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Periumbilical pain secondary to persistent urachal band
948
INTERNATIONAL ABSTRACTS
Prenatally Diagnosed Gastroschisis--A Preliminary Report Advocating the Use of Elective Caesarean Section. S. Hagberg, K-H.
associated with micturation should include persistence of a urachal band.--George W. Holcomb III
H~kegard, A. Rubenson, et al. Z Kinderchir 43:419-421, (December), 1988.
Pelvic Inflammatory Disease in Adolescents. N. Golden, S. Neu-
Seven cases of prenatally diagnosed gastroschisis are described. All infants were delivered by elective cesarian section and brought to the operating room immediately after birth where the abdominal wall was closed within one hour postpartum. Primary closure was easy and successful in all cases. The average duration of postoperative total parenteral nutrition (seven days) and hospital stay (18 days) was significantly shorter in this prenatally diagnosed group as compared with traditionally treated cases. The authors, therefore, recommend strongly the management of gastroschisis with prenatal diagnosis, subsequent elective cesarian section, and immediate surgery.-- Thomas A. ,4ngerpointner Myocutaneous Sartorius Flap for Major Congenital Abdominal
Wall Defects. P.K.H. Tam and HI. Wei. Pediatr Surg Internat 4:143-146, (February), 1989. Management of giant omphalocele/gastroschisisremains unsatisfactory. Primary fascial closure is not always possible, prosthetic applications lead to problems of infection and separation, and escharification or skin closure results in ventral hernias. The authors have therefore investigated the possible use of myocutaneous flaps in such situations. The myocutaneous flap, comprising a skin pedicle isolated along with the underlying muscle, has two major attractions: (1) the good blood supply minimizes risks of infection and flap separation, and (2) the muscle pedicle provides a strong faseialmuscular closure. The flap has to fulfill four criteria: (1) it must be viable, (2) it must provide adequate coverage, (3) it must reach the defect, and (4) its transposition should not result in functional disability of the organ from which it originates. Based on an anatomical study of 29 postmortem specimens in eight neonates and two adults, including contrast injections, the authors have found the sartorius musculocutaneous flap to be the ideal solution. The sartorius muscle is relatively more bulky in neonates than in adults. The major blood supply, which enters between its upper third and lower two thirds, can maintain a 7 • 3 cm flap. With the hips immobilized in flexion, the flap can reach the xiphisternum without tension. This study suggests that it is feasible to repair neonatal abdominal wall defects of up to 7 • 6 cm by sartorius musculocutaneous flaps. In particular, this approach appears ideally suited for reconstruction in cloacal exstrophy and for secondary repair of ventral hernias resulting from escharification, skin closure alone, or failed prosthetic applications in giant omphalocele/gastroschisis.--Prem Purl External Pneumatic Compression in the Late Repair of Exomphalos Major. R.G. Taylor and P.G. Jones. Pediatr Surg Internat 4:107-
109, (February), 1989. External pneumatic compression has been used in ten cases of exomphalos major where the initial treatment resulted in a progressively enlarging skin-covered sac and coelomic cavity of diminishing capacity. The method has been used successfully in eight cases as preparation for a single-stage repair of a large ventral hernia.-Prem Puri Periumbilical Pain Secondary to Persistent Urachal Band. L.D. Knoll, R.A. Pustka, J.R. Anderson, et al. Urology 32:526-528, (December), 1988.
