The impact of intraoperative culture on treatment and outcome in children with perforated appendicitis.

Background: Most protocols for the operative treatment of perforated appendicitis use a routine culture. Although isolated studies suggest that routine culture may not be necessary, these recommendations generally are not based on objective outcome data.

Methods: The authors reviewed the records of 308 children who underwent operative treatment for perforated appendicitis between 1988 and 1998 to determine if information gained from routine culture changes the management or improves outcome.

Perforated appendicitis in children: risk factors for the development of complications.

Background: Many aspects of the management of perforated appendicitis in children remain controversial. The objective of this study was to define risk factors associated with the development of postoperative complications in children undergoing treatment for perforated appendicitis.

Methods: We reviewed all children (age < 16 years) who were treated for perforated appendicitis at Cardinal Glennon Children's Hospital between 1988 and 1997.

Critical analysis of the operative treatment of Hirschsprung's disease.

Objective: To critically analyze complications and long-term results of the operative treatment of Hirschsprung's disease.

Design: Medical records of patients with Hirschsprung's disease were reviewed retrospectively. Follow-up was obtained using a standardized telephone questionnaire.

Torsion of a hepatic lobe in the neonate--ultrasound findings.

We report a case of projectile vomiting in an infant, secondary to torsion of an accessory lobe of the liver, imaged by ultrasound.

Sodium homeostasis in infants with biliary drainage procedures.

We studied biliary excretion of sodium and chloride in 17 infants with external bile drainage through a "biliostomy" and describe four additional children who became ill from sodium depletion following external biliary drainage procedures for biliary tract anomalies. In the 17 infants, the mean +/- SD bile sodium concentration was 122 +/- 15 mEq/L. The mean +/- SD serum sodium concentration was low (132 +/- 7 mEq/L) (normal, 138 to 145 mEq/L).

Management of severe gastroesophageal reflux in children.

To evaluate response to fundoplication, clinical results for 66 consecutive pediatric patients operated on for gastroesophageal reflux were retrospectively reviewed. Indications for operation were gastroesophageal reflux with apnea, repeated emesis, recurrent pneumonia, failure to thrive, stricture, and esophagitis. All patients had preoperative documentation of significant gastroesophageal reflux by either cinefluoroscopic reflux esophagogram or reflux nuclear scan.

Isolated testicular relapse five years after cessation of chemotherapy for acute lymphoblastic leukemia.

A 12-year-old boy was diagnosed as having acute lymphoblastic leukemia (ALL) at the age of 2 years 10 months. Chemotherapy was discontinued after 33 months of continuous remission of ALL. Isolated testicular relapse occurred 5 years after cessation of treatment.

Preoperative embolization of Wilms' tumors.

In two patients with Wilms' tumors, the ipsilateral kidney was nonfunctional. To facilitate initial surgical removal of the tumors, a preoperative transcatheter embolization was performed following diagnostic arteriography. Preoperative embolization of a renal tumor reduces the vascularity of the lesion prior to surgery, and a patient in whom primary surgical removal of the tumor would carry unacceptable risk may be converted into one in whom primary surgical removal is safe.

Visualization of the intestinal tract by amniography in a fetus with esophageal atresia.

In pregnancies complicated by hydramnios, amniography can be used for the detection of fetal gastrointestinal obstruction. A case is presented in which the appearance of contrast material in the fetal gastrointestinal tract was noted in an infant who proved to have esophageal atresia and tracheoesophageal fistula. Presumably, the contrast reached the intestinal tract by aspiration and passage through the fistula.