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Success of nonoperative treatment for congenital muscular torticollis is dependent on early therapy
INTERNATIONAL ABSTRACTS
cultures were negative, and evaluation included a voiding cystourethrogram. Diagnosis was lacuna magna in the area of the fossa navicularis, which was confirmed by cystoscopy. Each patient was treated endoscopically using a pediatric resectoscope and rightangle wire electrode. The valve was incised with the cutting current, and the base of the diverticulum fulgurated. The authors believe that this method of treatment is preferable to incision with tenotomy scissors. ---George W. Holcomb, Jr
Renal Transplantation Into The Dysfunctional Bladder: The Role Of Adjunctive Bladder Reconstruction. C.A. Sheldon, R. Gonzales, M.W. Bums, et al. J Urol 152:972-975, (September), 1994. A retrospective review of pediatric renal transplantation at three centers identified nine patients who had undergone major bladder reconstruction. Seven patients underwent bladder augmentation (five gastric, one colonic, one ureteral), and two received gastric neob!adders. Six patients required Mitrofanoff neourethras. Patient survival was 100%, with initial graft survival of 56% during a mean follow-up of 29.4 month s . Eight patients (89%) are presently dia!YS!s-free with functioning allografts, and all nine (100%) are continent of urine. It is concluded that renal transplantation and reconstruction to ensure continence are justifiable in even the most anatomically compromised children with end-stage renal disease. The authors believe it is essential that the pediatric urologist have an integral role in the management of such cases. ~ e o r g e W. Holcomb, Jr
Ureteral Reimplantation En Bloc for Refluxing Duplicated Ureters. 1~. Kistler, A.F. Schiirli, and H. Winiker. Pediatr Surg Int 9:373-376, (June), 1994. This is a retrospective review of 62 patients with 69 duplex units (DU) (18 right sided, 37 left sided, 7 bilateral). The age at operation was below 5 years in 47 children (75%) and included 15 infants. In all cases, reimplantation by a modified PolitanoLeadbetter procedure was performed using both ureters en bloc. In cases of bifid DU, the short common segment was resected. Follow-up was available in 66 units. Stenosis occurred in two reimplanted units, o n e of them required three reimplantations, the third being Cohen's procedure. In other unit, interpyelic anastomosis was performed in view of endangered function in the caudal unit. As determined by intravenous urography, renal function was good in all but one unit. At long-term follow-up of 5 to 16 years (35 patients with 40 DU), renal function was not impaired in any patients; 12 units showed scarring. Based on their results, the authors believe that en bloc ureteroneocyst0stomy is a safe and reliable operation. --P. Puri
Single-System Ureteral Ectopia. Associated Malformations and Management in Children Lacking an Orthotopic Ureter. A.S. Dange, S. Sen, N. Zachariah, et al. Pediatr Surg Int 9:377-380, (June), 1994. The authors present a series of six patients with bilateral singlesystem ectopic ureters and two patients with unilateral singlesystem ureteral ectopia with contralateral renal agenesis. Two renal units were agenetic, 3 were dysplastic, and 11 were functioning with varying degrees of renal damage and vesicoureteral reflux. One functioning renal unit was diverted as an end ureterostomy for severe uraemia. This patient Was lost to follow-up. The ureters of remaining functioning renal units were reimplanted by PolitanoLeadbetter or modified Cohen's techniques. One patient with a very small bladder underwent reimplantation without submucousal tunnelling but with a nipple fashioned at the ureteral end. Postoperative follow-up showed compiete cure in all boys, with good
507
continence and stable renal function. Three of the four girls are continent. One girl with cloacal malformation and sacral agenesis has to wear protective pads, although there is an improvement since operation. Based on their experience, the authors believe that the embryologically diverted bladder should be given time to prove its mettle before augmentation and bladder neck plasty is undertaken. --P. Put/
