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Management of gastro-oesophageal reflux
INTERNATIONAL ABSTRACTS preacinar and intra-acinar arteries in the no-honeymoon group was decreased by reduced external diameter or increased medial thickness. Clinical deterioration in the honeymoon group is based on a vasoconstrictive response of the hypoplastic vascular bed. Persistent bypoxemia in the no-honeymoon group is based on both severity of pulmonary hypoplasia and structural remodeling of the pulmonary arteries.--George llolcomb. Jr HEART AND GREAT VESSELS Complement Activation in Children during Cardiopulmonary Bypass. P. Purl A. Lee, M. llickey, e t a l . Ann Pediatr Surg
1:106-110, (April), 1984. Recently, complement activation has been reported to be an important factor in the pathogenesis of "post-pump syndrome" in adult patients undergoing open heart surgery. Fourteen children undergoing cardiopulmonary bypass for correction of congenital cardiac defects were investigated for complement activity. Activation of complement was observed in all patients during operations involving bypass similar to that reported in adults. Fall in serum complement level was not only confined to CHs0 levels but all protein levels measured, including total serum proteins. This suggests that plasma dilution occurring during cardiopulmonary bypass is the major cause of reduction in hemolytic complement levels.- Anthony
SparRon Effect of Acidosis on Contractile Function in the Newborn Rabbit
Heart. "1".Nakanishi, H. Okuda. M. Nakazawa, etal. Pediatr Res 19:482-488, (May), 1985. Effects of respiratory and metabolic acidosis (p! t approximately 6.8) on myocardial function were studied in newborn and adult rabbits. Mechanical function was studied in the isolated arterially perfused heart preparation. Acidosis was induced either by increase of the perfusate Pco 2 or by decrease of the bicarbonate content. During respiratory acidosis, developed tension (DT) decreased to 43 _, 3% of control (n - 18) in the adult. This depression was significantly greater than in the newborn (DT - 92 +_ 4%, n = 6). Depression of DT by respiratory acidosis was observed even at high extracellular Ca. During metabolic acidosis, mechanical function decreased gradually. DT at 30 minutes in the adult was 78 ~ 3% of control (n ~ 6). This depression of DT in the adult was significantly greater than in the newborn (DT at 30 min ~ 96 _, 1% of control, n 6). Statistical analysis using paired t test showed that respiratory acidosis, but not metabolic acidosis, caused significantly negative inotropism in the newborn. Myofibrils were isolated, and the ATPase was measured at 10 -s to 10 4 M Ca and at pH of 7.1 (control), 6.5, and 6.0. Reducing the pH depressed ATPase activity similarly in the newborn and adult, lntracellular buffer capacity was determined by titrating muscle homogenate with HCL. Although the initial pH was not different, addition of IlCI. to the homogenate caused less decrease in ptl in the newborn. These data indicate that contractile function in the newborn heart is more resistant to acidosis, and this may be due partly to the greater intracellular buffer capacity.--Prem Purl A L I M E N T A R Y TRACT Emergent and Therapeutic Upper Gastrointestinal Endoscopy in Children. G. Van Stiegman. and G.P. Stellin. World J Surg 9:294-
299, (April), 1985. The advent of flexible fiberoptic esophagogastroduodenoscopy has come slowly to the pediatric population but now is employed in a broad range of disorders. The full gamut of both rigid and flexible endoscopy in the pediatric population is discussed in this report. As is the case with most pediatric surgeons, general anesthesia is preferred for the majority of procedures. There follows a brief overview of
655
indications for pediatric UGI endoscopy, including UGI hemorrhage, bleeding varices (both diagnostic and therapeutic indications), foreign body extractions, esophageal dilatation, and assessment of corrosive injury.--Thomas V. Whalen Esophagea| Atresia: Embryogenesis and Management. A.A. De Lorimer, and M.R. Harrison. World J Surg 9:250-257, (April), 1985. The current best explanation for the embryogenesis of esophageal atresia--tracheo-esophageal fistula is reviewed. The association called alternately VATER or VACTERL is explored. Management is considered for several situations. First, one-stage definitive repair is covered, emphasizing preoperative determination of the side of the aortic arch. Indications for staged repair are reviewed, and esophageal substitution and alternatives are mentioned.- .Thomas V. Whalen Management of Gastro-oesophageal Reflux. I.J. Carrb. Arch Dis
