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Lung abscesses in childhood
IKTERNATIONAL
ABSTRAaS
OF
PEDIATRIC
I>EFT SIDED MAIN BRONCHUS RESECTION IN AN ELEVEN YEAR OLD GIRL. P. Wurnig. Z. K. Chir. 5:343-349, 1968. The author reports a case of a polyp of the left main bronchus which was treated by partial excision of the bronchus. At the same time the atelectatic and bronchiectatic lower lobe was resected. Follow-up investigations 2 years later showed good pulmonary function. It is suggested that radical bronchial resection is preferable to local removal of the tumour as this will only lead to a recurrence.-S. Hofmann and H. B. Eckstein. CONGEXITAL OEYOPHAGOBRONCHIAL FISTULA WITH PRESENTATIOPI’ IN ADULT LIFE. B. T. Le Roux and M. A. Williams. Brit. J. Surg. 55:306-308 (April) 1968. Three cases of esophagobronchial fistula, prescnting in adults, are reported and the symptomatology of the 23 other cases so far reported are briefly reviewed. That these fistulae are congenital is demonstrated by the fact that they are lined by squamous epithelium, have a definite muscularis mucosae ant 1 a recognizable smooth muscle wall. The absence of an inflammatory reaction around the fistula is striking. Diagnosis is made by a combination of bronchoscopy, esophagoscopy, and radiologic examination using contrast media. Treatment is by closure of the fistula. If lung damage is marked, or pneumonectomy Corkery.
,323
SURGERY
segmental resection, lobectomy may also be indicated-j.
ALVEOLAR RUI~ITIIIE IN THE NEWBORN. M. M. Nichols and Nancy J. Hopwood. Southern Med. J. 61:342-326 (April) 1968. Alveolar rupture is followed by dissection of air along pulmonary blood vessels and produces pneumomediastinum, rupture of visceral pleura with pneumothorax, or both conditions simultaneously. This situation may result spontaneously from the infant’s own efforts to breathe which produces negative pressures as high as -70 cm. of water and positive pressure of f60 cm. of water. Alveolar rupture, also, may occur iatrogenically as a result of artificial respiration. Obstetrical complications, such as abruptio placenta, placenta previa, face presentation, forceps rotation, and difficult or prolonged labor precede the rupture in about 50 per cent of the cases. Postmaturity is found in 25 to 30 per cent of these infants. The allthors report their experience with :3I
newborn infants of which 24 had pneumothorax, 5 pneumomediastinum, and 2 were combined. Twenty-one infants survived and 10 died. Iatrogenie alveolar rupture occurred in 10 of 342 infants which required intubation for resuscitation. Obstetric complications were present in 8 of the 10 iatrogenic cases. Eight of these infants died. There were 21 newborns who had spontant~ous rupture of the alveoli. No treatment was given except oxygen by mask for 16 infants. Needle aspiration was life saving in 2 cases, decompression of a tension of a pneumothorax by chest tube with under water drainage was necessary in 4 instances, and thoracotomy with repair of a 1 cm. rupture of the left upper lobe was performed in 1 case.--6. W. Holconfh. Jr. EXTRALOBAR PULMONARY SEQUESTRATION.A. 0. Williams and I;. I. Emmrah. Thorax 23:700203 (March) 1968. An rlnllsual pedunculated anterior mediastinal multicystic mass attached to the right pulmonary artery was present as an incidental autopsy fimling in a 3.year-old Nigerian male dying of enterocolitis. The attachment to the right pulmonary artery measured 1 cm. in diameter. The mass itself was 4 x 2% x 1 cm. in size. The mass was mlllticystic. filled with fluid. and lined with ~olur~11~1~ epithelial lining. The unusual location and nature is clisc,llssc*tl.of this so-called sequestration W. K. Siehcr. I,ulvc ABSCESSESIN CHILDHOOD. P. H. Jlnrk aucl J. A. P. Tttrtwr. Thorax X3:216-2.20 (Alarch) 1968. This review of 83 patients from the Hospital for Sick Children in Toronto presents all cases of lung abscesses in childhood at that institution between 1956 and 1965. The cases were clivicletl into primary cases of which there were 25 and secondary cases of which there were 58. These cases excluded patients with cystic fibrosis, bronchiectasis, and luqg cysts. The diagnosis was based on pathologic examination or by radioloa. Of the 25 primary cases, 19 were male. III I-1 there was no previous illness. In the remainder, colds, measles, etc. were present. None of these children were under 1 month of age. Cultures revealed staphlococcus to be present in the loose and throat of 14 of these children and to be present in the abscess in 11. H Influenza was present in 3 abscesses and in the nose and throat of 6 of these patients. All were treated with antibiotics. Eighteen had therapeutic bronchoscopy. All 2.5 lived. Of the 58 in the seconclary group, 18 wcrc
