The surgery of premature infants

INTERNATIONAL

186 Mesenchymal A Malignant

ABSTRACTS

OF PEDIATRIC

205 205

Hamartoma of Liver. ......................................... True Teratoma of Liver in Childhood. ...........................

Portal Hypertension Extrahepatic Portal Epidermoid

206 206

in Children. ........................................... Obstruction in Infants and Children. .......................

Cyst of the Spleen

Presenting

as an Abdominal

Emergency.

Ureterostomy:

Indications

in Children.

207

..........

Genitourinary System Crossed Ectopia of a Solitary Kidney. ....................................... Crossed Renal Ectopia without Fusion Associated with Giant Hydronephrosis. Ureterocele ............................................................. Cutaneous

SURGERY

207 207 207

.....

207

.............................

Ileal Loop Diversion ...................................................... Caruncle of Infant’s Urethra. ..............................................

207 208

Report of a Case of Diphallus. ............................................. Hypospadias: One-Stage Repair. ...........................................

208 208

Hypospadias: Principle of Third Degree. ..................................... Urinary Tract Evaluation in Hypospadias. ................................... The Natural History of Testicular Descent. .................................. ......................... The Undescended Testicle: Diagnosis and Treatment.

208 208 208

Torsion

of the Spermatic

Cord in the Newborn.

209 209

...............................

210 210 210

Meatal Stenosis in Girls: Report of a Case. ................................... Adhesions of the Labia Minora in Childhood. ................................ Carcinoma of the Vagina in Infancy. ....................................... Nongestational Chorio Functioning Malignant Agonadism

Carcinoma of the Ovary. .............................. Germ Cell Tumor of the Ovary in a 4% Year Old Girl.

211

.............................................................

Musculoskeletal System Tendon Injuries around the Ankle. ......................................... The Intriguing Fate of Tendon Grafts in Small Children’s Hands and Their Recurring Digital Fibrous Tumors of Childhood. .............................

211 Results

Neoplasms Chemotherapy in Childhood Cancer (Except Leukemia) ........................ Maturation of Tumors of the Sympathetic Nervous System. ..................... Pheochromocytomy-An Urgent Surgical Condition. ........................... Induction of Neoplasm in Rat Thyroid Gland by X-Irradiation of a Single Lobe.

GENERAL CBSEWATIONS

CONSIDERATIONS

ON BL~~II

BORN INFANTS.

Scopes. 1965.

211 211

.....

Arch.

PRESSURE IN NEW-

Gupta and J. W. Childhhood 40:637,

J. M.

Dis.

Using an automatic, double cuff device, the blood pressure was recorded indirectly at 2 minute intervals from the arm or leg of 50 newborn infants. Direct measurement of blood pressure was also made in 43 babies who required the insertion of an umbilical arterial catheter for clinical reasons. The blood pressure of newborn babies was found to be very variable. Crying, feeding and sitting upright caused a rise in both systolic and diastolic pressures, while the head-down position caused a fall. The pressures in babies between 1500 and 2500 Cm. in weight did not differ materially from those in bigger babies (average 71/48

...

211 212 212 212 213 213

mm. Hg when lying flat). In babies of weight less than 1500 Gm. and in babies with the respiratory distress syndrome the pressures were lower (average 64/43 mm. Hg and 63/45 mm. Hg, respectively). In one infant in whom the blood pressure was being recorded cardiac arrest occurred. External cardiac massage was performed and its efficiency was shown by the production of a good pulse pressure. Exchange transfusion, even when each maneuver was performed slowly, produced large fluctuations in blood pressure; the average fall of systolic pressure on withdrawing 20 ml. blood was Bmm. Hg.-I. H. Johnston SURGERY OF PREMATURE INFANTS. E. W. Fonkalsrud, H. Ogawa and H. W. Clatworthy, Jr. Surgery 58:550, 1965.

THE

The authors report 175 premature subjected to surgery for congenital

infants anbma-

INTERNATIONAL

lies of the

digestive

system,

urinary

tract,

diaphragm, and/or abdominal wall. The operative mortality of the entire group is 51.4 per cent as compared to 16.7 per cent operative mortality in 245 full-term infants subjected to similar procedures. The mortality among premature infants undergoing operation was found to be 30 per cent higher than among infants of the same weight not requiring surgery. The mortality in premature infants with more than one major anomaly was 71.4 per cent. Infection was the cause of death in approximately 75 per cent of the patients. It is noted that in this series, penicillin and streptomycin were after surgery.-Daniel

ANESTHESIA

given almost T. Clod

routinely

AND INHALATION THERAPY

TRACHEDSTOMY AND ITS CARE IN INFANTS.

E. Aberdeen. 900, 1965.

187

ABSTRACTS OF PEDIATRIC SURGERY

Proc.

Roy.

Sot.

Med.

58:

In the last 5% years at the Hospital for Sick Children, Great Ormond Street, London. 149 tracheostomies in I47 infants have indicated that most of the risks associated with this procedure can be avoided. Chief indications for it were improvement of respiratory efficiency and pulmonary drainage. Few were for upper obstructive lesions. Its avoidance was aided by full humidification of inspired material, nasopharyngeal aspiration and sedation, physiotherapy, intermittent tracheal aspiration. percutaneous tracheal catheter and nasotracheal intubation. One hundred and five out of 147 cases suffered from congenital heart disease and others in considerably lesser numbers suffered from esophageal atresia with or without congenital heart disease, diaphragmatic hernia, congenital emphysema, staphylococcal pneumonia, etc. One hundred and ten out of I49 were under 3 months of age. Fortv-six successful extubations were obtained indicating that many died from the severity of their disease or condition. Infection was the most common complicution affecting many cases in some degree. Bronchospasm was related to long and vigorous toilet maneuvers within the trachea.

There

were no instances

of tracheal

steno-

sis. Special P.V.C. tubes were developed and used, being pliable and nonirritant with a single lumen ranging up from 4.5mm. outer diameter and 24mm. intratracheal length. Other significant features were gentle curvature, oblique inner end, coned outer orifice for connector iftting. Tracheostomy was always done under general anesthesia with endotracheal inmidline incision through three tubation; tracheal rings without cartilage excision was practiced. was always present A special nurse throughout the intubated period. Tracheal aspiration was done at regular intervals and on requirement with a sterile catheter used gently-not an easy thing to do well. Fine humidification with nebulizer and tracheal saline instillation regularly as indicated, was essential. Mucolytics had their uses also on occasion. Avoidance of metabolic dehydration was found to be important. The head in the extended position was essential. Physiotherapy was used a great deal. Increasing use of ventilators increased the risk of tube displacement. The avoidance of abdominal distension by gastric aspiration, or rectal tube, was important. Urgent signs were restlessness and fa.t pulse and an estimation of the volume of air expired was judged audibly and palpably by placing the ear close to the stoma. Any vocal sound was considered of serious importance. Emergency resuscitation apparatus, spare tubes and inserting instruments were always available.-F. H. Robarts. MECHANICAL VENTILATION IN RESPIRATORY INSUFFICIENCY IN INFANTS. W.

Proc.

Roy. Sot.

Med. 58:902,

J. Glooer. 1965.

Periods of ventilation in the preceding series varied from 24 hours to several weeks and were accomplished usually by the Engstrom ventilator or the Bird Mark VIII machine for patients with fairly normal lungs. The majority of infants requiring ventilation suffer from cardiopulmonary disease--cardiac failure, respiratory distress syndrome of the newborn, etc. The lungs have decreased compliance with high airway resistance which as the disease advances rises as the compliance continues to