Big shunts for small patients with portal hypertension: a bit of history.

This is a brief resume of my personal experiences that led to the development of two portosystemic shunt procedures designed to be used in small patients with bleeding varices and portal hypertension. Both enable one to decompress the congested protal venous system in the preschool-aged group when about two thirds of such patients begin to suffer their first life threatening bleeding episodes.

Robert E. Gross.

Born in 1905, Gross graduated with honors from Carleton College and the Harvard Medical School. After spending 2 years in pathology, he entered his surgical training at the Peter Brent Brigham Hospital and at the Boston Children's Hospital with Dr. William E.

Esophageal sclerotherapy: an effective modality in children.

During the past five years, sclerotherapy has been used at our institution in 13 children for the management of recurrent major variceal bleeding. The varices were secondary to extrahepatic portal hypertension in seven patients and to intrahepatic portal hypertension in the remaining six. Sclerotherapy was performed under direct vision using either rigid or flexible endoscopic equipment, and the sclerosing agents were injected directly into the varices.

Carcinoma in a colon conduit urinary diversion.

In recent years urinary diversion by means of the colon conduit has gained popularity because of the failure to exhibit reflux and the lower incidence of stomal stenosis. However, colon conduit diversion may be associated with adenocarcinoma, as is ureterosigmoidostomy. We report the first occurrence of adenocarcinoma in a colon conduit and, perhaps more important, in a colon conduit in which there had never been a fecal stream.

Omphalocele: a prognostic classification.

A classification for infants born with an omphalocele is proposed that is based on the recognition of four syndromes and two common associated anomalies. The recognition of these syndromes and anomalies in our newborns with an omphalocele provided a better estimate of expected mortality and morbidity than the size of the omphalocele, preoperative rupture, delay in treatment, or low birth weight. This classification should aid the physician in determining priorities regarding the timing and type of treatment for the omphalocele itself.

The pediatric patient with sarcoma.

The results of the treatment of the commonest soft tissue sarcoma in childhood have improved dramatically during the past decade. The combination of reasonable surgery, radiotherapy and multiagent chemotherapy has been demonstrated to provide effective control of both the primary tumor and distant metastases in patients with rhabdomyosarcoma. Similar progress with the less common soft tissue malignancies will be more difficult to attain.

Successful spleno-renal shunt and splenectomy in two patients with alpha-1-antitrypsin deficiency.

Recent evidence suggests that the cirrhosis of alpha-1-antitrypsin deficiency is not invariably fatal as it was previously thought. Portal hypertension is often the major determinant of survival. The few reports of porta-systemic venous anastomosis in this disorder have shown poor results or uncertain outcome.

Calcium and phosphate requirements of preterm infants who require prolonged hyperalimentation.

Preterm infants require large amounts of calcium and phosphate to maintain skeletal mineralization during prolonged hyperalimentation. It is impossible to supply the amount of calcium and phosphate normally acquired transplacentally (150 mg/kg/day of calcium and 80 mg/kg/day of phosphate) with reasonable volumes of a single hyperalimentation solution of a physiological pH. We recently encountered calcium phosphate precipitates plugging our hyperalimentation catheters as we tried to raise the calcium concentration above 20 mEq of calcium per liter of hyperalimentation solution.

Appendiceal rupture: a continuing diagnostic problem.

The mortality rate for appendicitis in children has remained relatively unchanged since the 1940s, when antibiotics were introduced in the treatment of appendiceal peritonitis. However, since this time the incidence of appendiceal rupture has increased appreciably, presumably owing to a failure of early recognition and treatment. At Columbus Children's Hospital, one half of all patients undergoing appendectomy for ruptured appendix in 1975 had been seen by another physician before admission, but the correct diagnosis had not been made.

Reimplantation of the ampulla of Vater after total pancreatectomy for nesidioblastosis.

Total pancreatectomy is often required to control hypoglycemic seizures in infants with nesidioblastosis. If duodenal devascularization results, reconstruction is difficult because standard biliary-intestinal anastomoses may reflux, or, in infants, become strictured. Therefore, surgeons are loath to perform such procedures.

Reasonable surgery for thoracic neuroblastoma in infants and children.

Neuroblastoma is the most commonly encountered soft tissue malignant tumor of childhood. Over the past 30 years we have treated 180 patients with neuroblastoma. Sixty-five percent had primary abdominal tumors and 20 percent (41 patients) had primary chest tumors.

Is the risk of morbidity and rare mortality worth the cure?

Many more children with cancer are being cured, often as a result of aggressive treatment regimens. These employ several modalities and multiple chemotherapeutic agents. The acute complications resulting from this type of treatment are relatively well known.

Presinusoidal extrahepatic portal hypertension: a review of thirty-five cases variously treated.

Thirty-five cases of proven preinusoidal extrahepatic portal hypertension in children have been reviewed with particular reference to etiology, clinical course, therapy, and long-term follow up results. Thirty-three patients has significant gastrointestinal bleeding and 31 were operated upon. There were no operative deaths.