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Psychological determinants of infantile pyloric stenosis
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resulted in successful delayed esophageal anastomosis thereby avoiding the need for colonic esophageal replacement and, thus, greatly facilitating the repair of the anorectal agenesis. The results obtained utilizing this method are then compared with the reported results seen in patients managed by colonic interposition. The author concludes that every attempt should be made to effect an esophageal anastomosis as colonic interposition procedures carry a high early mortality and also a high late complication rate. The pertinent literature on which this statement is based is presented in the article.--M. R. Q. Davies T w o Cases of Congenital Esophageal Stenosis Due to Tracheobronchial Remnants With Associated Malformations.
T. Nishina. S. Makino, K. Yokomori, et al. J Jap Soc Pediatr Surg 14:563 568 (June), 1978. The authors experienced five cases of congenital esophageal stenosis due to tracheobronchial remnants. Two of these five cases had associated malformations, ano-vestibular fistula in one, microophthalmos with iris coloboma of the left eye in another. Among 56 cases of congenital esophageal stenosis due to tracheobronchial remnants reported in the Japanese literature, associated malformations were found in seven cases (12.5%). These were: imperforate anus in 2, congenital esophageal atresia in 2, Meckel's diverticulum in one, Down's syndrome in one, and microophthlmos with iris coloboma in one. Incidence of associated malformations in congenital esophageal atresia reported in the Japanese literature is 143 per 416 cases (34.4%).--H. Suzuki Tracheal Compression as a Cause of Respiratory Symptoms After Repair of Esophageal Atresia. R. C. M. Cook and G. H.
Bush. Arch Dis Child 53:246-248 (March), 1978. A 4-mo-old female presented after repair of esophageal atresia and TEF with episodes of coughing, apnea, and cyanosis. Bronchoscopy revealed left lateral and anterior flattening that was pulsatile. Cine angiograms revealed compromise of the tracheal lumen with each pulsation. After suturing the adventitia of the aorta and great vessels to the manubrium the obstruction was relieved. Early endoscopy is recommended for the post TEF repair infant with significant upper respiratory symptoms.--Randall W. Powell
ABSTRACTS
Hiatal Hernia in the Neonatal Period. H. Sa
Couto, L. Lassaletta. and J. Monereo. Rev Port Pediatr 8(4):409-426, 1977. A critical analysis of 32 patients with hiatal hernia treated in the neonatal period in the intensive care neonatal surgical unit of the pediatric surgical department of the Children's Hospital "La Paz" (Madrid) is presented. This is a retrospective study of the changes in patients submitted to medico-postural treatment between 1969 and 1976. It is important to emphazise the value of units for pre- and postoperative care of neonates. The percentage of total cures of hiatal hernia treated exclusively by medico-postural treatment was, however, relatively low, that is, less than 20%, a l t h o u g h symptomatology disappeared almost immediately. It is, nevertheless, obligatory to control radiographically and endoscopically these patients during a long follow-up because of eventual complications. Approximately two-thirds of the patients required operation, some of which were performed in the neonatal period. The technique used was the one advocated by Monereo that has given good results without a single death.--A. G. Martins Psychological Determinants of Infantile Pyloric Stenosis. S. 1.
Revill and J. A. Dodge. Arch Dis Child 53:66-68 (January), 1978. One hundred mothers of infants with pyloric stenosis, 100 controls, and 50 mothers of children with spina bifida were tested with the Life Events Inventory to quantitatively measure stressful life events during a given period. Forty-four percent of subject mothers had at least one "weighted" stressful event during pregnancy compared with 34% of spina bifida controls and 26% of normal controls. In the last trimester of pregnancy subjects experienced almost 4 times as many weighted items as normal controls and almost 3 times as many as the spina bifida controls. The authors conclude that normal mothers subjected to an increased number of stressful events during pregnancy may have children with an increased risk of developing hypertrophic pyloric stenosis. The mechanism could possibly be through a humoral agent.--Randall W. Powell Duodenal Hematoma in Infancy and Childhood: Changing Etiology and Changing Treatment. M. M. Woolley, G. H.
Mahour, and T. Sloan. Am J Surg 136:8-14 (July), 1978. Preventable Death in Esophageal Atresia. R. J. Brereton, R.
B. Zachary and L. Spitz. Arch Dis Child 53:276-283 (April), 1978. A retrospective review of 158 cases of esophageal atresia is presented. An initial survival rate of 61% and overall survival rate of 50% was obtained. Primary repair was done in 84 patients, 21 (25%) of whom died on the initial admission. Staged primary repair was done in 34 patients with 10 survivors and only 5 patients being successfully managed by staged primary repair alone. Esophagostomy and gastrostomy were done in 23 patients with 15 (65%) survivors requiring colon interposition. Thirteen (24%) of the 55 postoperative deaths were assessed to be preventable. Early recognition and treatment of problems in these patients should lead to improved survival.--Randall W. Powell
A retrospective review of 8 patients treated at the Childrens' Hospital of Los Angeles for duodenal hematoma between 1969 and 1977 contrasted with 7 patients reported in 1969. The pathophysiology of duodenal hematoma results from compression of the duodenum against the spine by a blow on the anterior abdominal wall. Submucosal hemorrhage causes partial obstruction of the duodenum. Although a bleeding disorder with or without mild trauma can cause duodenal hematoma, most children have a history of significant blunt abdominal trauma. In the present series, all patients had a history of blunt abdominal trauma and in 4 of 8 patients the trauma was due to child battering. This is in contrast to the series reported in 1969 in which child abuse was not recognized as an etiology for duodenal hematoma. The history of upper abdominal trauma (_+ reliable in instances of child abuse) is usually
resulted in successful delayed esophageal anastomosis thereby avoiding the need for colonic esophageal replacement and, thus, greatly facilitating the repair of the anorectal agenesis. The results obtained utilizing this method are then compared with the reported results seen in patients managed by colonic interposition. The author concludes that every attempt should be made to effect an esophageal anastomosis as colonic interposition procedures carry a high early mortality and also a high late complication rate. The pertinent literature on which this statement is based is presented in the article.--M. R. Q. Davies T w o Cases of Congenital Esophageal Stenosis Due to Tracheobronchial Remnants With Associated Malformations.
