- Email: [email protected]
Mediastinal tumors in childhood
INTERNATIONAL ABSTRACTS OF PEDIATRIC SURGERY
my. Intravaginal torsion of the testicle is the most common diagnosis in virtually all series of acute scrotal pathology in children. There are many signs noted on physical examination but none are pathognomonic. Treatment is emergency detorsion and testicular viability is virtually guaranteed if detorsion is achieved within three hours of the onset of symptoms. The percent of viability is about 90% at six hours, 75% at eight hours, 50% at ten hours and less than 10% after 24 hours from the onset of symptoms. Testicular scanning, ultrasound, and radionucleide imaging are diagnostic modalities available but should not be used if this would delay treatment in an already clear-cut case, particularly within the first 12 hours. If the history, physical examination, and urinalysis are not diagnostic, then these tests may be useful, particularly after the first 24 hours of symptoms. Epididymitis is the most common form of acute scrotal pathology in postpubertal males. The hallmark of this diagnosis is an abnormal urinalysis showing pyuria and bactiuria. Seventyfive percent of cases in men less than 35 years of age will be caused by Niesseria gonorrhea or Chlamydia trachomatis. The former should be treated with penicillin and the latter with tetracycline. The diagnosis of torsion of a testicular appendage is generally straight-forward if a tender nodule can be localized to the superior pole of the testis. The "blue dot" sign may also be present early in the course. This accounts for about 20% of acute scrotal pathology in pediatric patients. For patients with mild to moderate symptoms and when the diagnosis is not in question, conservative management with oral analgesics and restricted activity appears to be all that is necessary.--Richard R. Ricketts
959
authors have become increasingly aware of the diminished importance of cystoscopy in the entire spectrum of diagnostic procedures for children. They believe that cystoscopy should be used as a confirming modality at the time of surgical intervention. It usually does not warrant a separate anesthesia to obtain the small amount of information that it may provide.--George Holcomb, Jr Use of The AS792 Artificial Sphincter Following Urinary Undiversion. J. K. Light, F. N. Flores, and F. B. Scott. J Urol
129:548-551, (March), 1983. The presence of neuropathic bladder dysfunction has been considered a relative contraindication to urinary undiversion unless it can be established preoperatively that the patient will obtain urinary continence. Eight patients are reported who had successful outcome with the use of the AS792 artificial urinary sphincter to control incontinence after urinary undiversion. Because of this successful experience, the authors now believe that patients with neuropathic bladder dysfunction or anatomically abnormal lower tract should no longer be precluded from urinary undiversion. A variety of methods were used to reconstruct the urinary tract, including total reconstruction of the bladder and urethra with the sigmoid colon in one case. In this patient the artificial sphincter was placed around the bowel segment to provide continence. The use of the artificial sphincter around the bowel segment offers many possibilities for reconstructive procedures involving bowel in the future.--George Holcomb NEOPLASMS
Bladder Augmentation in The Pediatric Neuropathic Bladder. E. J. Kass and S. .4. Koff. J Urol 129:552-555, (March),
1983. Augmentation enteroeystoplasty was used as an aid to reconstruction of the urinary tract and undiversion in 14 children with neurogenic bladder dysfunction. In 13 children, the radiographic appearance of the upper urinary tracts and renal function studies have remained stable. Vesicoureteral reflux has persisted postoperatively in the one child in whom an ileocecal segment was used for undiversion. Each child has remained continent provided that intermittent catheterization is performed at 4-hour intervals. Bacilluria has been present periodically in all children despite continuous antimicrobial medication. However, febrile urinary tract infections have occurred only once in each of two patients. The elements and importance of preoperative evaluation are discussed.George Holcomb, Jr The Diagnostic Approach to Ectopic Ureterocele and The Renal Duplication Complex. A. M. Geringer, IV. E. Berdon,
