5% of cases. The operation mobilizes the concavity and maintains the raised sternum in a position of overcorrection by steel splints and metal bands, which remain in situ for 3 years. The optimum age for success of this operation in children is between 6 and 8 years or more than 12 years. Surgery is indicated for all severe deformities. Operation for moderate forms is only recommended in cases of ventilation disturbances, cardiac displacement, or psychological disorders.-Prem Puri Sternal Defects. R. C. Shamberger and KJ. Welch. Pediatr Surg Int
5:156-164, (May), 1990. The authors review a broad range of deformities of the sternum, heart, and upper abdominal wall that are classified as sternal defects. In their own series of 16 patients, there were five with thoracic ectopia cordis with a completely naked heart, eight with thoracoabdominal ectopia cordis with a covered heart, and three with a cleft sternum. All patients with thoracic ectopic cordis died. Five of the eight cases of thoracoabdominal ectopic cordis died, primarily due to associated pulmonary hypoplasia or intrinsic cardiac anomalies. In all three cases of bifid sternum successful repair was accomplished.-Prem Pun’ Subcostal Slide for Diaphragmatic Hernia Repair.A.1 and S. Cywes. Pediatr Surg Int 5298-299, (June), 1990.
ABSTRACTS
respiratory disease. Both patients were successfully treated by balloon dilatation. The authors discuss the advantages and disadvantages of this method as an alternative to lobectomy.-Z+em Puri Microbiology of Empyema in Children Brook. Pediatrics 85:722-726, (May), 1990.
and Adolescents.
I.
The author reports his experience over a 13-year period with 72 pediatric patients who were diagnosed with empyema. The patients ranged in age from 3 months to 17 years 8 months. A total of 93 organisms were cultured. Sixty aerobic or facultative bacteria and 33 anaerobic bacteria were recovered. Pure aerobic bacteria were present in 48 (67%), anaerobes only in 17 (24%), and mixed bacteria in 7 (10%). Thus, one third of the patients had anaerobic isolates. The predominant aerobic isolates were H it@uenzae, Spneumoniae, and S aureus. The predominant anaerobes were Bacteroides species, anaerobic cocci, and Fusobucterium. Blood cultures were positive in 11 of 42 cases, 10 of which matched the empyema isolate. Pneumonia was the most common predisposing factor (28 patients). Pneumonia secondary to aspiration accounted for 16 patients. Eight patients had lung abscess. In each of these two groups the empyema cultures grew anaerobes. Spreading infection from an adjacent site (oropharnyx, neck) occurred in seven cases. Suhdiaphragmatic abscess led to empyema in three cases, all of which grew anaerobic bacteria. Prior thoracotomy accounted for two cases. This study reinforces the importance of anaerobic bacteria in pediatric and adolescent empyemas, and places appropriate emphasis on meticulous anaerobic culture technique.Jefiey L. Zitsman
W. Millar
The authors describe a method of closing large congenital diaphragmatic hernial defects without significant tension. The simplicity of the method, the limited negative effects of surgical repair on lung compliance, the preservation of the dome shape of the diaphragm (thereby sparing intra-abdominal volume), and the better cosmetic results are the many advantages of this technique.-Prem Pun’ Long-Term Follow-Up After Inhalation of Foreign Bodies. H. Davies, I. Gordon, D.J. Matthew, et al. Arch Dis Child 65:619-621,
(June), 1990. The authors reviewed two groups of children, one from a district children’s hospital and one from a tertiary referral center. All these children had inhaled foreign bodies, which had been removed endoscopically. Follow-up by chest x-ray and V/Q lung scan was accomplished at a mean of 2 years following removal of the foreign body. The results showed that of the tertiary referral center group of 21 children, eight had abnormal chest x-rays and 14 had ahnormal lung scan on long-term review. Of the district hospital group of 12 children, three had abnormal chest x-rays and four had abnormal scans. The following factors were found to be of prognostic significance: (1) the site of impaction (left lung being more likely to be abnormal than right); (2) initial radiographic appearance; and (3) length of history before removal of the foreign body. These factors should be kept in mind in the follow-up of such children.D. M. Burge Balloon Dilatation of the Lobar Bronchi for Symptomatic Lobar Bronchial Stenosis. L. Morales, J. Roviru, M. Rottermann, et al. Pediatr Surg Int 5:250-252, (June), 1990.
The authors describe two cases of bronchial stenosis secondary to inflammatory processes with the clinical features of chronic
HEART AND GREAT VESSELS Role of Aortopexy in the Management of Primary Tracheomalacia and Tracheobronchomalacia. P.S. Malone and E.M. Kiely.
Arch Dis Child 65:438-440, (April), 1990. In this retrospective study the authors report 12 patients with primary tracheomalacia and five with tracheobronchomalacia treated with aortopexy because of severe stridor associated with apneic episodes or “death” attacks. Gastroesophageal reflux was found in 47% of these patients. Six patients were improved by aortopexy alone and a further five improved with the combination of aortopexy and reflux treatment. The authors found that aortopexy failed if gastroesophageal reflux was present. They discuss the concept that reflux might be the primary pathology requiring treatment in some cases, and they recommend that all children with tracheomalacia be investigated to confirm or exclude reflux. In patients with both conditions in whom aortopexy fails, a fnndoplication should be undertaken without delay.-D.M. Burge Innominate Artery Compression of the Trachea in InfancySurgical Therapy in 30 Cases. T. Schuster, WCh. He&q E. Ring-Mrozik, et al. Z Kinderchir 45:86-91, (April), 1990.
The authors report 30 cases of innominate artery compression of the trachea and its surgical correction by means of an aortotruncopexy. Tracheoscopy is the most important diagnostic tool. Magnetic resonance imaging (MRI) shows the anatomical relationship between the innominate artery, the aortic arch, and the trachea. It also shows the extent of tracheal compression. Surgical intervention is indicated if narrowing of the tracheal lumen is more than 70%. Tracheal compression is relieved by fixation of the aortic arch and the proximal innominate artery to the back of the sternum. There were no operative failures and no mortality in 30 consecutive cases. Temporary phrenic nerve lesions appeared in four cases.Thomas A. Angevointner