T. Nishina. S. Makino, K. Yokomori, et al. J Jap Soc Pediatr Surg 14:563 568 (June), 1978. The authors experienced five cases of congenital esophageal stenosis due to tracheobronchial remnants. Two of these five cases had associated malformations, ano-vestibular fistula in one, microophthalmos with iris coloboma of the left eye in another. Among 56 cases of congenital esophageal stenosis due to tracheobronchial remnants reported in the Japanese literature, associated malformations were found in seven cases (12.5%). These were: imperforate anus in 2, congenital esophageal atresia in 2, Meckel's diverticulum in one, Down's syndrome in one, and microophthlmos with iris coloboma in one. Incidence of associated malformations in congenital esophageal atresia reported in the Japanese literature is 143 per 416 cases (34.4%).--H. Suzuki Tracheal Compression as a Cause of Respiratory Symptoms After Repair of Esophageal Atresia. R. C. M. Cook and G. H.
Bush. Arch Dis Child 53:246-248 (March), 1978. A 4-mo-old female presented after repair of esophageal atresia and TEF with episodes of coughing, apnea, and cyanosis. Bronchoscopy revealed left lateral and anterior flattening that was pulsatile. Cine angiograms revealed compromise of the tracheal lumen with each pulsation. After suturing the adventitia of the aorta and great vessels to the manubrium the obstruction was relieved. Early endoscopy is recommended for the post TEF repair infant with significant upper respiratory symptoms.--Randall W. Powell
ABSTRACTS
Hiatal Hernia in the Neonatal Period. H. Sa
Couto, L. Lassaletta. and J. Monereo. Rev Port Pediatr 8(4):409-426, 1977. A critical analysis of 32 patients with hiatal hernia treated in the neonatal period in the intensive care neonatal surgical unit of the pediatric surgical department of the Children's Hospital "La Paz" (Madrid) is presented. This is a retrospective study of the changes in patients submitted to medico-postural treatment between 1969 and 1976. It is important to emphazise the value of units for pre- and postoperative care of neonates. The percentage of total cures of hiatal hernia treated exclusively by medico-postural treatment was, however, relatively low, that is, less than 20%, a l t h o u g h symptomatology disappeared almost immediately. It is, nevertheless, obligatory to control radiographically and endoscopically these patients during a long follow-up because of eventual complications. Approximately two-thirds of the patients required operation, some of which were performed in the neonatal period. The technique used was the one advocated by Monereo that has given good results without a single death.--A. G. Martins Psychological Determinants of Infantile Pyloric Stenosis. S. 1.
Revill and J. A. Dodge. Arch Dis Child 53:66-68 (January), 1978. One hundred mothers of infants with pyloric stenosis, 100 controls, and 50 mothers of children with spina bifida were tested with the Life Events Inventory to quantitatively measure stressful life events during a given period. Forty-four percent of subject mothers had at least one "weighted" stressful event during pregnancy compared with 34% of spina bifida controls and 26% of normal controls. In the last trimester of pregnancy subjects experienced almost 4 times as many weighted items as normal controls and almost 3 times as many as the spina bifida controls. The authors conclude that normal mothers subjected to an increased number of stressful events during pregnancy may have children with an increased risk of developing hypertrophic pyloric stenosis. The mechanism could possibly be through a humoral agent.--Randall W. Powell Duodenal Hematoma in Infancy and Childhood: Changing Etiology and Changing Treatment. M. M. Woolley, G. H.
Mahour, and T. Sloan. Am J Surg 136:8-14 (July), 1978. Preventable Death in Esophageal Atresia. R. J. Brereton, R.
B. Zachary and L. Spitz. Arch Dis Child 53:276-283 (April), 1978. A retrospective review of 158 cases of esophageal atresia is presented. An initial survival rate of 61% and overall survival rate of 50% was obtained. Primary repair was done in 84 patients, 21 (25%) of whom died on the initial admission. Staged primary repair was done in 34 patients with 10 survivors and only 5 patients being successfully managed by staged primary repair alone. Esophagostomy and gastrostomy were done in 23 patients with 15 (65%) survivors requiring colon interposition. Thirteen (24%) of the 55 postoperative deaths were assessed to be preventable. Early recognition and treatment of problems in these patients should lead to improved survival.--Randall W. Powell
A retrospective review of 8 patients treated at the Childrens' Hospital of Los Angeles for duodenal hematoma between 1969 and 1977 contrasted with 7 patients reported in 1969. The pathophysiology of duodenal hematoma results from compression of the duodenum against the spine by a blow on the anterior abdominal wall. Submucosal hemorrhage causes partial obstruction of the duodenum. Although a bleeding disorder with or without mild trauma can cause duodenal hematoma, most children have a history of significant blunt abdominal trauma. In the present series, all patients had a history of blunt abdominal trauma and in 4 of 8 patients the trauma was due to child battering. This is in contrast to the series reported in 1969 in which child abuse was not recognized as an etiology for duodenal hematoma. The history of upper abdominal trauma (_+ reliable in instances of child abuse) is usually