- Email: [email protected]
The role of partial splenectomy in children with thalassemia
INTERNATIONAL
ABSTRACTS
5.4 years) for those patients eventually requiring transplantation; and (4) portoenterostomy and liver transplant operations are complementary.-Edward G. Ford
rotomy. Manipulattons during surgery enhance additional bleeding. Operation should be reserved for very selected cases since conservative management is a safe alternative.--Thomas A. Angerpointner
The Role of Partial Splenectomy mia. A.H. Al-Salem, 1. Al-Dabboud, Surg 8:334-338, (December). 1998.
Prenatal Diagnosis M. Respondek-Liberska.
in Children With Thalasseand f? Bhamidibati. Eur J Pediatr
Partial splenectomy was performed in 12 children with thalassemia (9 B-thalassemia and 3 Hb H disease) to reduce blood transfusion requirements. The indication for partial splenectomy was the presence of splenomegaly and increased blood transfusion requirements. Their ages ranged from 3 to 10 years. On follow-up, two of the three children with Hb H disease required no more blood transfusions, while the third continued to do so, but at a lower frequency. For those with E-thalassemia major, the transfusion requirements and HB drop per week decreased in the majority of patients. In all patients, about one third of the spleen was preserved. No significant infections, no change in IgM levels, and no Howel-Jolly bodies were observed postoperatively. Partial splenectomy is recommended to start with for patients with Hb H disease. For patients with B-thalassemia major, partial splenectomy is beneficial as a temporary measure. It also should be considered for children under 5 years of age because they have a greater risk for the development of postsplenectomy sepsis.--Thomas A. Angerpointner Diagnosis and Initial Management of Blunt Pancreatic Trauma: Guidelines From a Multiinstitutional Review. EL. Bradley, P.R. Young, MC. Chang, et al. AM Surg 227:861-869, (June), 1998. Controversy surrounds operative intervention in patients with blunt pancreatic injury. Successful nonoperative management of patients wttb other blunt injuries have led some to delay operative repair in patients with suspected pancreatic injuries until clinical deterioration or the development of peritonitis. Others advocate prompt operative intervention to prevent delay-induced increases in morbidity and mortality. This is a multiinstitutional review of 101 patients with documented blunt pancreatic injuries who were 2 to 95 years of age. The actual number of infants and children is not clear. Increases in morbidity and mortality were associated with loss of structural integrity of the main pancreatic duct. The authors support early demonstration of pancreatic duct anatomy. In discussmg this paper, Dr James O’Neill, Jr, pointed out the differences in the adult and small child with reference to injury profile, clinical course, and the technical difficulty of defining ductal anatomy (ERCP). Whereas the study mcludes some infants and children, the recommendations may not be directly referable to this patient population.-Edward G. Ford Blood Transfusion Requirements in Children Spleen and Liver Injuries. A. Avanoglu, 1. Ulman, Eur J Pediatr Surg 8:322-325, (December), 1998.
With Blunt 0. Ergiin, et al.
The records of 174 children with blunt spleen and liver injuries were analyzed retrospectively to determine blood transfusion requirements in surgically versus conservatively managed patients. Seventy-eight patients were managed conservatively; 96 children underwent various operative procedures. The hematocrit values (Hct), transfused blood volumes @L/kg), and length of hospital stay were compared for the two groups. Although the initial Hct values were comparable for the nonoperative and operative groups (26.7 t 2.7% v 24.8 2 3.5%), transfused blood volumes were significantly higher in the operative group (20.9 mL/kg v 39.5 mL/kg; P < .05). Similarly, the mean length of hospital stay was longer for the surgical group. Associated injuries were evenly distributed among the two groups. The increased blood transfusion requirement for the surgical group may be due to excessive bleeding before operation, which virtually provides the indication for lapa-
of Abdominal Surg Childh
Wall Defects. A. Chilarski Int 6:15-18, (January), 1998.
and
It is estimated that 60% of abdominal wall defects can be detected prenatally by means of ultrasound examinatron performed between 16 and 22 weeks of gestation. The authors present a group of 56 neonates born with these defects. Between January 1991 and December 1997, detailed fetal sonographic evaluation was performed in 3,817 pregnant women. Fetal malformations were found in 1,123 instances. Among them, 554 were extracardiac anomalies, 47 of which were major abdominal wall defects. The diagnosis was established between 22 and 26 weeks’ gestation in 14 cases, between 27 and 33 weeks m 17, and between 34 and 36 weeks in 16 instances. In this series, all fetuses with abdominal wall defects were identified prenatally. Two babies with omphalocele were misdiagnosed as having gastroschisis. The results in this series are much better than those described in the literature. An explanation might be that in the majority of cases the sonographic evaluation was performed rather late, between 27 and 36 weeks’ gestation. Associated anomalies were found in 30% of newborns with omphalocele and in only 4% in the gastroschisis group. In the authors’ opinion, the importance of prenatal ultrasonographic detection of abdominal wall defects lies in the possibility of performing the delivery in an appropriate center and sparing the newborn, especially one with gastroschisis or ruptured omphalocele, the stress of transportation. The method of delivery remains controversial.-Jerry K. Niedzielski
GENITOURINARY Epididymitis in Children: nett, B. Gill, and S.J. Kogan.