D. W. Seldin, et al. J Urol 129:539-542, (March), 1983. The child with ectopic ureterocele frequently presents a diagnostic challenge. The use of standard excretory urography combined with newer modalities, such as ultrasonography and radionuclide renal scanning, provides an orderly diagnostic approach. Several illustrative cases are presented. This integrated approach should ensure the highest yield diagnostically and aid in assessing upper tract function. It should help in selecting the proper surgical management. The
Mediastinal Tumors in Childhood. R. Daum. Z Kinderchir
38:11-15, 1983. Symptoms of mediastinal tumors depend on their location in the mediastinum, size, and infiltration of neighbouring organs. An extraordinary size may be achieved without any symptoms. The authors present a series of 41 mediastinal tumors. Most common symptoms were dyspnea, stridor, coughing, and recurrent airway infections. Less common were arrhythmias, hoarseness, Horner's syndrome, phrenoplegia, and singultus. The authors state that myoclonic encephalopathia is not infrequently associated with a thoracic neuroblastoma. Neuroblastomas and duplications of the upper gastrointestinal tract are located in the posterior mediastinum, bronchogenous cysts; lymphomas and teratomas in the middle mediastinum; and thymomas, pericardial cysts, and teratomas in the anterior mediastinum. Neuroblastomas, lymphomas, and teratomas are the most common mediastiual tumors in childhood. Diagnosis is made by means of chest x-rays, ultrasound, computerized tomography, and measurement of catecholamines. Therapy of choice is surgical excision of the tumor except for non-Hodgkins lymphomas where primary cytostatic therapy and irradiation may lead to better results. In malignant tumors adjuvant chemotherapy and irradiation are indispensable. Eighteen of the 41 mediastinal tumors presented were benign (44%) and 23 malignant (56%). Mortality rate in children with malignant tumors was 52% (12). Eighty-five per cent of the malignant tumors were lymphomas and neuroblastomas. The children were between 8 months and 6.5 years of age. Four of nine
960
INTERNATIONAL ABSTRACTS OF PEDIATRIC SURGERY
children with mediastinal neuroblastoma developed a transverse lesion of the spinal cord.--Thomas A. Angerpointner The Problem of Benign Pulmonary Nodules in Children Receiving Cytotoxic Chemotherapy. H. Hidalgo, M. Korobkin, T. R. Kinney, et al. Am J Roentgenol 140:21-25,
(January), 1983. Three children being treated for sarcoma developed nodules in their lung fields on CT scans. All three underwent resection of the nodules with two patients having only benign fibrous lesions, while the other had a mixture of benign and malignant lesions. Nodular scar formation may represent the healing process after chemotherapy in metastatic pulmonary nodules, and persistence of such nodules may not mean an inadequate response to therapy. The authors recommend biopsy of persistent or changing lesions. They feel the limitations of CT scans in metastatic pulmonary disease include inability to detect all nodules, nodules detected may not be malignant, and persistent nodules do not always indicate inadequate response to treatment.--Randall W. Powell
Multiple Endocrine Neoplasia (MEN) Syndrome Type liB: Gastrointestinal Manifestations. T. C. Demos, J. Blonder, W. L. Schey, et al. Am J Roentgenol 140:73-78, (January),
1983. The authors review five patients (ages 37, 5, 3, 31 and 7) with the MEN liB syndrome characterized by medullary carcinoma of the thyroid, pheochromocytoma, and ganglioneuromas of the GI tract. All of these patients demonstrated megacolon at one time during their course and one underwent two procedures for Hirschsprung's disease. All of the children presented with a long history of constipation and all three had developed medullary carcinoma of the thyroid by the time of presentation. The syndrome, inherited as an autosomal dominant with variable penetrance, usually presents with the gastrointestinal tract neuromas first with symptoms depending on the site of the neuromas. The most frequent complaint is that of chronic constipation occasionally associated with bouts of diarrhea. The radiologic finding most often seen is megacolon. These early gastrointestinal signs and symptoms can lead to early diagnosis and appropriate monitoring for the neoplasms which tend to develop.--Randall W. Powell
BOOKS OF INTEREST
ENDOCRINE DISORDERS AND TUMOURS IN CHILDREN (Volume 16 of the Progress in Pediatric Surgery series). Edited by P. P. Rickham, et al. 206 pages, illustrated. $27.50. Baltimore: Urban & Schwarzenberg, 1983. PEDIATRIC ENDOSCOPY. Edited by Stephen L. Gans. 204 pages, 148 illustrations (40 in color). $35.00. New York, London, Toronto, Sydney, San Francisco: Grune & Stratton, 1983. BRAIN TUMORS IN THE YOUNG. Edited by Luis V. Amador. 900 pages, illustrated. $125.00. Springfield, Illinois: Charles C Thomas, 1983.
