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The intriguing fate of tendon grafts in small children's hands and their results
INTERNATIONAL
the
greatest
ABSTRACTS
chance
for
OF PEDIATRIC
cure.-W.
Hardy
Hendren. NONGESTATIONAL CHOPIN CARCINOMA OF THE OVARY: REPORT OF A CASE. Q. C. Dehuan.
Ohst. & Gynec.
26:708.
1965.
The author describes the case of a 7 year old white girl who presented with precocious puberty; a large right ovarian mass was removed and proved to he choriocarcinema. A 24 hour urine specimen 2 months later had a gonadotrophin titer of less than 200 M. U; subsequent urinary gonadotrophin assay was negative. A 2 year followup shows no evidence of recurrence and regression of sexual precocity.-W. Hardy
9 year
old child
with
primary
agonadism.
External sexual development was of “neuter” type and internal sexual organs consited only of rudimentary structures resembling fallopian tube and epididymis. Sex chromatin hodies were absent. The child had been reared as a male, although in retrospect, surgical procedures to improve the external genitalia would have been easier if the child had been brought up as a girl.-_(=oZin C. Ferguson.
MUSCULOSKELETAL
SYSTEM
TENDON INJURIES AROUND THE ANKLE. .l. C. G~i@hs. J. Bone & Joint Surg. 47B:686, 1965.
Hendren. FUNCTIONING ~I~LICNANT GERM CELL Tuhlon OF THE OVARY IN A 41/2 YEAR OLD GIRL. S. Bow&k, I. Berger. C. Echt and J. J. Gold. Cancer 18:1485. 1965. A case is reported of a 4 l/2 year old Negro girl who presented with bilateral breast enlargement, vaginal bleeding, and an ovarian mass, all of which is usually consistent with granulosa cell tumor, hut which proved to he a malignant germ-cell tumor of the ovary. Preoperative vaginal smear showed marked estrogenic activity and the urine contained a high titer of chorionic gonadotrophin. Postoperatively the estrogenic activity of the vaginal smear declined and the gonadotrophin titer fell. The chorionic gonadotrophin titer soon hecame mensurable again and triple chemotherapy with methotrexate, actinomycin D. and chlorambucil was given, and was well tolerated; vaginal smears again hecame normal. Ten months following surgery the child was admitted with severe respiratory distress; the chest x-ray showed widespread bilateral patchy infiltrates. She died shortly and autopsy was not permitted. The case is reported to record a very rare ovarian tumor in childhood and to document the first case of triple chemothrrapv in such a young individual.-W. Hardy. Hendren. A~DNAIIISM. H. E. Emson und A. E. Buckweld. Can. bled. A. J. 93:1080. 1965. The
211
SURGERY
authors
present
the case report
of a
A series of 20 patients with injury to foot tendons other than tendo-calcaneus, is reported; 19 were in association with open wounds and one with rheumatoid erosion. Seven of the patients were under 10 years of age. In 11 an immediate repair had been done, in 5 no attempt at repair had been made and in 4 the repair had only been carried out after the lapse of several weeks or months. A variety of unabsorbable sutures had been used and most had been in except in cases of repair of the plaster, extensor hallucis longus. With immediate repair
there
were
5
with recovery of function under 3 months. In cases without repair spontaneous and adequate recovery occurred twice in association with lesions of the external hallucis longus and external digitorum communis tendons, but 2 others involving peroneal tendons (aged 5 and 10 years. respectively) showed unsatisfactory results. In the third group with delayed repair deformity resulted in 3 cases aged 8, 9 and 10 years, respectively, involving the tibialis posterior, peroneals, or tihialis anterior respectively. In all 5 patients, all children developed deformitiei and disability from an isolated tendon injury-in a previouslv normal foot. Therefore immediate repair in children is imperative and the sacrifice of a single tendon in the normal foot of a child can be disastrous.-F. H. Robarts. THE INTRIGUING FATE OF TENDON GHAFTS IN SMALI. CHILDREN’S HANDS AND THEIR
212
INTERNATIONAL
HFSIJLTS. J. Hage
J. Plast.
Surg.
