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Transitory hypertension following urologic surgery in children
613
INTERNATIONAL ABSTRACTS OF PEDIATRIC SURGERY etc.) a cavernomatous transformation of the portal vein was found at splenoportography. On the late roentgenograms there was a good urogram on the right, but nonfunetion of the left kidney. The diagnosis of agenesis of the left kidney was confirmed at chromocystoscopy and retrograde pyelography. Because of this left renal agenesis a splenorenal anastomosis was not feasible. The author made thus a side-to-side anastomosis between the superior mesenterie vein and the inferior vena eava. Spleneetomy was also performed. The condition of the patient 5 months later was satisfactory.--M. Bettex. MEDIASTINAL PSEUDOCYST OF THE PANCI:tEAS IN A CHILD: REPORT OF A CASE. C. Andrew Laird, and O. Theron Clagett. Surgery 60:465-469, August, 1966. A case is presented of a 15 year old boy in whom pancreatitis developed secondary to blunt abdominal trauma, aDd subsequently a pancreatic pseudocyst developed which extended into the mediastinum. Surgical treatment consisted of retrograde drainage of the pancreatic duet and pseudocyst by a caudal Roux-en-Y pancreatieojejunostomy. This is thought to b e the only such case reported in the literature. --Daniel T. Cloud. RUPTURE OF THE NORMAL SPLEEN IN THE NEWBORN, W I T H SURVIVAL. Oscar Schwartz, and Bertram D. Cohn. Surgery 59:1124-1127, June, 1966. The authors report a case of rupture Of the normal spleen in a newborn infant. Seven previously reported cases were noted in the literature and reviewed. In this case symptoms were first noted 39 hours after delivery. The symptoms were pallor, falling hemoglobin and hematocrit, abdominal distention, x-ray evidence of intraperitoneal fluid, and a bluish cast of the abdominal wall. In the cases reviewed a nontraumatic delivery was usually reported, although the infants were slightly above average weight. A latent period between birth and the appearance of symptoms was consistently noted. Observation was made of the recommendations of using prophylactic antibiotic therapy on splenectomized infants, but apparently this was not done on this case.
The patient was well 14 months after surgery.--Daniel T. Cloud. DISEASES OF THE ADRENALS: DIAGNOSIS, TREATMENT AND RESULTS. V. Pettinari. P~idiat. prax. 5:355-366, 1966. The author describes in detail the main indications for adrenalectomy, differentiating the nonfunctional from the functional forms of adrenal diseases. The first group consists of carcinomas in the cortex and neuroblastomas in the medulla. The second group includes a variety of syndromes. In the cortex are found the Conn syndrome with increased aldosterone production, the Cushing syndrome, and the adrenogenital syndrome; in the medulla, pheochromocytoma. In the true pituitary Cushing syndrome with adrenal hyperplasia renaoval of both adrenals is preferred, followed by substitution therapy. Even in the congenital form of adrenogenital syndrome a combined surgical and internal treatment is suggested. In surgery of pheochroniocytoma the lumbar approach is preferred. Finally, arteriopathies and hypertensive syndromes with adrenal pathogenetic involvement are discussed.--W. Leuterer. MECONIUY~ PERITONITIS. W. S. Lorimer, Jr., and Dick G. Ellis. Surgery 60:470-475, August, 1966. Five cases of meconium peritonitis are presented. The principal clinical features are symptoms of intestinal obstruction with ascites. Polyhydramnios is common. X-rays of the abdomen are usually diagnostic with caldifications being demonstrated in approximately two-thirds of the cases. The surgical objective is to re-establish continuity of 50 per cent of the small intestine. It is important, especially in the cystic type, to limit the operative procedure to that objective inasmuch as continued surgery is associated with a h i g h e r mortality. Four of the 5 cases presented recovered.--Daniel T. Cloud. GENITOURINARY
TRACT
TRANSITORY HYPERTENSION FOLLOWING UROLOGIC SURGERY IN CHILDREN. S. C. Berens, L. M. Linde, and W. E. Goodwin. Pediatrics 38:194-200, August, 1966.
