560
ABSTRACTS
a major role in the early death of these animals. In most rabbits circulating endotoxin was detected between 90 and 120 min after immersion and in all by the third hour. Postmortem examination revealed no septic process visible in any tissue. The authors determined the endotoxin to be of intestinal origin. Endotoxemia failed to develop and rabbits survived which did not harbor gram-negative bacteria in the intestine. The authors believe the vasoactive substance is absorbed from the burned skin, results in the intestinal wall being made more permeable allowing absorption of the endotoxin.-George
Holcomb
Recurring Digital Fibroma of infancy. J. J. Bloem, U. D. Vuzevski, and A. 1. C. Huffstodt, J. Bone Joint Surg. 56:(Br) 746-751 (November), 1974.
This is a tumor of the hand and fingers of childhood in which origin, course. and prognosis are obscure. The tumors begin as small nodules and may reach considerable size. They are firm and fixed to the skin and deep tissues. Microscopically the dermis is replaced by tumor consisting of bands of fibrous connective tissue. Mitotic figures are rare. Most authors believe a virus to be the causative agent, but a strain has never been isolated. Until recently excision and skin grafting were widely recommended. Three cases of the condition are described. All of the patients had excision and skin grafting done in the first year of life, and as in all of them there were recurrences, it was decided to treat the condition conservatively. In all three cases gradual regression occurred and in one is now complete. From these findings the authors now recommend a strictly conservative approach owing to: (I) the difficulty of adequate removal: (2) the tendancy to spontaneous regression; and (3) no case of metastasis or persistence into adult life has been reported.--/. Aitken
HEAD AND NECK Methods of Measuring Intracranial Pressure Via the Fontanelle Without Puncture. S. R. Weoltholl and R. Smallwood.
37:88-96
(January),
J. Neural. Naurosurg. 1974.
Psychiatry.
In a search for a noninvasive method of measuring intracranial pressure in infants, the authors examine and discard various previously published methods in favor of a “Fontanometer” using the aplanation principle. The instrument was made from an ileostomy flange with
an aplanation Transducer secured into it: this was applied to the scalp over the anterior fontanelle and changes compared with simultaneous recordings from a pressure transducer attached to a ventricular puncture needle. In five infants studied, the aplanation transducer faithfully measured intracranial pressures. The authors suggest the method is suitable for noninvasive estimations and should be further studied.-J. Lisrer Epignathus. Jagdish
36:242-243
Chandler.
Indian
J. Surg.
(June), 1974.
A teratoma from the roof of the nasopharynx is reported in a newborn.-Vusanr Tufwlker.
THORAX Technical Considerations in the Surgical Management of Pectus Excavatum and Carinatum. f. Robicsek, H. K. Dougherty,
D. C. Mullen,
N.
6.
Horbold,
Jr., D. G. Ho//, R. D. Jackson, T. N. Mosters, ond P. W. Songer. Ann. Thorac. Surg. 18:549564 (December), 1974.
Six hundred fifty operations for deformities of the sternum are reported spanning a 25-yr period in 608 patients, The authors describe their own technique for repair of excavatum and carinatum deformities, which basically involves removal of deformed costal cartilages, freeing the manubrium to allow its correct positioning, and then the use of a V-shaped suspending stainless-steel wire from the second or third costal cartilage down to the xyphoid process in order to hold the sternum forward. Included in their operative descriptions are methods of handling unilateral deformities and recurrent deformities. The authors maintain that their procedure is simple and satisfactory and, as such. is applicable to all types of deformity without regard to careful individual evaluation of psychological disturbance caused by the deformity. Of 608 procedures, however, 73 were termed unsatisfactory results. Nearly half of these 73 patients underwent reoperation with only 509; satisfactory result from the second procedure. The authors attach perhaps more physiologic significance to the deformity than most other authors. This is an impressive series.-Keirh W. Ashcraft Surgical Repair of Total Cleft Sternum. J.
Verrko. J. Thorac. (February), 1975.
Cardiovasc.
Surg.
67:301-305
J.
