Intussusception: past,present and future

Intussusception is a common etiology of acute abdominal pain in children. Over the last 70 years, there have been significant changes in how we diagnose and treat intussusception, with a more recent focus on the role of ultrasound. In this article we discuss historical and current approaches to intussusception, with an emphasis on ultrasound as a diagnostic and therapeutic modality.     

Clitoroplasty: past,present and future

This paper reviews the history of clitoral surgery throughout the twentieth century. The changing operations, from amputation through to attempts to produce a normal clitoris mirror the changing attitudes and available knowledge. It also examines the current issues that arise out of available data on long-term outcomes of clitoroplasty.     

SIDS: past, present and future

Despite the large reduction in SIDS mortality, which occurred in the early 1990s following the 'Back to Sleep' campaigns, SIDS remains the leading cause of death in the postneonatal age group. This paper describes the position in the 1980s, the contribution of the New Zealand Cot Death Study, what should be recommended and the current research priorities.
Conclusion:  SIDS is preventable. Application of what we currently know could eliminate SIDS. The challenge is to find ways of implementing our knowledge.     

The Internet: past, present and future

Although the Worldwide Web has just blossomed this past decade, the origins of the Internet date to the late 1950s and Cold War concerns. The technological underpinning of the Internet rests with the concept of packet switching of data over dispersed routes of electronic intercommunication. Grounded in applications for the national defense, and nurtured in the domains of science within academia, the Internet of the masses has exploded with the addition of strong commercial interest and potential. Electronic mail is still the predominant application of the Internet, and the ease of widespread and near simultaneous dissemination of such communication has led to the genesis of listservers, especially appropriate as well as predominant in Medicine. One such list for pediatric surgeons is Pedsurg-L. There is an impressive evolving etiquette for those contributing to such lists. Initiatives are already well developed with public and private partnerships for the future of the Internet.     

America's schoolchildren: past, present, and future

To provide a context for the articles in this journal issue, which focus on programs for children in elementary and middle school, this article depicts the cohort of children who were between 5 and 14 years old in the 1990s and compares them with their counterparts earlier in the century. It reports their numbers, overall and by racial and ethnic heritage; the makeup, employment, and economic status of their parents; and the time they spend in school. The article examines changes in these demographics and characteristics of school-age children with an eye to the effect that these trends may have on public attitudes toward children and youths, and on support for government funding to keep young people safe and to promote their development.     

Malaria in India: Past,present and future

Malaria existed in ancient India even centuries before Christ. With the introduction of DDT as a residual insecticide, malaria control in India was attempted in 1953. It was converted into an eradication programme in 1958. With the help of DDT and chloroquine, the number of malaria cases came down sharply and only 0·1 million cases were recorded in 1965. Since then there had been a setback and cases went on increasing till 1976 when 6·4 million cases of malaria were recorded. by national malaria eradication programme. The eradication programme was converted into a control programme in 1977 by the introduction of modified plan of operations. Cases of malaria have shown progressive decline since 1977. But the most disturbing feature is the resurgence of P. falciparum malaria with appearance of chloroquine resistance in this species. The situation needs to be tackled urgently.     

Cochrane reviews in neonatology: past, present and future

The Neonatal Review Group of the Cochrane Collaboration is dedicated to improving outcomes of newborn infants through the collection and synthesis of the highest quality evidence. Much has been achieved with limited resources. Future challenges for the group are to maintain and extend current reviews of therapeutic interventions, to develop bridging reviews to assist clinicians in applying current evidence more easily, to expand the scope of the Cochrane Library to include diagnostic tests, and to utilize techniques such as prospective meta-analysis to answer remaining questions in the field. In future, the Neonatal Review Group needs to assist reviewers in developing countries to prepare reviews relevant to their settings that will reduce the global burden of neonatal mortality and morbidity.     

Split liver transplantation: past, present and future

The technique of liver splitting offers an effective way of increasing the donor pool and decreasing pediatric waiting list mortality. A donor liver is divided in such a way that the left lateral liver graft can be transplanted into a small child and the right extended liver graft into an adult. This innovative technique did not harm the adult recipient pool. Because of its technical complexity and the initial poor results after split liver transplantation (SLT) this procedure has slowly gained acceptance in the Transplantation Community after its first introduction in 1988 (4). Small children with end stage liver disease suffered the most from the extreme shortage of cadaveric donor organs due to the difficulty of finding size-matched donors. The successful surgical development of SLT and a better donor and recipient selection have led to a reduction of the pediatric pretransplant mortality to nearly zero and to results comparable with those after whole organ transplantation (WLT). By splitting a donor organ into two 'full' hemi-grafts and providing a small adult ( < 60 kg) or a big child ( > 30 kg) with the full left graft and a medium-sized adult (60-80 kg) with the full right graft, a small-for-size situation for adolescents or adults can be avoided and the total number of available grafts can be increased. It is the goal to provide each recipient with its customized graft in the near future. However, splitting for two adults requires high technical skills and profound knowledge of the anatomic variations and should be performed in centers with large transplantation experience.