Management of immature teratoma of the ovary in children by conservative resection and chemotherapy

Six patients with immature teratoma of the ovary were treated with surgery and chemotherapy. Surgical management consisted of unilateral salpingooophorectomy, biopsy and conservation of the contralateral ovary, and biopsy of peritoneal implants. Triple-agent chemotherapy with vincristine, actinomycin D, and cyclophosphamide was given to four patients and appeared to be beneficial. Radiation therapy was not employed. Local resection of teratomatous recurrences was frequently necessary. Thorough sampling of this tumor is mandatory for establishment of an exact pathologic diagnosis. All six patients are surviving in good health at 1–8-yr follow-up. The prognosis of immature teratoma in the child or adolescent appears more favorable than previously appreciated.     

Effects of surgery, anesthesia and intraoperative blood loss on immunocompetence

The effects of surgery, anesthetic agents, and/or intraoperative blood loss on the immune system were studied by comparing the preoperative, intraoperative, and postoperative peripheral blood lymphocyte blastogenic responses to mitogens and antigens. All anesthetic agents were associated with some degree of immunosuppression, but some were differentially suppressive of either the T-cell or B-cell subpopulation of the peripheral blood lymphocytes. A greater depression of blastogenic responses was associated with ether than with halothane, and the B-cell responses seemed more selectively affected by ether. Cyclopropane anesthesia was more depressive than nitrous oxide, and both T- and B-cells were equally affected. The volume of blood lost during surgery was also correlated with the degree of immunosuppression. This anesthesia and surgery-associated immunosuppression persisted for at least 7 days.     

Yersinia enterocolitis.

Human infection with Yersinia enterocolitica is being seen with increasing frequency. This disease has importance to the pediatric surgeon as it may mimic acute appendicitis in patients in the pediatric age group. Clinical suspicion should be high in the patient with right lower-quadrant symptoms suggestive of appendicitis with an inordinate amount of diarrhea. Serologic and microbiologic evidence should be sought, and tissues removed at the time of a negative exploration for appendicitis should be cultured for Yersinia enterocolitica. In general, the disease is associated with an excellent clinical response to simple antibiotic therapy and a good prognosis, but fatal cases have been reported, especially in older patients.     

Pancreatic cyst fluid glucose: rapid,inexpensive, and accurate diagnosis of mucinous pancreatic cysts

Background

The most widely accepted biochemical test for preoperative differentiation of mucinous from benign, nonmucinous pancreatic cysts is cyst fluid carcinoembryonic antigen. However, the diagnostic accuracy of carcinoembryonic antigen ranges from 70% to 86%. Based on previous work, we hypothesize that pancreatic cyst fluid glucose may be an attractive alternative to carcinoembryonic antigen.

270. Das Morbus Crohn-Rezidiv aus chirurgischer Sicht

Zusammenfassung Lymphogranulomatose (n = 58): 25 Milzen befallen; 19 Patienten präop. falschem Stadium zugeordnet; von 45 Scintigraphien 10 falsch-positiv und 5 falsch-negativ befundet; von 42 Lymphographien 10 falsch-positiv und 6 falsch-negativ befundet; 2 Patienten verstorben. Rupturen (n = 39): 38 traumatisch, 1 spontan; 10 Patienten verstorben (alle mehrfachverletzt). M. Werlhof (n = 33): postop. Thrombocytenanstieg. Splenomegalie (n = 18): postop. Ery-, Leuko- und Thrombocytenanstieg; 1 Patient verstorben. Anämien (n = 16): Erythrocyten- und Hdmoglobinanstieg. Technische Gründe (n = 14).     

A strain recording model: analysis of transverse osteotomy fixation in small bones

Many current experimental testing procedures are cumbersome when applied to osteotomies of small bones and are complicated by the need for in-depth analyses of data derived from various specimens tested to failure. This strain recording model minimizes these factors. Various forms of internal fixation may be serially tested on the same specimen with this system because constructs are not tested to failure but rather within the elastic range of each specimen. Sophistication in the form of strain recorded as a function of time allows the comparison of various fixation techniques. Fixation techniques applied to a transverse osteotomy and subjected to controlled flexion loading in a single plane have been evaluated. The study demonstrates the superiority of tension bands (wires) placed through holes immediately subjacent to the tension cortex in comparison with wires that fix the components through holes in the neutral longitudinal axis. In addition, for any given time, the strain generated by a single-looped tension band (wire) is greater than that of a figure-of-eight tension band (wire). Both types of tension bands afford superior stability experimentally, compared to conventional crossed Kirschner wire fixation of transverse osteotomies.     