Xanthogranulomatous Pyelonephritis in Childhood: Ultrasound and Computed Tomographic Diagnosis. C. Cousins, J. Somers, N. Broderick, et al. Pediatr Radio127:210-212, (June), 1994. Four patients with diffuse xanthogranulomatous pyelonephritis are reported. Three patients presented with weight loss, anaemia, neutrophilia, and a large renal mass. A fourth patient presented with hematuria, intermittent abdominal pain, anemia, and leucocytosis. Ultrasound (US) showed massively enlarged kidney with retained reniform shape and dilated fluid spaces containing calculi. Computed tomography (CT) confirmed the US findings and revealed the "bear paw" sign, which represents either dilated calyces or focal areas of destruction filled with pus or debris. CT also showed extrarenal extension. The affected kidneys were nonfunctioning. The authors believe that an awareness of the condition, along with the typical US and CT findings, will enable more accurate preoperative diagnosis and appropriate management. mR. Surana
Dysplastic Multicystic Kidney: Should the Classic Treatment (Nephrectomy) Be Changed After Prenatal Diagnosis?E. Spain, F. Moulinie~ J.C. Mikaelian, et al. Pediatr Surg Int 9:507-510, (August), 1994. The authors report 60 patients with dysplastic multicystic kidney (DMK) managed during 1983 to 1992. A diagnosis was made prenatally in 54 (90%) patients. One fetus with bilateral DMK was aborted, and 3 died during the neonatal period because of unrelated causes. Up to 1987, all patients underwent nephrectomy. Since 1987, 8 patients (21%) underwent early nephrectomy for an abdominal mass (3), contralateral pelviureteric obstruction (2), family history of renal disease (2), and associated anomalies (VACTERL syndrome) (1). Thirty-three children were initially managed nonoperatively with 3 to 4 ultrasounds (US) during the first 2 years. Seventeen underwent nephrectomy at a mean age of 26.8 months (range 12 to 72 months), On follow-up scans, DMKs had shrunk so that they could not be visualized by US in 9 cases, and in 7 cases there was some decrease in the size (5 cases less than 18 months of age). There was no evidence of nodular renal blastema or Wilms' tumorlets in any of the surgical specimens. Because there is a potential for malignant degeneration and hypertension in patients with DMKs left in situ, and a follow-up with nonoperative management cannot assured, the authors believe that a large, mnlticenter randomised prospective study is essential for establishing the safety of a nonoperative approach. --R. Surana MUSCULOSKELETAL SYSTEM
Success of Nonoperative Treatment for Congenital Muscular Torticollis is Dependent on Early Therapy. B.H. Cameron, ].C. Langer, and G.S. Cameron. Pediatr Surg Int 9:391-393, (June), 1994. This is a retrospective review of 126 children with congenital muscular torticollis treated over a 30-year period. Eighty-eight infants were under 3 months of age; 38 presented after 3 months of age. The spectrum of severity was similar in both groups. The authors give the protocol of passive stretching exercises and follow-up for infants but not for older children. The details of prior
508
INTERNATIONAL ABSTRACTS
exercise treatment are not provided in 19 children. These may represent a group of patients in whom physiotherapy failed. Of the 88 infants, follow-up was available in 87 children (median 9 months, range 1 month to 12 years). None of these patients required surgery. This study shows a successful outcome in 88 infants with torticollis treated with passive stretching exercises. In the absence of the details of the severity of torticoUis in infancy in patients belonging to the late group, it is difficult to compare these two groups. A prospective randomized studY is necessary to confirm or refute Jones' statement, "The value of passive manipulation (for CMT) has not been proved." --R. Surana
and without placing a tape around it during surgery. Application of papaverine hydrochloride (40 mg/mL) around the artery and the administration of prostaglandin E1 0.1 mg/kg/min may be helpful. The authors state that these measures have helped to prevent these complications but do not state whether papaverine or prostaglandin was used in their patients or not, and if so, how many patients were treated in this manner. --P. Puri
Fixation After Fractures of the Sternum and Lumbar Spine in Children and Adolescents. G. MOllemhoff, M. Walz, and G. Muhr. Chirurg 64:948-952, 1993.
