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The management and problems of caustic burns in children
INTERNATIONAL
ABSTRACTS
ALIMENTARY
OF PEDIATRIC
TRACT
INTRAUTERINE GROWTH RATE IN RELATION TO ANO-RECTAL AND OESOPHAGEALANOMALIES. F. Kozzi and A. W. Wilkinson. Arch. Dis. Child.
44~59-62, 1969. The authors review 168 babies born between September 1958 and June 1967, 75 with anorectal anomalies alone, 76 with esophageal anomalies alone, and 17 with combined anorectal and esophageal anomalies. They define a premature baby as one who was born following a gestation of less than 38 weeks and a small-for-dates baby, one who weighed 2500 Gm. or less, but was born after a gestation of 38 weeks or more. They compare the gestation period and birth weights of these babies with the normal in Great Britain. Of all the babies, 32 per cent weighed 2500 Gm. or less, four times as many as the normal, and of these 27 were born after gestations of 38 weeks or more. However, with esophageal atresia or anorectal anomalies alone the baby was more likely to be small for dates (21 per cent) than premature (10 per cent), whereas when the two anomalies were combined 47 per cent were premature and 11 per cent were small for dates. They suggest that mechanical factors may play some part in producing intrauterine growth retardation, since twinning and hydramnios were more common in the small-for-dates babies, but the precise relation of congenital anomalies with intrauterine growth rate is not understood. It is suggested that knowledge of the gestational age may be of assistance both in diagnosis and prognosis. Small-for-dates babies showed a lower mortality rate, and severe associated anomalies were twice as common in those babies who were premature as in those who were normal or small for dates. This, together with the known facts that respiratory distress syndrome is a problem of the premature baby, that oxygen and calorie requirements are related to intrauterine growth rate, and that blood volume may be relatively increased in the small-for-dates baby, make it important that both weight at birth and length of gestation should be accurately recorded in babies with congenital anomalies.--1. Lisfer. TREATMENT OF UNUSUAL FORMS OF ESOPHAGEAL ATRESIA BY MULTIPLE STAGE METHODS. J. Prhbvot and J. M. Babut. Ann. Chir. Inf. 9:
297-302,
489
SURGERY
1968.
In 3 cases of esophageal atresia with a long gap between the blind ends, the authors tried the preoperative elongation of the upper pouch ac-
cording to the method of Howard and Myers. One infant died of perforation of the stomach; the second died of a mediastinitis due to the rupture of the anastomosis; the third died, 2 months after delayed esophageal anastomosis, from peptic esophagitis due to a secondary hiatus hernia with reflux: intrathoracic fundoplication was attempted, but resulted in gastric perforation and abscess.M. Bettex. THE MANAGEMENT AND PROBLEMS OF CAUSTIC BURNS IN CHILDREN. J. N. Middelkamp, T. B. Ferguson, C. L. Roper, and F. D. Hoffman.
J. Thor. 1969.
Cardiov.
Surg. 57:341-347
(March),
The authors report 96 children, 10 months to 6 years of age, hospitalized following accidental alkali ingestion, with evident burns of the lips or mouth, between January 1954 and January 1968. Steroids (cortisone or prednisone) and antibiotics were started upon each patient. Esophagoscopy was performed 12 to 24 hours later except where deep burns of the larynx or hypopharynx were noted (10 patients). Steroids were continued for 14-30 days on all patients except those with negative esophagoscopy. Of the 86 patients esophagoscoped, 54 had no evidence of esophageal burn and did not develop strictures: 25 had mild burns, of whom one developed a stricture which responded to a single dilatation. Seven patients were judged to have severe burns of the esophagus (6 of whom had severe laryngeal burns-4 requiring tracheostomy) and all 7 developed esophageal stricture. One of these patients died on the nineteenth day from aspiration; 3 have had colon interpositions; and 3 have had gastrostomies and have had or are about to have surgical correction of their strictures. The authors do not state what happened to the 10 patients judged to have deep pharyngeal burns and who were not esophagoscoped. The authors emphasize the incidence of laryngeal burn in their series and point out the correlation between depth of burn as judged at esophagoscopy and subsequent stricture formation. Whether steroids are of any help cannot be determined from this study.-J. G. Rosenkrantz. LYE INJURIES OF THE ESOPHAGUS: ANALYSIS OF NINETY CASES OF LYE INGESTION. A. R. Borja, H. T. Ransdell, Jr., T. V. Thomas. and W. Johnson. J. Thor. Cardiov. Surg. 57:533-538
(April),
1969.