56 ‘I
ABSTRACTS
A I-mo-old
Brazilian
infant
with
cleft
ster-
num operated upon aboard the S.S. Hope is presented. While the condition is called lifethreatening. no report of nonoperative death is presented. In the four previous operative reports there was one death. A technique for repair is presented in which alternate costal cartilages are divided near and far from the sternum. The ribs with long cartilages are then shifted inferiorly to approximate the long sternal cartilages. This maneuver allows the cleft sternum to be approximated successfully. There are 17 references.-?%omas M. Holder Thoracocervical
Cysts as a
8. T. le Roux., 8. I. Henderson, M. A.
Rogers.
Thorax
Cause
of
Stridor.
E. U. Kiirklii,
29:564-566
out really producing
evidence, that open biopsy is better than percutaneous needle biopsy or aspiration of the lung. They emphasize that the early diagnosis allows proper treatment stating that probably 9 to IO days of treatment are necessary for survival to be expected.-Keith W. Ashcraft The Spectrum of Pulmonary Surg. l&644-658
(December), 1974.
sequestration involving a 20-yr-old man is presented, and the entire subject of pulmonary sequestration is reviewed in this collective review.-Keith W. Ashcraft
and
HEART Treatment
AND GREAT
of Congenital
Bentlqv Respiratory Obstruction ated with
in the Newborn
lncre.ased Volume
of the Hemithorax. and J. P. Geiger.
Associ-
and Opacification
G. L. Zumbro,
R. L. Treasure,
Ann. Thorac. Surg. 18:622-625
VESSELS
Superior
Stenosis in a Child. 6. Ii&%.
In five patients out of 82 with a mediastinal cyst or tumor, seen in a 7-yr period in Durban, South Africa, the presenting symptom was severe strider. Three patients were children and two were young adults, one of whom had a large mediastinal cystic hygroma. All the others had foregut duplications, and the adult experienced hypoxic cardiac arrest. All the patients recovered well after excisional surgery.-J.F.R.
R. M.
A case of pulmonary
(September),
1974.
Sequestration.
Sode, M. Clause, ond F. H. Ellis, Jr. Ann. Thoroc.
Vena
Cava
Rozhl. Chir. 53:708-
713,1974. A stenosis of the superior vena cava was demonstrated by cavography and detailed cardiologic examination in a 4-yr-old boy. At operation a hypoplasia of the superior vena cava in its intrapericardial segment was discovered, and there was a stenosis measuring 4 mm in diameter before the cava entered the left atrium. The entire segment was reconstructed using a pericardial flap patch. The postoperative course was uneventful. Cavography I yr after operation showed a good lumen of the vein. The author did not find a similar successfully treated case in the literature.V. Kafka
(December), 1974.
This article reports two patients with newborn respiratory distress and unilateral opacification of the chest. The first had a subcarinal bronchogenic cyst compressing the left main bronchus, and the other had a vascular sling. The clue to the diagnostic effort seems to be the unilaterality of the lesion.--Keith IV. Ashcraft The Role of Early Open lung Biopsy in the Diagnosis and Pneumonia.
Treatment
of
Pneumocystis
D. H. Tyros, W. Campbell,
carinii
C. Corley,
and C. R. Hatcher, Jr. Ann. Thorac. Surg. 18:571577 (December), 1974.
This article reports 12 patients with pneumocystic pneumonia complicating chemotherapy or immunosuppression for transplant or malignant tumor. Although all the patients are adults, the authors detail some of the clinical features which would indicate the value of early diagnosis of this infection. They conclude, with-
Surgical
Management
monory
Artery
of Anomalous
Causing
struction. R. Koopot,
left
Tracheobronchial
PulOb-
H. Nikoidoh, and F. S. Id&s.
J. Thoroc. Cordiovasc. Surg. 69:239-246
(February),
1975.
Five patients with pulmonary artery shng from the Children’s Memorial Hospital in Chicago and a survey of the world literature are presented. Of the five patients, three survived and two were diagnosed at autopsy. (One of these had a thoracotomy for respiratory distress, and the condition was unrecognized.) Recommended therapy is division of the left pulmonary artery and reanastomosis in front of the trachea by way of a left thoracotomy. Out of the 66 patients in the literature with pulmonary artery sling the symptoms in order of decreasing frequency were: intercostal retraction, 50; circumoral cyanosis, 41; stridor. 28; apneic episodes, 22; inspiratory and expiratory wheeze, IS; expiratory wheeze, 14;