Granular cell myoblastoma arising from the thoracic sympathetic nerve chain.

Granular cell myoblastoma has been of interest both to the clinician and the pathologist for many years. This uncommon tumor presents the usual diagnostic problem of a mass, but the actual diagnosis of granular cell myoblastoma is rarely made prior to biospy. The origin of the tumor from either myoblastic or neural tissue remains controversial. Light and electron microscopic studies of a granular cell myoblastoma uniquely located in the posterior mediastinum and associated with the sympathetic chain support the neural origin of this tumor.     

Hepatic artery ligation for exsanguinating liver injuries in children.

Selective hepatic dearterialization for exsanguinating liver injury has been performed in two young children without untoward sequelae. It appears to be a safe, simple, life-saving maneuver, as has been shown in adults. Simultaneous cholecystectomy and drainage of the extrahepatic biliary tree does not seem necessary. Postoperative studies in these two patients showed normal liver functions, normal liver scintiscans, and in one case, early rearterialization of the devascularized lobe by translobar collaterals. We would urge the use of this relatively simple procedure in place of major hepatic resection for selected severe hepatic injuries.     

Pelviureteric obstruction in infancy

Of 33 infants with pelviureteric obstruction, most presented in the first month of life with an abdominal mass and most were males. Half of these patients had bilateral renal pathology. The association between cystic dysplasia in the hydronephrotic kidney and contralateral cystic renal abnormality in patients with unilateral pelviureteric obstruction is noted. There were 34 pyeloureteroplasties performed on 27 patients, mostly with good results, even in patients with bilateral renal pathology.     

The meaning of the Leydig cell in relation to the etiology of cryptorchidism: An experimental electron-microscopic study.

In our electron-microscopic studies of testicular biopsies, both normal and cryptorchid, we found a simple atrophy of the Leydig cell in the cryptorchid testis. Based on experiments by Raynaud1,2 and Jean3 on pregnant mice, we tried to find the reason for changes in the Leydig cell relating to the etiology of cryptorchidism. We found on electron microscopic study of testes in the offspring of pregnant mice treated with estrogen the same atrophy of the Leydig cell as we see in human cryptorchidism. These changes are not evident when estrogen and HCG are given together. We can conclude from this experiment that lack of gonadotropin stimulation leads to the atrophy of Leydig cells. This atrophy then produces a lack of androgen which could be responsible for cryptorchidism.     

Oral cholestyramine and paregoric therapy for intractable diarrhea following surgical correction of catastrophic disease of the GI tract in neonates

Ten surgical neonates with postoperative intractable diarrhea and secondary weight loss were treated with combination cholestyramine and paregoric therapy. Within 3–5 days all infants except two showed significant clinical improvement with a decreasing number of stools, an increase in the consistency of the stool, and gradual weight gain. The exact mechanism of action of cholestyramine is not clear. It may act by binding with bile salts and/or endotoxins in the bowel lumen or decreasing the motility of the bowel. Used in combination with paregoric, a known bowel motility depressant, the doses of each medication can be kept quite low thus avoiding undesirable side effects. Medium chain triglyceride formula is helpful in some of these infants to improve fat absorption further. Medication in all of these infants has been discontinued without any adverse effects.     

Corrective treatment of isolated ventricular septal defect in infancy.

Intracardiac correction of VSD in infants should be indicated if the mortality and morbidity of the operation at this age group is lower than cumulative mortality of pulmonary artery banding plus second-staged procedure mortality. Experience with closure of VSD in 23 patients under 1 yr of age with 4% mortality and low morbidity is presented. Indications for operation are: (1) intractable heart failure; (2) persistence or progression of pulmonary hypertension; and (3) failure of banding procedure. Deep hypothermia and circulatory arrest facilitated the intracardiac repair in all patients. Mortality and morbidity related to the banding procedure are emphasized, and it is suggested that banding be restricted only to patients with associated coarctation of the aorta or to patients with multiple muscular ventricular septal defects in whom left ventriculotomy can be safely performed at an older age.     

Hereditary pancreatitis: report of a kindred

The natural history of hereditary pancreatitis has been outlined and another family is presented with this rare disease. In our patient a complicating pancreatic pseudocyst evolved during hospitalization. The development of the pseudocyst and its subsequent course after drainage has been illustrated by serial roentgenograms. Hereditary pancreatitis can be differentiated from other causes of pancreatitis in childhood, and the management of this disease has been indicated.     

Cricopharyngeal achalasia in childhood

A $\text{4}\text{1}\text{2}\text{-}\text{yr-old}$ boy with dysphasia since birth was repeatedly shown to have spasm of the cricopharyngeus muscle. An extramucosal myotomy successfully eliminated his laborious and prolonged problems of swallowing.     

Tracheoesophageal fistula after lye ingestion

Fistulous communications between the esophagus and tracheobronchial tree as a consequence of lye ingestion are very rare and may occur as a direct result of the caustic, or later, after dilatation of a resulting stricture.¹The experimental production and evolution of caustic burns of the esophagus have been well described.^2,3 The depth of the injury correlates with the concentration of lye both experimentally,⁴ and clinically.⁵ The virtually instantaneous, devastating, and fatal effects of concentrated lye have been emphasized recently.³The following report is that of a child who developed a tracheoesophageal fistula secondary to caustic ingestion which resulted in his death. The patient is presented to indicate the severity of the injury and the radiographic and operative findings.