Mediastinal teratoma: A rare cause of severe respiratory distress in the newborn.

An anterior mediastinal mass is a rare cause of severe respiratory distress in the newborn.^1–3 The distinction between the normally large neonatal thymus and a mediastinal tumor may be difficult. This report describes a newborn with severe respiratory distress due to a rapidly enlarging mediastinal teratoma. This enlargement was caused by elements of choroid plexus and enteric cysts secreting large amounts of fluid. As the mass increased in size it caused posterior displacement and compression of the airway. Clues to the diagnosis were present on the plain chest roentgenogram.     

Topical povidone-iodine reduces mortality from bacterial peritonitis

The efficacy of topical 10 and 1.5% povidone-iodine was assessed in a rat fecal peritonitis model. Both solutions were bactericidal in vitro. An LD₉₀ preparation of fecal peritonitis in the rat was then assessed and rats were assigned to control or four treatment groups consisting of lavage with saline, 10% povidone-iodine (2.5 ml/kg), povidone-iodine plus saline (600 ml/kg), or 1% cephalothin (600 ml/kg). Twenty-four-hour mortality rates were recorded. Quantitative peritoneal cultures were obtained before and 3 and 6 hr after lavage. Lavage was effective only with 1.5% povidone-iodine or when cephalothin was added. Each of these lavage solutions significantly reduced mortality (P < 0.05). Delayed intravenous cephalothin (200 mg/kg) reduced mortality significantly following 10 or 1.5% povidone-iodine. Failure of povidone irrigation is due to uncontrolled infection rather than to drug toxicity.     

Proximal row carpectomy with muscle transfers for spastic paralysis.

Fourteen patients with spastic paralysis from various causes (eight with cerebral palsy) who needed minimal two handed activities to assist in self-care and who desired improvement in appearance were treated by proximal row carpectomy. In twelve transfer of flexor carpi ulnaris to extensor carpi radialis brevis was done, and in two the extensors of the wrist were shortened. Various other procedures were done in some patients. Prolonged splinting was carried out. Better extension of the wrist was obtained and supination improved more when the transfer was subcutaneous around the ulnar border than when through the interosseus membrane. Less tendency for the carpus to displace ulnarward was seen when the distal half of the scaphoid was not removed. Strength of grasp and pinch improved, but ability to release objects was diminished due to the more dorsiflexed position of the wrist. Subjective use for two handed activities was improved and the patients were satisfied with the appearance.     

Continent ileostomy in the pediatric patient

Continent ileostomies have been performed in 10 juvenile patients. The operative technique and postoperative management are described. Nine patients wear only small dressings to cover the stoma. One patient is partially incontinent and frequently wears an appliance. Criteria for patient selection and contraindications are discussed.     

Editorial Commentary: Imaging of the Anterolateral Ligament of the Knee: The MR(eye) Sees What the Brain Knows…

Significant focus has recently been placed on the contribution of the anterolateral ligament (ALL) to controlling anterolateral rotatory laxity of the anterior cruciate ligament (ACL) injured knee. Many recent studies have investigated the use of magnetic resonance imaging and ultrasound on determining the degree of ALL injury and whether this is correlated to high-grade rotatory laxity. Unfortunately, most studies lack a reference standard, and as such it is challenging to determine whether it truly is the ALL that is injured or if the capsule-osseous layer and deep iliotibial band are involved. Historic literature has demonstrated the importance of these other structures having been noted to be injured at the time of ACL reconstruction. As such, it is clear that high-grade rotatory laxity does not result from an isolated ACL injury. We therefore must remain open to the idea that it is not just the ALL that may cause this injury pattern, and optimal solutions to address this patholaxity have yet to be fully determined.