524
INTERNATIONAL
under 1 month of age. Eighteen were between 1 month and 1 year of age. These lesions were usually secondary to staphlococcic pneumonia or to other serious disease. In 38 the abscess cultured out staphlococcus, in 9 pseudomonis organisms. Fifty-four of the 58 patients died. At necropsy, muItiple abscesses of the liver, peritoneum and brain were noted. Many of these patients also had underlying diseases such as leukemia, nephrosis, and congenital heart disease.-W. K. Sieber. HISTIOCYTOMA (FIBROUS ZANTHOMA) OF THE LUNG. L. D. Dubilier, L. R. Bryant, and G. K. Danielson. Amer. J. Surg. 115:420-426 (March) 1968. Twenty-two cases of primary histiocytoma of the lung were found in the literature and the authors added one case of their own. Of these 23 patients, 6 were under 12 years of age and 2 were 17 years old. This article is abstracted because of the occurrence of this tumor in these latter 8 patients, over a third of the known reported cases. Primary tumors of the lung are rare in the pediatric age group and lesions found on x-rays of the chest are usually assumed to be metastatic. These histiocytomata are more frequently found in other parts of the body but may be primary pulmonary tumors. They may be caused by a virus. From the records it would appear that their rate of growth is variable and they are not confined to any specific part of the lung. They may produce no symptoms and be found as an incidenta finding on routine chest x-ray or they may produce bronchial irritation and hemoptysis. At exploration, tumors have a rather characteristic appearance, having a yellow color on a gray-tan background. The histologic appearance has been quite varied but usually includes an intimate intermixture of plump hystiocytes and spindle cells arranged in simple bundles and whorls and in the so-called “pinwheel” patterns. The nuclei are regular in size. Local excision, with a margin of normal pulmonarv tissue, is recommended. A detailed case report of a 5-year-old girl treated with local excision is given.--h’. K. Connolly.
HEART
AND
GREAT
VESSELS
FAMILIAL ATRIAL SEPTAL DEFECT OF THE PRIMUM TYPE. J. Yao, M. W. Thompson, G. A. Trusler, and A. S. TrimbEe. Canad. Med. Assoc. J. 98:218-219, Jan. 27, 1968. This report presents a family in which 4 members of a sibship of 9 had atria1 septal defects of the primum type. The other 5 sibs and the
ABSTRACI’S
OF
PEDIATRIC
SURGERY
parents have been examined and are normal. Three of the 4 affected children have had open-heart correction of their ostium primum defects.-C. C.
Ferguson. COMPLETE INTERRUPTION OF THE AORTIC ARCH IN INFANCY. M. Rochette, P. Stanley, M. F. Ethier, and A. Dauignon. Canad. Med. Assoc. J. 98:131-139, Jan. 20, 1968. Three types of complete congenital interruption of the aortic arch occur. In Type A the interruption is situated below the left subclavian artery and the ductus arteriosus joins the distal aorta. In Type B, the interruption is just distal to the carotid arteries. The left subclavian artery has its origin distal to the ductus from the descending aorta. The right subclavian artery may have a normal origin or may be aberrant, arising also from the distaI aorta. Type C anomaly occurs when the interruption is situated between the two carotid arteries. In all types of the abnormality there is a high mortality rate with 80 per cent of infants dying within the first month of life. The authors report seven babies seen in the last 5 years with this anomaly. Six were Type B and one was Type A, Surgical correction was carried out in 5 infants, with 2 survivors.-C. C. Ferguson. HEMODYNAMIC EFFECTS OF OCCLUDING THE FETAL DUCTW ARTEFUOSUS.A. J. Hder, Jr. and B. M. Rodgers. Amer. Surg. 34:200 (March) 1968. The fetal ductus arteriosus was ligated or clipped in dogs between 45 and 55 days of gestation (term 63 days). In most cases this resulted in thrombosis of the pulmonary artery with death of the fetus at delivery. After ductus closure the fetuses were studied with electrocardiography and pressure studies of the pulmonary artery and left atrium. Pressure increased immediately in both after ligation then gradually returned to normal. Fetal survival is ascribed to the ability of the foramen ovale to transmit the entire venous return from right to left heart.-E. J. Berman. PULMONARY ARTERY DEBANDING. A. R. C. Dobell, D. R. Murphy, and J. E. Gibbons. Ann. Thorac. Surg. 5:435442 (May) 1968. This is a short precise report of the experience with pulmonary artery debanding at the McGill University Medical Center, Montreal, Canada. Sixteen patients are reported between the ages of 1 and 15 months who had their banding procedures, all but one, before the tenth month of life. The
