Recurrent tracheo-oesophageal fistula: experience with 24 patients.

Over an 11 year period, 275 infants with oesophageal atresia and tracheo-oesophageal fistula were treated. Of these, 22 (8%) developed a recurrent fistula. An additional two patients with an established recurrent fistula were referred for secondary surgery.

Congenital diaphragmatic defects that present late.

Twenty two patients (age range: 1 month to 11 years) were treated for congenital diaphragmatic defects (excluding hiatus hernia) in the six year period 1983-8. Presenting features were failure to thrive (n = 7), abdominal pain and vomiting (n = 4), chronic respiratory symptoms (n = 3), and inability to wean from ventilatory support (n = 3). The defect was an incidental finding in five patients.

Aneurysm of the ductus arteriosus.

Two neonates with aneurysms of the ductus arteriosus were seen. One suffered a fatal spontaneous rupture of the aneurysm, and the second (in which it was an incidental finding) the aneurysm was monitored by echocardiography, and seemed to resolve spontaneously.

Neonatal gastrointestinal perforation.

During the 7-year period from 1980 to 1986, 56 neonates with gastrointestinal (GI) perforation were treated in the Hospital for Sick Children, London. The overall mortality rate was 30%. The highest mortality rate (60%) was associated with gastric perforation, which in this series occurred only in premature neonates.

Penile response to intracavernosal vasoactive intestinal polypeptide alone and in combination with other vasoactive agents.

Intracavernosally injected vasoactive intestinal polypeptide (VIP) (2 micrograms and 4 micrograms) resulted in penile tumescence even in men with predominantly organic impotence. Papaverine and phentolamine were successful in inducing erections in all subjects studied but the addition of VIP to this combination improved the erectile response further. A combination of papaverine and VIP produced penile rigidity similar to that with papaverine and phentolamine.

Study of appropriate antibiotic therapy in transurethral prostatectomy.

Septicaemia is the commonest cause of morbidity and mortality following transurethral prostatectomy. Routine blind antibiotic prophylaxis is not always effective and there is a tendency to over-use potent new and expensive antimicrobials. Attempts to "sterilise" the urine preoperatively are also expensive and disruptive.

Extracorporeal shockwave lithotripsy using ultrasonic imaging: urologists' experience.

The EDAP LT.01 is a second generation shockwave lithotripter which employs ultrasound imaging and piezoelectric shockwave generation. We describe the first 12 months of its use in the treatment of urinary calculi by urologists with no previous practical experience of ultrasonography.

Endoscopic treatment of urinary tract calculi.

Removal of urinary tract calculi by endourological techniques is now widely practised and has reduced the indications for open surgical removal to a minority of cases. A review of 270 consecutive patients who presented to the Meath Hospital Urology department with urinary tract calculi and were treated by percutaneous or transurethral endoscopy is herein reported. The rates of successful clearance of renal (95%) and ureteric (78%) calculi compare well with previous reports.

Oesophageal atresia and associated anomalies.

Of 253 infants with oesophageal atresia treated over an eight year period, 122 (48%) had a total of 213 other anomalies. Most commonly affected were the cardiovascular (61 cases, 29%), anorectal (30 cases, 14%), and genitourinary (29 cases, 14%) systems. The VATER (or VACTERL) association was present in 10% of cases, but occurred more often in patients who had oesophageal atresia without an associated tracheo-oesophageal fistula (3/13, 23%).

Posterior sagittal anorectoplasty for reoperation in children with anorectal malformations.

A prospective study was carried out in 12 consecutive patients (7 boys and 5 girls), to evaluate posterior sagittal anorectoplasty for patients incontinent of faeces after anorectal reconstruction. Examination revealed anatomical problems such as: recurrent fistula (two), massive urethral diverticulum (one), absent vagina (one), and a missed urogenital sinus (one). Preliminary electromyography showed the external sphincter to be displaced from the anus in nine patients.

Surgery for neuroblastoma.

Over a 33-month period, 31 infants and children had surgery for neuroblastoma. Twenty-three of the total had stage IV disease at the time of presentation and all but five had an abdominal primary tumour. In only two children was the tumour considered unresectable.

Vascular access.

In a retrospective survey of vascular access by means of central venous catheters, those inserted via a tunnel lasted four times longer than those inserted directly into a vein. The latter were four times more likely to become infected. The general health of patients receiving chemotherapy resulted in frequent episodes of sepsis and one-third of all catheters were removed because of presumed infection.

Fibrous tissue tumours.

Thirty-three patients, ranging in age from newborn to 12 years, with fibrous tissue tumours, were treated at the Hospital for Sick Children, Great Ormond Street, London, from 1970 to 1984. Seven infants presented with tumours at birth. In 42% of cases, the tumour was noted during the 1st year of life.

Digital subtraction dynamic cavernosography.

Digital subtraction angiography (DSA) was used in the investigation, by dynamic cavernosography, of 35 men with acquired erectile impotence. The benefits of using DSA included shorter examination times, lower contrast medium dosage and better definition of abnormal veins. In particular deep crural veins are more clearly seen than in conventional studies and these may be of more importance than was previously thought.

Response of the benign hypertrophied prostate to treatment with an LHRH analogue.

Twenty patients with outflow tract obstruction secondary to benign prostatic hypertrophy were treated with an LHRH analogue, buserelin, for up to 6 months. Despite maintaining castrate levels of testosterone and achieving a significant reduction in tissue levels of dihydrotestosterone, no significant improvement was seen in flow rate or residual volume.

Diagnosis and treatment of venous leakage: a curable cause of impotence.

Sixteen of 149 patients complaining of impotence of a non-neurogenic or endocrine aetiology and with a penile brachial index of greater than 0.7 failed to achieve an erection following intracavernosal injection of 30 mg papaverine and 1 mg phentolamine. All 16 were shown to have a significant venous leak using digital subtraction cavernosography.

Real-time ultrasound measurement of bladder volume: a comparative study of three methods.

The accuracy of different ultrasound methods for determining the volume of urine in the bladder was compared using three methods in current use. Each method was applied to the same ultrasound images from 16 patients with prostatic hypertrophy. The calculated volumes were compared with the true volumes derived by measurement of voided and catheter-drained urine.

Impotence: treatment by autoinjection of vasoactive drugs.

One hundred and twenty five men with psychogenic or organic impotence used autoinjection of the penile corpora cavernosa with either papaverine or papaverine and phentolamine for a mean period of 10.5 months (range 1-24 months) to achieve penile erection for sexual intercourse. Prolonged (over four hours) painless erection resulted from 34 of the 3513 self administered injections.

Intrascrotal adenomatoid tumours.

The adenomatoid tumour occurs in the genital tract of both sexes and is probably of mesothelial origin. We describe its occurrence in five men, two of whom had an intratesticular tumour, and discuss the clinical features of this lesion and the lessons to be learned regarding the management of testicular and paratesticular swellings.

Gastric transposition for esophageal replacement in children.

Esophageal replacement by total gastric transposition was performed on 34 infants (32 with esophageal atresia) in the 5.5-year period from January 1981 to June 1986. There were three deaths (9%), two occurring in the early postoperative period, with the third occurring 1 year after surgery from persistent chronic respiratory problems.