THORACIC AND CARDIOVASCULAR SURGERY, 4th Ed. Edited by William W. L. Glenn. 1695 pages, illustrated. $145.00. Norwalk, CT: Appleton-Century-Crofts, 1982. ATLAS OF SURGICAL AND SECTIONAL ANATOMY. By Bok Y. Lee. 352 pages, 294 3-dimensional illustrations. $35.00. Norwalk, CT: Appleton-Century-Crofts, 1983.
my. Intravaginal torsion of the testicle is the most common diagnosis in virtually all series of acute scrotal pathology in children. There are many signs noted on physical examination but none are pathognomonic. Treatment is emergency detorsion and testicular viability is virtually guaranteed if detorsion is achieved within three hours of the onset of symptoms. The percent of viability is about 90% at six hours, 75% at eight hours, 50% at ten hours and less than 10% after 24 hours from the onset of symptoms. Testicular scanning, ultrasound, and radionucleide imaging are diagnostic modalities available but should not be used if this would delay treatment in an already clear-cut case, particularly within the first 12 hours. If the history, physical examination, and urinalysis are not diagnostic, then these tests may be useful, particularly after the first 24 hours of symptoms. Epididymitis is the most common form of acute scrotal pathology in postpubertal males. The hallmark of this diagnosis is an abnormal urinalysis showing pyuria and bactiuria. Seventyfive percent of cases in men less than 35 years of age will be caused by Niesseria gonorrhea or Chlamydia trachomatis. The former should be treated with penicillin and the latter with tetracycline. The diagnosis of torsion of a testicular appendage is generally straight-forward if a tender nodule can be localized to the superior pole of the testis. The "blue dot" sign may also be present early in the course. This accounts for about 20% of acute scrotal pathology in pediatric patients. For patients with mild to moderate symptoms and when the diagnosis is not in question, conservative management with oral analgesics and restricted activity appears to be all that is necessary.--Richard R. Ricketts
959
authors have become increasingly aware of the diminished importance of cystoscopy in the entire spectrum of diagnostic procedures for children. They believe that cystoscopy should be used as a confirming modality at the time of surgical intervention. It usually does not warrant a separate anesthesia to obtain the small amount of information that it may provide.--George Holcomb, Jr Use of The AS792 Artificial Sphincter Following Urinary Undiversion. J. K. Light, F. N. Flores, and F. B. Scott. J Urol
129:548-551, (March), 1983. The presence of neuropathic bladder dysfunction has been considered a relative contraindication to urinary undiversion unless it can be established preoperatively that the patient will obtain urinary continence. Eight patients are reported who had successful outcome with the use of the AS792 artificial urinary sphincter to control incontinence after urinary undiversion. Because of this successful experience, the authors now believe that patients with neuropathic bladder dysfunction or anatomically abnormal lower tract should no longer be precluded from urinary undiversion. A variety of methods were used to reconstruct the urinary tract, including total reconstruction of the bladder and urethra with the sigmoid colon in one case. In this patient the artificial sphincter was placed around the bowel segment to provide continence. The use of the artificial sphincter around the bowel segment offers many possibilities for reconstructive procedures involving bowel in the future.--George Holcomb NEOPLASMS
Bladder Augmentation in The Pediatric Neuropathic Bladder. E. J. Kass and S. .4. Koff. J Urol 129:552-555, (March),
1983. Augmentation enteroeystoplasty was used as an aid to reconstruction of the urinary tract and undiversion in 14 children with neurogenic bladder dysfunction. In 13 children, the radiographic appearance of the upper urinary tracts and renal function studies have remained stable. Vesicoureteral reflux has persisted postoperatively in the one child in whom an ileocecal segment was used for undiversion. Each child has remained continent provided that intermittent catheterization is performed at 4-hour intervals. Bacilluria has been present periodically in all children despite continuous antimicrobial medication. However, febrile urinary tract infections have occurred only once in each of two patients. The elements and importance of preoperative evaluation are discussed.George Holcomb, Jr The Diagnostic Approach to Ectopic Ureterocele and The Renal Duplication Complex. A. M. Geringer, IV. E. Berdon,
D. W. Seldin, et al. J Urol 129:539-542, (March), 1983. The child with ectopic ureterocele frequently presents a diagnostic challenge. The use of standard excretory urography combined with newer modalities, such as ultrasonography and radionuclide renal scanning, provides an orderly diagnostic approach. Several illustrative cases are presented. This integrated approach should ensure the highest yield diagnostically and aid in assessing upper tract function. It should help in selecting the proper surgical management. The
