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Pericarditis purulenta in children
202
ABSTRACTS
There was a male preponderance of 64%-75% and most patients were aged 3-4 me. Corticosteroid therapy usually produced a marked reduction of the hyperplasia of the thymus. This therapy led to good results in the medical department in 24 of another 27 patients, but some needed up to 3 courses of corticosteriod therapy. Irradiation was never performed because of the dangers of inducing leukemia and carcinoma. The indications for thoracotomy are: (1) swelling in the mediastinum not reacting to steroids; (2) uncertain differential diagnosis; (3) clinical symptoms not responding to corticosteroid therapy, and (4) hyperplasia persisting beyond the second year of life. Karl-Ludwig Waag Vascular Rings and Tracheobronchial Compression in Infants. H. H. Keith. Pediatr Ann 92:540 549 (August), 1977.
This is a review of the various types of vascular ring that can cause compression of the airway and esophagus. Attention is drawn to the symptoms that include not only the usual strider and opisthotonic positioning, but also episodes of reflex apnea that can also be seen in tracheomalacia and which represent an indication for surgery. She states that many cases of anomalous innominate artery will improve spontaneously with growth, but that severe cases who are suffering from attacks of apnea and severe obstruction require suspension of the innominate artery and aortic arch from the sternum as described by Gross.--David L. Collins Congenital
Lobar Emphysema. L. Weing~rtner. Paediatr
Paedol 12:33 47 (1), 1977. Referring to a series of 11 cases of congenital lobar emphysema and 6 cases of congenital pulmonary cysts, pulmonary hypoplasia with reduction of the alveoli and bronchioli is considered most important in congenital lobar emphysema, which is localized mainly in the left upper lobe. The diagnosis is made radiologically, but differentiation from multiple cysts can be difficult. In one of the author's cases a combination of both malformations was found. In lobar emphysema as well as in cystic disease surgery is indicated. Long-term results are considered to be very satisfactory. G. Brandesky Pulmonary R e s e c t i o n s in Children. T. E. Williams Jr., G. A.
Young, and J. W. Kilman. Arch Surg 112:481-483 (April), 1977.
Resection for neoplasia was necessary in only 2 of the 45 children. Indications for lobectomy include bronchiectasis, congenital cysts, lobar emphysema, right middle lobe syndrome, fibrocystic disease, chronic collapse, sequestration, and lung abscesses. Indications for pneumonectomy include cystic fibrosis, sarcoma, hypoplastic lung, h a m a r t o m a , lobar emphysema, Swyer-James syndrome, and sequestration.--Edward J. Berman
HEART A N D GREAT VESSELS Pericarditis Purulenta in Children. F. Wy/er, D. KnT~sli, M. Rulishauser, F. Stocker, J. Weber, and F. Real. Helv Paediatr Acta 32:135 140 (July), 1977.
The case histories of seven children with nontuberculous bacterial pericarditis are presented. Pneumonia was the
most common primary infection; one patient had purulent arthritis and another child was hospitalized for bacterial meningitis. All patients had high fever for 4 14 days and were critically ill on admission. Clinical symptoms included elevated s e d i m e n t a t i o n rate, weak a r t e r i a l pulses, tachycardia, cardiomegaly, enlarged liver, and imperceptible heart sounds. On the other hand, typical ECG changes (i.e., low voltage, ST-T segment elevations), pulsus paradoxus, and pericardial friction rub were present only in the minority of the cases. If the chest x-ray suggests pericardial effusion, angiocardiography, injection of radioisotopes, and echocardiography can be helpful in establishing the correct diagnosis. The authors recommend immediate surgical pericardiotomy through a sub-xiphoidal incision because needle aspiration usually is not sufficient for draining the thick fibrinous pus. During operation a reversible cardiac arrest occurred in two children. This was attributed to the myocardium depressing effect of halothane. With adequate antibiotic therapy secretion usually subsides after a few days and the drainage tube can be removed. All seven patients in this series recovered completely and no late complications (i.e., pericardial constriction or myocardial damage) were seen. The combination of early surgical drainage and antibiotics seems to be the treatment of choice for pericarditis purulenta in childrem--B, Kehrer Valve Replacement in Children and Adolescents. R. A. Me-
thews, S. C. Park, W. H. Neches, C. C. Lenox, J. R. Zuberbuhler, F. J. Fricker, R. D. Siewers, R. L. Hardesty, DI B. Lergerg, and H. T. Bahnson. J Tborac Cardiovasc Surg 73:872-876 (June), 1977.
