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Management of intussusception by barium enema versus surgery
85
ABSTRACTS a shunt,
(2)
patients who do not have suit-
able vessel for a shunt either because of extension of thrombosis to the splenic vein or because of previous splenectomy and (3 ) patients who continue to have recurrent hemorrhage in spite of previous surgery. The authors claim that in their hand this technique gives better results than other methods of direct attack on the esophagogastric vessels-J. Lari. A NASOJEJUNAL
TUBE FOR INFANT FEEDING.
James Rhea and John Kilby. Pediatrics 46:36-40 l._Tulv) . 1970. _,I
An alternative method to nasogastric feeding was attempted in 48 infants wherein a limp polyvinyl tube was passed from the stomach through the pylorus into the jejunum. Full enteric infant feedings for 3-4 weeks without complications were accomplished. Daily volumes of 150 cc. milk/Kg. in small, but frequent feedings were well tolerated
but the authors
attention
to the osmolarity
stress that careful is necessary
to
formation
has been seen in oblique
mosis performed
on baby
rabbits.
anastoNygaard
(1967) has pointed out that cutting the circular muscle in constructing an equal lumen in an end-to-side or oblique end-toend anastomosis produces a potentially weak area, which could predispose to diverticulum formation. Although blind pouch syndrome is more likely to occur in side-to-side anastomosis, there is, however, a slight risk of this occuring in end-to-end anastomosis--J. Lari. INTUSSUSCEPTION AFTER MAIOR ABDOMINAL OPERATIONS IN CHILDREN.-F. M. G&man, J. C. Duchasme and P. P. Co&n. Canad. J.
Surg.
13:427-433
(October),
1970.
The authors report five children who suffered from intussusception in the postoperative period following revision of a cervical jejuno-esophageal anastomosis; an abdominoperineal pull-through; an adrenalectomy; a Soave pull-through; and the construction of an ileal bladder.
prevent diarrhea and/or hypovolemic shock as fluid is mobilized in the gut--C. Rubin.
Since the symptoms and signs of intussusception in this situation are always bizarre, it is emphasized that surgeons should be
DIVERTICULUM FORMATION AFTER OBLIQUE END-TO-END ANASTOMOSIS FOR JEJUNOILEAL ATRESIA. S. M. L. Nade and I. A. S.
aware of this complication and suspect it in any infant presenting with the clinical pic-
Dickson. Brit. J. Surg. 57:54Q-543
(July),
ture of early postoperative mechanical tinal obstruction-c. C. Ferguson.
intes-
1970. Three patients are presented who developed a diverticulum at the anastomosis after successful treatment for small bowel atresia. Two followed an oblique end-to-end anastomosis and one Roux-en-Y anastomosis with ileostomy. In the first two there was no blind end and in the third the blind end (ileostomy) had been excised at the age of 7 months. Their main features at presentation, aged 4 to 6 years, were bleeding per rectum, anemia and “failure to thrive.” All three were treated successfully by resection of the segment containing the diverticulum. The anemia was due to congestion and ulceration of the diverticulum and the adjacent bowel. The “failure to thrive” was assumed to be due to stasis with disordered absorptive power and altered bacterial flora in the adjacent bowel. There was no evidence of mechanical obstruction in any. The mechanism of diverticulum formation is not known but (Nixon 1960) diverticular
MANAGEMENT OF INTUSSUSCEPTION BY BARIUM ENEMA VERSUS SURGERY. R. K. Leoick. Clin. Pediat. 9:457-462 ( August ), 1970. This paper deals mostly with the technical aspects of barium enema reduction of intussusception as done at the Children’s Hospital Western Bank, Sheffield. The author states that when the interval between the onset of symptoms and the attempted tion was under 24 hours the success
reducrate of
barium enema reduction was 70 per cent. However, if the interval was over 24 hours, the success rate dropped to 25 per cent. According to age groups, successful barium reduction was obtained in 33 per cent of children under 6 months, and 72 per cent in children over 6 months. Irrespective of the duration of symptoms, the main decision against use of the barium enema is the child’s general condition. Thus a shocky child is considered an immediate surgical case, with an occasional enema done only for
86
ABSTRACTS
diagnostic purposes. Following reduction, the patient is closely followed for 24 hours for clinical signs of incomplete reduction. The postenema recurrence rate was only ti per cent higher than the post operative recurrence rate.-M. Gilbert.
