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Midline cervical ectopic thyroid tissue
INTERNATIONAL
380
ABSTRACTS
OF PEDIATRIC
SURGERY
This describes the case of a I3-year-old girl with a massive, benign fibroadenoma of her left breast. The tumor was removed by enucleation. The case was unusual because of the extraordinary size of the tumor and the fact that only 8 similar cases had been reported in children I3 years of age or less.-D. T. Cloud.
histories suggestive of esophageal atresia with trachea-esophageal fistula. Nasogastric tube could not be passed and contrast studies demonstrated the presence of a diverticulum of the hypopharynx lying posterior to the esophagus. One child died 2 months following operation from repeated aspiration pneumonia. It is suggested that the difficulty in passing a nasogastric tube down to the stomach in each case was related to cricopharyngeal spasm which was also responsible for the difficulty in swallowing. The authors describe 2 other children with cricopharyngeal spasm, without traumatic pseudodiverticulum, who also presented as infants with esophageal atresia because of excessive salivation and vomiting associated with inability to pass a nasogastric tube. In the child who survived, cricopharYngealspasm was still present at 8 months of age.-B. M. Henderson.
DESMOIDOF THE ABDOMINAL AND THORACIC WALL. L. Hasman, H. Havel, and K.
MIDLINE CERVICAL ECTOPIC THYROID TISSUE. B. Meyerowitz and R. Buchholz.
drain inserted. Drains in 12 to 24 hours.
were usually removed
The controversy between management with and without pressure dressings was discussed. With either treatment, elevation appeared to be an effective method of controlling edema.-A. M. S&berg.
GIANT FIBROADENOMA (BENIGN CYSTOURCOMA PHYLLOIDES).REPORT OF CASE IN ~~-YEAR-OLD GIRL. T. E. Simpson, R. L. Van Derooort, ]r., Surgery 65:341-342
Audyouci.
and H. B. Lynn. (February), 1969.
Rozhl. Chir. 47:206-210,
1968.
A desmoidal tumor of the left lateral abdominal and thoracic part of the body developed in a boy. It was excised but recurred four times, At the last operation (at the age of 9 years) a broad excision of the full depth of the abdominal wall, a part of diaphragm, and chest wall was performed. The defect was covered by a reversed decorticated skin flap as internal layer, and a transferred skin flap from the neighboring left lumbodorsal region was the outer layer. Two and a half years after the last operation the patient is in good health, without signs of recurrence, able to take part in sports. The case is published as an example of rare desmoids in children, and of the suitability of using decorticated skin flaps for covering large defects of the abdominal wall-V.
Kafka.
HEAD
AND NECK
TRAUMATIC PSEUDODIVERTICULUM OF THE PHARYNX IN THE NEWBORN INFANT. B. R. Girdany, W. K. Sieber, and M. Z. Osmun. New Eng. J. Med. 260~237-240 (January 30), 1969. This is a presentation of 2 newborn infants, both of whom were delivered by breech extraction and who presented with
Surgery
65:356-362
(February),
1969.
The authors report 2 female children, age 8 and 13, respectively, who were found to have ectopic thyroid tissue in the anterior midline of the neck. One was associated with lingual thyroid tissue, but neither had normal lateral thyroid tissue. In each case at operation the thyroid tissue was bivalved and the segments buried under the adjacent strap muscles. Recoveries were uneventful and both patients were clinically euthyroid. Aside from visible swelling, the lesions were asymptomatic. Cervical thyroid is frequently the only functioning thyroid tissue present. Scintiscanning is recommended for all patients with a midline cervical mass or lingual thyroid. If enlargement of the lesion occurs, it should first be treated with thyroid hormone with the hope of reducing the size of the mass by blocking the thyroid-stimulating hormone. If this treatment is unsuccessful, surgical exploration is indicated. Solid thyroid tissue should be implanted under the strap muscles of the neck. If the thyroid tissue is abnormal ( adenomatous changes were seen in one of these cases), removal may be indicated.-D. T. Cloud.