Mediastinal Tumors in Childhood. R. Daum. Z Kinderchir
38:11-15, 1983. Symptoms of mediastinal tumors depend on their location in the mediastinum, size, and infiltration of neighbouring organs. An extraordinary size may be achieved without any symptoms. The authors present a series of 41 mediastinal tumors. Most common symptoms were dyspnea, stridor, coughing, and recurrent airway infections. Less common were arrhythmias, hoarseness, Horner's syndrome, phrenoplegia, and singultus. The authors state that myoclonic encephalopathia is not infrequently associated with a thoracic neuroblastoma. Neuroblastomas and duplications of the upper gastrointestinal tract are located in the posterior mediastinum, bronchogenous cysts; lymphomas and teratomas in the middle mediastinum; and thymomas, pericardial cysts, and teratomas in the anterior mediastinum. Neuroblastomas, lymphomas, and teratomas are the most common mediastiual tumors in childhood. Diagnosis is made by means of chest x-rays, ultrasound, computerized tomography, and measurement of catecholamines. Therapy of choice is surgical excision of the tumor except for non-Hodgkins lymphomas where primary cytostatic therapy and irradiation may lead to better results. In malignant tumors adjuvant chemotherapy and irradiation are indispensable. Eighteen of the 41 mediastinal tumors presented were benign (44%) and 23 malignant (56%). Mortality rate in children with malignant tumors was 52% (12). Eighty-five per cent of the malignant tumors were lymphomas and neuroblastomas. The children were between 8 months and 6.5 years of age. Four of nine
960
INTERNATIONAL ABSTRACTS OF PEDIATRIC SURGERY
children with mediastinal neuroblastoma developed a transverse lesion of the spinal cord.--Thomas A. Angerpointner The Problem of Benign Pulmonary Nodules in Children Receiving Cytotoxic Chemotherapy. H. Hidalgo, M. Korobkin, T. R. Kinney, et al. Am J Roentgenol 140:21-25,
(January), 1983. Three children being treated for sarcoma developed nodules in their lung fields on CT scans. All three underwent resection of the nodules with two patients having only benign fibrous lesions, while the other had a mixture of benign and malignant lesions. Nodular scar formation may represent the healing process after chemotherapy in metastatic pulmonary nodules, and persistence of such nodules may not mean an inadequate response to therapy. The authors recommend biopsy of persistent or changing lesions. They feel the limitations of CT scans in metastatic pulmonary disease include inability to detect all nodules, nodules detected may not be malignant, and persistent nodules do not always indicate inadequate response to treatment.--Randall W. Powell
Multiple Endocrine Neoplasia (MEN) Syndrome Type liB: Gastrointestinal Manifestations. T. C. Demos, J. Blonder, W. L. Schey, et al. Am J Roentgenol 140:73-78, (January),
1983. The authors review five patients (ages 37, 5, 3, 31 and 7) with the MEN liB syndrome characterized by medullary carcinoma of the thyroid, pheochromocytoma, and ganglioneuromas of the GI tract. All of these patients demonstrated megacolon at one time during their course and one underwent two procedures for Hirschsprung's disease. All of the children presented with a long history of constipation and all three had developed medullary carcinoma of the thyroid by the time of presentation. The syndrome, inherited as an autosomal dominant with variable penetrance, usually presents with the gastrointestinal tract neuromas first with symptoms depending on the site of the neuromas. The most frequent complaint is that of chronic constipation occasionally associated with bouts of diarrhea. The radiologic finding most often seen is megacolon. These early gastrointestinal signs and symptoms can lead to early diagnosis and appropriate monitoring for the neoplasms which tend to develop.--Randall W. Powell
BOOKS OF INTEREST
ENDOCRINE DISORDERS AND TUMOURS IN CHILDREN (Volume 16 of the Progress in Pediatric Surgery series). Edited by P. P. Rickham, et al. 206 pages, illustrated. $27.50. Baltimore: Urban & Schwarzenberg, 1983. PEDIATRIC ENDOSCOPY. Edited by Stephen L. Gans. 204 pages, 148 illustrations (40 in color). $35.00. New York, London, Toronto, Sydney, San Francisco: Grune & Stratton, 1983. BRAIN TUMORS IN THE YOUNG. Edited by Luis V. Amador. 900 pages, illustrated. $125.00. Springfield, Illinois: Charles C Thomas, 1983.
THORACIC AND CARDIOVASCULAR SURGERY, 4th Ed. Edited by William W. L. Glenn. 1695 pages, illustrated. $145.00. Norwalk, CT: Appleton-Century-Crofts, 1982. ATLAS OF SURGICAL AND SECTIONAL ANATOMY. By Bok Y. Lee. 352 pages, 294 3-dimensional illustrations. $35.00. Norwalk, CT: Appleton-Century-Crofts, 1983.