Seven children presenting with symptoms suggesting subacute appendicitis were found to have mesenteric lymphadenitis due to infection by Pasteurella pseudotuberculosis. The appendix was normal in all seven, and the large, dark, sometimes hemorrhagic, lymph nodes showed areas of necrosis on the cut surfaces. The organism was cultured
NEW METHOD OF ROENTCENOLOGICALDEMONSTRATIONOF ANORECTAL AI’JOMALIES. in three out of four lymph nodes removed and all patients had a high antibody titre J. J. Murugasu. Surgery 68:706-712 (October),
1970.
Aspiration of meconium through the anal plate in newly born infants with imperforate anus allowed instillation of 8 to 10 cc. of 30 to 60 per cent Urograffin into the blind end of the alimentary tract. The saline filled syringe attached to a 19 gauge needle permitted irrigation of thick meconium and correct placement of the contrast material. Roentgenograms then made allowed identification of genitourinary fistuli and accurate determination of the distance to the perineal skin. This procedure used in 25 infants has the virtue of accuracy and can be done immediately, before the infant becomes distended with air, and can thus direct prompt surgical management The author believes
that
infants
with
clinically obvious fistuli should be treated by surgical perineal approach. If there is gas in the bladder, the lesion is considered high. All infants other than these should have injection studies. The author believes that since an accurate classification of the anomaly is often possible soon after birth and before gross abdominal distension occurs, it should be possible to perform a one stage definitive procedure without preliminary colostomy. EDITORIAL COMMENT: It is current practice of most pediatric surgeons to avoid one stage abdominoperineal pull-throughs in imperforate anus in the newborn not because of the abdominal distension or difficult diagnosis but rather because of the technical difficulties in assessing the true location of the puborectalis.-W. K. Sieber.
ABDOMEN MESENTERIC LYMPHADENITIS DIJE TO PASTEIJRELLA PSEUDOTUBERCULOSIS.A. E. Hewstone and P. E. Campbell. Aust. Paediat. J. 6: 129-134 (September), 1970.
to the infecting organism. All seven patients were given antibiotics and all recovered uneventfully.-]. R. Solomon. GUSHING’S SYNDROME IN INFANCY. Michael
Gilbert and William Cleoeland. Pediatrics 46:217-229
(August),
1970.
Three infants with Cushing’s syndrome secondary to adrenal adenoma were diagnosed by abnormal IVP. Clinical features exhibited were massive and generalized obesity, hypertension and retarded linear growth. Surgical removal of the adenoma resulted in a cure in all three cases. Careful attention is noted to the administration of postoperative steroids, stressful situations, for years following cure.-C.
GENITOURINARY
especially as long as
during several
Rubin.
TRACT
V. Burkholder, ,P. D. Beach and R. Hall. J. Urol.
FETAL RENAL HAMARTOMA. G. 104:330337
(August),
1970.
Two cases are presented and several reported in the literature reviewed. This lesion, histologically, lacks malignant elements and has a characteristic appearance. Clinically it has a benign course and does not require radiotherapy or actinomycin D. In fact, the use of these methods of treatment can lead to iatrogenic complications which have been lethal. These tumors require only nephrectomy for their cure. Their origin is discussed.-B. M. Henderson. CLASSIFICATION OF RENAL CYSTS IN CIIILDREN. J. C. HoefeZ, G. Jacottin and J. M. Bourgeois. Aust. Paediat. J. (5123-128 ( September), 1970. A class&cation of children is presented pathologic features signs. Unilateral cysts
primary renal cysts in based on clinical and as well as radiologic are divided into renal
ABSTRACTS a shunt,
(2)
patients who do not have suit-
able vessel for a shunt either because of extension of thrombosis to the splenic vein or because of previous splenectomy and (3 ) patients who continue to have recurrent hemorrhage in spite of previous surgery. The authors claim that in their hand this technique gives better results than other methods of direct attack on the esophagogastric vessels-J. Lari. A NASOJEJUNAL
TUBE FOR INFANT FEEDING.