An 8-year-old boy with periumbilical pain associated with micturation was found to have a persistent urachal band. Surgical excision of the urachus resulted in resolution of the symptoms. The authors remind us that the differential diagnosis of periumbilical pain
hoff, and tt. Cohen. J Pediatr 114:138-143, (January), 1988. Clinical, laboratory, and sonographic data were collected prospectively from 100 female adolescents hospitalized with acute pelvic inflammatory disease (PID). The endocervical isolation rates for Chlamydia trachornatis and Neisseria gonorrhoeae were 44.7% and 36.4%, respectively. In comparison with adolescents with chlamydiaassociated P1D, those with gonococcus-associated PID had a shorter duration of pain before admission (P < .05), higher mean maximum temperature (P < .01), and higher leukocyte counts (P < .01). Pelvic ultrasound studies showed adnexal enlargement of tubo-ovarian abscess (TOA) in 85.2% of the patients. In 12 of 17 adolescents, the abscesses were identified sonographically before being diagnosed clinically. With clinical criteria alone, only the leukocyte count and prior history of PID differed significantly between those with TOA and those with uncomplicated PID. These findings support a more liberal use of pelvic ultrasound studies in teenagers with PID. A high detection rate of C trachomatis and the difficulty in predicting the cause of the infection in an individual patient support treating all adolescents with PID with agents effective against both C trachomatis and N gonorrhoeae.--G. 14/. Holcomb, Jr GENITOURINARY TRACT Experience With 1-Stage Repair of Hypospadias and Chordee Using Free Graft of Prepuce. W.H. Hendren and C.E. Horton, Jr. J
Urol 140:1259-1264, (November), 1988. From August 1978 to September 1987 a total of 103, 1-stage hypospadias-chordeeoperations were performed using a free graft of prepuce by the method of Devine and Horton. There were 94 primary cases and nine secondary cases in which prior operations had been performed. Chordee was mild in 11 patients, moderate in 67, and severe in 25. The meatus was at the distal shaft in 56 patients, midshaft in 34, and penoscrotal in I3. All patients underwent temporary perineal urethrostomy diversion of the urine. Postoperative complications included six fistulas that required closure and three meatal stenoses treated by meatotomy. There were no strictures, residual chordee, or other complications. The authors found that the Devine-Horton technique gave an essentially normal-appearing penis with a low overall complication rate.--George Holcomb, Jr The Gap (Glans Approximation Procedure) for Glanular/Coronal Hypospadias. M.R. Zaontz. J Urol 141:359-361, (February), 1989.
A modified glanuloplasty is described for the selective repair of glanular and coronal hypospadias with a wide, deep glanular groove and noncompliant urethral meatus. No urinary diversion is required, and cosmetic and functional results are excellent. A total of 24 children underwent the glans approximation procedure during 20 months. Follow-up ranged from 3 months to 1.5 years with no evidence of meatal or urethral stenosis. One distal glanular fistula developed that required division of a 2 mm skin bridge that separated the fistulous opening from the neomeatus.--George Holcomb, Jr The Value of Ultrasound Screening of the Upper Urinary Tract in Hypospadias, M. Davenport and ,,I.E. MacKinnon. Br J Urol
62:595-596, (December), 1988. Ultrasonography of the upper renal tract was performed in 82 children with varying degrees of hypospadias. There were two true positive results (2.4%) and one false negative (1.2%). The authors
INTERNATIONAL ABSTRACTS
Prenatally Diagnosed Gastroschisis--A Preliminary Report Advocating the Use of Elective Caesarean Section. S. Hagberg, K-H.
associated with micturation should include persistence of a urachal band.--George W. Holcomb III
H~kegard, A. Rubenson, et al. Z Kinderchir 43:419-421, (December), 1988.
Pelvic Inflammatory Disease in Adolescents. N. Golden, S. Neu-
Seven cases of prenatally diagnosed gastroschisis are described. All infants were delivered by elective cesarian section and brought to the operating room immediately after birth where the abdominal wall was closed within one hour postpartum. Primary closure was easy and successful in all cases. The average duration of postoperative total parenteral nutrition (seven days) and hospital stay (18 days) was significantly shorter in this prenatally diagnosed group as compared with traditionally treated cases. The authors, therefore, recommend strongly the management of gastroschisis with prenatal diagnosis, subsequent elective cesarian section, and immediate surgery.-- Thomas A. ,4ngerpointner Myocutaneous Sartorius Flap for Major Congenital Abdominal
Wall Defects. P.K.H. Tam and HI. Wei. Pediatr Surg Internat 4:143-146, (February), 1989. Management of giant omphalocele/gastroschisisremains unsatisfactory. Primary fascial closure is not always possible, prosthetic applications lead to problems of infection and separation, and escharification or skin closure results in ventral hernias. The authors have therefore investigated the possible use of myocutaneous flaps in such situations. The myocutaneous flap, comprising a skin pedicle isolated along with the underlying muscle, has two major attractions: (1) the good blood supply minimizes risks of infection and flap separation, and (2) the muscle pedicle provides a strong faseialmuscular closure. The flap has to fulfill four criteria: (1) it must be viable, (2) it must provide adequate coverage, (3) it must reach the defect, and (4) its transposition should not result in functional disability of the organ from which it originates. Based on an anatomical study of 29 postmortem specimens in eight neonates and two adults, including contrast injections, the authors have found the sartorius musculocutaneous flap to be the ideal solution. The sartorius muscle is relatively more bulky in neonates than in adults. The major blood supply, which enters between its upper third and lower two thirds, can maintain a 7 • 3 cm flap. With the hips immobilized in flexion, the flap can reach the xiphisternum without tension. This study suggests that it is feasible to repair neonatal abdominal wall defects of up to 7 • 6 cm by sartorius musculocutaneous flaps. In particular, this approach appears ideally suited for reconstruction in cloacal exstrophy and for secondary repair of ventral hernias resulting from escharification, skin closure alone, or failed prosthetic applications in giant omphalocele/gastroschisis.--Prem Purl External Pneumatic Compression in the Late Repair of Exomphalos Major. R.G. Taylor and P.G. Jones. Pediatr Surg Internat 4:107-
109, (February), 1989. External pneumatic compression has been used in ten cases of exomphalos major where the initial treatment resulted in a progressively enlarging skin-covered sac and coelomic cavity of diminishing capacity. The method has been used successfully in eight cases as preparation for a single-stage repair of a large ventral hernia.-Prem Puri Periumbilical Pain Secondary to Persistent Urachal Band. L.D. Knoll, R.A. Pustka, J.R. Anderson, et al. Urology 32:526-528, (December), 1988.
