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Staphylococcal pneumonia in infants and children
INTERNATIONAL
hyperthyroidism antithyroid
instead
of medication
drugs.-George
W. Hobtd,
TION. hl. Jaubert and P. Defrenne.
with Jr.
115-121, THORAX CARClNohlA OF BREAST IN YOUNG GIRLS. hf. B. Ciose and N. G. Maxima. Arch. Surg.
91:386,
93
ABSTRACTS OF PEDIATRIC SURGERY
1965.
Only nine authentic cases of carcinoma of the breast in girls under 20 have been found in the literature. Under the age of 15, the incidence of carcinoma of the breast is about the same in girls as in boys. Two new cases are added. The first, age 14, had a right radical mastectomy for adenocarcinoma, duct cell type, medullary variety. There were three positive axillary nodes. Thio-tepa, 15 mg., was given at the timr of surgery. This was repeated six days later. Radiation therapy also was employed. Metastases occurred. Bilateral oophorectomy was performed nine months after radical mastectomy. Death occurred eleven months approximately thirteen after mastectomy, months after the first tumefaction was noticed. The second patient, age 17, underwent radical mastectomy, with 35 nodes found positive. Radiation therapy was given. Approximately two and a half years later, the patient was readmitted with carcinoma of the opposite breast. Wedge resection was performed. A downhill course eventuated in death four and a half years after mastectomy. The authors conclude: “All discrete breast masses including those in the younger age group should be removed for pathological examination.“-Edward .l. Berman (Editor’s Note: The appearance of a breast bud beneath the nipple on one or both sides in children of either sex before puberty or at the time of puberty should not be treater1 surgically as a breast tumor. In girls, this mass may remain for a period of time and disappear or may persist until it merges with the pubertal enlargement of the breast. In boys, this mass usually recedes and requires no treatment.)
de Beaujeu, I’. Mollwd Ann. Chir. Infant. 6:
1965.
The authors discuss acute respiratory distress in newborn infants in cases of congenital malformations of the thoracic wall (2 cases), diaphragm ( I8 cases), great vessels ( 1 case), lungs (3 cases) and esophagus (45 cases ) .-id. Better A
CASE OF UI’PER STERNAL CLEFT AsSOCIATED WITH ANCIOMATOSIS OF THE TRACHEA. P. lngelrans and P. Debeugny. Ann. Chir. Infant.
6:123-128,
1965.
The authors give a detailed description of their case: cleft of the upper part of the sternum and angiomatosis of the face and the upper part of the thorax on the middle line. The child was in a state of acute respiratory distress and had to be operated upon in emergency at the age of four weeks. But the angiomatosis extended to the trachea and the child died of a tracheal hemorrhage.-M. Betiex ASPHYSIATINC.
THORACIC DYSTROPHY ( JEUNE’S DISEASE)-AN ATTEMPT OF CORRECTIVESURGERY.P. Durand, S. Blas-
tragostino, A. Razzi and F. A. Gimelli. Minerva Pediat. 17: 1437, 1965. Seventeen cases of cited in the literature.
Jeune’s disease are The additional case
herein described was a two and a half month old female. Because of the severe malformation of the chest and impairment of respiration, a two-stage superiostal resection of three ribs on the left side and of four ribs on the right side was performed. After a slight improvement, the patient died of pneumonia two and a half months after surgery. Autopsy revealed severe changes at the condro-costal junction, and reduction and degenerative changes of the anterior ganglion cells of the medulla.-C. Montagnuni STAPHYLOCOCCA~ PNEUMONIA IN INFANTS ANZ) CHILDREN. R. McBurney and Joseph Akin, Jr. Amer. Surg. 31:541, 1965.
