Ileocaecal atresia

Meconium ileus is one of the commonest causes of distal small bowel obstruction in neonates. Within the last six years at our hospital two newborns presented with identical signs and symptoms of meconium ileus. Abdominal x-rays showed distal small bowel obstruction with ground glass opacity in the right lower quadrant. Gastrografin enema in both cases demonstrated a microcolon, but there was no reflux of this contrast material into the terminal ileum. Laparotomy in both babies revealed atresia of the ileocaecal valve with dilatation of the terminal ileum loops which contained normal meconium. Ileocolic resection was carried out in both neonates. Sweat chlorides and eventual recovery were normal. Pathology in one of the specimens showed muscularis passing across the atretic area with a telescoped pattern of the muscularis propria suggesting intussusception in utero. Although the presentation of a newborn may be that of meconium ileus, the fact that the Gastrografin enema is unable to enter the terminal ileum in a retrograde fashion should be an indication for immediate laparotomy rather than persisting in this mode of treatment. It is obvious that occasionally the radiological diagnosis of meconium ileus is incorrect.     

Perforating appendicitis and antibiotics

In a retrospective study of 550 children with perforating appendicitis it appears that our patients were no more prone to develop complications due to infection than were patients in other published series who had received antibiotics. Antibiotics cannot supplant sound surgical principles and techniques in the treatment of perforating appendicitis.     

Partial gastric wrap-around as an alternative procedure in the treatment of hiatal hernia.

The Allison, Belsey, and Nissen antireflux operations have been widely used over the last 15 yr. A number of problems have followed from these procedures that have prompted us under certain circumstances to seek alternative operations. In the last 2 yr, in selected patients, we have done a partial gastric wrap-around (Dor-Nissen) operation on 16 children from age 2 wk to 13 yr for the following reasons: failed Allison and Nissen repairs, two infants with such a small stomach that only a partial stomach wrap-around was possible, with a Heller cardiomyotomy, and for reflux with or without an accompanying hiatal hernia. All of these Dor-Nissen partial wrap-around operations were technically easy to do and all the postoperative patients have been problem-free both clinically and radiologically. Moreover, the gass bloat syndrome seen with the Nissen fundoplication has not been encountered. We recommended this partial wrap-around antireflux operation as a primary procedure, an alterative to one of the more widely used operations, or when re-operating for recurrence of gastroesophageal reflux.     

Retractile testes: an outcome analysis on 150 patients

Background/Purpose

Retractile testes are testicles that can be brought down into their normal position in the scrotum but then immediately retract upward and out of the scrotum. The purpose of this study is to provide data on the outcome of pediatric patients with retractile testes.

Methods

A retrospective analysis was conducted on prospectively collected data on the outcome of 150 consecutive patients with retractile testis examined and followed up by one pediatric surgeon from April 1982 to April 1999, inclusive.

Results

Age at presentation was 5.2 ± 3.0 years, and follow-up duration was 3.8 ± 3.0 years. The number of retractile testes was 205, right-sided for 58 patients (38.6%), left-sided for 37 (24.6%), and bilateral for 55 (36.7%). Family history of retractile testis was positive in 8 patients (5.3%). Thirty-four patients required surgery (22.7%); indication for surgery was given when retractile testes ascended and became cryptorchid or if testicular size decreased during follow-up. Orchidopexy was required more frequently (P < .001) in patients with an associated hernia (68.8% of cases) than in patients without hernias (9.2%). One patient with spontaneous testicular descent during follow-up had a testicular carcinoma.

Conclusions

These findings suggest that the majority of patients (77.3%) with retractile testes have a spontaneously favorable evolution by 14 years of age and do not require surgical treatment. The authors report the first case of testicular carcinoma in a patient with retractile testis, and this indicates that these patients should be followed up even after testicular descent.     

国产麻黄的形态组织学研究——Ⅰ.北方主产的七种麻黄

据文献记载和作者的调查,我国产麻黄属(Ephedra)植物共有13种3变种1变型。本文报道我国北方生产的7种麻黄生药形态组织学比较研究结果。7种麻黄是:草麻黄Ephedra sinica Stapf、木贼麻黄E.equisetina Bunge、中麻黄E.intermedia Schrenk ex Mey.、膜果麻黄E.przewalskii Stapf,单子麻黄E.monosperma Gmel.ex Mey.、雌雄麻黄E.fedtschenkoae Pauls和细子麻黄E.reaeliana Florin。文中附有生药性状与组织构造特征比较表及生药组织图     

Torsion of an undescended intraabdominal benign testicular teratoma

A 4-year-old well boy was seen because of an asymptomatic left testicle undescended since birth; the testis was not palpable and the right side was normal. After an episode of left lower quadrant and left hip area pain, with some bladder symptoms and left leg limping, a work-up including a CAT scan showed a calcified retroperitoneal pelvic tumor on the left side. At laparotomy, an infarcted mass was found in the pelvis just above the internal ring. It was a torsion of an undescended intraabdominal testis with a benign testicular teratoma. The tumor was removed and his recovery was uneventful.