Twenty-four children, 6 17 yr of age, received 28 artificial heart valves. The Bj~Srk-Shiley valve was used for aortic replacement and Beall valves were used in the mitral position. Fifty-four percent had rheumatic heart disease and 46% had congenital heart disease. Mortality was 33%, significantly higher than in adults.--Thomas M. HoMer Cardiopulmonary Bypass in Infants Under Four Months of
Age. S. Sugimura and A. Starr. J Thorac Cardiovasc Surg 73:894 899 (June), 1977. Thirty infants less than 4 me of age were operated upon using conventional cardiopulmonary bypass. A variety of congenital cardiac defects were repaired. Mortality was 47 %. C a r d i o p u l m o n a r y bypass w i t h o u t profound h y p o t h e r m i a is feasible for even very small infants.--Thomas M. Holder Late Results After Repair of Tetralogy of Fallot. R. A.
Poirier, D. C. McGoon, G. K. Danielson, R. B. Wallace, D. G. Ritter, D. S. Moodie, and C. G. Wiltse. J Thorac Cardiovasc Surg 73:900 908 (June), 1977.
During a 17-yr period, 311 patients had total correction of their tetralogy of Fallot at the Mayo Clinic. Early mortality was 8%. Late results were excellent in 80%, fair in 10%, and poor in 3%. Late disease related mortality was 3%. Recommendations were: (1) to achieve as near as possible a complete relief of the pulmonary stenosis even if pulmonary insufficiency occurred and an outflow tract patch was required, and (2) to avoid substitute pulmonary valves until long-term fate of such valves is known. Thomas M. Holder
ABSTRACTS
There was a male preponderance of 64%-75% and most patients were aged 3-4 me. Corticosteroid therapy usually produced a marked reduction of the hyperplasia of the thymus. This therapy led to good results in the medical department in 24 of another 27 patients, but some needed up to 3 courses of corticosteriod therapy. Irradiation was never performed because of the dangers of inducing leukemia and carcinoma. The indications for thoracotomy are: (1) swelling in the mediastinum not reacting to steroids; (2) uncertain differential diagnosis; (3) clinical symptoms not responding to corticosteroid therapy, and (4) hyperplasia persisting beyond the second year of life. Karl-Ludwig Waag Vascular Rings and Tracheobronchial Compression in Infants. H. H. Keith. Pediatr Ann 92:540 549 (August), 1977.
This is a review of the various types of vascular ring that can cause compression of the airway and esophagus. Attention is drawn to the symptoms that include not only the usual strider and opisthotonic positioning, but also episodes of reflex apnea that can also be seen in tracheomalacia and which represent an indication for surgery. She states that many cases of anomalous innominate artery will improve spontaneously with growth, but that severe cases who are suffering from attacks of apnea and severe obstruction require suspension of the innominate artery and aortic arch from the sternum as described by Gross.--David L. Collins Congenital
Lobar Emphysema. L. Weing~rtner. Paediatr
Paedol 12:33 47 (1), 1977. Referring to a series of 11 cases of congenital lobar emphysema and 6 cases of congenital pulmonary cysts, pulmonary hypoplasia with reduction of the alveoli and bronchioli is considered most important in congenital lobar emphysema, which is localized mainly in the left upper lobe. The diagnosis is made radiologically, but differentiation from multiple cysts can be difficult. In one of the author's cases a combination of both malformations was found. In lobar emphysema as well as in cystic disease surgery is indicated. Long-term results are considered to be very satisfactory. G. Brandesky Pulmonary R e s e c t i o n s in Children. T. E. Williams Jr., G. A.