James Rhea and John Kilby. Pediatrics 46:36-40 l._Tulv) . 1970. _,I
An alternative method to nasogastric feeding was attempted in 48 infants wherein a limp polyvinyl tube was passed from the stomach through the pylorus into the jejunum. Full enteric infant feedings for 3-4 weeks without complications were accomplished. Daily volumes of 150 cc. milk/Kg. in small, but frequent feedings were well tolerated
but the authors
attention
to the osmolarity
stress that careful is necessary
to
formation
has been seen in oblique
mosis performed
on baby
rabbits.
anastoNygaard
(1967) has pointed out that cutting the circular muscle in constructing an equal lumen in an end-to-side or oblique end-toend anastomosis produces a potentially weak area, which could predispose to diverticulum formation. Although blind pouch syndrome is more likely to occur in side-to-side anastomosis, there is, however, a slight risk of this occuring in end-to-end anastomosis--J. Lari. INTUSSUSCEPTION AFTER MAIOR ABDOMINAL OPERATIONS IN CHILDREN.-F. M. G&man, J. C. Duchasme and P. P. Co&n. Canad. J.
Surg.
13:427-433
(October),
1970.
The authors report five children who suffered from intussusception in the postoperative period following revision of a cervical jejuno-esophageal anastomosis; an abdominoperineal pull-through; an adrenalectomy; a Soave pull-through; and the construction of an ileal bladder.
prevent diarrhea and/or hypovolemic shock as fluid is mobilized in the gut--C. Rubin.
Since the symptoms and signs of intussusception in this situation are always bizarre, it is emphasized that surgeons should be
DIVERTICULUM FORMATION AFTER OBLIQUE END-TO-END ANASTOMOSIS FOR JEJUNOILEAL ATRESIA. S. M. L. Nade and I. A. S.
aware of this complication and suspect it in any infant presenting with the clinical pic-
Dickson. Brit. J. Surg. 57:54Q-543
(July),
ture of early postoperative mechanical tinal obstruction-c. C. Ferguson.
intes-
1970. Three patients are presented who developed a diverticulum at the anastomosis after successful treatment for small bowel atresia. Two followed an oblique end-to-end anastomosis and one Roux-en-Y anastomosis with ileostomy. In the first two there was no blind end and in the third the blind end (ileostomy) had been excised at the age of 7 months. Their main features at presentation, aged 4 to 6 years, were bleeding per rectum, anemia and “failure to thrive.” All three were treated successfully by resection of the segment containing the diverticulum. The anemia was due to congestion and ulceration of the diverticulum and the adjacent bowel. The “failure to thrive” was assumed to be due to stasis with disordered absorptive power and altered bacterial flora in the adjacent bowel. There was no evidence of mechanical obstruction in any. The mechanism of diverticulum formation is not known but (Nixon 1960) diverticular
MANAGEMENT OF INTUSSUSCEPTION BY BARIUM ENEMA VERSUS SURGERY. R. K. Leoick. Clin. Pediat. 9:457-462 ( August ), 1970. This paper deals mostly with the technical aspects of barium enema reduction of intussusception as done at the Children’s Hospital Western Bank, Sheffield. The author states that when the interval between the onset of symptoms and the attempted tion was under 24 hours the success
reducrate of
barium enema reduction was 70 per cent. However, if the interval was over 24 hours, the success rate dropped to 25 per cent. According to age groups, successful barium reduction was obtained in 33 per cent of children under 6 months, and 72 per cent in children over 6 months. Irrespective of the duration of symptoms, the main decision against use of the barium enema is the child’s general condition. Thus a shocky child is considered an immediate surgical case, with an occasional enema done only for
86
ABSTRACTS
diagnostic purposes. Following reduction, the patient is closely followed for 24 hours for clinical signs of incomplete reduction. The postenema recurrence rate was only ti per cent higher than the post operative recurrence rate.-M. Gilbert.