This is a collected series from several institutions in Louisville, Kentucky, of patients suffering
ABSTRACTS
ALIMENTARY
OF PEDIATRIC
TRACT
INTRAUTERINE GROWTH RATE IN RELATION TO ANO-RECTAL AND OESOPHAGEALANOMALIES. F. Kozzi and A. W. Wilkinson. Arch. Dis. Child.
44~59-62, 1969. The authors review 168 babies born between September 1958 and June 1967, 75 with anorectal anomalies alone, 76 with esophageal anomalies alone, and 17 with combined anorectal and esophageal anomalies. They define a premature baby as one who was born following a gestation of less than 38 weeks and a small-for-dates baby, one who weighed 2500 Gm. or less, but was born after a gestation of 38 weeks or more. They compare the gestation period and birth weights of these babies with the normal in Great Britain. Of all the babies, 32 per cent weighed 2500 Gm. or less, four times as many as the normal, and of these 27 were born after gestations of 38 weeks or more. However, with esophageal atresia or anorectal anomalies alone the baby was more likely to be small for dates (21 per cent) than premature (10 per cent), whereas when the two anomalies were combined 47 per cent were premature and 11 per cent were small for dates. They suggest that mechanical factors may play some part in producing intrauterine growth retardation, since twinning and hydramnios were more common in the small-for-dates babies, but the precise relation of congenital anomalies with intrauterine growth rate is not understood. It is suggested that knowledge of the gestational age may be of assistance both in diagnosis and prognosis. Small-for-dates babies showed a lower mortality rate, and severe associated anomalies were twice as common in those babies who were premature as in those who were normal or small for dates. This, together with the known facts that respiratory distress syndrome is a problem of the premature baby, that oxygen and calorie requirements are related to intrauterine growth rate, and that blood volume may be relatively increased in the small-for-dates baby, make it important that both weight at birth and length of gestation should be accurately recorded in babies with congenital anomalies.--1. Lisfer. TREATMENT OF UNUSUAL FORMS OF ESOPHAGEAL ATRESIA BY MULTIPLE STAGE METHODS. J. Prhbvot and J. M. Babut. Ann. Chir. Inf. 9:
297-302,
489
SURGERY
1968.
In 3 cases of esophageal atresia with a long gap between the blind ends, the authors tried the preoperative elongation of the upper pouch ac-
cording to the method of Howard and Myers. One infant died of perforation of the stomach; the second died of a mediastinitis due to the rupture of the anastomosis; the third died, 2 months after delayed esophageal anastomosis, from peptic esophagitis due to a secondary hiatus hernia with reflux: intrathoracic fundoplication was attempted, but resulted in gastric perforation and abscess.M. Bettex. THE MANAGEMENT AND PROBLEMS OF CAUSTIC BURNS IN CHILDREN. J. N. Middelkamp, T. B. Ferguson, C. L. Roper, and F. D. Hoffman.
J. Thor. 1969.
Cardiov.
Surg. 57:341-347
(March),
The authors report 96 children, 10 months to 6 years of age, hospitalized following accidental alkali ingestion, with evident burns of the lips or mouth, between January 1954 and January 1968. Steroids (cortisone or prednisone) and antibiotics were started upon each patient. Esophagoscopy was performed 12 to 24 hours later except where deep burns of the larynx or hypopharynx were noted (10 patients). Steroids were continued for 14-30 days on all patients except those with negative esophagoscopy. Of the 86 patients esophagoscoped, 54 had no evidence of esophageal burn and did not develop strictures: 25 had mild burns, of whom one developed a stricture which responded to a single dilatation. Seven patients were judged to have severe burns of the esophagus (6 of whom had severe laryngeal burns-4 requiring tracheostomy) and all 7 developed esophageal stricture. One of these patients died on the nineteenth day from aspiration; 3 have had colon interpositions; and 3 have had gastrostomies and have had or are about to have surgical correction of their strictures. The authors do not state what happened to the 10 patients judged to have deep pharyngeal burns and who were not esophagoscoped. The authors emphasize the incidence of laryngeal burn in their series and point out the correlation between depth of burn as judged at esophagoscopy and subsequent stricture formation. Whether steroids are of any help cannot be determined from this study.-J. G. Rosenkrantz. LYE INJURIES OF THE ESOPHAGUS: ANALYSIS OF NINETY CASES OF LYE INGESTION. A. R. Borja, H. T. Ransdell, Jr., T. V. Thomas. and W. Johnson. J. Thor. Cardiov. Surg. 57:533-538
(April),
1969.
This is a collected series from several institutions in Louisville, Kentucky, of patients suffering