Coincidence of a ductal pancreatic cyst and a gastric duplication cyst: a case report

We report a case of two abdominal cystic formations in an 18-month-old girl. Laparotomy was performed with surgical removal of both cysts. The cysts were connected by a fibrous bridge. Histology revealed a gastric duplication cyst and a ductal pancreatic cyst originating from an aberrant pancreatic lobe. No fistula was found either to the alimentary tract or in either of the cysts. The clinical picture and treatment are described and compared to findings in the literature.

Severe autonomic dysfunction in an 11-year-old girl with generalised tetanus

Tetanus can occur even after minor injuries, and proper immunisation status must be ascertained and documented in every surgical patient. Failure to do so can have dramatic consequences. An 11-year-old non-immunised girl was admitted to the intensive care unit with severe generalised tetanus 8 days following an open fracture of the right forearm. Although she was under deep sedation and received high doses of opiates while being paralysed and mechanically ventilated, she developed pronounced cardiovascular instability with tachycardia and periods of rapid changes between arterial hyper- and hypotension secondary to severe autonomic dysfunction. Her cardiovascular status only began to stabilise after 14 days under concomitant treatment with clonidine, magnesium sulphate and labetalol.

[Legionellosis, a tourist problem?]

Legionellosis is a relatively rare disease characterized by an often prolonged and complicated course even in immunocompetent patients. Its diagnosis is mandatory for therapeutic and epidemiologic reasons. At the Kantonsspital Chur between 1998 and 2001, 6 cases of legionellosis have been observed: four of them were travel-associated and one concerned a local hotel employee. Due to the increasing international mobility epidemiologic investigations for the localization and elimination of the sources of infection are very difficult. A european task force, the European Working Group for Legionella Infections (EWGLI/www.ewgli.org) is addressing this problem. It is a matter of debate to what extent the public should be informed about sources of legionellosis (so called legionella hotels).

[Experiences with the Port-A-Cath system in children]

In a retrospective study (1987-1997) the complications of a totally implantable venous access device (Port-A-Cath, Fa. Pharmacia, Germany) were analysed in 91 children with 99 implants. All but 2 of these children had malignant diseases. Their age ranged from 0.1 to 18.1 (median 6) years. Overall implant time was 171.2 years (62,488 days), averaging 1.63 years (595 days) per device. 11 complications were registered, i.e. infections (6), occlusions (4) and disconnection (1), resulting in an overall infection rate of 0.06 and a total occlusion rate of 0.04. The overall complication rate was thus 0.11, which compares favourably with other studies. With careful handling, the Port-a-Cath device is very reliable and involves few complications.

The Palomo procedure in the treatment of boys with varicocele: a retrospective study of testicular growth and fertility

The Palomo procedure has often been criticized with regard to possible atrophy of the testis. Measuring the testicular volume is mainly used in pre- and postoperative assessment. Evidence concerning fertility remains unclear. The aim of this study was to learn whether now-adult former patients had any disturbance of their testicular growth and/or fertility. Out of 79 patients operated upon with Palomo's procedure between 1979 and 1990, 33 could be evaluated. They all had grade II or III left-sided varicoceles. Investigations consisted of: the patient's history, testicular-volume measurement by means of an orchidometer (OM) (Prader) and ultrasonography (US), and semen analysis (27/33) 6-17 years after surgery. No recurrence of grade II varicoceles was observed. Only 1 of the 33 patients might have had testicular atrophy, yet he had already fathered 3 children! Twenty-three had a normal sperm count and 24/27 showed normal sperm motility. Eight hydroceles were either present at the time of investigation or had been operated upon in the past. Estimations of testicular volume by OM and US showed significant differences between the two methods concerning volume and relation of right to left side. In general, the volume was overestimated by the OM. The study shows that in boys the simple surgical technique proposed by Palomo has - in the long run - no disadvantages for testicular development and sperm production. Fertility should therefore not be compromised.

Postoperative vomiting in children. A persisting unsolved problem

Nausea and vomiting after anaesthesia and surgery in children remains a major problem. The following survey studies the frequency of postoperative vomiting and relates it to the anaesthetic technique, the surgical procedure, and postoperative analgesia. During one year, September 1989 until September 1990, 2370 surgical patients requiring anaesthesia were studied prospectively with the following protocol: 1) patient data, surgery and anaesthesia technique; and 2) postoperative follow-up were registered. Outpatients were followed up by telephone. The overall incidence of vomiting was 19.5%, which was lower than in other studies. An increased incidence of vomiting was found in children over 2 years of age, after certain operative procedures, and after general anaesthesia. Furthermore, postoperative opioid administration on the ward increased the risk of vomiting. Despite the low overall incidence of vomiting in our study, we still found a high frequency after certain surgical procedures. The use of regional anaesthesia, prophylactic antiemetic medication, and the introduction of new anaesthetics, may help to reduce the sometimes high incidence of postoperative nausea and vomiting in paediatric patients.

Synovial chondromatosis of the knee joint: a rarity during childhood

Synovial chondromatosis is a rare disease, especially in children. We report on a 12-year old girl who suffered twice a knee trauma. She then developed an arthritis of her right knee joint and finally showed all signs of synovial chondromatosis arthroscopically. Treatment consisted of removal of loose as well as stalked chondromatous bodies by means of arthroscopy. According to Milgram (1975) the evolution of the disease progresses through three stages, starting with synovial metaplasia producing chondromas which are then shed into the joint. Kay, Freemont and Davies (1989) doubt this theory.