Tumors of the eye and adnexa in Africans of Uganda

INTERNATIONAL

438

the older girl, in whom partial amputation may be necessary. The fused labia are incised in the midline. The vaginal mucosa is undermined a little and sewn to skin. Then all the skin is excised from the clitoris except for a small island on the dorsum of the glans. A subcutaneous tunnel is made in a posterior direction from the base of the clitoris to the site selected for the “new phallus.” A buttonhole is made at this point. The suspensory ligaments of the clitoris are completely divided and the latter is pulled back through the tunnel. The island of skin on the glans is sewn all round to the buttonhole. The skin defect at the base of the phallus can be sewn directly with just a little undermining. A urethral catheter is not necessary postoperatively. Six months after operation it is difficult to distinguish the reconstructed vulva from a normal one. Reviewer’s Comment: If clitoridectomy is to be done at all it should be done as soon as the child is well stablized on steroids-within a few months of birth. This alternative method achieves a similar effect by removing from sight an abnormal structure, the awareness of which can cause severe psychologic disturbance. Whether the long-term preservative of a large subcutaneous phallus is better than none at all is still an open question.-.I. I. COrkery and R. B. Zachary. UROGENITAL NEUROFIBROMATOSIS S~MIJLATING AN INTERSEX PROBLEM. M. M. Labardini, H. A. Kallet and J. C. Cerny. J. Urol. 98:627-632, November

1967.

The authors report the case report of a 12-yearold child with clitoral enlargement and labial hypertrophy from neurofibromatosis which was thought to represent a case of ambiguous genitalia, prior to formal anatomic investigation of the patient.-w. H. Hen&en. MUSCULOSKELETAL

SYSTEM

DISLOCATABLE HIP AND DISLOCATED HIP IN THE NEWBORN INFANT. H. V. L. Finlay, R. H. Maudsley and P. I. Busfield. Brit. Med. J. 4377, 1967. Over 14,000 infants were examined within 36 hours of birth and the condition of the hip joints specifically noted. Excluding teratologic dislocation and dislocation associated with myelomeningocele, 60 infants with dislocatable or dislocated hips were discovered, with a female

ABSTRACTS OF PEDIATRIC SURGERY

preponderance of 4:l and approximately one third being affected bilaterally. The authors divide the hips into three groups-those that are normal, those that are unstable, and those that are pathosubdivisions. The authors logiowith various make the point that the routine examination and and splinting of unstable hips or pathologically dislocated hips is justified if it can be shown that the majority, if not all, of the potential cases of congenital dislocation of the hip are included within the unstable groups; and it is also most desirable that a large number of babies should not be subjected to unnecessary splinting, which carries with it considerable parental anxiety, infant discomfort, and a potential risk of inhalation of feeds. They estimate that in something over 14,000 infants there would finally have resulted at least 12 cases of established dislocation of the hip, and since 60 cases in their series were treated, 3 or 4 children were being subjected to unnecessary splinting for every one child who was saved from the development of established dislocation. To reduce these children who are splinted unnecessarily, some means of differentiating those cases with unstable hips in the neonatal period is needed. The earlier in life the examination is made the more unstable hips will be discovered and the authors suggest that it might be logical to splint those in the dislocatable group for a shorter period, for example 2 months, than those in the already dislocated group, for example 3 months---James Lister. EWING’S SARCOMA. C. W. Bayer, JT., T. J. Brickner, Jr. and R. H. Perry. Cancer 20:1&X-1606, October, 1967. A review is presented of 30 cases of Ewing’s sarcoma treated at Walter Reed Hospital in the past 18 years. The disease was most common in the second and third decades (2 patients under age 5, 0 from 6-10, 3 from 11-15, 15 from 16-20 years). Radiation was the primary treatment in 20 cases. It was found that radiation therapy regularly controls the lesion and provides effective paliation of metastases. They feel that removal of limbs and other portions of the body is a needless surgical exercise.-W. H. Hen&en. NEOPLASMS TUMORS OF THE EYE AND ADNEXA IN AFRICANS OF UGANDA. A. C. Templeton. Cancer 20:16891698, October, 1967. From Uganda,