614
INTERNATIONAL ABSTRACTS OF PEDIATRIC SURGERY
Sixteen pediatric patients experienced 18 episodes of transient postoperative hypertension after urological operations. The hypertension usually began 1 to 9 days postoperatively and lasted an average of 3.8 days. No therapy was necessary. Control patients undergoing nonurological operations developed similar but transient postoperative hypertension of much shorter duration. Relative renal ischemia due to (1) surgical stress with sympathetic tone elevation and renal arterial vasoconstriction, (2) ureter renal reflexes resulting in renal vascular constriction, and (3) generalized increased lability of vascular bed in such children, are suggested causes of the phenomenon.--William K. Sieber. NONTRAUMATIC HEMATURIA
IN CHILDREN.
W. E. Harrison, H. N. Habib, E. I. Smith, and R. P. McCarthy. J. Urol. 96:95-100, July, 1966. During a 6 year period 80 children were admitted to Children's Mercy Hospital, Kansas City, Missouri, with hematuria where trauma was not implicated. There was no significant sex difference. Glomerulonephritis was the cause of hematuria in 31 children. Sixteen had hemorrhagic cystitis. In 12 cases no etiology was found. Four had urethritis. Three had pyelonephritis. Fourteen had a variety of causes including ureteral stricture, Henoch-Schoenlein purpura, hemophilia, hepatic insufficiency, thrombocytopenic purpura, ureteropelvic junction obstruction with pyelonephritis, acute cystitis from vesical neck contracture, urethral prolapse, Wilms' tumor, bilateral hydronephrosis with pyelonephritis, trigonal ulcer, hemoglobinuria, subacute' bacterial endocarditis, and horseshoe kidney with partial obstruction. The authors believe that any child with hematuria deserves a complete workup; tumor is rarely the cause for hematuria in childhood.--W. Hardy Hendten.
.....
MORPHOLOGICAL OBSERVATIONS ON CHANGES OF RENAL VASCULAR ARCHITECTURE IN SEVERE HYDRONEPHROSIS IN CHILDREN. R. Domini. Riv Chir. Pediat. 8:49-54, Jan-March, 1966. Renal vascular architecture was studied by means of plastic casts of 12 kidneys
affected by congenital hydronephrosis of patients aged i to 12 years. While in the initial phase of the disease the distortion involves the orientation of the interlobar and interlobular vessels, in the later stages it involves the finer structures through glomerular atrophy and the appearance of an aglomerular network.--C. A. Montagnani. CONGENITAL STENOSIS OF THE PYELOURETERAL JUNCTION. A. Pampaloni. Riv. Clin.
Pediat. 8:71-94, Jan-March, 1966. The discussion is based upon the clinical findings and the surgical treatment of 22 cases. Sex: 13 males, 9 females. Age: major incidence between 2 and 4 years. Side involved: right 8, left 7, bilateral 7, with a total of 29 lesions. Of these 13 were intrinsic, 11 extrinsic and 5 both extrinsic and intrinsic. Symptoms and complications were: infection (50 per cent), fever (40 per cent), vomiting (30 per cent), colicy pain (27 per cent), dull pain (13 per cent), palpable mass (18 per cent), hematuria (18 per cent), albuminuria (18 per cent). Frequency in micturition, dysuria, gastroenteritis, abdominal distension, hyperazotemia, renal rickets and dwarfism were occasionally observed. Renal stones were present in 3 patients. Average onset of synaptoms was 18 months before surgery. Associated urinary malformations were present in 4 cases (18 per cent), double pelvis and ureter in 1 case, renal aplasia or hypoplasia in 2 cases, persistence of fetal lobation of the kidney in 1 case. The preoperative diagnosis was made in all cases on the basis of the clinical and radiological findings (I.V.P. and only occasionally retrograde pyelogram). Surgical treatment was strictly conservative and consisted in Y-V plastic in 4 cases and ureteral resection and anastomosis in 11 cases because of intrinsic obstruction. Section of anomalous polar vessels and section of congenital fibrous bands followed by nephropexy was performed because of extrinsic obstruction. In 2 of these cases a recurrence of the obstruction developed and resection and anastomosis was performed with complete recovery. Severe pyelonephritis developed in one case and nephrectomy was performed later on. No mortality is reported. Results were good in all cases with
