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Pediatric lateral ventral (spigelian) hernias
INTERNATIONAL ABSTRACTS Pediatric Lateral Ventral (Spigelian) Hernias. L. Graivier, B. Bronsther, N.R. Feins, et al. South Med J 81:325-326, (March), 1988.
Lateral ventral (spigelian) hernias may not be recognized if the physician is unaware that they can occur in pediatric patients. Diagnosis depends on finding a protrusion in the spigelian fascia lateral to the rectus sheath at the junction of the arcuate and semilunar lines below the umbilicus. Nine such cases are reported, bringing the total of recorded pediatric cases to 18. Surgical repair involves a layered overlappir~g closure using interrupted nonabsorbable sutures. Since the rim of the defect is extremely difficult to define once the child is asleep and relaxed, it must be outlined in indelible ink while the child is awake and straining.--George Holcomb, Jr Pediatric Abdominal Trauma: Evaluation by Computed Tomography. N.M. Kane, J.J. Cronan, G.S. Dorfman, et al. Pediatrics
82:11-15, (July), 1988. The authors describe their experience with the use of computed tomography (CT) of the abdomen and pelvis to evaluate children following blunt abdominal trauma. During a 2-year period, 100 consecutive pediatric patients were examined with CT. Twentyseven abdominal and pelvic CTs were abnormal. Findings included nine splenic fractures, six renal contusions, nine hepatic lacerations, one duodenal hematoma, one traumatic pancreatitis, four bony injuries, one intraperitoneal bleed, and six miscellaneous or incidental findings. Only two patients required abdominal surgery. Both children had splenic injuries and were treated with splenorrhaphy. The remaining 25 patients included six with hepatic lacerations, five with splenic lacerations, and three with both hepatic and splenic injury who were treated conservatively based on a stable clinical state and the extent of injury as delineated by CT. The splenic injury in one child was missed because of motion artifact. The authors conclude that CT is the radiographic examination of choice for hemodynamically stable pediatric patients following blunt abdominal trauma.--Martin R. Eichelberger and George Taylor GENITOURINARY TRACT Annual Meeting of the Section on Pediatric Urology. K.I. Glass-
berg. Pediatrics 81:588-594, (April), 1988. The author summarizes a range of reports presented at the Section of Urology meeting in November 1986. The topics discussed include fetal obstructive uropathy (sensitivity of ultrasound, efficacy of in utero treatment), varicocele (association with infertility, alternatives to surgery), cryptorchidism (lutenizing hormone/releasing hormone therapy), epididymitis (association with urogenital anomalies), neonatal testicular torsion (contralateral fixation), vesicoureteral reflux (antibiotic therapy, nuclear medicine cystography, sibling reflux, subureteric Teflon injection), dysfunctional voiding (etiology, biofeedback, cerebral palsy) antibiotic prophylaxis (complications, compliance), Wilms' tumor, renal dysgenesis (terminology and classification), technologic advances in diagnosis and therapy, bladder augmentation, and surgical techniques. Many of the reports presented have subsequently been published in the Journal o f Urology (138:941-1127, 1987 [suppl].--Jeffrey Zitsman Neonatal Circumcision and Penile Problems: An 8-Year Longitudinal Study. D.M. Fergusson, J.M. Lawton, and F.T. Shannon.
Pediatrics 81:537-541, (April), 1988. As part of a longitudinal study of child health and development, 635 boys were tracked over 8 years to evaluate the association of penile problems with circumcision. Eighty-seven percent of the patients completed the study. Uncircumcised boys had a higher rate of penile problems overall (18.8% v 11.1%). Circumcised children
141 were more likely to have problems in infancy (5.5% v 1.1%), whereas uncircumcised boys had problems more frequently after the first year (17.7% v 5.6%). Penile inflammation was the most common problem, occurring almost twice as frequently in uncircumcised males. Phimosis was the second most common problem, followed by inadequate circumcision. Despite the higher incidence in uncircumcised children, the authors note that the problems these boys encounter are not of sufficient magnitude to mandate routine neonatal circumcision.--Jeffrey Zitsman Unsuspected Urological Anomalies in Asymptomatie Cryptorchid Boys. C.H. Pappas, S.A. Argianas, D. Bousgas, et al. Pediatr Radiol
18:51-53, (January), 1988. In an effort to investigate the association of urologic abnormalities with cryptorchidism, the authors prospectively investigated boys who were asymptomatic for any such urinary problems. Routine orchiopexy was carried out, and on the third postoperative day, an intravenous pyelogram (IVP) was performed. There were 144 boys, and the mean age was 7 years. Minor abnormalities were found in 25% and major abnormalities in 5.5% (eight boys). A major defect was defined as one in which there was a significant loss of renal substance or where operative correction for conservation of renal substance was necessary. With regard to use of the IVP, the authors state that ultrasonic investigation was not available at the time of the study. Because of the significant incidence of urologic abnormalities, the authors recommend imaging of the urinary tract by one modality or another, even in the asymptomatic cryptorchid male.--Thomas V. Whalen Morphologic Effects of 0rchiopexy or Orchiectomy on the Contralateral Testis in Experimental Unilateral Cryptorcbidism. F.T.