Forty-five patients with hepatic tumor in childhood during the past 35 years underwent clinical analysis. Thirty-six cases were malignant, and all 9 patients who did not undergo hepatic resection died. Fifteen of 27 (55.6%) patients who received hepatic resection survived. Among 22 patients with hepatoblastoma and hepatocellular carcinoma, 13 patients (59.1%) survived, 3 developed local recurrence, and 8 developed pulmonary metastasis. The longest survival was obtained in an 8-month-old boy treated with right trisegmentectomy followed by resection of pulmonary metastasis twice. He is now disease-free at the age of 20 years. The improved prognosis of hepatic tumors in childhood is mainly due to (1) the introduction of modern diagnostic imaging procedures, ie, angiography, ultras0nography, computed tomography, and magnetic resonance imaging, (2) improved technique of hepatic resection, ie, ultrasonic dissection, Pringle's method, and argon beam coagulator, and (3) the introduction of adjuvant chemotherapy (adriamycin and cisplatinum). --Takesh Miyano
Spinal column trauma with fractures of the breast and lumbar spine (2% to 3%) is relatively uncommon in the pediatric patient population (from birth to 16 years). The treatment of 22 patient s between 1978 and 1988 is reviewed. The purpose of the study was to describe the indications for operative versus nonoperative treatment, and to determine the course of treatment depending upon the age of the patient. Follow-up studies after approximately 8 years showed an improvement in the neurological status of 8 patients and a spontaneous correction of kyphotic angulation from 21 ° to 3°. The authors conclude that treatment must be individualized and depends on the age of the patient. ~ u n t e r H . WilIital NEOPLASMS
Bone Metastasis in Wilms' Tumour--Report of Three Cases and Rev,ew I . of the Literature. S. Gururangan, J.A. Wiliiams, and B.D. Fletcher. Pediatr Radio124:85-87, (April), 1994. This is a report of 3 patients (0.8% of all Wilms' tumor patients) who were found to have bone metastasis. One patient was found to have bone metastasis at diagnosis and two at relapse. The patient with a favorable histology received further chemotherapy and local radiotherapy with evidence of healing of the metastasis on computed tomography and bone scintigraphy. This patient remains disease-free 30 months from relapse. Two other patients with primary anaplastic tumors died of uncontrollable disease. --P. Puri Congenital Mesoblastic Nephroma: Treatment Options. V. Kalisdasan, A. Mammon, ].M. Hutson, et al. Pediatr Surg Int 9:524-525, (August), 1994. Five patients with congenital mesoblastic nephroma are reported. Three were treated within the first week of life. Two other patients had a cellular variant and presented at 5 and 18 months of age. Four patients were treated by nephrectomy. One newborn, who had an exophytic lesion from the lower pole, underwent partial nephrectomy. --R. Surana Renal Atrophy Following Removal of a Neuroblastoma. L Yarnagiwa, K. Obata, H. Saito, et al. Pediatr Surg Int 9:387-390, (June), 1994. The authors report 3 of 18 patients with abdominal neuroblastoma treated between 1987 and 1993 who developed "renal atrophy" or deterioration in renal function after kidney preserving surgery. The probable reason in 2 patients was impaired renal peffusion during surgery, whereas in 1 patient with pelvic neuroblastoma, the ureter was occluded by periureteral fibrosis secondary to silver clips. The authors believe that the decreased renal perfusion may be caused by either renal spasm or endothelial damage. They therefore believe that the renal artery should be handled gently
Surgical Treatment of Hepatic Tumors in Childhood. ThirtyFive Years' Experience.A. Okada, S. Kamata, M. Fukuzawa, et al. J Jpn Soc Pediatr Surg 30:35-42, 1994.
Long-Term Complications of Laparotomy in Hodgkin's Disease. M. Jackovich, N.P. Mendenhall, M.D. Sombeck, et al. Ann Surg 219:615-524, (June), 1994. The authors review the complications in 133 patients who underwent staging laparotomy and splenectomy for Hodgkin's disease (stages I to IV). Mean follow-up was 15.7 years; age range 2.5 to 28 years. There were 10 episodes of overwhelming postsplenectomy infection (OPSI) in 9 patients (6.8%), 5 of whom developed their infection within 5 years after operation. Patients with stage III and IV or recurrent disease were at greater risk; also those receiving combined modality intensive oncologic therapy. None of 25 patients who received preoperative pneumococcal vaccination developed OPSI. Surgical complications included small bowel obstruction (13), atelectasis (17), subdiaphragmatic abscess (1), and wound dehiscence (1). There were no deaths as a result of surgical complications. The