INTERNATIONAL ABSTRACTS OF PEDIATRIC SURGERY etc.) a cavernomatous transformation of the portal vein was found at splenoportography. On the late roentgenograms there was a good urogram on the right, but nonfunetion of the left kidney. The diagnosis of agenesis of the left kidney was confirmed at chromocystoscopy and retrograde pyelography. Because of this left renal agenesis a splenorenal anastomosis was not feasible. The author made thus a side-to-side anastomosis between the superior mesenterie vein and the inferior vena eava. Spleneetomy was also performed. The condition of the patient 5 months later was satisfactory.--M. Bettex. MEDIASTINAL PSEUDOCYST OF THE PANCI:tEAS IN A CHILD: REPORT OF A CASE. C. Andrew Laird, and O. Theron Clagett. Surgery 60:465-469, August, 1966. A case is presented of a 15 year old boy in whom pancreatitis developed secondary to blunt abdominal trauma, aDd subsequently a pancreatic pseudocyst developed which extended into the mediastinum. Surgical treatment consisted of retrograde drainage of the pancreatic duet and pseudocyst by a caudal Roux-en-Y pancreatieojejunostomy. This is thought to b e the only such case reported in the literature. --Daniel T. Cloud. RUPTURE OF THE NORMAL SPLEEN IN THE NEWBORN, W I T H SURVIVAL. Oscar Schwartz, and Bertram D. Cohn. Surgery 59:1124-1127, June, 1966. The authors report a case of rupture Of the normal spleen in a newborn infant. Seven previously reported cases were noted in the literature and reviewed. In this case symptoms were first noted 39 hours after delivery. The symptoms were pallor, falling hemoglobin and hematocrit, abdominal distention, x-ray evidence of intraperitoneal fluid, and a bluish cast of the abdominal wall. In the cases reviewed a nontraumatic delivery was usually reported, although the infants were slightly above average weight. A latent period between birth and the appearance of symptoms was consistently noted. Observation was made of the recommendations of using prophylactic antibiotic therapy on splenectomized infants, but apparently this was not done on this case.
The patient was well 14 months after surgery.--Daniel T. Cloud. DISEASES OF THE ADRENALS: DIAGNOSIS, TREATMENT AND RESULTS. V. Pettinari. P~idiat. prax. 5:355-366, 1966. The author describes in detail the main indications for adrenalectomy, differentiating the nonfunctional from the functional forms of adrenal diseases. The first group consists of carcinomas in the cortex and neuroblastomas in the medulla. The second group includes a variety of syndromes. In the cortex are found the Conn syndrome with increased aldosterone production, the Cushing syndrome, and the adrenogenital syndrome; in the medulla, pheochromocytoma. In the true pituitary Cushing syndrome with adrenal hyperplasia renaoval of both adrenals is preferred, followed by substitution therapy. Even in the congenital form of adrenogenital syndrome a combined surgical and internal treatment is suggested. In surgery of pheochroniocytoma the lumbar approach is preferred. Finally, arteriopathies and hypertensive syndromes with adrenal pathogenetic involvement are discussed.--W. Leuterer. MECONIUY~ PERITONITIS. W. S. Lorimer, Jr., and Dick G. Ellis. Surgery 60:470-475, August, 1966. Five cases of meconium peritonitis are presented. The principal clinical features are symptoms of intestinal obstruction with ascites. Polyhydramnios is common. X-rays of the abdomen are usually diagnostic with caldifications being demonstrated in approximately two-thirds of the cases. The surgical objective is to re-establish continuity of 50 per cent of the small intestine. It is important, especially in the cystic type, to limit the operative procedure to that objective inasmuch as continued surgery is associated with a h i g h e r mortality. Four of the 5 cases presented recovered.--Daniel T. Cloud. GENITOURINARY
TRACT
TRANSITORY HYPERTENSION FOLLOWING UROLOGIC SURGERY IN CHILDREN. S. C. Berens, L. M. Linde, and W. E. Goodwin. Pediatrics 38:194-200, August, 1966.
