Minimally invasive diaphragm plication in an infant

INTERNATIONAL

ABSTRACTS

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THORAX Reduced-Size Lung Transplantation From Adult to Neonatal Swine. R. Greco, .I. Benito, G. Cordovilla, el al. Em 3 Pedintr Surg 8:268-273, (October), 1998. Lung donor shortage is a critical factor lirmting the expansion of pediatric lung transplantation programs. This report details the surgical technical feasibility of a training model of lobar lung transplantation as well as the perioperative monitoring to evaluate the appropriate pulmonary graft function. Ten hybrid Large-White pigs underwent Ieft-lowerlobe lung allotransplantation. Donors weighed 15 to 20 kg, and recipients weighed 5 to 7 kg. The first five animals were used to learn the surgical anatomy and to establish the surgical techmque and instrumentation (group A). One hour after transplantation the right lung was excluded. Lung function and hemodynanuc data were collected sequentially in the following five animals (group B). The left inferior pulmonary lobe was found to be the most suitable allograft for transplantation, Usually, bronchial size discrepancy allowed telescoping of the airway anastomosrs. Left atrial clamping was well tolerated dunng the pulmonary vein anastomoses. Preoperative antiaggregation and postoperanve heparinization prevented left atria1 thrombosis. After right lung exclusion. hemodynamic changes consisted of a sustained increase m pulmonary vascular resistance and a reduction of cardiac output. Lung mechanics also were modified, with a gradual increase in airway resistance and decrease in compliance. The neonatal prg tolerates left lobar pulmonary transplantation satisfactorily. Although it is a useful and promising surgical learning model, questions remain regarding the applicability to clinical pediatric lung transplantation.-Thomas A. Angerpointner liming and Priorities for Cystic Fibrosis Patients Transplantation. F: Venata, E.A. Rend&a, Z De Giacomo, J Pediatr Surg 5274-277, (October). 1998.

to Lung et al. Em

Bilateral lung transplantation actually is considered a valuable option for patients with end-stage lung disease related to cystic fibrosis. Timing is crucial to transplant successfully as many patients as possible, and it is mainly based on the progressive worsening of pulmonary function tests and qualify of life. The authors reviewed the charts of all patients (n = 28) accepted for lung transplantation at their institution in order to assess the role of several functional and demographic parameters. They compared the 15 patients able to wait for transplantation (group A) with the 7 who were dying while on the waiting list (group B). Fifteen of them were successfully transplanted (mean waiting time, 117 days), 7 died waiting (mean waitmg time, 108 days). and 6 are still on the list. The authors recorded FEV-1, FVC. Paop, Pacoz, supplemental 02 requirement, 6-minute walking test result, right ventrtcular ejection fraction, and cardiopulmonary hemodynamics measured at right heart catheterization. Age at the time of diagnosis and the time of evaluation. sex. weight, and SCHWACHMAN score also were evaluated. These parameters were compared between group A and B. Age at time of evaluatron, sex, weight, and SCHWACHMAN score did not differ significantly between the two groups; neither did pulmonary function tests, Paoz, 6-minute walking test result, or right ventnlcular ejection fractron. Statistically significant differences were found in Pacol, heart rate at rest, mean pulmonary artery pressure, pulmonary vascular resistance, and cardiac index, Therefore it is concluded that a careful evaluation of CF candrdates for lung transplantation is useful. A deterioration in pulmonary function and quality of life are useful parameters to accept patients on the waiting list. However. priority should also be based on cardiopulmonary hemodynamics.-27zomas A. Angerporntner

Minimally Invasive Smith, J.P Jacobs, (March), 1998.

Diaphragm Plication in an Infant. C. van and R.F! Burke. Ann Thorac Surg 65842844,

The authors report the case of a 3-kg newborn with pulmonary atresta and other complex cardiac anomalies who underwent placement of a right modified Blalock-Taussig shunt. The procedure was complicated by paralysis of the right hemidiaphragm due to phrenic nerve injury. resulting in ventilator dependence Nerther the length of time of ventilator dependence nor the methods used in attempting to wean the patient were mentioned. Plication of the diaphragm was performed usmg a video-assisted endoscopic procedure. Two ports were used. consisting of a 2-cm working incision placed at the level of the diaphragm in the midaxillary Iine and a 4-mm port placed in the midaxillary line above the diaphragm. A posterior trocar was used to retract the lower lobe superiorly. Plication was performed with a suture line extending from the central tendon laterally to the chest wall. Type, size. and technique of suturing were not stated. The child was extubated on the first postoperative day, underwent subsequent bidirectional cavopulmonary anatstamsosis at age 8 months, and was alive and well at 13 months of age. Refinements in minimally invasive instrumentation and surgical techmque may result m wider application of these techniques in children requiring surgical procedures on the diaphragm. Additional details of the patient’s hospital course and the technical aspects of the procedure would have been helpful.--inichnel M. Fuenfer

ALIMENTARY

TRACT

Eosinophilic Gastroenteritis Mimicking phic Pyloric Stenosis. B.H. Hummer-Ehret, Oleszczuk-Raschke, et al. Pediatr Radio1 1998.

Idiopathic HypertroWK. Rohrschnelde< K. 28:711-713. (September),

The authors report on three patients who initially presented with symptoms and ultrasound findings similar to idiopathic hypertrophic pyloric stenosis (IHPS), but the final diagnosis was eosinophilic gastroenteritis (EG). The first patient, a grrl, started projectile vomiting at the age of 3 weeks. She underwent two pyloromyotomy procedures before transfer to the authors’ institution. Therapeutic trials with atropine, hydrolysed cows milk formula, and endoscopic dilatation did not improve the clinical condition. Blood eosinophiha was elevated to 21%, which raised the suspicion of EG. Hence, corticosteroids were commenced. which quickly improved the clinical symptoms. However, hypertrophy of the pyloric muscle persisted for more than 7 months. The second patient, also a girl. presented with vomiting at age 5 months. Ultrasound findings suggested pyloric hypertrophy, plus marked thickening of small bowel loops and antrum. There was a blood eosinophilia of 42%. Vormting ceased soon after the commencement of steroids. and an early follow-up ultrasound examination showed improvement For the third patrent, a lo-week-old boy, histological con&nation of the diagnosis was obtained. The authors suggest that eosinophilic gastroenterms should be considered in the differential dtagnosrs of IHPS, especially if pyloromyotomy has failed.-A.B. Mathur Qualitative and Quantitative Analysis of Synapses sprung’s Disease. B. Wiedenmunn, C. Riedel, M. John. Surg Int 13:468-473, (September), 1998.

in Hirschet al. Pediatr

The aim of this study was to analyze the distribution of synaptophysin in aganglionic bowel and to quantitatively assess the synaptophysin content. Aganglionic bowel specimens were obtained from eight cases with Hirschsprung’s disease (HD) Gangliomc bowel from three cases with HD and normal colon from SIX cases (obtained at time of resection for colorectal carcinoma) served as control tissue. Specimens were examined with acetylcholinesterase (AChE) histochemistry and immunohistochemistry, with antibodies raised against synaptophysin, neuro-