Young, and J. W. Kilman. Arch Surg 112:481-483 (April), 1977.
Resection for neoplasia was necessary in only 2 of the 45 children. Indications for lobectomy include bronchiectasis, congenital cysts, lobar emphysema, right middle lobe syndrome, fibrocystic disease, chronic collapse, sequestration, and lung abscesses. Indications for pneumonectomy include cystic fibrosis, sarcoma, hypoplastic lung, h a m a r t o m a , lobar emphysema, Swyer-James syndrome, and sequestration.--Edward J. Berman
HEART A N D GREAT VESSELS Pericarditis Purulenta in Children. F. Wy/er, D. KnT~sli, M. Rulishauser, F. Stocker, J. Weber, and F. Real. Helv Paediatr Acta 32:135 140 (July), 1977.
The case histories of seven children with nontuberculous bacterial pericarditis are presented. Pneumonia was the
most common primary infection; one patient had purulent arthritis and another child was hospitalized for bacterial meningitis. All patients had high fever for 4 14 days and were critically ill on admission. Clinical symptoms included elevated s e d i m e n t a t i o n rate, weak a r t e r i a l pulses, tachycardia, cardiomegaly, enlarged liver, and imperceptible heart sounds. On the other hand, typical ECG changes (i.e., low voltage, ST-T segment elevations), pulsus paradoxus, and pericardial friction rub were present only in the minority of the cases. If the chest x-ray suggests pericardial effusion, angiocardiography, injection of radioisotopes, and echocardiography can be helpful in establishing the correct diagnosis. The authors recommend immediate surgical pericardiotomy through a sub-xiphoidal incision because needle aspiration usually is not sufficient for draining the thick fibrinous pus. During operation a reversible cardiac arrest occurred in two children. This was attributed to the myocardium depressing effect of halothane. With adequate antibiotic therapy secretion usually subsides after a few days and the drainage tube can be removed. All seven patients in this series recovered completely and no late complications (i.e., pericardial constriction or myocardial damage) were seen. The combination of early surgical drainage and antibiotics seems to be the treatment of choice for pericarditis purulenta in childrem--B, Kehrer Valve Replacement in Children and Adolescents. R. A. Me-
thews, S. C. Park, W. H. Neches, C. C. Lenox, J. R. Zuberbuhler, F. J. Fricker, R. D. Siewers, R. L. Hardesty, DI B. Lergerg, and H. T. Bahnson. J Tborac Cardiovasc Surg 73:872-876 (June), 1977.
Twenty-four children, 6 17 yr of age, received 28 artificial heart valves. The Bj~Srk-Shiley valve was used for aortic replacement and Beall valves were used in the mitral position. Fifty-four percent had rheumatic heart disease and 46% had congenital heart disease. Mortality was 33%, significantly higher than in adults.--Thomas M. HoMer Cardiopulmonary Bypass in Infants Under Four Months of
Age. S. Sugimura and A. Starr. J Thorac Cardiovasc Surg 73:894 899 (June), 1977. Thirty infants less than 4 me of age were operated upon using conventional cardiopulmonary bypass. A variety of congenital cardiac defects were repaired. Mortality was 47 %. C a r d i o p u l m o n a r y bypass w i t h o u t profound h y p o t h e r m i a is feasible for even very small infants.--Thomas M. Holder Late Results After Repair of Tetralogy of Fallot. R. A.
Poirier, D. C. McGoon, G. K. Danielson, R. B. Wallace, D. G. Ritter, D. S. Moodie, and C. G. Wiltse. J Thorac Cardiovasc Surg 73:900 908 (June), 1977.
During a 17-yr period, 311 patients had total correction of their tetralogy of Fallot at the Mayo Clinic. Early mortality was 8%. Late results were excellent in 80%, fair in 10%, and poor in 3%. Late disease related mortality was 3%. Recommendations were: (1) to achieve as near as possible a complete relief of the pulmonary stenosis even if pulmonary insufficiency occurred and an outflow tract patch was required, and (2) to avoid substitute pulmonary valves until long-term fate of such valves is known. Thomas M. Holder