TRACT
The Circumcision J Urol 160: 1842-1844,
Factor7 RX Ben(November), 1998.
The authors studied the relationships among the circumcision status of 36 boys with epididymitis in a review of 128 with acute scrotal inflammation (group l), circumcision status of 43 for whom the diagnosis of epididymitis at discharge home had been made elsewhere (group 2), New York State hospital discharge figures for circumcision in newborns (group 3), and the regional prevalence of circumcision in 200 consecutive pediatric emergency department patients at the same institution with nonurologic diagnoses (group 4). The New York State Department figures indicate that 70% of male newborns are discharged home with a hospital code for circumcision. Similarly, an evaluation of 200 consecutive male patients without urologic diagnoses younger than 18 years in the emergency department revealed that 13 1(65%) had been circumcised. Comparatively, in groups 1 and 2, only 25% and 26% of patients (respectively) were circumcised. The statistical difference in circumcision status among the four groups was significant (P > .0004). These data demonstrate that a highly significant relationship exists between epididymitis and the presence of foreskin. The authors found that intact foreskin is an important etiological factor in boys with epididymitis.-George V? Holcomb, Jr Reservoir Calculi: A Comparison of Reservoirs Constructed From Stomach and Other Enteric Segments. M. Kaefex WH. Hendren, S.B. Buuec et al. J Urol 160:2187-2190, (December), 1998. The authors retrospectively reviewed the records of all patients undergoing augmentation cyptoplasty (215) or creation of a freestanding reservoir (44) between May 1976 and March 1996. Of these cases, 83 were augmented with stomach and 179 were constructed from other intestinal segments (ie, ileal, ileocecal, sigmoid, and/or a combination of these). Presenting diagnosis, patient age, gender, additional surgical procedures, interval to stone formation, and calculous composition were recorded. Patients were excluded from the study if there had been less
ABSTRACTS
5.4 years) for those patients eventually requiring transplantation; and (4) portoenterostomy and liver transplant operations are complementary.-Edward G. Ford
rotomy. Manipulattons during surgery enhance additional bleeding. Operation should be reserved for very selected cases since conservative management is a safe alternative.--Thomas A. Angerpointner
The Role of Partial Splenectomy mia. A.H. Al-Salem, 1. Al-Dabboud, Surg 8:334-338, (December). 1998.
Prenatal Diagnosis M. Respondek-Liberska.
in Children With Thalasseand f? Bhamidibati. Eur J Pediatr
Partial splenectomy was performed in 12 children with thalassemia (9 B-thalassemia and 3 Hb H disease) to reduce blood transfusion requirements. The indication for partial splenectomy was the presence of splenomegaly and increased blood transfusion requirements. Their ages ranged from 3 to 10 years. On follow-up, two of the three children with Hb H disease required no more blood transfusions, while the third continued to do so, but at a lower frequency. For those with E-thalassemia major, the transfusion requirements and HB drop per week decreased in the majority of patients. In all patients, about one third of the spleen was preserved. No significant infections, no change in IgM levels, and no Howel-Jolly bodies were observed postoperatively. Partial splenectomy is recommended to start with for patients with Hb H disease. For patients with B-thalassemia major, partial splenectomy is beneficial as a temporary measure. It also should be considered for children under 5 years of age because they have a greater risk for the development of postsplenectomy sepsis.--Thomas A. Angerpointner Diagnosis and Initial Management of Blunt Pancreatic Trauma: Guidelines From a Multiinstitutional Review. EL. Bradley, P.R. Young, MC. Chang, et al. AM Surg 227:861-869, (June), 1998. Controversy surrounds operative intervention in patients with blunt pancreatic injury. Successful nonoperative management of patients wttb other blunt injuries have led some to delay operative repair in patients with suspected pancreatic injuries until clinical deterioration or the development of peritonitis. Others advocate prompt operative intervention to prevent delay-induced increases in morbidity and mortality. This is a multiinstitutional review of 101 patients with documented blunt pancreatic injuries who were 2 to 95 years of age. The actual number of infants and children is not clear. Increases in morbidity and mortality were associated with loss of structural integrity of the main pancreatic duct. The authors support early demonstration of pancreatic duct anatomy. In discussmg this paper, Dr James O’Neill, Jr, pointed out the differences in the adult and small child with reference to injury profile, clinical course, and the technical difficulty of defining ductal anatomy (ERCP). Whereas the study mcludes some infants and children, the recommendations may not be directly referable to this patient population.-Edward G. Ford Blood Transfusion Requirements in Children Spleen and Liver Injuries. A. Avanoglu, 1. Ulman, Eur J Pediatr Surg 8:322-325, (December), 1998.
