Idiopathic perforation of the colon in a newborn

Although infrequent, idiopathic perforation of the colon in the newborn is a surgical emergency. Etiology remains obscure. Diagnosis of a pneumoperitoneum, prompt operative intervention, and the use of antibiotic therapy are essential to the survival of these infants.

[Aortic coarctation. Treatment under one year (author's transl)]

Fifteen patients operated upon for aortic coarctation under one year are reported. Nine of them survived. The E.C.G. was very useful as far as the surgical prognosis is concerned. Dead patients showed either right or biventricular hypertrophy, with alteration of the repolarisation. On the other hand 50% of survivors had left ventricular hypertrophy. In six of the operated patients a plasty between subclavian artery and aortic arch was performed. The remaining patients were treated by end-to-end anastomosis.

Bilateral testicular torsion in the newborn

A neonate with bilateral torsion of the testes is described. Torsion occurred in utero and was discovered only on routine examination after birth. The relevance of the comparatively silent torsion is discussed in relation to the age of the child, and the timing of routine examination of the newborn.

Wound infection in a children's hospital

The operation wounds of 20 per cent of the children operated on in one surgical unit of a children's hospital became infected. Infection was commonest in the newly born operated on as emergencies, 50 per cent of whose wounds became infected. No connection was found between injection and nasal carriage of staphylococci. A possible source of infection in the young may be the umbilicus.

Bochdalek hernias in infants: factors determining mortality

From 1950 through 1974, 76 infants with Bochdalek hernias have been surgically repaired. Mortality has been confined to those admitted at under 30 hr of age, and the highest mortality has been among those infants admitted within the first 8 hr of life. A recent increase in mortality is explained by the arrival of a new group of infants who arrived intubated, had large diaphragmatic defects, required postoperative ventilatory assistance, and had hypoplastic lungs at autopsy. Six infants might have benefited from an early intervention to hasten closure of their patent ductus arteriosus. Since we cannot be positive that intubation of these infants prior to arrival will not have a deleterious effect, we urge great discretion in choosing which infants to intubate.

Changes of the postoperative minimal oxygen consumption of the newborn

Minimal oxygen consumption and carbon dioxide production were studied in newborns without operation and with minor or major operation by means of open indirect calorimetry. (1) A postnatal increase in the mVO2 was observed in most of the full-term newborns without operation or with minor operation. (2) A postoperative increase in the mVO2, as observed in the adult, was not found in all newborns with a major operation. (3) This finding was particularly obvious in the newborn with a major abdominal operation and with a long pre- and postoperative periods of starvation. (4) The most important factor determining the postoperative decrease in the mVO2 is not the intensity of operative stress but the amount of caloric intake.

Pyloric stenosis: a 13-year experience in operative management

Infantile hypertrophic pyloric stenosis is best treated surgically, after an appropriate period of rehydration and resuscitation. Our experience with this entity has resulted in the performance of fewer contrast studies to establish the diagnosis as well as the use of an operative technique which can be safely applied to the teaching environment.

Complicated giant hemangioma: excision using cardiopulmonary bypass and deep hypothermia

A child with a giant hemangioma of the left scalp, neck, and upper chest had severe complications including congestive cardiac failure. Surgical excision using cardiac bypass, deep hypothermia, and circulatory arrest was successfully carried out.

Modification of the endorectal procedure for Hirschsprung's disease

During the last four years, 25 patients have been operated upon using a technical modification of the endorectal procedure for the treatment of Hirschsprung's disease. There have been no major complications, and the ease with which the lower anastomosis was carried out has been quite remarkable. This opinion has been substantiated by surgeons who previously used other techniques for the lower anastomosis and have now adopted this modification.

Urinary ascites secondary to posterior urethral valves

Neonatal urinary ascites demands prompt diagnostic and therapeutic medical attention. Obstructing posterior urethral valves are a major cause (70 per cent) of this entity. Survival in these children can be directly related to age, selection of therapeutic modality and the presence or absence of associated pulmonary and electrolyte abnormalities. Oligohydramnios is implicated in the production of pulmonary hypoplasia leading to respiratory distress in these patients. Other manifestations of prolonged, increased fetal compression, that is the non-renal features of Potter's syndrome, include altered facies, aberrant hand and foot development and late fetal growth deficiency. Aberrant pulmonary development seems to be related to increased intrauterine pressure (oligohydramnios alone) as well as increased fetal intra-abdominal pressure (oligohydramnios plus urinary ascites). The best therapeutic results were achieved in those children treated by early, high urinary diversion. The mortality rate for newborns less than 72 hours old was significantly higher (66 per cent) than for those more than 72 hours old (15 per cent).

Surgical treatment of congenital defects in the abdominal wall

A series of 28 patients is presented with the two conditions of omphalocoele and gastroschisis treated over a five-year period . Improved survival can be obtained by the use of staged procedures with a silastic prosthesis plus intravenous alimentation with later definitive operation. If peripheral veins are used, serious complications are almost totally avoided. This combined form of therapy is the treatment of choice in infants with massive defects in the abdominal wall.

Neonatal pancreatic beta-cell hyperplasia: report of a case with failure of diazoxide and benefit of early subtotal pancreatectomy

A newborn infant with pancreatic beta-cell hyperplasia had persistent hypoglycemia due to hyperinsulinism. After medical management, including the use of diazoxide and constant glucose infusions had proved ineffective, a subtotal pancreatectomy was curative. Cumulative experience seems to indicate that there should be little delay in performing a subtotal pancreatectomy when aggressive medical management cannot maintain normoglycemia in a neonate.

[The laryngeal cyst of the new born (author's transl)]

Only 30 cases of cysts of the ventricular cord in the new born baby have been published. Because of the respiratory stridor one third of the cases died soon or later. The other 2/3 were treated by endolaryngeal procedures. With a case of a new born suffering from a large cyst of the ventricular cord the author demonstrates the possible danger and inefficiency of different endolaryngeal procedures. Only the external operation through the thyrohyoid membrane with complete removal of the cyst - without tracheotomy--resulted in permanent cure.

Primary repair of esophageal atresia without staging or preliminary gastrostomy

Twenty-two neonates with esophageal atresia and a distal tracheoesophageal fistula were treated by primary repair. Only if an anastomotic leak was demonstrated was a tube gastrostomy for decompression with trangastric placement of a duodenal tube for feeding performed. Twelve newborns were classified as high-risk by the presence of prematurity with low birth weight (less than 2,250 gm), significant pneumonia, or obvious significant associated anomalies. There was one operative death and 1 late death. Three babies required a tube gastrotomy and duodenal tube for anastomotic leaks. All 20 survivors are symptom free and thriving. Progress in perioperative management of neonates with esophageal atresia may obviate the need for routine gastrostomy and for staging of high-risk newborns.

A modified method for the repair of esophageal atresia with tracheoesophageal fistula

Forty patients with esophageal atresia with tracheoesophageal fistula were operated upon during a period of 2 years, 39 of them with the end-to-side anastomosis technique. According to Waterston's classification, the survival rate was 91 percent for Group A (11 patients), 60 percent for Group B (15 patients), and 14 percent for Group C (14 patients). A prospective study carried out with the first 30 patients showed that the partial removal of the mucosa of the lower esophagus, just distal to its junction with the trachea, reduced significantly the incidence of recanalization of the tracheoesophageal fistula.

Neonatal pneumothorax. A Simple drainage device

A simple method of providing under-water-seal drainage using readily available equipment is described. It enables adequate treatment of pneumothorax to be instituted with the minimum delay.