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Use of the hodgsons XX (modified asopa) procedure to correct hypospadias with chordee: Surgical technique and results
INTERNATIONAL ABSTRACTS
biliary obstruction. It is interesting to speculate how the results of this study relate to the infectious problems observed in patients with biliary atresia.--Richard R. Ricketts Spontaneous Perforation of the Extrahepatie Biliary Tract in
Infancy and Childhood. T.C. Moore and R.B. Cameron. Pediatr Surg Internat 1:206-209, (November), 1986.
Spontaneous perforation of the extrahepatic biliary tract in infancy and early childhood is a poorly understood and infrequently reported disorder of unknown etiology. The reported experience with 77 operative cases is reviewed. The onset is generally insidious but may be acute in 25% of cases. The major symptoms are abdominal distention and jaundice. The younger the patient at the time of onset, the more likely is jaundice to be found. Drainage-type operations were most commonly used in the early reported cases while more recently anastomosis/bypass procedures have predominated due to the relatively frequent occurrence of distal biliary tract obstruction. This disorder appears to be a part of the biliary atresia--neonatal hepatitis---choledochal cyst complex, which occurs in the neonatal period and early infancy and appears to be acquired rather than congenital. Because of the theoretical potential for late malignancy, lifelong follow-up with periodic evaluation of the intrahepatic and extrahepatic biliary tracts is recommended.--Prem Puri Spontaneous Perforation of the Common Bile Duct in Infancy. D.C.
Dunn and V.C. Lees. Br J Surg 73:929, (November), 1986. The case of a 23-month-old female infant who had a laparotomy for suspected bowel infarction with peritonitis is reported. At operation, a necrotic perforation of the anterior aspect of the common bile duct was identified. As the perforation was large, involving three quarters of the circumference of the common bile duct, it was considered that simple suture and/or drainage would lead to a stricture. Instead, a patch of gall bladder was raised as a flap on a leash of cystic vessels and transposed to close the perforation. The postoperative recovery was uneventful, and after an 8-year follow-up period there have been no further sequelae.--Tony Spar-
non Distal Splenoranal (Warren) Shunt in the Management of Actively Bleeding Oesophageal Varices. K. Peterson and G.R. Giles. Br J
Surg 73:618-620, (August), 1986. A retrospective evaluation of the results obtained in 53 patients (age range 11 to 79 years) having emergency distal splenorenal shunts performed is discussed. In 38 patients, urgent operative intervention was indicated for uncontrolled hemorrhage or for major relapse after initial control. The remaining 15 patients had a semielective operation after major hemorrhage had been controlled by conservative measures for 72 hours or more. Overall, 77% survived, 100% after semielective shunts, 80% after emergency shunts for uncontrolled hemorrhage, and 60% for shunts performed for recurrent variceal hemorrhage after initial control. A higher mortality was found in patients with poor liver reserve and in whom prolonged conservative management had been attempted. Rebleeding occurred in 20% of patients in the early postoperative period. Of 39 patients with longer term follow-up, eight suffered mild portosystemic encephalopathy and 19 died from multifactorial causes related to the progression of liver disease.--Tony Sparnon
683
<500 mL/min. Fatal pulmonary emboli were seen in two of 40 experiments. The venovenous flow in the four pediatric recipients was 200 to 1,200 mL/min. The four children were 21/2to 9 years old and weighed between 13 and 24 kg. In these selected human recipients, the advantages of venovenous bypasses were the same as previously described for adults and there were no complications.-
George Holcomb, Jr. Splenic Conservation After Trauma in Children. D. Gourevitch and
G.P. Hadley. Surg Gynecol Obstet 163:536-538, (December), 1986. The authors report on the management of 25 consecutive children with splenic injury. In 23 patients, the spleen was preserved (92%). Two were treated by splenectomy. Five splenic injuries occurred in neonates. Four patients (16%) were treated nonoperatively. It was demonstrated that operative splenic conservation is usually possible and is a viable option when diagnostic doubt or logistic difficulties preclude safe nonoperative management. Avoidable operations were performed on two patients (8%). In four (16%), associated intraabdominal lesions requiring surgical treatment were encountered. In 60% of the patients, extensive extraabdominal trauma was pres-
ent.--George Holcomb, Jr. Incidence of Postoperative Adhesion Obstruction Following Neonatal Laparotomy. B.M. Wilkins and L. Spitz. Br J Surg 73:762-
764, (September), 1986. A retrospective review of 649 neonates who had undergone an intraperitoneal procedure revealed that 54 (8.3%) had developed adhesion-related intestinal obstruction requiring laparotomy. There were nine deaths, two of which were a direct consequence of the adhesion obstruction. The highest incidence occurred in patients undergoing correction of a gastroschisis (15.4%), esophageal atresia with gastrostomy (16.6%), and malrotation (15%). Seventy percent of the patients had completely recovered from the previous surgical procedure and were admitted as emergencies from home with adhesion obstruction. The remaining 30% obstructed after a period of prolonged ileus and were still inpatients. Over 75% of the obstructions occurred within 6 months of the last laparotomy with 90% occurring within the first year after surgery. The authors conclude that parents and family practitioners should be made aware of the substantial risk of developing adhesion obstruction within 12 months of a neonatal laparotomy. The development of obstructive signs necessitates early referral to prevent the onset of dehydration that can result in rapid and dramatic deterioration.-
Tony Sparnon GENITOURINARY TRACT Usa of the Hodgaons XX (Modified Asopa) Procedure to Correct Hypospadias With Chordee: Surgical Technique and Results. J.