Satman, S. Adkins, and E.W. Fonkalsrud. N Engl J Med 103:573578, (May), 1988. Unilateral cryptorchidism was produced in 21-day-old mice by suturing the left testis to the inner abdominal wall, while a sham operation was performed in 20 control mice (S). Subsequent orchiopexy (P) or orcbidectomy (O) was performed at 2 weeks, (group I), or 10 weeks (group ll). Both testes were removed in all animals for examination 2 weeks after orchiopexy or orchiectomy, and at the same time in the sham group. The testicular weights, seminiferous tubular diameters, and tubular biopsy scores of the contralateral O testis were not statistically different from the values in the contralateral S testis ( P > .01 ). The tubular biopsy scores of the contral~teral P and S testis were similar in group I ( P > .01), but were significantly different in group 11 (P < .01). The contralateral testicle is protected when orchiopexy is performed within 2 weeks, but it is not protected after 10 weeks. It is only benefitted morphologically and functionally by orchiectomy at this later date.--Eugene S. Wiener Acute Scrotal Abnormalities in Children: Diagnosis by Combined Sonography and Scintigraphy. D.L. Mueller, G.M. Amundson, S.Z.
Rubin, et al. A JR 150:643-646, (March), 1988. Forty-three patients (mean age, 8 years) who presented with acute scrotal pathology compatible with acute torsion underwent the usual scintigraphy. To this was added ultrasonography to see if any additional information was obtained that altered therapy. Only seven patients (16%) were found to have torsion. Epididymitis or orchitis was the most common diagnosis, occurring in 16 (37%). Ultrasound was shown to significantly alter the diagnosis in six patients. Three patients had central "cold" defects on the scan, which were compatible with torsion, but the defects were readily explained on a sonogram by the presence of hydroceles. Two patients who had normal scans, which would have ruled out torsion, were seen on ultrasound to have evidence of recent torsion with subsequent
Lateral ventral (spigelian) hernias may not be recognized if the physician is unaware that they can occur in pediatric patients. Diagnosis depends on finding a protrusion in the spigelian fascia lateral to the rectus sheath at the junction of the arcuate and semilunar lines below the umbilicus. Nine such cases are reported, bringing the total of recorded pediatric cases to 18. Surgical repair involves a layered overlappir~g closure using interrupted nonabsorbable sutures. Since the rim of the defect is extremely difficult to define once the child is asleep and relaxed, it must be outlined in indelible ink while the child is awake and straining.--George Holcomb, Jr Pediatric Abdominal Trauma: Evaluation by Computed Tomography. N.M. Kane, J.J. Cronan, G.S. Dorfman, et al. Pediatrics
82:11-15, (July), 1988. The authors describe their experience with the use of computed tomography (CT) of the abdomen and pelvis to evaluate children following blunt abdominal trauma. During a 2-year period, 100 consecutive pediatric patients were examined with CT. Twentyseven abdominal and pelvic CTs were abnormal. Findings included nine splenic fractures, six renal contusions, nine hepatic lacerations, one duodenal hematoma, one traumatic pancreatitis, four bony injuries, one intraperitoneal bleed, and six miscellaneous or incidental findings. Only two patients required abdominal surgery. Both children had splenic injuries and were treated with splenorrhaphy. The remaining 25 patients included six with hepatic lacerations, five with splenic lacerations, and three with both hepatic and splenic injury who were treated conservatively based on a stable clinical state and the extent of injury as delineated by CT. The splenic injury in one child was missed because of motion artifact. The authors conclude that CT is the radiographic examination of choice for hemodynamically stable pediatric patients following blunt abdominal trauma.--Martin R. Eichelberger and George Taylor GENITOURINARY TRACT Annual Meeting of the Section on Pediatric Urology. K.I. Glass-
berg. Pediatrics 81:588-594, (April), 1988. The author summarizes a range of reports presented at the Section of Urology meeting in November 1986. The topics discussed include fetal obstructive uropathy (sensitivity of ultrasound, efficacy of in utero treatment), varicocele (association with infertility, alternatives to surgery), cryptorchidism (lutenizing hormone/releasing hormone therapy), epididymitis (association with urogenital anomalies), neonatal testicular torsion (contralateral fixation), vesicoureteral reflux (antibiotic therapy, nuclear medicine cystography, sibling reflux, subureteric Teflon injection), dysfunctional voiding (etiology, biofeedback, cerebral palsy) antibiotic prophylaxis (complications, compliance), Wilms' tumor, renal dysgenesis (terminology and classification), technologic advances in diagnosis and therapy, bladder augmentation, and surgical techniques. Many of the reports presented have subsequently been published in the Journal o f Urology (138:941-1127, 1987 [suppl].--Jeffrey Zitsman Neonatal Circumcision and Penile Problems: An 8-Year Longitudinal Study. D.M. Fergusson, J.M. Lawton, and F.T. Shannon.
