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Preventing wound infection after appendicectomy: A review
716
INTERNATIONAL ABSTRACTS
fluids and antibiotics and decompression of the esophagus by a nasogastric tube or gastrostomy with proximal esophageal tube. A tube thoracostomy was indicated in only one child when the perforation extended into the pleural space. A thoracotomy was used to treat the one child who presented late with intrathoracic abscesses. Esophageal perforations in children can be successfully managed with a conservative approach.--Marleta Reynolds What Happens to the Pylorus After Pyloromyotomy? N.M. Okorie, J.A.S. Dickson, R.A. Carver, et al. Arch Dis Child 63:1339-1340, (November), 1988.
Twenty-five babies with infantile hypertrophic pyloric stenosis diagnosed during surgery and 24 control patients were studied by serial ultrasound scanning to assess pyloric volume and pyloric muscle index (volume divided by the weight of the baby in kilograms). The patients were studied up to 14 weeks postoperatively. The pyloric muscle index took up to 12 weeks to achieve a normal range.--D.M. Burge Intramural Duodenal Hematoma in Children: Reappraisal of Current Management. C.A. Thorns and R.R. Ricketts. South Med J
81:985-988, (August), 1988. In children, intramural duodenal hematomas resulting from blunt abdominal trauma are generally managed nonoperatively with nasogastric suction and parenteral nutrition. Experience with three cases in which this form of treatment failed caused the authors to reappraise its benefits and results. Consequently, it is now recommended that surgical evacuation of intramural duodenal hematomas be accomplished for children in whom there is no evidence of partial resolution of the obstruction after five days, or of complete resolution after ten days of conservative management.--George W. Holcomb, Jr The Split Notochord Syndrome: Alpha and Omega, D.J.
Byrne,
P.A. Grace, and R.J. Fitzgerald. Pediatr Sarg Int 4:52-55, (December), 1988. Two cases of split notochord syndrome are described. Each patient presented with different clinical features that can be attributed to similar embryological defects. One infant presented with a covered lumbosacral meningocele, caudal to which lay isolated, exposed small-bowel mucosa. This is the second such case described in the literature. The second child presented with respiratory difficulties and was found to have a long thoracoabdominal bowel duplication. Each child had surgical treatment of the abnormalities, and both remain well with no neurological deficits at 6 and 3 years, respectively. The abnormalities are explained as consequences of a division of the notochord resulting in abnormal endo-ectodermal adhesion. Surgery is advocated for excision of an unacceptable skin lesion, spinal dysraphism, and because of the risks of hemorrhage and neoplasm.--Prem Purl Necrotizing Enteroeolitis in Term Infants. S. Silberman, R. Udassin, O. Zamir, et al. Pediatr Surg Int 4:35-38, (December), 1988.
Nine full-term infants developed necrotizing enterocolitis (NEC) at a mean age of 33/4months. In six, NEC developed following severe diarrhea. One infant had major congenital heart disease. Two were in apparently good health before developing rapidly progressing NEC. Two infants died before surgery was feasible, one survived without an operation, and only one of six infants survived following surgical treatment. Awareness that NEC can occur in full-term infants may enable early diagnosis and treatment, and may reduce the high mortality associated with this uncommon disease.--Prem Purl
A Surgical Condition, D. Wilson-Storey, G.A. MacKinlay, S. Prescott, et al. J R Coil Surg Edinb 33:270-273, (October), 1988. Intussusception:
In 18 years, 125 patients with intussusception were admitted to the Children's Hospital, Edinburgh. Seventy percent were <1 year of age; the sex distribution was equal. Abdominal pain, vomiting, and blood and mucus per rectum were the presenting features in most cases. Two thirds had a palpable mass. In the latter part of the review, ultrasound was used to identify the mass. Seventy-six had a barium enema; less than half of these underwent successful reduction. There were no perforations. Seventy-five percent required surgery either electively or following failed enema. Ten had resection, which was not related to the length of history. A definite Cause of intussusception was found in only four patients. There were four recurrences. Half the patients were referred initially to a medical service. Barium enema redaction by an experienced radiologist backed by available operating theater access is recommended. Barium enema is not advised where the history is longer than 24 hours, in the presence of obstruction or peritonitis, or in older patients.--W.G. Scobie Intussusception: Clinical Prediction of Outcome of Barium Reduction. F. Bettenay, S.W. Beasley, J.F. De Campo, et al. Ansi N Z J
Surg 58:899-902, (November), 1988. The authors reviewed the records of 602 patients with 630 episodes of intussusception (occurring between 1970 and 1985). Two groups of patients were compared--those successfully treated with hydrostatic reduction (n = 200), and those who required surgery and bowel resection irrespective of their initial treatment. The following features were noted in each group: age, symptoms (diarrhea, vomiting, abdominal pain, respiratory symptoms within 2 weeks), signs (abdominal distension, abdominal mass, blood per rectum, dehydration >5%, fever, rectal mass, pallor), and abdominal x-ray findings. The four features that most accurately predicted that a bowel resection would be required were age (<3 months, >2 years), duration of symptoms for more than 24 hours, the presence of small bowel obstruction on radiographs, and dehydration >5%. The authors state that patients with three or more adverse features have a high resection rate and a low chance of successful enema reduction. It is appropriate to avoid hydrostatic reduction in this group and in patients with obvious peritonitis.--Patricia M. Davidson Preventing Wound Infection After Appendicectomy: A Review.