Wacksman. J Urol 136:1264-1265, (December), 1986. The author reports on 150 patients operated for hypospadias between 1983 and 1985. Of these patients, 37 underwent the Hodgson XX (Modified Asopa) repair. Two patients suffered urethral fistulas, one had meatal stenosis, and one had mild torsion. No strictures were noted. Based on these findings, it is the author's opinion that the Hodgson XX (modified Asopa) procedure provides excellent results for patients with hypospadias and chordee.--
George Holcomb, Jr.
Low Flow Vanovenous Bypasses in Small Dogs and Pediatric Patients Undergoing Replacement of the Liver. L. Kam, S. Lynch,
Cryptorchidism: An Apparent Substantial Increase Since 1960.
S. Todo, et al. Surg Gynecol Obstet 163:33-36, (July), 1986.
293:1401-1404, (November), 1986.
A venovenous bypass for transplantation of the liver was developed and evaluated in dogs and applied clinically. Flows averaged
A total of 1,849 boys born to mothers resident in a defined area around Oxford were examined for cryptorchidism. Those born in
John Radcliffe Hospital Cryptorchidism Study Group. Br Mad J
biliary obstruction. It is interesting to speculate how the results of this study relate to the infectious problems observed in patients with biliary atresia.--Richard R. Ricketts Spontaneous Perforation of the Extrahepatie Biliary Tract in
Infancy and Childhood. T.C. Moore and R.B. Cameron. Pediatr Surg Internat 1:206-209, (November), 1986.
Spontaneous perforation of the extrahepatic biliary tract in infancy and early childhood is a poorly understood and infrequently reported disorder of unknown etiology. The reported experience with 77 operative cases is reviewed. The onset is generally insidious but may be acute in 25% of cases. The major symptoms are abdominal distention and jaundice. The younger the patient at the time of onset, the more likely is jaundice to be found. Drainage-type operations were most commonly used in the early reported cases while more recently anastomosis/bypass procedures have predominated due to the relatively frequent occurrence of distal biliary tract obstruction. This disorder appears to be a part of the biliary atresia--neonatal hepatitis---choledochal cyst complex, which occurs in the neonatal period and early infancy and appears to be acquired rather than congenital. Because of the theoretical potential for late malignancy, lifelong follow-up with periodic evaluation of the intrahepatic and extrahepatic biliary tracts is recommended.--Prem Puri Spontaneous Perforation of the Common Bile Duct in Infancy. D.C.