ABSTRAaS
OF
PEDIATRIC
I>EFT SIDED MAIN BRONCHUS RESECTION IN AN ELEVEN YEAR OLD GIRL. P. Wurnig. Z. K. Chir. 5:343-349, 1968. The author reports a case of a polyp of the left main bronchus which was treated by partial excision of the bronchus. At the same time the atelectatic and bronchiectatic lower lobe was resected. Follow-up investigations 2 years later showed good pulmonary function. It is suggested that radical bronchial resection is preferable to local removal of the tumour as this will only lead to a recurrence.-S. Hofmann and H. B. Eckstein. CONGEXITAL OEYOPHAGOBRONCHIAL FISTULA WITH PRESENTATIOPI’ IN ADULT LIFE. B. T. Le Roux and M. A. Williams. Brit. J. Surg. 55:306-308 (April) 1968. Three cases of esophagobronchial fistula, prescnting in adults, are reported and the symptomatology of the 23 other cases so far reported are briefly reviewed. That these fistulae are congenital is demonstrated by the fact that they are lined by squamous epithelium, have a definite muscularis mucosae ant 1 a recognizable smooth muscle wall. The absence of an inflammatory reaction around the fistula is striking. Diagnosis is made by a combination of bronchoscopy, esophagoscopy, and radiologic examination using contrast media. Treatment is by closure of the fistula. If lung damage is marked, or pneumonectomy Corkery.
,323
SURGERY
segmental resection, lobectomy may also be indicated-j.
ALVEOLAR RUI~ITIIIE IN THE NEWBORN. M. M. Nichols and Nancy J. Hopwood. Southern Med. J. 61:342-326 (April) 1968. Alveolar rupture is followed by dissection of air along pulmonary blood vessels and produces pneumomediastinum, rupture of visceral pleura with pneumothorax, or both conditions simultaneously. This situation may result spontaneously from the infant’s own efforts to breathe which produces negative pressures as high as -70 cm. of water and positive pressure of f60 cm. of water. Alveolar rupture, also, may occur iatrogenically as a result of artificial respiration. Obstetrical complications, such as abruptio placenta, placenta previa, face presentation, forceps rotation, and difficult or prolonged labor precede the rupture in about 50 per cent of the cases. Postmaturity is found in 25 to 30 per cent of these infants. The allthors report their experience with :3I
newborn infants of which 24 had pneumothorax, 5 pneumomediastinum, and 2 were combined. Twenty-one infants survived and 10 died. Iatrogenie alveolar rupture occurred in 10 of 342 infants which required intubation for resuscitation. Obstetric complications were present in 8 of the 10 iatrogenic cases. Eight of these infants died. There were 21 newborns who had spontant~ous rupture of the alveoli. No treatment was given except oxygen by mask for 16 infants. Needle aspiration was life saving in 2 cases, decompression of a tension of a pneumothorax by chest tube with under water drainage was necessary in 4 instances, and thoracotomy with repair of a 1 cm. rupture of the left upper lobe was performed in 1 case.--6. W. Holconfh. Jr. EXTRALOBAR PULMONARY SEQUESTRATION.A. 0. Williams and I;. I. Emmrah. Thorax 23:700203 (March) 1968. An rlnllsual pedunculated anterior mediastinal multicystic mass attached to the right pulmonary artery was present as an incidental autopsy fimling in a 3.year-old Nigerian male dying of enterocolitis. The attachment to the right pulmonary artery measured 1 cm. in diameter. The mass itself was 4 x 2% x 1 cm. in size. The mass was mlllticystic. filled with fluid. and lined with ~olur~11~1~ epithelial lining. The unusual location and nature is clisc,llssc*tl.of this so-called sequestration W. K. Siehcr. I,ulvc ABSCESSESIN CHILDHOOD. P. H. Jlnrk aucl J. A. P. Tttrtwr. Thorax X3:216-2.20 (Alarch) 1968. This review of 83 patients from the Hospital for Sick Children in Toronto presents all cases of lung abscesses in childhood at that institution between 1956 and 1965. The cases were clivicletl into primary cases of which there were 25 and secondary cases of which there were 58. These cases excluded patients with cystic fibrosis, bronchiectasis, and luqg cysts. The diagnosis was based on pathologic examination or by radioloa. Of the 25 primary cases, 19 were male. III I-1 there was no previous illness. In the remainder, colds, measles, etc. were present. None of these children were under 1 month of age. Cultures revealed staphlococcus to be present in the loose and throat of 14 of these children and to be present in the abscess in 11. H Influenza was present in 3 abscesses and in the nose and throat of 6 of these patients. All were treated with antibiotics. Eighteen had therapeutic bronchoscopy. All 2.5 lived. Of the 58 in the seconclary group, 18 wcrc
