Experience with reduction clitoroplasty for clitoral hypertrophy.

A technique for reduction clitoroplasty has been devised which provides an excellent cosmetic appearance for female patients with clitoromegaly due to virilizing CAH. Contrary to previous views, total clitorectomy should rarely, if ever, be considered as an initial method of management of children with clitoral hypertrophy. One of the 4 patients who has undergone reduction clitoroplasty using the described technique has achieved sexual gratification on several occasions postoperatively without discomfort.

Ileo-ileal intussusception in the newborn. Report of a radiologically diagnosed case.

Ileo-Ileal intussusception was demonstrated preoperatively in a newborn infant by gastrografin enema with deliberate reflux of the contrast material into the small bowel. An intraluminal filling defect and stretching of the mucosal folds were demonstrated. The indications and proper use of contrast enemas are discussed.

Motivation of university surgeons to achieve excellence in teaching.

In view of the recent focus on the accountability of their commitment to teaching, university surgeons will have to rearrange their academic priorities to place teaching at the top of the list. Since excellence in medical teaching appears to be directly related not only to the motivation of the educator but to knowledge of the subject, we must retain our superiority as clinical surgeons and continue to pursue new scientific information by investigation. Inasmuch as the major reason for the low priority of teaching in our busy academic schedules is the difficulty of quantifying teaching excellence, I hope that the members of this Society will direct further attention to developing new evaluative approaches.

Home total parenteral nutrition: an alternative approach to the management of children with severe chronic small bowel disease.

A home program of total parenteral nutrition (HTPN) has been developed for managing patients with severe chronic small bowel disease who would otherwise be unable to leave the hospital. Six such children were treated by this program using a Broviac catheter to shorten hospitalization, to decrease the cost of care, and to normalize their lives as much as possible. They ranged in age from 2 1/4-17 yr and received HTPN for periods of from 1-11 mo.

Serial changes in arterial endothelium following ischemia and perfusion.

The acute and chronic changes produced in canine femoral arteries by ischemia and by perfusion with D10W were examined by light and by scanning electron microscopy. Mild changes of injury characterized by medial and adventitial inflammation and an increase in intimal lining cells occur following 30 minutes of perfusion with return to a normal microscopic appearance within one week. Perfusion for 6 hours produces significant injury to the entire arterial wall, as evidenced by depletion of cells and elastin from the media, replacement with collagen, and eventual fibrosis.

Surgical management of esophageal stricture due to recessive dystrophic epidermolysis bullosa.

Esophageal stricture may occur as a complication of the dystrophic recessive form of epidermolysis bullosa. Mechanical dilatation by bougienage may cause more severe esophageal injury. The fourth reported case of esophageal replacement by colonic interposition for this condition is presented.

Enterocolitis with peritonitis in a child with pheochromocytoma.

An 8-year-old boy presented at UCLA Hospital with a one month history of hypertension prior to suffering a sudden onset of acute abdominal pain, rectal bleeding, peritonitis, and shock. Sigmoidoscopy showed diffuse mucosal friability. At laparotomy, inflammation and edema of the entire colon and terminal ileum were detected with two necrotic areas on the cecum.

Effect of Nissen fundoplication on the lower esophageal sphincter pressure of children with gastroesophageal reflux.

Nine children (age range, 5 weeks to 13 years) with gastroesophageal reflux unresponsive to medical management were evaluated with esophageal manometry studies before and after Nissen fundoplications were performed. All patients had a postoperative increase in lower esophageal sphincter (LES) pressure. The mean preoperative LES pressure was 11.

Gastroesophageal fundoplication for reflux in infants and children.

Fifteen infants and young children with symptomatic gastroesophageal reflux underwent fundoplication during a 6 1/2-yr period. Standard barium esophagrams clearly demonstrated reflux in only 10 of the 15 patients; however, cine esophagrams indicated reflux in the remaining patients. Esophagoscopy with mucosal biopsy demonstrated esophagitis in 9 of the 10 patients in whom it was performed, and it is a very helpful diagnostic procedure.

[Histological research on the effect of viruses on wound healing].

The influence of pure virus solution on wound healing was studied in animals. The rate of disturbed wound healing was proportional to the concentration of the virus solution. Severe necrosis without inflammatory reaction could be demonstrated histologically.

Reappraisal of skin flap closure for neonatal gastroschisis.

During the past 11 years, 18 infants with gastroschisis abdominal wall defects have undergone surgical repair at the UCLA Hospital. Sixteen infants had skin flap closure in infancy. A gastrostomy was performed on all infants, and peripheral intravenous hyperalimentation was used in 14 of the 18 infants.

Arterial endothelial changes after ischemia and perfusion.

The effects of six hours of ischemia and six hours of perfusion with 10 per cent dextrose and water solution, Sacks' solution and Intralipid on the endothelium of common femoral arteries in dogs were examined by light and by scanning electron microscopy and compared with normal arteries. Arteries that were ischemic or perfused with 10 per cent dextrose and water solution or Sacks' solution showed a flattening of the normal linear convolutions and extensive crater formation, with fragmentation and even complete loss of endothelial cells in many areas. The more severe changes occurred in perfused vessels.

Urinary lysosomal enzymes for detection of acute renal allograft rejection.

Six patients who received renal transplants were closely monitored to compare the sensitivity of urine levels of beta-galactosidase and N-acetyl-beta-glucosaminidase with conventional clinical and laboratory parameters in the detection of impending rejection. A rapid (60 minute), simple, accurate fluorometric assay was used to measure activities of both enzymes. Eighty per cent of ten rejection episodes were accompanied by a two- to sixfold increase in enzyme release.

Malignant hyperpyrexia during anesthesia in childhood.

Malignant hyperpyrexia is a highly lethal complication of general anesthesia. It occurs with sufficient frequency, particularly in children and young adults, to justify use of continuous temperature monitoring during adminnstration of general anesthesia. Fever may be a late manifestation of the malignant hyperpyrexia syndrome, and it is important to be aware of the early signs.

Evaluation of pulmonary function in the ischemic expanded canine lung.

Twenty-four dogs underwent in vivo left pulmonary hilar occlusion with the lung continuously expanded at 10 centimeters or 25 centimeters of water pressure to determine the period of pulmonary ischemia that may be tolerated before consistent pulmonary edema and congestion develop after lung revascularization. Consistent and prolonged pulmonary edema and congestion that caused death of the dog occurred in at least one-half of the dogs when the period of hilar occlusion was extended beyond six hours. Elevation of the left pulmonary artery pressure was only a rough measurement of the severity of the anoxic pulmonary injury.

The occurrence in a neonate of a pancreatic adenoma with nesidioblastosis in the tumor.

A newborn with persistent hypoglycemia and fixed insulin secretion unresponsive to medical management underwent 80% pancreatectomy. A 1-cm. nonencapsulated islet-cell adenoma near the tail of the pancreas was identified histologically.

[Animal-experiment studies on the pathogenesis of peptic ulcer in the newborn].

Gastric secretion was studied in 188 fetuses of 28 pregnant dogs near term. Baseline secretory values were determined and gastric secretion was stimulated in additional fetuses with histamine, insulin, or gastrin. A significant increase in volume, acidity and pepsin output was observed in fetuses stimulated during the last week of gestation.

Fatal outcome in a child with pseudomembranous colitis.

The clinical and histologic changes occurring with antibiotic-associated pseudomembranous colitis are usually reversible with discontinuation of the causative medication. The spectrum of disease patterns ranges from a benign form to a very fulminant and occasionally fatal one. This report describes a child with a severe form of the disease.