THORAX CONSIDERATIONSIN THE MANAGEMENT OF SPO~~TANEOUS PNEUMOTHORAX IN THE
INTERNATIONAL
NEWBORN. J. Camamta. uary),
John
ABSTRACTS OF PEDIATRIC SURGERY
M.
Amer.
and
Samuel
Surg. 35:27-29
Salyer
(Jan-
1969.
Pneumothorax or pneumomediastinum occurs in 0.05 to 2.9 per cent newborn infants. This incidence will include the pneumothorax which occurs both before and after prompt postdelivery resuscitative measures and the differentiation between these two types of pneumothorax is clinically noteworthy, but not of great significance, since intercostal tube waterseal drainage, with few exceptions, should be the method of approach, regardless of the estimated extent or localization of the pneumothorax or pneumomediastinum. This report includes 40 newborn children who were diagnosed and treated for pneumothorax and/or pneumomediastinum during an eight-year period between 1969 and 1967. Thirty-six of the 40 children were treated by intercostal tube drainage without suction and there were no fatalities during hospitalization in any infant so treated. Two deaths resulted from bilateral tension pneumothorax which was not treated by tube drainage. A technic for the insertion of the intercostal tube is described, utilizing a #12 or #I4 catheter inserted through the third or fourth interspace at the anterior axillary line.-A. M. Sal&erg. ADENOMATOIDMALFORMATIONOFTHELUNC IN THE NEW BORN INFANT. Fr. Moyson, R. Poncelet, G. Carpent, N. Cremer, and Ph. Pourhaix. Ann. Chir. Inf. 9:275-288. 1968. Congenital cystic adenomatoid malformation of the lung, also known as pulmonary adenomatosis of the newborn, is a very rare disease. The authors could collect only 26 cases in the literature. They had the opportunity of observing a twenty-seventh case. Clinically, cyanosis and dyspnea were already present 2 hours after birth, as well as displacement of the heart to the right and on the plain x-ray of the chest a polycystic appearance of the left upper lobe, combined with emphysema and micronodular formations. Lobectomy, performed on the twenty-fifth day of life, was followed by recovery and cure. Microscopic examination of the specimen showed the typical adenomatous structure with tufts of very clear mucous cells here and there. Differential
381
diagnosis (hyaline membrane syndrome, syndrome of Wilson-Mikity, congenital pulmonary cystic lymphangiectasis, hamartoma of the lung, sequestration, congenital cysts, staphylococcic pneumatocele, and arteriovenous aneurysm) is discussed. Surgery is the only successful treatment. All cases in the literature who were not operated upon died.-M. Better SOME LATE SEQUELS OF CHILDHOOD PNEUMONECTOMY. Z. Sety, 1. Ressl, and J. Vyhnalek. Surgery 65:343-351 (February), 1968. Sixteen patients who had undergone pneumonectomy at 18 years of age or less were studied. Fifteen of the patients were less than 14 years old at the time of surgery. The youngest was 6 months old at the time of surgery. The most common indication for pneumonectomy was extensive suppurative lung disease. There were 3 cases of tuberculosis. Follow-up was from 3 to 17 years after the operation. All of the patients were doing well clinically and able to go about their usual activities in a normal manner. Substantial deformities of the chest and spine were observed in every case, but these were not readily apparent unless the patients were unclothed. No correlation was established between the degree of deformity and the functional capacity of the lungs. X-rays revealed an increase in volume of the remaining lung in all cases with herniation of varying degrees toward the opposite side. There were no symptoms relative to the esophagus, but esophagrams showed changes in the position and shape of the esophagus in every case. Electrocardiography showed marked vnriation in the electrical axis with no relationship to the side of the pneumonectomy. Electrocardiographic evidence of significant right ventricular hypertrophy was found in only 2 cases. Lung function tests showed reduction in maximum breathing capacity to a mean value of 48 per cent of the normal for both lungs. In some cases these values were less than expected for one lung. This was thought due to impairment of the mechanics of ventilation from anatomic alterations in the thoracic cage following surgery, and possibly from increased airway resistance. Thirteen patients had measurements of
380
ABSTRACTS
OF PEDIATRIC
SURGERY
This describes the case of a I3-year-old girl with a massive, benign fibroadenoma of her left breast. The tumor was removed by enucleation. The case was unusual because of the extraordinary size of the tumor and the fact that only 8 similar cases had been reported in children I3 years of age or less.-D. T. Cloud.