authors conclude that with presplenectomy vaccination, the risks of a staging procedure are acceptable if knowledge of the pathological extent of the abdominal disease would alter treatment. John N. Schullinger Fibrous Hamartoma of Infancy in the Genital Region: Findings in 15 Cases, EJ. Popek, E.A. Montgomery, andJ.L. Fourcroy. J Urol 152:990-993, (September), 1994. Fibrous hamartoma of infancy is a benign myofibroblastic proliferation that typically occurs in the axillary or shoulder region of male infants. Fifteen cases of this condition are reported that involved the inguinal region (5), scrotum (5), spermatic cord (1), perineum (1), labium majus (1), suprapubic region (1), and pubic area (1). Patient median and mean ages were 10 and 6.7 months, respectively (range 2 to 24 months). No case was reported to be congenital. Median and mean tumor size was 3 em (range 0.5 to 6 cm). The microscopic features were identical to those seen in fibrous hamartoma of infancy occurring in more typical sites and
cultures were negative, and evaluation included a voiding cystourethrogram. Diagnosis was lacuna magna in the area of the fossa navicularis, which was confirmed by cystoscopy. Each patient was treated endoscopically using a pediatric resectoscope and rightangle wire electrode. The valve was incised with the cutting current, and the base of the diverticulum fulgurated. The authors believe that this method of treatment is preferable to incision with tenotomy scissors. ---George W. Holcomb, Jr
Renal Transplantation Into The Dysfunctional Bladder: The Role Of Adjunctive Bladder Reconstruction. C.A. Sheldon, R. Gonzales, M.W. Bums, et al. J Urol 152:972-975, (September), 1994. A retrospective review of pediatric renal transplantation at three centers identified nine patients who had undergone major bladder reconstruction. Seven patients underwent bladder augmentation (five gastric, one colonic, one ureteral), and two received gastric neob!adders. Six patients required Mitrofanoff neourethras. Patient survival was 100%, with initial graft survival of 56% during a mean follow-up of 29.4 month s . Eight patients (89%) are presently dia!YS!s-free with functioning allografts, and all nine (100%) are continent of urine. It is concluded that renal transplantation and reconstruction to ensure continence are justifiable in even the most anatomically compromised children with end-stage renal disease. The authors believe it is essential that the pediatric urologist have an integral role in the management of such cases. ~ e o r g e W. Holcomb, Jr
Ureteral Reimplantation En Bloc for Refluxing Duplicated Ureters. 1~. Kistler, A.F. Schiirli, and H. Winiker. Pediatr Surg Int 9:373-376, (June), 1994. This is a retrospective review of 62 patients with 69 duplex units (DU) (18 right sided, 37 left sided, 7 bilateral). The age at operation was below 5 years in 47 children (75%) and included 15 infants. In all cases, reimplantation by a modified PolitanoLeadbetter procedure was performed using both ureters en bloc. In cases of bifid DU, the short common segment was resected. Follow-up was available in 66 units. Stenosis occurred in two reimplanted units, o n e of them required three reimplantations, the third being Cohen's procedure. In other unit, interpyelic anastomosis was performed in view of endangered function in the caudal unit. As determined by intravenous urography, renal function was good in all but one unit. At long-term follow-up of 5 to 16 years (35 patients with 40 DU), renal function was not impaired in any patients; 12 units showed scarring. Based on their results, the authors believe that en bloc ureteroneocyst0stomy is a safe and reliable operation. --P. Puri
Single-System Ureteral Ectopia. Associated Malformations and Management in Children Lacking an Orthotopic Ureter. A.S. Dange, S. Sen, N. Zachariah, et al. Pediatr Surg Int 9:377-380, (June), 1994. The authors present a series of six patients with bilateral singlesystem ectopic ureters and two patients with unilateral singlesystem ureteral ectopia with contralateral renal agenesis. Two renal units were agenetic, 3 were dysplastic, and 11 were functioning with varying degrees of renal damage and vesicoureteral reflux. One functioning renal unit was diverted as an end ureterostomy for severe uraemia. This patient Was lost to follow-up. The ureters of remaining functioning renal units were reimplanted by PolitanoLeadbetter or modified Cohen's techniques. One patient with a very small bladder underwent reimplantation without submucousal tunnelling but with a nipple fashioned at the ureteral end. Postoperative follow-up showed compiete cure in all boys, with good
507
