Pediatric surgery international
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We review our experience and the literature in treating 4 patients with Wilms' tumor (WT) with intracardiac extension among 92 patients with this neoplasm. Cardiopulmonary bypass with circulatory arrest and profound hypothermia was used. There were 3 boys (3 years, 4 years 5 months, and 15 years) and 1 girl (6 years). ⋯ We propose that preoperative chemotherapy should be used, as it shrinks the thrombus and causes desirable adherence of the thrombus to the venous wall, reducing the probability of thromboembolism during the surgical procedure. We also find this method safer than in our 1st case, where neither cardiac arrest nor hypothermia was used. Our results agree with the literature that intracardiac extension of WT does not worsen its prognosis when a rational surgical approach is used.
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The possibility of sustaining ovarian damage as a consequence of an inguinal hernia becoming strangulated is well recognised. However, the mechanism by which this gonadal damage occurs is rarely stated; it is assumed that the injury is secondary to compression of ovarian vessels by an entrapped bowel loop. ⋯ In all cases the primary aetiological event was torsion of the ovary and tube on its pedicle whilst suspended from the neck of the hernial sac. This mechanism constituted the major cause of ovarian damage within irreducible herniae in our series.
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Anorectal injuries (ARI) are uncommon in children in civil practice. In developed countries the injuries are mainly due to sexual abuse and firearms. This report reviews the experience in tropical Africa. ⋯ It is concluded that ARI remains uncommon in children. Morbidity and mortality can, however, be high. Meticulous rectal palpation and visualisation is necessary to avoid missing injuries.
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We describe our experience using the laryngeal mask airway (LMA) in children to facilitate diagnostic procedures in fiberoptic bronchoscopy (FOB). Two cases of stridor, two cases of protracted pneumonia, and one case of laryngotracheomalacia were studied. Intravenous atropine (0.02 mg/kg) was given, and induction was carried out by either inhalation of a mixture of halothane-nitrous oxide-oxygen (n = 3) or IV injection of propofol (n = 2). ⋯ A 2.7-mm-OD flexible fiberoptic bronchoscope was introduced through the LMA and the diagnostic procedure was performed. Ventilation and oxygenation were maintained, and no serious morbidity was associated with the procedure. We found the use of the LMA to facilitate FOB to be useful, easy to perform, and safe, avoiding nasal trauma and providing a patent airway.
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Pediatr. Surg. Int. · Jul 1999
Case ReportsEnlargement and maturation in benign cystic ovarian teratoma.
This is a report of a 13(1/2) year old girl with bilateral benign cystic ovarian teratomas (BCOT). The clinical presentation was with an abdominal mass and an abdominal X-ray film confirmed the mass which contained teeth. Previous abdominal X-ray at 3 and 10 years of age had not shown any abnormality. The clinical features and the radiological findings indicated that the BCOT had enlarged and matured during the period of follow-up.