Z.H. Krukowski, S.T. Irwin, S. Denholm, et al. Br J Surg 75:10231033, (October), 1988. The authors reviewed the literature over the past 25 years. Antibiotics reduced the frequency of wound sepsis with evidence, favoring a spectrum of antibacterial activity against aerobic and anarobic organisms. Topical antiseptics were found to have no significant effect, but topical antibiotics were beneficial. The varying results achieved with similar antibiotic regimens indicated the importance of technical and operator-related factors in determining the frequency of wound sepsis.--John D. Orr Defective White Blood Cell Function in Hirschsprung's Disease: A Possible Predisposing Factor to Enterocolitis. /). Wilson-Storey,
W.G. Scobie, and J.A. Raeburn. J R Coil Surg Edinb 33:185-188, (August), 1988. The authors examined the immunological mechanisms in children with Hirschsprung's disease. Nine children with this disease, five of whom either had or subsequently developed enterocolitis, were compared with ten age-matched controls. Total WBC counts were estimated, and the absolute neutrophil count in uncomplicated
INTERNATIONAL ABSTRACTS
fluids and antibiotics and decompression of the esophagus by a nasogastric tube or gastrostomy with proximal esophageal tube. A tube thoracostomy was indicated in only one child when the perforation extended into the pleural space. A thoracotomy was used to treat the one child who presented late with intrathoracic abscesses. Esophageal perforations in children can be successfully managed with a conservative approach.--Marleta Reynolds What Happens to the Pylorus After Pyloromyotomy? N.M. Okorie, J.A.S. Dickson, R.A. Carver, et al. Arch Dis Child 63:1339-1340, (November), 1988.
Twenty-five babies with infantile hypertrophic pyloric stenosis diagnosed during surgery and 24 control patients were studied by serial ultrasound scanning to assess pyloric volume and pyloric muscle index (volume divided by the weight of the baby in kilograms). The patients were studied up to 14 weeks postoperatively. The pyloric muscle index took up to 12 weeks to achieve a normal range.--D.M. Burge Intramural Duodenal Hematoma in Children: Reappraisal of Current Management. C.A. Thorns and R.R. Ricketts. South Med J
81:985-988, (August), 1988. In children, intramural duodenal hematomas resulting from blunt abdominal trauma are generally managed nonoperatively with nasogastric suction and parenteral nutrition. Experience with three cases in which this form of treatment failed caused the authors to reappraise its benefits and results. Consequently, it is now recommended that surgical evacuation of intramural duodenal hematomas be accomplished for children in whom there is no evidence of partial resolution of the obstruction after five days, or of complete resolution after ten days of conservative management.--George W. Holcomb, Jr The Split Notochord Syndrome: Alpha and Omega, D.J.