Child, 60:71 75, (January), 1985. Two main groups of patients were identified: (A) Infants with reflux alone, and (B) infants with reflux plus hiatus hernia. Infants with reflux alone suffer from a self-limiting disorder, which responds to thickening of feeds and postural therapy. Sixty-five percent of infants with hiatus herniae will have resolution of symptoms by the age of 2 years. The author reviewed 710 patients in this group, of which 128 were followed up for 20 years and 80 for 30 years. Keeping the child sitting up at 60 ~ both by night and day is the first measure used to treat these infants. Thickening of the feeds or giving frequent small feeds may also help. Medication with Asilone in the infant and Gaviscon in the older child reduces the frequency of reflux. Results of treatment can be measured readily by the frequency of vomiting. If started in early infancy, more than 90% have resolution of symptoms by 1 year. Response to treatment is often gradual. Only 35% of those without treatment will be symptom-free at I year. Of those with relief of symptoms and followed for 30 years, 40% still have radiologic evidence of hiatus hernia. If radiologic resolution is going to take place, it usually does so between 4 and 6 years of age. In older patients, the response to conservative measures is less satisfactory. Patients who fail to respond to treatment, or who have strictures, require surgical intervention.Alasdair H.B. Fyfe Modified Fundoplication Technique for Correction of Gastroesophageal Reflux in Children. V.A. Ferraris, L. Martinez, and J.D.
Burrington. Surg Gynecol Obstet 161:379-380, (October), 1985. The authors report their experience with a modified fundoplication performed upon 47 children over a three-year period. The technique involves reinforcement of conventional Nissen fundoplication with two lateral additional rows of sutures at the gastroesophagoal junction. This modified technique prevents symptomatic recurrence by lessening the chance of disruption of the fundoplication sutures. It also prevents formation of paraesophageal hiatal hernia. All 47 patients were observed postoperatively for an average of 12 months. Two deaths occurred and 45 patients who had correction of GER were considered improved. In addition, no slippage of the fundoplication causing esophageal obstruction or severe dysphagia has been observed. During the same period, a standard Nissen fundoplication failed in 4 of 31 patients.--George Holcomb, Jr Hematochezia and the False Negative Meckel's Scan: A Continued Need for Barium Studies. K.S. Gebarski, W.J. Byrne, S.S. Gebars-
ki. et al. Am J Gastroenterol 80:781-783, (October), 1985. A 17-year-old man developed cramping right lower quadrant abdominal pain followed 8 hours later by the passage of a large
1:106-110, (April), 1984. Recently, complement activation has been reported to be an important factor in the pathogenesis of "post-pump syndrome" in adult patients undergoing open heart surgery. Fourteen children undergoing cardiopulmonary bypass for correction of congenital cardiac defects were investigated for complement activity. Activation of complement was observed in all patients during operations involving bypass similar to that reported in adults. Fall in serum complement level was not only confined to CHs0 levels but all protein levels measured, including total serum proteins. This suggests that plasma dilution occurring during cardiopulmonary bypass is the major cause of reduction in hemolytic complement levels.- Anthony
SparRon Effect of Acidosis on Contractile Function in the Newborn Rabbit
Heart. "1".Nakanishi, H. Okuda. M. Nakazawa, etal. Pediatr Res 19:482-488, (May), 1985. Effects of respiratory and metabolic acidosis (p! t approximately 6.8) on myocardial function were studied in newborn and adult rabbits. Mechanical function was studied in the isolated arterially perfused heart preparation. Acidosis was induced either by increase of the perfusate Pco 2 or by decrease of the bicarbonate content. During respiratory acidosis, developed tension (DT) decreased to 43 _, 3% of control (n - 18) in the adult. This depression was significantly greater than in the newborn (DT - 92 +_ 4%, n = 6). Depression of DT by respiratory acidosis was observed even at high extracellular Ca. During metabolic acidosis, mechanical function decreased gradually. DT at 30 minutes in the adult was 78 ~ 3% of control (n ~ 6). This depression of DT in the adult was significantly greater than in the newborn (DT at 30 min ~ 96 _, 1% of control, n 6). Statistical analysis using paired t test showed that respiratory acidosis, but not metabolic acidosis, caused significantly negative inotropism in the newborn. Myofibrils were isolated, and the ATPase was measured at 10 -s to 10 4 M Ca and at pH of 7.1 (control), 6.5, and 6.0. Reducing the pH depressed ATPase activity similarly in the newborn and adult, lntracellular buffer capacity was determined by titrating muscle homogenate with HCL. Although the initial pH was not different, addition of IlCI. to the homogenate caused less decrease in ptl in the newborn. These data indicate that contractile function in the newborn heart is more resistant to acidosis, and this may be due partly to the greater intracellular buffer capacity.--Prem Purl A L I M E N T A R Y TRACT Emergent and Therapeutic Upper Gastrointestinal Endoscopy in Children. G. Van Stiegman. and G.P. Stellin. World J Surg 9:294-