With Blunt 0. Ergiin, et al.
The records of 174 children with blunt spleen and liver injuries were analyzed retrospectively to determine blood transfusion requirements in surgically versus conservatively managed patients. Seventy-eight patients were managed conservatively; 96 children underwent various operative procedures. The hematocrit values (Hct), transfused blood volumes @L/kg), and length of hospital stay were compared for the two groups. Although the initial Hct values were comparable for the nonoperative and operative groups (26.7 t 2.7% v 24.8 2 3.5%), transfused blood volumes were significantly higher in the operative group (20.9 mL/kg v 39.5 mL/kg; P < .05). Similarly, the mean length of hospital stay was longer for the surgical group. Associated injuries were evenly distributed among the two groups. The increased blood transfusion requirement for the surgical group may be due to excessive bleeding before operation, which virtually provides the indication for lapa-
of Abdominal Surg Childh
Wall Defects. A. Chilarski Int 6:15-18, (January), 1998.
and
It is estimated that 60% of abdominal wall defects can be detected prenatally by means of ultrasound examinatron performed between 16 and 22 weeks of gestation. The authors present a group of 56 neonates born with these defects. Between January 1991 and December 1997, detailed fetal sonographic evaluation was performed in 3,817 pregnant women. Fetal malformations were found in 1,123 instances. Among them, 554 were extracardiac anomalies, 47 of which were major abdominal wall defects. The diagnosis was established between 22 and 26 weeks’ gestation in 14 cases, between 27 and 33 weeks m 17, and between 34 and 36 weeks in 16 instances. In this series, all fetuses with abdominal wall defects were identified prenatally. Two babies with omphalocele were misdiagnosed as having gastroschisis. The results in this series are much better than those described in the literature. An explanation might be that in the majority of cases the sonographic evaluation was performed rather late, between 27 and 36 weeks’ gestation. Associated anomalies were found in 30% of newborns with omphalocele and in only 4% in the gastroschisis group. In the authors’ opinion, the importance of prenatal ultrasonographic detection of abdominal wall defects lies in the possibility of performing the delivery in an appropriate center and sparing the newborn, especially one with gastroschisis or ruptured omphalocele, the stress of transportation. The method of delivery remains controversial.-Jerry K. Niedzielski
GENITOURINARY Epididymitis in Children: nett, B. Gill, and S.J. Kogan.
TRACT
The Circumcision J Urol 160: 1842-1844,
Factor7 RX Ben(November), 1998.
The authors studied the relationships among the circumcision status of 36 boys with epididymitis in a review of 128 with acute scrotal inflammation (group l), circumcision status of 43 for whom the diagnosis of epididymitis at discharge home had been made elsewhere (group 2), New York State hospital discharge figures for circumcision in newborns (group 3), and the regional prevalence of circumcision in 200 consecutive pediatric emergency department patients at the same institution with nonurologic diagnoses (group 4). The New York State Department figures indicate that 70% of male newborns are discharged home with a hospital code for circumcision. Similarly, an evaluation of 200 consecutive male patients without urologic diagnoses younger than 18 years in the emergency department revealed that 13 1(65%) had been circumcised. Comparatively, in groups 1 and 2, only 25% and 26% of patients (respectively) were circumcised. The statistical difference in circumcision status among the four groups was significant (P > .0004). These data demonstrate that a highly significant relationship exists between epididymitis and the presence of foreskin. The authors found that intact foreskin is an important etiological factor in boys with epididymitis.-George V? Holcomb, Jr Reservoir Calculi: A Comparison of Reservoirs Constructed From Stomach and Other Enteric Segments. M. Kaefex WH. Hendren, S.B. Buuec et al. J Urol 160:2187-2190, (December), 1998. The authors retrospectively reviewed the records of all patients undergoing augmentation cyptoplasty (215) or creation of a freestanding reservoir (44) between May 1976 and March 1996. Of these cases, 83 were augmented with stomach and 179 were constructed from other intestinal segments (ie, ileal, ileocecal, sigmoid, and/or a combination of these). Presenting diagnosis, patient age, gender, additional surgical procedures, interval to stone formation, and calculous composition were recorded. Patients were excluded from the study if there had been less