Byrne,
P.A. Grace, and R.J. Fitzgerald. Pediatr Sarg Int 4:52-55, (December), 1988. Two cases of split notochord syndrome are described. Each patient presented with different clinical features that can be attributed to similar embryological defects. One infant presented with a covered lumbosacral meningocele, caudal to which lay isolated, exposed small-bowel mucosa. This is the second such case described in the literature. The second child presented with respiratory difficulties and was found to have a long thoracoabdominal bowel duplication. Each child had surgical treatment of the abnormalities, and both remain well with no neurological deficits at 6 and 3 years, respectively. The abnormalities are explained as consequences of a division of the notochord resulting in abnormal endo-ectodermal adhesion. Surgery is advocated for excision of an unacceptable skin lesion, spinal dysraphism, and because of the risks of hemorrhage and neoplasm.--Prem Purl Necrotizing Enteroeolitis in Term Infants. S. Silberman, R. Udassin, O. Zamir, et al. Pediatr Surg Int 4:35-38, (December), 1988.
Nine full-term infants developed necrotizing enterocolitis (NEC) at a mean age of 33/4months. In six, NEC developed following severe diarrhea. One infant had major congenital heart disease. Two were in apparently good health before developing rapidly progressing NEC. Two infants died before surgery was feasible, one survived without an operation, and only one of six infants survived following surgical treatment. Awareness that NEC can occur in full-term infants may enable early diagnosis and treatment, and may reduce the high mortality associated with this uncommon disease.--Prem Purl
A Surgical Condition, D. Wilson-Storey, G.A. MacKinlay, S. Prescott, et al. J R Coil Surg Edinb 33:270-273, (October), 1988. Intussusception:
In 18 years, 125 patients with intussusception were admitted to the Children's Hospital, Edinburgh. Seventy percent were <1 year of age; the sex distribution was equal. Abdominal pain, vomiting, and blood and mucus per rectum were the presenting features in most cases. Two thirds had a palpable mass. In the latter part of the review, ultrasound was used to identify the mass. Seventy-six had a barium enema; less than half of these underwent successful reduction. There were no perforations. Seventy-five percent required surgery either electively or following failed enema. Ten had resection, which was not related to the length of history. A definite Cause of intussusception was found in only four patients. There were four recurrences. Half the patients were referred initially to a medical service. Barium enema redaction by an experienced radiologist backed by available operating theater access is recommended. Barium enema is not advised where the history is longer than 24 hours, in the presence of obstruction or peritonitis, or in older patients.--W.G. Scobie Intussusception: Clinical Prediction of Outcome of Barium Reduction. F. Bettenay, S.W. Beasley, J.F. De Campo, et al. Ansi N Z J
Surg 58:899-902, (November), 1988. The authors reviewed the records of 602 patients with 630 episodes of intussusception (occurring between 1970 and 1985). Two groups of patients were compared--those successfully treated with hydrostatic reduction (n = 200), and those who required surgery and bowel resection irrespective of their initial treatment. The following features were noted in each group: age, symptoms (diarrhea, vomiting, abdominal pain, respiratory symptoms within 2 weeks), signs (abdominal distension, abdominal mass, blood per rectum, dehydration >5%, fever, rectal mass, pallor), and abdominal x-ray findings. The four features that most accurately predicted that a bowel resection would be required were age (<3 months, >2 years), duration of symptoms for more than 24 hours, the presence of small bowel obstruction on radiographs, and dehydration >5%. The authors state that patients with three or more adverse features have a high resection rate and a low chance of successful enema reduction. It is appropriate to avoid hydrostatic reduction in this group and in patients with obvious peritonitis.--Patricia M. Davidson Preventing Wound Infection After Appendicectomy: A Review.
Z.H. Krukowski, S.T. Irwin, S. Denholm, et al. Br J Surg 75:10231033, (October), 1988. The authors reviewed the literature over the past 25 years. Antibiotics reduced the frequency of wound sepsis with evidence, favoring a spectrum of antibacterial activity against aerobic and anarobic organisms. Topical antiseptics were found to have no significant effect, but topical antibiotics were beneficial. The varying results achieved with similar antibiotic regimens indicated the importance of technical and operator-related factors in determining the frequency of wound sepsis.--John D. Orr Defective White Blood Cell Function in Hirschsprung's Disease: A Possible Predisposing Factor to Enterocolitis. /). Wilson-Storey,
W.G. Scobie, and J.A. Raeburn. J R Coil Surg Edinb 33:185-188, (August), 1988. The authors examined the immunological mechanisms in children with Hirschsprung's disease. Nine children with this disease, five of whom either had or subsequently developed enterocolitis, were compared with ten age-matched controls. Total WBC counts were estimated, and the absolute neutrophil count in uncomplicated