ACUTE REsPmAToRY INSUFFICIENCY IN THE Ninety-one cases are reported: 91 per cent CONSIDERATIONS PERIOD: NEONATAL ABOUT RESPIHATORY INSUFFICIENCY DUE of the organisms were resistant to penicillin, 58 per cent were resistant to tetracycline TO A “Low” CONGENITAL MALFORMA-
94
INTERNATIONAL
and 29 per cent were resistant to chloramphenicol. Prompt surgical management of
ABSTRACTS
OF PEDIATRIC
SURGERY
found to be a 2.5 cm. diverticulum of the pericardium. The lesion was excised uneventfully.-CoIin C. Ferguson
were asymptomatic and twenty-nine were symptomatic, with vomiting occurring in twenty-eight, bleeding in thirteen, esophageal obstruction in eleven and pain in two. Roentgen studies demonstrated anatomic as well as functional abnormalities at the esophagogastric junction; however, there was no correlation between hernia size and severity of symptoms. The authors emphasize that persistent neonatal vomiting is an indication for appropriate roentgen studies to rule out hiatal hernia. In such infants, where a hiatal hernia can be demonstrated as the cause of vomiting, postural treatment often makes the infant asymptomatic. Hematemesis, melena, or anemia indicate esophagitis due to reflux and are indications for surgical consultation. Transthoracic repair of the hernia in uncomplicated cases gives good results. With esophagitis and esophageal stricture, dilation
DIWRTICULIJ~~ OF THE LEFT VENTRICLE. E. El-Akkari, M. K. B. El-Din and A. S.
may be of some value, but esophagectomy and bowel interposition have given best results.
complications man
is required.-Edward
.I. Be+
DIVERTICULUM OF THE PERICARDIUM.M. N.
Srouji and Surg.
W.
8:296,
T.
Mustard.
Canad.
J,
1965.
A chest roentgenogram of a 12 year old boy suffering from asthma revealed an abnormal density on the left side of the cardiac shadow near the apex. An aneurysm of the left ventricle was suspected. Complete investigation, including angiocardiography, however, was negative. An exploratory thoracotomy was performed and the mass was
Kassem. A case verticulum
Arch.
Dis.
Child.
40:545,
1965.
is described of a congenital diof the left ventricle which pro-
truded through a defect in the diaphragm behind the xiphoid process into a large epigastric hernia. The hernia was covered with thin, pigmented skin. At operation the diverticulum was excised and the diaphragmatic defect and the hernia were repaired. The child died from ventricular fibrillation shortly after operation. Autopsy revealed a large ventricular septal defect. The condition is due to an abnormality of the septum transversum, which normally gives rise to the basilar part of the pericardium, the ventral part of the diaphragm and the ventral cephalic portion of the abdominal wall. If the epimyocardium of the cardiac loop fuses to the septum transversum, a cardiac diverticulum develops when the septum descends.-.I.
H. Johnston
ESOPHAGEAL HIATUS HEHNIA IN INFANCY AND CHILDHOOD. George H. Humphreys, P. D. Wiedel, D. H. Baker and W. E. B&n.
Pediatrics
36:351-358,
1965.
The diagnosis of esophageal hiatus hernia was established in thirty-four infants and children I2 years of age and less during the twenty year period from 1943 to 1963 at Babies Hospital in New York City. Five
Sixteen of the thirty-four patients were treated without operation. Twelve of these had a good or a fair result, and two died. Eighteen patients were operated upon; twenty-three operations were performed. The result in fifteen patients was good; seven of these were treated by simple transthoracic herniorrhaphy and eight by esophagectomy and bowel interposition. Five operations failed, and reoperation was done. There were two deaths.-W. Sieber
HEART
AND
GREAT
VESSELS
SUCCESSFUL “CORRECTION” OF TRANSPOSED GREAT ARTERIES BY MUSTARD’S OPERATION. Eoin Aberdeen, David J. Waterston, Ian Carr, Gerald Graham, R. E. BonhamCartm and S. Subramanian. Lancet 2: 1233-1235,
1965.
The successful operative correction of transposed great arteries in seven children is reported in this article. A functionally normal circulation was achieved by rerouting the blood within the atria. The method used to redirect the blood flow within the atria was Mustards technic with certain modifications introduced by the authors. All children in the series had an atria1 septal defect created by the technic of Blalock and Hanlon. All the children had care-
hyperthyroidism antithyroid
instead
of medication
drugs.-George
W. Hobtd,
TION. hl. Jaubert and P. Defrenne.
with Jr.