Dunn and V.C. Lees. Br J Surg 73:929, (November), 1986. The case of a 23-month-old female infant who had a laparotomy for suspected bowel infarction with peritonitis is reported. At operation, a necrotic perforation of the anterior aspect of the common bile duct was identified. As the perforation was large, involving three quarters of the circumference of the common bile duct, it was considered that simple suture and/or drainage would lead to a stricture. Instead, a patch of gall bladder was raised as a flap on a leash of cystic vessels and transposed to close the perforation. The postoperative recovery was uneventful, and after an 8-year follow-up period there have been no further sequelae.--Tony Spar-
non Distal Splenoranal (Warren) Shunt in the Management of Actively Bleeding Oesophageal Varices. K. Peterson and G.R. Giles. Br J
Surg 73:618-620, (August), 1986. A retrospective evaluation of the results obtained in 53 patients (age range 11 to 79 years) having emergency distal splenorenal shunts performed is discussed. In 38 patients, urgent operative intervention was indicated for uncontrolled hemorrhage or for major relapse after initial control. The remaining 15 patients had a semielective operation after major hemorrhage had been controlled by conservative measures for 72 hours or more. Overall, 77% survived, 100% after semielective shunts, 80% after emergency shunts for uncontrolled hemorrhage, and 60% for shunts performed for recurrent variceal hemorrhage after initial control. A higher mortality was found in patients with poor liver reserve and in whom prolonged conservative management had been attempted. Rebleeding occurred in 20% of patients in the early postoperative period. Of 39 patients with longer term follow-up, eight suffered mild portosystemic encephalopathy and 19 died from multifactorial causes related to the progression of liver disease.--Tony Sparnon
683
<500 mL/min. Fatal pulmonary emboli were seen in two of 40 experiments. The venovenous flow in the four pediatric recipients was 200 to 1,200 mL/min. The four children were 21/2to 9 years old and weighed between 13 and 24 kg. In these selected human recipients, the advantages of venovenous bypasses were the same as previously described for adults and there were no complications.-
George Holcomb, Jr. Splenic Conservation After Trauma in Children. D. Gourevitch and
G.P. Hadley. Surg Gynecol Obstet 163:536-538, (December), 1986. The authors report on the management of 25 consecutive children with splenic injury. In 23 patients, the spleen was preserved (92%). Two were treated by splenectomy. Five splenic injuries occurred in neonates. Four patients (16%) were treated nonoperatively. It was demonstrated that operative splenic conservation is usually possible and is a viable option when diagnostic doubt or logistic difficulties preclude safe nonoperative management. Avoidable operations were performed on two patients (8%). In four (16%), associated intraabdominal lesions requiring surgical treatment were encountered. In 60% of the patients, extensive extraabdominal trauma was pres-
ent.--George Holcomb, Jr. Incidence of Postoperative Adhesion Obstruction Following Neonatal Laparotomy. B.M. Wilkins and L. Spitz. Br J Surg 73:762-
764, (September), 1986. A retrospective review of 649 neonates who had undergone an intraperitoneal procedure revealed that 54 (8.3%) had developed adhesion-related intestinal obstruction requiring laparotomy. There were nine deaths, two of which were a direct consequence of the adhesion obstruction. The highest incidence occurred in patients undergoing correction of a gastroschisis (15.4%), esophageal atresia with gastrostomy (16.6%), and malrotation (15%). Seventy percent of the patients had completely recovered from the previous surgical procedure and were admitted as emergencies from home with adhesion obstruction. The remaining 30% obstructed after a period of prolonged ileus and were still inpatients. Over 75% of the obstructions occurred within 6 months of the last laparotomy with 90% occurring within the first year after surgery. The authors conclude that parents and family practitioners should be made aware of the substantial risk of developing adhesion obstruction within 12 months of a neonatal laparotomy. The development of obstructive signs necessitates early referral to prevent the onset of dehydration that can result in rapid and dramatic deterioration.-
Tony Sparnon GENITOURINARY TRACT Usa of the Hodgaons XX (Modified Asopa) Procedure to Correct Hypospadias With Chordee: Surgical Technique and Results. J.
Wacksman. J Urol 136:1264-1265, (December), 1986. The author reports on 150 patients operated for hypospadias between 1983 and 1985. Of these patients, 37 underwent the Hodgson XX (Modified Asopa) repair. Two patients suffered urethral fistulas, one had meatal stenosis, and one had mild torsion. No strictures were noted. Based on these findings, it is the author's opinion that the Hodgson XX (modified Asopa) procedure provides excellent results for patients with hypospadias and chordee.--
George Holcomb, Jr.
Low Flow Vanovenous Bypasses in Small Dogs and Pediatric Patients Undergoing Replacement of the Liver. L. Kam, S. Lynch,
Cryptorchidism: An Apparent Substantial Increase Since 1960.
S. Todo, et al. Surg Gynecol Obstet 163:33-36, (July), 1986.
293:1401-1404, (November), 1986.
A venovenous bypass for transplantation of the liver was developed and evaluated in dogs and applied clinically. Flows averaged
A total of 1,849 boys born to mothers resident in a defined area around Oxford were examined for cryptorchidism. Those born in
John Radcliffe Hospital Cryptorchidism Study Group. Br Mad J