histories suggestive of esophageal atresia with trachea-esophageal fistula. Nasogastric tube could not be passed and contrast studies demonstrated the presence of a diverticulum of the hypopharynx lying posterior to the esophagus. One child died 2 months following operation from repeated aspiration pneumonia. It is suggested that the difficulty in passing a nasogastric tube down to the stomach in each case was related to cricopharyngeal spasm which was also responsible for the difficulty in swallowing. The authors describe 2 other children with cricopharyngeal spasm, without traumatic pseudodiverticulum, who also presented as infants with esophageal atresia because of excessive salivation and vomiting associated with inability to pass a nasogastric tube. In the child who survived, cricopharYngealspasm was still present at 8 months of age.-B. M. Henderson.
DESMOIDOF THE ABDOMINAL AND THORACIC WALL. L. Hasman, H. Havel, and K.
MIDLINE CERVICAL ECTOPIC THYROID TISSUE. B. Meyerowitz and R. Buchholz.
drain inserted. Drains in 12 to 24 hours.
were usually removed
The controversy between management with and without pressure dressings was discussed. With either treatment, elevation appeared to be an effective method of controlling edema.-A. M. S&berg.
GIANT FIBROADENOMA (BENIGN CYSTOURCOMA PHYLLOIDES).REPORT OF CASE IN ~~-YEAR-OLD GIRL. T. E. Simpson, R. L. Van Derooort, ]r., Surgery 65:341-342
Audyouci.
and H. B. Lynn. (February), 1969.
Rozhl. Chir. 47:206-210,
1968.
A desmoidal tumor of the left lateral abdominal and thoracic part of the body developed in a boy. It was excised but recurred four times, At the last operation (at the age of 9 years) a broad excision of the full depth of the abdominal wall, a part of diaphragm, and chest wall was performed. The defect was covered by a reversed decorticated skin flap as internal layer, and a transferred skin flap from the neighboring left lumbodorsal region was the outer layer. Two and a half years after the last operation the patient is in good health, without signs of recurrence, able to take part in sports. The case is published as an example of rare desmoids in children, and of the suitability of using decorticated skin flaps for covering large defects of the abdominal wall-V.
Kafka.
HEAD
AND NECK
TRAUMATIC PSEUDODIVERTICULUM OF THE PHARYNX IN THE NEWBORN INFANT. B. R. Girdany, W. K. Sieber, and M. Z. Osmun. New Eng. J. Med. 260~237-240 (January 30), 1969. This is a presentation of 2 newborn infants, both of whom were delivered by breech extraction and who presented with
Surgery
65:356-362
(February),
1969.
The authors report 2 female children, age 8 and 13, respectively, who were found to have ectopic thyroid tissue in the anterior midline of the neck. One was associated with lingual thyroid tissue, but neither had normal lateral thyroid tissue. In each case at operation the thyroid tissue was bivalved and the segments buried under the adjacent strap muscles. Recoveries were uneventful and both patients were clinically euthyroid. Aside from visible swelling, the lesions were asymptomatic. Cervical thyroid is frequently the only functioning thyroid tissue present. Scintiscanning is recommended for all patients with a midline cervical mass or lingual thyroid. If enlargement of the lesion occurs, it should first be treated with thyroid hormone with the hope of reducing the size of the mass by blocking the thyroid-stimulating hormone. If this treatment is unsuccessful, surgical exploration is indicated. Solid thyroid tissue should be implanted under the strap muscles of the neck. If the thyroid tissue is abnormal ( adenomatous changes were seen in one of these cases), removal may be indicated.-D. T. Cloud.
