Complications of laparoscopy-aided gastrostomies in pediatric practice.

Purpose: The aim of this report is to establish the frequency and type of complications of laparoscopy-aided gastrostomy in pediatric practice and to identify patients at risk for postoperative complications.

Method: This is a follow-up study of 98 children with nutritional problems including inability to swallow, inadequate calorie intake in neurologically impaired children, patients with cystic fibrosis, malignancies, neurometabolic diseases, and cardiac malformations. Laparoscopy-aided gastrostomy was attempted in all patients.

Power Doppler ultrasonography: alternative to computed tomography in abdominal trauma patients.

The aim of this study was to determine if power Doppler ultrasonography, contrast enhanced when necessary, can be used as an alternative to computed tomography in the diagnosis of trauma-related organ rupture or hematoma. Fifteen patients who had sustained abdominal trauma but who had normal results on B-mode scans were included in the study. Twenty organs (13 livers and 7 spleens) were examined with both contrast-enhanced computed tomography and power Doppler ultrasonography in a blinded fashion.

Routine laparoscopy for nonpalpable testes?

There are still no accepted criteria for the selection of patients with nonpalpable testes for laparoscopy versus a primary surgical exploration. We here report our experience using routine laparoscopy in such patients. The aim was to determine whether laparoscopy should be the first operative intervention or follow an inguinal exploration.

Topical clobetasol propionate compared with placebo in the treatment of unretractable foreskin.

Objective: To assess whether it is the steroid alone or the gentle physical retraction combined with ointment that is responsible for the excellent results observed with topical steroid treatment of unretractable foreskin.

Design: Prospective, randomised, double-blind study.

Setting: University hospital, Sweden.

Laparoscopy for nonpalpable testis in childhood: is inguinal exploration necessary when vas and vessels are not seen?

A case of bilateral nonpalpable testes is described. Ultrasonography showed no testis. Laparoscopy revealed no intraabdominal testis, vas or vessels.

Low prevalence of anti-neutrophil cytoplasmic antibodies in ulcerative colitis patients with long-term remission.

Objectives: In spite of a strong positive association between ulcerative colitis and the presence of perinuclear anti-neutrophil cytoplasmic antibodies (p-ANCAs), the immunogenetic significance of these antibodies remains unclear. We studied patients with quiescent disease to clarify whether ANCAs are present even in the absence of inflammation.

Design: The prevalence of ANCAs was estimated blindly in 137 patients with ulcerative colitis, 128 of whom had quiescent disease with a mean duration of complete clinical and biochemical remission of 14 years.

HLA DR and DQ RFLP analysis in Crohn's disease.

A study of 109 Swedish patients and 85 healthy Swedish controls with Crohn's disease (CD) by HLA class II RFLP genotyping was carried out. There was no significant association for any single DR or DQ specificity or phenotypic combination of DR and/or DQ specificities among our study group of Caucasian extraction.

Small bowel barium examination in children. Diagnostic accuracy and clinical value as evaluated from 331 enteroclysis and follow-through examinations.

The indications for small bowel barium examination, the radiologic findings, and the clinical outcome were compared retrospectively in 331 children, aged 0 to 15 years. Sixty examinations (18%) were pathologic, which is in accordance with adult materials. The most common indications for referral were inflammatory bowel disease (48%) and small bowel obstruction (25%).

Inguinal hernia in patients with congenital dislocation of the hip. A sign of general connective tissue disorder.

During a 5-year period, all the children born in Malmö, Sweden, were examined for congenital dislocation of the hip (CDH) and for inguinal hernia. Girls with CDH had a hernia five times more frequently than other girls, and boys with CDH three times more frequently. The children with CDH sustained their hernia abnormally early in life.

Surgical treatment of inflammatory bowel disease--a review of some current opinions and controversies.

There are many controversial issues regarding the treatment of patients with inflammatory bowel disease. From this review we have concluded that the longer surgery for Crohn's disease is delayed, the higher the rate is of pre- and postoperative complications. A plea is thus made for relatively early surgical intervention.

Fertility and outcome of pregnancy in patients operated on for Crohn's disease.

Fertility and outcome of pregnancy were assessed in all 78 women below 40 years of age in a total, unselected series of patients with Crohn's disease, diagnosed during a 17-year period and consecutively treated with resectional surgery, in most cases at an early stage. The median follow-up time after the primary operation was 12.8 years.

Are superficial lesions of the distal part of the ileum early indicators of Crohn's disease in adult patients with abdominal pain? A clinical and radiologic long term investigation.

The possibility of early superficial Crohn's disease should be considered when mucosal irregularities without transmural abnormalities are seen in the distal 15 cm of the ileum in young patients with protracted symptoms of abdominal pain and diarrhoea. Radiologic assessment of the small bowel is improved using the barium/air double contrast technique and in this study mucosal abnormalities were categorised as a 'mucosal nodularity pattern', an 'abnormal mucosal fold pattern', and a 'specks of barium pattern'. None of the 21 patients followed prospectively for four to seven years developed established criteria for Crohn's disease, or any other chronic progressive disease of the small bowel.

Pre- and post-operative complications in Crohn's disease with special reference to duration of preoperative disease history.

In an analysis of a consecutive series of 133 patients with a diagnosis of Crohn's disease established preoperatively and in which early surgical intervention was the prevailing policy, the median time between diagnosis and operation was short. For patients with predominantly small-bowel disease it was 4 months and for patients with predominantly colonic involvement 8 months. The frequencies of preoperative and early postoperative complications were low compared with those in other reports.

Recurrence rate after surgical treatment of Crohn's disease.

In an unselected series of 207 consecutive patients with Crohn's disease diagnosed between 1958 and 1974, 170 underwent a resection of all the macroscopically involved bowel ('radically' resected). Two patients died during the first postoperative month. The crude recurrence rate for the surviving 168 patients was 49%.

Occult bleeding from giant small-bowel diverticula.

Two cases of occult intestinal blood loss due to giant ileal diverticula are described. In one of them, ectopic gastric mucosa was found at microscopic dissection. In the other that was probably originating from a blind loop formation at a previous operation, multiple mucosal erosions, probably due to retained bowel contents, were considered responsible for the blood loss.

Crohn's disease in a defined population course and results of surgical treatment. Part II. Large bowel disease.

In a total consecutive series of 182 patients operated upon for Crohn's disease, 95 (52%) had the lesions predominantly or exclusively confined to the colon. A "radical" operation was performed in 88 of these 95 patients. The general policy was to spare the rectum, if possible.

Crohn's disease in a defined population course and results of surgical treatment. I. Small bowel disease.

In a total, unselected series of 207 patients with Crohn's disease diagnosed between 1958 and 1974, 87 of the 182 patients operated upon during the investigated period were, at a comprehensive reevaluation, found to have the disease predominantly or exclusively confined to the small bowel. In five of these cases wide-spread lesions were present. The frequency of preoperative sequelae or complications was low.

Crohn's disease confined to the appendix.

Crohn's disease confined to the appendix is a rare entity, less than 50 cases having been reported. The present study reports on another 12 cases representing 6 per cent of all 194 patients operated upon for Crohn's disease in a total, unselected series. The indications for surgery were appendicitis in eight patients, appendiceal abscess in two, suspected pyosalpinx in one, and an ovarian cyst in one.