Makerere University College, 312 proven tumors of the

Kampala, eye and

1NTERNATIONAL

adnexa in the between 1961

ABSTRACTS

OF

PEDIATRIC

439

SURGERY

African population of Uganda and 1966 are presented. The

tumors show a very different incidence compared with Caucasian communities, and some of these differences appear to be racial such as the extreme rarity of intraocular melanoma and basal cell carcinoma of the eyelid. Retinoblastoma accounts for 21 per cent of the tumors and presented at an average of 2.8 years. Eleven per cent of cases were Burkitt’s lymphoma and they presented at an average of 6 years of age. Embryonal rhabdomyosarcoma was seen in 9 cases, all of them children except one. Malignant tumors of the eye and adnexa accounted for 3.3 per cent of cases of cancer in Africans recorded in the Kampala Cancer Registry, a much greater percentage than in European Cancer Registries. The author compares the incidence of these tumors with those reported in other populations in other locations. He notes that in Uganda much fruitful research can be accomplished for there are similar peoples in different environments and different people in similar environments, the result of tribal society. He believes that all that is rcclnired is that someone read the results! -\I’. II. Hen&en. CLASSIFICATION OF PRI~~ARY MALIGNANT TUMORS OF LIVER IN INFANCY AND CHILDHOOD. K. Jli.srrgi, II. Okaiima, N. Misugi and W. A. Newton, Jr. Cancer 20:1760-1771, October, 1967. A report from the Children’s Hospital, Columbus, Ohio, reviews 24 cases of primary malignant hepatic tumors in infants and children. They fall into two groups: (1) those under 3 years of age and characterized by a mixture of embryonal hepatic parenchymal tissue and neoplastic mesenchymal tissue: (2) those in children older than 6 and characterized by hepatic parenchymal elements. They conclude that the tumors in the younger children are embryonal and congenital in origin, and that those in the older children are clinicaIly and histologically similar to hepatomas in the atlnlt.-W. II. Hendren. v~O~~4~-Bo0y OPA~IFICATIOS IN THE DIAGSOSIS OF Wxxfs Tu~roR Am NELX~OBLASTOIIA: A NOTE OF GAuTIos. Gerald 1. Kurlander and Eurctt P. Smitlf. Hadioloq 89:107Z-1076. December 1967. O‘Connrr and Seuhauser in 1963 described a incthod for “total body opacification” with large (lo.>t,s of I. V. opaclue contrast. An avascular or c,ystic lesion in an organ such as liver or kidney will st,intl (nit more clearly on a radiograph, Other

authors

suggested

that

finding

a “lesion”

in this

manner lends support to the diagnosis of a benign lesion and surgical delay is acceptable for good reasons. The present paper contradicts the ncctptnhilit?: of delay by presenting two cases of “nonvascular” or “Cystic” (and therefore lesions which were a Wilms’ blastoma.-William L. S&e!/.

apparently benign) tumor and a neuro-

UROTHELIAL I;\IPLANTATION OY WILXLS' Tuhfo~s. D. hf. Woodhead, J. H. Gigax, W. II. Wahlc and T. M. Holcomb. Ann. Surg. 167:127-131, January

1968.

The authors report a case of Wilm’s tumor in a 2-year-old child, in whom 6 months following a right nephrectomy, hematuria developed. Retrograde urethrogram revealed a polypoid mass I.5 cm. proximal to the meatus. Biopsy revealed metastatic nephroblastoma. This was subseqiiently excised. At the time of excision there was no other evidence of metastases. Eight months later he did develop diffuse mtastases and expired. The literature is reviewed and 3 cases previously reported are discussed. All 3 had ureteral implants which were not contiguous with the renal lesion. The authors emphasize the possibility of urothelial implantation as a ram mode of metastases from Wilms’ Tumor.-Keith M. Schneider. ~~ETASTATIC RENAL LOWING THERAPY. and T. L. Arnold.

&fBRYOhfA: SURVIVAL FoLR. A. Garrett, J. P. Donohue J. Ural. 98444449, October

1967. A report of 20 years’ experience with Wilms’ tumor at the Indiana University Medical Center is presented. Seventeen are alive and free of disease; 31 are dead, 29 from metastatic disease. Nine of these patients had advanced metastases when first seen. Of the 17 we11 patients, 6 had metastatic disease treated successfully. The authors emphasize the necessity of following children closely after nephrectomy for Wilms’ tumor: they now employ routine chemotherapy every 2 months for the first 2 years even without metastatic disease in evidence, treating pulmonary metastases with x-ray and with surgical resection if disease persist< or rrtinns.-11’. H. Ilcndren. I~I.~RORL.ASTOXfA: KATCRAL HISTORY AND Fb\cL'~‘\1s TREATIVG 1,33 CASES. F. Fortner, -1. Nicastri and M. L. Murphy. Ann. of Slirc. 167: 13%142. January 1968. I’rom Jl11y 1951 to June 1961. 133 cases of histo-