Esophagogastric separation for failed fundoplication in neurologically impaired children.

Purpose: Recurrent gastroesophageal reflux (GER) after a fundoplication in severely neurologically impaired children is a frustrating problem without an effective solution: redo fundoplications carry a significant recurrence rate and gastrojejunostomy (GJ) tube feedings are associated with frequent tube dislodgment. The authors report a series of esophagogastric separation (EGS) procedures aimed at the management of failed fundoplication in neurologically impaired children.

Methods: Medical records of 10 patients who underwent EGS for recurrent GER were reviewed retrospectively.

Predictability of splenic salvage by computed tomography.

The recognition of overwhelming post-splenectomy infection (OPSI) has led to greater efforts to conserve splenic tissue in patients sustaining blunt torso trauma. Nonoperative management of splenic trauma has emerged as a means to enhance splenic salvage yet criteria to assure the safety of such an approach remain ill defined and controversial. Since severity of injury directly influences outcome, a need exists for identification of splenic injuries that require early operation and repair or removal.

Beneficial use of an evocative test in chronic relapsing pancreatitis in children.

The true incidence and cause of chronic recurrent pancreatitis in children remains enigmatic because little is known about its early natural history, it is considered only infrequently, and diagnosis is difficult. Chronic recurrent abdominal pain in children continues to be common. To help evaluate the possibility that such pain is related to chronic recurrent pancreatitis, this study used the morphine-prostigmine pancreatic evocative test with the recent addition of concomitant pancreatic ultrasonography to evaluate ductal activity.

Posterior sagittal anoplasty combined with ventricular peritoneal shunting: an unusual complication.

This report is intended to point out the potential difficulties in patients with the combined abnormalities of anorectal agenesis and central nervous system disorders requiring diversion of CSF. The potential accumulation of this diverted fluid in and around meticulously approximated pelvic musculature so important to continence was a real concern and prompted immediate reexploration and shunt conversion. It is recommended that future cases with these coexisting abnormalities should be carefully considered for shunt conversion prior to or at the time of posterior sagittal anorectoplasty, particularly if the peritoneum is inadvertantly entered.

A new technique for the placement of continuous ambulatory peritoneal dialysis catheters in infants and small children.

The technique described herein is simple and straightforward. Strict attention to detail should result in a peritoneal catheter which will function indefinitely. Using this method of catheter placement, patients have not only had the renal disease controlled but have experienced improved dietary and caloric intake orally and, through the dialysate, increased protein utilization and subsequent accelerated weight gain and improved height velocity in centimeters per year.

Chronic relapsing pancreatitis in childhood.

Chronic intermittent abdominal pain in childhood, reported to afflict nine to 12 per cent of all children, is an enigma of such magnitude that more than 30 per cent of these patients reach adulthood with persistent problems and no definitive diagnosis. This report discusses 20 children with such pain (9 girls and 11 boys) in whom routine diagnostic evaluation failed to identify the etiology. Selected special diagnostic studies and considerable suspicion for chronic pancreatitis prompted surgical intervention in three patients.

Successful venomous snakebite neutralization with massive antivenin infusion in a child.

Intravenous antivenin requirements to neutralize venomous snake bites can be appropriately calculated based on accurate estimations of injury severity, and/or safely titrated if systemic symptoms are present. This report describes a case in a child given 13 10-ml vials of crotalidae antivenin before and during transfer, and tetanus prophylaxis, cephalosporin (200 mg IV q 6 h), and the titration of 62 additional 10-ml vials of antivenin within 14 hours, based on the child's response to therapy. By the tenth day all symptoms had resolved.

Esophageal reconstruction for benign disease: a long-term appraisal.

Replacement of all or part of the esophagus, for whatever reason, requires intimate familiarity with the advantages, disadvantages, and long-term results of various techniques of reconstruction. For benign esophageal disease, because of the expected longer natural history of such lesions, long-term results should be more informative. The Mayo Clinic experience with esophageal reconstruction for benign disease is reviewed for the 15-year period of July 1955 through July 1970, critically evaluating the long-term results of from 8 to 21 years.

Vasoactive intestinal peptide secreting tumors of childhood.

A 2-year-old boy with failure to thrive, watery diarrhea, abdominal distention, hypokalemia, metabolic acidosis, and episodes of hypertension and sweating was found to have a calcified right lower quadrant mass. Blood levels of vasoactive intestinal peptide (VIP) and norepinephrine (NE) were elevated. Presurgical management with phenoxybenzamine hydrochloride and metyrosine was associated with an absence of expected postoperative hypotension, and resection of a benign ganglioneuroma resulted in prompt relief of all symptoms and return to normal of VIP and NE levels.

Transcutaneous oxygen (tcPO2) measurements as an aid to fluid therapy in necrotizing enterocolitis.

Impaired peripheral perfusion is a major problem in necrotizing enterocolitis with delayed recognition and definite documentation being primary factors. While blood pressure and other clinical measurements may improperly estimate the severity of the problem, changes in transcutaneous oxygen measurements and their relationship to arterial oxygen (the tcPO2/PaO2 ratio) potentially afford a sensitive measurement of peripheral perfusion. Experience in our unit confirms a close relationship between tcPO2/ and PaO2 being 0.

Christmas bow tragedies.

Two cases of fatal accidents involving plastic buttons from Christmas bows are described. Although accidents are the commonest cause of death in children less than 3 years old, governmental mechanisms, properly enforced, can be instrumental in preventing such catastrophies.

Splenorrhaphy: changing concepts for the traumatized spleen.

Established doctrine dictating splenectomy for the traumatized spleen has come under considerable critism since the report of fatal postsplenectomy sepsis by King and Shumacher in 1952. With expanding knowledge of immunologic and physiologic function, splenectomized persons have been proven at risk in different areas, but the most important impetus for splenic preservation has been the observation of overwhelming postsplenectomy sepsis. Several reports have confirmed this concern, with a documented increase in morbidity and death of splenectomized patients of 50 to 200 times the normal.

Pulmonary arteriovenous malformations in children.

Pulmonary arteriovenous malformations are a life-threatening, but curable, cause of persistent cyanosis in children. Abnormal communications may be single or multiple and are usually in the lower lobes. Three patients with pulmonary arteriovenous malformations have recently been managed at this hospital.

Bilateral Wilms tumor presenting with acute renal failure and clinical findings mimicking cardiac failure.

A six-year-old girl presented with clinical signs and symptoms of right-sided heart failure. Cardiac catheterization demonstrated filling defects in both pulmonary arteries felt to represent metastatic lesions or thromboemboli. Intravenous pyelogram revealed bilateral renal masses and intrarenal obstruction.

Ventriculoperitoneal (VP) shunt migration causing an acute scrotum: a case report of Doppler evaluation.

The diagnosis and management of a scrotal complication of a ventriculoperitoneal shunt simulating testicular torsion in a neonate is outlined. Radiologic evaluation determined the location of the shunt tube and adequate blood flow to the testicle was confirmed by use of the Doppler stethoscope, allowing for definitive therapy by extraperitoneal shortening of the shunt catheter. Surgery to the scrotum was, thus, avoided.