THORAX CONSIDERATIONSIN THE MANAGEMENT OF SPO~~TANEOUS PNEUMOTHORAX IN THE
INTERNATIONAL
NEWBORN. J. Camamta. uary),
John
ABSTRACTS OF PEDIATRIC SURGERY
M.
Amer.
and
Samuel
Surg. 35:27-29
Salyer
(Jan-
1969.
Pneumothorax or pneumomediastinum occurs in 0.05 to 2.9 per cent newborn infants. This incidence will include the pneumothorax which occurs both before and after prompt postdelivery resuscitative measures and the differentiation between these two types of pneumothorax is clinically noteworthy, but not of great significance, since intercostal tube waterseal drainage, with few exceptions, should be the method of approach, regardless of the estimated extent or localization of the pneumothorax or pneumomediastinum. This report includes 40 newborn children who were diagnosed and treated for pneumothorax and/or pneumomediastinum during an eight-year period between 1969 and 1967. Thirty-six of the 40 children were treated by intercostal tube drainage without suction and there were no fatalities during hospitalization in any infant so treated. Two deaths resulted from bilateral tension pneumothorax which was not treated by tube drainage. A technic for the insertion of the intercostal tube is described, utilizing a #12 or #I4 catheter inserted through the third or fourth interspace at the anterior axillary line.-A. M. Sal&erg. ADENOMATOIDMALFORMATIONOFTHELUNC IN THE NEW BORN INFANT. Fr. Moyson, R. Poncelet, G. Carpent, N. Cremer, and Ph. Pourhaix. Ann. Chir. Inf. 9:275-288. 1968. Congenital cystic adenomatoid malformation of the lung, also known as pulmonary adenomatosis of the newborn, is a very rare disease. The authors could collect only 26 cases in the literature. They had the opportunity of observing a twenty-seventh case. Clinically, cyanosis and dyspnea were already present 2 hours after birth, as well as displacement of the heart to the right and on the plain x-ray of the chest a polycystic appearance of the left upper lobe, combined with emphysema and micronodular formations. Lobectomy, performed on the twenty-fifth day of life, was followed by recovery and cure. Microscopic examination of the specimen showed the typical adenomatous structure with tufts of very clear mucous cells here and there. Differential
381
diagnosis (hyaline membrane syndrome, syndrome of Wilson-Mikity, congenital pulmonary cystic lymphangiectasis, hamartoma of the lung, sequestration, congenital cysts, staphylococcic pneumatocele, and arteriovenous aneurysm) is discussed. Surgery is the only successful treatment. All cases in the literature who were not operated upon died.-M. Better SOME LATE SEQUELS OF CHILDHOOD PNEUMONECTOMY. Z. Sety, 1. Ressl, and J. Vyhnalek. Surgery 65:343-351 (February), 1968. Sixteen patients who had undergone pneumonectomy at 18 years of age or less were studied. Fifteen of the patients were less than 14 years old at the time of surgery. The youngest was 6 months old at the time of surgery. The most common indication for pneumonectomy was extensive suppurative lung disease. There were 3 cases of tuberculosis. Follow-up was from 3 to 17 years after the operation. All of the patients were doing well clinically and able to go about their usual activities in a normal manner. Substantial deformities of the chest and spine were observed in every case, but these were not readily apparent unless the patients were unclothed. No correlation was established between the degree of deformity and the functional capacity of the lungs. X-rays revealed an increase in volume of the remaining lung in all cases with herniation of varying degrees toward the opposite side. There were no symptoms relative to the esophagus, but esophagrams showed changes in the position and shape of the esophagus in every case. Electrocardiography showed marked vnriation in the electrical axis with no relationship to the side of the pneumonectomy. Electrocardiographic evidence of significant right ventricular hypertrophy was found in only 2 cases. Lung function tests showed reduction in maximum breathing capacity to a mean value of 48 per cent of the normal for both lungs. In some cases these values were less than expected for one lung. This was thought due to impairment of the mechanics of ventilation from anatomic alterations in the thoracic cage following surgery, and possibly from increased airway resistance. Thirteen patients had measurements of