524
INTERNATIONAL
under 1 month of age. Eighteen were between 1 month and 1 year of age. These lesions were usually secondary to staphlococcic pneumonia or to other serious disease. In 38 the abscess cultured out staphlococcus, in 9 pseudomonis organisms. Fifty-four of the 58 patients died. At necropsy, muItiple abscesses of the liver, peritoneum and brain were noted. Many of these patients also had underlying diseases such as leukemia, nephrosis, and congenital heart disease.-W. K. Sieber. HISTIOCYTOMA (FIBROUS ZANTHOMA) OF THE LUNG. L. D. Dubilier, L. R. Bryant, and G. K. Danielson. Amer. J. Surg. 115:420-426 (March) 1968. Twenty-two cases of primary histiocytoma of the lung were found in the literature and the authors added one case of their own. Of these 23 patients, 6 were under 12 years of age and 2 were 17 years old. This article is abstracted because of the occurrence of this tumor in these latter 8 patients, over a third of the known reported cases. Primary tumors of the lung are rare in the pediatric age group and lesions found on x-rays of the chest are usually assumed to be metastatic. These histiocytomata are more frequently found in other parts of the body but may be primary pulmonary tumors. They may be caused by a virus. From the records it would appear that their rate of growth is variable and they are not confined to any specific part of the lung. They may produce no symptoms and be found as an incidenta finding on routine chest x-ray or they may produce bronchial irritation and hemoptysis. At exploration, tumors have a rather characteristic appearance, having a yellow color on a gray-tan background. The histologic appearance has been quite varied but usually includes an intimate intermixture of plump hystiocytes and spindle cells arranged in simple bundles and whorls and in the so-called “pinwheel” patterns. The nuclei are regular in size. Local excision, with a margin of normal pulmonarv tissue, is recommended. A detailed case report of a 5-year-old girl treated with local excision is given.--h’. K. Connolly.
HEART
AND
GREAT
VESSELS
FAMILIAL ATRIAL SEPTAL DEFECT OF THE PRIMUM TYPE. J. Yao, M. W. Thompson, G. A. Trusler, and A. S. TrimbEe. Canad. Med. Assoc. J. 98:218-219, Jan. 27, 1968. This report presents a family in which 4 members of a sibship of 9 had atria1 septal defects of the primum type. The other 5 sibs and the
ABSTRACI’S
OF
PEDIATRIC
SURGERY
parents have been examined and are normal. Three of the 4 affected children have had open-heart correction of their ostium primum defects.-C. C.
Ferguson. COMPLETE INTERRUPTION OF THE AORTIC ARCH IN INFANCY. M. Rochette, P. Stanley, M. F. Ethier, and A. Dauignon. Canad. Med. Assoc. J. 98:131-139, Jan. 20, 1968. Three types of complete congenital interruption of the aortic arch occur. In Type A the interruption is situated below the left subclavian artery and the ductus arteriosus joins the distal aorta. In Type B, the interruption is just distal to the carotid arteries. The left subclavian artery has its origin distal to the ductus from the descending aorta. The right subclavian artery may have a normal origin or may be aberrant, arising also from the distaI aorta. Type C anomaly occurs when the interruption is situated between the two carotid arteries. In all types of the abnormality there is a high mortality rate with 80 per cent of infants dying within the first month of life. The authors report seven babies seen in the last 5 years with this anomaly. Six were Type B and one was Type A, Surgical correction was carried out in 5 infants, with 2 survivors.-C. C. Ferguson. HEMODYNAMIC EFFECTS OF OCCLUDING THE FETAL DUCTW ARTEFUOSUS.A. J. Hder, Jr. and B. M. Rodgers. Amer. Surg. 34:200 (March) 1968. The fetal ductus arteriosus was ligated or clipped in dogs between 45 and 55 days of gestation (term 63 days). In most cases this resulted in thrombosis of the pulmonary artery with death of the fetus at delivery. After ductus closure the fetuses were studied with electrocardiography and pressure studies of the pulmonary artery and left atrium. Pressure increased immediately in both after ligation then gradually returned to normal. Fetal survival is ascribed to the ability of the foramen ovale to transmit the entire venous return from right to left heart.-E. J. Berman. PULMONARY ARTERY DEBANDING. A. R. C. Dobell, D. R. Murphy, and J. E. Gibbons. Ann. Thorac. Surg. 5:435442 (May) 1968. This is a short precise report of the experience with pulmonary artery debanding at the McGill University Medical Center, Montreal, Canada. Sixteen patients are reported between the ages of 1 and 15 months who had their banding procedures, all but one, before the tenth month of life. The