Pediatrics 81:537-541, (April), 1988. As part of a longitudinal study of child health and development, 635 boys were tracked over 8 years to evaluate the association of penile problems with circumcision. Eighty-seven percent of the patients completed the study. Uncircumcised boys had a higher rate of penile problems overall (18.8% v 11.1%). Circumcised children
141 were more likely to have problems in infancy (5.5% v 1.1%), whereas uncircumcised boys had problems more frequently after the first year (17.7% v 5.6%). Penile inflammation was the most common problem, occurring almost twice as frequently in uncircumcised males. Phimosis was the second most common problem, followed by inadequate circumcision. Despite the higher incidence in uncircumcised children, the authors note that the problems these boys encounter are not of sufficient magnitude to mandate routine neonatal circumcision.--Jeffrey Zitsman Unsuspected Urological Anomalies in Asymptomatie Cryptorchid Boys. C.H. Pappas, S.A. Argianas, D. Bousgas, et al. Pediatr Radiol
18:51-53, (January), 1988. In an effort to investigate the association of urologic abnormalities with cryptorchidism, the authors prospectively investigated boys who were asymptomatic for any such urinary problems. Routine orchiopexy was carried out, and on the third postoperative day, an intravenous pyelogram (IVP) was performed. There were 144 boys, and the mean age was 7 years. Minor abnormalities were found in 25% and major abnormalities in 5.5% (eight boys). A major defect was defined as one in which there was a significant loss of renal substance or where operative correction for conservation of renal substance was necessary. With regard to use of the IVP, the authors state that ultrasonic investigation was not available at the time of the study. Because of the significant incidence of urologic abnormalities, the authors recommend imaging of the urinary tract by one modality or another, even in the asymptomatic cryptorchid male.--Thomas V. Whalen Morphologic Effects of 0rchiopexy or Orchiectomy on the Contralateral Testis in Experimental Unilateral Cryptorcbidism. F.T.
Satman, S. Adkins, and E.W. Fonkalsrud. N Engl J Med 103:573578, (May), 1988. Unilateral cryptorchidism was produced in 21-day-old mice by suturing the left testis to the inner abdominal wall, while a sham operation was performed in 20 control mice (S). Subsequent orchiopexy (P) or orcbidectomy (O) was performed at 2 weeks, (group I), or 10 weeks (group ll). Both testes were removed in all animals for examination 2 weeks after orchiopexy or orchiectomy, and at the same time in the sham group. The testicular weights, seminiferous tubular diameters, and tubular biopsy scores of the contralateral O testis were not statistically different from the values in the contralateral S testis ( P > .01 ). The tubular biopsy scores of the contral~teral P and S testis were similar in group I ( P > .01), but were significantly different in group 11 (P < .01). The contralateral testicle is protected when orchiopexy is performed within 2 weeks, but it is not protected after 10 weeks. It is only benefitted morphologically and functionally by orchiectomy at this later date.--Eugene S. Wiener Acute Scrotal Abnormalities in Children: Diagnosis by Combined Sonography and Scintigraphy. D.L. Mueller, G.M. Amundson, S.Z.
Rubin, et al. A JR 150:643-646, (March), 1988. Forty-three patients (mean age, 8 years) who presented with acute scrotal pathology compatible with acute torsion underwent the usual scintigraphy. To this was added ultrasonography to see if any additional information was obtained that altered therapy. Only seven patients (16%) were found to have torsion. Epididymitis or orchitis was the most common diagnosis, occurring in 16 (37%). Ultrasound was shown to significantly alter the diagnosis in six patients. Three patients had central "cold" defects on the scan, which were compatible with torsion, but the defects were readily explained on a sonogram by the presence of hydroceles. Two patients who had normal scans, which would have ruled out torsion, were seen on ultrasound to have evidence of recent torsion with subsequent