An 8-year-old boy with periumbilical pain associated with micturation was found to have a persistent urachal band. Surgical excision of the urachus resulted in resolution of the symptoms. The authors remind us that the differential diagnosis of periumbilical pain
hoff, and tt. Cohen. J Pediatr 114:138-143, (January), 1988. Clinical, laboratory, and sonographic data were collected prospectively from 100 female adolescents hospitalized with acute pelvic inflammatory disease (PID). The endocervical isolation rates for Chlamydia trachornatis and Neisseria gonorrhoeae were 44.7% and 36.4%, respectively. In comparison with adolescents with chlamydiaassociated P1D, those with gonococcus-associated PID had a shorter duration of pain before admission (P < .05), higher mean maximum temperature (P < .01), and higher leukocyte counts (P < .01). Pelvic ultrasound studies showed adnexal enlargement of tubo-ovarian abscess (TOA) in 85.2% of the patients. In 12 of 17 adolescents, the abscesses were identified sonographically before being diagnosed clinically. With clinical criteria alone, only the leukocyte count and prior history of PID differed significantly between those with TOA and those with uncomplicated PID. These findings support a more liberal use of pelvic ultrasound studies in teenagers with PID. A high detection rate of C trachomatis and the difficulty in predicting the cause of the infection in an individual patient support treating all adolescents with PID with agents effective against both C trachomatis and N gonorrhoeae.--G. 14/. Holcomb, Jr GENITOURINARY TRACT Experience With 1-Stage Repair of Hypospadias and Chordee Using Free Graft of Prepuce. W.H. Hendren and C.E. Horton, Jr. J
Urol 140:1259-1264, (November), 1988. From August 1978 to September 1987 a total of 103, 1-stage hypospadias-chordeeoperations were performed using a free graft of prepuce by the method of Devine and Horton. There were 94 primary cases and nine secondary cases in which prior operations had been performed. Chordee was mild in 11 patients, moderate in 67, and severe in 25. The meatus was at the distal shaft in 56 patients, midshaft in 34, and penoscrotal in I3. All patients underwent temporary perineal urethrostomy diversion of the urine. Postoperative complications included six fistulas that required closure and three meatal stenoses treated by meatotomy. There were no strictures, residual chordee, or other complications. The authors found that the Devine-Horton technique gave an essentially normal-appearing penis with a low overall complication rate.--George Holcomb, Jr The Gap (Glans Approximation Procedure) for Glanular/Coronal Hypospadias. M.R. Zaontz. J Urol 141:359-361, (February), 1989.
A modified glanuloplasty is described for the selective repair of glanular and coronal hypospadias with a wide, deep glanular groove and noncompliant urethral meatus. No urinary diversion is required, and cosmetic and functional results are excellent. A total of 24 children underwent the glans approximation procedure during 20 months. Follow-up ranged from 3 months to 1.5 years with no evidence of meatal or urethral stenosis. One distal glanular fistula developed that required division of a 2 mm skin bridge that separated the fistulous opening from the neomeatus.--George Holcomb, Jr The Value of Ultrasound Screening of the Upper Urinary Tract in Hypospadias, M. Davenport and ,,I.E. MacKinnon. Br J Urol
62:595-596, (December), 1988. Ultrasonography of the upper renal tract was performed in 82 children with varying degrees of hypospadias. There were two true positive results (2.4%) and one false negative (1.2%). The authors