299, (April), 1985. The advent of flexible fiberoptic esophagogastroduodenoscopy has come slowly to the pediatric population but now is employed in a broad range of disorders. The full gamut of both rigid and flexible endoscopy in the pediatric population is discussed in this report. As is the case with most pediatric surgeons, general anesthesia is preferred for the majority of procedures. There follows a brief overview of
655
indications for pediatric UGI endoscopy, including UGI hemorrhage, bleeding varices (both diagnostic and therapeutic indications), foreign body extractions, esophageal dilatation, and assessment of corrosive injury.--Thomas V. Whalen Esophagea| Atresia: Embryogenesis and Management. A.A. De Lorimer, and M.R. Harrison. World J Surg 9:250-257, (April), 1985. The current best explanation for the embryogenesis of esophageal atresia--tracheo-esophageal fistula is reviewed. The association called alternately VATER or VACTERL is explored. Management is considered for several situations. First, one-stage definitive repair is covered, emphasizing preoperative determination of the side of the aortic arch. Indications for staged repair are reviewed, and esophageal substitution and alternatives are mentioned.- .Thomas V. Whalen Management of Gastro-oesophageal Reflux. I.J. Carrb. Arch Dis
Child, 60:71 75, (January), 1985. Two main groups of patients were identified: (A) Infants with reflux alone, and (B) infants with reflux plus hiatus hernia. Infants with reflux alone suffer from a self-limiting disorder, which responds to thickening of feeds and postural therapy. Sixty-five percent of infants with hiatus herniae will have resolution of symptoms by the age of 2 years. The author reviewed 710 patients in this group, of which 128 were followed up for 20 years and 80 for 30 years. Keeping the child sitting up at 60 ~ both by night and day is the first measure used to treat these infants. Thickening of the feeds or giving frequent small feeds may also help. Medication with Asilone in the infant and Gaviscon in the older child reduces the frequency of reflux. Results of treatment can be measured readily by the frequency of vomiting. If started in early infancy, more than 90% have resolution of symptoms by 1 year. Response to treatment is often gradual. Only 35% of those without treatment will be symptom-free at I year. Of those with relief of symptoms and followed for 30 years, 40% still have radiologic evidence of hiatus hernia. If radiologic resolution is going to take place, it usually does so between 4 and 6 years of age. In older patients, the response to conservative measures is less satisfactory. Patients who fail to respond to treatment, or who have strictures, require surgical intervention.Alasdair H.B. Fyfe Modified Fundoplication Technique for Correction of Gastroesophageal Reflux in Children. V.A. Ferraris, L. Martinez, and J.D.
Burrington. Surg Gynecol Obstet 161:379-380, (October), 1985. The authors report their experience with a modified fundoplication performed upon 47 children over a three-year period. The technique involves reinforcement of conventional Nissen fundoplication with two lateral additional rows of sutures at the gastroesophagoal junction. This modified technique prevents symptomatic recurrence by lessening the chance of disruption of the fundoplication sutures. It also prevents formation of paraesophageal hiatal hernia. All 47 patients were observed postoperatively for an average of 12 months. Two deaths occurred and 45 patients who had correction of GER were considered improved. In addition, no slippage of the fundoplication causing esophageal obstruction or severe dysphagia has been observed. During the same period, a standard Nissen fundoplication failed in 4 of 31 patients.--George Holcomb, Jr Hematochezia and the False Negative Meckel's Scan: A Continued Need for Barium Studies. K.S. Gebarski, W.J. Byrne, S.S. Gebars-
ki. et al. Am J Gastroenterol 80:781-783, (October), 1985. A 17-year-old man developed cramping right lower quadrant abdominal pain followed 8 hours later by the passage of a large