614
INTERNATIONAL ABSTRACTS OF PEDIATRIC SURGERY
Sixteen pediatric patients experienced 18 episodes of transient postoperative hypertension after urological operations. The hypertension usually began 1 to 9 days postoperatively and lasted an average of 3.8 days. No therapy was necessary. Control patients undergoing nonurological operations developed similar but transient postoperative hypertension of much shorter duration. Relative renal ischemia due to (1) surgical stress with sympathetic tone elevation and renal arterial vasoconstriction, (2) ureter renal reflexes resulting in renal vascular constriction, and (3) generalized increased lability of vascular bed in such children, are suggested causes of the phenomenon.--William K. Sieber. NONTRAUMATIC HEMATURIA
IN CHILDREN.
W. E. Harrison, H. N. Habib, E. I. Smith, and R. P. McCarthy. J. Urol. 96:95-100, July, 1966. During a 6 year period 80 children were admitted to Children's Mercy Hospital, Kansas City, Missouri, with hematuria where trauma was not implicated. There was no significant sex difference. Glomerulonephritis was the cause of hematuria in 31 children. Sixteen had hemorrhagic cystitis. In 12 cases no etiology was found. Four had urethritis. Three had pyelonephritis. Fourteen had a variety of causes including ureteral stricture, Henoch-Schoenlein purpura, hemophilia, hepatic insufficiency, thrombocytopenic purpura, ureteropelvic junction obstruction with pyelonephritis, acute cystitis from vesical neck contracture, urethral prolapse, Wilms' tumor, bilateral hydronephrosis with pyelonephritis, trigonal ulcer, hemoglobinuria, subacute' bacterial endocarditis, and horseshoe kidney with partial obstruction. The authors believe that any child with hematuria deserves a complete workup; tumor is rarely the cause for hematuria in childhood.--W. Hardy Hendten.
.....
MORPHOLOGICAL OBSERVATIONS ON CHANGES OF RENAL VASCULAR ARCHITECTURE IN SEVERE HYDRONEPHROSIS IN CHILDREN. R. Domini. Riv Chir. Pediat. 8:49-54, Jan-March, 1966. Renal vascular architecture was studied by means of plastic casts of 12 kidneys
affected by congenital hydronephrosis of patients aged i to 12 years. While in the initial phase of the disease the distortion involves the orientation of the interlobar and interlobular vessels, in the later stages it involves the finer structures through glomerular atrophy and the appearance of an aglomerular network.--C. A. Montagnani. CONGENITAL STENOSIS OF THE PYELOURETERAL JUNCTION. A. Pampaloni. Riv. Clin.
Pediat. 8:71-94, Jan-March, 1966. The discussion is based upon the clinical findings and the surgical treatment of 22 cases. Sex: 13 males, 9 females. Age: major incidence between 2 and 4 years. Side involved: right 8, left 7, bilateral 7, with a total of 29 lesions. Of these 13 were intrinsic, 11 extrinsic and 5 both extrinsic and intrinsic. Symptoms and complications were: infection (50 per cent), fever (40 per cent), vomiting (30 per cent), colicy pain (27 per cent), dull pain (13 per cent), palpable mass (18 per cent), hematuria (18 per cent), albuminuria (18 per cent). Frequency in micturition, dysuria, gastroenteritis, abdominal distension, hyperazotemia, renal rickets and dwarfism were occasionally observed. Renal stones were present in 3 patients. Average onset of synaptoms was 18 months before surgery. Associated urinary malformations were present in 4 cases (18 per cent), double pelvis and ureter in 1 case, renal aplasia or hypoplasia in 2 cases, persistence of fetal lobation of the kidney in 1 case. The preoperative diagnosis was made in all cases on the basis of the clinical and radiological findings (I.V.P. and only occasionally retrograde pyelogram). Surgical treatment was strictly conservative and consisted in Y-V plastic in 4 cases and ureteral resection and anastomosis in 11 cases because of intrinsic obstruction. Section of anomalous polar vessels and section of congenital fibrous bands followed by nephropexy was performed because of extrinsic obstruction. In 2 of these cases a recurrence of the obstruction developed and resection and anastomosis was performed with complete recovery. Severe pyelonephritis developed in one case and nephrectomy was performed later on. No mortality is reported. Results were good in all cases with