continence and stable renal function. Three of the four girls are continent. One girl with cloacal malformation and sacral agenesis has to wear protective pads, although there is an improvement since operation. Based on their experience, the authors believe that the embryologically diverted bladder should be given time to prove its mettle before augmentation and bladder neck plasty is undertaken. --P. Put/
Xanthogranulomatous Pyelonephritis in Childhood: Ultrasound and Computed Tomographic Diagnosis. C. Cousins, J. Somers, N. Broderick, et al. Pediatr Radio127:210-212, (June), 1994. Four patients with diffuse xanthogranulomatous pyelonephritis are reported. Three patients presented with weight loss, anaemia, neutrophilia, and a large renal mass. A fourth patient presented with hematuria, intermittent abdominal pain, anemia, and leucocytosis. Ultrasound (US) showed massively enlarged kidney with retained reniform shape and dilated fluid spaces containing calculi. Computed tomography (CT) confirmed the US findings and revealed the "bear paw" sign, which represents either dilated calyces or focal areas of destruction filled with pus or debris. CT also showed extrarenal extension. The affected kidneys were nonfunctioning. The authors believe that an awareness of the condition, along with the typical US and CT findings, will enable more accurate preoperative diagnosis and appropriate management. mR. Surana
Dysplastic Multicystic Kidney: Should the Classic Treatment (Nephrectomy) Be Changed After Prenatal Diagnosis?E. Spain, F. Moulinie~ J.C. Mikaelian, et al. Pediatr Surg Int 9:507-510, (August), 1994. The authors report 60 patients with dysplastic multicystic kidney (DMK) managed during 1983 to 1992. A diagnosis was made prenatally in 54 (90%) patients. One fetus with bilateral DMK was aborted, and 3 died during the neonatal period because of unrelated causes. Up to 1987, all patients underwent nephrectomy. Since 1987, 8 patients (21%) underwent early nephrectomy for an abdominal mass (3), contralateral pelviureteric obstruction (2), family history of renal disease (2), and associated anomalies (VACTERL syndrome) (1). Thirty-three children were initially managed nonoperatively with 3 to 4 ultrasounds (US) during the first 2 years. Seventeen underwent nephrectomy at a mean age of 26.8 months (range 12 to 72 months), On follow-up scans, DMKs had shrunk so that they could not be visualized by US in 9 cases, and in 7 cases there was some decrease in the size (5 cases less than 18 months of age). There was no evidence of nodular renal blastema or Wilms' tumorlets in any of the surgical specimens. Because there is a potential for malignant degeneration and hypertension in patients with DMKs left in situ, and a follow-up with nonoperative management cannot assured, the authors believe that a large, mnlticenter randomised prospective study is essential for establishing the safety of a nonoperative approach. --R. Surana MUSCULOSKELETAL SYSTEM
Success of Nonoperative Treatment for Congenital Muscular Torticollis is Dependent on Early Therapy. B.H. Cameron, ].C. Langer, and G.S. Cameron. Pediatr Surg Int 9:391-393, (June), 1994. This is a retrospective review of 126 children with congenital muscular torticollis treated over a 30-year period. Eighty-eight infants were under 3 months of age; 38 presented after 3 months of age. The spectrum of severity was similar in both groups. The authors give the protocol of passive stretching exercises and follow-up for infants but not for older children. The details of prior
508
INTERNATIONAL ABSTRACTS
exercise treatment are not provided in 19 children. These may represent a group of patients in whom physiotherapy failed. Of the 88 infants, follow-up was available in 87 children (median 9 months, range 1 month to 12 years). None of these patients required surgery. This study shows a successful outcome in 88 infants with torticollis treated with passive stretching exercises. In the absence of the details of the severity of torticoUis in infancy in patients belonging to the late group, it is difficult to compare these two groups. A prospective randomized studY is necessary to confirm or refute Jones' statement, "The value of passive manipulation (for CMT) has not been proved." --R. Surana
and without placing a tape around it during surgery. Application of papaverine hydrochloride (40 mg/mL) around the artery and the administration of prostaglandin E1 0.1 mg/kg/min may be helpful. The authors state that these measures have helped to prevent these complications but do not state whether papaverine or prostaglandin was used in their patients or not, and if so, how many patients were treated in this manner. --P. Puri
Fixation After Fractures of the Sternum and Lumbar Spine in Children and Adolescents. G. MOllemhoff, M. Walz, and G. Muhr. Chirurg 64:948-952, 1993.