115-121, THORAX CARClNohlA OF BREAST IN YOUNG GIRLS. hf. B. Ciose and N. G. Maxima. Arch. Surg.
91:386,
93
ABSTRACTS OF PEDIATRIC SURGERY
1965.
Only nine authentic cases of carcinoma of the breast in girls under 20 have been found in the literature. Under the age of 15, the incidence of carcinoma of the breast is about the same in girls as in boys. Two new cases are added. The first, age 14, had a right radical mastectomy for adenocarcinoma, duct cell type, medullary variety. There were three positive axillary nodes. Thio-tepa, 15 mg., was given at the timr of surgery. This was repeated six days later. Radiation therapy also was employed. Metastases occurred. Bilateral oophorectomy was performed nine months after radical mastectomy. Death occurred eleven months approximately thirteen after mastectomy, months after the first tumefaction was noticed. The second patient, age 17, underwent radical mastectomy, with 35 nodes found positive. Radiation therapy was given. Approximately two and a half years later, the patient was readmitted with carcinoma of the opposite breast. Wedge resection was performed. A downhill course eventuated in death four and a half years after mastectomy. The authors conclude: “All discrete breast masses including those in the younger age group should be removed for pathological examination.“-Edward .l. Berman (Editor’s Note: The appearance of a breast bud beneath the nipple on one or both sides in children of either sex before puberty or at the time of puberty should not be treater1 surgically as a breast tumor. In girls, this mass may remain for a period of time and disappear or may persist until it merges with the pubertal enlargement of the breast. In boys, this mass usually recedes and requires no treatment.)
de Beaujeu, I’. Mollwd Ann. Chir. Infant. 6:
1965.
The authors discuss acute respiratory distress in newborn infants in cases of congenital malformations of the thoracic wall (2 cases), diaphragm ( I8 cases), great vessels ( 1 case), lungs (3 cases) and esophagus (45 cases ) .-id. Better A
CASE OF UI’PER STERNAL CLEFT AsSOCIATED WITH ANCIOMATOSIS OF THE TRACHEA. P. lngelrans and P. Debeugny. Ann. Chir. Infant.
6:123-128,
1965.
The authors give a detailed description of their case: cleft of the upper part of the sternum and angiomatosis of the face and the upper part of the thorax on the middle line. The child was in a state of acute respiratory distress and had to be operated upon in emergency at the age of four weeks. But the angiomatosis extended to the trachea and the child died of a tracheal hemorrhage.-M. Betiex ASPHYSIATINC.
THORACIC DYSTROPHY ( JEUNE’S DISEASE)-AN ATTEMPT OF CORRECTIVESURGERY.P. Durand, S. Blas-
tragostino, A. Razzi and F. A. Gimelli. Minerva Pediat. 17: 1437, 1965. Seventeen cases of cited in the literature.
Jeune’s disease are The additional case
herein described was a two and a half month old female. Because of the severe malformation of the chest and impairment of respiration, a two-stage superiostal resection of three ribs on the left side and of four ribs on the right side was performed. After a slight improvement, the patient died of pneumonia two and a half months after surgery. Autopsy revealed severe changes at the condro-costal junction, and reduction and degenerative changes of the anterior ganglion cells of the medulla.-C. Montagnuni STAPHYLOCOCCA~ PNEUMONIA IN INFANTS ANZ) CHILDREN. R. McBurney and Joseph Akin, Jr. Amer. Surg. 31:541, 1965.