After tendon able shortening
and C. C. Dupuis. 18:314, 1965.
Brit.
grafts in children considerof the finger occurred in 7
out of 22 grafts and only in 3 digits was there no detectable shortening. When allowance is made for the growth of the hand, it was calculated that the tendon grafts had in fact grown between I and 3 cm. Direct primary repair is advised in children with clean injuries seen in the first 8 hours and tendon graft in all other cases even in young children under 5 years of age.-R. B. Zachary. RECURRING DIGITAL FIBROUS TUMORS OF CHILDHOOD. R. D. Ii. Reye. Arch. Path. 80~228, 1965. A series of 9 fibrous tumors removed from the digits of 6 patients over a 5 year period are studied. In 4 of the cases, the tumor was noticed at birth or during infancy. The remaining 2 cases were 4 and 3% years of age at the time of tumor removal. The tumors varied in size from 0.25 to 1 cm. in diameter. They were formed of interlacing bundles of fibrocellular tissue. Mitotic figures were scanty but never absent. Inclusion bodies were noted within the cell cytoplasm of these tumors, and this feature renders this group of tumors distinct from all other fibrous tumors at the histologic level. This type of lesion is known to recur unless complete removal is accomplished. and this often necessitated complete digital amputation.-Daniel T. Cloud.
NEOPLASMS CHEMOTHERAPY IN CHILDHOOD CANCER (EXCEPT LEuKEhrIA). W. W. &tow. Cancer
18: 1585,
1965.
The author presents an appraisal of the role of chemotherapy in tumors of childhood based on published data and review of the pediatric section at M. D. Anderson Hospital, The cancers most affected were neurorhabdomyosarblastoma. Wilms’ tumor, retinoblastoma. Appropriate coma and chemotherapy can produce some degree of
benefit
ABSTRACTS
in 20
OF PEDIATRIC
to 30
per
cent
SURGERY
of children
with disseminated or recurrent disease from these sensitive tumors. Significant palliation will occur in 10 per cent. There is strong clinical evidence that in these 4 tumors the use of drugs in and/or radiation in children who been saved.-W.
combination with surgery therapy has produced cures otherwise would not have Hardy Hendren.
MATURATION OF TUhIORS OF THE SYMPATHETIC NEHVOUS SYSTEM. R. L. Goldman, A. N. Winterling and C. C. Winterzing. Cancer
18:1510.
1965.
Report of long-term survival in 2 patients, one with disseminated osseous metastases, and review of cases from the literature. Two cases of maturation of an undifferentiated malignant neuroblastoma into ganglioneuroma are recorded. Case 1, a 3 year old white boy presented with a large abdominal mass which proved to be neuroblastoma. Postoperative x-ray treatment and vitamin B12 were given. Initially skeletal survey showed only a punched out area in the roof of the left acetabulum. Later disseminated osteolytic defects appeared in many bones. Five years from the time of first observation a thoracic vertebra was biopsied, showing ganglioneuroma. The patient has been observed for an additional 4 years and serial x-rays have shown a stable appearance of the osseous fossi. Case 2. A 9 month old female with a large right thoracic paravertebral mass causing leg weakness. Thoracic laminectomy was performed and neuroblastoma was diagnosed histologically. X-ray treatment was given. She remained well except for spastic paraplegia. The paravertebral mass remained and progressive scoliosis required spinal fusion. Fifteen years from the time of original observation the patient developed increasing anorexia and weight loss and a painful paraspinal mass. Biopsy showed ganglioneuroblastoma, with areas of ganglioneuroma and partially differentiated pleomorphic ganglion cells. No immature neurohlastic elements were found. This raised the question whether this represents recrudescent activity in ganglioneuroblastoma which had remained dormant for I5 years or dedifferentiation in a mature ganglioneuroma.-W. Hardy Hendren.
the
greatest
ABSTRACTS
chance
for
OF PEDIATRIC
cure.-W.