Forty-five patients with hepatic tumor in childhood during the past 35 years underwent clinical analysis. Thirty-six cases were malignant, and all 9 patients who did not undergo hepatic resection died. Fifteen of 27 (55.6%) patients who received hepatic resection survived. Among 22 patients with hepatoblastoma and hepatocellular carcinoma, 13 patients (59.1%) survived, 3 developed local recurrence, and 8 developed pulmonary metastasis. The longest survival was obtained in an 8-month-old boy treated with right trisegmentectomy followed by resection of pulmonary metastasis twice. He is now disease-free at the age of 20 years. The improved prognosis of hepatic tumors in childhood is mainly due to (1) the introduction of modern diagnostic imaging procedures, ie, angiography, ultras0nography, computed tomography, and magnetic resonance imaging, (2) improved technique of hepatic resection, ie, ultrasonic dissection, Pringle's method, and argon beam coagulator, and (3) the introduction of adjuvant chemotherapy (adriamycin and cisplatinum). --Takesh Miyano
Spinal column trauma with fractures of the breast and lumbar spine (2% to 3%) is relatively uncommon in the pediatric patient population (from birth to 16 years). The treatment of 22 patient s between 1978 and 1988 is reviewed. The purpose of the study was to describe the indications for operative versus nonoperative treatment, and to determine the course of treatment depending upon the age of the patient. Follow-up studies after approximately 8 years showed an improvement in the neurological status of 8 patients and a spontaneous correction of kyphotic angulation from 21 ° to 3°. The authors conclude that treatment must be individualized and depends on the age of the patient. ~ u n t e r H . WilIital NEOPLASMS
Bone Metastasis in Wilms' Tumour--Report of Three Cases and Rev,ew I . of the Literature. S. Gururangan, J.A. Wiliiams, and B.D. Fletcher. Pediatr Radio124:85-87, (April), 1994. This is a report of 3 patients (0.8% of all Wilms' tumor patients) who were found to have bone metastasis. One patient was found to have bone metastasis at diagnosis and two at relapse. The patient with a favorable histology received further chemotherapy and local radiotherapy with evidence of healing of the metastasis on computed tomography and bone scintigraphy. This patient remains disease-free 30 months from relapse. Two other patients with primary anaplastic tumors died of uncontrollable disease. --P. Puri Congenital Mesoblastic Nephroma: Treatment Options. V. Kalisdasan, A. Mammon, ].M. Hutson, et al. Pediatr Surg Int 9:524-525, (August), 1994. Five patients with congenital mesoblastic nephroma are reported. Three were treated within the first week of life. Two other patients had a cellular variant and presented at 5 and 18 months of age. Four patients were treated by nephrectomy. One newborn, who had an exophytic lesion from the lower pole, underwent partial nephrectomy. --R. Surana Renal Atrophy Following Removal of a Neuroblastoma. L Yarnagiwa, K. Obata, H. Saito, et al. Pediatr Surg Int 9:387-390, (June), 1994. The authors report 3 of 18 patients with abdominal neuroblastoma treated between 1987 and 1993 who developed "renal atrophy" or deterioration in renal function after kidney preserving surgery. The probable reason in 2 patients was impaired renal peffusion during surgery, whereas in 1 patient with pelvic neuroblastoma, the ureter was occluded by periureteral fibrosis secondary to silver clips. The authors believe that the decreased renal perfusion may be caused by either renal spasm or endothelial damage. They therefore believe that the renal artery should be handled gently
Surgical Treatment of Hepatic Tumors in Childhood. ThirtyFive Years' Experience.A. Okada, S. Kamata, M. Fukuzawa, et al. J Jpn Soc Pediatr Surg 30:35-42, 1994.
Long-Term Complications of Laparotomy in Hodgkin's Disease. M. Jackovich, N.P. Mendenhall, M.D. Sombeck, et al. Ann Surg 219:615-524, (June), 1994. The authors review the complications in 133 patients who underwent staging laparotomy and splenectomy for Hodgkin's disease (stages I to IV). Mean follow-up was 15.7 years; age range 2.5 to 28 years. There were 10 episodes of overwhelming postsplenectomy infection (OPSI) in 9 patients (6.8%), 5 of whom developed their infection within 5 years after operation. Patients with stage III and IV or recurrent disease were at greater risk; also those receiving combined modality intensive oncologic therapy. None of 25 patients who received preoperative pneumococcal vaccination developed OPSI. Surgical complications included small bowel obstruction (13), atelectasis (17), subdiaphragmatic abscess (1), and wound dehiscence (1). There were no deaths as a result of surgical complications. The authors conclude that with presplenectomy vaccination, the risks of a staging procedure are acceptable if knowledge of the pathological extent of the abdominal disease would alter treatment. John N. Schullinger Fibrous Hamartoma of Infancy in the Genital Region: Findings in 15 Cases, EJ. Popek, E.A. Montgomery, andJ.L. Fourcroy. J Urol 152:990-993, (September), 1994. Fibrous hamartoma of infancy is a benign myofibroblastic proliferation that typically occurs in the axillary or shoulder region of male infants. Fifteen cases of this condition are reported that involved the inguinal region (5), scrotum (5), spermatic cord (1), perineum (1), labium majus (1), suprapubic region (1), and pubic area (1). Patient median and mean ages were 10 and 6.7 months, respectively (range 2 to 24 months). No case was reported to be congenital. Median and mean tumor size was 3 em (range 0.5 to 6 cm). The microscopic features were identical to those seen in fibrous hamartoma of infancy occurring in more typical sites and