ACUTE REsPmAToRY INSUFFICIENCY IN THE Ninety-one cases are reported: 91 per cent CONSIDERATIONS PERIOD: NEONATAL ABOUT RESPIHATORY INSUFFICIENCY DUE of the organisms were resistant to penicillin, 58 per cent were resistant to tetracycline TO A “Low” CONGENITAL MALFORMA-
94
INTERNATIONAL
and 29 per cent were resistant to chloramphenicol. Prompt surgical management of
ABSTRACTS
OF PEDIATRIC
SURGERY
found to be a 2.5 cm. diverticulum of the pericardium. The lesion was excised uneventfully.-CoIin C. Ferguson
were asymptomatic and twenty-nine were symptomatic, with vomiting occurring in twenty-eight, bleeding in thirteen, esophageal obstruction in eleven and pain in two. Roentgen studies demonstrated anatomic as well as functional abnormalities at the esophagogastric junction; however, there was no correlation between hernia size and severity of symptoms. The authors emphasize that persistent neonatal vomiting is an indication for appropriate roentgen studies to rule out hiatal hernia. In such infants, where a hiatal hernia can be demonstrated as the cause of vomiting, postural treatment often makes the infant asymptomatic. Hematemesis, melena, or anemia indicate esophagitis due to reflux and are indications for surgical consultation. Transthoracic repair of the hernia in uncomplicated cases gives good results. With esophagitis and esophageal stricture, dilation
DIWRTICULIJ~~ OF THE LEFT VENTRICLE. E. El-Akkari, M. K. B. El-Din and A. S.
may be of some value, but esophagectomy and bowel interposition have given best results.
complications man
is required.-Edward
.I. Be+
DIVERTICULUM OF THE PERICARDIUM.M. N.
Srouji and Surg.
W.
8:296,
T.
Mustard.
Canad.
J,
1965.
A chest roentgenogram of a 12 year old boy suffering from asthma revealed an abnormal density on the left side of the cardiac shadow near the apex. An aneurysm of the left ventricle was suspected. Complete investigation, including angiocardiography, however, was negative. An exploratory thoracotomy was performed and the mass was
Kassem. A case verticulum
Arch.
Dis.
Child.
40:545,
1965.
is described of a congenital diof the left ventricle which pro-
truded through a defect in the diaphragm behind the xiphoid process into a large epigastric hernia. The hernia was covered with thin, pigmented skin. At operation the diverticulum was excised and the diaphragmatic defect and the hernia were repaired. The child died from ventricular fibrillation shortly after operation. Autopsy revealed a large ventricular septal defect. The condition is due to an abnormality of the septum transversum, which normally gives rise to the basilar part of the pericardium, the ventral part of the diaphragm and the ventral cephalic portion of the abdominal wall. If the epimyocardium of the cardiac loop fuses to the septum transversum, a cardiac diverticulum develops when the septum descends.-.I.
H. Johnston
ESOPHAGEAL HIATUS HEHNIA IN INFANCY AND CHILDHOOD. George H. Humphreys, P. D. Wiedel, D. H. Baker and W. E. B&n.
Pediatrics
36:351-358,
1965.
The diagnosis of esophageal hiatus hernia was established in thirty-four infants and children I2 years of age and less during the twenty year period from 1943 to 1963 at Babies Hospital in New York City. Five
Sixteen of the thirty-four patients were treated without operation. Twelve of these had a good or a fair result, and two died. Eighteen patients were operated upon; twenty-three operations were performed. The result in fifteen patients was good; seven of these were treated by simple transthoracic herniorrhaphy and eight by esophagectomy and bowel interposition. Five operations failed, and reoperation was done. There were two deaths.-W. Sieber
HEART
AND
GREAT
VESSELS
SUCCESSFUL “CORRECTION” OF TRANSPOSED GREAT ARTERIES BY MUSTARD’S OPERATION. Eoin Aberdeen, David J. Waterston, Ian Carr, Gerald Graham, R. E. BonhamCartm and S. Subramanian. Lancet 2: 1233-1235,
1965.
The successful operative correction of transposed great arteries in seven children is reported in this article. A functionally normal circulation was achieved by rerouting the blood within the atria. The method used to redirect the blood flow within the atria was Mustards technic with certain modifications introduced by the authors. All children in the series had an atria1 septal defect created by the technic of Blalock and Hanlon. All the children had care-