Hardy
Hendren. NONGESTATIONAL CHOPIN CARCINOMA OF THE OVARY: REPORT OF A CASE. Q. C. Dehuan.
Ohst. & Gynec.
26:708.
1965.
The author describes the case of a 7 year old white girl who presented with precocious puberty; a large right ovarian mass was removed and proved to he choriocarcinema. A 24 hour urine specimen 2 months later had a gonadotrophin titer of less than 200 M. U; subsequent urinary gonadotrophin assay was negative. A 2 year followup shows no evidence of recurrence and regression of sexual precocity.-W. Hardy
9 year
old child
with
primary
agonadism.
External sexual development was of “neuter” type and internal sexual organs consited only of rudimentary structures resembling fallopian tube and epididymis. Sex chromatin hodies were absent. The child had been reared as a male, although in retrospect, surgical procedures to improve the external genitalia would have been easier if the child had been brought up as a girl.-_(=oZin C. Ferguson.
MUSCULOSKELETAL
SYSTEM
TENDON INJURIES AROUND THE ANKLE. .l. C. G~i@hs. J. Bone & Joint Surg. 47B:686, 1965.
Hendren. FUNCTIONING ~I~LICNANT GERM CELL Tuhlon OF THE OVARY IN A 41/2 YEAR OLD GIRL. S. Bow&k, I. Berger. C. Echt and J. J. Gold. Cancer 18:1485. 1965. A case is reported of a 4 l/2 year old Negro girl who presented with bilateral breast enlargement, vaginal bleeding, and an ovarian mass, all of which is usually consistent with granulosa cell tumor, hut which proved to he a malignant germ-cell tumor of the ovary. Preoperative vaginal smear showed marked estrogenic activity and the urine contained a high titer of chorionic gonadotrophin. Postoperatively the estrogenic activity of the vaginal smear declined and the gonadotrophin titer fell. The chorionic gonadotrophin titer soon hecame mensurable again and triple chemotherapy with methotrexate, actinomycin D. and chlorambucil was given, and was well tolerated; vaginal smears again hecame normal. Ten months following surgery the child was admitted with severe respiratory distress; the chest x-ray showed widespread bilateral patchy infiltrates. She died shortly and autopsy was not permitted. The case is reported to record a very rare ovarian tumor in childhood and to document the first case of triple chemothrrapv in such a young individual.-W. Hardy. Hendren. A~DNAIIISM. H. E. Emson und A. E. Buckweld. Can. bled. A. J. 93:1080. 1965. The
211
SURGERY
authors
present
the case report
of a
A series of 20 patients with injury to foot tendons other than tendo-calcaneus, is reported; 19 were in association with open wounds and one with rheumatoid erosion. Seven of the patients were under 10 years of age. In 11 an immediate repair had been done, in 5 no attempt at repair had been made and in 4 the repair had only been carried out after the lapse of several weeks or months. A variety of unabsorbable sutures had been used and most had been in except in cases of repair of the plaster, extensor hallucis longus. With immediate repair
there
were
5
with recovery of function under 3 months. In cases without repair spontaneous and adequate recovery occurred twice in association with lesions of the external hallucis longus and external digitorum communis tendons, but 2 others involving peroneal tendons (aged 5 and 10 years. respectively) showed unsatisfactory results. In the third group with delayed repair deformity resulted in 3 cases aged 8, 9 and 10 years, respectively, involving the tibialis posterior, peroneals, or tihialis anterior respectively. In all 5 patients, all children developed deformitiei and disability from an isolated tendon injury-in a previouslv normal foot. Therefore immediate repair in children is imperative and the sacrifice of a single tendon in the normal foot of a child can be disastrous.-F. H. Robarts. THE INTRIGUING FATE OF TENDON GHAFTS IN SMALI. CHILDREN’S HANDS AND THEIR
212
INTERNATIONAL
HFSIJLTS. J. Hage
J. Plast.
Surg.