Seven children presenting with symptoms suggesting subacute appendicitis were found to have mesenteric lymphadenitis due to infection by Pasteurella pseudotuberculosis. The appendix was normal in all seven, and the large, dark, sometimes hemorrhagic, lymph nodes showed areas of necrosis on the cut surfaces. The organism was cultured
NEW METHOD OF ROENTCENOLOGICALDEMONSTRATIONOF ANORECTAL AI’JOMALIES. in three out of four lymph nodes removed and all patients had a high antibody titre J. J. Murugasu. Surgery 68:706-712 (October),
1970.
Aspiration of meconium through the anal plate in newly born infants with imperforate anus allowed instillation of 8 to 10 cc. of 30 to 60 per cent Urograffin into the blind end of the alimentary tract. The saline filled syringe attached to a 19 gauge needle permitted irrigation of thick meconium and correct placement of the contrast material. Roentgenograms then made allowed identification of genitourinary fistuli and accurate determination of the distance to the perineal skin. This procedure used in 25 infants has the virtue of accuracy and can be done immediately, before the infant becomes distended with air, and can thus direct prompt surgical management The author believes
that
infants
with
clinically obvious fistuli should be treated by surgical perineal approach. If there is gas in the bladder, the lesion is considered high. All infants other than these should have injection studies. The author believes that since an accurate classification of the anomaly is often possible soon after birth and before gross abdominal distension occurs, it should be possible to perform a one stage definitive procedure without preliminary colostomy. EDITORIAL COMMENT: It is current practice of most pediatric surgeons to avoid one stage abdominoperineal pull-throughs in imperforate anus in the newborn not because of the abdominal distension or difficult diagnosis but rather because of the technical difficulties in assessing the true location of the puborectalis.-W. K. Sieber.
ABDOMEN MESENTERIC LYMPHADENITIS DIJE TO PASTEIJRELLA PSEUDOTUBERCULOSIS.A. E. Hewstone and P. E. Campbell. Aust. Paediat. J. 6: 129-134 (September), 1970.
to the infecting organism. All seven patients were given antibiotics and all recovered uneventfully.-]. R. Solomon. GUSHING’S SYNDROME IN INFANCY. Michael
Gilbert and William Cleoeland. Pediatrics 46:217-229
(August),
1970.
Three infants with Cushing’s syndrome secondary to adrenal adenoma were diagnosed by abnormal IVP. Clinical features exhibited were massive and generalized obesity, hypertension and retarded linear growth. Surgical removal of the adenoma resulted in a cure in all three cases. Careful attention is noted to the administration of postoperative steroids, stressful situations, for years following cure.-C.
GENITOURINARY
especially as long as
during several
Rubin.
TRACT
V. Burkholder, ,P. D. Beach and R. Hall. J. Urol.
FETAL RENAL HAMARTOMA. G. 104:330337
(August),
1970.
Two cases are presented and several reported in the literature reviewed. This lesion, histologically, lacks malignant elements and has a characteristic appearance. Clinically it has a benign course and does not require radiotherapy or actinomycin D. In fact, the use of these methods of treatment can lead to iatrogenic complications which have been lethal. These tumors require only nephrectomy for their cure. Their origin is discussed.-B. M. Henderson. CLASSIFICATION OF RENAL CYSTS IN CIIILDREN. J. C. HoefeZ, G. Jacottin and J. M. Bourgeois. Aust. Paediat. J. (5123-128 ( September), 1970. A class&cation of children is presented pathologic features signs. Unilateral cysts
primary renal cysts in based on clinical and as well as radiologic are divided into renal