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The records of 31 consecutively treated children who had mediastinal masses were prospectively evaluated with computed tomography (CT) measurements of tracheal cross-sectional area and pulmonary function testing. The authors’ purpose was to evaluate the use of these tests to determine the extent of respiratory compromise in children with anterior mediastinal masses. A variable group of mediastinal masses was studied; Hodgkin’s disease had the greatest representation (19 patients). Tumor size and exact position are not mentioned in the report. Eleven patients had significant pulmonary restriction, defined by total lung capacity measurement of less than 75% of the predicted value. Eight had peak expiratory flow rate (PEFR) reductions of greater than 50%. In 28 of the 34 evaluations, the tracheal areas were greater than 50% of predicted. However, that measurement did not identify all patients who had significant impairment of pulmonary function. Five patients had PEFR of less than 50% of predicted for tracheal areas greater than 50% of predicted. General anesthesia was tolerated in children whose tracheal area and PEFR were greater than 50% of predicted. The study did not evaluate whether pulmonary function would be predictive of respiratory collapse because all patients with 50% reduction of either parameter were excluded from general anesthesia and operated on under local anesthesia.Thomas
F. Tracy, Jr
Extra-Lobar Pulmonary Sequestration With Prenatal Diagnosis. A Report of 5 Cases and Review of the Literature. B. Plattner, B. Haustein, B. Llanas, et al. Em J Pediatr Surg 51235-237,
(August), 1995. Five cases of extralobar pulmonary sequestration (ELPS) were diagnosed prenatally. In two the prenatal diagnosis was based on the presence of a left suprarenal mass for which tumor markers proved negative postnatally. These two infants underwent surgery at 3 weeks of age for supposed neuroblastoma or teratoma. In the other three cases the diagnosis was based on the presence of a solid mass at the base of the left thorax. The systemic vessel was visualized in two of these cases. Mediastinal displacement was noted in one case, and hydrothorax in another. The infant with hydrothorax was born at 34 weeks, and the hydrothorax disappeared postnatally after excision of the ELPS. The other two infants were asymptomatic at birth and underwent surgery on the eighth day and during the sixth month, respectively. Supradiaphragmatic ELPS can be complicated prenatally by hydrothorax or even hydrops, requiring drainage in utero. If the infant is asymptomatic postnatally, surgical excision should be considered. ELPS is a mass of nonfunctional lung tissue vascularized by an abnormal systemic artery and covered with a pleural layer isolating it from the rest of the parenchyma. The diagnosis of these malformations is based increasingly on obstetric ultrasonography.-Thomas A. Angerpointner Videothoracoscopic rax. E. Schippers,
Treatment for Spontaneous PneumothoA. Tittel, S. Truong, et al. Chirurgie 651722-725,
(August), 1994. The authors present the indications for thoracoscopic treatment of spontaneous pneumothorax and note that adequate instruments for children are now available. The report is an additional contribution to thoracoscopic procedures. The acceptance of the surgical treatment of spontaneous pneumothorax (SPT) has been tempered by the serious trauma of thoracotomy. Development of video equipment and miniaturized instruments now allows thoracoscopic resection of bulla with minimal access. Twenty-five patients with either recurrent SPT (15), primary resistant SPT (5) or first SPT (5) were treated thoracospically. Bullae resection was performed with Roeder ligature or an Endo-GIA. Pleurodesis was induced by
ABSTRACTS
mechanical irritation or coagulation of the upper thoracic aperture with the argon laser. Postoperative lung reinflation was rapid and without patchy collapse. The need for drug analgesia was reduced dramatically, and the patients were mobilized on the first postoperative day. They were discharged on the fourth postoperative day. The major complications were an incidence of hemothorax and a recurrence of SPT. The advantages of thoracoscopic surgical treatment are rapid, full expansion of the lung, decreased postoperative pain, short postoperative hospital stay, and early return to normal activity.-G.H. Willital ALIMENTARY
TRACT
Long-Term Functional Results and Quality of Life After Colon Interposition for Long-Gap Esophageal Atresia. B.M. Ure, E. Slany, E.P. Eypasch, et al. Eur .I Pediatr Surg 5:206-210, (August),
1995. Of a series of 146 patients with esophageal atresia, nine (6.2%) underwent colon interposition. All eight surviving patients had follow-up evaluation after a mean of 22 years. Three patients were free of specific symptoms according to the criteria of DeMeester, two had moderate distress, and three had severe distress. The mean time for consuming a standard test meal was 15 minutes, compared with 8 minutes for healthy controls. The patients required 1 to 9 minutes to transport liquid barium through the transplant, compared with 5 10 seconds for controls. Histological evaluation showed normal architecture of the colonic and ileal epithelium in three patients who underwent endoscopy. In none of the patients were contractions in the graft related to the act of swallowing recorded on manometry. Unimpaired quality of life was indicated by the Spitzer index; the mean score was 9 out of 10 points. However, on a lOO-point visual analogue scale, the patients’ global quality of life was 66 and their mean gastrointestinal quality of life index was 92.2, compared with 107.6 for healthy controls. This impairment was exclusively related to specific symptoms that scored 49.3 in patients and 59 in healthy individuals. Physical and social functions, emotions, and inconvenience of medical treatment were similar for patients and controls. It is concluded that colon interposition for long-gap esophageal atresia achieves acceptable long-term functional results. However, specific symptoms lead to considerable impairment of life quality.--Thomas A. Angerpointner
Operative Management Nielsen, E. Arnbjomsson
of Duodenal et al. Pediatr
Atresia.
E. Waever,
O.H.
Surg Int 10:322-324, (July),
1995. The authors present the results for 67 neonates operated on at two hospitals (in Sweden and Denmark) between 1969 and 1991. Most patients had surgery within 3 days of birth. Forty percent had Down’s syndrome. Thirty-five patients had a diaphragm (type I); others had blind ends with or without a fibrous connection between them. The mean hospital stay was 25 days. Duodeno-duodenostomy (DD) was performed on 22 neonates, and 45 had duodenojejunostomy (DJ). There were no significant complications in the immediate postoperative period and no deaths. Three children had surgery at a later date because of adhesive obstruction. There was no difference in outcome between the two groups of patients (DD or DJ). The authors discuss briefly the various surgical options available and conclude that there appears to be no difference between performing a DD or DJ anastomosis. The decision to perform one or the other may be made at the time of surgery, by the individual surgeon, depending the anatomy of the patient.-P. Puri