After tendon able shortening
and C. C. Dupuis. 18:314, 1965.
Brit.
grafts in children considerof the finger occurred in 7
out of 22 grafts and only in 3 digits was there no detectable shortening. When allowance is made for the growth of the hand, it was calculated that the tendon grafts had in fact grown between I and 3 cm. Direct primary repair is advised in children with clean injuries seen in the first 8 hours and tendon graft in all other cases even in young children under 5 years of age.-R. B. Zachary. RECURRING DIGITAL FIBROUS TUMORS OF CHILDHOOD. R. D. Ii. Reye. Arch. Path. 80~228, 1965. A series of 9 fibrous tumors removed from the digits of 6 patients over a 5 year period are studied. In 4 of the cases, the tumor was noticed at birth or during infancy. The remaining 2 cases were 4 and 3% years of age at the time of tumor removal. The tumors varied in size from 0.25 to 1 cm. in diameter. They were formed of interlacing bundles of fibrocellular tissue. Mitotic figures were scanty but never absent. Inclusion bodies were noted within the cell cytoplasm of these tumors, and this feature renders this group of tumors distinct from all other fibrous tumors at the histologic level. This type of lesion is known to recur unless complete removal is accomplished. and this often necessitated complete digital amputation.-Daniel T. Cloud.
NEOPLASMS CHEMOTHERAPY IN CHILDHOOD CANCER (EXCEPT LEuKEhrIA). W. W. &tow. Cancer
18: 1585,
1965.
The author presents an appraisal of the role of chemotherapy in tumors of childhood based on published data and review of the pediatric section at M. D. Anderson Hospital, The cancers most affected were neurorhabdomyosarblastoma. Wilms’ tumor, retinoblastoma. Appropriate coma and chemotherapy can produce some degree of
benefit
ABSTRACTS
in 20
OF PEDIATRIC
to 30
per
cent
SURGERY
of children
with disseminated or recurrent disease from these sensitive tumors. Significant palliation will occur in 10 per cent. There is strong clinical evidence that in these 4 tumors the use of drugs in and/or radiation in children who been saved.-W.
combination with surgery therapy has produced cures otherwise would not have Hardy Hendren.
MATURATION OF TUhIORS OF THE SYMPATHETIC NEHVOUS SYSTEM. R. L. Goldman, A. N. Winterling and C. C. Winterzing. Cancer
18:1510.
1965.
Report of long-term survival in 2 patients, one with disseminated osseous metastases, and review of cases from the literature. Two cases of maturation of an undifferentiated malignant neuroblastoma into ganglioneuroma are recorded. Case 1, a 3 year old white boy presented with a large abdominal mass which proved to be neuroblastoma. Postoperative x-ray treatment and vitamin B12 were given. Initially skeletal survey showed only a punched out area in the roof of the left acetabulum. Later disseminated osteolytic defects appeared in many bones. Five years from the time of first observation a thoracic vertebra was biopsied, showing ganglioneuroma. The patient has been observed for an additional 4 years and serial x-rays have shown a stable appearance of the osseous fossi. Case 2. A 9 month old female with a large right thoracic paravertebral mass causing leg weakness. Thoracic laminectomy was performed and neuroblastoma was diagnosed histologically. X-ray treatment was given. She remained well except for spastic paraplegia. The paravertebral mass remained and progressive scoliosis required spinal fusion. Fifteen years from the time of original observation the patient developed increasing anorexia and weight loss and a painful paraspinal mass. Biopsy showed ganglioneuroblastoma, with areas of ganglioneuroma and partially differentiated pleomorphic ganglion cells. No immature neurohlastic elements were found. This raised the question whether this represents recrudescent activity in ganglioneuroblastoma which had remained dormant for I5 years or dedifferentiation in a mature ganglioneuroma.-W. Hardy Hendren.